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medicare insurance

Medicare is a federally funded health insurance program that plays a vital role in ensuring access to essential medical services for Medicare beneficiaries aged 65 and older.

Understanding Medicare

Medicare is divided into 4 different parts, each serving a distinct purpose in addressing various aspects of healthcare needs. Parts A and B, sometimes known as Original Medicare are provided by the Federal Government and Parts C and D are provied by private Insurance companies.

Medicare Enrollment

Most individuals become eligible for Medicare when they turn 65. This eligibility is automatic for those receiving Social Security benefits. If you aren't receiving Social Security benefits, you can still enroll during the Initial Enrollment Period. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease). There are three times when you can enroll in Medicare.

Initial Enrollment Period (IEP)

The Initial Enrollment Period is a critical window during which individuals are encouraged to enroll in Medicare to ensure timely coverage. This period begins three months before the individual turns 65, includes the birth month, and extends for three months afterward. For those eligible due to disability, the IEP occurs during the 25th month of receiving SSDI.

General Enrollment Period (GEP)

If you miss the Initial Enrollment Period, the General Enrollment Period offers another opportunity to enroll in Medicare. This period runs from January 1 to March 31 each year. Keep in mind that late enrollment penalties and delayed coverage may apply if you enroll during the GEP.

Special Enrollment Periods (SEPs)

Certain life events may trigger Special Enrollment Periods, allowing individuals to enroll in or make changes to their Medicare coverage outside the standard enrollment periods. Qualifying events may include retirement, loss of employer-based coverage, or a change in residence.

Medicare Costs

Part A - Hospital Insurance

There is no premium for Medicare part A providing you have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration. The deductibles for 2024 are shown in the table below.

Part A Deductible and Coinsurance Amounts for Calendar Year 2024

Inpatient hospital deductible

$1,632

Daily hospital coinsurance for 61st - 90th day

$408

Daily hospital coinsurance for lifetime reserve days

$816

Skilled nursing facility daily coinsurance (days 21 - 100)

$204.00

Part B - Medical Insurance

Medicare Part B has a premium due based on income. The premium payments and deductibles for 2024 are shown in the tables below.

Part B Premium Amounts for Calendar Year 2024

Beneficiaries who file individual tax returns with modified adjusted gross income:

Beneficiaries who file joint tax returns with modified adjusted gross income:

Income-Related Monthly Adjustment Amount

Total Monthly Premium Amount

Less than or equal to $103,000

Less than or equal to $206,000

$0.00

$174.70

Greater than $103,000 and less than or equal to $129,000

Greater than $206,000 and less than or equal to $258,000

$69.90

$244.60

Greater than $129,000 and less than or equal to $161,000

Greater than $258,000 and less than or equal to $322,000

$174.70

$349.40

Greater than $161,000 and less than or equal to $193,000

Greater than $322,000 and less than or equal to $386,000

$279.50

$454.20

Greater than $193,000 and less than $500,000

Greater than $386,000 and less than $750,000

$384.30

$559.00

Greater than or equal to $500,000

Greater than or equal to $750,000

$419.30

$594.00



Part B Deductible Amounts for Calendar Year 2024

Benefit

Medicare Covers

You Pay

Annual Deductible

 

$240

Medical Expenses

80% of approved amount

20% of approved amount

Excess Doctor Charges

0%

100%

Clinical Laboratory Services

Generally 100% of approved amount.

You could pay all costs if not approved.

Home Healthcare

100% of approved amount. 80% of approved amount for durable medical equipment.

0% for services. 20% of approved amount for durable medical equipment.

Blood

80% of approved amount after first 3 pints of blood.

First 3 pints of blood plus 20% of approved amount for additional pints.

Part C - Medicare Advantage

Medicare Advantage plans are provided by independent insurance companies not the federal government and carry additional premiums and deductions. Costs vary by insurer, coverage and health care providers.

Part D - Prescription Drug Coverage

Medicare Part D plans come with monthly premiums, which vary based on the specific plan and coverage level. They often have an annual deductible and require copayments or coinsurance for prescription medications.

Medicare Advantage Plans

Medicare Advantage plans, offered by private insurance companies, combine Parts A, B, and sometimes include part D prescription drug coverage. You must be enrolled in Original Medicare (parts A & B) to be able to apply for a Medicare Advantage plan.

Medicare Advantage plans may also offer additional beneftis such as Dental and Vision Insurance as well as wellness benefits like free access to gyms, fitness centers and exercise classes.

Like any insurance policy Medicare Parts A and B have coverage limits, once those are reached you are responsible for any additional costs. Medicare Advantage plans have a cap or maximum on your medical expenses per year. Once you have reached that level, there are no further costs incurred, no matter how much care you receive.

There are six types of Advantage plan:

For more information about Medicare please visit the Medicare section of our Insurance 101 guides.

Frequently Asked Questions

Can I have both Medicare and other health insurance coverage, such as through an employer?

Yes, you can have both Medicare and other health insurance, such as employer-sponsored coverage. Coordination of benefits rules may apply, and it's essential to understand how the coverage works together.

What happens if I continue working after age 65? Do I still need to enroll in Medicare?

If you continue working and have employer-sponsored health coverage, you may delay enrolling in Medicare without penalty. Once you retire or lose employer coverage, you can enroll during a Special Enrollment Period.

Once I have chosen a Medicare plan can i change it?

Yes, you can change your Medicare plan during the annual Open Enrollment Period, which runs from October 15 to December 7 each year. Changes made during this period take effect on January 1 of the following year.

How do I choose the right Medicare Advantage plan for my needs?

Consider factors such as your healthcare needs, preferred doctors, prescription medications, and budget. Compare plan options, including premiums, coverage, and additional benefits. Here at the J G Petit Insurance Agency we can work with you to ensure you get the right policy for your situation.

We do not offer every plan available in your area. Currently we represent AETNA, United Healthcare organizations which offer AETNA: MA and PDP and United Healthcare: MA, PDP, CSNP, DSNP products in your area. Please contact Medicare. gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

Not affiliated with or endorsed by the government or Federal Medicare Program. J G Petit Insurance sales agents not affiliated with the government.

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