Estimate Medicare Costs

Estimating your Medicare costs now is a smart way to plan for your future health care needs, and may help you find the plan that's right for you.

It's important to understand the many cost factors, which may vary from one plan to the next. Typical costs can include:

  • Premium: A monthly fee you pay to a health plan for coverage.
  • Copay: A fee you pay at the time you receive a covered health service. A copay is generally a pre-set, fixed dollar amount (for example, a $15 copay for an office visit).
  • Coinsurance: Coinsurance is a charge you must pay for certain health services covered by your plan. Coinsurance is usually stated as a percentage of eligible expenses. For example, a plan might pay 75% and you would pay 25% for a covered service.
  • Deductible: The pre-set, fixed amount you must pay for healthcare costs before the insurance company or Medicare begins to pay. Note: In many cases, a higher deductible means a lower premium payment for the same coverage.
  • Maximum out-of-pocket costs: The maximum amount of money a plan member has to pay during a specific period.

Questions to consider when looking for a Medicare plan

  • How often do you visit the doctor?
    If you don't visit the doctor very often, you may decide to choose a plan with a lower monthly plan premium and a higher copay.
    If you do visit the doctor regularly, you may decide to pay a higher monthly plan premium for a plan that offers a lower copay or a lower deductible.
  • How many times you have been hospitalized or foresee being hospitalized?
    If hospital visits are rare, you might consider a plan that offers a lower monthly plan premium in exchange for a higher deductible.
  • What's the maximum amount you could afford to pay out-of-pocket in one year for premiums, copays, coinsurance and deductibles?
    If you want to limit your out-of-pocket expenses or want catastrophic coverage for your prescription drug spending, you may want a plan that offers an annual out-of-pocket maximum.
  • Would you rather pay a monthly premium instead of paying at each doctor visit?
    If you prefer not to pay copays and coinsurance each time you visit the doctor, you might choose a plan with a monthly plan premium that has limited copays for office visits.
  • Would you rather pay a higher monthly premium for predictable coverage, lower out-of-pocket expenses and a choice of doctors?
    If these coverage options are important to you, you may want to consider plans with a higher monthly premium, plans without a provider network or plans with options to visit out-of-network providers.

Cost differences across Medicare plans

Main differences among the Medicare plans include:

  • How much you pay in premiums, out-of-pocket costs and deductibles.
  • How much choice you have to see your own doctors or hospitals.
  • Whether you can go directly to a specialist without a referral.
  • Whether you get prescription drug coverage.
  • Whether you get additional benefits, such as routine vision or hearing coverage.
  • Whether you're covered for non-emergency care when you travel.

Find out how these costs are handled before you choose a plan.

Consider your prescription drug costs

Even if you do not take prescription medications now, the possibility of needing them can increase each year. To help decide if you want prescription drug coverage, answer these questions:

  • Do you have more than one or two prescriptions?
  • How much do you currently spend on prescription drugs, including copays, coinsurance and/or non-covered drugs?
  • Does the plan you are interested in include your medications on its list of covered prescription drugs (the formulary)?
  • Would you like to be covered for future drug needs and avoid possible cost penalties, even if you might not need the coverage immediately?

Prescription drug coverage is available to all people with Medicare. How much you pay for coverage will depend on the type of plan you choose and when you sign up.

If you currently take prescription drugs

It may be a good idea to select a plan that offers drug coverage. Keep this information in mind when choosing a plan:

  • Make sure that the coverage applies to your specific medications. To find out if your drugs are covered by a plan, review the plan's formulary (prescription drug list). Many plans have their formularies on their website.
  • Check the plan benefits to find out your prescription drug copays. Drug copays vary from plan to plan.
  • Check the plan benefits to see if there is a deductible for drug coverage. Some plans have deductibles specifically for prescription drugs.

If you do not take prescription drugs at this time but are eligible to enroll in Part D, you may want to consider enrolling now in order to be covered for the future.

The Part D late enrollment penalty

If you select a plan that does not cover prescription drugs, you may end up paying a Part D late enrollment penalty if you change to a plan that covers prescription drugs later.

Once you enroll in Part D, the accumulated penalty amount becomes a fee added to the total monthly premium you pay for the plan for as long as you're enrolled. Learn more about the Part D late enrollment penalty.

It's important to consider enrolling in a Part D plan as soon as you are eligible, regardless of your current prescription drug use.

Questions? Call UnitedHealthcare at:
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Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental plan (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage, vision and hearing coverage and fitness programs.

Creditable Coverage

Refers to prescription drug coverage that offers benefits the same as or better than coverage available through Medicare.

Tier 1: Preferred Generic. Lowest Copay.

This tier includes lower-cost, commonly used generic drugs. Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2: Non-Preferred Generic. Low Copay.

This tier includes most generic drugs. Use Tier 2 drugs, instead of Tier 3 or 4, to help reduce your out-of-pocket costs.

Tier 5 : Specialty Tier. Coinsurance.

This tier includes unique and/or very high-cost drugs. You pay a percentage of the total drug cost, called coinsurance.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Tier 3: Preferred Brand. Medium Copay.

This tier includes many common brand name drugs, called preferred brands, and some higher-cost generic drugs. Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Drug List tool tip

A list of drugs covered by your Medicare Part D plan. A drug list may also be referred to as a covered prescription drugs list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating network pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.


Carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs. A drug list may change during the year.

Tier 2: Low Copay

This tier includes most generic drugs. Use Tier 2 drugs, instead of drugs in Tiers 3 or 4 to help reduce your out-of-pocket costs.

Coverage Gap Stage:

During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 72% of the total cost for generic drugs or 47.5% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $4,550 in year-to-date out-of-pocket costs.

You may pay less if your plan has better coverage in the gap.

Always use your Medicare Part D member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.

Out-of-Pocket Costs:

The amount you (or others pay on your behalf) pay for prescription drugs starting January 1, 2013 not including premiums.

Premium (or monthly premium)

The monthly fee you pay for Medicare coverage.

Deductible/annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drug costs before Medicare or the plan begins to pay.

Deductible/Annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drugs costs before the insurance company or Medicare begins to pay.

Coinsurance

A kind of cost sharing where you pay a percentage of the cost of a service. For example, a plan might pay 75% and you would pay 25%. In Medicare Advantage, coinsurance varies depending on the plan.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an annual check-up.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an office visit.

Primary Care Physician's name and ID

Your primary care physician (PCP) plays an important role in your health care, and we want you to have the opportunity to select one you are comfortable with. Your PCP can:

  • Help you make good lifestyle choices to maintain and improve your health.
  • Serve as a direct point of contact in case of an emergency.
  • Manage the drugs prescribed to you and identify potential adverse interactions.
  • Coordinate the care of specialists who may diagnose and treat your conditions.
  • Help ensure that you are getting the care you need while helping to minimize your out-of-pocket costs.

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