Medicare Advantage Plans or Medicare Supplement Plans?
Your Medicare coverage options
There are 2 main ways to get your Medicare coverage—Original Medicare and Medicare Advantage.
Choose the option you want to explore first. Don’t worry, you can review both. Just start with either one.
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Original Medicare
o Includes Hospital (Part A) and Medical (Part B) insurance.
o If you want drug coverage, you can add a separate Drug plan (Part D).
o You can also add a Medicare Supplement Insurance (Medigap) policy to help pay your out-of-pocket costs.
Original Medicare
Medicare Advantage Plan
o An all-in-one alternative to Original Medicare.
o These “bundled” plans include Part A, Part B, and usually Part D.
o Most plans offer extra benefits—like vision, hearing, dental, and more.
Medicare Advantage Plan
What Part A covers
What’s covered?
Note
If you’re in a Medicare Advantage Plan or other Medicare plan, your plan may have different rules. But, your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
In general, Part A covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
2 ways to find out if Medicare covers what you need
- Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
- Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
- Federal and state laws.
- National coverage decisions made by Medicare about whether something is covered.
- Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
What Part B covers
Note
If you’re in a Medicare Advantage Plan or other Medicare plan, your plan may have different rules. But, your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
What’s covered?
Part B covers 2 types of services
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Part B covers things like:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Inpatient
- Outpatient
- Partial hospitalization
- Limited outpatient prescription drugs
2 ways to find out if Medicare covers what you need
- Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
- Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
- Federal and state laws.
- National coverage decisions made by Medicare about whether something is covered.
- Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Medicare costs at a glance
Listed below are basic costs for people with Medicare. If you want to see and compare costs for specific health care plans, visit the Medicare Plan Finder.
For specific cost information (like whether you’ve met your deductible, how much you’ll pay for an item or service you got, or the status of a claim), log into your secure Medicare account.
Find out if Medicare covers a specific test, item or service that’s not listed under the detailed Medicare cost information section of this page.
2021 costs at a glance
Part A premium
Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”). If you buy Part A, you’ll pay up to $471 each month in 2021. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $471. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $259.
Part A hospital inpatient deductible and coinsurance
You pay:
- $1,484 deductible for each benefit period
- Days 1-60: $0 coinsurance for each benefit period
- Days 61-90: $371 coinsurance per day of each benefit period
- Days 91 and beyond: $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve days: all costs
- Part B premium
The standard Part B premium amount is $148.50 (or higher depending on your income).
Part B deductible and coinsurance
$203. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (dme)
Part C premium
The Part C monthly premium varies by plan. Compare costs for specific Part C plans.
Part D premium
The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.
Part A costs
How much does Part A cost?
Premium-free Part A
You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.”
Most people get premium-free Part A.
You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
Part A premiums
If you don’t qualify for premium-free Part A, you can buy Part A.
People who buy Part A will pay a premium of either $252 or up to $458 each month in 2020 depending on how long they or their spouse worked and paid Medicare taxes. If you choose NOT to buy Part A, you can still buy Part B.
In most cases, if you choose to buy Part A, you must also:
- Have Medicare Part B (Medical Insurance)
- Pay monthly premiums for both Part A and Part B
Contact Social Security for more information about the Part A premium.
Learn how and when you can sign up for Part A.
Find out what Part A covers.
Find out what you pay for Part A-covered services.
Part B costs
Some people automatically get Medicare Part B (Medical Insurance), and some people need to sign up for Part B. Learn how and when you can sign up for Part B.
If you don’t sign up for Part B when you’re first eligible, you may pay a late enrollment penalty.
How much does Part B cost?
Part B premiums
You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:
- Social Security
- Railroad Retirement Board
- Office of Personnel Management
If you don’t get these benefit payments, you’ll get a bill.
Most people will pay the standard premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. This is the most recent tax return information provided to Social Security by the IRS.
The standard Part B premium amount in 2020 is $144.60. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
If your yearly income in 2018 (for what you pay in 2020) was
You pay each month (in 2020)
File individual tax return
File joint tax return
File married & separate tax return
$87,000 or less
$174,000 or less
$87,000 or less
$144.60
above $87,000 up to $109,000
above $174,000 up to $218,000
Not applicable
$202.40
above $109,000 up to $136,000
above $218,000 up to $272,000
Not applicable
$289.20
above $136,000 up to $163,000
above $272,000 up to $326,000
Not applicable
$376.00
above $163,000 and less than $500,000
above $326,000 and less than $750,000
above $87,000 and less than $413,000
$462.70
$500,000 or above
$750,000 and above
$413,000 and above
$491.60
Get started with Medicare
Getting Medicare is a major milestone. Here’s where you can get the information you need, no matter where you are in your Medicare journey. Before you choose a path below, check out these 5 important facts:
- Some people get Medicare automatically, and some have to sign up. You may have to sign up if you’re 65 (or almost 65) and not getting Social Security.
- There are certain times of the year when you can sign up or change how you get your coverage.
- If you sign up for Medicare Part B when you’re first eligible, you can avoid a penalty.
- You can choose how you get your Medicare coverage.
- You may be able to get help with your Medicare costs.
Your Medicare coverage choices
Note
New to Medicare? Get the basics.
When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap).
Use this information to help you compare your coverage options and decide what coverage is right for you.
Original Medicare
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- If you want drug coverage, you can join a separate Medicare drug plan (Part D).
- You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
- If you choose Original Medicare, you can also decide to:
- Join a separate Medicare drug plan (Part D) if you want drug coverage.
- Add other insurance (like Medicare Supplement Insurance (Medigap), Medicaid, or employee or union coverage), to help pay your out-of-pocket costs (like your 20% coinsurance).
Note
If you don’t get Medicare drug coverage or Medigap when you’re first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare drug coverage.
Learn more about how Original Medicare works.
Medicare Advantage (also known as Part C)
- Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
- Plans may have lower out-of-pocket costs than Original Medicare.
- In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs.
- Most plans offer extra benefits that Original Medicare doesn’t cover—like vision, hearing, dental, and more.
Learn more about how Medicare Advantage Plans work.
Call Reynold Jones Insurance Group at 817-545-3900 Ext. 102 for Individual Consultation
Explore All of this and More at www.Medicare.gov