FAQ
What Medicare is…
A federal health insurance program for eligible U.S. citizens and legal residents
Funded in part by taxes you pay while working
Individual health insurance
Who’s eligible for Medicare?
Under age 65 and have been on Social Security disability for at least 24 months
What does Part A cost?
That Medicare tax you see on your pay stub is pre-funding for your Medicare Part A benefits.
What does Part A cover?
Skilled nursing – Because you’re in the nursing home for a reason – broke a hip, therapy, you are there to get better and go home.
Home health care – Itis more cost effective to rehabilitate at home sometimes.
Covers 100% of all Medicare-approved home health care visits, providing that the home health care agency caring for you is approved by Medicare
Hospice – Deemed when a person has 6 months or less to live.
Part A covers 100% of care from a Medicare-approved hospice program.
What does Part C cost?
Whatever the premium, you do have to still continue to pay your Part B premium, on top of whatever Medicare Advantage premium you might have.
IMPORTANT: It will also have a Max out of pocket so you will know that you have a safety net, and your expenses will be capped each year.
What does Part C cover?
Medicare Advantage Plans have to offer coverage at least as good or better than Original Medicare and typically offer extra coverage.
That’s where those dental or vision benefits usually are offered.
Many plans also build in the Part D, prescription drug benefit if its an MAPD plan, so it’s a one-stop shop.
What Medicare is not…
A family health plan
Social Security
Medicaid
Free
Does Medicare have an annual max out-of-pocket limit?
This is risk exposure that needs to be considered when deciding between Original Medicare and a Medicare Advantage plan.
What does Part B cost?
The annual deductible for Part B can increase each year.
Once you’ve met that Part B deductible then Part B coverage kicks in and the 80/20 cost share kicks in.
What does Part B cover?
~ Doctors' services
~ Labs and X-rays
~ Ambulance Services
~ Emergency Room
~ Outpatient Services
~ Durable Medical Equipment
A lot more is done on an outpatient basis nowadays compared to the way it used to be.
Remember, there is no annual max out of pocket in the Medicare world. There is no safety net.
What does Part D cost?
There is a premium, which varies across plans and carriers.
You can’t just look at the premium, you have to look at the formulary and ask, are my drugs included in my plan?
There is going to be tiers for the drugs.
Typically, a plan has 4 to 5 tiers.
Tier 1 being the lowest cost, generics,
Tier 4 or 5 being those expensive brand name drugs or specialty drugs.
The lower the tier, the lower the cost share, sometimes even $0 for generics.
What does Part D cover?
Must be enrolled in Part A, Part B or both
May be required to use a pharmacy network
Coverage and costs vary by plan and may change each year
Part D premium penalty for late enrollment may apply
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“We do not offer every plan available in your area. Currently we represent 5 organizations which offer 84 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.”