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Medicare Basics

Part A – Hospital

Inpatient hospital
Skilled nursing facility
Home health care
Hospice care

Part B – Medical

Physician services
Lab tests
X-rays
Clinical research
Ambulance
Durable medical equipment
Mental health

Part C – Medicare Advantage Plans

Administered by private companies
Includes Medicare Part A and Part B
Many include Prescription Drug Coverage (Part D)
Some plans include dental, vision and hearing

Part D – Prescription Drug Coverage

Administered by private companies
Prescription medications are found in a formulary
Uniquely designed with 4 phases

What Medicare Costs?

Premium

Typically, you don’t pay a monthly premium for Medicare Part A (Hospital) if you or your spouse paid Medicare taxes for a certain amount of time.

If you are Disabled for more than 24 months you will receive "Premium-Free Part A"

Part A

Hospitalization per benefit period

  • First 60 Days in hospital - $1,340
  • 61st-90th day - $335 per day
  • 91st and after - $670 per day
  • Beyond 150 days – All Costs

Skilled Nursing Facility Stay

  • $0 for the first 20 days of each benefit period
  • $167.50 per day for days 21–100 of each benefit period
  • All costs for each day after day 100 of the benefit period

Premium

The monthly premium is 2018 is $134 (could be higher depending on income)

Coinsurance and Deductible

$183 Deductible

20% coinsurance of the balance of the Medicare approved amount

  • Medicare Advantage (Part C) plans combine coverage for hospital care, doctor visits and other medical services all in one plan
  • Includes all benefits of Part A, including Hospital stay, skilled nursing, home health care and associate services
  • Includes all the benefits for Part B, including doctor visits, outpatient care, screening and lab tests, and associated services

  • Coverage can be obtained from a standalone Part D Plan or you can choose a Medicare Advantage Plan that includes Part D.
  • Each drug plan has a “formulary” that includes the list of drugs being covered.
  • Drug "tier levels" determine the co-pay.
  • is uniquely designed and have 4 different phases

Late Enrollment Penalties

If you decide not to elect Part B during your initial enrollment period there will usually be a penalty if you decide to elect Part B in the future.

Penalty: Your monthly premium for Part B may go up 10% for each full 12 month period you could have had Part B, but didn’t sign up for it.

The cost of the late enrollment penalty for Part D depends on how long you went without Part D coverage. This penalty is calculated by multiplying 1% of the national base beneficiary premium by the number of months you didn’t have Part D coverage.