Medicare has Become a staple in our society and has allowed for older generations to age gracefully. Many people know "ABOUT" Medicare, but few truly "KNOW" Medicare. We pride ourselves in "KNOWING" Medicare.
In a nutshell, Medicare is divided into 4 parts; A, B, C & D
Medicare Part A is Hospital Coverage. It covers hospitalization with a one-time deductible for the first 60 days of confinement. If you are hospitalized for more than 60 days, there is a daily copay for days 61-90 and a separate daily copay for any days from day 91 on. These days past the 90th day in any year are referred to as Lifetime Reserve Days and you are allotted 60 of them for your whole life.
Part A also covers Skilled Nursing Facilities and Hospice Care. It is important to note that Part A only covers room and board in the hospital. All medical diagnosing and treatments are under Part B.
Medicare Part B is Medical Coverage. If you have approved medical needs under Part B, you will be responsible for a modest copay and 20% of the Medicare Allowable cost of the service. While this is not bad for a $200 doctor's office visit, 20% can add up quickly for diagnostics, procedures and physician fees. This 20% responsibility is the scariest number in all of Medicare because it has to cap.
Whereas Part A is usually at no cost due to paying into Medicare through payroll taxes for at least 40 quarters (or having a spouse who did so), Part B comes with a premium. You do not have to enroll in Part B, however, if you do not have "creditable coverage" through an employer or union, you will be penalized for the time when you were eligible but did not have it. These penalties can be steep and last for the duration of your life.
Medicare Part D is the prescription drug component of Medicare. These plans cost a monthly premium and are designed to help defray the cost of drugs. Since we do not know when we will be prescribed an expensive drug, this coverage can be very valuable. Just like Part B, you are subject to a penalty if you are eligible for a drug plan but do not enroll in one when you have the chance. This is also subject to the "Creditable Coverage" like Part B, and these penalties last for the rest of your life.
You might have noticed that I left out Part C. Actually, it is easier to discuss this part after all of the other parts are on the table. Part C is known as Medicare Advantage and it is a program where you get your Medicare benefits (Parts A, B and usually D) through a private company. The benefit structures are very different from Original Medicare and usually consist of copays for doctor visits and hospital stays and such. Most of these plans also incorporate a Prescription Drug plan in them as well. They are usually network based and cost little more, if any, than original Medicare premiums. They also are mandated to have an out-of-pocket maximum unlike Original Medicare.
Medicare Supplement Insurance is another piece to be aware of. Since many people like the flexibility of Original Medicare (No Networks, No Prior Authoriations), Medicare Supplements are designed to do exactly what they are named - they supplement original Medicare. Here are several different types, but they all cover most of the potential costs that are left over by Original Medicare. These plans are available with no health underwriting within the first 6 months of becoming eligible for Part B. They do come with a premium attached to them and they typically increase in cost every year. They are a solid alternative for many people, especially younger Medicare beneficiaries due to the guaranteed issue nature of these plans.
The biggest takeaway about Medicare is that it can be very confusing. That is why it is imperative to have a local, personal agent that can help you make the right decision for your needs. If you do not have an agent that you can depend on during the time of life when you need them most, reach out to us and let us earn your business.
