Your Healthcare: Navigating Medicare

When it comes to healthcare, seniors face a unique set of challenges.

 The cost of healthcare can easily exceed your budget. With the increasing costs of medical services, it can be difficult for seniors to afford the care they need. 

Seniors 65 or older can sign up for Medicare. Medicare beneficiaries must pay a premium for Medicare Part B which covers doctors’ services and Medicare Part D which covers prescription drugs. The premiums paid by Medicare beneficiaries cover about 25% of the program costs for Part B and Part D. The government pays the other 75%.

Medicare - Parts A, B, D

Medicare can help seniors manage the cost of healthcare. Medicaid eligibility begins at age 65, providing seniors with access to healthcare services and prescription drug coverage. Medicare helps seniors cover the cost of doctor visits, hospital stays, and preventive services. However, Medicare does not cover all medical costs and may require seniors to pay for additional services.

"Medicare Part A covers hospital care, while Part B covers outpatient services and preventive care. You'll also need a Part D drug plan, which you enroll in separately.  Medicare might cover a lot of the healthcare services you need. But it won't pay for everything. Dental treatment and eye exams are generally excluded from coverage, as are hearing aids. Long Term Care is not included."  (Quoted from 3 Things You Need to Know About Medicare Before You Retire. Maurie Backman.  MSN.com)

Medicare is not "free"

Part A

"Most people eligible for Part A (hospital care insurance) have premium-free coverage ($0). The premium is based on credits earned by working and paying taxes.  

Part A Annual Deductible

This deductible is what you must pay before Medicare covers your inpatient hospital care. In 2023, this deductible is $1,600 per benefit period.

Part B

The Part B (Outpatient services and preventive care or medical care insurance) premium, on the other hand, is based on income. 

Part B Annual Premium

In 2023, the monthly premium starts at $164.90, referred to as the standard premium."  (Medicare.org)  Monthly premium is usually deducted from your Social Security Check. 

Part B Annual Deductible

"The annual deductible for all Medicare Part B (Medical Care Insurance) beneficiaries is $226 in 2023."  (CMS.gov) Deductible is usually paid "out of pocket". 

Part B Premium Income-Related Monthly Adjustment

Medicare imposes surcharges on higher-income beneficiaries. The surcharge is called IRMAA (Income-Related Monthly Adjustment Amount). Part B premium is adjusted (upward) based on your Modified Federal Adjusted Gross Income (MAGI).   Premium is based on IRMAA Tables. 

Part C - "Medicare Advantage".  

Medicare Advantage plans are offered by private insurance companies and provide the same coverage as Original Medicare, but they may also include additional benefits, such as prescription drug coverage, vision, dental, and hearing services. The cost-sharing amounts are usually lower than those of Original Medicare, but the trade-off is that beneficiaries may have fewer choices when it comes to doctors and hospitals. Medicare Advantage plans charge copayments or coinsurance for services rendered.  (Source: Medigap | Definition, How It Works, Types, Pros, and Cons (msn.com)

Part D Drug Plan

Part D Drug plan is purchased separately from a Part D provider.  A "co-pay" is generally required. 

If Medicare is not "free", what is my cost?

Part A - no cost if you have been paying throughout your working life, Medicare tax

Part B - monthly cost as follows:

$164.90 monthly premium for "married filing jointly" if MAGI is $194,000 or less; $97,000 or less when filing "individually".   Part B Premium will increase to $174.70 a month for 2024, an increase of $9.80 from $164.90 in 2023.

Premium increases to $230.80 for "married filing jointly" if MAGI is $194,001 to $246,000 OR $97,001 to $123,000 when filing "individually".  See CMS.gov for MAGI tables. 

Deductible: 1st, $226 Part B expense is paid "out-of-pocket". 

Part D - 

The average Medicare Part D cost for 2023 is $31.50 per month.  (From: Medicare Part D Cost Differences in 2023.  Moneygeek.com)

MediGap - optional, 3rd party provider, additional coverage that helps cover gaps in Part A & B coverage.  Note: Medicare.gov has an excellent tool to help you find coverage:  Find a Medigap policy that works for you (medicare.gov) 

Late Enrollment Penalty

"Medicare can charge up to 10% more for every 12-month cycle you could have been enrolled in Part A had you signed up. This higher premium is imposed for twice the number of years that you failed to register. Part B late enrollment has an even greater impact. The 10% increase for every 12-month period is the same, but the duration in most cases is for as long as you are enrolled in Part B." (Quoted from Medicare.org)

Medicare Advantage Annual Enrollment

Medicare’s annual enrollment period runs between Oct. 15 and Dec. 7.  Beneficiaries can join, drop or switch plans, including Medicare Advantage and a drug plan.  If there has been a change in your medication, you may want to review Part D drug coverage change.  (Source: Half of Medicare Advantage beneficiaries have been on their plans for at least two years. That could be a bad thing.)

Where to Get Help with Medicare Costs

To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs).  https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs

Call to Action: Optimize your Medicare Benefits

RESOURCES THAT MIGHT BE HELPFUL..

Medicare - What to Know, Penalties

3 Things You Need to Know About Medicare Before You Retire. Maurie Backman.  MSN.com.  3 Things You Need to Know About Medicare Before You Retire (msn.com)

4 Types of Medicare Penalties - and How to Avoid Them.  Msn.com  4 Types of Medicare Penalties — and How to Avoid Them | Watch (msn.com)

14 Things That Are Free (no out of pocket cost) With Medicare.  Maryalene LaPonsie and Brandon Ballenger.  14 Things That Are Free With Medicare (msn.com)

Medicare Advantage

Medicare vs. Medicare Advantage: How to Choose.  Barrons.  Medicare vs. Medicare Advantage: How to Choose (msn.com)

Half of Medicare Advantage beneficiaries have been on their plans for at least two years. That could be a bad thing.  Alessandra Malito. MSN.com  Half of Medicare Advantage beneficiaries have been on their plans for at least two years. That could be a bad thing. (msn.com)

Part A & B - Premiums and Coverage

2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts.  CMS.gov.  2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts | CMS

12 Things Medicare Part B Covers and 5 Things It Doesn’t.  Michelle Smith.  12 Things Medicare Part B Covers and 5 Things It Doesn’t (msn.com)

Part D - Best Plans 2022

Best Medicare Part D plans 2022: Find the right prescription drugs plan for you. Paul Oswell. Top Ten Reviews.  Best Medicare Part D plans 2022 | Top Ten Reviews

Medigap - Is it Worth It, What to Know

Is Medicare supplemental insurance worth it? Here's what some experts think. Tim Maxwell.  CBS News.   Is Medicare supplemental insurance worth it? Here's what some experts think. (msn.com)

What to know before you buy a Medigap policy.  Richard Eisenberg.  What to know before you buy a Medigap policy (msn.com)

Medigap | Definition, How It Works, Types, Pros, and Cons.  True Tamplin.  Medigap | Definition, How It Works, Types, Pros, and Cons (msn.com)

Find a Medigap policy that works for you.  Medicare.gov.  Find a Medigap policy that works for you (medicare.gov)    

Medicare "Flex Card" - Do I Need One

What is a Medicare Flex card? Get the facts about the flexible benefits card—including where to get one.  Liz Seegert.  What is a Medicare Flex card? Get the facts about the flexible benefits card—including where to get one (msn.com)

Does Medicare Pay for Nursing Care

What Happens When Medicare Stops Paying for Skilled Nursing Care: Navigating the Transition.  Ruben Castaneda.  U.S. News and World Report.  What Happens When Medicare Stops Paying for Skilled Nursing Care: Navigating the Transition (msn.com)

PACE (Medicare and Medicaid program to help get care outside of a nursing home). 

The PACE program for senior care: What to know.  Rebecca Schier-Akamelu. msn.com The PACE program for senior care: What to know (msn.com)  Also, see: Medicare, "Your Health Options":  PACE | Medicare

Find a PACE Plan in your area.  Medicare.gov   Find a PACE Plan in your area (medicare.gov)  

Medicare Part B 2024 Increase

Medicare Part B to rise about $10 a month in 2024.  Jessica Hall. Medicare Part B to rise about $10 a month in 2024 (msn.com)

Request to Lower Your IRMAA

Request to lower an Income-Related Monthly Adjustment Amount (IRMAA) | SSA

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