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Lifting the Fog of Confusion Surrounding Medicare is as Easy as Learning Your A B D’s (C is in there, but we will deal with that later)

Medicare Part A – Your Hospital Insurance. It is free for everyone who is eligible for Medicare.

Medicare Part B – Your Medical Insurance (doctor, preventive and outpatient services).
There is a monthly premium for Part B. For 2021, the standard premium is $148.50. Your Part B premium may be higher based upon your modified adjusted gross income. Your premium is either withheld from your monthly social security payment or paid by you directly to Medicare.

Medicare Part D – Your Prescription Drug Coverage.
It is available to everyone on Medicare, but there is a separate monthly premium for this coverage paid directly to the insurance company providing the coverage. Your premium is withheld from your monthly social security check or paid by you directly to the insurance company.

As with All Insurance You Pay Annual Deductibles and Copayments

  • Part A Deductible – $1,484 for your hospital insurance – paid by you
  • Part A Copayments (paid by you) for hospital expenses
    • $1,484 for the first 60 days
    • $371 a day for the next 61 to 90 days
    • $743 a day for the next 91 to 150 days
    • After 150 days all costs (with no limit)
  • Part A Copayments for Skilled Nursing Facility Care
    • First 20 days zero, Medicare pays all approved amounts
    • $185.50 a day for the 21st through 100th day
    • You will pay all additional amounts after the 100th day
  • Part B Deductible is $203 – paid by you
  • Part B Copayment is 20% for medical expenses with no limit, after you pay the $203 annual deductible

Now Let’s Fill in the Gaps in Medicare with either a Medicare Supplement (Medigap) or a Medicare Advantage Plan

There are nine standardized Medigap plans designated by a letter (A through N) that work in tandem with original Medicare. These plans will pay some or all the Part A deductible, co-insurance and co-payments, and fill all or part of the 20% Part B gap. However, anyone turning 65 in 2021 or beyond will be required to pay the Part B deductible ($203 for 2021).

The optimal or top Medigap plan is Plan G or Plan G Extra. Plan G pays all Part A expenses, and the 20% Part B expenses (after payment of the Part B deductible). This means your total medical expenses in a calendar year will be $203.

All Medigap plans are the same by letter (i.e., Plan G) no matter where you reside or the insurance carrier offering the plan. There is only one variable – the monthly premium.

Medicare Advantage (Part C)

Medicare Part C or Medicare Advantage Plans are health plans offered by private insurance companies and approved by Medicare. They combine Part A hospitalization, Part B providers, and Part D prescription drug coverage into one plan. The most common Plans offered by carriers are HMO and PPO plans. All Plans have a maximum out of pocket medical cost.

Medicare Advantage Plans must follow rules set by Medicare. However, each Plan can charge different out-of-pocket costs and have different rules for how you get services (such as whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan). To be eligible to enroll in a Plan you must be enrolled in Medicare Part A and B, reside in the Plan’s service area, and continue to pay your Part B premium.

Both HMO and PPO plans have a network of providers that accept these plans; however, with a PPO Plan you may also go to any provider that accepts Medicare but you may pay a higher amount for your medical services.

 

These videos are for educational purposes. We represent many of the top carriers available. We will review your unique situation and be able to offer you a variety of carrier products and plans to choose from.

 

Understanding Medicare Enrollment Periods
Deciding to Sign Up for Medicare Part B
Medicare & You: Traveling Abroad
Medicare Supplemental Insurance (Medigap) for People Under Age 65

 

Medicare.gov Resource Links