Part A covers Hospitalization. This includes inpatient hospitalizations, skilled nursing, home health care and hospice care. If you, or your spouse, have worked 40 quarters in your lifetime, Part A is no cost to you. If you do not meet these requirements, you may purchase Part A. For 2017, the deducible for Part A is $1,316 per 60-day benefit period.
Part B covers Medical. This includes doctor visits, screenings, lab work, x-rays, outpatient services, etc. Unlike Part A, Part B has a monthly premium. The standard premium in 2017 for most Americans is $134/month and is taken directly out of your Social Security check. If your income is greater than $85,000 as an individual or $170,000 as a couple your premium could be more than the standard rate. The annual deductible for Part B is $183 for 2017. After the deductible has been met, Medicare will pay 80% of your Part B charges and you will be responsible for the remaining 20%. If you do not enroll into Part B when you are first eligible, you may be assessed a Late Enrollment Penalty.
Part C or Medicare Advantage plans are offered through independent insurance companies that contract with Medicare, which becomes the primary provider for your health insurance payments. These plans combine Part A & Part B coverage, as well as offering additional benefits such as: hearing, vision, dental & fitness memberships. They may also include coverage for Part D Prescription Drugs. These plans have low premiums and deductibles along with Co-Pays and Co-Insurance. To be enrolled into a Medicare Advantage Plan, you must: be enrolled in Original Medicare Part A & B and reside in the plan’s service area (Networks). Also, you cannot be diagnosed with End Stage Renal Disease.
Part D is Prescription Drug Coverage offered through independent insurance companies. Part D Prescription Drug plans differ between insurance companies and are required to be the same or better than Medicare Guidelines.For 2017, the Part D Prescription Drug Guidelines are:
If not enrolled into a Part D Prescription Drug Plan or have other creditable drug coverage when first eligible, you may have a Late Enrollment Penalty.
Medicare Supplements aka “MediGap” plans are offered by independent insurance companies and help cover some of the costs that Original Medicare does not.
Late Enrollment Penalty
Plan B For every 12 months you go without Part B or other credible coverage (employer or union plan) you will be charged a 10% penalty. You may not be able to enroll into Part B until the Medicare Open Enrollment Period which runs January 1st – March 31st every year and will become effective July 1st
Plan D A penalty assessed if you do not go onto a Part D Drug Plan when you first become eligible. You will be charged 1% of the national average of a Part D plan for each month you do not have credible coverage.
HMO: Health Maintenance Organization
PPO: Preferred Provider Organization
PFFS: Private Fee For Service
MSA: Medical Savings Account
Initial Enrollment Period: 7 Months total, 3 months before, the month of, and 3 months after your Part B effective date Open Enrollment Period: October 15th – December 7th yearly
Medicare Advantage Disenrollment Period: January 1st – February 15th
Special Enrollment Periods: Happen throughout the year (loss of employer coverage, move out of the plans service area, receive assistance from the state, etc)
(True Out of Pocket Costs)
TROOP = Deductibles + Copays + Co-insurance + Drug Company payments
Open Enrollment for Medicare Supplements is the month Part B becomes effective and the 5 months that follow.
Guarantee Issue Period