Medicare Basic Cost Structure & Options - InsuringMyself.com LLC - Independent Insurance Agency

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Medicare Basic Cost Structure & Options

Medicare - Info & Rates
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We’ve helped hundreds of clients to get on Medicare for the first time and we've helped many others by saving them money on the same level of coverage or even improving it!
Don't forget, Medicare Supplement Plans are completely different from Advantage Plans - they are NOT the same thing!
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Medicare Supplements / Medigap Plans
Medicare Supplements, also known as Medigap Insurance Plans, are popular insurance policies that are designed to cover Medicare's copays, deductibles, and co-insurance amounts. They are accepted by all medical providers that take Medicare as payment.

Premiums for Medicare Supplements can vary by age, sex, location, smoking status, health and other factors. Get a quote by using the above Free Comparison.


Contact us to review your eligibility for getting one of these plans.
Medicare Supplement Carriers Represented
Additional Carriers May Be Offered
EXTRA HELP
"Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help with the costs-monthly premiums, annual deductibles, and prescription co-payments-related to a Medicare prescription drug plan..."

Get info on the program -

APPLY for the program -

"Original Medicare" - Main Costs & Structure
Are you eligible for Medicare?

"Original Medicare" comes in two main parts - Part A (hospitalization) and Part B (physician costs and durable medical equipment).

Original Medicare doesn't have a "Maximum Out-of-Pocket Provision". That means that there is no limit on potential costs. If that is a concern, there are plans that you can obtain to help protect you (see here).

What do each of these parts cost and what are the major potential medical costs for original Medicare? (info below uses 2021 price data)

Medicare Part A: You are entitled to premium-free Part A if you paid Medicare taxes for 40 or more calendar quarters over your lifetime. Otherwise, it is available for $259 or $471 per month (as of 2021) - depending on work history, including spouse.

Hospitalization
Deductible and copays are measured per each benefit period

First 60 Days: $1484 deductible
Days 61-90 = $371 co-pay per day
Days 91- 150 = $742 co-pay per day
(these are Lifetime Reserve Days, LRD)
All costs for all days after 150 or after 90 if all LRD have been used

You have 60 Lifetime Reserve Days to utilize beyond the base 90 days of coverage per benefit period (each LRD is exhausted once used). You incur all costs once all LRD are used.

Skilled Nursing Home Care
Under certain conditions, Medicare will pay for some skilled nursing facility care.

Days 1-20 = Covered
Days 21-100 = $185.50 co-pay per day
Days 101 and beyond = Not Covered - you pay all costs

Medicare Part B:
Medicare Part B covers medically necessary services and preventive services.

The Standard Monthly Premium is $148.50 but higher income earners will pay more (note - calculation is based on your modified adjusted gross income from 2 years prior).

Annual $203 deductible

Pays 80% of Medicare Approved Amounts
(you pay the remaining 20% balance).

Foreign Travel - Not Covered by Medicare

Prescription Medications - Not covered by Original Medicare, unless administered in hospital or medical office setting.

For more information, including the income-based cost structure for Medicare Part B and Medicare Part D (prescription drug coverage) CLICK HERE.

Choosing a Medigap Policy
All Medigap Plans are Standardized - meaning that plans with the same letter name offer the same benefits. The Centers for Medicare & Medicaid Services states, "Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies." (Page 9 of their "Choosing a Medigap Policy" booklet)




Additional Key Excerpts From the Guide:

  • Page 9 - "Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it."

  • Page 13 - "When you have your Medigap Open Enrollment Period you can buy a Medigap policy from any insurance company that's licensed in your state."

  • Page 13 - "Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you stay enrolled and pay the premium."

Take a look at the above guidebook
and then contact us for your:


Our agents will help explain the deductibles, coinsurance, and copayments of Medicare and the benefits of the different Medigap Plans. They can also help you stay informed in regards to Medicare changes or new coverage opportunities for you.


MORE MEDIGAP KEY NOTES
  • Your Medigap Open Enrollment Period lasts for six months from the time of your Medicare Part B effective date, assuming you are age 65 or older.
  • Claim Forms - most plans handle claims electronically so it's easy to use.
  • Attained Age Pricing - most insurers use this method where plan premiums rise on an annual basis.
  • Tobacco Rates - during your Medigap Open Enrollment Period, you can obtain non-tobacco premium rates even if you are a smoker. Otherwise, tobacco users pay a higher premium.
  • Block Rate Changes - insurers can change the premium rates for an entire plan but can't single you out for a rate increase. While increases are most common, rate decreases do also occur.

Personal Consultation


MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLANS
Advantage Plans are similar to traditional major medical policies such as those that you would have had through an employer or on the federal marketplace.

Both Advantage and Drug Plans may be bought from October 15th through December 7th (Annual Enrollment Period) of each year - unless you have a Special Enrollment Period that would be derived from one of several qualifying scenarios - contact us to review your situation.

Medicare Advantage Plans and Medicare Prescription Drug Plans are HIGHLY regulated. We can't disclose specific plan details without first acquiring a Scope of Appointment form, otherwise we can only discuss these plans in a general manner. Please click on the button for a Personal Consultation or start shopping by clicking the link below -

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