Medicare 101

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Medicare Plans

Medicare coverage options can vary greatly from person to person, There are multiple options and benefits in each of the available Medicare plans. You should compare your plan options carefully. Our licensed agents can help you sort through the details and help find a plan that works best for you.
Medicare Part A: Hospital Insurance

Medicare Part A covers hospital stays and inpatient care.

Medicare Part B: Medical Insurance

Medicare Part B covers doctor visits and outpatient care.

Medicare Part C: Medical Advantage

Medicare Advantage covers benefits of Part A (except hospice*) and Part B.

Medicare Part D: Prescription Drug Coverage

Provides coverage for types of drugs commonly prescribed and others. See details.

Medicare Supplement: medigap

Medicare supplement insurance helps with Part A & Part B deductibles, copays and coinsurance, excess charges, & More.

2020/2021 Enrollment Periods

Oct 15 - Dec 7: Annual Enrollment Period.
Jan 01 - Mar 31: Open Enrollment Period.
*Other Periods Available.

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Medicare Part A: Hospital Insurance

Medicare Part A helps pay for hospital stays and inpatient care.
You cannot be denied Part A coverage. You may go to any qualified health care provider in the United States who participates in the Medicare program and is accepting Medicare patients.

Medicare Part A covers hospital stays and inpatient care, including:

  • A semi-private room
  • Your hospital meals
  • Skilled nursing services
  • Care in special units, such as intensive care
  • Drugs, medical supplies and medical equipment used during an inpatient stay
  • Lab tests, X-rays and medical equipment as an inpatient
  • Operating room and recovery room services
  • Some blood transfusions in a hospital or skilled nursing facility
  • Inpatient or outpatient rehabilitation services after a qualified inpatient stay
  • Part-time, skilled care for the homebound
  • Hospice care for the terminally ill, including medications to manage symptoms and control pain

Part A costs in 2020

Premium

  • $0 per month for most people
  • Up to $458 per month if neither you nor your spouse paid Social Security taxes for at least 10 years (40 quarters)

Deductible

  • $1,408 per benefit period

Copay for hospital stays

  • $0 for days 1–60
  • $352 a day for days 61–90
  • $704 a day for each lifetime reserve day

Copay for skilled nursing facility stays

  • $0 for days 1–20
  • $176 a day for days 21–100

For hospice care

  • Copay up to $5 for each prescription to manage symptoms
  • Coinsurance for inpatient respite care to give primary caregiver rest or time off

Medicare Part B: Medical Insurance

Medicare Part B helps pay for doctor visits and outpatient care.
You cannot be denied Part B coverage. You may go to any doctor or qualified health care provider in the United States who participates in the Medicare program and is accepting Medicare patients.

Medicare Part B covers doctor visits and outpatient care, including:

  • Physician services, including in the hospital
  • An annual wellness visit and preventive services, like flu shots and mammograms
  • Lab services, like blood tests
  • X-rays and some other diagnostic tests
  • Some health programs, like smoking cessation, obesity counseling and cardiac rehab
  • Physical therapy, occupational therapy and speech-language pathology services
  • Diabetes screenings, diabetes education and certain diabetes supplies
  • Mental health care
  • Durable medical equipment for use at home, like wheelchairs and walkers
  • Ambulatory surgery center services
  • Ambulance and emergency room services

Part B costs in 2020

Premium

$144.60 per month if any of the following apply to you:

  • You enroll for the first time in 2020.
  • You have Medicare and Medicaid, and Medicaid pays your premiums.

Your premium may be less than $144.60 if you enrolled in Part B before 2019 and your payments are deducted from your Social Security checks.

Your premium may be more than $144.60 if your reported income from 2018 was above $87,000 for individuals or $174,000 for couples.

Deductible

$198 per year

Coinsurance

20% of the Medicare-approved amount for most covered services after you pay the deductible, with no annual out-of-pocket maximum

Medicare Part C: Medicare Advantage

Medicare Advantage (Part C) is another way to get your Medicare benefits.

There are different types of Part C plans. Some plans have provider networks you need to use. Plans are offered by private insurance companies approved by Medicare. Your choices vary depending on where you live. Coverage and costs beyond the standards set by Medicare vary from plan to plan. You must be enrolled in both Part A and Part B to be eligible for a Part C plan.

All Medicare Advantage plans cover:

  • All the benefits of Part A (except hospice care, which is still covered by Part A)
  • All the benefits of Part B

Most Medicare Advantage plans cover:

  • Prescription drugs

Medicare Advantage plans may offer additional benefits, such as:

  • Dental exams, cleanings and X-rays
  • Eye exams, eyeglasses and
  • corrective lenses
  • Hearing tests and hearing aids
  • Wellness programs, fitness membership and worldwide emergency coverage
  • Extras like rides to appointments and home safety devices

Part C costs in 2020

Premium

  • Plan premiums vary widely and can change from year to year.
  • You continue to pay your Part B premium to Medicare.

Deductible

  • Some plans have deductibles, and others don’t.
  • Plans may charge deductibles for drug benefits only.
  • Amounts vary from plan to plan.

Copay

  • Many plans charge copays for doctor visits, prescriptions, etc.
  • Amounts vary from plan to plan.

Coinsurance

  • Plans may set coinsurance terms for certain services.
  • Costs during the Part D coverage gap may apply.

Medicare Part D: Prescription drug coverage

Medicare Part D helps with the cost of prescription drugs.

You can get drug coverage with a standalone Part D plan or as part of a Medicare Advantage plan (Part C).
Some plans have pharmacy networks and mail order pharmacies that offer discounted prices.
Plans are offered by private insurance companies approved by Medicare. Your choices vary depending on where you live. Coverage and costs beyond the standards set by Medicare vary from plan to plan.
You must be enrolled in Part A or Part B to be eligible for a Part D plan.

Medicare Part D plans cover:

  • Types of drugs most commonly prescribed according to federal standards
  • Specific brand name and generic drugs on the plan formulary, or list of drugs
  • Commercially available vaccines not covered by Part B

Coverage stages

Part D coverage has four stages. You pay a share of the cost for your drugs in each stage up to a limit. You may not reach all stages. The cycle restarts each year.

  1. Annual deductible: You pay 100% of the cost up to the plan deductible amount.
  2. Initial coverage: You pay copays or coinsurance up to a set limit ($4,020 in 2020).
  3. Coverage gap (donut hole): You pay a percentage of the cost up to an out-of-pocket limit ($6,350 in 2020).
  4. Catastrophic coverage: You pay reduced copays for the rest of the year.

Part D costs in 2020

Premium

  • Plan premiums vary widely and can change from year to year.
  • You may pay a premium penalty if you are late to enroll in Part D.
  • Many Part C plans include drug coverage.

Deductible

  • The maximum deductible in 2020 is $435.
  • Not all plans have a deductible.
  • Plans may apply separate deductibles for drugs in different tiers.

Copay

  • Plans may charge copays for prescriptions and refills. Amounts vary.

Coinsurance

  • Some plans may set coinsurance rates for certain drugs or drug tiers.
  • In 2020, you pay 25% of the cost for both brand name and generic drugs.

Medicare supplement insurance: Medigap

Medicare supplement insurance helps pay some out-of-pocket costs that come with Original Medicare.

Medicare supplement insurance plans are standardized by the federal government. Each is labeled with a letter. Every plan with the same letter offers the same benefits, no matter what state it’s offered in or by which insurance company. Massachusetts, Minnesota and Wisconsin standardized plans differently.
The level of coverage varies. There are standardized plans that cover all your Medicare deductibles, copayments and coinsurance, while others leave some costs for you to pay on your own. Medicare supplement plans provide nationwide coverage.

All Medicare supplement plans fully or partially pay:

  • Part A hospital coinsurance
  • Part B coinsurance or copays
  • Cost of blood transfusions (first 3 pints)
  • Costs for 365 extra hospital days
  • Hospice care coinsurance

Medicare supplement plans may also help pay:

  • Part A deductible
  • Part B deductible (not available to those newly eligible in 2020 or beyond)
  • Part B excess charges
  • Cost of foreign travel emergency care up to plan limits
  • Part A skilled nursing facility care coinsurance

Medicare supplement insurance costs

Premium

  • Insurance companies set their own plan premiums.
  • Plans that provide more coverage generally have higher premiums.
  • Premiums may vary from insurer to insurer even if the plans offer the exact same coverage.
  • Premiums may change from year to year.

Enrolling in Medicare

Initial Enrollment Period

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. 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 may also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D).

General Enrollment Period

You may use the General Enrollment Period (GEP) to enroll in Medicare Part A, Part B or both if you miss your IEP. The GEP happens every year from January 1 to March 31. You may also choose to join a Medicare Advantage plan or a prescription drug plan from April 1 to June 30 the same year.

Medicare Supplement Open Enrollment Period

Your 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 can apply to enroll at any time after this, but during open enrollment you are guaranteed coverage. Later you could be denied or charged more based on your health history. Some states may allow for additional enrollment periods.

Special Enrollment Period: Working past 65

You may qualify for a Special Enrollment Period (SEP) to enroll in Part A, Part B or both without penalty for up to 8 months after the month your (or your spouse’s) employment or employer coverage ends, whichever comes first. You may join a Medicare Advantage plan or prescription drug plan up to 2 full months after the same event, if you are eligible.

You have just 63 days to enroll in Part D without penalty once your employer coverage ends. Ask your employer for a notice of “creditable drug coverage.”

Medicare Made Clear 2020 Getting Started Guide

The information found in this section of our website is derived from the Medicare Made Clear Getting Started Guide. For more detailed information about Medicare plans, coverage options, plan changes, who is eligible, and more, we invite you to download a copy the guide using the link below.