Real Life Medicare Examples

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See how different people chose their plans.

Medicare offers a lot of choices. You'll need to compare your needs with the plans that are available where you live.

 

It can help to see examples of what other people decided and why, based on each individual’s situation. The examples on this page tell the stories of very different people with different needs. You may relate better to some than to others, but each can help you understand how you can combine Medicare choices to meet your personal needs. The costs given are examples. You'll need to look at actual costs when making a decision about your own coverage.

STORY SUMMARIES

David's story: 65 and retired

Georgia's story: Limited income and specialist needs

Leroy's story: Serious health problems and multiple medications

David

David just turned 65 and is already retired. He's in good shape and generally healthy. He takes a daily prescription drug to keep his high blood pressure in check. The drug currently costs him about $90 each month. David takes good care of himself. He is careful to live within his budget.

David's wish list

  • Access to a full range of health care services, including preventive care    
  • Coverage that provides a safety net in case of a serious illness
  • Access to specialists if he needs them; he's comfortable with sticking to choices in a plan's network    
  • Access to prescription drug coverage in case he needs additional medications in the future

David's choice

Health Maintenance Organization (HMO) Medicare Advantage plan with built-in prescription drug coverage. To qualify for this plan, David must be enrolled in Medicare Part A and Part B. He will continue to pay the Part B premium to Medicare.

Plan features

  • Preventive care
  • Network of local doctors and hospitals
  • Fitness program at no additional cost
  • Built-in prescription drug benefit

Plan costs (2015 amounts)

Premiums:

$104.90 per month  Part B premium (The Part B premium may be automatically deducted from your Social Security check.)

$0 per month Medicare Advantage premium (includes prescription drug coverage)*

$104.90 per month  Total costs

Other costs: David’s out-of-pocket costs include co-pays or co-insurance based on the type and amount of services he uses and drugs he takes.

*Cost shown is for illustration only. Your costs may be different.

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Georgia

Georgia will be 65 next month. She has been working part-time since her husband died five years ago, but her income is limited. Georgia has heart disease, so she sees a heart specialist regularly and takes a blood-thinning medicine every day. She cannot afford a Medicare supplement insurance plan.

Georgia's wish list

  • Health care at an affordable price
  • Access to her trusted doctors
  • Discounted prices on her prescription drugs

Georgia's choice

Original Medicare Parts A and B plus a standalone Medicare Part D prescription drug plan

Plan features

  • Access to the doctors and hospitals she uses now
  • The possibility of help with her premiums and cost sharing if she qualifies for low-income assistance

Plan costs (2015 amounts)

Premiums: $104.90 per month Part B (If you receive Social Security, this will be deducted from your check automatically.)

$20.50 per month Medicare Part D prescription drug plan premium*

$125.40 per month Total costs

Other costs: Georgia pays co-pays or other costs associated with her drug plan. She also must pay all costs not covered by Original Medicare. If Georgia qualifies for financial help, her out-of-pocket costs may be greatly reduced.

*Cost shown is for illustration only. Your costs may be different.

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Leroy’s story: Serious health problems and multiple medications

Leroy is about to turn 65. He has had serious health problems for years. He suffers from diabetes and high blood pressure, and his doctor has told him he needs to lose a considerable amount of weight. Leroy takes insulin and blood pressure medication every day. He has had trouble in the past with interactions of the drugs he is taking.

Leroy's wish list

  • Expert help with managing his health problems
  • Help with improving his diet, exercise and weight management
  • Discounted prices on prescription drugs

Leroy's choice

Medicare Advantage Special Needs Plan (SNP) for people with diabetes, with built-in prescription drug coverage. To qualify for this plan, Leroy must be enrolled in Medicare Part A and Part B. He will continue to pay the Part B premium to Medicare.

Plan features

  • Access to a care manager who will create a plan for coordinating his care
  • Help with finding out if he qualifies for financial assistance with Medicare costs
  • Discounted prices on the drugs he takes
  • Help with adopting a healthier lifestyle

Plan costs (2015 amounts)

Premiums:

$104.90 per month Part B premium (If you receive Social Security, this will be deducted from your check automatically.)

$24.00 per month    Medicare Advantage Special Needs Plan premium*

$128.90 per month  Total costs

Other costs: Leroy will have out-of-pocket costs as determined by the plan. His total spending will depend on the type and amount of services he uses and drugs he takes.

*Cost shown is for illustration only. Your costs may be different.

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