Additional Monthly Premium for Drug Coverage

If you currently have a Medicare Supplement plan, you may have Part D coverage through a separate provider. Please enter any additional monthly premiums for drug coverage here.
 

Medical Care

Enter the amount you pay for each of the services below. This may be a copayment or coinsurance amount. Following are definitions of each.

Copayment: is a fee you may be required to pay as your share of the cost for medical services or supplies, such as doctor visits or prescriptions. It is usually a set amount; so, for example, you might pay $20 for a doctor visit or $6 for a prescription.

Coinsurance: is an amount you may be required to pay as your share toward the cost of services rendered after you have satisfied any deductibles. Coinsurance is a percentage of a cost, such as 20 percent.

Deductible: is a fixed amount of money you have to pay before your health insurer contributes toward the cost of your care. You are responsible for all of your health care costs while you are in the deductible phase of your policy.

Maximum Out-of-Pocket (OOP)

The annual out-of-pocket maximum is the total amount your health insurance company requires you to pay toward your health care costs (excluding your monthly premium). Out-of-pocket expenses are what you pay for health-related services and are in addition to the monthly premium that you pay your health insurer. Depending on your health plan, these expenses may include an annual deductible, copayments or coinsurance amounts for doctor visits and prescription drugs. Note: copayments for prescription drugs are not counted towards your out-of-pocket maximum. Not every plan caps what you will pay out of pocket.
 

Primary Care Visit Payment

Enter the amount you pay out of pocket for each visit to your primary care provider. This may be a copayment, coinsurance or deductible amount. For example, if you have a 20 percent coinsurance payment and the cost of a visit is $180, the out-of-pocket expense you would enter in this box is $36.
($180 x .20 = $36)
 

Specialist Visit Payment

Enter the amount you pay out of pocket for each visit to a specialist. This may be a copayment, coinsurance or deductible amount. For example, if you have a 20 percent coinsurance payment and the cost of a visit is $225, the amount you would enter in this box is $45.00. ($225 x .20 = $45.00)
 

Physical/Occupational/Speech Therapy Visits

These services may be categorized differently in your plan. You might try locating the information for these services under Outpatient Therapy, Rehabilitation or Medical Expenses.
 

Prescription Drug Coverage

In some cases, a plan may charge different rates for an extended day supply of your prescription drug. For this comparison, please enter the amount you pay out of pocket for a one-month (30-day) supply for each of the tiers below.
 

Important Note if You Have an Annual Prescription Drug Deductible

Some drug plans require that you pay an annual, fixed-rate deductible before copayment or coinsurance amounts apply. If your plan includes a prescription drug deductible, those charges are not reflected in the calculation for your plan total. Your actual plan costs would be greater than the total amount listed.