Medicare Basics
Medicare Parts A, B, C & D

Medicare Part A

This is your hospital health plan.

Part A helps pay for hospital visits and other hospital-related care including Inpatient hospital stays, hospice and home health care.

If you or your spouse have paid into SS for 10 years, it is free coverage. This is known as the premium–free part of Medicare.

In most cases, you’re automatically enrolled in Part A. Coverage starts on the first day of the month of your 65th birthday.

Medicare Part B

Part B helps to pay for care that isn’t covered by Part A.

Together this makes up Original Medicare.

Part B is optional, however, it is needed if you want additional coverage, like supplemental insurance, Medicare Advantage or Part D. Part B is also needed if you want to avoid penalties.

The standard Premium for Part B is $144.60 in 2020.

However, most people who receive social security benefits will pay less. Part B has a deductible of $198 per yr. after the deductible is met you are responsible for the 20% coinsurance that Medicare does not pay.

Part B exceptions

If you have the creditable coverage you do not need to apply for Part B.

If you are still working and have an employer group plan that qualifies as creditable coverage. You will have your own election period when you decide to retire.

If you are still working and have an employer group plan that qualifies as creditable coverage. You will have your own election period when you decide to retire.

Remember Medicare is an 80/20 system, with you the beneficiary responsible for the 20%.

The Majority of Beneficiaries purchase more insurance to cover the 20% Medicare does not pay.

Since most are on fixed incomes, Beneficiaries will contain that potential out of pocket cost through a secondary plan. Medicare Part C, also Known as Medicare Advantage is one of those options.

This Coverage is offered by private companies like Aetna, BCBS, Humana, United Health, Clover and more

Medicare Advantage Must include same benefits as Medicare part A and B.

1. To be eligible you must live in the network of service.
2. These are HMO and PPO type plans similar to employer plans.
3. Many will include some form of vision, dental, and prescription drug coverage.

Approximately 30% of Medicare beneficiaries are choosing Medicare Advantage programs, this number has been growing each year. Medicare Advantage is sometimes referred to as “ The Free Plan” or ZEROPLANS.

These plans have defined networks of coverage, HMO, PPO types – think group employer-sponsored plan with “pay as you go” coverage. You will pay per visit to DR and Specialist.

This is an annual renewable plan for both beneficiary and doctors.

The 2020 max out of pocket limit is anywhere from $0-$6,700. This can change each year. Plans make decisions as far as necessary treatments and services.

Network restrictions do apply, so you may need referrals depending upon the plan.

There are very few health questions to answer with Medicare Advantage. The AEP (Annual enrollment period) is when you can make changes in these plans.

Medicare Part D

Prescription Drug Plans-remember “D” is for DRUGS

Most important is to make sure your medications are covered by the plan. Each plan will cover drugs differently- so what is good for your spouse may not be good for you. You must be enrolled in both Part A and Part B to get Part D.

There is an Initial election period when beneficiary is first eligible for Medicare.

Avoiding penalties

The late enrollment penalty is an amount added to your Medicare Part D monthly premium. The national base beneficiary premium may increase each year, so your penalty amount may also increase each year. The penalty lasts as long as you receive Part D coverage. Join a Medicare Prescription Drug Plan when you’re first eligible. Don’t go 63 days or more in a row without a Medicare drug plan or other creditable drug coverage.

How to shop for a plan

If you are choosing a Medicare supplement you will need an individual Part D plan. Medicare Advantage programs can Include Part D coverage. Match a plan with your prescribed Medications and preferred pharmacy for best cost savings. Shop for plans based on your individual needs and not your wife or neighbors.