Medicare is a federal health insurance program that pays most of the health care costs for people who are 65 or older. It will also pay for health care for some people under age 65 who have disabilities.
These are the basics of Medicare:
Medicare doesn’t pay 100% of your health care costs. Your out-of-pocket costs may include deductibles, co-insurance, and co-pays. You must also pay the Part B monthly premium (and the Part A premium if you owe it).
Part B (medical insurance) generally pays 80% of the Medicare-approved amount for outpatient services, such as doctor visits, after you meet the annual deductible. You are responsible for the remaining 20%. With Part A (hospital insurance) you are responsible for deductibles, co-insurance, and co-pays when you receive covered inpatient services.
Original Medicare has co-pays, coinsurances, deductibles, and a Part B premium for which you would be responsible and does not include an annual out-of-pocket maximum. A Medicare supplement insurance plan or a Medicare Advantage plan may help keep out-of-pocket costs down. But they do it in different ways, and you have to choose. You can’t use both of these plans together.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A for free. If you have to buy Part A, you’ll pay up to $471 each month.
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. What Medicare covers is based upon, Federal and state laws, National coverage decisions made by Medicare about whether something is covered, local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Medicare Part B is available at a monthly rate set annually by Congress ($148.50 in 2021 for incomes of $85000.00 or less for an individual). Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.
Remember, in most cases, if you don’t sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year. Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.