Medicare 101
Learn the basics of Medicare
Part A
Covers:
– Inpatient hospital stays
– Care in a skilled nursing facility
– Hospice care
– Some home health care
Cost:
– No monthly premium if you have paid into Medicare for 40 quarters. Cost can be as high as $506 per month if you have less than 40 quarters of coverage.
– Deductibles/copays (varies depending on the service)
*Example: If you were hospitalized for three days you must pay $1,316 for your Part A deductible.
Part B
Covers things like:
– Doctor visits
– Outpatient care
– Medical supplies
– Preventative services
– Mental Health services
– Ambulance services
– Laboratory tests and X-rays
– Rehabilitation services
– Home Health Care
Costs:
– Monthly Premium
– Annual Deductible
– 80/20 coinsurance of Medicare approved amount
*Example: If the Doctor bill is $100, the beneficiary pays $20 or 20%.
Part C
Also called a Medicare Advantage Plan
Covers:
– Part A
– Part B
– Many also cover part D
– Coverage is all under one plan administered by a private insurance company.
Cost:
– Monthly premium varies between private insurance company
– If it covers part D, there may be a prescription Annual Deductible
– Copays for different services
Part D
Also called Prescription Drug Plan
Covers:
– Medications
Cost:
– Varies
*Part D Prescription Drug Plan, although part of the Medicare Program, is not offered directly through CMS – The Center for Medicare and Medicaid Services. If one wishes to enroll in Part D program, it is done through a private insurance company’s approved plan.
Medicare Supplement Insurance Plan(s) will help pay Part A and Part B deductibles, as well as the Part B coinsurance. The amount the insurance company will pay depends on which plan you purchase. All Medicare Supplement Insurance Plan(s) are standardized by the federal government and labeled “A” through “N.” This means the only difference in benefits for a standardized Medicare Supplement Insurance Plan is the premium an insurance company charges.
Do Medicare Supplements cover prescription drugs?
- Medicare Supplement Insurance Plan(s) do not include a qualifying Part D Prescription Drug Plan.
- Some plans, however, offer prescription discounts. A separate stand-alone Part D Prescription Drug Plan is often purchased for prescription coverage
Frequently Asked Questions
What is a Medicare Advantage Plan?
Medicare Advantage Plans, also known as ‘Part C’, are Medicare Plans run by private insurance companies that must follow rules set by Medicare. Medicare pays these companies to cover your Medicare benefits. Medic
What types of Medicare Advantage Plans are there?
- Health Maintanence Organizations (HMOs) require you to use health care providers in your network and may require referrals from a primary care physician in order to see a specialist.
- Preferred Provider Organizations (PPOs) recommend the use of “preferred providers” in an established network and these plans are more likely to cover most of your medical costs if you stay in-network. You do not need a referral to see a specialist. PPO plans also give you the option to see “Out of Network” providers.
- Private Fee For Service (PFFS) plans determine how much they will pay health care providers and how much the client is responsible to pay for out-of-pocket costs.
- Medical Savings Plans (MSP) deposit money into a “health care checking account” that combines high-deductible health plans with a medical savings account to help pay for costs.
- Special Needs Plan (SNP) are tailored health insurance plans designed for clients with certain health conditions.
What Does Medicare Cost?
Part A of Medicare has no monthly premium if you or your spouse have paid Medicare taxes for a total of 10 years or 40 quarters while working. If you don’t qualify for “Premium free Part A”, you can buy Part A. Part A in 2023 cost: No monthly premium if you have paid into Medicare 10 years/40 quarters while working. Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities who pay a monthly premium in order to voluntarily enroll in Medicare Part A could pay up to $506 a month in 2023, a $7 increase from 2022, if they have to purchase Part A. The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,600 in 2023, an increase of $44 from $1,556 in 2022.
Part B of Medicare also has a premium. Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
Part B deductible and Coinsurance
The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022. After you meet your deductibles for the year, you will typically pay 20% of the Medicare-approved amounts for additional healthcare needs. Medicare Supplements and Medicare Advantage plans can help cover those deductibles and more.
What is the difference between Medicare & Medicaid?
Medicare and Medicaid are both government healthcare programs but they are very different. Medicare is generally for people who are 65 and older or who are disabled. Medicaid is for people with limited income and resources. When a person qualifies for both programs out-of-pocket costs can be minimal.
I am disabled - when can I get Medicare?
You automatically get Part A and Part B after you get one of these:
- Disability benefits from Social Security for 24 months
- Certain disability benefits from the RRB for 24 months
You don’t need to sign up if you automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.
When you decide how to get your Medicare coverage, you might choose:
- A Medicare Advantage Plan (Part C) that includes Prescription coverage
- A Medicare Supplement Plan
- Medicare prescription drug coverage (Part D)
There are specific times when you can sign up for these plans, or make changes to coverage you already have.