Medicare Insurance
What is Medicare?
Medicare is a federal health insurance program in the United States that primarily provides coverage for people aged 65 and older, as well as some younger individuals with certain disabilities or medical conditions. Medicare helps eligible individuals cover a portion of their healthcare expenses, including hospital stays, doctor visits, prescription drugs, and preventive care services.
Original Medicare includes Part A (Hospital insurance) and Part B (Medical Insurance). It DOES NOT include Prescription Drug Coverage, which is commonly known as Part D. It also doesn't include dental, vision or hearing coverage.
Overall, the costs of Medicare can vary widely depending on your individual circumstances and the coverage options you choose. It's essential to carefully review your Medicare coverage options and associated costs to ensure that you have the coverage you need at a price that fits your budget.
Download the "Medicare & You 2024 Handbook" Here: https://www.medicare.gov/publications/10050-Medicare-and-You.pdf
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🚨 REMINDER
It's important to know that you can be penalized for not enrolling into Original Medicare (Parts A and B) when you are first eligible. This includes the 3 months prior to the month you turn 65, the month you turn 65, and the 3 months after the month you turn 65. You can also be penalized for not obtaining creditable drug coverage when first eligible.
Original Medicare + Part D
Medicare Part A (Hospital Insurance)
Medicare Part A (Hospital Insurance)
Medicare Part A (Hospital Insurance)
Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.
PREMIUM: Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working. If you don't qualify for premium-free Part A, you may be able to purchase it, but there may be a monthl
Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.
PREMIUM: Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working. If you don't qualify for premium-free Part A, you may be able to purchase it, but there may be a monthly premium.
DEDUCTIBLE: The deductible for Part A is $1,632 per benefit period, which is the first 60 days of a Medicare-covered hospital stay. The Part A deductible is not annual, and you may have multiple benefit periods in a year.
COPAY/COINSURANCE: Part A also has copays and coinsurance costs for certain services, such as hospital stays over 60 days, skilled nursing facility care, and durable medical equipment.
Medicare Part B (Medical Insurance)
Medicare Part A (Hospital Insurance)
Medicare Part A (Hospital Insurance)
Part B helps cover outpatient medical services, such as doctor visits, preventive care, diagnostic tests, outpatient surgeries, durable medical equipment, and some home health care services.
PREMIUM: Part B requires payment of a monthly premium, which can vary depending on your income. The 2024 standard premium for Part B is $174.70. Most
Part B helps cover outpatient medical services, such as doctor visits, preventive care, diagnostic tests, outpatient surgeries, durable medical equipment, and some home health care services.
PREMIUM: Part B requires payment of a monthly premium, which can vary depending on your income. The 2024 standard premium for Part B is $174.70. Most people pay the standard premium amount set by Medicare, but higher-income individuals may pay an income-related monthly adjustment amount (IRMAA).
DEDUCTIBLE: In addition to the monthly premium, Part B also has an annual deductible of $240 (2024). Unlike Part A, you are only responsible for this deductible once per year.
COPAY/COINSURANCE: coinsurance or copayments for covered services. After meeting your annual deductible, Medicare will pay 80% and you pay 20%. Lastly, and importantly, there is no maximum out-of-pocket limit on the "80/20" coinsurance.
Medicare Part D (Prescription Drug)
Medicare Part A (Hospital Insurance)
Medicare Part D (Prescription Drug)
Part D is administered by private insurance companies that are approved by Medicare. These insurance plans offer coverage for prescription drugs to Medicare beneficiaries.
Part D plans vary in terms of the specific drugs they cover, the cost of premiums, deductibles, copayments, and coinsurance. Beneficiaries can choose from a range of pla
Part D is administered by private insurance companies that are approved by Medicare. These insurance plans offer coverage for prescription drugs to Medicare beneficiaries.
Part D plans vary in terms of the specific drugs they cover, the cost of premiums, deductibles, copayments, and coinsurance. Beneficiaries can choose from a range of plans offered in their area, selecting the one that best fits their needs and budget.
Medicare Part D is optional, but if beneficiaries choose not to enroll when they are first eligible, they may face penalties if they decide to enroll later unless they have other creditable prescription drug coverage.
Overall, Medicare Part D is designed to help Medicare beneficiaries afford the cost of prescription medications and ensure they have access to necessary treatments.
Medicare Supplement
Medicare Supplement Insurance (Medigap) is private health insurance designed to supplement Original Medicare (Parts A and B). In addition to your Part B premium, you must pay a monthly premium to the insurance company that offers the plan you choose. These plans help cover some of the costs that you would otherwise incur, such as deductibles, coinsurance, and copayments.
Supplement plans are standardized and regulated by the federal government, meaning that each plan type offers the same basic benefits, regardless of the insurance company selling it. There are ten standardized plans labeled A through N, each offering a different combination of benefits.
The best time to enroll in a Supplement, or Medigap plan, is during the Medigap Open Enrollment Period. During this period, insurance companies cannot deny coverage or charge higher premiums based on pre-existing conditions.
With a Supplement plan, beneficiaries have the flexibility to visit any doctor or healthcare provider that accepts Medicare, without needing a referral. You don't have to worry about staying in-network.
📝 It's important to note that Supplement plans do not cover services that Medicare doesn't cover, such as dental care, vision care, hearing aids, or long-term care. Additionally, Supplement plans do not include prescription drug coverage.
Medicare Advantage
Medicare Advantage (Part C) is an alternative way to receive Medicare benefits. These plans are offered by private insurance companies that are approved by Medicare.
Advantage plans combine the benefits of Original Medicare (Parts A and B) into a single plan. Most plans also include prescription drug coverage (Part D), and some plans may offer additional benefits not covered by Original Medicare, such as dental, vision, and hearing.
Medicare beneficiaries can enroll in Advantage plans during specific enrollment periods, such as the Initial Enrollment Period (when first eligible for Medicare), the Annual Enrollment Period (October 15 to December 7 each year), or other special enrollment periods for qualifying life events.
Individuals are still required to pay their Part B premium. While some plans do have an additional monthly premium, many have premiums as low as $0.
Unlike Original Medicare, Medicare Advantage plans may have different cost-sharing arrangements. This can include copayments, coinsurance, and deductibles for covered services. Some plans offer cost-sharing reductions for certain services or have annual out-of-pocket maximums to limit beneficiaries' financial exposure.
📝 It's important to note that Medicare Advantage plans often have provider networks, meaning beneficiaries may need to use doctors, hospitals, and other healthcare providers within the plan's network to receive the full benefits of the plan. Some plans, however, offer out-of-network coverage at higher costs.