Parts of Medicare

Medicare Part A

Original Medicare comprises of two main parts: Medicare Part A or hospital insurance as well as Medicare Part B or medical insurance. Medicare Part A covers Medicare inpatient care, which includes care received when staying in a nursing house, a hospital and in rare circumstances, at home. In addition to that, it also covers blood transfusions and hospice services. It does NOT, however, cover long-term care, like extended stays in a nursing home. Individuals can think about buying long-term care insurance if this is something they wish to plan for.

A majority of people become eligible for Medicare Part A automatically when they reach the age of 65 if they are already collecting retirement benefits from the Social Security Administration. You may also qualify for Part A before 65 in case you have a disability, ALS, or an end-stage renal disease. You must either be an American citizen or a legal permanent US citizen for a minimum of 5 consecutive years.

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Cost of Medicare Part A

A majority of beneficiaries will pay nothing for Medicare Part A. However, Medicare Part A receivers pay taxes during their working years that are particularly for their future Medicare hospital coverage during retirement. These taxes go to compensate for the cost of Part A in the long run

As a beneficiary of Medicare A, you will receive coverage for hospital costs that are important to your inpatient care, like meals, a semi-private room, medications, nursing services that are part of your treatment, and other supplies and services from the services. This includes care that was received through:

Critical access hospitals
Mental healthcare
Long-term care facilities
Acute care medical facilities
Participation in a qualifying clinical research study
Inpatient rehab facilities

The cost for a private room (unless medically required), personal care stuff such as razors, shampoo, private-duty nursing, or other extraneous charges such as TV and telephone.

Part A Premiums

If you purchase Part A Medicare, you will pay around $506 every month in 2023. If you paid taxes related to Medicare for less than thirty quarters, the normal Part A premium is $506. On the other hand, if you paid those taxes for 30 to 39 quarters, the normal premium for Part A will be $278. If you have contributed for 40 or more quarters during your life, then there is no cost to Medicare Part A. In most cases, if you decide to buy Part A Medicare, you are required to have Medicare Part B or medical insurance.

Medicare Part B

Medicare Part B or medical insurance covers medically critical supplies and service required for the treatment or diagnosis of your health state. This includes outpatient services provided in a hospital, clinic, doctor’s office, or any other health facility. Moreover, Part B helps cover several preventative services to detect illnesses or avoid them at an early stage. Benefits Of Medicare Part B Medical supplies and services covered by Medicare Part B include, but are not limited to:

Visits to the doctor
X-rays and lab tests
Long-lasting medical equipment
Mental health services
Preventative services, like flue flu shots, pap tests, and screenings
Rehab services, including occupational therapy, physical therapy, as well as speech-language pathology services.

The coverage offers you access to a range of outpatient medical services, as well as ordinary outpatient services such as doctor’s visits, home health care, ambulance ride, lab testing, and some kind of chiropractic care. However, it also sometimes covers more costly services that occur in the hospital, such as radiation, surgeries, chemotherapy for cancer, medical equipment, and dialysis for failing kidneys.

Cost Of Medicare Part B

You are required to make a monthly payment to receive the benefits of Medicare Part B. Most US citizens will pay the normal monthly payment as set by the government. The base rate in 2023 for Part B is $164.90 per month for those individuals who are new to Medicare. But remember that you might owe more if your earnings are above a specific level. For 2023 the Medicare Part B Premium will be.

Individuals with 2022 income less than or equal to $97,000, or married couples with 2022 income less than or equal to $194,000, the Part B monthly premium amount would be $164.90.
Individuals with 2022 income between $97,000 to $123,000 or married couples with 2022 income between $194,000 to $246,000, the Part B monthly premium amount would be $230.80.
Individuals with 2022 income between $153,000 to $183,000 or married couples with 2022 income between $306,000 to $366,000, the Part B monthly premium amount would be $428.60.
Individuals with 2022 income between $183,000 to $500,000 or married couples with 2022 income between $366,000 to $750,000, the Part B monthly premium amount would be $527.50.
Individuals with 2022 income greater than or equal to $500,000 or married couples with 2022 income greater than or equal to $750,000, the Part B monthly premium amount would be $560.50.

If you did not enroll in Part B when you were first eligible, you might have to pay a late-fee penalty via a higher premium, unless you are qualified for a Special Enrollment period. For individual supplies and services, your Medicare costs may differ accordingly. Certain preventative services are fully covered if your health care provider accepts Medicare assignment. If the Part B deductible is applicable, you must pay all costs until you meet the annual deductible amount before Medicare starts paying its part. Once your deductible has been met, you generally pay around 20% of the Medicare-approved amount for the service. You might also owe a co-payment for some types of outpatient services. Consult with your doctor or healthcare provider regarding the supplies or services that you will need to better estimate the final cost.

Medicare Part C

Also known as Medicare Advantage plans, Medicare Part C is a private, Medicare-approved health insurance plan designed for individuals registered in Original Medicare, Part A, and Part B. It does not provide you an alternative to traditional Medicare but combines coverage for doctor visits, hospital care, and other medical services in one plan. It is mandatory that you must be enrolled in Medicare Part A and Part B to join. This means you will continue paying the Part B monthly premium for Part B and may also have to pay the Medicare Advantage Plan’s premium as well. Just like Part A and B, you will generally have to pay some out-of-pocket expenses (for instance co-insurance or copayments) for certain services. You can have your premium automatically deducted from your checking or savings account or charged via a debit or credit card. You can also have the premium deducted from your Social Security check/benefit (provided that your monthly payment covers your premium).

Advantages of Medicare Part C

Your costs may be lesser as compared to the Original Medicare Plan
You may be able to receive additional benefits offered by the plan like coverage for hearing, dental, vision, special discounts on certain health-related products and wellness programs.
You don’t need to purchase a separate plan to supplement Medicare Part A and B
You might be eligible for help paying for subsidies (premiums)
Prescription drug coverage may be included.

What Does Medicare Part C Cover?

Medicare Part C covers all the services of Part and B, meaning you will have both outpatient and hospital benefits. However, rather than paying deductibles and around 20% of your medical services, you will be paying the plan’s copays. Keep in mind that every penny you spend on Part A and B services is contributed towards your out-of-pocket maximum. When you hit that maximum, your Part C will pay 100% for the remaining year. Part C coverage also usually comes with a built-in Part-D drug plan. Remember that all Medicare Advantage plans have different networks, rules, and enrollment periods. Restrictions, copays, and limitations may apply, so make sure you understand everything prior to applying for a plan.

Medicare Part D

Also referred to as the Medicare prescription drug benefit, Medicare Part D is a US federal government program to subsidize the expenses of prescription drugs and their insurance premium for Medicare beneficiaries. The “D” stands for drugs, and the program is designed to offer Medicare recipients the following basic options:

Stay in conventional Medicare without enrolling in a drug prescription drug benefit highlighted in the Act.
Stay in conventional Medicare and sign up for a Medicare drug plan.
Sign up for a detailed private health plan.
Sign up for other Medicare plans. Individuals who sign up for Medicare Part D can choose from a diverse list of approved drug plan options. None of which cover all prescription drugs.

Many PDP Plans have Deductibles, and most plans have initial coverage amounts, then you fall into the GAP, and ultimately if you use many expensive medications, you may find yourself benefiting from catastrophic coverage. Details vary from plan to plan. Call us for details. There are a few plans that have no deductible. Medicare Part D is coverage for prescription drugs that you can acquire from a retail chemist. This voluntary plan enables you to get access to medications at a more reasonable cost and provides insurance against catastrophic drug expenses. You don’t sign up for Part D through Social Security. Instead, you opt for a Part D program offered by a private insurance provider.

Monthly Premiums for Part D

The monthly premiums for Medicare Part D differ depending on the plan opted. Every insurance company’s rate will vary based on its own policy. For 2023, plan monthly premiums start as low as $12.20. Each insurance company determines its own formula of drugs covered by the plan and can thus decide on what monthly payment they will charge for the plan every year. In addition, people who are ‘high-income wage earners’ may be required to pay a substantial additional premium to subsidize lower income individuals. Keep in mind that it is best to opt for a plan with a formula that provides the prescription drugs you need. When you enroll in the cheapest program without researching the plan’s formulary, you might later find out that the plan doesn’t cover one or more of your medications.

What Qualifies You to Enroll in a Medicare Part D

You become eligible for Part D if:

• You already have Medicare Part A and/or B.
• Your residence is in the service area of a Part D Plan.

Do You want to make changes to you Medicare Coverage?

There are certain times when you can make these changes; some of these time periods are different depending on the type of Medicare plan. For Medicare Advantage (also known as Medicare Part C) and Medicare prescription drug plans, there’s an Annual Election Period (AEP) when you can sign up for, change, or disenroll from the plan.

The Annual Election Period runs from October 15 to December 7 each year.
If you didn’t sign up for one of these plans when you first became eligible for Medicare (during your Initial Enrollment Period), the AEP is generally your chance to make these changes, unless you qualify for a Special Election Period (SEP).

What Changes can you make during the AEP?

Here’s a quick rundown of what you can do during the Annual Enrollment Period:

• Change to a Medicare Advantage plan from Original Medicare, Part A, and Part B.
• Change from a Medicare Advantage plan to Original Medicare, Part A, and Part B.
• Change from one Medicare Advantage plan to another (regardless of whether either plan offers drug coverage).
• Enroll in a Part D prescription drug plan.
• Change from one Medicare prescription drug plan to another.
• Opt out of Medicare prescription drug coverage completely.

Changes you make during the AEP go into effect January 1 of the next year.

What Changes can you make during the AEP?

Making changes after the Medicare AEP

Suppose you’re enrolled in a Medicare Advantage plan, and you want to switch to Original Medicare, Part A, and Part B. You can make this change during the Medicare Enrollment Period, from January 1 to March 31 each year.

If you switch to Original Medicare during this period, you will have until March 31 to enroll in a Medicare Part D prescription drug plan. This coverage is optional, but if you wait until a future date to add it, you could pay a penalty for late enrollment (see below). Your coverage will begin the first day of the month after the plan gets your enrollment form.
Medicare allows changes outside the standard enrollment periods in specific situations that are often out of the beneficiary’s control, such as Medicare ending its contract with your plan, through Special Election Periods (SEPs). Other examples of these situations include, but are not limited to, the following:

• Moving out of your plan’s service area.
• Receiving both Medicare and Medicaid benefits.
• Qualifying for Extra Help.
• Living in, moving to, or moving from an institution such as a long-term care hospital or skilled nursing facility.

You could be charged a late-enrollment penalty (an amount that is added to your Medicare Part D premium for as long as you have this coverage) if all of the following are true:

• You don’t enroll in a Medicare prescription drug plan (such as a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage) when you’re first eligible.
• You don’t have other creditable prescription drug coverage for 63 or more days in a row.
• You then decide to enroll in a Medicare drug plan at a later date.

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