Medicare | Selman Leaf

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Medicare

MEDICARE OVERVIEW

Medicare is a national health insurance program in the United States, that begun in 1965 under the Social Security Administration (SSA) and it is currently administered by the Centers for Medicare and Medicaid Services(CMS). It primarily provides health insurance for Americans aged 65 and older, but it can also be utilized by some younger people that have a disability status as determined by the Social Security Administration. This would include individuals with end stage renal disease and amytrophic lateral sclerosis (ALS or Lou Gehrig’s Disease).

Medicare Parts, A, B, C, and D are the four types of coverage available to qualified individuals. Each Medicare part covers distinctive healthcare related costs. Medicare A and Medicare Part B are administered by the Centers for Medicare and Medicaid Services (CMS), Medicare Part C and Medicare Part D are handled by private insurance companies.

Medicare can be compared to the health insurance coverage you may have had with an employer or an individual insurance policy. Coverage includes doctor visits, inpatient and outpatient hospital care, lab tests, and prescription drugs. Medicare plans also offer coverage for vision and dental.

WHAT IS MEDICARE

PART A, B, C, & D?

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MEDICARE PART A

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Medicare Part A (also referred to as Hospital Insurance) is a simple insurance plan that covers medical services related to inpatient hospitalization and skilled nursing care. It is offered at a low or no cost to Americans who are 65 years old and have paid into Social Security, in addition to other qualified individuals.

When applying for Social Security benefits, you’re automatically enrolled in Medicare Part A

What Medicare Part A Covers:

Inpatient care in a skilled nursing facility
Inpatient care in a hospital
Skilled nursing facility care
Home health care
Hospice care

What is the Cost of Medicare Part A?

If you or your spouse have worked at least 40 calendar quarters in any job in which you have paid Social Security taxes, you do no have to pay a premium for Part A.

Premium: $0 per month
The 2021 Medicare Part A premium for those who do not qualify for $0 premiums is either $259 or $471 each month in 2021. The amount will depend on how long you worked and paid Medicare taxes.

What’s the Part A late enrollment penalty?

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A but didn’t enroll.

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MEDICARE PART B

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Medicare Part B (also referred to as medical insurance) is an insurance plan that covers medical services related to outpatient and doctor care.

Part B covers medically necessary care and treatment, including:

Medically necessary services or supplies
Getting a second opinion before surgery
Limited outpatient medications
Durable medical equipment
Mental health services
Ambulance services
Preventive services
Clinical research

What is the Cost of Medicare Part B?

The standard Part B premium amount in 2021 is $148.50.

In 2021, you pay $203 for your Part B deductible (The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.) After you meet your deductible for the year, you typically pay 20% of the Medicare-Approved Amount (In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount, and you're responsible for the difference.) for these:

Most doctor services (including most doctor services while you're a hospital inpatient)
Outpatient therapy
Durable Medical Equipment (DME) (Certain medical equipment, like a walker, wheelchair, or hospital bed, that's ordered by your doctor for use in the home.)

What’s the Part B late enrollment penalty?

See page 23 of Medicare and You 2022

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MEDICARE PART C

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Medicare Part C (also referred to as Medicare Advantage) includes the coverage benefits of Medicare Parts A and B, Medicare Part C plans can also offer prescription drug benefits and other additional coverage (like vision and dental). In total, Medicare Part C can cover things like:

Medicare Part A (hospital insurance)
Medicare Part B (medical insurance)
Medicare Part D (prescription drugs)
Health and wellness programs
Hearing
Dental
Vision

What is the Cost of Medicare Part C?

The monthly premium varies by plan.

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MEDICARE PART D

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Medicare Part D offers coverage for prescription drugs. The prescriptions covered depend on the plan you select; they can be found in your plan’s drug formulary.

What is the Cost of Medicare Part D?

The monthly premium varies by plan.

What’s the Part D late enrollment penalty?

The late enrollment penalty is an amount that is permanently added to your Part D premium. You may owe a late enrollment penalty if, at any time after your Initial Enrollment Period (IEP) is over, there is a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage.

If you get Extra Help, you do not pay a late enrollment penalty.

3 ways to avoid paying a penalty:

Join a Medicare drug plan when you are first eligible
Enroll in a Medicare drug plan if you lose other creditable coverage
Keep records showing when you had creditable drug coverage and tell your plan if they ask about it.

WHEN CAN I ENROLL

INITIAL ENROLLEMENT PERIOD:

The Initial Enrollment Period (IEP) is the first time you can sign up for Medicare.

GENERAL ENROLLEMENT PERIOD:

The General Enrollment Period (GEP) allows individuals to enroll in Parts A and B, but late enrollment penalties may apply and increase the amount you pay for your premiums..

OPEN ENROLLEMENT PERIOD:

The Medicare Open Enrollment Period often refered to as the Annual Enrollment Period (AEP), is the time when individuals can change their Medicare Advantage and/or Medicare Part D plans. This also the time to switch from Original Medicare to Medicare Advantage or vice versa.