can also specify with CMS approval at what
level (or tier) they wish to cover it, and are
encouraged to use step therapy. Some drugs
are excluded from coverage altogether and
Part D plans that cover excluded drugs are
not allowed to pass those costs on to Medi-
care, and plans are required to repay CMS
if they are found to have billed Medicare in
these cases.
OUT-OF-POCKET COSTS
No part of Medicare pays for all of
a beneficiary's covered medical costs and
many costs and services are not covered
at all. The program contains premiums,
deductibles and coinsurance, which the
covered individual must pay out-of-pocket.
PREMIUMS
Most Medicare enrollees do not pay a
monthly Part A premium, because they (or a
spouse) have had 40 or more 3-month quar-
ters in which they paid Federal Insurance
Contributions Act taxes. The benefit is the
same no matter how much or how little the
beneficiary paid as long as the minimum
number of quarters is reached. Medicare-el-
igible persons who do not have 40 or more
quarters of Medicare-covered employment
may buy into Part A for an annual adjusted
monthly premium. Most Medicare Part B
enrollees pay an insurance premium for this
coverage.
Robert Rhinesmith is a Registered Investment
Advisor, Applewood Capital Management Asso-
ciates, LLC.
www.himpowermagazine.com 29