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25% Cost Sharing Plan

Some plans cover all excess costs, while others don’t. The 25% cost-sharing plan only requires you to pay a quarter of out-of-pocket health care expenses up to a limit.

The 25% Cost Sharing plan will pay a portion of approved Medicare Plan B copayments and coinsurance costs. For example, if you have a $100 copayment for a service covered under Medicare Part B, your cost sharing plan coverage would pay $75, leaving you to pay the remaining 25%.

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Coverage

The 25% Cost Sharing plan only covers specific Original Medicare out-of-pocket costs, including:

  • Medicare Part A coinsurance: 100% covered
  • Medicare Part A deductible: 75% covered
  • Part A hospice care coinsurance: 75% covered
  • Part A hospice care copayments: 75% covered
  • Medicare Part B coinsurance: 75% covered
  • Medicare Part B copayments: 75% covered   
  • Skilled nursing facility coinsurance: 75% covered
  • First 3 pints of blood: 75% covered

Cite: Medicare.gov

It also features an annual limit on cost-sharing that is designed to limit out-of-pocket costs for enrollees. This limit changes every year. In 2023, it is $3,470.[1] Once that limit is met, beneficiaries will have the full cost of their benefits paid for.

Cost sharing plans allow you to tailor your healthcare coverage to suit your individual needs specifically. Grutz Financial can provide you guidance throughout this process, allowing you to select the best plan for you. 

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References

1. https://www.cms.gov/medicare/health-plans/medigap/kandl; Published: Sep 30, 2022; Accessed: Nov 17, 2022

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