Medicare: When, What, Costs, FAQ

You start Medicare on the 1st of  the month you were born in (unless you were born on the 1st, then you start the prior month on the 1st.  You can sign up for Medicare as soon as three months before your start date. If you already receive monthly benefits from Social Security, Medicare will automatically enroll you in Parts A and B and then you just need to do the other parts mentioned here below. Otherwise, if not yet claiming Social Security benefits, you have to proactively sign up for everything.

Overview On How it All Gets Set Up and Covered

This is an over-simplified sketch to get you basic understanding and headed in the right direction, but is not an authorized comprehensive description. Please consult official Medicare publications and official brochures from insurance companies. We can provide such brochures at your request.

Part A 

from government

Part B 

from government

Covers hospitalization hospice care, nursing home etc. with annual deductible of $1364 (Yr. 2019).  Zero monthly cost for most people.

Covers 80% of Medicare allowable charges for things like Dr. visits, surgery, x-ray, CT Scans & MRI's etc. Costs $135.50 month (Yr. 2019)*

*Unless you make over $85,000 filing single or $170,000 filing joint. If you do make more, contact me regarding specifics, and especially if your income has dropped or will soon because they automatically look at the last two years and not current income, but you can remedy that if it applies to you .

How are you billed for Part B premium cost? IF you are already getting Social Security benefits, they will take it out of that (you have no other choice). If you are not yet receiving Social security monthly benefits, the they will send you a quarterly bill for Part B premiums. You can pay by check or credit card, or through online bill payment if you have it set up through your bank. If you don't like quarterly they have an option where you can set up monthly auto-deduction from your checking account, this service is called Medicare Easy Pay. See the following link  https://www.medicare.gov/your-medicare-costs/ways-to-pay-part-a-part-b-premiums/medicare-easy-pay

Next, to cover the rest you get either a Part C HMO + Part D

OR a Medicare Supplement  + Part D

This

Part C HMO 

from insurance Co

 

(choose primary care Dr. who is contracted with the plan - referral needed to go to specialist)

 

(+) Part D

from insurance Co

Fills in the hospital deductible 100%. Covers the other 20% of doctor visits so you pay zero for a doctor visit. Usually you pay zero for surgery. Some things have a copay like ambulance and MRI's, CT Scans, emergency room etc. Some things like durable medical equipment and chemotherapy have coinsurance of 20%.

 

Because you have some copays and coinsurance there is a yearly out-of-pocket maximum of typically $1000 to $3400. This only applies to Part C.

 

Part D covers prescriptions and most tiers have a copay although some generics are 0 copay.

(Not all plans  cover as good as this, but typically the ones we offer do.)

Typically costs Zero per month in So Cal, may have cost in Central and Northern CA.

Why is HMO zero cost in most of So Cal? Medicare seems to reimburse insurance companies higher in these areas for managed care, so insurance companies can afford to charge nothing. The insurance company contracts with Medicare and gets paid by Medicare to manage A,B, C and D all in one package for you.

Or This

Medicare Supplement

 

from insurance Co

(choose one plan option: F, G or N)

 

No referral needed. Go to any Dr. in country that accepts Medicare.

 

(+) Part D

from insurance Co

Plan F: fills in the gaps and covers all Medicare medical costs not covered by A and B so you're covered at 100%. No Copays! Costs $130 to $190 monthly depending on zip code.

 

Plan G: same as Plan F except has an annual deductible of $185 (Yr. 2019) Costs $110 to $160 monthly depending on zip code.

 

Plan N: annual deductible of $185 (Yr. 2019) plus $20 Dr. visits, $75 ER copay, and does not cover excess charges, which some doctors charge and some don't. Costs $85 to $130 monthly depending on zip code.

Prescriptions. Copays vary  depending on the tier. Costs $20 to $60 monthly. (Most get by for $25 to $40)

Foreign Travel

Medicare Supplement plans F, G and N all cover Foreign Travel Emergency 80% of care during first two months of each trip. $250 deductible. Usually has a lifetime benefit of $50,000.

Advantage HMO plans usually have worldwide emergency and urgent care. consult specific brochure for details.