WHAT IS MEDICARE?

Medicare

The federal health insurance program for:

People who are 65 or older
Certain younger people with disabilities
People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What are the parts of Medicare?

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part D (prescription drug coverage)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines). If not Activated with Part B Late Penalty could apply.

Part A & Part B Premiums

1. Most people don't pay a monthly premium for Part A.

You usually don't pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes called "premium-free Part A."

2. If you don't qualify for premium-free Part A, You can buy Part A.

If you aren't eligible for premium-free Part A, you may be able to buy Part A. You'll pay up to $506 each month in 2023 ($505 in 2024). If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $506 ($505 in 2024). If you paid Medicare taxes for 30–39 quarters, the standard Part A premium is $278 (in 2023 and 2024).

3. Everyone pays a monthly premium for Part B.

Most people will pay the standard Part B premium amount. The standard Part B premium amount in 2023 is $164.90 ($174.70 in 2024). If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

HOW DOES MEDICARE WORK?

With Medicare, you have options in how you get your coverage. Once you enroll, you’ll need to decide how you’ll get your Medicare coverage. There are 3 main ways:

OPTION 1 Original Medicare: Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) Monthly average Premium cost is $174.70, Premium cost is based on income (as of 2024). You pay for services as you get them. When you get services, you’ll pay a deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. Original Medicare has No Yearly Cap on Costs, You will continue to pay 20% of Medicare-approved services). You must activate Part D or Penalty could apply for not having creditable coverage.

PART D PRESCRIPTION COVERAGE:

Has a premium OF *$ 15-$75 ADDITIONALLY ONTOP OF YOUR SUPPLEMENT PLAN AND MEDICARE APRT B. You will still have copays on prescriptions.

OPTION 2 Medicare Supplement (Medigap): This can help you pay the 20% you are responsible for. Helps pay for some of the out-of-pocket costs not paid by Orginal Medicare. Can have a Premium of $150-$350 ADDITIONALLY on top of your Medicare Part B. You will have a deductible and some coinsurance.

OPTION 3 Medicare Advantage Part C: (Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) Monthly average Premium cost is $174.70, and the Premium cost is based on income (as of 2024).) PART C: Offered by private co. Private Co will administer the Medicare A, B, and D Benefits. Private Co like Humana, Aetna, United Healthcare, Cigna Etc. Part C can help you pay the 20% you are responsible for with low Copays and Max-out-of-pocket. (The most you must pay for covered services in a plan year.) After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. Part D Also includes Part D.

MEDICARE ADVANTAGE = PART A, B, C, &D. You can get extras: Vision, Dental, Hearing, Chiro, and much more.

* Premiums Listed are Estimates.

PART D 2025 CHANGES

Medicare Part D

The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year (January–December). Starting in 2025, anyone with a

Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option, and participation is voluntary.

If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.

(https://www.medicare.gov/prescription-payment-plan)