Medicare Basics

What is Medicare?

Medicare is our nation’s health insurance program for people who are age 65 or over. Medicare is also available to certain individuals under 65 who have certain disabilities or End-Stage Renal Disease. The program helps with the cost of health care, but it does not cover all medical expenses. The medical expenses that aren’t covered by Medicare are sometimes referred to as the “Medicare Gap.”

Original Medicare comes in two “Parts.” Part A is the hospitalization coverage while Part B is the general medical coverage. Part B costs a monthly premium. The standard rate for 2018 is $134 per month, but you may be required to pay a little more depending on certain economic factors.

 

The Medicare "Gap" - Medicare Deductibles, Copays & Coinsurance

Part A (Hospitalization) Deductibles and Copays

Part A (Hospitalization) Deductibles and Copays)
Inpatient Deductible – First 60 days $1,340 per benefit period
Inpatient copay days 61-90 $335 per day
Inpatient copay days 91-150 $670 per day
Skilled Nursing Facility copay days 1-20 No coverage
Skilled Nursing Facility days 21-100 $167.50 per day
Skilled Nursing Facility Days 100+ No Coverage

Part B (General Medical) Deductibles and Coinsurance)

Part B (General Medical) Deductibles and Coinsurance)
Calendar Year Deductible $183 per Year
Coinsurance 80% / 20%

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Medicare Part A (Hospitalization) has no fee to sign up for most people. If you’ve signed up for Social Security or Railroad Retirement Board benefits already, then you will be automatically enrolled in Part A.

If you’re not receiving Social Security benefits, you should sign up for Part A 3 months before your 65th birthday. You should do this regardless of whether you’re planning to continue working.

Medicare Part B (General Medical) will help cover medically necessary fees from medical professionals and other things such as Durable Medical Equipment. You’ll want to sign up for your Part B unless you have good coverage through your work that is more affordable than a supplemented Medicare Plan.

Everyone should look into Part B as an option, even if you’re planning to continue working.

If you didn’t sign up for Part A when you first turned 65, you can sign up and still have it retroactive up to 6 months.

Your Initial enrollment period for Part B starts 3 months before you turn 65 and lasts for seven months.

 

If you have existing coverage through your work, you should sign up for Part A, anyway.

If your employer has 20 or more employees, you can defer your Part B without a penalty. Part B will be limited use to you because it would pay secondary to your major medical plan. You’d also be starting your 6-month Medigap Open Enrollment period early when it wouldn’t be of much use to you.

You should speak with your company’s health benefits administrator before making any decision to not take Part B. There are some instances where you could still see a penalty for not enrolling in Part B when you turn 65.

Even if you’re planning on continuing to work, enrolling in Part B with a Medicare Supplement or Medicare Advantage plan may still be advantageous to you. You should contact me for a free, no-pressure consultation to go over your options.

You’ve already handled the biggest part of handing your coverage. Now you’re ready to start researching and purchasing either a Medicare Advantage, or Medicare Supplement, and/or Prescription Drug Plan. You have 6 months after signing up for your Part B for a Medigap plan. You should contact me to learn about your options today!