Understanding how Medicare helps cover the costs of medical care can be challenging. Contact Schuder Insurance Agency in Mansfield, Texas, to learn more about your Medicare coverage options.
How Much Does Medicare Cost?
Your Original Medicare (Parts A and B) costs depend on how long you worked and paid Medicare taxes. Most people receive Medicare Part A (hospital insurance) without paying a premium. Part B (medical insurance) premiums vary, but most people will pay $164.90 per month in 2023. Medicare Part B premiums may change each year.
Medicare recipients with limited resources and income may be eligible for programs designed to help cover healthcare costs not covered by Original Medicare. Medicare Savings Programs provided by your state may help cover Part A and/or Part B premiums. Depending on which Medicare Savings Program you qualify for, Medicare providers may not be allowed to bill you for medical care covered by Medicare, including coinsurance, copayments and deductibles.
Does Medicare Cover Prescription Drugs?
Original Medicare does not cover prescription drugs. There are two ways to get prescription drug coverage with Medicare.
- Medicare Advantage plans may include drug coverage.
- Medicare Part D helps pay for prescription drugs and is optional when you sign up for Original Medicare.
You can sign up for Medicare Part D (prescription drug coverage) during your Medicare open enrollment period. If you forgo Part D coverage and want to sign up later, you may pay a penalty for as long as you have Part D coverage.
When Can I Sign Up for Medicare?
During the months leading up to your 65th birthday, if you are not getting Railroad Retirement Board (RRB) benefits or Social Security, you can apply for Part A and Part B.
If you are eligible for Medicare, you can sign up during your initial enrollment period (IEP), which starts three months before the month you turn 65, includes the month of your 65th birthday and extends three months after you turn 65.
How Will I Pay for Out-of-Pocket Medicare Costs?
Original Medicare recipients who don’t choose a Medigap or Medicare Advantage plan must pay for Medicare coinsurance, deductibles and copays on their own. Depending on your financial situation and the healthcare you need, out-of-pocket costs with Medicare can be high.
Both Medigap and Medicare Advantage plans must follow Medicare’s rules. You can get a Medigap or Medicare Advantage plan from a private insurance company, and you may have to pay a monthly premium.
What Is Medicare Advantage?
Medicare Advantage plans, also called Medicare Part C, replace Original Medicare and may include additional coverage for medical services not covered by Original Medicare, including vision, dental and prescription drug coverage.
Medicare pays insurance companies a fixed amount each month for your Medicare Advantage plan, so some plans may have a low premium. The insurance company may have different out-of-pocket costs and rules for getting medical care, such as whether you need a referral from your primary physician to see a specialist. In general, you must get medical care from in-network providers with a Medicare Advantage plan.
What Are Medicare Supplements?
Medicare supplements, also called Medigap plans, work with Original Medicare and cover certain out-of-pocket expenses, which may include the following:
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance or copayment
- Part A hospice care coinsurance or copayment
- Skilled nursing facility coinsurance
- Part A deductible
- Part B deductible
- Part B excess charges
Medigap plans do not include coverage for prescription drugs. Original Medicare recipients who want a Medigap plan can sign up for Part D to get coverage for prescription drugs.
If you have Original Medicare, you can choose a Medigap plan offered by a private insurance company. Medigap plans, named A–D, F, G, and K–N in most states, provide the same coverage. However, premiums may differ according to the insurer and your location.
Talk with your agent to understand how a Medigap or Medicare Advantage plan may impact your future out-of-pocket healthcare costs.
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Medicare recipients concerned about the potential out-of-pocket costs of getting the healthcare they need now and in the future have numerous options. Contact Schuder Insurance Agency today to learn more about how Medigap or Medicare Advantage plans can help cover out-of-pocket healthcare costs.