Here to help you solve the Medicare puzzle
Medicare Part A provides coverage on inpatient and some other services. In general, Part A covers: Hospital care, Skilled nursing facility care, Nursing home care (as long as custodial care isn’t the only care you need), Hospice, Home health services.
You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.”
Medicare Part B provides coverage on many outpatient services. Part B covers things like: Doctor and Specialist visits, Diagnostic Testing, Ambulance Services, Durable Medical Equipment (DME), Mental Health, Outpatient surgery, Chemotherapy and Infusion Therapy.
You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
Medicare Supplement Insurance coordinates with “Original Medicare Insurance.” This insurance helps to pay the deductibles, copays and coinsurance of Medicare A and B. Medicare Supplement Insurance plans do not have any doctor networks- as long as your doctor accepts Medicare A and B, they will accept your Medicare Supplement insurance. When you enroll in Medicare Part-B, you are in the Open Enrollment Period—no medical questions. If you retire past age 65, you may be in a Guaranteed Issue Period—no medical questions. Your Medicare Supplement benefits remain the same each year (only federal government can change benefits). You can change your Medicare Supplement anytime –but may be subject to medical underwriting.
Medicare Part C (Medicare Advantage) is an option instead of using “Original Medicare Insurance” and a Medicare Supplement; however, you are still required to pay your Part B Premium and any IRMAA charges. Medicare Advantage Plans are managed care plans that have participating doctor networks. Typical examples of Medicare Advantage plans are HMOs, PPOs and Private Fee For Service Plans. Medicare Part-C has a lock-in period, and can only be changed at your Annual Enrollment Period. Plans should be reviewed annually during the Annual Enrollment Period (Oct 15th-Dec 7th) as plan benefits change annually every January 1st.
Medicare Part D Prescription Drug Plans that can help cover some of your Rx costs. Initially, choose a Rx plan that fits your medication list. You should enroll during your Open Enrollment Period or Special Election Period to avoid penalty. Plans should be reviewed annually during the Annual Enrollment Period (Oct 15th-Dec 7th), as plan benefits change every January 1st.