Before you make any decisions about your coverage, learn the basics.
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Medicare is Simple
It’s seem everyone is trying to make Medicare sound so complicated, but it’s not! We are here to help you understand it and make decisions based on your health and budget.
Who Can Get Medicare?
U.S. Citizens & Legal Residents
Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage reneal disease or ALS
What Is Medicare?
Medicare is a federal program that offers health insurance to American citizens and other eligible individuals.
The program is called Original Medicare. It has two original parts, Part A and Part B.
When you are admitted into a hospital as a patient, Part A will help you pay the bill. If you have worked for 10+ years in the US and you paid taxes, in most cases you will have $0 premium.
When you go to your doctor or you’re doing some blood tests, Part B will help you pay for that. It pays for most things you will do outside of a hospital. Everyone has to pay a premium for Part B, in 2020 the standard rate is $144.60 per month.
In 2006 the government added Part D, which is a program to help Medicare beneficiary with the cost of Prescription drugs. Here is a few details you need to know about Part D.
- You need to be enrolled in Part A and/or B of Medicare to be able to buy a drug plan.
- You can buy a Part D plan from many private insurance companies who have been contracted by Medicare to offer the coverage. These companies have to follow strict rules set by Medicare.
- You will have to pay a monthly premium for the plan and you also might have deductibles, copayment and/or coinsurance.
- Part D is optional but if you decide you don’t want to join a plan when you are first eligible, you might have an late enrolment penalty if you decide you want to sign up in the future.
Original Medicare is a great, but it does not cover everything.
Once you are enrolled, you will have other cost associated with your care other than your premiums. Let’s look at some of those gabs.
Once you are admitted into a hospital, you will have to pay a deductible. In 2020 that deductible is $1,408. This will cover all your hospital charges for a period of 60 days. If you return to the hospital after 60 days, you will have to pay this deductible again. You can pay this deductible up to 6 times per year. (Emergency Room visits are covered by Part B and not Part A)
Part B is simple but it has the biggest impact on your wallet. You have to pay a yearly deductible of $198. After that the 80/20 rule applies, which means Medicare will pay 80% and YOU ARE RESPONSIBLE FOR 20% OF ALL BILLS! Medicare has NO out-of- pocket maximum. So, if the bill is $100,000, you are responsible for $20,000!
It’s hard to explain what you will have to pay for your presctiption drugs here because everyone takes different drugs and has different plans. To give you a general understanding, you might have a deductible in the beginning of the year, after you pay that you will be paying a share of the costs for your drugs. This all depends on what drugs you are taking.
Now you know each part and how much they cost.
Your next step is to figure out how to protect yourself from the gabs. Don’t worry it’s not complicated, 95% of people choose one of two options.
When you first enroll and during certain times of the year, you can choose how you get your coverage.
Keep Original Medicare
You can keep everything the way it is and to cover the deductibles and the 20% you can just buy a Medigap policy. With a Medigap policy which is also know as a Supplement plan you can go to any doctor or hospital that accepts Medicare, anywhere in the United States. You don’t need referrals or anything like that, over 60% of people choose to have there coverage this way. Medigap plan can rage from $100 to $250 per month based on what you choose.
Switch to Part C
Around 35% of people choose to switch to Part C which is also know as an Advantage Plan. You have to enroll with a private insurance company who has a contract to provide you all your health care services.
These plans have restriction that original medicare does not but the reason people chose this route is because these plans offer many additional services not offered by Medicare. You can find plans that offer Dental, Vision, Hearing and many other perks. Some of these plan also have $0 premium.