What does Part B cover?

Medicare Part B generally covers “medically necessary services” & preventive services

• Medically necessary services – services or supplies that are needed to diagnose or treat your medical condition & meet accepted standards of medical practice
• Preventive services – Health care to prevent illness (ex: flu) or detect it at an early stage when treatment is most likely to work best

What can I expect to pay for Part A and Part B (Original Medicare)?

Part A

• Usually you will not pay a monthly premium for Part A coverage (Hospital Insurance) if you or your spouse paid Medicare taxes while working.

Part B

• Most people will pay the standard Part B premium amount of $134 in 2017
  • If your modified adjusted gross income (MAGI) is above a certain amount, you may be required to pay an Income Related Monthly Adjustment Amount (IRMAA)
    • Medicare uses the MAGI from 2 years ago in the current year’s calculation
  • Most people receiving Social Security benefits will pay less than the standard premium because the Part B premium increased more than the cost-of-living increase for 2017 Social Security benefits
• You will pay the standard premium amount if you meet 1 of 5 requirements this year
  • Enrolling in Part B for the first time
  • You don’t get Social Security Benefits
  • You are billed directly for Part B premiums
  • You have Medicare & Medicaid, and Medicaid pays your premiums
  • Your MAGI from 2 years ago is above a certain amount

Part B Deductible & Coinsurance

• The annual deductible for Part B is $183. After this is met, you will typically pay 20% of the Medicare-approved amount for the following:
  • Most doctor visits
  • Most doctor services while you are a hospital inpatient
  • Outpatient therapy
  • Durable medical equipment

What does Part C (Medicare Advantage Plan) cover?

Part C is offered by private companies that contract with Medicare to provide you with all of your Part A & Part B benefits. Medicare Advantage Plans must cover all services that Original Medicare (Part A & Part B) covers, except hospice care, and is provided by private insurance companies.

• In most plans, you will need to use doctors, hospitals & other providers allowable under your specific plan or you will pay more or pay all of the costs
• The plan has the ability to choose not to cover the costs of services that are not medically necessary under Medicare
  • Check with your provider before you get the service if you are unsure whether a service is covered

What does Part D (Prescription Drug Plan) cover?

Part D adds prescription drug coverage & is offered by insurance companies and other private companies approved by Medicare. Each Medicare Prescription Drug Plan has a unique list of covered medications. These medications are organized into different “tiers” based on the specific plan with each tier having a different cost.

What does Medicare Supplement Insurance (Medigap) cover?

A Medigap policy is sold by a private company & can help pay some health care costs not covered by Original Medicare (ex: medical care when you travel outside the U.S.)

• You must have Medicare Part A and Part B in order to purchase a Medigap policy

How does Medicare work with other insurance?

When you have other health insurance/coverage, each is considered a “payer”. When there is more than one payer, “coordination of benefits” rules apply to decide which one pays first.

• Primary payer pays up to the limits of its coverage
• Secondary payer then pays if there are uncovered costs remaining that the primary insurer did not cover
  • The secondary payer may not pay all of these uncovered costs
• If your employer insurance is secondary, you may need to enroll in Medicare Part B before that insurance will pay anything

Are there any unique/special Circumstances?

Special rules apply to those with Railroad Retirement Board (RRB) benefits and/or disability benefits, in addition to other things. Contact your financial planner if you think you might have a special circumstance.

Check out these additional sources of information from The Center

• Medicare Open Enrollment Webinar
• Medicare Updates for 2017
• Hold-Harmless Provision
• The Official National Medicare Handbook