Medicare is structured similarly to any health insurance plan in that it has deductibles and coinsurance amounts, or copayments, which are the patient’s responsibility at the point of service. Because many on Medicare are also on fixed incomes, supplemental insurance is a popular way to limit out-of-pocket costs to more predictable amounts that the patient can manage more easily. There are 10 Medicare supplement plans available on the market today. These health plans are also sometimes called Medigap insurance, because they fill in some of the gaps in original Medicare.
Medicare Part A is inpatient hospital insurance. It helps pay for medically necessary inpatient hospital stays. Part A also helps pay for some home health care and hospice care.
Inpatient hospital care is subject to a $1,340 deductible for each 60 day benefit period. If you are still in the hospital after 60 days, you will be required to pay a daily copayment between $335 and $670 until the 150th day when your hospital coverage ends.
A Medigap policy will pick up and pay an additional 365 days after Medicare runs out.
In general, Medicare Part A pays:
Medicare Part B is called Medical on your card, but what it really means is outpatient insurance. It helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition. It also covers preventive services.
Medicare Part B covers 80% of covered costs after you meet the deductible ($183 for 2018), and you would pay the other 20%, but a Medigap policy will cover the 20% for you.
You should sign up when you’re first eligible, unless you have other coverage to pay the 80% such as an employer group plan. If you don’t, your monthly premium may be higher when you do sign up, and you will have to wait until the yearly general enrollment period.
Yes, you need to pay the Part B premium each month. The amount you pay can change each year and may be different depending on your income. Your Part B premium may come out of your Social Security benefits, or you may get a monthly bill. The standard monthly premium in 2018 is $134, but can be as high as $428 per month for high income individuals.
Medicare Part D is prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare.
You are eligible for Part D when you first become eligible for Part A. You can avoid late enrollment penalties by joining a Part D plan when you first become eligible. If you have had other credible coverage you are not subject to a penalty. Group insurance or Veterans benefits are examples of credible coverage. If you lose your credible coverage, you have 60 days to enroll in a plan.
Yes. Premiums vary depending upon the plan option you choose. Generally they are under $30 per month and in some cases under $20 per month. The plan you chose depends on your prescriptions.
To learn more about your options, call us at 229.249.7014
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