Medicare

If you are looking for information about Medicare; what it is, who is eligible for Medicare, what it covers, how to sign up, the different types of plans available, see below:

What is Medicare?

Medicare is a federal health insurance program only  for people who are either:

• 65 or older,
• Some disabled younger people and
• People with End-Stage Renal Disease (ESRD).

For most people, the Part A insurance is free, although you may have co-pays and deductibles.

In 2023, 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. 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

What are the Medicare “Parts”?

Medicare is broken up in to separate “parts” to cover specific services:

• Medicare Part A (Hospital Insurance) – Free for most eligible people. Part A covers
  inpatient hospital stays,
  care in a skilled nursing facility,
  hospice care, and
  some home health care.
  But there ARE deductibles (this is why you also need a Part E – N Supplement plan or Advantage plan):

  Part A Deductible and Coinsurance Amounts for Calendar Years 2022 and 2023 by Type of Cost Sharing
  	2022	2023
  Inpatient hospital deductible	$1,556	$1,600
  Daily coinsurance for 61st-90th Day	$389	$400
  Daily coinsurance for lifetime reserve days	$778	$800
  Skilled Nursing Facility coinsurance	$194.50	$200.00

  Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.  Aftrer 60 days, you pay everything, unless you also have a Supplement or Advantage plan.

• Medicare Part B (Medical Insurance) – Part B covers
  certain doctors’ services,
  outpatient care,
  medical supplies, and
  preventive services.
  This plan does cost a monthly premium.

  Full Part B Coverage
  SINGLE tax payers – individual tax returns with modified adjusted gross income:	JOINT tax payers Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly  Premium Amount
  Less than or equal to $97,000	Less than or equal to $194,000	$0.00	$164.90
  Greater than $97,000 and less than or equal to $123,000	Greater than $194,000 and less than or equal to $246,000	$65.90	$230.80
  Greater than $123,000 and less than or equal to $153,000	Greater than $246,000 and less than or equal to $306,000	$164.80	$329.70
  Greater than $153,000 and less than or equal to $183,000	Greater than $306,000 and less than or equal to $366,000	$263.70	$428.60
  Greater than $183,000 and less than $500,000	Greater than $366,000 and less than $750,000	$362.60	$527.50
  Greater than or equal to $500,000	Greater than or equal to $750,000	$395.60	$560.50

  Medicare Part B also requires you to pay a yearly deductible ($226 in 2023). Once you’ve met the deductible, you pay a coinsurance of 20% of the Medicare-approved amount charged by your providers. And many preventive services are provided at no cost to you, without requiring you to first meet your deductible.

• Next you choose EITHER a Supplement plan OR an Advantage plan.
  The basic difference is supplement plans allow you to see any doctor anywhere in the US, while Advantage plans are HMOs; cheaper but more limiting.
  • Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.
  • Medicare Part C (Medicare Advantage Plans) – These are type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Medicare Advantage Plans are an alternative way to get your Medicare Part A and B coverage and, in some cases, provide additional benefits. Some plans may also offer vision, dental, hearing and/or health and wellness programs at an extra cost.
    Plans include
    Health Maintenance Organizations,
    Preferred Provider Organizations,
    Private Fee-for-Service Plans,
    Special Needs Plans, and
    Medicare Medical Savings Account Plans.
    If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
• Medicare Part D (prescription drug coverage) – Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. There is a monthly premium for Part D coverage.
  

  If your filing status and yearly income in 2015 was
  File individual tax return	File joint tax return	File married & separate tax return	You pay (in 2017)
  $85,000 or less	$170,000 or less	$85,000 or less	your plan premium
  above $85,000 up to $107,000	above $170,000 up to $214,000	not applicable	$13.30 + your plan premium
  above $107,000 up to $160,000	above $214,000 up to $320,000	not applicable	$34.20 + your plan premium
  above $160,000 up to $214,000	above $320,000 up to $428,000	above $85,000 up to $129,000	$55.20 + your plan premium
  above $214,000	above $428,000	above $129,000	$76.20 + your plan premium

Add it up: total monthly costs

For most people who are not earning a substantial income (in other words, you earn less than $85k as an individual or $170k joint) your monthly costs are:

• Part A: $0
• Part B: $134
• Part D: $13.30
• And any deductibles co-pays or excesses, if you actually have medical needs during a given month.

This means your monthly premiums are about $150/ month.

But, as noted above you could still have co-pays, deductibles and excesses.  So let’s look at what isn’t covered and supplemental coverage.

What Doesn’t Part A & Part B Cover?

Medicare doesn’t cover everything. If you need certain services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or you’re in a Medicare health plan that covers them.  And even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.

Some of the items and services that Medicare doesn’t cover include:

• Long-term care (also called custodial care)
• Most dental care
• Eye examinations related to prescribing glasses
• Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them
• Routine foot care

Supplemental Insurance plans Also called MediGap Plans

Medicare Supplement Insurance (Medigap) policies are sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. See this page for detailed information about the benefits and costs of MediGap plans.

How to verify the coverage you have?

There are several methods:

• Check your red, white, and blue Medicare card.
• Check all the other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
• Check your Medicare health or drug plan enrollment documents.
• Call Medicare at 1-800-MEDICARE (1-800-633-4227).

How to Sign up for Medicare or Change plans

You can enroll three months before the month you turn 65, the month of your birthday or three months after your birth month. Eligibility requirements include:

1. You or your spouse have worked for at least 10 years in Medicare-covered employment, and
2. You’re a U.S. citizen or permanent resident for at least five years.

Even if you’re not collecting Social Security yet, you’re eligible to join at age 65 or later.

Click on the links below for more information about each topic

1. Getting started with Medicare
2. Your Medicare coverage choices (Original Medicare or a Medicare Advantage Plan (Part C) )
3. How to sign up for Part A & Part B
4. How to apply online for Medicare on Social Security’s website.
5. How to get prescription drug coverage
6. Changing  health or drug plan
7. Find out more about different types of Medicare health plans (such as Medicare Advantage, Medicare Savings Accounts, Cost Plans, demonstration/pilot programs, PACE, and Medication Therapy Management)
8. Find and compare drug plans, health plans, and Medicare Supplement Insurance (Medigap) policies.