Medicare cost-sharing

RBI National Sales Manager: Charlie Ferrell

Charlie started his senior insurance career after a brief 30-year stint in the restaurant industry. In the 12 years since then, he has been blazing trails and setting standards for excellence all over! A native son of Utah, he has been a state manager for RBI as well as a managing general agent for UHC, Coventry, Molina and other carriers! Charlie came to RBI as the National Sales Manager in 2015, and is an invaluable resource for our agents and staff for marketing, compliance, and sales topics! Charlie’s field experience with senior insurance sales has made him an expert in our insurance CRM: Medicare Sales Engine. If all of that wasn’t enough, Charlie specializes in the Dual-Eligible market and is leading the charge behind RBI’s new “Dual Eligibles for Newbies” seminars!

2018 Medicare Cost-Sharing

Medicare has released the 2018 Medicare cost-sharing amounts and MOOP for standardized Medicare Supplement Plans. Without further ado, here it is!

Medicare cost-sharing

Part A – Hospital Insurance


  • $1,340 (+$24) deductible per benefit period.
  • $335 (+$6) for days 61-90.
  • $670 (+$12) for 60 lifetime reserve days (days 91-150.)

Skilled Nursing

  • $167.50/day (+$3) for days 21-100.

Part A premium

  • $422 if you’ve worked less than 30 quarters.
  • $232 if you’ve worked over 30 quarters but less than 40.

Part B – Medical Insurance

  • $134 premium. Deductible remains at $183.
  • Cost-sharing remains the same for Part B services, Medicare pays 80% and the beneficiary pays 20%.

Part D – Prescriptions

Deductible – $405

  • The standard part D deductible for 2018 is $405.  Many plans however have eliminated the deductible entirely.

Initial coverage limit – $3,750

  • After the deductible has been met, beneficiaries enter into stage 2, the Initial Coverage Limit.  At which point beneficiaries will either pay 25% or more typically they will have co-pays for tiers 1 – 5.
  • Once the retail amount (what you pay + what the carrier pays) of your prescriptions reaches $3,750 for the year, beneficiaries will enter into gap also known as the “doughnut hole.”

Coverage Gap/”Doughnut hole” TROOP- $5,000

  • Once in stage 3, more commonly referred to as the “Gap” or the “Doughnut-Hole” beneficiaries will be paying 35% for brand name drugs and 44% for generics.
  • After out-of-pocket (what you and the manufacturer pay) costs reach $5,000 beneficiaries will enter into stage 4 or “Catastrophic Coverage.”

Catastrophic Coverage

Medicare cost-sharing

  • Once in stage 4, beneficiaries will pay the greater of:
    • 5% OR
    • $3.35 copay for generics and $8.35 copay for all other drugs.

Prescription drug coverage premiums range from $12.70 and up.

Part C – Medicare Advantage plans

Premiums for Medicare Advantage plans range from $0 and up.

Max-out-of-Pocket – $6,700

Cost sharing for Medicare Supplement plans

  • Deductible for the High Deductible plan F is $2240 (+40)
  • MOOP
    • Plan K – $5240 (+$120)
    • Plan L – $2660 (+$60)

We hope everyone is having a successful AEP and thank you all for your hard work!  While AEP ends in a little over a week, it’s important to remember that there is an incredible year-round opportunity in the Medicare market that most agents aren’t taking advantage of.  To jump start your business in the new year, the time to start is RIGHT NOW!  Plan out community events and any marketing necessities to keep the momentum going.  If you want help with marketing, contact us to do a MAPS plan.

Not yet contracted with RB Insurance Group?  Give us a call today to learn how RBI will take your Medicare business to new heights! 1-800-997-3107!