Do you need help sorting through all your Medicare options in Humble, Texas? We can help! Our agency simplifies the Medicare process and teaches you how all the aspects of Medicare work together to provide you with your healthcare coverage. To get started on your Medicare journey, there are a few things you need to know about the Medicare program.
Today, we want to give you an understanding of the different parts of Medicare and what options you have in Humble, TX. We’ll talk about who is eligible for Medicare, the benefits of each part, and when you should enroll. Let’s dive in!
Medicare Eligibility
The Medicare program is available to every United States citizen who is 65 or older. It’s also available for individuals who are younger than 65 that have been on disability for two years, or who have been diagnosed with End-Stage Renal Disease (ESRD).
To be eligible for Medicare, you must be a United States citizen or a legal resident who has lived in the U.S. for five consecutive years.
The Parts of Medicare
Medicare is an alphabet soup of parts, and it can be difficult to remember what each one is for. We’re going to give you an overview of what kind of coverage you can expect from each part and an idea of how much you’ll pay for coverage.
Part A: Coverage and Cost
Medicare Part A provides coverage for inpatient hospital visits. Think of Part A as your room and board when you’re admitted to a hospital or skilled nursing facility.
As long as you have met just one requirement, you’ll receive premium-free Part A. The only requirement is that you (or your spouse) must have paid Medicare taxes for ten years (or 40 quarters). If you’ve not met this requirement, you will pay a monthly premium for Part A. If you paid taxes for at least 30 quarters, your premium would be $274. Anything less than that, and you will be responsible for the full monthly premium of $499.
The deductible for Part A is $1556 in 2022. This deductible must be met once per benefit period. A benefit period starts the first day you become an inpatient and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days.
Part A does not pay for all costs associated with a hospital stay. Your coinsurance will be dependent on how many days you have spent in the hospital. You won’t pay anything for the first 60 days, but as of day 61, your responsibility will be $389 per day. Beginning on day 91, you will pay $778 per day, assuming you still have the 60 lifetime reserve days to use. Once the reserve days have been exhausted, you will have no coverage, and you’ll be responsible for the full amount out-of-pocket. (Don’t worry, we’ve got options to help with these expenses!)
Coinsurance for skilled nursing facilities is slightly different. Your coinsurance will be $0 for the first 20 days, and then you will pay $194.50 from days 21 to 100.
Part B: Coverage and Cost
Part B is the second part of what is referred to as Original Medicare. (Part A was the first.) Part B provides coverage for your outpatient medical expenses. This may include visits to your physician, diagnostic tests, surgeries, durable medical equipment (DME), and many preventive services.
The standard premium for Part B is $170.10 in 2022. While that is what most Medicare beneficiaries pay, individuals who earn high incomes may pay more. This additional amount is called the Income-Related Monthly Adjustment Amount (IRMAA) and is calculated by using your tax return from 2 years prior.
There is also a deductible for Part B, which is $233 in 2022. Unlike the Part A deductible, this one only has to be met once per year. Once you have met this deductible, most services that fall under Part B are covered at 80%, leaving the individual with approximately 20% in out-of-pocket expenses.
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Part B is the second part of what is referred to as Original Medicare.
Part C: Coverage and Cost
You’ll often hear Part C referred to as Medicare Advantage. These Part C plans are offered by private insurance carriers and replace your coverage under Original Medicare. (You’ll still have the benefits of Part A and B and will still need to pay those premiums, but your coverage will be provided by the private insurance company, not the federal government.) Most Medicare Advantage plans offer extra benefits such as routine dental, vision, and hearing services as well as prescription drug coverage.
Your premium, deductible, and coinsurance costs in a Part C plan will vary based on the plan. There are many plans available depending on where you live. (We’ve got lots of Medicare Advantage options in Humble, TX!)
Part D: Coverage and Cost
Medicare Part D plans provide individuals with prescription drug coverage. These can be purchased as stand-alone plans or as part of your Medicare Advantage plan. Like the Medicare Advantage plans, your premium and coverage level will depend on the specific plan you choose.
There are a few things that all Part D plans have in common. First, is the deductible. Your insurance carrier can choose its own deductible, but it can never exceed $480 (in 2022 at least). Most plans do choose to use this standard deductible. Second, your Part D plan includes a drug formulary. The drug formulary is a list of all the prescriptions that are covered under the plan and at what cost.
Medigap Plans: Coverage and Cost
Medigap plans are a great option to supplement your coverage under Original Medicare. (You can choose either a Medicare Advantage or a Medigap plan to supplement Original Medicare coverage.) Medigap plans are designed to fill in the “gaps” left by Parts A and B. Anything that is covered under Original Medicare is also covered by a Medigap plan.
Medigap plans are sold by private insurance carriers, just like Medicare Advantage plans are. The key difference is that these plans are standardized, meaning that the coverage is the same no matter which company you purchase a plan through. For example, Plan G with Company X is the same coverage as Plan G with Company Y. The only difference is the monthly premium.
There are currently ten Medigap plans available, so your premium and coverage will vary depending on which plan you choose. There are several plans that offer comprehensive coverage, making your out-of-pocket healthcare expenses very minimal.
Get Help with Your Medicare Options
We hope this has given you an understanding of how Medicare works, but we know it’s nearly impossible to understand all of it. The good news is, you don’t have to know it all! If you choose to work with us, our licensed agents can help you navigate all your Medicare options in Humble, TX. We’ll take the time to get to know you and your healthcare needs and then present options that best fit you. What are you waiting for? Give our office a call today and schedule your free consultation.
