What is Medicare?

The federal government's health insurance program for these US citizens:

• people 65 or older
• people under 65 with certain disabilities
• people suffering with kidney failure needing dialysis or who have received a transplant (ESRD)
• people suffering from Lou Gehrig's Disease (ALS)

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What is Original Medicare?

• Part A (Hospital Insurance)
• Part B (Medical Insurance)

Whether you live in Lubbock, Amarillo, or West TX, if you receive benefits through Original Medicare, you can see any doctor or hospital that accepts it.

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What does Part A cover?

Part A hospital insurance covers:

• inpatient hospitalization
• skilled nursing facility care
• some home health care
• hospice care
• blood after the first 3 pints

Part A details at medicare.gov

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What does Part B cover?

Part B medical insurance covers:

• physicians services inpatient or outpatient
• inpatient and outpatient medical services
• inpatient and outpatient surgical services
• inpatient and outpatient supplies
• diagnostic test
• durable medical equipment
• physical therapy and speech therapy
• blood is covered at 80% after the first 3 pints and deductible
• some home health care

Part B details at medicare.gov

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What does Part A cost?

For most people Part A is free upon turning age 65. This is due to the fact that Part A is funded by Medicare payroll taxes. If Part A is not free to you it can be purchased. Click here for Part A costs

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What does Part B cost?

The Part B premium for most is $164.90 per month. Higher income recipients will pay more.

Monthly Part B Premiums

• $164.90 for individual tax return $1-$97,000 or joint tax return $1-$194,000
• $230.80 for individual tax return $97,001-$123,000 or joint tax return $194,001-$246,000
• $329.70 for individual tax return $123,001-$153,000 or joint tax return $246,001-$306,000
• $428.60 for individual tax return $153,001-$183,000 or joint tax return $306,001-$366,000
• $527.50 for individual tax return above $183,001 and less than $500,000 or joint tax return above $366,001 and less than $750,000
• $560.50 for individual tax return $500,000 or above or joint tax return $750,000 or above

Part B Deductible for 2023 is $226.00 for the calendar year.

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Does Medicare pay for everything?

No, you must pay any Medicare deductibles, co-pays and co-insurances. This is why many people purchase a Medicare Supplement.

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Part A deductible & coinsurance's

Hospitalization* (Semiprivate room and board, general nursing, and miscellaneous services and supplies)

• $1,600 Part A Deductible for each benefit period (Patient responsibility)
• Days 1-60 Medicare pays all but the Part A Deductible for each benefit period
• Days 61-90 Medicare pays all but $400 coinsurance per day for each benefit period (Patient is responsible for the $389 coinsurance per day)
• Days 91-150 Medicare pays all but $800 coinsurance per each "lifetime reserve day" for each benefit period up to a total of 60 days over your lifetime (Patient is responsible for the $800 coinsurance per day)
• Beyond lifetime reserve days patient pays all costs

Skilled Nursing Facility Care* (You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital)

• Days 1-20 Medicare pays all approved costs for each benefit period
• Days 21-100 Medicare pays all but $200 coinsurance per day for each benefit period (Patient is responsible for the $200 coinsurance per day)
• Day 101 and beyond patient pays all costs

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Blood

• Patient pays for the first 3 pints
• Medicare pays any approved additional ammounts

Hospice Care (You must meet Medicare's requirements, including a doctor's certification of terminal illness)

• Medicare pays for approved amounts including all but very limited copayment or coinsurance for outpatient drugs and inpatient respite care
• Patient pays Medicare copayment or coinsurances

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Part B deductible & coinsurance's

Medical Expenses (In or out of the hospital and outpatient hospital treatment such as: physicians services, inpatient and outpatient medical services, surgical services or supplies, physical and speech therapy, diagnostic tests, durable medical equipment)

• $226 Part B Deductible (Patient responsibility for each calendar year)
• Medicare pays generally 80% of approved amounts after the Part B Deductible has been met
• Patient responsibility for the remaining approved 20% amount and any non-approved charges

Part B Excess Charges (Patient responsibility if doctor charges above Medicare's approved amounts)

Blood

• Patient pays for the first 3 pints
• Patient pays $226 Part B Deductible if that has not been met for the calendar year
• Medicare generally pays 80% of Medicare approved amounts
• Patient responsibility for the remaining Medicare approved 20% amount

Clinical Laboratory Services (Tests for diagnostic services)

• Medicare pays all approved amounts

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What is Medicare Part D?

• The federal government's prescription drug plan
• Avoid the Part D late enrollment penalty

 

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What is Part C (Medicare Advantage)?

Health plans that provide Part A and B benefits through privately owned companies who have contracted with Medicare.

Part C details

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New to Medicare 101 Education Recap:

• Part A is Hospital coverage
• Part B is Medical coverage
• Part D is Prescription Drug Plan coverage
• Part C is a Medicare Advantage Plan coverage

Staying on Original Medicare allows you to see any doctor or hospital that accepts it, whether you live in Lubbock, Amarillo, West TX or travel in the USA.

Click here if you are no longer new to Medicare & ready to enroll

Click here for education on Medicare Supplement Plans available in Lubbock, Amarillo & West TX