Medicare is complicated, understand the basics in just 5 minutes.
Medicare Part A: Hospital Benefits
Available at age 65 or in case of disability for 24 consecutive months.
A deductible per hospital admission thru day 60 is charged. From day 61-90 there is a per day co-payment. After day 90 there is a higher per day co-payment up to 60 reserve days over your lifetime. Deductibles and copayments change every January 1.
Will cover Medicare Approved Skilled care for the first 20 days. From days 21-100 there is a co-payment per day.
Medicare Part B: Medical Benefits
Available at 65 (Must enroll if you DON’T have creditable health coverage from an employer to avoid penalty.) MUST request if not receiving SSI. There are different ways to enroll, and I can guide you.
There is a monthly premium and higher income households will pay a higher premium graded on their income. The amount changes every January.
There is an annual deductible that changes January 1 every year.
20% co-insurance for all Medicare approved medical services: doctor visits, lab work, diagnostic tests, etc.
There is NO LIMIT to this 20% co-insurance.
Medicare Part C: Also known as Medicare Advantage Plans
Plans are privatization of Medicare (You apply through me as your agent or insurance company directly).
Works as Primary insurer. You still pay your Medicare Part B premium.
Pays for the same services that Medicare allows/approves but may have additional coverages above and beyond Medicare as well i.e. annual physicals, preventative dental, additional comprehensive dental riders, routine vision, allowances for eye glasses, hearing aids, health membership, routine chiropractic and acupuncture, routine footcare, transportation, credits towards over-the-counter benefits, etc.
Co-payments/co-insurances for services. Most plans have Part D drug benefits bundled into them.
These plans have provider networks you will need to utilize. They can be Preferred Provider Plans (PPO) or Health Maintenance Organization Plans (HMO).
NOTE: Medicare does NOT pay for long term care!
Medicare Part D: Prescription Drug Coverage (PDP)
Available when one has Part A AND/OR Part B. If you pay a higher premium for your Part B, you will also be assessed a higher premium for your prescription drug plan whether it is through an Advantage Plan or a stand-alone PDP.
Must sign up when eligible or a Late Enrollment Penalty will apply.
All Formularies vary from plan to plan. Some may require Prior Authorization, Step Therapy, Quantity Limit. Preferred and Standard Pharmacies. Mail Order available. Included in most Advantage Plans.
Medicare Supplement Plans: Also known as MediGap Plans
Standardized plans with letter names A-N. These plans are the same from company to company.
Works with Medicare. Medicare is primary, and the Supplement is secondary.
Will only pay for what Medicare allows.
There is no drug coverage. You must add a part D plan for drugs.
No networks. No Referrals. You may see any doctor that is accepting Medicare and patients.
Deductible – A set amount you pay out of pocket for covered services each year before Medicare or your plan begins to pay.
Copay – A fixed amount you pay at the time you receive a covered service. For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.
Co-insurance – A percentage of the cost of covered service that you pay when you receive it. For example, you might pay 20% for an MRI and the plan would pay the remaining 80%.
Your monthly premium costs will include:
Medicare Part B.
Part D prescription drug coverage, either through a stand-alone Prescription Drug Plan (PDP) or as part of your Medicare Advantage Plan. (Prescriptions are included with the Advantage Plans)
A Medicare Supplement Plan or a Medicare Part C/Advantage Plan to cover the Medicare A and B deductibles and coinsurance.
You do not pay for the cost of an agent/consultant. Compensation is from the carriers based on the products sold to you by agent/consultant. Your monthly premium is not reduced if you do not use one.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.