- Medicare Hospital Copay 2020 Schedule
- Medicare Inpatient Hospital Deductible 2020
- Medicare Co Days 2020
- 2020 Medicare Deductible
Medicare copays differ from coinsurance in that they're usually a specific amount, rather than a percentage of the total cost of your care. Medicare does cover emergency room visits. You'll pay a Medicare emergency room copay for the visit itself and a copay for each hospital service. Medicare Part A (Hospital Insurance) covers inpatient hospital care when all of these are true: You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury. The hospital accepts Medicare.
Published April 2, 2020
Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.
The Centers for Medicare & Medicaid Services (CMS) mandated in early March that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers. A COVID-19 vaccine will also be covered if and when one becomes available.
Now, some private insurance carriers are going a step further by eliminating cost-sharing for COVID-19 treatment protocols as well.
Cigna, Humana and Aetna have each taken measures to reduce out-of-pocket spending for their Medicare plan members who undergo treatment for the disease. These out-of-pocket costs can include plan deductibles, coinsurance and copayments.
COVID-19 treatment can potentially include inpatient hospital stays, doctor’s office appointments, inpatient skilled nursing facility stays, home health visits and emergency ambulance transportation.
These services can typically come with costs such as copays and deductibles.
With waived coinsurance and deductibles for COVID-19 treatment, savings can add up
Cigna and Humana both waived COVID-19-related cost-sharing for their Medicare Advantage (Medicare Part C) plans.
Medicare Advantage plans cover the same inpatient and outpatient services and items that are covered by Original Medicare (Medicare Part A and Part B).
While Original Medicare is provided by the federal government, private insurance companies administer Medicare Advantage plans.
Some of the out-of-pocket costs that a beneficiary who has Original Medicare may face if they receive covered COVID-19 treatment include:
- Beneficiaries who have Original Medicare and who receive inpatient hospital treatment for COVID-19 will typically have to pay the 2020 Medicare Part A deductible of $1,408 for each benefit period that they receive inpatient care.
There are also Part A daily coinsurance costs for lengthy hospital stays that last longer than 60 days. - Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care.
After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay for covered services and items.
For members of Medicare Advantage plans from Cigna and Humana, however, those costs will be waived for covered COVID-19 treatment.
“Our customers with COVID-19 should focus on fighting this virus and preventing its spread,” David M. Cordani, President and CEO of Cigna1
“While our customers focus on regaining their health, we have their backs,” David Cordani, President and CEO of Cigna, said in a statement.
Cigna’s cost-sharing waiver expires May 31, 2020.
“We know we’re uniquely positioned to help our members during this unprecedented health crisis,” said Bruce Broussard, President and CEO of Humana. “It’s why we’re taking this significant action to help ease the burden on seniors and others who are struggling right now.”2
Humana’s waivers includes costs related to COVID-19 treatment by both in-network and out-of-network facilities or physicians.
Humana’s cost sharing waivers currently have no end date, as the company plans to readdress the situation as needed.
Aetna, a CVS Health company, is also dismissing COVID-19-related inpatient cost-sharing for its members.
“The additional steps we’re announcing today are consistent with our commitment to delivering timely and seamless access to care as we navigate the spread of COVID-19,” said Karen S. Lynch, president of Aetna Business Unit. “We are doing everything we can to make sure our members have simple and affordable access to the treatment they need as we face the pandemic together.”3
Aetna’s cost-sharing waiver for inpatient admissions to any in-network facility for treatment of COVID-19 is currently in effect until June 1, 2020.
Medicare Plus Blue PPO Assure (PPO) H9572-003 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross Blue Shield of Michigan available to residents in Michigan. This plan includes additional Medicare prescription drug (Part-D) coverage. The Medicare Plus Blue PPO Assure (PPO) has a monthly premium of $199.00 and has an in-network Maximum Out-of-Pocket limit of $3,425 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,425 out of pocket. This can be a extremely nice safety net.
Medicare Plus Blue PPO Assure (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Blue Cross Blue Shield of Michigan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medicare Plus Blue PPO Assure (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross Blue Shield of Michigan and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Blue Cross Blue Shield of Michigan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2020 Blue Cross Blue Shield of Michigan Medicare Advantage Plan Details
| Name: | |
|---|---|
| ID: | H9572-003 |
| Provider: | Blue Cross Blue Shield of Michigan |
| Year: | 2020 |
| Type: | Local PPO |
| Monthly Premium C+D: | $199.00 |
| Part C Premium: | $204.70 |
| MOOP: | $3,425 |
| Part D (Drug) Premium: | $61.10 |
| Part D Supplemental Premium | $33.20 |
| Total Part D Premium: | $94.30 |
| Drug Deductible: | $0.00 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
Part-C Premium
Blue Cross Blue Shield of Michigan plan charges a $204.70 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
Medicare Plus Blue PPO Assure (PPO) has a monthly drug premium of $61.10 and a $0.00 drug deductible. This Blue Cross Blue Shield of Michigan plan offers a $61.10 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $33.20 this Premium covers any enhanced plan benefits offered by Blue Cross Blue Shield of Michigan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $94.30. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Medicare Plus Blue PPO Assure (PPO) medicare insurance offers a $64.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $71.70 for 75% low income subsidy $79.20 for 50% and $86.80 for 25%.
| Full LIS Premium: | $64.10 |
|---|---|
| 75% LIS Premium: | $71.70 |
| 50% LIS Premium: | $79.20 |
| 25% LIS Premium: | $86.80 |
Gap Coverage
In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Blue Cross Blue Shield of Michigan plan does offer additional coverage through the gap.
Blue Cross Blue Shield of Michigan Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Medicare Plus Blue PPO Assure (PPO) H9572-003 Formulary here.
See the 2020 Blue Cross Blue Shield of Michigan Formulary
2019 Plan Services
(*2020 Plan services will be added when available)
Health plan deductible
| $180 annual deductible |
|---|
Emergency care/Urgent care
| Emergency | $90 per visit (always covered) |
|---|---|
| Urgent care | $40 per visit (always covered) |
Diagnostic procedures/lab services/imaging
| Diagnostic tests and procedures | Out-of-Network | 30% |
|---|---|---|
| Diagnostic tests and procedures | In-Network | $35-75 |
| Lab services | Out-of-Network | 30% |
| Lab services | In-Network | $0-20 |
| Diagnostic radiology services (e.g., MRI) | Out-of-Network | 30% |
| Diagnostic radiology services (e.g., MRI) | In-Network | $75 |
| Outpatient x-rays | Out-of-Network | 30% |
| Outpatient x-rays | In-Network | $35-75 |
Hearing
| Hearing exam | Out-of-Network | 50% |
|---|---|---|
| Hearing exam | In-Network | $5-35 |
| Fitting/evaluation | Out-of-Network | 50% |
| Fitting/evaluation | In-Network | $0 copay |
| Hearing aids | Out-of-Network | $0 copay |
| Hearing aids | In-Network | $0 copay |
Preventive dental
| Oral exam | Out-of-Network | 50% |
|---|---|---|
| Oral exam | In-Network | $0 copay |
| Cleaning | Out-of-Network | 50% |
| Cleaning | In-Network | $0 copay |
| Fluoride treatment | Not covered | |
| Dental x-ray(s) | Out-of-Network | 50% |
| Dental x-ray(s) | In-Network | $0 copay |
Comprehensive dental
| Non-routine services | Not covered |
|---|---|
| Diagnostic services | Not covered |
| Restorative services | Not covered |
| Endodontics | Not covered |
| Periodontics | Not covered |
| Extractions | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
Vision
| Routine eye exam | Out-of-Network | $10 or 30% |
|---|---|---|
| Routine eye exam | In-Network | $0 copay |
| Other | Out-of-Network | $10 or 30% |
| Other | In-Network | $35 |
| Contact lenses | Out-of-Network | $0 copay |
| Contact lenses | In-Network | $0 copay |
| Eyeglasses (frames and lenses) | Out-of-Network | $0 copay |
| Eyeglasses (frames and lenses) | In-Network | $0 copay |
| Eyeglass frames | Out-of-Network | $0 copay |
| Eyeglass frames | In-Network | $0 copay |
| Eyeglass lenses | Out-of-Network | $0 copay |
| Eyeglass lenses | In-Network | $0 copay |
| Upgrades | Not covered |
Mental health services
| Inpatient hospital - psychiatric | Out-of-Network | 30% per stay |
|---|---|---|
| Inpatient hospital - psychiatric | In-Network | $100 per day for days 1 through 6 $0 per day for days 7 through 90 |
| Outpatient group therapy visit with a psychiatrist | Out-of-Network | 30% |
| Outpatient group therapy visit with a psychiatrist | In-Network | $40 |
| Outpatient individual therapy visit with a psychiatrist | Out-of-Network | 30% |
| Outpatient individual therapy visit with a psychiatrist | In-Network | $40 |
| Outpatient group therapy visit | Out-of-Network | 30% |
| Outpatient group therapy visit | In-Network | $40 |
| Outpatient individual therapy visit | Out-of-Network | 30% |
| Outpatient individual therapy visit | In-Network | $40 |
Skilled Nursing Facility
| Out-of-Network | 30% per stay |
|---|---|
| In-Network | $0 per day for days 1 through 20 $172 per day for days 21 through 100 |
Rehabilitation services
| Occupational therapy visit | Out-of-Network | 30% |
|---|---|---|
| Occupational therapy visit | In-Network | $30 |
| Physical therapy and speech and language therapy visit | Out-of-Network | 30% |
| Physical therapy and speech and language therapy visit | In-Network | $30 |
Ground ambulance
| Out-of-Network | $200 or 30% |
|---|---|
| In-Network | $200 |
Other health plan deductibles?
| In-Network | No |
|---|
Transportation
| Not covered |
|---|
Foot care (podiatry services)
Medicare Hospital Copay 2020 Schedule
| Foot exams and treatment | Out-of-Network | 30% |
|---|---|---|
| Foot exams and treatment | In-Network | $35-100 |
| Routine foot care | Not covered |
Medical equipment/supplies
| Durable medical equipment (e.g., wheelchairs, oxygen) | Out-of-Network | 30% per item |
|---|---|---|
| Durable medical equipment (e.g., wheelchairs, oxygen) | In-Network | 20% per item |
| Prosthetics (e.g., braces, artificial limbs) | Out-of-Network | 30% per item |
| Prosthetics (e.g., braces, artificial limbs) | In-Network | 20% per item |
| Diabetes supplies | Out-of-Network | $0 copay |
| Diabetes supplies | In-Network | $0 copay |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
|---|
Medicare Part B drugs
| Chemotherapy | Out-of-Network | 0-30% |
|---|---|---|
| Chemotherapy | In-Network | 20% |
| Other Part B drugs | Out-of-Network | 0-30% |
| Other Part B drugs | In-Network | 0-20% |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $6,000 In and Out-of-network $3,900 In-network |
|---|
Optional supplemental benefits
| Yes |
|---|
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network | No |
|---|
Inpatient hospital coverage
Medicare Inpatient Hospital Deductible 2020
| Out-of-Network | 30% per stay |
|---|---|
| In-Network | $100 per day for days 1 through 6 $0 per day for days 7 through 90 |
Outpatient hospital coverage
| Out-of-Network | 30% per visit |
|---|---|
| In-Network | $75-100 per visit |
Doctor visits
| Primary | Out-of-Network | 30% per visit |
|---|---|---|
| Primary | In-Network | $5 per visit |
| Specialist | Out-of-Network | 30% per visit |
| Specialist | In-Network | $35 per visit |
Preventive care
| Out-of-Network | $0 copay |
|---|---|
| In-Network | $0 copay |
Ratings for Medicare Plus Blue PPO Assure (PPO) H9572
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
| Part D Summary Rating |
| Staying Healthy: Screenings, Tests, Vaccines |
| Managing Chronic (Long Term) Conditions |
| Member Experience with Health Plan |
| Complaints and Changes in Plans Performance |
| Health Plan Customer Service |
| Drug Plan Customer Service |
| Complaints and Changes in the Drug Plan |
| Member Experience with the Drug Plan |
| Drug Safety and Accuracy of Drug Pricing |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
| Colorectal Cancer Screening |
| Annual Flu Vaccine |
| Improving Physical |
| Improving Mental Health |
| Monitoring Physical Activity |
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
Medicare Co Days 2020
| Total Rating |
|---|
| SNP Care Management |
| Medication Review |
| Functional Status Assessment |
| Pain Screening |
| Osteoporosis Management |
| Diabetes Care - Eye Exam |
| Diabetes Care - Kidney Disease |
| Diabetes Care - Blood Sugar |
| Rheumatoid Arthritis |
| Reducing Risk of Falling |
| Improving Bladder Control |
| Medication Reconciliation |
| Plan All-Cause Readmissions |
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
| Timely Care and Appointments |
| Customer Service |
| Health Care Quality |
| Rating of Health Plan |
| Care Coordination |
Member Complaints and Changes in Medicare Plus Blue PPO Assure (PPO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
| Members Leaving the Plan |
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Medicare Plus Blue PPO Assure (PPO)
| Total Customer Service Rating |
|---|
| Timely Decisions About Appeals |
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
Medicare Plus Blue PPO Assure (PPO) Drug Plan Customer Service ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
| Appeals Auto |
| Appeals Upheld |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
|---|
| Complaints about the Drug Plan |
| Members Choosing to Leave the Plan |
| Drug Plan Quality Improvement |
2020 Medicare Deductible
Member Experience with the Drug Plan
| Total Rating |
|---|
| Rating of Drug Plan |
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
| Drug Adherence for Diabetes Medications |
| Drug Adherence for Hypertension (RAS antagonists) |
| Drug Adherence for Cholesterol (Statins) |
| MTM Program Completion Rate for CMR |
| Statin with Diabetes |
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Medicare Plus Blue PPO Assure (PPO)
(Click county to compare all available Advantage plans)
| State: | Michigan |
|---|---|
| County: | Allegan, Barry, Ionia, Kalamazoo, Mason, Muskegon, Newaygo, Oceana, Ottawa, Berrien, Branch, Calhoun, Eaton, Gratiot, Hillsdale, Ingham, Jackson, Monroe, Montcalm, St. Joseph, Van Buren, Alcona, Alger, Alpena, Arenac, Baraga, Bay, Charlevoix, Cheboygan, Chippewa, Clare, Crawford, Gladwin, Huron, Iosco, Kalkaska, Keweenaw, Luce, Mackinac, Montmorency, Ogemaw, Ontonagon, Oscoda, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, Tuscola, Antrim, Benzie, Cass, Clinton, Delta, Dickinson, Emmet, Genesee, Gogebic, Grand Traverse, Houghton, Iron, Isabella, Kent, Lake, Lapeer, Leelanau, Lenawee, Livingston, Manistee, Marquette, Mecosta, Menominee, Midland, Missaukee, Osceola, Otsego, St. Clair, Wexford, Macomb, Oakland, Washtenaw, Wayne, |
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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.