On this page we will define Medicare, discuss eligibility and enrollment periods then look at Parts A and B in a little more detail including coverage, choices and costs.
Medicare is a federal health insurance program for people 65 and older and others with disabilities.
• Medicare Parts A and B are considered Original Medicare.
• Part A pays for hospital care and Part B pays for doctor visits and other outpatient care.
Original Medicare does not cover everything.
While original Medicare helps you get basic health care coverage, you are expected to pay some of the costs. There are several options to cover these costs through a standardized Medicare Supplement to which you can add a stand-alone Medicare Part D prescription plan. Or you can enroll in a Medicare Part C Advantage Plan that may include prescription drug coverage.
Some of the elements original Medicare (Parts A and B) does not cover are: vision, hearing, dental, prescription drugs.
When are you eligible?
You are eligible to enroll in Medicare at age 65 or if you are younger and have been disabled for 24 months. Your Initial Election Period (IEP) runs three months before your 65th birthday month, the month of your 65th birthday, and three months after your 65th birthday month. During this time, you can enroll in a Medicare advantage plan with or without prescription drug coverage or a stand-alone part D prescription plan. If you are enrolling in a Medicare supplement you have an additional two months to enroll. If you wait longer than these initial enrollment dates you may have to pay more and or go through an underwriting process.
Your plan choices are not permanent.
The choices you make during your Initial Election Period (IEP) do not lock you in permanently. Over time, as your health care coverage needs change you may change coverage. Medicare supplements can be changed any time of year. For Medicare Advantage Plans and Part D Prescription Drug Plans (PDPs) you will have an opportunity each year during the fall Annual Enrollment Period (AEP) to make changes to these plans. Remember there may be restrictions to rejoining an employer-sponsored Medicare Companion plan.
Medicare Part A (hospital coverage).
Medicare Part A helps to cover the cost of inpatient hospital stays and skilled nursing facility visits after a hospital stay as well as hospice care and home healthcare visits for the homebound. You may use any facility in the United States that accepts Medicare.
Deductibles and coinsurance.
The Part A inpatient hospital coverage for 2019 has a $1,364 deductible. If you are in the hospital longer than 60 days consecutively there is a copayment for days 61 through 90 of $341 per day. For days 91 through 150 that copayment doubles to $682 per day. The skilled nursing facility coverage pays the full cost of your inpatient visit for days one through 20. Beyond that, days 21 through 100 you are responsible for a $170.50 per day copayment. After 100 days the skilled nursing facility care benefits stops. The hospice care and home healthcare visits for the homebound do not require a copayment on your part provided you use a Medicare approved agency or facility.
If you made payroll contributions to Medicare for 40 quarters or 10 years you will not pay a premium for Part A. If you did not make those contributions you will be charged a premium.
Medicare Part B (doctor visits).
Medicare Part B helps to cover the cost of medical expenses including doctor visits, lab tests, x-rays, radiology and surgery etc. generally you can see any doctor who accepts Medicare and is accepting patients. There are some coverage limits for example physical therapy is limited to a specific dollar amount annually. Remember that Part B will only cover vision services under certain circumstances for example, glaucoma, cataracts or macular degeneration.
Deductibles and coinsurance.
Medicare Part B has a calendar year deductible, starting at $185. Once you meet that deductible Medicare will pay 80% of the Medicare approved amount and you are responsible for 20%. It is important to remember that that 20% has no out-of-pocket maximum. You are also responsible for Part B excess charges, if the doctor does not accept the Medicare approved amount as full payment, they can charge more. However, they may only charge 15% more than the Medicare approved amount.
In most cases, for people new to Medicare, the premium for Medicare part B is $135.50 per month which will be deducted from your Social Security check. If you are not collecting Social Security you will be billed quarterly for that premium. For those with higher incomes the premium for part B can be more.