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Medicare : The Basics

Let's talk Medicare!  Below you will find easy to understand basics of Medicare.

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How Do I Become Eligible for Medicare?

  • After working at a job that makes contributions to Medicare, you will receive 40 calendar quarters.

  • You can keep working or choose the option to collect your social security check. Keep in mind that if you don't receive your Social Security check, Medicare will bill you for your part B, three months in advance.

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What is Part A?

What it helps cover:

  • Hospital care

  • Skilled nursing facility care

  • Nursing home care (as long as that isn't the only care you need)

  • Hospice care

  • Home healthcare

 

What it costs:

  • Most people generally don't pay a monthly premium for Original Medicare Part A because they paid Medicare taxes while they were working. If you didn't work enough quarters, there might be a premium you'll have to pay. 

 

Other Part A costs for 2022:

  • An annual deductible of $1,556 for inpatient hospital stays.

  • $389 per day coinsurance payment for inpatient hospital stays for days 61 to 90.

    • After day 91 there is a $778 daily coinsurance payment for each lifetime reserve day used.

    • After the maximum 60 lifetime reserve days are exhausted, there is no more coverage under Part A for inpatient hospital stays.

  • There is a 20% copay for Medicare-approved durable medical equipment (DME).

  • Medicare does not cover any room and board costs for hospice care in your home or in a nursing home if that is where you live.

  • $194.50 coinsurance payment for days 21 to 100 for a skilled nursing facility stay.

    • After day 100 you are responsible for all costs.

  • 20% copay for mental health services connected with a hospital stay.

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What is Part B?

What it helps cover:

  • Clinical research  

  • Ambulance services

  • Durable medical equipment (DME)

  • Mental health

  • Inpatient

  • Outpatient

  • Partial hospitalization

  • Limited outpatient prescription drugs

 

What it costs:

  • $170.10 each month (or higher depending on your income). The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services.

 

Other Part B costs for 2022:

  • $233 before Original Medicare starts to pay. You pay this deductible once each year.

  • $0 for covered clinical laboratory services.

  • $0 for covered home health care services.

  • Usually 20% of the Medicare-approved amount for doctor and other health care providers’ services.

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What is Part D?

It is an optional prescription drug program for people on Medicare.

 

Medicare Part D is simply insurance for your medication needs.

You pay a monthly premium to an insurance carrier for your Part D plan.

In return, you use the insurance carrier's network of pharmacies to purchase your prescription medications.

Yes, it's a voluntary program, but, if you don't have a prescription plan from your work or as dependent on your spouse's, then a Late Enrollment penalty will be imposed.

Avoid paying a penalty:

  • Join a Medicare drug plan when you first get Medicare Part A and/or Part B

  • Don’t go 63 days or more without creditable drug coverage (coverage that’s similar in value to Part D).

These plans come in different prices and with different formularies, call us for more details.

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What are My Options?

In order to control your expenses, you have two options:

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