2018 Medicare Terms and Changes

Medicare is available to people age 65 and older who are US citizens or lawful permanent residents. Also, you or your spouse must have worked for 10 years (40 quarters). Some people under the age of 65 may also qualify for Medicare coverage if they have certain disabilities and meet the guidelines.

The government provides Medicare Parts A and B.

a fee

Most people don’t pay a premium for Part A, which covers inpatient hospital care, skilled nursing facility care, home health care, and hospice stays, because when you worked, you paid To the system. There is a deductible of about $1,316.00 and coinsurance after 60 days.

installment B

This is health insurance that covers visits to doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services in lieu of hospital care. The premium is approximately $134.00 and the deductible is $183.00. Part B is designed for the government to pay about 80% of medical expenses.

C share

This is called Medicare Advantage, which combines Parts A and B and adds additional benefits such as prescription drug coverage (Part D) and dental or vision coverage. They can be zero premium (you still have to pay Medicare premiums) or have an additional premium based on benefits.

D-share

Private insurance companies cover the Medicare Prescription Drug Plan and the costs range from $15.00 to $100.00 per month. Each has a list of approved drugs.

Medicare Options and Supplements

Because Medicare doesn’t cover all health care costs, these policies, known as Medigap, cover some or all of the costs not included in Parts A and B. However, these plans don’t cover drugs and have premiums in addition to Parts A and B of Medicare.

Many people select a combination of these to get the most comprehensive coverage possible. For example:

• Medicare Supplement Plan that contains Medicare Parts A and B and Part D (to cover prescription drugs)
• Medicare Advantage Plan (Part C) that contains Medicare Parts A and B, and most Part C plans include Part D (to cover prescription drugs)

Other Medicare Facts

• You can’t have both a Medicare Supplement and a Medicare Advantage plan.

• You can change your Part C or Part D plan each year during the annual enrollment period, which for 2018 ran from October 15 to December 7, 2017.

Part B premiums for 2018 are:

• $1340.00/month: less than $85,001 (single)/less than $170,001 (married)
• $187.50/month: $85,001-$107,000 (single)/$170,001-$214,000 (married)
• $267.90/month: $107,001-$133,500 (single)/$214,001-$267,000 (married)
• $348.30/month: $133,501-$160,000 (single)/$267,001-$320,000 (married)
• $428.60/month: over $160,000 (single)/over $320,000 (married)

Some people who qualify for Medicaid (another government program) may only qualify for QMB (Qualified Medicare Beneficiary) status. This means they get help with Medicare premiums and cost-sharing items like deductibles, coinsurance, or copayments. With this status, however, there is no coverage for other health costs. Medicare-approved providers should NOT bill people with QMB status, but state Medicaid may pay these costs.

Also note that if Medicare denies a charge as a non-covered service, supplemental insurance will deny it as well. An example is a person who has ambulance transportation to a doctor’s office. Medicare denies as not covered and secondary insurance also denies. The remainder is the responsibility of the patient or the patient may appeal with medical records indicating medical necessity for transportation.

While you may be getting better coverage than before, the Medicare maze is still something to watch out for. Please review your Medicare bills and summary notices carefully and take steps to have a claim decision reconsidered before the appeal deadline expires.