THE FOUR PARTS OF MEDICARE
Who is eligible for Medicare?
You are eligibility for Medicare Part A and B begins for most people at age 65, or if you have been on Social Security disability for at least 2 years (24 months).
To be eligible you have work 10 years or 40 quarters in the US during your lifetime. Your spouse will qualify as well even if they didn’t work the 10 years.
How much is Part A?
For most people, there is no premium for Part A, if you or your spouse worked 10 years, and paid Medicare taxes. If you worked less than 30 quarters, you would pay the standard premium of $413. The cost is $227 for people who worked between 30-39 quarters.
When can I start Part A?
You can enroll into Part A 90 days before you turn 65. When you are first eligible for Medicare, you will have a 7-month Initial Enrollment Period (IEP) to sign up for Part A as well as B. For those who continue to work beyond 65, you can enroll in Part A, through a special enrollment period, when you drop your employer based plan. Contact our office to discuss this in greater detail.
What is my out of pocket costs on Part A?
Every year, the federal government, under the direction of CMS (Center for Medicare and Medicaid Services) sets the following years costs. For 2017, the costs are as follows:
$1316 deductible for each hospital stay, except when stays are within the same 60-day period.
$329 per day for days 61-90 of a consecutive hospital stay
$658 per day for days 91-150 of a consecutive hospital stay
And all costs for day 150 and beyond.
These costs are what a Medicare beneficiary would be responsible for, but our agency has Medicare Supplement plans that cover these expenses. Contact us today for a free quote!
Covers doctors’ visits, services and supplies necessary to treat your health condition. This includes, Ambulance services, Preventative care services, outpatient services and durable medical equipment.
How much is Part B?
In 2017, the costs for people is as follows:
If your yearly income in 2015 (for what you pay in 2017) was
You pay each month (in 2017)
File individual tax return
File joint tax return
File married & separate tax return
$85,000 or less
$170,000 or less
$85,000 or less
above $85,000 up to $107,000
above $170,000 up to $214,000
above $107,000 up to $160,000
above $214,000 up to $320,000
above $160,000 up to $214,000
above $320,000 up to $428,000
above $85,000 and up to $129,000
When do I start Part B?
Like Part A, you can take part B when you turn 65 or when you lose your group insurance through your employer. If you don’t sign up for Part B when you are eligible you must pay the Part B penalty for the entire time you are on Part B. This penalty is called the late enrollment penalty, and it takes the standard premium amount and increases it by 10% for each full 12-month period you were you eligible but didn’t take part B.
What are my out of pocket costs on Part B?
Medicare is an 80-20 plan for all medical services rendered that are necessary. Medicare Part B in 2017, has an $183 deductible, then you would pay 20% of all remaining charges with no stop loss or out of pocket maximum. You will also be responsible for all excess charges by the facility or doctor may legally charge above the Medicare reimbursement. This is noteworthy, because services like surgeries, or chemotherapy are very expensive and 20% of these costs can be astronomical.
Fortunately, there are Medicare Supplement, also known as Medigap plans or Medicare Advantage plans that you can take to cover these expenses. Please call today for a free quote and more information on the plan to fit your needs and budget. 800.891.5929 or 513.368.5694.
is the legal name given for the term Medicare Advantage. This is an alternative to original Medicare offered to people who are eligible for Medicare. You do not sign up for Part C through social security, but through a private insurance company.
Medicare Advantage companies receive a set monthly amount from Medicare to administer your care. These plans usually have co pays, and 20% co insurance until an out of pocket max is met. They usually are HMO’s with specific networks the member must use.
How much is Part C?
It will depend on your county, but many Medicare Advantage plans have a $0 premium. Again, this is possible because the private health plan is reimbursed from Medicare through a formal contract. You will still be required to pay your part B premium even if enrolled in Part C.
Does Part C have enrollment periods?
Yes, Part C enrollment falls within the following enrollment periods. If you are new to Medicare you can enroll during your Initial enrollment period (IEP), or change plans annually during the open enrollment period (OEP). The annual enrollment period is from October 15th through December 7th.
Another date to remember is Feb. 14th. This is the last day of the MADP (Medicare Advantage dis-enrollment period). You can choose to return to original Medicare during this time. (Be sure to have your new Medicare supplement plan approved before you do this). Please call our office with more questions about this. 513.368.5694.
What are my out of pocket costs with Part C?
This varies from state to state and company to company. These plans generally have a co-pay for the doctor’s office and an out of pocket maximum between $4-6k. These plans have the right to change year to year, and do not have all the doctors that original Medicare has. Before enrolling, be sure to make sure your doctor is in network, and you understand how the plans work. For more information please call us 513.368.5694.
Part D: What is Part D?
Part D also the Medicare prescription drug benefit, is the program we to subsidize the costs of prescription drugs and prescription insurance plans over through Medicare contracted providers. This program is voluntary and allows you access to medications at an affordable rate.
What is cost of Part D?
Each plan is different, and your price can change depending on your income but plans range from $15-$200 per month for the premium. Along with this, the beneficiary could have co-pays and deductibles. You have a lot of choices when it comes to which plan you can take, and if your needs change you can change plans during the next open enrollment period.
Are my prescriptions covered?
Every plan is different, so to be sure that your prescriptions are covered refer to the plans formulary. This is the plans list of drugs that are covered. Every year you can change plans during open enrollment if your needs change.
How do I, and when can enroll in Part D?
We recommend people review each of the different Rx plans available. You will have full access to see all the plans available with a true comparison of the out of pocket costs. You can enroll in Part D 3 months before you turn 65 and then the month you turn 65 as well as the following 3 months without incurring the late enrollment penalty.
Our agency provides a free analysis of your Part D options, please call us at 800.891.5929 and we would be happy to help.