Medicare basics

1. Days 01-60 = $1216 (average stay 1 week)
2. Days 61-90 = $304 per day
3. Days 91-150 = $608 per day
4. Days 151 on = 100% of costs

1. Days 01-20 = $0
2. Days 21-100 = $152 per day
3. Day 101 on = 100% (most people go on Medicaid at this point)

1. Deductible = $147
2. Doctor visits, outpatient medical/surgical, diagnostics, etc = 20%
3. Durable Medical Equipment = 20%
4. Blood = first 3 pints $0 + 20% for additional pints
5. Annual physical exams = $0
6. Clinical laboratory services = $0
7. Extra charges over Medicare-approved amount = 100%

1. Deductible = $310
2. When Deductible met, Initial Coverage Phase = Generics usually under $3, Brand-Name usually under $35, Non-Preferred Brand-Name usually under $95, Specialty usually under 33%
3. When Out-Of-Pocket reaches $2850, Coverage Gap = 72% Generic cost/47.5% Brand-Name cost
4. When True Out-Of-Pocket (Out-Of-Pocket + discounts) reaches $4550, $2.55 Generic/$6.35 Brand-Name or 5% coinsurance

• Part-A = 65th birthday or 24 months after beginning SSDI
• Part-B = 65th birthday or 24 months after beginning SSDI. If you fail to sign up at 65, you can sign up in February for a July 1st effective date
• Part-D = 65th birthday or January-Valentines Day
• Medicare Supplements = 6 months before your 65th birthday or 24 months after beginning SSDI
• MAPD = 3 months before your 65th birthday or 24 months after beginning SSDI

LisaH said:

So the earliest one can go on Medicare is 65?

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momeason said:

Question: Do stay at home spouses qualify for Medicare under the working spouse's record as they do with Social Security?
In my case, half of my husband's social security benefits are more than 100% of mine.
Does each person need to qualify for their own Medicare benefits or is it possible to qualify under your spouse's work record?

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simpsontruckdriver said:

Since I've been answering questions about Medicare here and there, I thought I would put it all out there in one mega-post. I am licensed and appointed in Florida, so most of what I am going to post is Federal. I can only do basics on Medicare Supplements, Part-D (Rx), and Medicare Advantage plans. An agent in your area (I HIGHLY suggest a local agent, not a call center) can give you specifics.

Part-A is paid for when you work 40 quarters (10 years), so at 65, you pay $0 premium. It is also available for someone who has been on Social Security Disability Income (not SSI) for 24 months, those with Lou Gherig's Disease, or End-Stage Renal (kidney failure) Disease. If you go into the hospital, you are charged:

1. Days 01-60 = $1216 (average stay 1 week)
2. Days 61-90 = $304 per day
3. Days 91-150 = $608 per day
4. Days 151 on = 100% of costs

If you are sent to a Nursing Home:

1. Days 01-20 = $0
2. Days 21-100 = $152 per day
3. Day 101 on = 100% (most people go on Medicaid at this point)

Part-B has the same qualifications as Part-A, but is "optional". What I mean is, if you choose NOT to take it at 65, your premium will go up 10% per year (Late Enrollment Penalty - LEP) for life. If you have a PPACA-compliant group or Exchange plan, and you choose to keep it, you will not be charged the LEP. It is either withdrawn from your Social Security Check ($104.90/month as of 2014), or you can have it billed every quarter ($104.90 x 3). This is what you will also pay:

1. Deductible = $147
2. Doctor visits, outpatient medical/surgical, diagnostics, etc = 20%
3. Durable Medical Equipment = 20%
4. Blood = first 3 pints $0 + 20% for additional pints
5. Annual physical exams = $0
6. Clinical laboratory services = $0
7. Extra charges over Medicare-approved amount = 100%

Part-D (Prescription Drug Plan - PDP) is very tricky. It is not run by Medicare, but it is regulated by them, and run by private insurers. Whatever you pay in premium, they lower many of the copayments. If you do not sign up at 65, you are charged 1% per month Late Enrollment Penalty (LEP) up to 100% of average premiums (approx $35).

1. Deductible = $310
2. When Deductible met, Initial Coverage Phase = Generics usually under $3, Brand-Name usually under $35, Non-Preferred Brand-Name usually under $95, Specialty usually under 33%
3. When Out-Of-Pocket reaches $2850, Coverage Gap = 72% Generic cost/47.5% Brand-Name cost
4. When True Out-Of-Pocket (Out-Of-Pocket + discounts) reaches $4550, $2.55 Generic/$6.35 Brand-Name or 5% coinsurance

Most Retirees want to cut those costs! The first way is a Medicare Supplement (aka MedSupp or Medigap). This plan has a premium based on the plan the person chooses, what they want covered and what they want to pay for themselves. But, there are NO networks, since the only "network" is any doctor, specialist, and hospital that accepts Medicare. They do not include a PDP. They are standardized by Medicare, but they are regulated by your state. Premiums vary by state and sometimes regions within the state. They are guaranteed renewable, meaning you will not be dropped for any reason, except non-payment. They are customizable to what YOU want.

Another option is the Medicare Advantage Plan with Part-D (MAPD). These plans are regulated by Medicare, they have low copayments, usually no deductibles even for drugs, add vision and dental, may add Silver Sneakers, and they are either an HMO or PPO (networks). They are paid for by Medicare, so if budgets change, your insurer may cancel your plan, requiring you to sign up for another one with higher deductibles/copays - or switching to a Medicare Supplement. The only pre-existing condition is ESRD (above), so a person can not join an MAPD plan if they have kidney failure, but the plan will allow them to join ONLY IF they had a successful transplant. Basically, MAPD plans are "one size fits all".

Now, what if the retiree needs MORE assistance with the bills? Social Security and Medicare offer help depending on income. If your assets (not including primary home and automobile) are less than $26860 married/$13440 single, and your monthly working income is less than $1790/month, Medicare and/or Social Security will erase many of those costs. Many don't want it, but Medicare and Social Security has millions available to help low-income retirees.

Since people paid for Medicare with their hard work, they should take it and make it work for them, as soon as they turn 65. Using an agent to wade through this whole maze is a must, not some $12/hour rep at a call center, but a person who you meet and forge a business relationship with. I know agents in 49 states (not Wisconsin), if you want a referral. It is what fits YOUR budget.

Now, when can you FIRST sign up?

• Part-A = 65th birthday or 24 months after beginning SSDI
• Part-B = 65th birthday or 24 months after beginning SSDI. If you fail to sign up at 65, you can sign up in February for a July 1st effective date
• Part-D = 65th birthday or January-Valentines Day
• Medicare Supplements = 6 months before your 65th birthday or 24 months after beginning SSDI
• MAPD = 3 months before your 65th birthday or 24 months after beginning SSDI

I welcome any and all questions. You can ask here, or privately. My qualifications: I am licensed with the Florida 2-40 Health Insurance License, and AHIP 2014 (aka Medicare Advantage and Part-D certification). I'm NOT advertising, only offering help.

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rapmarks said:

It sounds like it unless you are on social security disability or have one of the illnesses he mentioned.

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