Medicare 101

What Is Medicare?

  Medicare is health insurance for the following:
  • People 65 or older
  • People under 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

 What Is Part A (Hospital Insurance)?

Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

How Much Does Part A Cost?

Most people don’t pay a Part A premium because they paid Medicare taxes while working. This is called “premium-free Part A.”

If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:

  • You’re 65 or older, you’re entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.
  • You’re under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)

In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

How Do I Get Part A?

Some people automatically get Part A.  Learn how and when you can sign up for Part A.

What Does Part A Cover?

To find out if Part A covers something specific, visit Your Medicare Coverage. In general, Part A covers:

Part A Cost Share for 2013 is:
$1184 Deductable for days 1-60 in the hospital
$296 Per Day for Days 61-90
$592 Per Days Beyond 90

Part A Cost Share for 2014 is:
$1216 Deductable for days 1-60 in the hospital
$304 Per Day for Days 61-90
$608 Per Days Beyond 90


Note: Staying overnight in a hospital doesn’t always mean you’re an inpatient. 
You’re considered an inpatient the day a doctor formally admits you to a hospital with a doctor’s order. Being an inpatient or an outpatient affects your out-of-pocket costs. Always ask if you’re an inpatient or an outpatient. Read Are You a Hospital Inpatient or Outpatient? If You Have Medicare C Ask for more information.

Medicare & You Handbook 2014

 

Medicare Part B (Medical Insurance)

Part B helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

How Much Does Part B Cost?

If you have Part B, you pay a Part B premium  ( $99.90 Standard Premium more depending on income ) each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

How Do I Get Part B?

Some people automatically get Part B.  Learn how and when you can sign up for Part B.

What Does Part B Cover?

To find out if Part B covers something specific, visit Your Medicare CoveragePart B covers two types of services:

There will be a $147 annual deductable for 2013 and then 20% co-insurance for:

 

  • Medically-necessary services Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services  Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Enrollment Periods

Enrollment Periods Every Year for Parts C and  D

Every year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are two separate enrollment periods each year. See the chart below for specific dates.

Enrollment Period

What You Can Do

October 15 -December 7 Open Enrollment Period for Medicare Advantage AND Medicare prescription drug coverage
  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan. 
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely. 
January 1-February 14
  • If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
  • If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage.
  • Your coverage will begin the first day of the month after the plan gets your enrollment form.

Note: During this period, you can’t do the following: Switch from Original Medicare to a Medicare Advantage Plan.

  • Switch from one Medicare Advantage Plan to another. 
  • Switch from one Medicare Prescription Drug Plan to another.

             Medicare & You Handbook 2014

 

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