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What is medicare?

Medicare is a Federal Health Insurance Program administered by the Centers for Medicare and Medicaid Services for those who are:

1. 65 and older
   
2. Any age and disabled
   
3. Diagnosed with end stage renal disease

Medicare Part A covers:

• Inpatient hospitalization​
• Skilled Nursing Facilities
• Home Health Care
• Hospice 

$1,600 Hospital 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).

Medicare Part B Covers:

• Doctors and Providers
• Preventative Benefits
• Durable Medical Equipment
• Outpatient Services 

The standard Part B premium amount in 2021 is $164.90. 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.

Part C Medicare Advantage:

A Medicare Advantage plan is a type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include:

• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

• Most Medicare services are covered through the plan
• Medicare services aren’t paid for by Original Medicare

Most Medicare Advantage Plans offer prescription drug coverage.


Part D Prescription Drug Coverage:

All people with Medicare can get Part D

Medicare’s Prescription Drug Coverage

Offered by Private Companies that contract with Medicare

Medicare prescription drug coverage is available two ways:

•  Stand alone Prescription Drug Plans (PDP’s)
• Available through Medicare Advantage Plans (MAPD’s)

Initial enrollment in Medicare Part D is the same as Part B

Open Enrollment for Prescription Drug Coverage is October 15th- December 7th

Your coverage will begin on January 1st 

Medicare beneficiaries can expect to pay more during the various coverage phases.

This cost-sharing chart outlines what people with Medicare will pay for prescription coverage in each phase, including:

• A deductible of up to $505 (varies by plan)
• 25% of the costs of their prescription drugs in the Initial Coverage Period (or up to $1,107.50 if in a plan with no deductible)
• Up to a total of $4,660 out-of-pocket before the beneficiary reaches the Catastrophic Benefits Period. Once they hit this threshold, the Medicare beneficiary will pay either 5% coinsurance or $3.95 copay for generic medications, and $9.85 for brand-name drugs