Medicare has many options making it very confusing and difficult to decide which plan is best to suit your needs. Not knowing that your final decision on what a plan has to offer could leave you with a plan that does not fully cover your specific healthcare needs.
It is easy to request a meeting with us in the comfort of your own home, at a time that works for you. We always encourage family members, or friends to be present. Our goal is to make sure you get the plan of your choice, and all of the Medicare Benefits you are entitled to.
Original Medicare is provided by the federal government for 65 and older or those under 65 with certain disabilities. Original Medicare has two parts, Part A and B. It covers services needed in hospitals and as an outpatient excluding vision and dental care, acupuncture, most prescription medications, long term care such as nursing homes and services or supplies that are not considered medically necessary.
Part A - Hospital Care
It covers the hospital charges and most of the associated services received while you are admitted as an inpatient. Some people will be automatically enrolled in a Part A, while others will have to sign up.
- You or your spouse had Medicare-covered government employment.
- 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 filed for them yet.
Part A does not cover the following services:
- A private room in the hospital or a skilled nursing facility, unless medically necessary.
- A television or telephone in your room, and personal items unless the hospital or skilled nursing facility provides these to all patients at no additional charge.
- The costs of staying as a long-term resident in a nursing home or assisted living facility.
- Private nursing care.
- The first three pints of blood, unless the hospital gets it from a blood bank at no charge, or you arrange to replace it by donating your own or somebody else’s blood, or you have additional insurance (such as Medigap) that covers this cost.
Most people get Part A at no cost (sometimes called “premium-free part A), but some have to pay a premium for this coverage. If you or your spouse paid Medicare taxes for at least 40 quarters or approximately 10 years), you won’t pay a part A premium.
A person who is entitled to monthly Social Security or Railroad Retirement Board (RRB) benefits on the basis of disability is also automatically entitled to Part A after receiving disability benefits for 24 months.
You are responsible for paying a deductible per each benefit period ($1,600 in 2023), and a daily coinsurance for extended hospital stays.
If you are not eligible for premium-free Part A, you can purchase it. Part A monthly premiums range from $278 or $506 in 2023, based on how much Medicare tax you or your spouse paid while working. You also have to sign up for Part B to buy Part A.
- Home health care - $0 for covered home health care services. 20% of the Medicare-approved amount for durable medical equipment like wheelchairs, walkers, hospital beds, and other equipment.
- Hospice Care - $0 for covered hospice care services. You may also pay 5% of the Medicare-approved amount for inpatient respite care and/or copayment of up to $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home.
- Inpatient stay – Days 1-60: $0 after you pay your Part A deductible. Days 1-60: $0 after you pay your Part A deductible. Days 91-150: $800 copayment each day while using your 60 lifetime reserve days. After day 150: You pay all costs.
- Skilled nursing facility stay - Days 1-20: $0 copayment. Days 21-100: $200 copayment each. Days 101 and beyond: You pay all costs.
If you are not eligible for premium-free Part A, you can purchase it. Part A monthly premiums range from $278 or $506 in 2023, based on how much Medicare tax you or your spouse paid while working. You also have to sign up for Part B to buy Part A.
If you cannot receive premium-free Part A and you do not buy Part A when you are first eligible, you will have to pay a late enollment penalty. The monthly premium for Part A may increase up to 10%. You will have to pay the higher premium for twice the number of years you could have had Part A, but did not sign up.
Original Medicare provides some dental and vision coverage, but only in limited situations. If you need more comprehensive dental and vision coverage, you can enroll in a Medicare Advantage plan that includes these benefits.
Part B - Medical Care
It covers certain health care costs not covered by Part A, such as doctor visits and services, outpatient hospital care, physical and speech therapy, lab tests, blood transfusions, medical equipment and supplies, and ambulance services. Original Medicare only covers about 80% of your Part B services.
Medicare Part B does NOT cover routine physical exams; eye glasses; custodial care; dental care; dentures; routine foot care; hearing aids; orthopedic shoes; or cosmetic surgery. It also does not cover most prescription drugs or health care you get while traveling outside the United States (except under limited circumstances).
The standard Medicare Part B premium for medical insurance in 2023 is $164.90, down from $170.10 in 2022. The decrease in the 2023 Part B premium aligns with the CMS recommendation in a May 2022 report that excess SMI reserves be passed along to people with Medicare Part B coverage. Premium increases for individuals with an annual income over $97,000 and married couples with an annual income above $194,000. The cost for these higher-earning participants can range from $230.80 to $560.50 per month in 2023.
If you are already receiving Social Security benefits, payment for your monthly Part B premium is deducted from your Social Security checks. If you are not yet collecting benefits, Social Security will send you a quarterly bill.
The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.
If you did not sign up for Part B when first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but did not sign up for it.
