Seniorstar Insurance Group

Category: Original Medicare

  • Maximizing Your Medicare Advantage: 5 Ways to Optimize AEP Decision-Making

    Maximizing Your Medicare Advantage: 5 Ways to Optimize AEP Decision-Making

    The Annual Election Period (AEP) is a crucial time for Medicare Advantage beneficiaries to review and make changes to their healthcare coverage. AEP occurs annually from October 15th to December 7th, allowing beneficiaries the opportunity to assess their current Medicare Advantage plan and make adjustments if needed.

    During AEP, Medicare Advantage beneficiaries have several options available to them:

    • Switching Plans: Beneficiaries can change from their existing Medicare Advantage plan to a different one. This could involve transitioning to a plan with different coverage options, network providers, or prescription drug coverage. It’s essential to compare plans to ensure the new choice aligns with their healthcare needs.
    • Enrolling in Medicare Advantage: Individuals who are eligible for Medicare but not currently enrolled in a Medicare Advantage plan have the option to join one during the AEP. This is an opportunity for those who have Original Medicare to explore the benefits of Medicare Advantage, which often includes additional coverage like dental, vision, and prescription drugs.
    • Returning to Original Medicare: If a Medicare Advantage beneficiary decides that they no longer want the additional benefits provided by their current plan, AEP allows them to switch back to Original Medicare (Part A and Part B). They can also enroll in a standalone Medicare Part D prescription drug plan if needed.
    • Changing Prescription Drug Coverage: Beneficiaries can review and adjust their prescription drug coverage during AEP. This might involve switching to a different Medicare Advantage plan that offers better prescription drug coverage or enrolling in a separate Part D prescription drug plan if their current plan doesn’t adequately meet their medication needs.
    • Reviewing Costs and Benefits: AEP is an ideal time for beneficiaries to assess their healthcare needs, budget, and any changes in their health status. Comparing plans’ costs, including premiums, deductibles, copayments, and coinsurance, alongside the benefits they offer, can help individuals select a plan that provides the coverage they need at a price they can afford.

    In summary, the Annual Election Period offers Medicare Advantage beneficiaries the chance to reevaluate their healthcare coverage and make necessary adjustments. Whether it’s switching plans, enrolling in Medicare Advantage for the first time, returning to Original Medicare, modifying prescription drug coverage, or simply reviewing costs and benefits, beneficiaries should take advantage of this period to ensure their healthcare plan aligns with their evolving needs. It’s advisable to research and compare available plans, considering factors such as coverage options, provider networks, costs, and additional benefits to make an informed decision that suits their individual circumstances.

  • Medicare and Disabilities: What You Should Know

    Medicare and Disabilities: What You Should Know

    Medicare and Disabilities: What You Should Know

    For most beneficiaries, Medicare eligibility begins near. However, this is not the only qualifier for Medicare eligibility. Certain people with disabilities will qualify for Medicare enrollment before age 65. A few criteria must be met before one is eligible to receive Medicare before the age of 65.

    End Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS)

    Beneficiaries with either ESRD or ALS do not have to receive Social Security Disability benefits for 24 months to be eligible for Medicare.

    A person with ESRD must wait three months after a regular course of dialysis or three months after a kidney transplant to become eligible for Medicare. For ESRD, there are some criteria you must meet to receive benefits. You must have worked the required time and paid Social Security. You can also join the Railroad Retirement Board or have been a government employee. Getting Social Security or Railroad Retirement Board benefits will also qualify you. These two criteria can enable you to be covered if your spouse also meets these criteria.

    ALS is different because you are eligible for Medicare when collecting Social Security Disability benefits. There is typically a 5-month window between when a person is diagnosed with a disability and when they begin receiving Social Security Disability benefits.

    How Can I Enroll in Medicare If I Have a Disability?

    To enroll in Medicare with a disability, if you have been receiving Social Security Disability benefits for 24 months, you will automatically be enrolled. You will receive your Medicare card in the mail and a letter explaining that you are now enrolled in Medicare Part A and Part B. If you meet the standards but don’t qualify for Social Security Disability benefits, you can still purchase Medicare by paying a monthly premium for Part A and B.

    What Are the Medicare Benefits People with Disabilities Receive?

    The benefits people with disabilities receive through Original Medicare are the same as other beneficiaries who enroll in Original Medicare. This includes Medicare Part A coverage (inpatient care at a hospital, care in a skilled nursing facility, care in a nursing home, hospice care, and home health care) and Medicare Part B coverage (clinical research, ambulance services, durable medical equipment, and mental health care). These services don’t have to relate to a person’s disability.  Dual Special Needs Plans are a type of Medicare Advantage (Part C) plan that can offer personal care services and nursing home care that Original Medicare doesn’t cover for beneficiaries with certain conditions.

    Are There Other Conditions that Can Disqualify Me from Medicare Enrollment?

    Technically, no disabilities, illnesses, or underlying conditions disqualify someone from ever being enrolled in Original Medicare. Once someone meets the criteria for becoming Medicare eligible, they can enroll in Original Medicare. Beneficiaries can’t be denied coverage because of a timetable related to their condition or improvement of that condition. This means that people with mental illness, dementia, and other long-term chronic conditions could still possibly enroll in Medicare.

    However, it is crucial to understand the eligibility requirements for Medicare and that not all conditions make an individual eligible for Medicare. If someone does not have conditions or disabilities making them eligible for Medicare before turning 65, they will still become eligible when they are turning 65.

    Can Medicare Deny “Maintenance Only” Services?

    Even if a service is considered “maintenance only,” meaning it is only expected to maintain a condition or slow deterioration, it can still be covered by Original Medicare. Examples of “maintenance-only services” include physical therapy, which may be critical to maintaining a livable variant of a condition. Some conditions are more at risk of being unfairly denied coverage for services than others.

    Beneficiaries with conditions such as Alzheimer’s Disease, mental illness, Multiple Sclerosis, Parkinson’s Disease, and other long-term conditions are entitled to coverage if their provider order care that meets Medicare criteria. Consult with your doctor if you feel coverage has been wrongfully denied.

    If I Have a Disability, Can I Still Work and Receive Medicare Coverage?

    You can still work and receive Medicare coverage because of your disability. However, one must follow many guidelines while needing Medicare coverage while working with a disability. The Social Security Administration breaks this eligibility down into three time frames: Trial Work Period (TWP), Extended Period of Eligibility (EPE), and indefinite access to Medicare.

    Trial Work Period (TWP)

    If a disabled individual wants to try and work, they can do so and still receive Medicare during their Trial Work Period. The Trial Work Period consists of 9 months within any rolling 5-year period. A month is considered a month of service for a trial work period if it exceeds 2023’s amount of $1050 a month or if they work over 80 hours of self-employment monthly. It’s important to note that these nine months need not be consecutive. The beneficiary’s ability to perform their job cannot be used to disqualify them from receiving Medicare benefits – during the 9-month Trial Work Period. However, the work may be considered in determining the individual’s disability status and Medicare eligibility once the 9-month period has ended.  

    Extended Period of Eligibility (EPE)

    Beneficiaries whose disability is still active but who’ve earned income meeting or surpassing that of the “Substantial Gainful Activity” level can still receive Medicare coverage after their trial work period is over.

    The Substantial Gainful Activity levels are levels of income an individual cannot pass and still receive Medicare benefits. For statutorily blind individuals in 2023, the monthly amount is $2460; for non-blind individuals, the monthly amount is $1470. Read more here.

    The Extended Period of Eligibility lasts much longer than the trial work period; it can be extended as long as 93 months after it has ended. The beneficiary will pay no premiums for Medicare Part A; however, they are still responsible for their Medicare Part B premium. An individual’s Social Security Disability (SSDI) cash benefits may also end during this period.

    Indefinite Access to Medicare

    Suppose an individual remains medically disabled after the Extended Period of Eligibility (8.5 years) is up. In that case, they can still receive access to Medicare benefits if they are still considered medically disabled. They will however be required to pay both the Medicare Part A premium and the Medicare Part B premium. Original Medicare Part A’s premium will be determined by how many quarters you or your spouse worked and paid into Social Security. There is a helpful state-run buy-in program that can help low-income individuals pay these premiums.

    Seniorstar Insurance Group can help with any Medicare questions you may have. Contact us today for a free, no-obligation review of your coverage.

  • Will Medicare cover help for back pain?

    Will Medicare cover help for back pain?

    Will Medicare Cover Help for Back Pain?

    Back pain is a common problem among older adults in the United States. Because of this, the Centers for Medicare and Medicaid Services (CMS) has added more coverage in recent years that assists with covering back pain treatments.

    What kind of back pain treatments are covered by Medicare?

    Medicare will cover a list of non-surgical or minimally invasive treatments and even some required surgeries. Each part of Medicare will cover their respective treatments for back pain, and the costs have many factors that go into them. Even though Medicare has expanded its coverage of back pain, some more invasive treatments can still be difficult to get. Medicare may require treatments to be medically necessary before it is covered. This means they may require your pain to be at a certain level for a while. It could also mean they might make you try less invasive treatments first; if they fail, they will cover further treatment.

    What Are the Non-Surgical Treatments Medicare Covers?

    Medicare covers most common treatments and has even expanded the coverage in recent years. Below is a chart showing which common back pain treatments are covered by the different parts of Medicare.                                             

    What Are the Surgical Treatments Medicare Covers?

    Medicare may cover surgeries for back pain but often require less invasive treatment to be tried and unsuccessful first. When it comes to surgery, Medicare looks at it as a last resort and wants it to be medically necessary to cover it.

    Always speak with your physicians and surgeons if you suspect you may need surgery to ensure your back pain treatments are covered. Seniorstar Insurance Group can help you get the right Medicare coverage for your needs. Call us for a free, no-obligation review of your coverage today!

  • What Isn’t Covered by Original Medicare?

    What Isn’t Covered by Original Medicare?

    What Isn’t Covered by Original Medicare?

    If you choose to enroll in Original Medicare, it covers most of your healthcare needs after you turn 65 or if you qualify earlier due to certain disabilities or End Stage Renal Disease (ESRD). Original Medicare Part A covers inpatient hospital stays, surgeries, skilled nursing facilities, and some hospice and home care. Original Medicare Part B covers doctor visits, preventative services, durable medical equipment and supplies, and outpatient care. With all that coverage, Original Medicare still leaves you are responsible for some out-of-pocket costs, and there are still services left uncovered. If you choose to keep your Original Medicare coverage, enrolling in a Medicare Supplement, aka Medigap, plan can help fill in some of these gaps. You also have the option to opt for a Medicare Advantage (Part C) plan; these plans offer at least as much coverage as Original Medicare Parts A & B. They also may include additional benefits as well as prescription drug coverage.

    Here are a few things Original Medicare Parts A & B don’t cover.

    Prescription Drugs

    Original Medicare Part A & Part B do not cover prescription drugs. You will need to enroll in a standalone Medicare Part D Prescription Drug Plan to receive prescription drug coverage (and avoid penalties ) if you plan on enrolling in Original Medicare. You can enroll in Medicare Part D during your initial enrollment period. If you choose to enroll in a Medicare Advantage (Part C) Plan, prescription drug coverage may be included.

    Long-Term-Care

    Original Medicare Parts A & B do not cover long-term care. While some of the care in a skilled nursing facility may be covered, not all is. The average cost of a nursing home is upwards of $100,000 without any form of insurance. There is long-term care insurance to help individuals cover these costs.

    Co-pays and Deductibles

    Although Original Medicare covers trips to the doctor’s office, hospital stays, or any outpatient care, you still have to pay co-pays or deductibles. Original Medicare Part A will require a deductible before coverage begins, and you must pay a portion of the cost of a long hospital stay starting at day 61. Original Medicare Part B will also require a deductible, but you also must pay 20% of the costs of doctors’ services with Part B. Medicare Supplements can help ease the burden of some of these costs.

    Dental and Vision Care

    Most routine dental care is not covered by Original Medicare. Routine visits, cleanings, fillings, extractions, and dentures will have to be covered by a separate insurance plan if you choose to enroll in Original Medicare. Some Medicare Advantage (Part C) Plans can cover these basic cleanings and X-rays, but these plans have an annual coverage cap (as may some standalone dental plans). Routine vision care is also not covered by Original Medicare. There are exceptions to this, such as if you have diabetes or must have cataract surgery; you may get an annual eye exam through this exception. Some Medicare Advantage (Part C) Plans include routine vision care. For those choosing to enroll in Original Medicare, you may want to consider a standalone vision insurance plan.

    Hearing Care

    Hearing aids are another essential healthcare item for many. However, unfortunately, Original Medicare does not cover hearing aids or routine hearing exams. Just like vision or dental, some  Medicare Advantage (Part C) plans may be able to cover hearing care costs. Standalone hearing care plans are also an option.

    Traveling Abroad

    Any care you receive while abroad will not be covered by Original Medicare. However, some Medicare Supplements offer emergency care coverage when traveling abroad.

    Choosing the Best Coverage for Your Needs

    It’s important to fully understand the coverage you will receive, regardless of which type of plan you choose to enroll in when the time comes. For some people, Original Medicare and a Medicare Supplement provide the most effective mix of coverage, along with a Medicare Part D Prescription Drug Plan. Others may find the best option for their needs & budget is to enroll in a Medicare Advantage (Part C) plan. If you have questions about evaluating your Medicare options, give us a call for a no-cost, no-obligation coverage review.

  • How Does Medicare Determine My Premium?

    How Does Medicare Determine My Premium?

    Medicare Part A

    Most people don’t have to pay a premium for Medicare Part A. If you’ve paid Medicare taxes, generally, at least 10 years, or you enrolled in Medicare before 65, you won’t pay a premium for Medicare Part A. Buying Medicare Part A is an option if you don’t qualify for premium-free Medicare Part A. Your Medicare Part A premium will be determined by how long you or your spouse worked and paid Medicare taxes, you will pay either $278 or $506 as your monthly premium.

    Medicare Part B

    Your Medicare Part B premium is determined by your modified adjusted gross income (MAGI). Your MAGI is calculated using your adjusted gross income and several other income sources. The majority of people won’t have to add additional sources of income, so their modified adjusted gross income is the same as their adjustable gross income. This is what is used to determine your monthly premium. Unless you are a high-income earner, you will pay the 2023 standard Medicare Part B premium – $164.50.

    The chart below shows how the Medicare Part B monthly premium increases with your income.

    If you fall into one of these higher income tiers, the Social Security Administration will send a letter explaining their justification for this higher premium.

    If you have a special life event changes your income and puts you in a lower payment tier when it comes to your Medicare Part B premium. Contact the Social Security Administration to explain how this change affects your income.

    Medicare Part D Prescription Drug Plans

    Medicare Part D premiums are similar to Medicare Part B premiums in that the monthly premium can increase for those with higher incomes. The extra amount you pay is called an Income Related Monthly Adjustment Amount (IRMAA). Like Part B, you can let the Social Security Administration know if you’ve had a life-changing event that will change the income level used to determine your Medicare Part D.

    Below, you can see the IRMAA you will pay in addition to your plan premium depending on your income:

    If your filing status and yearly income in 2021 was
    File individual tax returnFile joint tax returnFile married & separate tax returnYou pay each month (in 2023)
    $97,000 or less$194,000 or less$97,000 or lessyour plan premium
    above $97,000 up to $123,000above $194,000 up to $246,000not applicable$12.20 + your plan premium
    above $123,000 up to $153,000above $246,000 up to $306,000not applicable$31.50 + your plan premium
    above $153,000 up to $183,000above $306,000 up to $366,000not applicable$50.70 + your plan premium
    above $183,000 and less than $500,000above $366,000 and less than $750,000above $97,000 and less than $403,000$70.00 + your plan premium
    $500,000 or above$750,000 or above$403,000 or above$76.40 + your plan premium

  • Things to Consider When Changing Medicare Coverage

    Things to Consider When Changing Medicare Coverage

    Regardless of your coverage type, Medicare gives beneficiaries opportunities every year to change coverage to adjust to their ever-changing needs. The biggest time for changing Medicare coverage is the Annual Enrollment Period or AEP. Every year, from October 15th to December 7th, you can switch up your Medicare coverage and join, change, or drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan. When you start thinking about wanting to change your coverage, there are a few things to consider.

    Costs of Medicare Coverage

    When changing your Medicare coverage, one of your main concerns may be “Will my costs change with my new Medicare plan?” Make sure to compare what you currently pay in premiums and deductibles, how much an unexpected hospital stay might be, or what you will pay out of pocket to what you are estimated to pay with any coverage you consider switching to.

    Original Medicare has no out-of-pocket limits unless you have a Medicare Supplement. However, most Medicare Advantage (Part C) plans provide a yearly limit for out-of-pocket costs. 

    If you have an illness or medical problem that requires you to take a lot of prescription medication, it’s important to understand the costs of the prescriptions you take associated with your Medicare Part D Prescription Drug Plan.  You will want to evaluate and compare formularies and Medicare Part D Prescription Drug Plan costs when choosing a new plan.

     Other Coverage

    It’s important to also look at how enrolling in or changing your Medicare coverage is how it may interact with any other coverage you may have, such as retiree insurance or employer-sponsored coverage.

    Prescription Drug Coverage

    For prescription drug coverage, it’s important to evaluate the plan’s star rating, formulary, and coverage rules. Make sure you compare it against your current Medicare Part D Prescription Drug Plan and ensure the medications you need are covered at a cost you can afford.

    Hospital Choice, Doctors, and Travel

    If you choose a Medicare Advantage plan, the network of doctors and hospitals that accept your plan is a very important thing to consider. This can affect the quality and timing of the care you receive. It’s also important to look at if doctors in a new plan are accepting new patients (if

    If you are enrolled in a Medicare Supplement alongside Orignal Medicare, you can see any provider that accepts Medicare.  Care received when traveling outside the United States is not covered by Original Medicare. If you travel abroad, you may want to consider a Medicare Supplement that covers emergency care when abroad. You also may want to consider a Medicare Supplement if you travel in the US, as you can see all providers who take Medicare and are not restricted to a network.

    Whether you are looking to change your Medicare plan to find coverage that will best fit your needs, or you are looking to review your current plan, Seniorstar group can help. Contact us today for a free, no-obligation coverage review.

  • How to Enroll in Medicare if You Have Retiree Insurance

    How to Enroll in Medicare if You Have Retiree Insurance

    How to Enroll in Medicare if You Have Retiree Insurance

    Retiree insurance is employer-provided health insurance that some employers provide to former employees after retirement. This insurance usually pays second to Medicare so in order to be fully covered, you must be enrolled in Medicare. Depending on your policy, you may be required to sign up for Medicare Part A & Part B when you are Medicare-eligible.

    Should I Keep My Retiree Insurance?

    There are some instances where keeping your retiree insurance along with your Medicare coverage may be beneficial if you can afford the premium. Some Retiree insurance plans cover things like Medicare deductibles, copayments, and coinsurances. The Retiree plan may also include prescription drug coverage. If you are satisfied with that coverage, call your plan to see if you can delay your Medicare Part D enrollment.

    It is also important to know that your spouse or family members are not eligible to enroll in your Medicare coverage. If you choose to drop your retiree insurance, keep in mind they may need coverage of their own.

    How Do Medicare and Retiree Insurance Interact?

    Medicare and Retiree insurance are intermingled because if you have retiree insurance you must be enrolled in Medicare to be fully covered. There are differences, however, in how Medicare interacts depending on the type of plan you have.

    Fee for Service (FFS) Plans

    Fee for Service plans act almost like a supplemental insurance policy and cover Medicare cost-sharing. They can pay for healthcare from any hospital or healthcare professional.

    HMO or PPO (Managed Care) Plans

    Managed care plans, known as HMO or PPO plans, require you and rely on you seeing healthcare providers and getting care from facilities in your network. Most of the time, your costs will be lowest when getting care from providers in your network who accept retiree insurance and Medicare. If you see out-of-network providers, you will pay full Medicare cost-sharing & your retiree coverage may not pay anything at all.

    Employer-Sponsored Medicare Advantage (Part C)

    There are some employers that require you to enroll in a Medicare Advantage (Part C) plan to continue getting your retiree insurance once you are eligible for Medicare. If you choose not to enroll in your employer’s Medicare Advantage (Part C) coverage, you may have difficulty getting retiree coverage back. With this in mind, you are also free to enroll in Original Medicare or another Medicare Advantage (Part C) plan of your choosing.

    Employer-Sponsored Medicare Supplements

    Another employer insurance plan option is employer-sponsored Medigap, or Medicare Supplement, policies. Just like employer-sponsored Medicare Advantage (Part C) plans, you do not have to enroll in employer-sponsored Medigap plans but it may be harder to get your retiree insurance back later.

    Retiree Insurance and Medicare Part D Prescription Drug Plans

    Retiree insurance can offer prescription drug coverage as well. If the prescription drug coverage offered with your retiree insurance is creditable drug coverage (as good or better than basic Medicare Part D) you are eligible to delay Part D enrollment. It may be beneficial to keep your retiree insurance even if it doesn’t provide creditable drug coverage. This is because some plans keep you covered when you are in the coverage gap. Remember that some plans don’t allow you to drop prescription drug coverage without losing your retiree insurance.

  • What is the Medicare Part B IRMAA?

    What is the Medicare Part B IRMAA?

    What is the Medicare Part B IRMAA?

    Original Medicare Part B, sometimes referred to as medical insurance, helps to cover the cost of outpatient care, ambulance services, mental health services, durable medical equipment, and other medically necessary doctor’s services.

    For those enrolled in Original Medicare, the monthly premium for Original Medicare Part B is standardized. The standard premium (which most beneficiaries will pay) in 2023 is $164.90.

    For individuals with a higher income, a charge called the IRMAA (Medicare Income-Related Monthly Adjustment Amount) is added to the Medicare Part B premium.

    The IRMAA is determined annually by the Social Security Administration. They calculate whether or not you have to pay the IRMAA based on your annual income reported on your taxes from 2 years prior.

    In 2023, those who filed single and made more than $97,000 annually or those married, filing jointly making more than $194,000 annually will have to pay the IRMAA. IRMAA is a different amount based on your income from there, and individuals can pay up to $560.60 monthly for Original Medicare Part B. The chart below shows how IRMAA increases across the income brackets.

    If you feel the Social Security Administration’s tax amounts may need to be updated or corrected, you can file an appeal to have your IRMAA charge reduced or eliminated. Also, if you have a sudden life change affecting your annual income, this is another reason for filing an appeal. After receiving your notice of the change, you have 60 days to file an appeal.

    Seniorstar Insurance Group can assist in understanding these charges or answer any of your Medicare questions. Don’t hesitate to call us and reach out at 844-779-5010 or visit seniorstargroup.com for a no-cost, no-obligation coverage review.

  • Does Medicare Provide Dental Coverage?

    Does Medicare Provide Dental Coverage?

    Does Medicare Provide Dental Coverage?

    Dental health is an essential aspect of one’s overall health. Poor dental health can become very costly without proper insurance coverage, making it hard for many to get the care they need. Uncared for dental issues can even create new health problems in other parts of the body.

    If you’re new to Medicare, you may have some questions when it comes to Medicare and dental coverage. This is important to consider when you are evaluating your Medicare options as well. In short, Original Medicare does not provide dental coverage, but that does not mean you do not have options.

    Does Original Medicare Provide Dental Coverage?

    Original Medicare Part A and Part B do not cover dental care. The only exception in which Original Medicare will cover dental care is if you have a traumatic injury affecting your jaw, mouth, or teeth and are hospitalized. Only then might Original Medicare cover some dental care.

    Will Medicare Advantage (Part C) Plans Cover Dental Care?

    There are some Medicare Advantage plans that include dental coverage. Each plan can be different in the services and care they provide; however, this dental coverage typically includes extractions, fillings, teeth cleaning, and routine X-rays. Medicare Advantage plans are also similar to traditional health plans regarding cost and coverage. This means they can include coinsurance, copays, and deductibles for dental just as it does medical, prescription, etc.

    Are there any Medicare Supplement plans that cover Dental Care?

    Medicare Supplements (Medigap) do not cover dental care; however, they can offer help with out-of-pocket costs, which can be used to help lessen the cost of an out-of-pocket dentist bill.

    How Can I Get Dental Coverage Without Changing my Medicare Coverage?

    Even if you are enrolled in Medicare coverage that meets all your needs except dental – don’t worry. You have options!

    In this case, you can purchase a separate dental insurance plan from a private insurance company. These plans can offer basic preventive care or a more premium plan for more coverage, with a higher premium. These options will be similar to those you may have seen if you ever chose dental coverage through an employer-sponsored plan.

    If you are not interested in enrolling in another line of coverage, walk-in dental clinics or local dental schools may provide free or low-cost care. These are good for beneficiaries paying out-of-pocket for care because the prices are more affordable. Your local Health Department can help lead you to walk-in clinics near you or other resources offering affordable dental care.

  • What Does Original Medicare Cost in 2023?

    What Does Original Medicare Cost in 2023?

    2023 Medicare Part A and B Deductibles, Premiums, and Medicare Part D Income-Related Monthly Adjustments Amounts

    In late 2022, the Centers for Medicare & Medicaid Services (CMS) delivered the dollar amounts for the 2023 Original Medicare Part A & Part B co-insurance, premiums, and deductibles. This article will give you what you need to know about these amounts, how these amounts are calculated, and how these amounts affect Medicare beneficiaries.

    Medicare Part B: Premium and Deductible Information and Amounts

    Original Medicare Part B is the part of Medicare that covers outpatient hospital services, physician services, some home health services, medical equipment, and other services not covered by Medicare Part A. The prices of the deductibles, coinsurance rates, and premiums for Medicare Part B are settled by the Social Security Act. For 2023, the standard monthly premium for Medicare Part B enrollees is $164.90. All Medicare Part B beneficiaries will also pay $226 for 2023’s annual deductible. These costs are lower than in 2022, primarily because of a larger reserve in the Medicare Part B sliver of the Supplementary Medical Insurance Trust Fund. There is also a small stipulation for Medicare enrollees that are 36 months post kidney transplant, making them no longer eligible for full Medicare coverage. Starting this year, they can pay a premium of $97.10 for coverage of immunosuppressive drugs.

    Medicare Part B: Income-Related Monthly Adjustment Amounts

    The Medicare Part B monthly premium each beneficiary pays is based on their income. The standard price of $164.90 for 2023 is the price most beneficiaries will pay. Depending on their adjusted gross income, the premium may increase as shown in the chart below.

    Medicare Part B Premium Chart

    The same levels of adjusted gross income affect the premium the 36-month-out kidney transplant beneficiaries pay for their immunosuppressive drug coverage. The amounts are shown in the chart below.

    How you file your yearly tax returns can affect these prices as well. Below are two charts respectively showing the two different Medicare Part B premiums discussed above for married beneficiaries who lived with their spouse for any period during the last year but filed a separate tax return.

    Medicare Part A Deductibles and Premiums

    Original Medicare Part A is the part of Medicare that covers skilled nursing facilities, inpatient hospital stays, hospice, inpatient rehabilitation, and several home healthcare services. Beneficiaries with at least 40 quarters of Medicare-covered employment don’t have to pay an Original Medicare Part A premium which amounts to around 99% of all beneficiaries.

    In 2023, the inpatient hospital deductible that Original Medicare Part A beneficiaries will pay if admitted will be $1,600. This deductible covers the beneficiary’s costs for the first 60 days of inpatient hospital care in a benefit period. If any more inpatient hospitalization is necessary in a benefit period, the beneficiary is required to pay a coinsurance amount per day. For days 61-90, the beneficiary will pay a coinsurance amount of $400 per day. If the beneficiary uses any of their lifetime reserve days, they will pay $800 daily. In skilled nursing facilities, days 21-100 of extended care services in a benefit period will require beneficiaries to pay a $200 daily co-insurance.

    A monthly premium for Original Medicare Part A is required to enroll in Original Medicare Part A under certain circumstances voluntarily. These circumstances include being age 65 and over and having fewer than 40 quarters of coverage, and certain people with disabilities. If an individual had fewer than 30 quarters of coverage or was married to someone with at least 30 quarters of coverage, they may buy into Medicare Part at a discounted monthly premium rate. This discounted rate in 2023 is $278 per month. Some uninsured aged persons who have less than 30 quarters of coverage will pay the entire premium, which is $506 a month in 2023. If certain individuals with disabilities have drained other entitlement, they will also pay this premium for Medicare Part A.

    Medicare Part D Prescription Drug Plan Income-Related Monthly Adjustment Amounts

    Medicare Part D Prescription Drug Plan premiums depend vary based on the individual plan, but there are income-based adjustments for beneficiaries with a higher income. The income-related monthly adjustment amounts can follow these same payment routes. These amounts are as follows:

    Again, just like Original Medicare Part B, tax returns affect these amounts. Individuals who are married and lived with their spouse for any period of the taxable year but file a separate return will pay different amounts, which are listed below:

    Medicare Savings Programs

    These deductibles and premiums can add up for extensive hospitalization, specialized care, nursing facilities, etc. For low-income beneficiaries or those on a fixed income, this can be extremely frustrating and difficult to handle financially. However, there is help in the way of the Medicare Savings Programs for some of these individuals. These programs can help reduce the costs of the high-quality care a beneficiary may need. They help pay Medicare premiums and possibly cover co-insurance, deductibles, and co-payments for those who meet eligibility.

    For any additional information on Original Medicare Part A & Part B or Medicare Part D Prescription Drug Plan premiums, co-insurance, co-payments, deductibles, or Medicare Savings Programs, contact Seniorstar Insurance Group at 844.779.5010.

    Medicare Savings Programs List

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