Are you curious about your Medicare options in Lakeland, Florida? At Better Place Insurance, we’ve got all the answers to your Medicare questions. Today, we’d like to introduce you to all the working parts of Medicare so that you can get a better understanding of the Medicare program and how to make the most of your benefits.
Medicare’s Moving Parts: A-D
You may not need to enroll in every part of Medicare, but you’ll need to know the benefits and costs associated with each part so that you can piece them together and get helpful healthcare coverage.
Medicare Part A
Part A provides coverage for inpatient hospital stays. It will help pay for your room and board expenses in either a hospital or skilled nursing facility. Most Medicare beneficiaries don’t pay a premium for Part A. If you or your spouse has paid Medicare taxes for 40 quarters, you are eligible for premium-free Part A. If you haven’t met that requirement, your premium in 2022 will be either $274 or $499, depending on how many quarters you did pay Medicare taxes.
There is also a deductible for Part A. In 2022, that deductible is $1556. You’ll pay the deductible for each benefit period. A benefit period begins on the day you become an inpatient and ends after you have been hospital-free for 60 days in a row.
Your coinsurance expenses are based on how many days you spend in the hospital or in a skilled nursing facility. In a hospital, you will not pay any coinsurance up to day 60. From day 61 to day 90, you’ll pay $389 per day. After day 90, you’ll pay $778 if you still have your 60 lifetime reserve days. After those have been used, you’ll pay the entire cost per day out-of-pocket.
Medicare Part B
Since Part A covers your inpatient expenses, Part B is used to cover your outpatient expenses. These include doctor’s visits, many preventive services, diagnostic imaging and test, surgeries, durable medical equipment, among a few other things. The standard premium for Medicare Part B in 2022 is $170.10. However, if you earn a high income, you could pay an Income-Related Monthly Adjustment Amount (IRMAA). This amount is calculated based on your tax return from two years prior.
Part B also has a deductible, but it is only applied annually. The Part B deductible in 2022 is $233. After you have paid this amount, most of your Part B expenses will be covered at 80%. There is no maximum amount you will pay for Part B per year, which is why many beneficiaries choose to enroll in a Medicare Advantage Plan or a Medicare Supplement. (More on those coming up!)
Medicare Part C
Medicare Part C is more often known as Medicare Advantage. These plans are sold by private insurance carriers who have been approved by the Medicare program to offer coverage. Part C plans bundle all of your coverage from Parts A and B and add in additional benefits like those for dental, vision, and hearing services, as well as prescription drug coverage. Not all plans offer all of these extras, but many do.
Both your benefits and expenses for Part C largely depend on the plan that you enroll in. Some of the plans offer as little as $0 monthly premiums. (They are paid by the Medicare program to offer the plan, so they are able to offer you lower premiums.) However, be aware that a $0 premium does not mean you get free coverage. There are still other expenses associated with these plans.
The Part C plan options you have will depend on where you live. If you enroll in a Part C plan, you’ll need to receive care from a provider who is part of the plan’s network. Therefore, the options you have will depend on the providers who choose to contract with the insurance company.
Medicare Advantage Options in Lakeland, FL
There are different types of Medicare Advantage plans. The two most popular are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations). A few of the popular Medicare Advantage plans in Lakeland, FL, that also offer prescription drug coverage include those offered by BayCare, Cigna, Optimum, UnitedHealthcare, and Aetna. There are many more carriers that offer these plans, depending on your zip code.
Medicare Part D
Medicare Part D includes plans that offer prescription drug coverage. You can purchase a stand-alone Part D plan, or you may have one that is included in your Part C plan. Either way, these plans are structured the same way and are sold by private insurance companies.
Every Part D plan includes a drug formulary. This is the list of medications the plan provides coverage for and at what cost to the beneficiary. Each covered prescription is placed in a tier. The lower tiers include generic, common medications, while the higher tiers include name-brand specialty drugs. The higher the tier, the more you’ll pay for the prescription.
Insurance companies can choose their own deductible, but most use the standard deductible, which is $480 in 2022. (No plan can have a deductible over this amount.) The deductible may not apply to all tiers. Most of the time, medications in tier one do not have a deductible. As with Part C, your monthly premium will depend on the plan you choose.
Part D Options in Lakeland, FL
Like your Part C options, the options you have for Part D plans will vary based on your location and zip code. The agent you choose to help you enroll in one of these plans will input your list of medications to find the plan that offers coverage for all of your current prescriptions. Some of the popular providers for Part D plans in Lakeland, FL, are UnitedHealthcare, Humana, Aetna, Cigna, and Mutual of Omaha.
Medigap Plans AKA Medicare Supplements
We’ve said that not all of your medical expenses are covered under Parts A and B. Since you’ll have some out-of-pocket expenses after Parts A and B pay their portion, Medicare beneficiaries usually choose to enroll in either a Medicare Advantage plan or a Medicare supplement. We’ve talked a little about Medicare Advantage already.
Medicare supplements are also known as Medigap plans since they fill in the gaps left by Original Medicare (Parts A and B). There are currently ten Medigap plans on the market: Plans A, B, C, D, F, G, K, L, M, and N. These plans are standardized, meaning that no matter which company you purchase one through, it will offer the same coverage. Unlike Medicare Advantage plans, Medigap plans do not offer any extra benefits not found in Original Medicare. However, some Medigap plans offer comprehensive coverage that leaves the individual with nearly no out-of-pocket costs for their healthcare.
Now that you’ve got a grasp on Medicare’s moving parts, you can make good choices about your healthcare coverage. However, you don’t have to make these decisions alone. Our licensed agents can help simplify your Medicare options in Lakeland, FL, so you don’t have to sort through all of them yourself. We’ll let you know which options are available to you and how they may best serve your needs. Give our office a call today and schedule a free consultation!