Medicare Information

When you are approaching your Medicare start date, Part A will automatically start on the 1st of the month your eligibility begins. Generally speaking, your Part B will start the 1st of the same month.

There are scenarios where you have the option of delaying Part B, perhaps you are still working and have employer coverage, or your spouse has employer coverage for you. Not all employer coverage can take the place of Part B, or sometimes it turns out it is beneficial to take Medicare Part B over your employer coverage.

I advise you to call your benefits coordinator with your employer for further explanation on your options, or feel free to contact myself and I’ll let you know what questions you need to ask.

Part A (Hospital)
Includes coverage at Inpatient Hospital, Inpatient Psychiatric Hospital, Skilled Nursing Facility, Home Health Care, and Hospice.
Financial Obligations – $1,316.00 deductible, along with additional copays depending on your stay.

Part B (Medical)
Includes a monthly premium that can vary depending on when you enrolled in Part B, or if adjusted for those earning a higher income. Some beneficiaries have Medicaid benefits, along with their Medicare coverage, that can help cover the cost of the Part B premium, and possibly all copays and coinsurance depending on the level you qualify for.

Financial Obligations – $134.00 monthly premium, $183.00 annual deductible, plus 20% coinsurance on all services not considered Part A, or related to drug coverage.

Part C (Medicare Advantage)
May or may not have monthly premiums. Financial obligations are copays when services are received.

Part D (Prescription Drug Coverage)
Monthly premium in addition to possible deductibles and copays for prescriptions.

Original Medicare + Medicare Part D Prescription Drug Plan
Go to any provider that accepts Medicare.
Subject to deductibles, copays and coinsurance.
No Maximum Out of Pocket on expenses.

Medigap (Medicare Supplement Insurance Plans) + Medicare Part D Prescription Drug Plans
Depending on the plan, it is a policy with a monthly premium that can cover all or some of the deductibles, copays, and coinsurance. Still allows you to visit any provider that accepts Original Medicare. They do not include drug coverage. A person would typically enroll in a Part D Prescription Drug Plan for drug coverage to go along with their Supplement, which would be an additional monthly premium. Open Enrollment for a Medigap policy is the first six months your Medicare has become effective. Companies vary on how early you can get your policy. If you miss your Open Enrollment, you could be subject to underwriting to get the policy.

Medicare Advantage with/without Drug Coverage (Part C)
These are plans provided by private companies that receive payments from Medicare to care for your health care needs. HMO’s and PPO’s are available, so some require in-network doctors and possibly referrals. Depending on the plan, extra benefits such as dental, vision, transportation, over-the-counter drug allowance, health club memberships and hearing aid allowance may be offered. All Medicare Advantage plans must have Maximum Out of Pocket. Keep in mind, you must continue to pay your Part B premium while enrolled in a Medicare Advantage plan. You are allowed to change your Medicare Advantage plan on a yearly basis during the Annual Enrollment Period, October 15th – December 7th for a January 1 start date. These plans are available based on the county in which you reside. The Initial Enrollment Period for this type of coverage is a 7 month window, the month your Medicare becomes effective along with the 3 months before/after it began. This enrollment period applies to Prescription Drug Coverage as well.