Medicare Costs Explained

medicare explanation

Almost everyone is covered under a variety of health insurance plans these days. This means that the health insurance company will cover the costs of your medical needs such as surgery, procedures and hospitalization. There are legions of private and government run insurance plans. Today, we will discuss Medicare and the costs involved in being covered under this insurance plan.

medicare cost
Source: hint

What is Medicare? Medicare is the federal health insurance program created in 1965 and administered by CMS, a division of the U.S. Department of Health & Human Services (HHS). It covers the country’s senior citizen population; that is all people over the age of 65. It also covers certain young people with disabilities who are receiving SSDI (Social security disability Insurance) and people who have end stage renal disorders and amyotrophic lateral sclerosis also known as ALS. Medicare is further split into four coverage categories to help cover specific services.

senior health insurance program
Source: realtor

Medicare Part A: Hospital Coverage. Part A covers inpatient medical care, hospice care, nursing homestay services and other non ambulatory procedures.

Medicare Part B: Covers certain OPD services, Physician fees, preventative healthcare treatment and the purchase of medical supplies.

Medicare Part C: Advantage Plans. Medicare Advantage Plans provide all of your Part A and Part B benefits. This plan is offered by a private company that contracts with Medicare.

Medicare Part D: Covers Prescription Drugs and controlled substances.

It is important to pick the coverage that suits you best in order to minimize your co-pay costs and reap maximum benefits from the federal insurance program. For instance, the Original Medicare program is widely accepted by physicians and other caregivers in the country, as opposed to Medicare Advantage Plans that cover limited hospital networks under their wing.

What is medicare
Source: ritter insurance marketing

On the other hand, the Medicare Advantage plan covers procedures that involve routine dental care and visits to the ophthalmologist.

More information on Medicare 2018 costs

Out of pocket costs: Medicare will not pay for all of the beneficiary’s medical costs irrespective of which part you are enrolled under. It also excludes certain services and procedures from the coverage plan. For this, the beneficiary has to pay out of pocket.

  • Premiums: Most Americans do not have to pay monthly premiums for Medicare Part A because they have had over forty quarters in which they paid FICA (Federal Insurance Contributions Act) taxes. For the unlucky few who do not meet this criteria, CMS offers Part A enrollment for an annual adjusted monthly premium of $232.00 per month for those with 30–39 quarters of Medicare-covered employment, or $422.00 per month for those with fewer than 30 quarters of Medicare-covered employment. Here is how much you pay for Part A hospital inpatient deductible and coinsurance. $1,340 deductible for each benefit period. Day 1 to 60: $0 coinsurance. Day 61 – 90 $335 coinsurance per day. Day 91 and beyond $670 per day coinsurance for each lifetime reserve day.
medicare premiums
Source: health market

Medicare part B is a paid for insurance and comes at a premium of $104.90 – $335.70 per month. The premium increased to over $120 a month in 2016 but only for those who were not on Social Security in 2015. An income-based premium surtax schema demands that individuals with incomes exceeding $85,000 and married couples with incomes exceeding $170,000 pay higher premiums for Part B enrollments. The higher the income, the higher the premium. These Part B premiums are $139.90, $199.80, $259.70, or $319.70 with the highest premium paid by individuals earning more than $214,000, or married couples earning more than $428,000. One factor that may raise your Medicare Part B premium is the late enrollment penalty. Medicare Part B requires you to pay a yearly deductible of $183.

medicare part b premium
Source: senior financial group

Part C may or may not charge a premium as deemed suitable by CMS. Part D premiums are based upon the benefits included under ones enrollment and varies by plan. The annual deductible for a standard Medicare Part D Prescription Drug Plan is a maximum of $405 as of 2018.

Seeing as there are so many options to pick from, choosing the right plan for yourself can be a tough decision to make. Research. Look around and study all of the available options you can enroll under before you sign the deal. If you need professional help and advise, you can contact our experts at Flagship Financial and book a consultation.

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