Medicare is the U.S. federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Medicare Part B (Medical Insurance) helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and many preventive services.
Medicare Parts A and B don't cover everything. If you need services Part A or Part B doesn't cover, you'll have to pay for them yourself unless you have other coverage (including Medicaid) to cover the costs, or you're in a Medicare Advantage Plan or Medigap Plan that covers these services.
Some of the items and services Medicare doesn't cover include Long-Term Care (also called custodial care), most dental care, eye exams (for prescription glasses), dentures, and hearing aids.
Medicare Part D (Drug coverage) helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare Part D drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage.
Medicare Supplemental Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan N. The benefits in each lettered plan are the same, no matter which insurance company sells it.
When you first sign up for Medicare, you can choose which way to get your Medicare coverage. There are two main ways: Original Medicare with a Medigap plan and Medicare Advantage.
Original Medicare includes Part A and Part B. You can use any doctor or hospital that takes Medicare, anywhere in the U.S. To help pay your out-ofpocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), Medicare Advantage (also known as Part C), or have coverage from a former employer or union, or Medicaid.
Medicare Advantage is an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. In most cases, you’ll need to use doctors who are in the plan’s network. Plans may offer some extra benefits that Original Medicare with a Medigap doesn’t cover — like vision, hearing, and dental services.
In 2023, the Part A (Hospital Insurance) premium is $0 for most people (because they paid Medicare taxes long enough while working - generally at least 10 years). If you don’t qualify for a premium-free Part A, you might be able to buy it. In 2023, the premium is either $278 or $506 each month, depending on how long you or your spouse worked and paid Medicare taxes. You also have to sign up for Part B to buy Part A. If you don’t buy Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty.
The Part A deductible in 2023 is $1,600 for each time you’re admitted to the hospital per benefit period, before Original Medicare starts to pay. There's no limit to the number of benefit periods you can have.
The Part B premium in 2023 is $164.90 each month (or higher, depending on your income). The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services.
You might pay a penalty if you don’t sign up for Part B when you’re first eligible for Medicare (usually when you turn 65). Generally, you won’t have to pay a penalty if you qualify for a Special Enrollment Period. To qualify, you (or your spouse) must still be working and you must have health coverage based on that job.
In 2023, you’ll pay the $226 Part B deductible before Original Medicare starts to pay. You pay this deductible once each year. If you do not have a Medigap or Medicare Advantage, you’ll usually pay 20% of the cost for each Medicarecovered service or item after you’ve paid your deductible.
Don’t take advice from your best friend’s uncle’s barber’s daughter, unless she is a licensed and certified Medicare insurance agent. It pays to have a trusted, educated advisor when it comes to making your Medicare insurance selections. We represent several carriers, so we will help find the best plan for your specific needs.
Please give me a call at (8060 607-6307 so we can set up a time to visit about your situation. You can also find more information at www.medicare. gov.
Carrie Blair is a Medicare consultant based in Dickens and Motley Counties, in West Texas.
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