Most persons do not have to pay a Part A premium if they or their spouse paid Medicare taxes for at least ten years while working.
Part A is also free if:
- When enrolling, you receive Social Security or Railroad Retirement Board (RRB) payments.
- You’ve been on disability for at least 24 months.
Part B has a monthly fee collected from your Social Security or, for those who receive them, your RRB payments. The usual Part B premium for 2022 is $170.10 – or higher, depending on your income.
In addition to premiums, plan participants must pay a deductible and coinsurance with Original Medicare. For example, the inpatient hospital stays deductible in 2022 is $1,556 per benefit period. Part B has a $233 yearly deductible. When you have reached your deductible, you generally pay 20% of the Medicare-approved price for most doctor treatments.
Private insurance firms hired by the federal government, such as Humana, provide Medicare Advantage plans. Medicare Advantage, commonly known as Medicare Part C, except for hospice care, covers the same healthcare services as Original Medicare. For example, prescription medication coverage is available with many Medicare Advantage plans. In addition, many Medicare Advantage plans offer vision, dental, and hearing care. Fitness programs and other health and wellness advantages may also be provided.
There are two options for obtaining Medicare prescription medication coverage:
- You have the option of selecting a Medicare Advantage plan that includes prescription medication coverage (these are called Medicare Advantage prescription drug plans)
- You may supplement your Original Medicare with a separate prescription medication coverage known as Part D.
The amount you pay out of pocket for prescription medication deductibles, copays, and coinsurance varies by plan. Check the Drug List (a list of covered pharmaceuticals) for each plan to discover what drugs are covered.
Medicare Supplement insurance, often known as Medigap coverage, may assist in covering some of the healthcare expenditures that Original Medicare does not cover. This might include:
- Copayments
- Coinsurance
- Deductibles
- Medical treatment when traveling outside of the U.S.
In addition to your Part B costs, you’ll have to pay a monthly premium for a Medicare Supplement plan. Medicare Supplement plans and Medicare Advantage plans are not the same thing. Only Original Medicare and Medicare Supplement policies can be combined.
A primary care physician is not necessary under Original Medicare. However, you are free to see any doctor who takes Medicare. The type of doctor you may see with a Medicare Advantage plan determines whether you choose a health maintenance organization (HMO) or a preferred provider organization (PPO).
Under an HMO plan, you can pick any doctor in the plan’s network as your primary care provider. Choosing a primary care provider is often optional if you choose a PPO plan. Visiting a network supplier can typically save you money on both sorts of services.
It should be noted that Medicare Advantage plans must provide emergency coverage outside the plan’s service region, anywhere in the United States.