Maximizing Medicare
Medicare pays for much of the cost of hospital stays and doctor’s office visits for beneficiaries eligible for Medicare. This government health insurance program has also more recently added preventive care to its covered services. Here’s how to make the most of your Medicare benefit.
What’s covered.
Hospital care is covered by Medicare Part A. Medicare Part B is medical insurance that covers doctor’s visits and outpatient services. Medicare Advantage Plans are an alternative to get your Original Medicare coverage offered by private insurance companies, typically with different premiums and restrictions. Prescription drug coverage is offered through a stand-alone Medicare Part D prescription drug plan or is included in a Medicare Advantage Prescription drug plan.
How much you are paying in.
Employees and employers each pay 1.45 percent of the worker’s wages into the Medicare system. Self-employed workers contribute 2.9 percent of their income. People who earn more than $200,000 as individuals and $250,000 for couples pay an additional 0.9 percent tax.
Enrollment deadlines
You can first sign up for Medicare during the seven-month window that includes the three months before your 65th birthday, your birthday month and the three months after the month you turn 65. Coverage can start beginning the month you turn 65. If you fail to sign up during this initial enrollment period, you could be charged a late enrollment penalty for as long as you are enrolled in Medicare. If you delay Medicare enrollment due to group health insurance through your current job, sign up for Medicare within eight months of leaving the job or the coverage ending to avoid the penalty.
Premium amounts
Most people don’t pay a premium for Medicare Part A. The standard Medicare Part B premium is $134 in 2018 (or higher based on your income), though some Social Security recipients will pay $130, on average, per month. Premium costs are also higher for retirees with a modified adjusted gross income above $85,000 for individuals and $170,000 for couples.
Out-of-pocket costs
There’s a $183 Medicare Part B deductible in 2018, after which you will be charged 20 percent of the Medicare-approved amount for most services. There’s no annual limit on out-of-pocket costs. For each benefit period, Medicare Part A has a $1,340 deductible if you are hospitalized, and additional costs apply if your hospital stay exceeds 60 days.
Covered services
Medicare provides many preventive care services without any cost-sharing requirements, including flu shots. Beneficiaries are also eligible for a wellness doctor’s visit at no cost once each year. However, tests performed during the wellness visit could result in additional charges.
Prescription drug coverage
Medicare beneficiaries must choose between an average of 23 Medicare Part D prescription drug plans, which each have different covered medications, premiums and copays. The covered medications and their costs also change annually, so it’s a good idea to shop around for a new plan each year during the Medicare fall open enrollment period.
How to make changes.
Medicare beneficiaries can make changes to their Medicare Part D prescription drug coverage each year during the Medicare fall open enrollment period from Oct. 15 to Dec. 7. This is a good time to check that the medications you use will continue to be covered at an affordable price and to switch plans if they won’t.
How to supplement Medicare.
A Medigap plan will pay for some of traditional Medicare’s out-of-pocket costs. Remember to purchase a Medigap policy during the six-month period when you’re 65 or older and enrolled in Medicare Part B. You could be charged significantly higher premiums or denied coverage if you try to buy a policy after that point.
What’s not covered.
Original medicare typically doesn’t cover certain eye exams, dental care or hearing aids. Medicare also won’t pay for more than 100 days of long-term care like nursing home stays.
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10 Things You Need to Know About Medicare originally appeared on usnews.com
Update 04/03/18: This slideshow was originally published on Nov. 15, 2016, and has been updated to with new information.