What is Medicare?
Medicare is a government-sponsored program designed to assist Medicare eligible individuals with medical expenses. In order to be eligible for Medicare you must meet one of the following criteria:
• Age 65 or older
• Medicare Disabled
• End Stage Renal Disease
The Medicare Puzzle
Medicare consists of multiple pieces. The pieces that are of utmost concern are Part A, Part B, and Part D.
Part A: Free for most individuals.
Pays for impatient hospital, skilled nursing facility and some home health care.
What you pay:
• Skilled Nursing Facility
Part B: Most beneficiaries with incomes below $85,000 (single) or $170,000 (married) will pay a monthly Part B premium of $104.90. Enrollees with incomes higher than these levels may be required to pay a higher monthly premium.
Pays for Medicare eligible physician services, outpatient hospital services, certain home health services and durable medical equipment.
What you pay:
• $147 deductible/year
• 20% of Medicare approved amount
Part D: Cost varies.
Adds prescription drug coverage to the Medicare plan, Medigap plans and some Medicare Advantage plans. Part D is not a government-supplied benefit but is required. The purchase and cost of Part D coverage is the responsibility of the Medicare enrollee.
Additional Medicare Costs
Medicare is a nice benefit, however it does not cover everything. The costs of deductible and coinsurance add up quickly. An individual enrolled in Medicare can easily spend tens of thousands of dollars per year.
So, What do I do?
Medicare has approved many plans to help individuals lower their out-of-pocket expenses. These plans are provided by private insurance companies and vary in cost.
Medigap fills the “gaps” in Medicare coverage. Medigap policies help pay most of the health care costs that Medicare doesn’t cover.
Medicare Advantage plans are approved by Medicare and ran by private companies. They provide all of your Part A and Part B coverage.
Medicare Advantage plans generally offer extra benefits and many include prescription drug coverage. These plans often have networks, which means you may have to see doctors who belong to the plan or go to specific hospitals for services to be covered. Often your costs for services can be lower than if you are enrolled in Medicare only, however it is important to check with the plan to determine what your costs will be.
Medicare is so confusing, how do I decide which plan is best for me?
The staff at Benefit Connections is devoted to helping you complete the Medicare puzzle.
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