Coverage Options

Part A Hospital
Part B Medical
Part C Medicare Advantage
Medigap (Supplemental)
Part D Prescription Drug Coverage

Medicare Part A

Most people do not pay a premium for Part A (Hospital Insurance). This is also known as “premium-free Part A. If you or your spouse paid Medicare taxes for less than 10 years total, you will have a monthly cost for Part A of $413 (2017) per month.

Part A Hospital Inpatient Deductible and Coinsurance:

You pay (2017):

$1,316 deductible for each benefit period
Days 1-60: $0 coinsurance for each benefit period
Days 61-90: $329 coinsurance per day of each benefit period
Days 91 and beyond: $658 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 A Skilled Nursing Facility Care:

You pay (2017):

Days 1-20: $0 for each benefit period
Days 21-100: $164.50 coinsurance per day of each benefit period
Days 101 and beyond: all costs

Part A Home Health Services:

Medicare Part A covers eligible home health services such as intermittent skilled nursing care, physical, speech, and occupations therapy.

Part A Hospice:

You pay (2017): $0 for hospice care
May have co-pay of not more than $5 for each prescription and other similar products for pain relief
May pay 5% of the Medicare-approved amount for respite care

 

Medicare Part B

Services from doctors and other health care providers:

Clinical research
Home health care
Ambulance services
Mental health (inpatient, outpatient, partial hospitalization)
Outpatient care
Durable medical equipment
Some preventive services

You pay $183 per year for your Part B deductible in 2017. After your deductible is met, you typically pay 20% of the Medicare-approved amount.

In 2017, the standard Part B premium amount will be $134 (or higher depending on your income).

You’ll pay a different premium amount in 2017 if:

You enroll in Part B for the first time in 2017.
You don’t get Social Security benefits.
You have Medicare and Medicaid, and Medicaid pays your premiums.
Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.

Medicare Part C

Medicare Advantage (Part C) Helps Cover:

Benefits included in parts A & B of Medicare
May include prescription drug coverage (typically)
May have extra benefits such as fitness membership, dental, or vision coverage (not included in Medicare)
Must follow Medicare rules
Run by private insurance companies approved by Medicare

Medigap policies are standardized

Each Medigap policy must adhere to government and state laws intended to protect you, and they should be clearly stated as “Medicare Supplement Insurance”. Insurance companies can offer you only a “standardized” policy recognized in most states by letters A through D, F through G, and K through N (Massachusetts, Minnesota, and Wisconsin policies are standardized differently). All policies offer the same basic benefits, however, some offer extra benefits so you can pick the one that best fits your needs and budget.

Note: Plans E, H, I and J are no longer available to purchase, yet in the event that you already have one of these policies, you can keep it. Contact your insurance company for more information.

Different insurance companies might charge different premiums for the exact same policy. As you compare plans, make certain you’re comparing the same policy. For instance, compare Plan G from one company and Plan G from another company.

How do I compare Medigap policies?

In a few states, you might be able to purchase a kind of Medigap policy called Medicare SELECT, which is a policy that requires you to utilize certain hospitals and, in some cases, particular doctors or other health care suppliers to get full coverage. In the event that you purchase a Medicare SELECT policy, you have the option to change your mind in 12 months and switch to a standard Medigap policy.

What else should I know about Medicare Supplement Insurance (Medigap)?

Important Facts:

You are required to have Part A and Part B.
A Medigap policy is limited to just one individual. Spouses must purchase a separate policy. It’s essential to compare Medigap policies since the expenses may differ and costs might go up as you get older. A few states limit Medigap premium costs.
You can’t have prescription drug coverage in both your Medigap policy and a Medicare drug plan.
In addition to your monthly Part B premium that you pay to Medicare, you pay the private insurance company a premium (monthly, quarterly, semi-annual, or annual).

When to buy:

The best time to purchase a Medigap policy is amid your Medigap Open Enrollment Period. After this Enrollment period, you will most likely be unable to buy a Medigap policy. This 6-month period starts on the first day of the month in which you’re 65 or older and enrolled in Part B. Some states may have additional Open Enrollment Periods.

If you’re younger than 65 years old, you may not be able to purchase the Medigap policy you need, or any Medigap policy, until you turn 65. This is because Federal law doesn’t require insurance companies to offer Medigap policies to individuals under 65. That being said, a few states require Medigap insurance companies to offer Medigap policies to individuals under 65 (those qualified for Medicare).

When you delay enrolling in Part B because you have group health coverage based on you or your spouse’s current employment, your Medigap Open Enrollment Period won’t begin until you sign up for Part B.

Medicare Part D

Medicare Part D plans can offer more benefits than what you see below, but here are the minimum requirements:

A drug benefit program which provides outpatient prescription coverage for individuals on Medicare Part D is governed by Centers for Medicare and Medicaid Services (CMS), but administered by private insurance companies.

Individuals can shop for stand-alone prescription plans or Medicare Advantage Plan that include drug coverage (MAPD).

Medicare Part D is optional. However, penalties may apply in the future for not having Part D coverage or creditable coverage through a group or your employer’s plan.