OPEN SEASON FOR MEDICARE

If you are approaching age 65, you should start reviewing your Medicare options even if you don’t plan to retire right away. Knowing what Medicare coverage is, when to enroll and what options are available for additional coverage is essential to getting the health insurance you need going forward. What is Medicare?

Medicare is health insurance available through the federal government. To qualify for it, you must meet one of the following requirements:

■ Be age 65 or older;

■ Have a qualifying disability; or

■ Have end-stage renal disease.

Medicare embodies three parts to offer comprehensive health care coverage.

Part A, hospital insurance

This provides coverage for stays in the hospital or a skilled nursing facility, as well as hospice care and even some home health care services. If you or your spouse worked and paid Medicare taxes for a minimum of 10 years, there is no premium for Part A. If you or your spouse paid Medicare taxes for less than 30 quarters, the premium for Part A is $506 for 2023. If you or your spouse paid Medicare taxes for 30 to 39 quarters, the premium for Part A is $278 for 2023. Anyone who qualifies for Medicare before age 65 will not have to pay a premium for Part A.

The deductible for Part A coverage is $1,600 for each benefit period before Original Medicare (Parts A and B) coverage kicks in. A benefit period begins the day you’re admitted to a hospital or skilled nursing facility as an inpatient and ends when you go 60 straight days without receiving any inpatient hospital or skilled nursing facility care. Therefore, you could have more than one benefit period in a year.

If you are in the hospital for more than 60 days or a skilled nursing facility for more than 20 days, you will have a copayment. If you are in the hospital for more than 150 days or a skilled nursing facility for more than 100 days, you are responsible for all costs.

Part B, medical insurance

This covers qualifying doctors’ visits, preventive services, medical supplies, and outpatient treatment and services. Everyone pays a premium for Part B coverage. The standard premium for 2023 is $164.90. However, if your modified adjusted gross income was more than $97,000 for an individual or $194,000 filing jointly on your tax return two years before enrolling in Medicare, your monthly premium will be higher.

The deductible for Part B is $226 per year. You may have to pay coinsurance of 20% of the Medicare-approved amount for certain services, such as for a wheelchair, outpatient mental health care or outpatient hospital care.

Part D, prescription drug plans

This pays toward the cost of prescription drugs as well

Medicare

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