All About Medicare

Medicare Part A

Hospital Coverage

Inpatient Care in Hospitals

You Pay:

In 2019

$1,364

deductible this year

$0

For the first 60 days

$341

Per day for days 61-90

$682

Per “lifetime reserve day” after covered day 90 (up to a max of 60 days in your lifetime)

Skilled Nursing Facility Care

You Pay:

In 2019

$0

For the first 20 days of eligible coverage

$170.50

Per day for days 21-100 of eligible coverage

All Costs

For each day after day 100 of eligible coverage

Hospice Care

To qualify your doctor must certify you as terminally ill. You pay nothing for hospice care.

Coverage includes:

All items and services needed for pain relief and symptom management

Medical, nursing and social services

Drugs – you may need to pay a co-pay of no more than $5 for each prescription drug

Certain durable medical equipment

Aide and homemaker services

Other covered services, like spiritual and grief counseling

Home Health Care

To qualify you must be home bound due to an illness or injury. A doctor must order your care and a Medicare certified home health agency must approve it. You pay nothing for covered home health care services and 20% of the Medicare approved amount for durable medical equipment.

Coverage includes medically necessary:

Part time or intermittent skilled nursing care

Physical therapy

Speech – language pathology services

Occupational therapy

Part A Premium

Most people do not pay a Part A premium because they paid Medicare taxes while working. If you don’t qualify for premium free Part A, you can pay up to $437 each month.

Medicare Part B

Medical Insurance

Medical Insurance Helps Cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventative services
Under Original Medicare, if the Part B deductible ($185 in 2019) applies, you must pay all costs, up to the Medicare approved amount until you meet the yearly Part B deductible before Medicare begins to pay its share.
After your deductible is met you typically pay 20% of the Medicare approved amount of the service. You will pay nothing for most covered preventative services if you receive the service from a doctor who accepts assignment.

Part B Premium

You pay a Part B premium each month. The standard Part B premium amount in 2019 is $135.50 (or higher depending on your income). If you pay your Part B premium through your monthly Social Security benefit, you will pay less. Social Security will tell you the exact amount you will pay for Part B in 2019.

You will pay a different premium amount in 2019 if:

  • You enroll in Part B for the first time in 2019
  • You don’t get Social Security benefits
  • You are directly billed for your Part B premiums
  • You have Medicare and Medicaid, and Medicaid pays your premium
  • Your modified adjusted gross income reported on your IRS tax return from 2 years ago is above a certain amount. If so, you will pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA) which is an extra charge added to your premium.

Yearly Income in 2017 (for what you pay in 2019) 

File individual tax return

File joint tax return

File married & separate tax return

You pay (in 2019)

$85,000 or less

$170,000 or less

$85,000 or less

$135.50

Above $85,000 up to $107,000

Above $170,000 up to $214,000

N/A

$189.60

Above $107,000 up to $133,500

Above $214,000 up to $267,000

N/A

$270.90

Above $133,500 up to $160,000

Above $267,000 up to $320,000

N/A

$352.20

Above $160,000 and less than $500,000

Above $320,000 and less than $750,000

Above $85,000 and less than $415,000

$433.40

$500,000 or above $750,000 and above $415,000 and above $460.50

Late Enrollment Penalty:

After your deductible is met you typically pay 20% of the Medicare approved amount of the service. You will pay nothing for most covered preventative services if you receive the service from a doctor who accepts assignment.

Medicare Part C

Medicare Advantage Plans

  • All benefits and services covered under Part A and Part B
  • Usually includes Medicare Prescription drug coverage (Part D) as part of the plan
  • Run by Medicare approved private insurance companies
  • May include extra benefits and services for an extra cost

You Can Join a Medicare Advantage Plan If:

  • You have Part A and Part B
  • You live in the plan's service area
  • You do not have End-Stage Renal Disease (ESRD)
  • You are a U.S. citizen or lawfully present in the United States
If you enroll in a Medicare Advantage Plan, the carrier providing that coverage is PRIMARY, NOT Medicare directly!

Part C Premium

If you join a Medicare Advantage Plan you will still have to pay your Part B monthly premium in addition to the cost of the plan. Some plans have a $0 monthly premium.

Medicare Part D

Prescription Drug Coverage

  • Helps cover the cost of prescription drugs
  • Run by Medicare and Medicare approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future
  • If you decide not to join a Medicare drug plan when first eligible and you don’t have other creditable prescription drug coverage you will likely pay a late enrollment penalty if you join a plan later.

What is the Part D Coverage Gap or “Donut Hole”?

Stage 1: Yearly Deductible

You pay 100% of the cost of the drug until the plan deductible is met.

If the plan does not have a deductible, you will begin in Stage 2.

Stage 2: Initial Coverage

The plan pays its share of the cost of drugs and you pay your share of the cost.

You stay in this stage until your total cost for drugs (the co-pay amount you pay and the cost the plan pays) totals $3,820.

Stage 3: Coverage Gap (Donut Hole)

You pay 25% of the cost for brand drugs and 37% of the cost of generic drugs

Some plans have coverage in the gap. If so, you will pay a co-pay or coinsurance for covered drugs.

Stage 4: Catastrophic Coverage

After your total out of pocket costs reach $5,100.

You pay $3.40 for generics and $8.50 for brand drugs, or 5% of the total cost (whichever is greater).

Part D Premium

Part D premium varies by plan (the higher your income the more you will pay). See the chart below for estimated monthly premiums based on income as reported on your IRS tax return from 2 years ago and last year. If you income is above a certain limit, you will have to pay an Income Related Monthly Adjustment Amount (IRMAA) in addition to your plans premium. 

If your filing status and yearly income in 2017 was

File individual tax return

File joint tax return

File married & separate tax return

You pay (in 2019)

$85,000 or less

$170,000 or less

$85,000 or less

Your plan premium

Above $85,000 up to $107,000

Above $170,000 up to $214,000

N/A

$12.40 + your plan premium

Above $107,000 up to $133,500

Above $214,000 up to $267,000

N/A

$31.90 + your plan premium

Above $133,500 up to $160,000

Above $267,000 up to $320,000

N/A

$51.40 + your plan premium

Above $160,000 and less than $500,000

Above $320,000 and less than $750,000

Above $85,000 and less than $415,000

$70.90 + your plan premium

$500,000 or above $750,000 and above $415,000 and above $77.40 + your plan premium

Part D Late Enrollment Penalty:

  • You may owe a late enrollment penalty if at any time after your Initial Enrollment Period ends; you go 63 or more days in a row without Part D or other creditable coverage.
  • The penalty depends on how long you lack creditable prescription drug coverage
  • It is calculated by multiplying 1% of the national base beneficiary premium ($33.19 in 2019) by the number of full uncovered months that you were eligible but didn’t join a drug plan and went without other creditable prescription drug coverage.