26 Haven Rd Wellesley Hills, MA 02481

Tel: (781) 431-7550

Need Help Navigating the Medicare Maze?

 

Two parts of Medicare are provided by the federal government (Original Medicare)


 

Part A – Hospital Insurance


 

Part B – Medical Insurance

 

Original Medicare is health insurance, but results in a beneficiary having financial gaps in coverage: deductibles, coinsurance and no cap on out-of-pocket expenses.  If a beneficiary has Original Medicare, there will be an effective date for Part A and another effective date of Part B on their Medicare Card (the dates can be the same or different, depending on the enrollment date for Part B).  

Medicare Part A – Hospital Insurance

1) Covers hospital and skilled nursing facility stays, some home health and hospice care

2) Premium: $0 for most people if you or your spouse/former spouse paid Medicare taxes for at least 40 calendar quarters (10 years)

3) Has a deductible in 2019 of $1,364… per benefit period.  A new benefit period occurs once a beneficiary has been discharged from the hospital for 60+ days


 

Medicare Part B – Medical Insurance

 

1)  Covers medically necessary services and some preventive services like doctor visits, lab tests, outpatient hospital care and durable medical equipment

2)  Premium: $135.50 for most people in 2019, however those considered “higher wage earners” pay higher amounts.  (See Blogs #1 and #5)

3)  Has an annual deductible in 2019 of $185

4)  Coinsurance:  Medicare pays 80%, of covered benefit… you pay 20%

5)  Medicare Part B can be deferred with no penalty if you have equivalent "creditable" coverage through an employer health plan (self/spouse)

 

To choose any additional Medicare plan, a beneficiary must have Medicare A and B and continue to pay their Part B premiums.


 

How do you fill in the gaps or expand the coverage provided by Medicare?

 

Most people enroll in a Medicare Supplement Plan or a Medicare Advantage Plan.  These types of plans are mutually exclusive.  This represents the basic health coverage decision, once you’re eligible for Medicare.  Will you be better served on a Medicare Supplement Plan or a Medicare Advantage plan? That depends… we can help you make the decision that’s best for you, usually after a conversation and some analysis.