Medicare is a government funded and run health insurance program for eligible individuals. To be eligible you must be: 65+ years old; have collected SSDI more than 24 months; or have been diagnosed with end stage renal disease (ESRD) or ALS. There are currently about 62 million Americans enrolled in Medicare.
Part A: Hospital Insurance. Includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
Part B: Medical Insurance. Includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare-approved private insurance company. Make sure to select a plan that covers your health care providers.
Part D: Prescription Drug Coverage. You have different plans to choose from depending on where you live, with different premiums and formularies. Make sure to select a plan that covers the drugs you take.
If Your Yearly Income in 2021 (for what you pay in 2023) was:
|File Individual Tax Return||File Joint Tax Return||File Married & Separate Tax Return||You Pay in 2023|
|$97,000 or less||$194,000 or less||$97,000 or less||$164.90|
|above $97,000 up to $123,000||above $194,000 up to $246,000||Not applicable||$230.80|
|above $123,000 up to $153,000||above $246,000 up to $306,000||Not applicable||$329.70|
|above $153,000 up to $183,000||above $306,000 up to $366,000||Not applicable||$428.60|
|above $183,000 and less than $500,000||above $366,000 and less than $750,000||above $97,000 and less than $403,000||$527.50|
|$500,000 or above||$750,000 and above||$403,000 and above||$560.50|
|Prescription Drug Expenses||You Pay||Medicare Pays|
|$505-$7,400 (total out-of-pocket costs)||25% brand name and generic||75% brand name and generic|
|$7,400+||greater of 5% or $4.15 for generic; $10.35 for brand name||95%|
A Medigap plan is a supplemental insurance plan that will help pay for your deductibles, co-payments, and cost share amounts. Plans are labeled as A through N, and each plan with the same letter must offer the same basic benefits. The premiums and deductibles vary with each plan. If you have chosen original Medicare (Parts A & B), there is a 20% cost share amount, so a Medigap plan can help pay for that expense.
Most people are automatically enrolled in Medicare Parts A and B when they become eligible. In some cases, you may need to sign up for Medicare during a 7-month initial enrollment period, which begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you didn’t sign up during your Initial Enrollment period, there is a General Enrollment period that runs from January 1 to March 31, but your coverage will not begin until the month after you enroll, and you may face late enrollment penalties. You can also make changes to your coverage every year during an Open Enrollment period that runs from October 15 to December 7.
|Open Enrollment||10/15 to 12/7||January 1|
|General Enrollment A/B||1/1 to 3/31||Month after you enroll|
|General Enrollment C/D||4/1 to 6/30||July 1|
Medicare beneficiaries are now entitled to a free annual wellness visit, free preventive care, and lower costs for prescription drugs.
Medicare does NOT cover some services (e.g., long-term care, most dental care, eye exams related to prescription glasses, dentures, cosmetic surgery, acupuncture, hearing aids, and routine foot care. These services may be covered by a Medicare Advantage (Part C) plan.
Last updated: 11/22
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