FAQ

Part A covers limited services and supplies provided in hospitals, skilled nursing facilities and nursing homes.  Part A can also cover hospice care and eligible home health services. 

Part A costs for hospitals and skilled nursing facilities are defined by 60-day “benefit periods.”  Each benefit period triggers the Part A deductible ($1364 in 2019).[1]  A new benefit period begins when you are re-admitted after 60 days of receiving no inpatient hospital or skilled nursing facility care.  It is possible to incur the Part A deductible several times in one year if you have multiple hospitalizations.  You are also responsible to pay copays for days 61-90 in a hospital and for days 21-100 in a skilled nursing facility.

 


[1] “Medicare costs at a glance,” U.S. Centers for Medicare and Medicaid, accessed January 3, 2019, https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

 

 

Part B is known as medical insurance and covers a wide range of benefits, such as eligible doctors’ services, outpatient services, screenings, diagnostic and lab tests, rehabilitation, chemotherapy and preventive services. 

After paying a once-per-year Part B deductible ($185.50 in 2019)[1], you are responsible for 20% of most Part B services.  Some services are covered 100% by Medicare, such as screenings, flu shots and a yearly Wellness Visit.

 


[1] Medicare costs at a glance

Your first opportunity to enroll in Part B is usually when you turn 65, in your Initial Enrollment Period.  You may enroll in Part B as soon as three months before the month you turn 65.  In this case, your Part B coverage will begin the first of the month in which you turn 65.  You may also enroll in Part B during the three months following your birthday month.  Your effective date will be the first of the following month after you enroll.  If you enroll during the third month following your birthday month, your effective date will be the first of that month. 

If you do not enroll in Part B during your Initial Enrollment Period, you may enroll in Part B during the General Enrollment Period between January 1 - March 31.  Your coverage will be effective the following July 1.  Late enrollment penalties may apply.

Certain life events may qualify you to enroll in Part B during the year through a Special Enrollment Period.  The most common Special Enrollment Period occurs when you leave a group health plan based on the current employment of yourself or your spouse.  You’ll have an 8-month period to sign up for Part B without incurring a late enrollment penalty.

I’m turning 65 and I’m already receiving my Social Security benefit:  If you are already receiving your retirement benefit from Social Security, you will be automatically enrolled in Part B as of the first of the month of your 65th birthday.  You can expect to receive your Medicare card in the mail before your birthday month.

I’m turning 65 but I’m delaying my Social Security benefit:  If you are delaying your Social Security retirement benefit, you will not be automatically enrolled in Medicare. You can easily apply for Medicare online at https://www.ssa.gov/medicare.  You can also apply in person at a local Social Security office, or by calling Social Security at 800-772-1213. 

I’ve been working since I turned 65 and have been covered by a group plan:  You will not be able to apply for Medicare online. You will need to submit two forms to Social Security in order to qualify for a Special Enrollment Period and avoid the late enrollment penalty.  The first form, CMS 40-B, is the Application for Enrollment in Medicare-Part B.  In the “Remarks” section of the form, indicate the first of which month you would like your Part B coverage to be effective.  The second form, CMS-L564, documents your group coverage since you became eligible for Medicare and requires your employer to complete part of the form.  Once both forms are completed, take them to your local Social Security office. 

I did not enroll in Part B when I turned 65 and have not had group coverage:  During the General Enrollment Period between January 1 - March 31, you can enroll in Part B by completing the form CVS 40-B, the Application for Enrollment In Medicare-Part B, and submitting it to your local Social Security office.  Your coverage will be effective on July 1.  You may be subject to a late enrollment penalty. 

If you delay enrollment in Part B after you have become eligible for Medicare and are not covered by other insurance such as a group plan, you may incur a late enrollment penalty.  The penalty is triggered when you enroll in Part B and is based on the amount of time that has passed since your Initial Enrollment Period expired at the end of the third month following your 65th birthday month.  The penalty will be applied as long as you have Part B. 

The Part B late enrollment penalty is 10% of the Part B monthly premium for each full 12-month period you were without Part B following your Initial Enrollment Period. 

EXAMPLE:  Mr. Farnham turned 65 in September of 2011 and is not covered by a group plan.  He enrolled in Part B as of July 1, 2015.  His penalty begins January 2012, three months following the month he turned 65.  Three full 12-month periods elapse before he enrolls in Part B in July of 2015.  Therefore, his Part B late enrollment penalty is 30%.

If you delay enrollment in Part D after you have become eligible for Medicare and do not have creditable prescription drug coverage from another source, you may incur a late enrollment penalty.  Creditable prescription drug coverage is coverage as good as or better than Medicare drug coverage.  Examples would include drug coverage from most group plans, VA and TRICARE.  If you receive state aid for your prescriptions costs through the Extra Help program, you are exempt from the late enrollment penalty.  The penalty is triggered when you enroll in Part D and will be applied as long as you have Part B or Part D.

The Part D late enrollment penalty is 1% of the “national base beneficiary premium” ($33.19 in 2019)[1] times the number of full months you were without Part D, starting 63 days after your Initial Enrollment Period ends.  Your Initial Enrollment Period ends three months following your 65th birthday month.  The national base beneficiary premium may change every year.


[1] “Part D Late Enrollment Penalty,” U.S. Centers for Medicare and Medicaid, accessed January 3, 2019, https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty

If your modified adjusted gross income exceeded $85,000 (single) or $170,000 (joint) two years ago, then an Income Related Monthly Adjustment Amount (IRMAA) may be applied to your Part B and Part D premiums in the current year.  Every year this IRMAA will be recalculated based on the MAGI on your tax return reported two years previously. 

Individual Tax Return Filed in 2017

Joint Tax Return Filed in 2017

Married & Separate Tax Return Filed in 2017

Part B Premium in 2019

$85,000 or less

$170,000 or less

$85,000 or less

$135.50

above $85,000
up to $107,000

above $170,000
up to $214,000

Not Applicable

$189.60

above $107,000
up to $133,500

above $214,000
up to $267,000

Not Applicable

$270.90

above $133,500
up to $160,000

above $267,000
up to $320,000

Not Applicable

$352.20

above $160,000
up to $500,000

above $320,000
up to $750,000

above $85,000
up to $415,000

$433.40

$500,000 and above $750,000 and above $415,000 and above $460.50

 

[1]

 

Individual Tax Return Filed in 2017

Joint Tax Return Filed in 2017

Married & Separate Filed in 2017

Part D Premium in 2019

$85,000 or less

$170,000 or less

$85,000 or less

your plan premium

above $85,000
up to $107,000

above $170,000
up to $214,000

Not Applicable

your plan premium + $12.40

above $107,000
up to $133,500

above $214,000
up to $267,000

Not Applicable

your plan premium + $31.90

above $133,500
up to $160,000

above $267,000
up to $320,000

Not Applicable

your plan premium + $51.40

above $160,000
up to $500,000

above $320,000
up to $750,000

above $85,000
up to $415,000

your plan premium + $70.90

$500,000 and above $750,000 and above $415,000 and above your plan premium + $77.40

 

[2]

 

[1] “Part B Costs,” U.S. Centers for Medicare and Medicaid Services, accessed January 3, 2019, https://www.medicare.gov/your-medicare-costs/part-b-costs

[2] 5 “Monthly premium for drug plans,” U.S. Centers for Medicare and Medicaid Services, accessed January 3, 2019, https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

Your costs for a Part D prescription drug plan include monthly premiums, copays, and possibly a deductible.  Each plan has a monthly premium which is usually paid out of your Social Security benefit.  If you are not receiving your Social Security benefit, you will be billed on a quarterly basis.  Depending on your income, you may be subject to an Income Related Monthly Adjust Amount (IRMAA).
Your cost for prescription drugs purchased at a pharmacy are determined by four stages of payment, known as Deductible, Initial Coverage, Coverage Gap and Catastrophic Coverage.  Part D prescription drug plans may or may not impose a deductible.  You are responsible to pay the full cost of prescriptions until you have satisfied the deductible.  After the deductible is satisfied, you pass into the Initial Coverage stage, where the plan pays a portion of your prescription costs and you pay copays based on the tier assigned to your drug.  If the retail cost of your prescriptions passes a certain threshold, you will reach the Coverage Gap, where you pay 25% of brand name drugs and 37% of generic drugs.  After passing another threshold, you reach the Catastrophic Coverage stage where you are responsible for only a small coinsurance (5%) or a flat copay.

Medicare is a secondary payor for medical services received as a result of an auto-related injury.  Therefore, it is important for Medicare beneficiaries to have auto insurance policies with primary payor coverage for auto-related medical services.

Medicare does not cover dental services.  Some Medicare Advantage plans offer limited dental coverage and may also offer “buy-ups” for additional dental services.  It is possible to buy stand-alone dental insurance plans.  In addition, many dentists offer cash payment programs for dental services to their clients.