MEDICARE ADVISORS MISSISSIPPI

What is Medicare?

Medicare is the federal program that offers medical coverage for individuals ages 65 and older. The program started in 1965 as a way for retirees to get health insurance. It also offers coverage for younger individuals who have been on disability for more than two years and to those who have been diagnosed with End-Stage Renal Disease.

Original Medicare: Parts A and B

Original Medicare is made of two parts: Part A and Part B. Part A offers hospital insurance to beneficiaries. You can think of Part A as your room and board for hospital stays. If you or your spouse paid Medicare taxes for ten years, you would receive premium-free Part A. If you have not met that requirement, you could pay up to $499 per month for Part A in 2022. The deductible for Part A is currently $1556. Once that deductible has been met, your coinsurance costs will depend on how many days you have spent as an inpatient.

Medicare Part B provides outpatient coverage. It will help pay for visits to your doctor, surgeries, diagnostic tests, durable medical equipment, and preventive services. Part B does have a monthly premium, which is $170.10 in 2022. That amount is the standard premium that most beneficiaries pay, but you could pay more if you have a high income. The Social Security Administration will use your Modified Adjusted Gross Income from your tax return two years prior to calculating your current premium. If you earned income above a certain threshold, you would pay an Income-Related Monthly Adjustment Amount or IRMAA. The annual deductible for Part B is $233. Once you have met your deductible, Part B will pay for about 80% of your outpatient services.

Part C: Medicare Advantage Plans

Medicare Advantage (MA) plans offer an alternative solution to Original Medicare. If you enroll in a Medicare Advantage plan, your benefits from Parts A and B will be moved into one plan. Private insurance companies sell these plans, often at very low monthly rates. (You’ll still need to pay your Part B premium.) The only “catch” is that you must see a provider who participates in your plan’s network. Receiving care outside the network will cost the beneficiaries much more out-of-pocket.

The majority of MA plans offer extra benefits, but the exact coverage will depend on the plan. You may get benefits for dental, vision, and hearing care, as well as coverage for prescription drugs. Some MA plans even offer gym memberships, transportation to and from medical appointments, and meal delivery.

Medicare Supplement Plans

If you choose not to enroll in a Medicare Advantage plan, you’ll likely choose a Medicare supplement. A Medicare supplement will help pay for the leftover expenses from Parts A and B. They do not offer extra benefits as MA plans do, but you are not limited to a specific network of providers. If your provider accepts Medicare, they will also accept your Medicare supplement.

Coverage in a supplement is more predictable than in an MA plan. Medicare supplements are standardized, meaning that the coverage remains the same no matter who your purchase the plan through. There are ten supplements available to choose from. The most popular supplements leave the beneficiary with nearly no out-of-pocket expenses once the premiums are paid.

Part D: Prescription Drug Plans

Part D plans include prescription drug coverage. They can be purchased as a stand-alone option or included in your Medicare Advantage plan. Either way, all Part D plans are structured in a similar manner.

Each Part D plan has a drug formulary. The formulary lists all of the prescriptions covered by the plan and categorizes each of them into tiers. There can be anywhere from 3-5 tiers in a formulary. Prescriptions in lower tiers cost less than prescriptions in higher tiers. The annual deductible for the most part D plans is $480 in 2022. (It could be less, but it will never be more during the current year.)