Medicare Insurance
When you turn 65 you can choose to go on a Medicare plan as recognized by the Center for Medicare Services (CMS) division of the federal Department of Health and Human Services. If you are disables and you qualify for Medicare Disability payments for 2 years you will be awarded Medicare also.
If you have worked for 10 years, 40 calendar quarters you qualify for “Original Medicare” Part A and Medicare Part B. You can also be awarded Medicare if you have been on Social Security Disability for 2 years. There are holes in “Original Medicare” that can be fileld by either a “Medicare Supplement” plan (also called a “Medigap”) plan or with a “Medicare Advantage” plan.
Your tax payments during your at least 10 years (40 quarters) of working life to Medicare pay for Part A of Medicare that pays for hospitalization. The 2024 government set deductible per hospitalization on “Original Medicare” per hospitalization if $1600. Part B of Medicare covers all outpatient services at the rate of 80%/20% where the government pays 80% and you pay 20%.
The government premium for Part B of Medicare is $174.70/month in 2024 if your annual income is less than $103,000 as an individual or $206,000 for a couple. The government premium goes up as your income rises above that figure.
Medicare Part D, prescription plans:
The government requires ALL Medicare enrollees to have a “Prescription Drug Plan (PDP)” comparable to the government standards for a prescription plan or you may be fined by the government for the entire time when they are forced to get a Medicare PDP. If you are still working and are enrolled in an employer group plan in 2024 a majority of group prescription plans are comparable in 2024. 2025 will be a different story and most group employer prescription plans are not comparable to the government standard. People working and getting group employer coverage should take a serious look at Medicare PDP plans for 2025 from October 1st to December 7th.
Everyone first getting awarded Medicare Part B has 63 days to enroll in at least a government approved PDP plan or you will be fined by tie government.
GOVERNMENT EXTRA HELP:
If your income is low enough you may qualify for “Extra Help” to pay your Part B government premium and, if your income is low enough it also helps with co-payments.
“MEDIGAP” or “MEDICARE SUPPLEMENT” plans:
To fill the coverage holes in Medicare you can purchase from a licensed Medicare Insurance company either a “Medigap” plan, also called “Medicare Supplement” plan, first introduced in 1965 when Medicare was introduced. The plans standards for these plans are set by the government and can be examined in a government annually published book called “Medicare and You” that all Medicare enrollees receive annually. There are several hundred companies offering these type plans.
A “Medigap”plan is NOT a PPO or an HMO. It is a “Medicare Supplement” that any medical doctor or medical facility that accepts government payments has to recognize. In other words there are no “In Network” or “Out of Network” question. “Medigap” plans cost an additional premium above and beyond the cost of the government premium. The premiums rise each year with your age.
“Medicare Advantage” (Plan C)
“Medicare Advantage” plans can be HMO, or PPO plans that require you to pay more attention to “in network” and “out of network” coverage. A growing numberothem offethe same copayments for “in network”and “out of network.” Many of these plans have a $0 or very low premium. They usually include dental and vision coverage, NOT available from a “Medigap” plan. They can include prescription coverage, Plan D. Many offer additional benefits like “Over the Counter” non prescription medical coverage and a growing number of them allow you to use that “Over the Counter” benefit to cover food or utilities or your rent.