Medicare

Medicare Part A - Your Hospital Insurance. You usually don't pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called premium-free Part A.

Medicare Part B - Your Medical Insurance (doctor, preventive and outpatient services). The standard Part B premium amount in 2018 is $134 (or higher depending on your income). However, most people who get Social Security benefits pay less than this amount. If you pay your Part B premium through your monthly Social Security benefit, you pay less ($130 on average). Social Security will tell you the exact amount of your Part B premium.

Medicare Part D - Your Prescription Drug Coverage. It's available to anyone eligible for Part A of 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 will Pay Annual Deductibles, Coinsurance and Copayments.
For complete details on Medicare, please download the Medicare & You Guide located at https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf

Part A Deductible - $1,340 for your hospital insurance - paid by you per admission
Part A Copayments (paid by you) for hospital expenses:

Part B Deductible for 2018 is $183 - paid by you. The Part B Coinsurance is 20% for medical expenses, after you pay the $183 annual deductible.


Medicare Supplement (Medigap) or a Medicare Advantage Plan

Medicare Supplement (aka Medigap) plans are designed to pay the deductibles, copayments and coinsurance of Medicare Parts A & B. The reason that you would purchase a separate Medicare Supplement policy is that, depending on the plan selected, it could pay all or part of the following:

  1. Part A deductible of $1,340
  2. Part B deductible of $183
  3. All of your Part A hospital copayments
  4. The 20% remainder (after the $183 deductible) of your Part B expenses
  5. Up to 365 more days for hospital stays after you use your Part A hospital benefits
  6. Part B excess charges by doctors who do not accept approved Medicare payments
  7. All costs of the first 3 pints of blood
  8. $167.50 per day for days 21 - 100 staying in a Skilled Nursing Facility
  9. Home Health Care - 20% of the remainder after the Part B $183 deductible
  10. Foreign Travel Emergencies

Medicare Supplement plans are STANDARDIZED. Every Medicare Supplement policy must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F through G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs.


Medicare Advantage (Part C)

Medicare Part C or Medicare Advantage plans are health plans offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, the plan provides all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Some Medicare Advantage Plans also include Part D drug coverage and may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs.

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).

Most Plans are structured as HMO's; however, there are also PPO's, private fee for services plans (PFFS), and several Special Needs Plans available.