Medicare is a health insurance program for:

• people age 65 or older
• people under age 65 with certain disabilities
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Part A Hospital Insurance 

Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance 

Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage 

Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Medicare Advantage Plans, sometimes called Part C, are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

 

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2023, the standard Part B premium amount is $164.90 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.

When can I enroll?

 

Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.

 

• For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
• If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
• You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.

This information obtained from  www.medicare.gov

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles.

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

What you need to know about Medicare Supplement policies

1. You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
3. You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
5. You can buy a Medicare Supplement insurance policy from any insurance company that’s licensed in your state to sell one.
6. Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy as long as you pay the premium.
7. Medicare Supplement insurance policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a  Medicare Prescription Drug Plan (Part D).
8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.

 

It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.

Let us help you with your enrollment

If you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.

Making Part D work

In 2023, you are facing higher out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending threshold will increase by $350, from $7,050 to $7,400 in 2023.

You will also face higher out-of-pocket costs in 2022 for the deductible and in the initial coverage phase before reaching the catastrophic coverage. The standard deductible is increasing from $480 in 2022 to $505 in 2023, while the initial coverage limit is increasing from $4,430 in 2022 to $4,660 in 2023.

For costs in the coverage gap phase, beneficiaries will pay 25% for both brand-name and generic drugs. Manufacturers provide a 70% discount on brands and plans pay the remaining 5% of costs for brand name drugs. Plans pay the remaining 75% of generic drug costs. For total drug costs above the catastrophic threshold, Medicare pays 80%, plans pay 15%, and enrollees pay either 5% of total drug costs or $4.15/$10.35 for each generic and brand-name drug, respectively.

 

Choosing a plan

It pays to review your Part D coverage every year, especially if you have started taking new drugs.

 

• Start at  Medicare.gov, where you can find the basics about the benefit and Part D plans. There’s a link to the  Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year

Call us to help you understand your options.

Getting financial help

Individuals with annual incomes of less than $20,385 and financial resources of up to $15,510, or married couples with incomes of less than $27,465, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

• You have received Social Security or Railroad Retirement
• Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your 

Part A and Part B benefits.

Medicare Advantage Plans include the following:

Health Maintenance Organization (HMO) Plan

In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan’s list except in an emergency. You may also need to get a referral from your primary care doctor to see other doctors or specialists.  Find and compare HMO Plans in your area.

 

Preferred Provider Organization (PPO) Plans

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) Plans

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Medicare Special Needs (SNP) Plans

Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.  Find out who can join a Medicare SNP

These definitions are directly from  www.medicare.gov

Medicare Supplement policies (also known as Medigap policies) are standardized and must follow federal and state laws designed to protect you. Insurance companies can only sell you a “standardized” policy identified in most states by letters (see the chart below).

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. As you can see in the comparison chart there are many options from which to choose. As licensed insurance agents we can help you understand the differences between the plans so that you can decide on the right plan for you. 

In  Massachusetts,  Minnesota, and  Wisconsin, Medigap policies are standardized in a different way.

Did you know that each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer? Insurance companies that sell Medigap policies:

• Don’t have to offer every Medigap plan
• Must offer Medigap Plan A if they offer any Medigap policy
• Must also offer Plan C or Plan F if they offer any plan

Keep in mind, that the Medicare Supplement policy covers co-insurance after you’ve paid the deductible (unless the Medigap policy also pays the deductible). 

2023 Costs at a GlancePart A premium

Most people don’t pay a monthly premium for Part A (sometimes called  “premium-free Part A”). If you buy Part A, you’ll pay up to $506 each month in 2023. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $506 in 2023. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278 in 2023.

Part A hospital and inpatient deductible

 You pay: 

• $1,600 deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $400 coinsurance per day of each benefit period
• Days 91 and beyond: $800 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
• Beyond lifetime reserve days: all costs

Part B premium

Most people pay $164.90 each month (or higher depending on your income). 

Part B deductible and coinsurance

$226. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment.

Part C premium

Part C monthly premium varies by plan

Part D premium

The Part D monthly premium varies by plan (higher-income consumers may pay more)

 

 This information comes from  www.medicare.gov

This is a solicitation for insurance. Submitting information or calling numbers listed on this website will direct you to a licensed Agent/Broker.

Important disclosures about Medicare Plans: Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.