What Does Medicare Cost?
What Does Medicare Cost?
- Original Medicare and many Medicare plans charge premiums—a fixed amount that you pay each month for your coverage.
- You also pay a share of the cost for health care services you receive. There are three types of payments you may have:
- -Deductible: A set amount that you pay out of pocket for covered services each year before Medicare or your plan begins to pay.
- -Copay: A fixed amount you pay at the time you receive a covered service. For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.
- -Coinsurance: A percentage of the cost for a covered service that you pay when you receive it. For example, Medicare might pay 80% of the covered service and the remaining 20% would be paid by you.
How Do I Choose My Coverage?
How Do I Choose My Coverage?
Think about your needs so you can see how different coverage options might work for you. Aspects to consider:
- Your health:
How often do you go to the doctor?
What health problems do you have?
What medications do you take regularly? - Your budget:
What are you able to pay each month in premiums?
How comfortable are you covering copays or coinsurance for services?
How willing are you to accept the risk of high out-of-pocket costs? - Your preferences:
Which doctors, hospitals and pharmacies do you like to go to?
How important is it for you to have access to health care while traveling?
What other coverage do you have, such as an employer or retiree plan?
- Your health:
How Do I Enroll?
- The Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. It begins and ends 1 month earlier if your birthday is on the first of the month. You may enroll in Part A, Part B, or both. You can also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D). You will receive your Medicare Benefits card approximately a few months before your 65th birthday. Have this card ready when you call or begin online enrollment.
- The General Enrollment Period (GEP) happens every year from January 1 to March 31. You may use the GEP to enroll in Original Medicare if you miss your IEP. You can also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D) from April 1 to June 30 the same year.
- The Medicare Supplement Open Enrollment is 6 months long. It begins the month you are 65 or older and are enrolled in Medicare Part B. You cannot be denied coverage or charged more based on your health history if you enroll during your open enrollment. Some states may allow for additional Open Enrollment Periods.
- If you are older than 65 and still working, you may qualify for a Special Enrollment Period to enroll in Original Medicare. You can enroll for up to 8 months after the month your or your spouse’s employment or employer coverage ends. You can also join a Medicare Advantage plan or prescription drug plan up to 2 full months after the same event, if you are eligible.
When Can I Enroll?
- Your Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after.
- Your IEP begins and ends one month earlier if your birthday is on the first of the month.
- Your IEP is based on your 25th month of receiving benefits if you become eligible for Medicare due to a qualifying disability.
- You should be enrolled in Part A and Part B automatically at age 65 if you are receiving social security or Railroad Retirement Board benefits. Medicare will mail your card to you.
What Services Are Not Covered By Original Medicare?
What Services Are Not Covered By Original Medicare?
What Is Not Covered By Original Medicare?
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- Original Medicare (Parts A and B) covers many medical and hospital services, but it doesn’t cover everything. Many people are surprised to learn that prescription drugs aren’t covered. Prescription drug coverage can be purchased through Medicare Part D, but it’s not provided by Part A or Part B. You may have to pay for these services yourself unless you have other insurance that covers them.
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- Some Medicare Advantage (Part C) plans may help with certain services not covered by Original Medicare
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- Other services not covered by Original Medicare:
- Dental exams, most dental care or dentures
- Routine eye exams, eyeglasses or contacts
- Hearing aids or related exams or services
- Most care while traveling outside the United States
- Help with bathing, dressing, eating, etc. (custodial care)
- Comfort items such as a hospital phone, TV or private room
- Long-term care
- Cosmetic surgery
- Most chiropractic services
- Acupuncture or other alternative treatments
- Routine foot care
- Other services not covered by Original Medicare:
What Does A 5-Star Plan Rating Mean?
What Is A 5-Star Rating?
- Medicare awards overall performance ratings to plans from private carriers using information gleaned from member satisfaction surveys, healthcare providers, and the plan itself. The plans are rated from 1-5 stars and are used to help members compare plans based on quality and performance. Medicare releases these ratings every fall.
- 5-star Medicare Advantage plans are considered excellent. Members can enroll in these plans any time of the year; they are not subject to any particular enrollment period. However, members can only switch one time between December 8 and November 30 of the following year.
