What is Medicare?
Medicare is the federal government program that provides health care coverage if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare.
Once you have become Medicare-eligible and enroll, you can choose to get your Medicare benefits from Original Medicare, the traditional fee-for-service program offered directly through the federal government, or from a Medicare Advantage Plan, a type of private insurance offered by companies that contract with Medicare (the federal government).
Most people join the Medicare program after turning 65 years old, or when they retire and leave their group health insurance.
THIS IS WHAT YOUR
SHOULD LOOK LIKE
Your Medicare Coverage is Comprised of Four Parts:
Original Medicare consists of Part A and Part B. Together they provide the basis for your health insurance coverage.
Part A – This is commonly known as hospitalization insurance. This mostly covers the cost of your time in the hospital (inpatient care), skilled nursing facility care, hospice care, home health care, and more.
Part B – This helps cover your doctors visits and other services including: outpatient procedures, x-rays, lab tests, and preventative services.
Part C – These plans are offered by private insurance carriers who have a contract with Medicare and are required to offer the same benefits as Original Medicare. You may enroll in this option to replace your “Original Medicare” (Part A and Part B) and many times it will include your Part D prescription drug coverage.
Part D – This is your prescription drug coverage. This is offered to everyone with Medicare. Most Part C plans cover prescription drugs; however, you may be able to add drug coverage to some plans, if they are not already included.
What is covered by Original Medicare?
The combination of Parts A & B of Medicare make up what we call “Original Medicare”.
The combination of Parts A & B of Medicare become our basic hospitalization and medical coverage while on Medicare. This foundation of coverage is usually complemented by either electing a Medicare Supplement, or Part C Advantage plan.
What is Covered Medicare Part A
While Medicare Part A is often referred to as hospital insurance since it covers your care while in a hospital. It will also cover some care in nursing facilities, assisted living, home health care, and hospice.
In general, Part A covers:
· Hospital care
· Skilled nursing facility care
· Nursing home care (as long as custodial care isn’t the only care you need)
· Home health services
· And more
What is Covered Medicare Part B
Medicare Part B is medical insurance and covers services such as Doctors, X-rays, lab tests and other outpatient services.
In general, Part B covers:
· Outpatient care
· Lab tests, X-rays, and blood work
· Ambulance services
· Durable medical equipment
· Some outpatient prescription drugs
· Mental healthcare
· And more
How much does Part A cost?
You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.”
If you buy Part A, you’ll pay up to $437 each month in 2019.
Most people get premium-free Part A. You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
- You have received Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
In most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both.
Part B costs:
You pay a premium each month for Medicare Part B (Medical Insurance). Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
How much does Part B cost?
Most people pay the Part B premium of $135.50 (in 2019) each month, however consult the chart below if you have an individual income over $85,000 or joint income over $170,000.
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Social Security will contact some people who have to pay more depending on their income. The amount you pay can change each year depending on your income. If you have to pay a higher amount for your Part B premium and you disagree, contact Social Security at 1-800-772-1213.
If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty.