Medicare: Understanding the Basics and Making Informed Choices
/A summarized recap from our June 6th Medicare Event presented by Capitol Benefits Group.
Navigating the world of Medicare can be overwhelming, but Medicare is an essential aspect of an individual’s financial plan. Gilbert & Cook recently hosted an educational seminar entitled “Medicare 101: Understanding the Basics and Making Informed Choices.” This article will recap the information shared at the seminar.
Medicare Part A, provides coverage for inpatient hospital stays, skilled nursing facility care, home health care, hospice care and drugs administered in a hospital or nursing facility. For the year 2024, the deductible for Part A is $1,632. Individuals are responsible for paying this amount before Medicare coverage kicks in.
Medicare Part B provides coverage for doctor office visits, outpatient mental health care, outpatient hospital care, home health care and clinical lab services. In 2024, the deductible for Part B is $240. After meeting the deductible, individuals typically pay 20% of the cost for covered services.
Medicare Part D provides coverage for prescription drugs. Medicare Part D is offered by private companies. The coverage provided by a Medicare Part D plan, including the covered drug list, can change annually. You should review your Medicare Part D coverage annually to ensure your plan still covers your prescriptions and meets your needs.
Medicare Supplements, also known as Medigap plans, are designed to fill the “gaps” in Medicare Parts A and B. Medicare Supplement plans are offered by private insurance companies and provide coverage for deductibles, coinsurance, and other out-of-pocket costs. Medicare determines whether a service is covered, not the Supplement carrier.
Medicare Advantage, also referred to as Part C, is an alternative to original Medicare (Medicare Parts A, B and D with a Medicare Supplement). Medicare Advantage plans are offered by private insurance companies and only cover services provided by in-network (HMO or PPO) physicians and facilities. Many Medicare Advantage plans have a $0 monthly premium and include dental and vision benefits, over-the-counter allowances, and prescription drug coverage. It's important to review the specific details of each plan, as deductibles and coinsurance can vary from county to county and change annually. If you choose a Medicare Advantage plan, you will still enroll in Medicare Parts A and B, but the insurance company will manage your care and pay claims, not Medicare.
Medicare Part A has no monthly premium, as long as the individual or his/her spouse paid Medicare taxes for at least 10 years. The Medicare Part B premium for 2024 is $174.70 per month. The premiums for Medicare Parts B and D are adjusted for individuals who earned more than $103,000 in 2022 filing single or married but separate), and for married individuals who earned more than $206,000 in 2022 filing jointly. The income lookback window for Medicare Parts B and D adjustments is two years.
You apply for Medicare through the Social Security Administration (SSA). Your Initial Enrollment Period (IEP) typically begins three months before you turn 65 and ends three months after your birthday month. The SSA provides online resources and the option to schedule an appointment with your local office for assistance.
Online Resources: www.ssa.gov/medicare
Schedule with your local office: www.ssa.gov/locator/
Understanding the basics of Medicare will help you make informed decisions. Whether you choose original Medicare -- Medicare Parts A, B and D plus a Medicare Supplement – or a Medicare Advantage plan, it is important to review the available options and select the plan that best meets your individual needs. Consider consulting with a Medicare insurance professional for guidance on your Medicare decisions.
