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- How much does Medicare cost by state?
- Does Medicare cost change by income level?
- How do I cancel Medicare?
- What is Medicare Easy Pay?
- How do I enroll in a Medicare Advantage plan?
- What is a Special Enrollment Period?
- What is a Medicare Special Needs Plan?
- How does Medicare work with other forms of coverage?
- 5 Star Medicare Advantage Plans" What is a 5-star Medicare Advantage plan?
What are the different parts of Medicare?
There are 4 parts of Medicare: Parts A, B, C, and D.
- Part A: Basic hospital insurance
- Part B: Basic medical insurance
- Part C: Medicare Advantage plans
- Part D: Medicare prescription drug plans
Some people may be automatically enrolled in Medicare when they turn 65 — if they meet certain conditions. If you aren’t automatically enrolled, you can enroll online in just a few minutes. Simply fill out a Medicare application through the Social Security website.
When to sign up for Medicare
Most people can sign up for Medicare three months before their 65th birthday. Once you become eligible to sign up for Medicare, you have 7 months (known as your Initial Enrollment Period) to enroll. If you fail to enroll in Medicare during your Initial Enrollment Period, you could end up paying more for your healthcare, unless you qualify for special enrollment.
Medicare Advantage could save you money
Medicare Advantage plans provide at least the same benefits as Medicare Part A and Part B, but may offer additional benefits that they do not, such as:
- Prescription drug coverage
- Dental coverage
- Vision coverage
- Wellness programs
You must enroll in Medicare Part A and Part B, and you must live in the plan's service area, before you can enroll in Medicare Advantage.
If you’re new to Medicare
If you’re new to Medicare and would like to enroll in a Medicare Advantage plan, you can do so anytime during your Medicare Initial Enrollment Period. Your Initial Enrollment Period begins 3 months before your 65th birthday, includes your birthday month and ends 3 months after your 65th birthday.
If you do not enroll in a Medicare Advantage plan during your initial enrollment period, you will have another chance to enroll during the Medicare Fall Open Enrollment Period, which runs from October 15 to December 7 each year.
What is the Costs?
Unlike Original Medicare, which is managed by the federal government, Medicare Advantage is managed by private insurers who have control over the plans they offer and how much they charge for them.
Even if you enroll in Medicare Advantage, you will still have to pay a monthly Part B premium. The standard Part B premium is $148.50 in 2022. Your premium may be higher depending on your income.
If your Medicare Advantage plan has a premium, you are responsible for paying it on top of your Medicare Part B premium. Some Medicare Advantage plans have premiums as low as $0,2 so we recommend shopping around to find the best deal.
Note: the insurance company determines your out-of-pocket costs, including deductibles, copayment and coinsurance, so specific out-of-pocket amounts will vary from plan to plan.
Who Is Eligible for Medicare?
You are eligible for Medicare Part A and Part B at age 65 if:
- You are a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years
- You or your spouse have worked long enough to be eligible for Social Security or Railroad Retirement benefits
- You or your spouse are government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes
You can meet Medicare eligibility under 65 if you:
- Have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months
- You have ALS (amyotrophic lateral sclerosis or Lou Gehrig's disease)
- You have End-Stage Renal Disease (ESRD) and you or your spouse have paid Social Security taxes for a certain length of time
When to Enroll in Medicare
Automatic Medicare Enrollment
You may be automatically enrolled for Medicare Part A and Part B benefits if you are age 65 and already receive Social Security or Railroad Retirement benefits.
If you are under age 65, you may be automatically enrolled if you have received Social Security or Railroad Retirement disability benefits for 24 calendar months.
If you are automatically enrolled, you will receive your red, white and blue Medicare benefits card in the mail. Your Medicare coverage will begin either on the first day of the month during which you turn 65 or on the first day of your 25th month receiving disability benefits.
If you are under 65 and have ALS/Lou Gehrig’s disease, your Medicare benefits will start the same month your disability benefits begin — there’s no 24-month waiting period.
Manual Medicare Enrollment
You may need to manually sign up for Medicare if one of the following circumstances apply to you:
- You are approaching your 65th birthday, meet Medicare eligibility requirements and do not currently receive Social Security or Railroad Retirement board benefits
- You are under 65 and eligible for Medicare because you have ESRD
- You are over age 65 and you did not enroll in Medicare when you were first eligible
Veterans who receive VA coverage and are eligible for Medicare can also consider enrolling in Medicare Part A and Part B. If you have VA benefits as well as Medicare coverage, your options for care and your coverage net can be widened. Your qualified care would be covered under Medicare Part A and/or Part B, even if you go to a non-VA hospital or doctor.
Medicare Initial Enrollment Period (IEP)
The earliest time you can enroll in Original Medicare, a Medicare Advantage plan or a Medicare Part D prescription drug plan is during your Medicare Initial Enrollment Period (IEP).
Your Initial Enrollment period lasts for seven months:
- It begins three months before you turn 65
- It includes your birth month
- It extends for another three months after your birth month
If you are under 65 and qualify for Medicare due to disability, the 7-month period is based around your 25th month of disability benefits.
Medicare General Enrollment Period
If you don't sign up during your Initial Enrollment Period and if you aren't eligible for a Special Enrollment Period, the next time you can enroll in Medicare is during the Medicare General Enrollment Period.
The General Enrollment Period lasts from January 1 to March 31 each year.
You can only sign up for Part A and/or Part B during this period, and your coverage starts on July 1. You may have to pay a late enrollment period for Part A and/or Part B, as detailed below.
What will Medicare Part A cost in 2022?
Medicare Part A is hospital insurance. It covers some of your costs when you are admitted for inpatient care at a hospital, skilled nursing facility and some other types of inpatient facilities.
Part A can include a number of costs, including premiums, a deductible and coinsurance.
2022 Part A premiums
There are two important things to keep in mind about Part A premiums:
- Most people qualify for premium-free Part A.
To you or your spouse must have worked and paid Medicare taxes for the equivalent of 10 years (40 quarters). Those 40 quarters do not have to be consecutive.
- If you pay a premium for Part A, your premium could be up to $471 per month in 2022.
If you paid Medicare taxes for only 30-39 quarters, your 2022 Part A premium will be $259 per month. If you paid Medicare taxes for fewer than 30 quarters, your premium will be $471 per month.
2022 Part A deductible
If you are admitted to a hospital for inpatient treatment, Medicare Part A helps cover your hospital costs once you reach your Medicare Part A deductible. The Part A deductible is $1,484 per benefit period in 2022.
The Medicare Part A deductible is not annual — you could potentially need to meet this deductible more than once in a given year.
2022 Part A coinsurance
After you meet your Part A deductible, you may be required to pay Part A coinsurance for extended hospital stays.
For the first 60 days of your hospital stay, you aren’t required to pay Part A coinsurance.
But beginning on day 61 of your stay in 2022, you’re required to make a Medicare Part A coinsurance payment of $371 per day through day 90. After your 90 th day in the hospital, you must pay $742 per day for up to 60 more days in 2022.
Those 60 “lifetime reserve days” do not reset annually. They can only be used once.
Beyond that, you are responsible for all costs.
Part A also requires coinsurance for hospice care and skilled nursing facility care.
- Part A hospice care coinsurance or copayment
Medicare Part A requires a copayment for prescription drugs used during hospice care. You might also be charged a 5 percent coinsurance for inpatient respite care costs.
- Skilled nursing facility care coinsurance
Medicare Part A requires a coinsurance payment of $185.50 per day in 2022 for inpatient skilled nursing facility stays longer than 20 days. You are responsible for all costs after day 101 of an inpatient skilled nursing facility stay.
Skilled nursing care is based on benefit periods like inpatient hospital stays.
What is the cost of Medicare Part B for 2022?
Medicare Part B covers medical insurance benefits and includes monthly premiums, an annual deductible, coinsurance and other potential costs.
2022 Part B premiums
The standard monthly premium for Medicare Part B is $148.50 per month in 2022.
Some Medicare beneficiaries may pay more or less per month for their Part B coverage. The Part B premium is based on your reported income from two years ago (2022).
People who had higher income in 2022 may pay higher Part B premiums, which is called the IRMAA (Income-related Monthly Adjustment Amount).
The 2022 Part B premium breakdown is below.
2022 Part B deductible
You must meet your Part B deductible before Part B pays its share of most covered services (the deductible doesn’t apply to certain preventative services), for example:
- Most doctor services
- Outpatient therapy
- Durable medical equipment (DME)
The 2022 Part B deductible is $203 per year.
2022 Part B coinsurance or copayment
Once you meet your Part B deductible for the year, you typically pay 20 percent of the Medicare-approved amount for services that are covered by Part B.
Part B late enrollment penalty
If you don’t sign up for Medicare Part B when you’re first eligible, you may be required to pay a late enrollment penalty.
The Part B late enrollment penalty is as much as 10 percent of the Part B premium for each 12-month period that you were eligible to enroll but did not.
For example, if you waited three years after your Initial Enrollment Period to sign up for Medicare Part B, your late enrollment penalty could be 30 percent of the Part B premium.
You will continue to owe this penalty for as long as you remain enrolled in Medicare Part B.
As mentioned above, the 2022 standard premium for Part B is $148.50 per month. If you owe the standard Medicare Part B premium but sign up for Part B a year after you were initially eligible, the late enrollment fee can add another $14.85 per month to your Part B premium.
Part B excess charges
If you receive services or items covered by Medicare Part B from a health care provider who does not accept Medicare assignment (meaning they do not accept Medicare as full payment), they reserve the right to charge you Part B Excess Charges up to 15 percent more than the Medicare-approved amount.
These additional costs are called Medicare Part B excess charges, and they can potentially add up to thousands of dollars.
How much does Medicare Advantage cost per month?
In 2022, the average monthly premium for Medicare Advantage plans with prescription drug coverage is $33.57 per month
Depending on your location, $0 premium plans may be available in your area.
Medicare Part C, also known as Medicare Advantage, is sold by private insurance companies. Medicare Advantage offer the same benefits that are covered by Original Medicare, and most Medicare Advantage plans include additional benefits that Original Medicare doesn’t cover.
Because Medicare Advantage plans are sold by private insurance companies, plan costs (such as coinsurance, copayments and deductibles) can vary based on location, carrier, benefits offered and more.
Find out the average cost of Medicare Advantage plans in your state.
Medicare Advantage Special Needs Plans (SNP) may have lower costs
A Medicare Special Needs Plan (SNP)is a type of Medicare Advantage plan that is designed specifically for someone with a particular disease or financial circumstance.
Many Medicare SNPs cover most of the qualified health care costs for beneficiaries. All SNPs must include prescription drug coverage.
Some Medicare SNPs are designed for people who are dual-eligible, meaning they are eligible for both Medicare and Medicaid. These plans are commonly called Dual-Eligible Special Needs Plans (DSNP).
Medicare Advantage Special Needs Plans can also cater more specifically to the needs of people with specific medical conditions, such as:
- Dependence issues with alcohol or other substances
- Autoimmune disorders
- Cardiovascular disorders
- Chronic heart failure
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD) that requires dialysis
- Severe hematologic disorders
- Chronic lung disorders
Some SNPs can also be available to people who live in a long-term care facility such as a nursing home.
Medicare Advantage plans have an out-of-pocket spending max
When you enroll in a Medicare Advantage plan<, you can ask about your specific policy’s out-of-pocket spending limit.
Original Medicare does not include an out-of-pocket spending limit. While it’s not common, you could potentially be responsible for thousands of dollars in out-of-pocket costs if you only have Original Medicare coverage and require extensive medical care throughout the year.
What is the average cost of Medicare Part D prescription drug plans?
In 2022, the average monthly premium for a Medicare Part D plan is $41.64 per month.
Medicare Part D plan provide coverage solely for prescription medications. Part D plan costs may vary based on your plan and your location.
Learn about the average cost of Part D plans in your state.
Depending on your income, you may be required to pay a higher Part D premium. As with Medicare Part B premiums, this adjusted amount is called the IRMAA (Income-related Monthly Adjustment Amount).
If you are required to pay a higher Part D premium, it will be based on your reported income from two years ago (2022).
Medicare Part D deductible
Medicare Part D plans cannot have a deductible of more than $445 per year in 2022.
Some Medicare Part D plans have a $0 deductible. In 2022, the average Part D deductible is $342.97 for the year.
Medicare Part D “donut hole” coverage gap costs
Medicare Part D prescription drug plans and some Medicare Advantage plans have what is known as a “donut hole” or “coverage gap,” which is a temporary limit on how much a Prescription Drug Plan will pay for prescription drug costs.
As of 2020, Part D beneficiaries pay 25 percent of the cost of brand name and generic drugs during the coverage gap until reaching catastrophic coverage spending limit.
What is the average cost of Medicare Supplement Insurance (Medigap)?
The average premium paid for a Medicare Supplement Insurance (Medigap) plan in 2022 was $125.93 per month.
It’s important to note that each type of Medigap plan offers a different combination of standardized benefits. Plans with fewer benefits may offer lower premiums.
Other factors such as age, gender, smoking status, health and where you live can also affect Medigap plan rates.
Medicare Supplement Insurance plans help pay for some of the out-of-pocket expenses you’ll face when you use Medicare Part A and Part B benefits. Medigap plans are sold by Mutual of Omaha Medigap plans private insurance companies.
These costs can include certain Medicare deductibles, coinsurance, copayments and other charges.
There are 10 different Medigap plans available in most states. You can use the chart below to compare the costs that each type of Medigap plan may cover.
Medigap plans and Medicare Advantage plans are not the same thing. You cannot have a Medigap plan and Medicare Advantage plan at the same time.
At Angel Family Insurance we are committed to helping you find the right insurance coverage at the best price. We are an independent insurance broker with options for you.
Our experienced, local insurance agents, take the time to assess your individual needs and develop a policy that fits your budget.
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