Medicare 101

 

Medicare has 3 parts.

Part A – Hospital Coverage

Part B- Doctors and services

Part D- Drug coverage

 

Premium-free Part A

You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working.  This is sometimes called “premium-free Part A.”

Most people get premium-free Part A.

You can get premium-free Part A at 65 if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
  • You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

  • You got Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements.

Part A premiums

If you buy Part A, you’ll pay up to $422 each month in 2018. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $422. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $232.

In most cases, if you choose to buy Part A, you must also:

Contact Social Security for more information about the Part A premium.

Some people automatically get Medicare Part A (Hospital Insurance). Learn how and when you can sign up for Part A.

Some people automatically get Medicare Part B (Medical Insurance), and some people need to sign up for Part B. Learn how and when you can sign up for Part B.

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty.

Part A costs if you have Original Medicare

Note

All Medicare Advantage Plans must cover these services. If you’re in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those in Original Medicare. Review the “Evidence of Coverage” from your plan.

  • Home health care
  • Hospice care
    • $0 for hospice care.
    • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you’re at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Part D.
    • You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
    • Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
  • Hospital inpatient stay
    • $1,340 deductible for each benefit period.
    • Days 1–60: $0 coinsurance for each benefit period.
    • Days 61–90: $335 coinsurance per day of each benefit period.
    • Days 91 and beyond: $670 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond lifetime reserve days: all costs.

How much does Part B cost?

Part B premiums

You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill.

Most people will pay the standard premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS).

2018

The standard Part B premium amount in 2018 will be $134 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount ($130 on average). You’ll pay the standard premium amount (or higher) if:

  • You enroll in Part B for the first time in 2018.
  • You don’t get Social Security benefits.
  • You’re directly billed for your Part B premiums (meaning they aren’t taken out of your Social Security benefits).
  • You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $134.)
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount. If so, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

If you’re in 1 of these 5 groups, here’s what you’ll pay:

If your yearly income in 2016 (for what you pay in 2018) was You pay each month (in 2018)
File individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less $134
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $187.50
above $107,000 up to $133,500 above $214,000 up to $267,000 Not applicable $267.90
above $133,500 up to $160,000 above $267,000 up to $320,000 Not applicable $348.30
above $160,000 above $320,000 above $85,000 $428.60

 

Part B deductible & coinsurance

You pay $183 per year for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for these:

  • Most doctor services (including most doctor services while you’re a hospital inpatient)
  • Outpatient therapy
  • Durable medical equipment

Find out what Part B covers.

Find out what you pay for Part B covered services.

Costs for Part D Medicare drug coverage

You’ll make these payments throughout the year in a Medicare drug plan:

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan’s network
  • Whether the drugs you use are on your plan’s formulary
  • Whether you get Extra Help paying your Medicare Part D costs

Look for specific Medicare drug plan costs, and then call the plans you’re interested in to get more details.

If you have limited income and resources, your state may help you pay for Part A and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage. Call me today and I will help you find out if you are eligible.