Medicare Basics

Medicare BasicsOriginal Medicare consists of Medicare Part A Hospital Insurance and Medicare Part B medical insurance.

Medicare Part A

Helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Home hospice care
  • Some home health care

There is no premium for Part A for most people as long as they or their spouse paid Medicare taxes for 40 quarters or ten years.  In 2022 there is a $1,556 deductible per benefit period for inpatient hospital care.

Note: The benefit period for Medicare Part A is 60 days. If a person is admitted as an inpatient, they or their plan will pay the $1,556 deductible. If they are released and admitted again 60 days or more, they or their plan will owe another $1,556 deductible.

Medicare Part B

Helps pay for:

  • Services from doctors and providers
  • Outpatient care
  • Lab fees and X-rays
  • Durable medical equipment (wheelchairs, walkers, oxygen equipment, etc.)
  • Some preventive services

In 2022 people new to Medicare will pay a $170.0 monthly Part B premium. There is a $233 annual deductible and a 20% copay for all Medicare-approved services.

As you can see, Medicare does not cover all your approved medical expenses.

Note: Individuals earning more than $91,000 a year and married couples filing a joint tax return earning more than $182,000 will pay a higher Part B premium. Medicare uses your IRS tax return from two years ago. For people going on Medicare in 2022, Medicare will use their annual income from 2020.

Medicare Supplement Plans (also known as Medigap insurance)
Medicare supplement plans are standardized plans offered by private insurance companies and approved by Medicare. They can help pay some of the costs not covered by Original Medicare.

There are ten standard Medigap Plans A, B, C, D, F, G, K, L, M, and N. The different lettered policies offer various benefits and costs. All Plans with the same letter must offer the same basic benefits. Even though the basic benefits are the same for each standard policy, the insurance companies may charge different premiums for the same plan. The only difference in any Plan G is the monthly premium charged by the other insurance companies.

A plan may not cancel your coverage as long as you continue to pay your premium. Additionally, they cannot single out a person for a rate increase. You may go to any provider that accepts Medicare.

You must also purchase a Part D prescription drug plan when you purchase a Medicare Supplement.

Note: Medicare Supplement Plan F is no longer available to people that turned 65 after January 1, 2020.

Medicare Part C (Medicare Advantage plans)
Medicare Advantage plans are offered by private insurance companies approved by Medicare. All Medicare Advantage plans are not created equal, as benefits, copays, deductibles, and availability vary by county and state. To control costs, Medicare Advantage plans are allowed to limit a patient’s choices of doctors, hospitals, labs, etc. This can be a significant disadvantage if a patient’s favorite doctor, specialist, or hospital is not a member of a plan’s network.

Medicare Part D (prescription drug coverage)

Prescription drug plans are run by Medicare-approved private insurance companies and help cover the cost of prescription drugs.

  • Deductibles vary by plan
  • Costs vary from plan to plan
  • Drug lists (known as formularies) vary by plan

Enrollment Period for People Turning 65
The Initial Enrollment Period (IEP) for Medicare starts three months before you turn 65 and ends three months after you turn 65.

Late Enrollment Penalties
If you or your spouse plan to work past age 65 and have insurance through an employer, contact your employer’s HR Department. They should know if Medicare considers your employer’s coverage creditable.

We are Here to Help
Medicare can be confusing. I specialize in Medicare products for seniors and represent all Medicare Supplement plan types.

I make the complex simple by shopping the plans and rates for you. There is never a fee, and you are under no obligation to use my services.

Medicare Explained in Plain English