Medicare Parts & Costs

What Is "Original Medicare?"

When you hear "Original Medicare," that means Medicare Parts A & B only. That means having only Parts A & B and no other plan. Medicare Parts A & B offer some coverage, but they are not comprehensive.

 

There are large deductibles, coinsurances, and many times where "Original Medicare - Parts A & B Only" end. That is why many people chose to also have a Medicare Plan on top of Original Medicare.

 

There are four main types of Medicare plans: Medicare Advantage plans, Medicare Savings Accounts, Medicare Cost plans, and Medicare Supplements. Some of these plans include Medicare Drug plans and some require you to purchase the Drug plan separately.

 

Each plan type is offered by many different insurance companies and each company offers multiple plans. That is where "Health Insurance Advisors" comes in. We meet with people and help them figure out the best plan type, company and specific plan inside that company for each person.

 

There is no one company or plan best for everyone, which is why we work with all the top companies and can search for the best plan for that person and their lifestyle. We are paid for everything we do by the insurance companies and therefore do not charge our clients any fees! You pay the same premiums whether you use an insurance broker like us or not.

 

We study each company and plan full-time, all year round! We can easily tell you the top plans for the year and help you pick one best for you and your lifestyle! It is just too much to do on your own.

 

Let us take your stress away, by contacting us today!

Happy Senior Couple

Medicare Part A

If you have worked 40 quarters (10 years) in your life, then usually Medicare Part A costs $0. If you have not worked 10 years, Medicare could cost up to $471/month (in 2021) depending on how long you worked in your life. 

Medicare Part A has some coverage for Inpatient Hospital, Skilled Nursing Facility, Home Health & Hospice.

 

Inpatient Hospital coverage includes a $1,484 deductible (in 2021) for the first 60 days and then:

Days 61-90: $371 Copay per day (2021)

60 Extra Lifetime reserve days: $742 Copay per day (2021)

After these days, you would be responsible for all costs. That is why many people get a plan on top of Medicare Part A.

Medicare overs a $0 Copay for a Skilled Nursing stay for up to 20 days and then a $185.50 copay for days 21 - day 100.  In order to get this benefit you have to have stayed in the hospital 3 overnights to qualify. Some Medicare plans take away this 3 overnight qualification.

Medicare also offers a $0 Home Health and Hospice benefit. Of course, you must also meet certain qualifications to receive this benefit.

Medicare Part B

Medicare Part B costs the average person $148.50 (in 2021). Some people may pay more or less depending on their income. You can find the chart and prices here (scroll to the bottom of the page). There are also Medicare Savings Programs for low-income people, you can find them here.

The monthly premium will be taken right out of your Social Security check monthly. If you are not on Social Security, you will be billed quarterly for the Medicare Part B amount. If you do not want the bill quarterly, you can sign up for auto pay monthly. Go to our "Forms" page and click on "Auto Pay Part B."

You will get a penalty if you are past age 65, do not sign up for Medicare Part B and do not have other creditable medical coverage. Creditable coverage means:

  1. You have health insurance through your employer or your spouses employer.

  2. The employer has more than 20 employees.

  3. The health insurance is "group coverage as defined by the IRS."

  4. Your plan includes "creditable drug coverage," which means it covers as good or better than Medicare Part D plans.

The penalty is 10% of the current Part B rate in the year you sign up for Part B. They add this 10% by each 12 month period you went without it and then you pay that penalty each month for the rest of your life.

Medicare Part B has a $203 deductible (in 2021) and covers most things 80% and you are charged 20%. There is no "out-of-pocket-max" on Original Medicare.

The 80% coverage includes Hospital Observation (if you go to hospital and they put you under observation, rather than admitting you), Chemotherapy, Medical Equipment, Diabetic Supplies, Doctor visits, Labs, Tests, Procedures, Day Surgery, Air & Ground Ambulance and most things you do in a clinic setting.

Medicare Part C

Couple with Dogs

Medicare Part C is also known as Medicare Advantage Plans. These two terms mean the same thing and are used interchangeably.

Medicare Advantage plans mean that Medicare Parts A, B, and sometimes D are combined into one plan. You chose a Medicare Advantage plan by choosing a plan offered by a Health Insurance company. These companies and plans have to submit their proposals to Medicare each year and Medicare approves them offering a plan.

If you chose a Medicare Advantage plan, that company gets money from Medicare to administer your benefits, which is why they can cost as low as $0. 

Medicare Part D 

Medicare Part D is a prescription drug plan. You do not sign up for this through Medicare. You chose a Medicare drug plan by signing up for a plan through an approved Insurance Company.

If you do not have a drug plan, and do not have creditable coverage after age 65, you will get a penalty every month you go without drug coverage. Creditable coverage means:

  1. You have health insurance through your employer or your spouses employer.

  2. The employer has more than 20 employees.

  3. The health insurance is "group coverage as defined by the IRS."

  4. Your plan includes "creditable drug coverage," which means it covers as good or better than Medicare Part D plans.

Veterans Administration drug coverage is creditable.

 

The penalty is 1% of the average Medicare drug plan price on the year you finally sign up and this 1% is added each month you went without it and you will pay this penalty each month for the rest of your life.

The information on this website is for educational purposes only. While we have taken every precaution to ensure all information is accurate, errors can occur. Health Insurance Advisors, LLC assumes no responsibility for any errors on this page. Sources: Medicare.Gov & SSA.Gov