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.