UNDERSTANDING MEDICARE
WHAT IS MEDICARE?
If you are approaching or recently turned 65, you may be wondering what medicare is and what your options are. Medicare is a federal health insurance program that covers a variety of medical expenses, where the beneficiaries are typically 65 years and older.
The good news is you can choose the type of medicare coverage that best suits your needs! You can choose between Original Medicare, Medicare Advantage & Prescription Drug Plans and Medicare Supplement Plans or MediGap.
ORIGINAL MEDICARE (PART A AND B)
Medicare Part A (Hospital Insurance) Costs
Part A Monthly Premium
Most people don’t pay a Part A premium because they paid Medicare taxes while
working. If you don’t get premium-free Part A, you pay up to $458 each month.
Hospital Stay
In 2020, you pay
■ $1,408 deductible per benefit period
■ $0 for the first 60 days of each benefit period
■ $352 per day for days 61–90 of each benefit period
■ $704 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
Skilled Nursing Facility Stay
In 2020, you pay
■ $0 for the first 20 days of each benefit period
■ $176 per day for days 21–100 of each benefit period
■ All costs for each day after day 100 of the benefit period
ATTENTION: YOU NEED TO BE CLASSIFIED AS AN “IN-PATIENT” TO QUALIFY!
You need to meet the 3-day inpatient hospital stay requirement before you can qualify for skilled nursing facility coverage. If you are coded “Observation Status,” you will be considered an outpatient and not qualify even if you stay in the hospital for 3 days.
Just another reason why it is important to receive our guidance during your coverage, so you can avoid unforeseen costs and problems!
Remember, since we are an insurance broker, you also get more choices and priceless expert guidance, at no additional cost to your coverage!
Medicare Part B (Medical Insurance) Costs
Part B Monthly Premium
The standard Part B premium amount in 2020 is $144.60 or higher depending on your
income. Social Security will tell you the exact amount you’ll pay for Part B in 2020.
You pay the standard premium amount (or higher) if:
■ You enroll in Part B for the first time in 2020.
■ You don’t get Social Security benefits.
■ You’re directly billed for your Part B premiums.
■ You have Medicare and Medicaid, and Medicaid pays your premiums.
(Your state will pay the standard premium amount of $144.60 in 2020.)
■ Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.
If you’re in 1 of these 5 groups, here’s what you’ll pay:
| If your yearly income in 2018 was | You pay (in 2020) | ||
| File individual tax return | File joint tax return | File married & separate tax return | |
| $87,000 or less | $174,000 or less | $87,000 or less | $144.60 |
| above $87,000 up to $109,000 | above $174,000 up to $218,000 | not applicable | $202.40 |
| above $109,000 up to $136,000 | above $218,000 up to $272,000 | not applicable | $289.20 |
| above $136,000 up to $163,000 | above $272,000 up to $326,000 | not applicable | $376.00 |
| above $163,000 and less than $500,000 | above $326,000 and less than $750,000 | above $87,000 and less than $413,000 | $462.70 |
| $500,000 or above | $750,000 and above | $413,000 and above | $491.60 |
The information in this chart can be found at Medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. If you have questions about your Part B premium, call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. If you pay a late enrollment penalty, these amounts may be higher.
Part B Deductible—$198 per year
Some people are perfectly happy with the coverage they obtain from Original Medicare Part A & B, however most people choose a Part D or Prescription Drug plan (comes with Most Medicare Advantage Plans, but not all) to help cover prescription drug costs.
WHAT IS NOT COVERED BY MEDICARE PART A AND B?
It is important to also factor in the coinsurance, copayments and deductible payments that need to be paid with these plans. In addition to this, Medicare doesn’t cover everything, which may include services that are important to your lifestyle. They include:
1) Care outside the United States
2) Nursing home expenses
3) Long-term or custodial care
4) Most types of dental care
5) Eye Examinations related to prescription glasses
6) Dentures
7) Cosmetic surgery
8) Acupuncture
9) Hearing aids and exams for fitting them
10) Routine foot care
*Please note that there may be some other medical services that may not be covered that isn’t included in this list
If you want to get coverage on additional medical services, fill those gaps not covered by Medicare as listed above or want to reduce your overall out of pocket costs, it may be prudent to learn more about Medicare Supplement Insurance and Medicare Advantage Plans to determine the most suitable plan for your needs.
Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) Premiums
Visit Medicare.gov/find-a-plan to get plan premiums. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. You can also call the plan or your State Health Insurance Assistance Program (SHIP). To get the most up-to-date SHIP phone numbers, visit shiptacenter.org or call 1-800-MEDICARE.
Part D Monthly Premium
The chart below shows your estimated prescription drug plan monthly premium based on your income. If your income is above a certain limit, you will pay an income-related monthly adjustment amount in addition to your plan premium. The information in the chart above can be found at Medicare.gov/your-medicare-costs/medicare-costs-at-a-glance.
| If your yearly income in 2018 was | You pay (in 2020) | ||
| File individual tax return | File joint tax return | File married & separate tax return | |
| $87,000 or less | $174,000 or less | $87,000 or less | Your plan premium |
| above $87,000 up to $109,000 | above $174,000 up to $218,000 | not applicable | $12.20 + your plan premium |
| above $109,000 up to $136,000 | above $218,000 up to $272,000 | not applicable | $31.50 + your plan premium |
| above $136,000 up to $163,000 | above $272,000 up to $326,000 | not applicable | $50.70 + your plan premium |
| above $163,000 and less than $500,000 | above $326,000 and less than $750,000 | above $87,000 and less than $413,000 | $70.00 + your plan premium |
| $500,000 or above | $750,000 and above | $413,000 and above | $76.40 + your plan premium |
2020 Part D National Base Beneficiary Premium—$32.74
This figure is used to estimate the Part D late enrollment penalty and the income-related monthly adjustment amounts listed in the table above. The national base beneficiary premium amount can change each year. See your Medicare & You handbook or visit Medicare.gov for more information.
For more information about Medicare costs, visit Medicare.gov.