Key Medicare Information for 2023

Medicare vs. Medicaid- Both Government sponsored health insurance

• Medicare’s beneficiaries are primarily age 65 and older or meet other exceptions. Beneficiaries have paid into the Medicare system through payroll taxes over their working life.
• Medicaid’s beneficiaries are low to moderate income individuals. This program is dependent on income.

Premiums:

• Part A- Most people receive this “premium free”
• Part B- $164.90 (2023) per month
  • Could be more based on prior income
• Part D- Depends on chosen plan
  • Could be more based on prior income

 Deductibles:

• Part A- Hospital Deductible: $1,600 (2023) for each benefit period
  • A Benefit period starts the day you are admitted as an inpatient in a hospital or Skilled Nursing Facility (SNF) and ends when you have not received inpatient hospital care or skilled care in SNF for 60 days in a row.
  • If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins.
• Part B- $226 (2023) per year
• Part D- Depends on chosen plan

Coinsurances:

• Part A:
  • Days 1-60: $0 coinsurance after you pay your Part A Deductible
  • Days 61-90: $400 Per day
  • Days 91 and beyond:
    • $800 for each lifetime reserve day (up to 60 over your lifetime)
    • All costs after you use your lifetime reserve days
  • Part B: 20 % of the Medicare-approved amount after you pay your deductible
  • Part D: Depends on chosen Plan
    • Depending on costs of prescriptions taken, you may be subjected to the Coverage gap pricing, also known as the donut hole

What’s covered? A few examples:

• Part A:
  • Inpatient hospital care
  • Inpatient skilled nursing care, after qualifying event(s)
• Part B:
  • Medically necessary doctors’ services
  • Medically necessary Durable Medical Equipment (DME)
  • Many preventative services
• Part D:
  • Prescribed medication on a list of covered drugs (Formulary)

Options:

• Original Medicare, you can add a supplemental plan and Part D
• Medicare Advantage (Part C)- some include or you can add on extra coverage such as vision or dental

When to sign up:

• If you are collecting Social Security, you’ll automatically be enrolled when you turn 65
• If not, you’ll need to enroll yourself during your Initial Enrollment Period or Special Enrollment Period (SEP).
  • Initial enrollment period- the 7 month period that begins 3 months before and ends 3 months after the month you turn 65
  • Special enrollment period- a period of time that exempts/excuses you from late enrollment penalties because you were covered under a group health plan based on current employment.
    • This is an 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.

Important things to know:

• You can no longer contribute to an HSA once you sign up for Medicare.
  • Could have up to a 6-month look-back, where you are not able to contribute if you sign up after you turn 65.
• You could have higher premiums based on “Income Related Monthly Adjustment Amount” (IRMAA), calculated annually using your tax return information from 2 years prior
• If you miss the enrollment period, you could be subjected to a late enrollment penalty, which could be in place for the entire time you have Medicare.