Medicare explained – for you
What is Medicare?
Medicare is the federal health insurance program for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Learn more about other common health insurance terms in our Ultimate Health Insurance Terms Guide.
What are the different parts of Medicare?
- Part A (Hospital Insurance) helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
- Part B (Medical Insurance) helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment) and Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits).
- Part C (Medicare Advantage) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage.
- These “bundled” plans include Part A, Part B, and usually Part D.
- In most cases, you’ll need to use doctors who are in the plan’s network.
- Plans may have lower out-of-pocket costs than Original Medicare.
- Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
- Part D (Drug coverage) helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
- Medicare Supplemental Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. It can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. However, it’s important to note that Medigap, otherwise known as med supp, doesn’t cover everything. Medigap policies generally don’t cover long-term care, vision or dental services, hearing aids, eyeglasses, and private-duty nursing.
Enroll in Medicare
For most people, the first time you are eligible to enroll in Medicare is three months before you turn 65 and ends three months after the month you turn 65. When you first sign up for Medicare and during certain times of the year, like Open Enrollment or a special enrollment period, you will choose which combination of coverage options you want.
For example, Original Medicare includes Part A and Part B. You can also join a separate Medicare drug plan to get Medicare drug coverage (Part D). This plan allows you to use any doctor or hospital that takes Medicare, anywhere in the U.S.
To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.
How much does Original Medicare cost?
Generally, you pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.
Most people don’t get a premium bill from Medicare because they get their Medicare Part B (Medical Insurance) premium deducted automatically from their Social Security benefit payment (or Railroad Retirement Board benefit payment).
Costs for Original Medicare Part A (Hospital Insurance)
Most people will end up paying $0 for their premium because they paid Medicare taxes long enough while working – generally at least 10 years). This is sometimes called “premium-free Part A.” However, if you don’t qualify for a premium-free Part A, you might be able to buy it.
In 2022, the premium was either $274 or $499 each month, depending on how long you or your spouse worked and paid Medicare taxes. You also have to sign up for Part B to buy Part A. But, if you don’t buy Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty.
You had to pay $1,556 as a deductible each time you were admitted to the hospital per benefit period, before Original Medicare starts to pay. There’s no limit to the number of benefit periods you can have.
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Costs for Original Medicare Part B (Medical Insurance)
Previously, the premium was $170.10 each month (or higher depending on your income) and the deductible was $233, which you have to pay once each year before Original Medicare starts to pay. Again, these amounts can change each year.
When it comes to costs for services, coinsurance, you’ll usually pay 20% of the cost for each Medicare-covered service or item after you’ve paid your deductible.
Costs for Part C: Medicare Advantage
Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:
- Whether the plan charges a monthly premium. Many Medicare Advantage Plans have a $0 premium. If you enroll in a plan that does charge a premium, you pay this in addition to the Part B premium (and the Part A premium if you don’t have premium-free Part A).
- Whether the plan pays any of your monthly. Medicare Part B (Medical Insurance) premium. Although not available in all areas, some plans will help pay all or part of your Part B premium. This is sometimes called a “Medicare Part B premium reduction.”
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
- The type of health care services you need and how often you get them. Whether you go to a doctor or supplier who accepts assignment if you’re in a PPO, PFFS, or MSA plan; or, you go out-of-network.
- Whether you follow the plan’s rules, like using network providers.
- Whether you need extra benefits and if the plan charges for it.
- The plan’s yearly limit on your out-of-pocket costs for all medical services.
- Whether you have Medicaid or get help from your state.
Costs for Medicare Drug coverage (Part D)
Monthly premiums vary based on which plan you join. The amount can change each year. You may also have to pay an extra amount each month based on your income.
Most plans charge a deductible, an amount you pay before the plan starts to pay, for prescriptions you fill. The deductible amount varies based on which plan you join. Your actual costs vary depending on the medicines you take, if they are on your plan’s list of covered drugs, and which pharmacy you use.
There is also assistance available for people with limited income and resources to help pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. In 2022, prescription costs were no more than $3.95 for each generic/$9.85 for each brand-name covered drug for those enrolled in the Extra Help program.
Costs for Medicare Supplement Insurance (Medigap)
Monthly premiums vary based on which policy you buy, where you live, and other factors. The amount can change each year.
You must keep paying your Part B premium to keep your supplement insurance. Helps lower your share of costs for Part A and Part B services in Original Medicare. Some Medigap policies include extra benefits to lower your costs, like coverage when you travel out of the country.
Medicare Open Enrollment 2023
The annual open enrollment period runs from October 15 – December 7 each year. During this time, you can join, drop, or switch to another plan. You can also add or drop drug coverage during this time.
If you enroll during this time, coverage will begin on January 1 of the next year.
Note: Extra time to sign up for Medicare is available for anyone who wasn’t able to contact the Social Security Administration because of problems with Social Security’s telephone system between January 1, 2022 – December 30, 2022.
Do you have to enroll in Medicare every year?
For the most part, no. As long as you pay your premiums (if applicable) on time, then your plan will automatically renew each year. However, changes in your income or circumstances may warrant you to revaluate your plan selections.
Medicare Advantage Open Enrollment 2023
The annual open enrollment period (if you’re already in a Medicare Advantage Plan) runs from January 1 – March 31 each year. During this time, you can switch to another Medicare Advantage Plan with or without drug coverage, drop your Medicare Advantage Plan and go back to Original Medicare, or join a Medicare drug plan.
If you enroll during this time, coverage will begin the first of the month after the plan gets your request.
Do you have to enroll in Medicare Advantage every year?
For the most part, no. If you pay your premiums on time, then your plan should automatically renew each year. However, you are doing yourself a disservice if you don’t shop your options every year to see if there is a better plan out there. Since Medicare Advantage plans are administered by private companies (but regulated by the federal government) there could be changes in prices and benefits from year to year.
What is medicare supplement open enrollment?
Medicare supplement open enrollment is when you can enroll in a Medigap plan. While there is no limited timeframe, the best time to buy a Medigap policy is the 6-month enrollment period that starts as soon as you become eligible to enroll. This begins the first day of the month you’re 65 or older AND enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.
After this enrollment period, your option to buy a Medigap policy may be limited, and it may cost more. Some states have additional open enrollment periods.
Medicare and Medicare Advantage through Woligo
Woligo has a dedicated team of Medicare specialists who are product trained and AHIP-Certified (a Medicare sales requirement). Call us now at 888-633-5229 or get a no obligation quote by clicking here. They will take the time to talk to you, provide a comprehensive comparison of plan choices and answer any questions or concerns you may have.