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Medicare Basics – Think of Medicare as a two step process:

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Step One

(Medicare Basics – click on a topic below to open the content)

Enroll into Original Medicare consisting of Medicare Part A & Medicare Part B.

Original Medicare is the government provided health care coverage for people that are 65 and over, have been on Social Security Disability for 24 months or more or have end of stage renal failure (kidney failure). Medicare covers hospital and medical costs. You have a 7 month period surrounding the month of your 65th birthday to sign up for Medicare. If you wait to sign up, you may have to pay a penalty when you do join. You may have special circumstances that allow you to enroll outside of the initial enrollment period without penalty. If you are receiving SSDI, you will automatically enroll into Medicare after being on Social Security Disability for 24 months. Original Medicare does not cover prescription drugs… Please see “Step Two” on this page or “Part D” on the Medicare Insurance page for more information about drug coverage. Generally you will be automatically enrolled into Medicare if you are receiving Social Security benefits…either retirement or disability. If you are not drawing your Social Security benefits you will need to contact your local Social Security office so they can explain the process to you & assist you with your enrollment. We recommend that you schedule an appointment to speak with a local Social Security worker or if transportation is difficult, you can be enrolled over the phone.

Medicare Part A helps you cover your hospital expenses...like when you are admited into a hospital.

Medicare Part A hospital starts with a deductible ($1,340 in 2018) that you must pay before Medicare starts paying for your Part A benefits. You pay this deductible at the start of every benefit period so this means you could pay your deductible multiple times during a year. Medicare explains a Part A benefit period starts the day you’re admitted as an inpatient in a hospital or skilled nursing facility and ends when you haven’t had any inpatient hospital care (or skilled nursing facility care) for 60 days in a row. So basically if you are admitted to a hospital as an inpatient in March for two days and then again 61 days later in May or June, you will pay the deductible again. Below are the bullet points of your costs when it comes to Medicare Part A…

    • 2018 Part A Monthly Premium

      Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you did not meet the qualifications  for premium-free Part A, you pay up to $422 each month.
    • Hospital Stay…your 2018 out of pocket expenses.

      $1,340 deductible per benefit period.

      $0.00 for the first 60 days of each benefit period

      $335 co-pay per day for days 61–90 of each benefit period ($10,050 total co-pay cost per benefit period).

      $670 co-pay per “lifetime reserve day” after day 90 of each benefit period, up to a maximum of 60 days over your lifetime. ($40,200 total co-pay cost for “lifetime reserve days”).

      No hospital coverage after the benefit period is reached (90 days) and the “lifetime reserve days” (60 total) are used. You will be responsible to pay the full hospital bill from this point on…
  • Skilled Nursing Facility Stay…your 2018 out of pocket expenses.

    $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.

As you can see the costs can add up quickly. Medicare is a fee for service set up so this means you will continue to pay as you need medical services. There is no maximum out of pocket or “safety net” built into Medicare…this can financially ruin retirement plans. Do not worry too much because there are ways to protect yourself and loved ones from possible financial hardships. To learn more you can contact us.

Medicare Part B helps you cover your medical expenses...like doctor office visits and outpatient surgeries.

Just like Part A, Medicare Part B also starts with a deductible. In 2018 the deductible is $183. The deductible for Part B is a yearly deductible so you will only pay it once during the calendar year. As a general rule Medicare Part B is set as up as an 80/20 coinsurance. This means that Medicare pays 80% of your medical expenses and you will pay the remaining 20%. Medical expenses are things like doctor costs, out-patient surgery costs, ambulance costs, emergency room costs and durable medical equipment like oxygen tanks and diabetic testing supplies. Below are the bullet points of your costs when it comes to Medicare Part B…

    • Part B Monthly Premium

      You pay a Part B premium each month. Most people will pay the standard premium amount of $134 unless you were new to Part B in 2018 or after, you premium will $121.80. However, if your income is over a certain amount you may be required to pay more…also if your income is below a certain level, you may qualify for the Medicare Savings Program that will help you pay your Part B premium.

      (Please see the Extra Help With Medicare Costs page or contact us for information on the Medicare Savings Program).
  • Part B…your out of pocket expenses.

    You pay 20% of all medical bills.


Medicare Part B does not have a maximum out of pocket or a financial “safety net” set up. This means that as you need services, you will be billed for those services. For example if you go to your primary doctor and Medicare allows the doctor to charge $140 for the office visit then Medicare will pay $112 (80%) of the bill and you will pay $28…the remaining 20%. Since there is no maximum out of pocket, if you happen to need services that amount to $300,000.00 then Medicare will pay the 80% and that will leave you with the 20% or a bill of $60,000.


As you can see the costs can add up quickly. Medicare is a fee for service set up so this means you will continue to pay as you need medical services. There is no maximum out of pocket or “safety net” built into Medicare…this can financially ruin retirement plans. Do not worry too much because there are ways to protect yourself and loved ones from possible financial hardships. To learn more you can contact us.

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Step Two

If you feel you need more than Original Medicare provides…you have options.

Option 1 - Keep original Medicare and add the following...

PRESCRIPTION DRUG PLAN…MEDICARE PART D

Helps pay for prescription drug costs.

2018 Average National Monthly Premium $34.

Avoid the Late Enrollment Penalty (LEP)…Enroll in Part D.

AND/OR

MEDICARE SUPPLEMENT INSURANCE (MEDIGAP)

Upsides

Covers some or all of the costs that are not covered by Original Medicare…fills in the “gaps.”

Downsides

Monthly premiums are paid if you need to use your insurance or not.

Monthly premiums generally increase every year.

Option 2 - Manage your Medicare Benefits with Part C.

MEDICARE PART C…MEDICARE ADVANTAGE PLANS

Part C Plans are private health plans that are contracted with Medicare to manage your Medicare Part A and Part B benefits. Most plans are structured as a PPO or HMO…just like you probably had with your employer while working.

Since they manage your Medicare benefits, all Part C plans give you the same benefits as Original Medicare, plus more…

Many Part C plans also include Part D, Prescription Drug Coverage so you will avoid the late enrollment penalty.

Part C plans usually have a low or no monthly premium.

Additional benefits can include: dental services, vision services, hearing services, health screening tests, gym access and nurse helplines are some of the items that are often included in Medicare Advantage plans.

Plans also cap your out-of-pocket expenses for the year. The maximum out of pocket limit provides a financial “safety net” for members.

After having gone through Medicare basics STEP ONE and STEP TWO options above, you might feel a little overwhelmed…so lets keep it simple. Once you are enrolled into Medicare you have one of two options…

1) Purchase a stand alone prescription drug plan with a Medicare supplement policy to help cover the gaps in Original Medicare.

2) Enroll into a Medicare Advantage plan with a no or low monthly premium that also provides prescription drug coverage.

Simple…right?

For help on deciding on how to set Medicare up for you or to help a loved one, check out our Setting Up Your Medicare page for more information about how to decide what is the best fit for you…or you can contact us and speak to someone that is local, licensed and certified. We will be happy to help educate and guide you on your options and choices so that you can make an informed decision on what is right for you.

NoteIf you have limited income & assets please take the time to visit the Extra Help With Medicare Costs page for information about programs that are built into Medicare to help you pay for your health & drug costs.

Find the plan that is right for you or a loved one