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A special enrollment period (SEP) exists for individuals affected by a disaster or other emergency declared by a federal, state or local government entity who were unable to, and did not make an election during another valid election period. This SEP is valid from 9/23/2022 through 9/30/2023.
Who's eligible? Individuals are eligible for this SEP if they:
*Please consult a licensed health insurance agent for more detailed information. Our agents are licensed and have completed Medicare certification for plan year 2023.
Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. Medicare beneficiaries that have at least 40 quarters of Medicare-covered employment do not have a Part A premium. A premium is due for beneficiaries with less than 40 quarters of employment. The maximum Part A premium in 2022 is $499.*
The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. The Medicare Part A inpatient hospital deductible for plan year 2023 is $1,600. In 2023, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of a hospitalization in a benefit period and $800 per day for lifetime reserve days.
There is no deductible applied to a stay in a skilled nursing facility. Medicare beneficiaries are responsible for a daily coinsurance of $200for days 21 through 100 of extended care services in a benefit period.
Medicare beneficiaries who are required to buy Part A and don't buy it when they are first eligible for Medicare will pay a 10% late enrollment penalty.* You'll have to pay the higher premium for twice the number of years you didn't sign up.
*Please consult a licensed health insurance agent for more detailed information. Our agents are licensed and have completed Medicare certification for plan year 2023.
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023. The annual deductible for all Part B beneficiaries is $226 in 2023. A beneficiary’s Part B monthly premium is based on his or her income so if your income is higher, you may pay more. Ask an agent or contact 800-MEDICARE.
To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The government estimates that only about 50% of people who qualify for these cost-saving programs are enrolled in them. MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance, and copayments for those who meet the conditions of eligibility.
If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage.
Medicare Advantage (Part C) combines everything you get in Original Medicare (Part A and Part B) with other benefits, like prescription drug coverage.** In essence, your Medicare benefits are “bundled” into one convenient plan. Medicare Advantage plans also have predictable costs with set copays, which can make it easier to plan your expenses. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Many MA plans have a $0 monthly plan premium.*
In most cases, you’ll need to use health care providers who participate in the plan’s network. It is important to make your agent aware of your provider and hospital choices.
Some Medicare Advantage plans offer comprehensive dental, routine vision, hearing, gym membership, over the counter product benefit, transportation and meals after a hospital stay. Some plans offer unique benefits such as paying a portion of your Part B premium. Your agent will review these benefits with you each year.
Medicare Advantage plans are offered in all states. Available plans vary according to your zip code.
*Please consult a licensed health insurance agent for more detailed information. Our agents are licensed and have completed Medicare certification for plan year 2023. Call today!
**Some MA plans do not offer prescription drug (Part D) coverage.
A beneficiary’s Part D monthly premium is based on his or her income. Part D premiums vary from plan to plan and roughly two-thirds are paid directly to the plan, with the remaining deducted from Social Security benefit checks. Beneficiaries who file individual tax returns with modified adjusted gross income greater than $91,000 with have an income-related monthly adjustment amount of at least $12.40.
You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other creditable prescription drug coverage. The late enrollment penalty is an amount that is permanently added to your Medicare drug coverage (Part D) premium.*
All Medicare Part D drug plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. If you take insulin, you may be able to get Medicare drug coverage that offers savings on your insulin. You could pay no more than $35 for a month's supply.
A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost.
Most Part D plans have a coverage gap (known as the “donut hole”). During the coverage gap there is a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,660 on covered drugs in 2023, you're in the coverage gap. This amount may change each year. If a beneficiary receives Extra Help paying Part D costs, they will not enter the coverage gap. Once you've spent $7,400 out-of-pocket in 2023, you're out of the coverage gap. Once you get out of the coverage gap, you automatically get "catastrophic coverage." It assures you only pay a small coinsurance percentage or copayment for covered drugs for the rest of the year. (Most people do not enter the coverage gap.)
*Please consult a licensed health insurance agent for more detailed information. Our agents are licensed and have completed Medicare certification for plan year 2023.
ALTA Benefits LLC does not discriminate and strives to assist every client with dignity and respect. There is no fee for agent consultations.
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