For more than half a century, Medicare has been providing a safety net for retired folks, those with certain disabilities of any age, and people experiencing End-Stage Renal Disease. Medicare benefits cover hospital stays, hospice care, durable medical supplies, and other health care basics.
While the costs of Medicare may depend on how much money you’ve paid into Social Security during your career, there are some standards that provide a baseline for costs. In order to receive Medicare benefits, you will have had to work 40 quarters or roughly 10 years during your life.
If you didn’t work for 10 years, or at least weren’t paid for your work, you are still eligible to enroll in Medicare. You’ll just be responsible for larger Medicare premiums because you haven’t been paying into the system. You may be available for Medicare under a spouse as well.
It may sound easy: Turn 65, enroll in Medicare, and catch up on some traveling, fishing, or whatever else you’re looking forward to doing in your golden years. As you’ll soon discover, there are a lot of moving parts when it comes to Medicare. There are several enrollment periods and federal, state, and even county-to-county differences between plans.
Will your doctor or health care provider accept Medicare? What facilities will you be able to visit for your health care needs? What plans are available to you? There is no one way to answer these questions without knowing exactly what your situation is.
What we can do, however, is give you a quick rundown of general costs, income limits, monthly premiums, and so on. There are four Medicare “parts” to consider, although you may not be interested in all four – yet. So let’s take a look at Original Medicare (Parts A and B), Medicare Advantage Plans, and Medicare prescription drug coverage and costs.
Please Note: All of the listed costs will be broken down based on your income in 2019, if you were filing taxes as an individual, filing jointly with a spouse, or filing as a married couple and separate tax returns. At a certain income level, you’ll pay the standard plan premiums in addition to Income Related Monthly Adjustments Amount (IRMAA). Information provided by U.S. Centers for Medicare & Medicaid Services.
What Part A covers: Inpatient hospital stays, skilled nursing care, hospice care, and home health care.
Costs for Part A: In most cases, there are no premiums for Part A if you qualify. This is paid from the Social Security taxes you or your spouse paid during working years or covered in a few other instances. If you don’t meet the Part A criteria, you can pay $259 or $471 monthly depending on how much you paid in Medicare income taxes.
What Part B Covers: Covers most doctor services, outpatient therapies, physical therapy, preventive care, and durable medical equipment.
Costs for B: Although Parts A and B are often acquired together, you can choose to enroll in just Part B health insurance. Costs depend on your income bracket from two years earlier – the standard Medicare Part B premium is $148.50. For individuals (or filing both married and separate returns), the income limit is $88,000 to pay that price.
For married couples, the limit is $176,000. There are a few other income levels that require a higher payment, although once you reach $500,000 as an individual, $750,000 as a married couple, or $412,000 as a married and separate filer, you’ll pay a total of $504.90 every month for Part B coverage.
MEDICARE C (Advantage Plans)
What Part C Covers: A combination of Parts A and B while covering additional benefits not offered by Original Medicare (Parts A and B).
Costs For Advantage Plans: There are no “baselines” for Part C because each plan is different. You will be responsible for 2 premiums, your part B premium, and your Part C premium. Additional out-of-pocket costs include deductibles, copayments or coinsurance (along with private insurance), and any additional benefits you require. There are no income limits/levels that determine your costs.
What Part D Covers: Medicare prescription drug costs.
Costs for Part D: There are no income thresholds for Part D costs. However, there are several factors that go into determining the costs of your prescription medication and how Medicare covers those costs. These include, which medication you need, what tier the medication is in, if deductibles have been reached, and even the pharmacy you use to get the prescriptions.
In some cases, prescription costs have a cap. For example, starting Jan. 1, 2021, insulin prices top out at $35 per 30-day supply. Many Part C plans include Part D coverage so you don’t have an additional premium to pay.
Work With the Medicare Experts at VibrantUSA
Although Original Medicare costs are determined by income brackets, prescriptions, advantage plans, and supplemental insurance can vary wildly. That’s why it’s so important to get as much information as you can from people you can trust. Doubling up on insurance unnecessarily or being caught without the right Medicare benefits can be costly.
Since 2003, VibrantUSA has been dedicated to providing our clients with the information they need to make the right decisions. As an independent agency, we have access to more than 30 insurance carriers and more than 50 different plans. Depending on where you live, we can find out what plans are available, the best prices, and which doctors are available.
If you’re turning 65, or recently went through a life-changing event while on Medicare, contact VibrantUSA for help. We take the time to learn about what you need and find the plans that fit your finances. We look forward to working with you!