Medicare Eligibility

Who is eligible to enroll in Medicare? You are entitled to Medicare if you are at least 65 years old, a U.S. Citizen or permanent legal resident for the past 5 years, and paid into Social Security for 40 quarters during their lifetime (to avoid a premium for Part A). That last part is important because if you have not paid into Social Security for 40 quarters, you may be subject to a Part A premium. The monthly cost for Medicare Part A may change, but in 2021, people who paid Medicare taxes and earned between 30 and 39 quarters pay a monthly Part A premium of $259. Individuals who paid Medicare taxes for less than 30 quarters pay $471 a month. An individual may also be eligible for Medicare if they have a qualifying disability, end-stage renal disease, and for amyotrophic lateral sclerosis (ALS).

Medicare Enrollment Periods

Lastly, we have Special Enrollment Periods. Special Enrollment Periods allow you to join, switch or drop your Medicare coverage outside of the previous enrollment periods. To qualify for a Special Enrollment Period, you need to have a qualifying event such as moving, losing your current health care or prescription drug coverage, or another qualifying event.

How Does Medicare Work?

Medicare Part B provides coverage for doctor visits and other qualifying medically necessary services. Part B typically covers things like routine doctor visits, preventative care, durable medical equipment, and more. Unlike Medicare Part A, Part B requires a monthly premium and has a co-insurance. The standard monthly premium in 2021 is $148.50. Part B provides coverage for the first 80% of your qualifying healthcare expenses, and you are left to cover the remaining 20%. If you don’t plan accordingly, this can really put you in a bad spot as there are no out of pocket maximums for Part A and Part B annually.

Lastly, you have other plans like Prescription Drug Plans, Medicare Advantage Plans, and Medicare Supplement Plans which are designed to help control your out-of-pocket expenses not covered by Original Medicare (Part A & Part B).

After you have enrolled in Part A and/or Part B, you may have other plans options available to you as well, such as Medicare Part C (Medicare Advantage), Medicare Part D (Prescription Drug Plans), and Medicare Supplement Plans which are designed to help control your out-of-pocket expenses not covered by Original Medicare (Part A & Part B).

Why Should I Consult With A Licensed Independent Insurance Agent?

As you can see from our brief overview, understanding Medicare can be complicated. Understanding what each plan covers, how it relates to your current medical and prescription drug needs, and what your out-of-pocket expenses look like is critical to your financial security. Meeting with a licensed independent insurance agent puts an advocate in your corner. At Greystone Insurance Solutions, we are here to help you understand how a plan can help you, what gaps exist, and how to protect your retirement for the future. Click the link below and schedule your free, no obligation Medicare Insurance Review today and one of our licensed independent insurance agents will reach out to you to discuss your options!

Medicare Part A

Medicare Part A is often referred to as your Hospital Insurance under original Medicare. Medicare Part A helps pay for things like inpatient care in a hospital or skilled nursing facility following a hospital stay. The hospital must accept Medicare. It may also pay for some home health care and hospice care. If you’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury. In certain cases, the Utilization Review Committee of the hospital approves your stay while you’re in the hospital. Hospice care is covered if your doctor determines that you’re terminally ill and have six months or less to live. Such services include doctor and nursing services, hospice aid services, physical and occupational therapy services, prescription drugs for symptom control and limited, short-term respite care from caregivers. There are some general guidelines that apply to determine if Medicare Part A will cover your inpatient hospital care.

The most common question that we get surround the costs associated with Medicare Part A. Typically, there is no monthly premium associated with Part A as long as you have worked/paid taxes for 40 quarters or 10 years. If you are not sure if you have worked/paid taxes for 40 quarters, give us a call and we can help review your particular situation. With that said, Part A does have a deductible and coinsurance and this can get pricey. The Part A inpatient hospital deductible covers your share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2021, beneficiaries must pay a coinsurance amount of $371 per day for the 61st through 90th day of a hospitalization in a benefit period and $742 per day for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $185.50 in 2021. To illustrate this simply, see the chart below.

Medicare Part B

Unlike Medicare Part A, there are more costs associated with Part B. The reason is, Medicare Part B not only has a monthly premium associated with it, but it also has a co-insurance which means it only covers the first 80% of your qualifying medical expense. You owe the remaining 20%. The most important thing to remember is that there are no out-of-pocket maximums for Medicare Part B meaning you could be stuck with a sizeable out of pocket expense depending on the procedure. To illustrate the point, the non-surgical treatment of a broken arm in the United States is $2,500. So basically, Medicare will cover the first $2,000 and you would be responsible for $500. Another example is a back injury. According to the NIOSH, the average back injury can cost more than $10,000 in direct costs. Depending on the circumstance, that could cost you upwards of $2,000! Using these two examples, should they happen in the same benefit year, you could be looking at $2,500 alone in out-of-pocket expenses! This is in addition to the Medicare Part B monthly premium that starts at $148.50 per month. Single people with adjusted gross incomes over $85,000 and married couples with AGIs over $170,000 pay higher premiums. Medicare Part B has a $203 deductible. You can see how this really adds up.

Here is a little visual to illustrate how Medicare Part B works…