Basic Medicare FAQs
WHAT IS MEDICARE?
Medicare is a Federal Insurance program started in 1965. Persons 65 or older and younger persons who are disabled, have permanent kidney failure, or ALS, and have received Social Security benefits for 24 months are eligible to participate
Medicare today is very similar to how it was originally set up. Medicare was modeled after the most comprehensive Blue Cross/Blue Shield at the time. Medicare paid 80% of expenses leaving 20% for the beneficiary to pay. This format is continued today with the addition of various deductibles and co-pays.
Medicare today is very similar to how it was originally set up. Medicare was modeled after the most comprehensive Blue Cross/Blue Shield at the time. Medicare paid 80% of expenses leaving 20% for the beneficiary to pay. This format is continued today with the addition of various deductibles and co-pays.
WHAT ARE THE PARTS OF MEDICARE?
Part A – Hospital Insurance
Beneficiaries are eligible the first of the month they turn 65. If your birthday falls on the first day of the month – your Part A starts the first of the prior month. This process is automatic if you are eligible for benefits.
Beneficiaries are eligible the first of the month they turn 65. If your birthday falls on the first day of the month – your Part A starts the first of the prior month. This process is automatic if you are eligible for benefits.
Part B – Medical Insurance
Beneficiaries are eligible the first of the month they turn 65. If a beneficiary signs up for Social Security, enrollment onto Part B is automatic. If an individual does not enroll onto Social Security – he/she will need to enroll in Part B to be fully covered by Medicare. If an individual is still working and is receiving company group medical benefits he/she may decide not to enroll as there is a cost to Part B. Enrollment on to Part B opens the way to purchasing a Medicare Advantage plan or a Medicare Supplement.
Beneficiaries are eligible the first of the month they turn 65. If a beneficiary signs up for Social Security, enrollment onto Part B is automatic. If an individual does not enroll onto Social Security – he/she will need to enroll in Part B to be fully covered by Medicare. If an individual is still working and is receiving company group medical benefits he/she may decide not to enroll as there is a cost to Part B. Enrollment on to Part B opens the way to purchasing a Medicare Advantage plan or a Medicare Supplement.
Part C – Medicare Advantage
Requires enrollment in Parts A and B. Medicare Advantage plans supersede Medicare with health insurance carriers providing coverage and paying all claims. Includes prescription coverage. Part D – Prescription Drug Coverage Requires enrollment in Part A. Must be purchased when first eligible, at Annual Enrollment or after loss of Creditable Coverage from group plan benefits.
Requires enrollment in Parts A and B. Medicare Advantage plans supersede Medicare with health insurance carriers providing coverage and paying all claims. Includes prescription coverage. Part D – Prescription Drug Coverage Requires enrollment in Part A. Must be purchased when first eligible, at Annual Enrollment or after loss of Creditable Coverage from group plan benefits.
How much does medicare cost?
Part A
Generally no cost
Generally no cost
Part B
- $134.00/month if enrolling in Part B for the first time in 2017 (Standard Premium)
- $187.50/month if earning more than $85,000 filing individually or $170,000 filing jointly
- $267.90/month if earning more than $107,000 filing individually or $214,000 filing jointly
- $348.30/month if earning more than $160,000 filing individually or $320,000 filing jointly
- $428.60/month if earning more than $214,000 filing individually or $428,000 filing jointly
WHAT SUPPORT PRODUCTS CAN I BUY AND HOW MUCH ARE THEY?
If you have Parts A and B you are not required to buy additional coverage. People purchase additional coverage because they want to cover Medicare deductibles and the 20% Medicare doesn’t cover. Also, Medicare does not cover expenses incurred outside of the U.S.
Part C – Medicare Advantage
Requires enrollment in Parts A and B. Medicare Advantage plans supersede Medicare with health insurance carriers providing coverage and paying all claims. Includes prescription coverage.
Medicare Advantage or Part C generally require you use a specific network of doctors often requiring a referrals to see specialists. Medicare Supplements allow you to see any facility or provider that accepts Medicare.
Medicare Advantage plans may cover some services that Medicare doesn’t cover such as a vision exam, but often have high out-of-pocket limits. In addition, Medicare Advantage plans tend to change every year whereas Supplements rarely have more than slight benefit adjustments based on changes in Medicare.
Annual premiums range from $0 to over $200 per month
Requires enrollment in Parts A and B. Medicare Advantage plans supersede Medicare with health insurance carriers providing coverage and paying all claims. Includes prescription coverage.
Medicare Advantage or Part C generally require you use a specific network of doctors often requiring a referrals to see specialists. Medicare Supplements allow you to see any facility or provider that accepts Medicare.
Medicare Advantage plans may cover some services that Medicare doesn’t cover such as a vision exam, but often have high out-of-pocket limits. In addition, Medicare Advantage plans tend to change every year whereas Supplements rarely have more than slight benefit adjustments based on changes in Medicare.
Annual premiums range from $0 to over $200 per month
Part D – Prescription Drug Plan (PDP)
Requires enrollment in Part A. Must be purchased when first eligible, at Annual Enrollment, or after loss of Creditable Coverage from group plan benefits.
PDPs are available to everyone with Medicare. They are separate plans designed to help pay prescription drug costs. You may have deductibles, co-pays or coinsurance costs.
When choosing a PDP it is important to look for one that covers the prescriptions you are currently taking as comprehensively as possible and at lowest cost to you.
Each PDP has its own list of covered drugs (called a 'formulary'). Each formulary places drugs in different 'tiers', and each tier has a different cost. Drugs in lower tiers will generally cost you less than a drug in a higher tier. If you are taking a drug that's in a higher tier, you or your doctor can ask your plan for an exception to get a lower copayment.
Plan premiums range from $15 monthly and up.
Requires enrollment in Part A. Must be purchased when first eligible, at Annual Enrollment, or after loss of Creditable Coverage from group plan benefits.
PDPs are available to everyone with Medicare. They are separate plans designed to help pay prescription drug costs. You may have deductibles, co-pays or coinsurance costs.
When choosing a PDP it is important to look for one that covers the prescriptions you are currently taking as comprehensively as possible and at lowest cost to you.
Each PDP has its own list of covered drugs (called a 'formulary'). Each formulary places drugs in different 'tiers', and each tier has a different cost. Drugs in lower tiers will generally cost you less than a drug in a higher tier. If you are taking a drug that's in a higher tier, you or your doctor can ask your plan for an exception to get a lower copayment.
Plan premiums range from $15 monthly and up.
Medicare Supplement or Medigap plan
Requires enrollment in Parts A and B. After Medicare pays – a supplement will pay the remainder of Medicare eligible expenses. Some Supplement Plans have deductibles and co-pays. Must purchase a Part D plan for prescription coverage
Plan premiums range from $68 to $256 – based on plan design and insurance carrier
Requires enrollment in Parts A and B. After Medicare pays – a supplement will pay the remainder of Medicare eligible expenses. Some Supplement Plans have deductibles and co-pays. Must purchase a Part D plan for prescription coverage
Plan premiums range from $68 to $256 – based on plan design and insurance carrier
HOW MUCH DO MEDICARE SUPPORT PRODUCTS COST?
Supplement or Medigap plans
Plan premiums range from $68 to $256 – based on plan design and insurance carrier.
Plan premiums range from $68 to $256 – based on plan design and insurance carrier.
Medicare Advantage
Medicare Advantage plans range from $0 - $200 - with prescription drug coverage included.
You may pay an additional amount depending on your income or you may be eligible for assistance to help pay premiums.
Medicare Advantage plans range from $0 - $200 - with prescription drug coverage included.
You may pay an additional amount depending on your income or you may be eligible for assistance to help pay premiums.
Prescription Drug Plans (PDP)
Stand alone Prescription Drug Plans range in cost starting from $15 a month and can be paired with a Medicare Supplement. However, only Part A is required before purchasing a PDP.
Stand alone Prescription Drug Plans range in cost starting from $15 a month and can be paired with a Medicare Supplement. However, only Part A is required before purchasing a PDP.
WHO OFFERS MEDICARE SUPPORT PRODUCTS?
Insurance Carriers often offer both Medicare Advantage and Medicare Supplement Plans. Prescription Drug plans are also offered by Insurance Carriers.
WHEN DO I ENROLL IN MEDICARE AND SUPPORT PRODUCTS?
- Initial Enrollment Period – Date you are first eligible to in Medicare benefits.
- Special Enrollment Period – Based on a Qualifying Event – time when you can enroll in or change a plan
- Annual Enrollment Period – October 15 to December 7th – Period in which you can change Medicare Advantage or Prescription Drug Plans. If you are on a Medicare Supplement plan – you can change to another Supplement plan at any time in Washington State.
late Penalties
Part B and Part D have late enrollment penalties if you don’t enroll timely. However, if you are enrolled in current creditable group insurance coverage you are not penalized. Please note COBRA enrollment is not considered to be a Group Plan and Penalties can be applied.
The late enrollment penalty is an amount added to your Part B or Part D premium. The cost of the late enrollment penalty is determined by Medicare based on how long you went without coverage when you were first eligible to receive it.
The late enrollment penalty is an amount added to your Part B or Part D premium. The cost of the late enrollment penalty is determined by Medicare based on how long you went without coverage when you were first eligible to receive it.
More Medicare information
Qualifying Events List
IRMA Costs to 2018
Medicare and Group Insurance
Financial Help with Medicare and Medicare Products
Medicare Supplement vs. Medicare Advantage
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Supplement |
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Require A & B
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Yes
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Yes
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Plan Structure
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Designated Network
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Any Provider who accepts Medicare
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Primary Care Physician Required
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Usually
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No
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Referrals Required
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Usually
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No
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Plan Changes
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During Annual Enrollment
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Anytime During the Year (WA State only)
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Use Outside of WA
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Generally Emergencies Only
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Yes (providers accepting Medicare)
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Monthly Cost
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$0-$270 Monthly
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$68-$256 Monthly
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