If you visit the doctor often or take daily prescription medications, the Care Plus Plan may offer the best coverage for you. This plan provides coverage for Medicare Part B services (medical services and supplies) as well as Part A services (hospital stays). Prescription drug benefits are included in the plan, with copays for generic and brand name medications (the standard Medicare coverage gap applies).
The monthly rate is higher than for the Care Basic Plan, but this plan may help you better manage your overall out-of-pocket costs. One of the main differences between the Care Plus and the Care Basic Plans is Part B coverage (medical services and supplies). On the Care Plus Plan, all Medicare-eligible Part B expenses that are not paid by Medicare will be paid by your Care Plus Plan after you pay the Medicare Part B deductible.
2012 monthly rate: $232.90
(per person, per month)
| Part A Services (as defined by Medicare) |
Medicare Pays |
Care Plus Plan Pays |
You Pay1 |
Hospital stays:
Semi-private room and board, general nursing, and other hospital services and supplies |
- 100% days 1-60
- Costs over $289 a day for days 61-90
- Costs over $578 a day for days 91-150 (lifetime reserve days)
|
- 50%of the Part A deductible (for every benefit period)2
- $289/day for days 61-90
- $578/day for days 91-150 (lifetime reserve days); 100% after reserves are depleted
- All costs after 150 days
|
$578
(50% of the Part A deductible) 2 |
| Skilled nursing facility care |
- 100% days 1-20
- Costs over $144.50 a day for days 21-100
|
Not a covered benefit |
- $144.50/day for days 21-100
- 100% after 100 days
|
| Part B Services (as defined by Medicare) |
Medicare Pays |
Care Plus Plan Pays |
You Pay1 |
Preventive care*
(for recommended preventive care services, including an annual wellness visit) |
100% |
Nothing |
Nothing |
Medical services and supplies:
Doctors' services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment and other services |
80% of Medicare-approved amounts for covered services |
Remaining 20% of Medicare-approved amounts |
$140
(Part B deductible)3 |
| Outpatient mental health services |
55% of Medicare-approved amounts for covered services |
Remaining 45% of Medicare-approved amounts for covered services |
Deductible applies |
| Diagnostic clinical laboratory service |
100% of Medicare-approved amounts for covered services |
Nothing (Medicare covers it at 100%) |
Costs above Medicare-approved amounts are not covered by Medicare |
* For those enrolled in Medicare Part B, Medicare pays 100% of costs for recommended preventive care services (including an annual wellness visit), per Your Guide to Medicare Preventive Services. You may find a copy of this guide on Medicare's website.
1 You are responsible for 100% of any charges not covered by Medicare or that are above the Medicare-approved amount.
2 You must pay 50% of the Part A deductible for every benefit period, which begins when you are admitted and ends when you have not received hospital or skilled nursing facility treatment for 60 days in a row.
3 You pay the Part B deductible once a year.