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Medicare 2024 Explained 

Medicare is a government-funded health insurance program in the United States. It was established in 1965 and is primarily aimed at providing health insurance coverage for individuals aged 65 and older though it also covers certain younger individuals with disabilities and those with end-stage renal disease.
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Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services. The program is funded through payroll taxes, premiums paid by beneficiaries, and general government revenue. Medicare is made up of four parts:

Medicare Part A

Hospital Insurance

Medicare Part B

Medical Insurance

Medicare Part C

Medicare Advantage

Medicare Part D

Prescription Drug Coverage

Medicare Part A (hospital insurance)​

Premiums

Medicare Part A covers the majority of in-patient hospital expenses. When you sign up for Medicare, you will ALWAYS subscribe to Part A because you've already been paying into it through your Medicare taxes. For this reason, you will NOT have to pay a premium for Medicare Part A each month (so long as you or your spouse paid Medicare taxes for 10 years).

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Deductibles

Like most health care plans, Medicare Part A has a deductible that must be met before benefits begin. Unlike most health care plans however, the Medicare Part A deductible is paid "per spell of illness" rather than an annual deductible. This means that the deductible is paid for each separate hospital stay (so long as its for a "new" illness) before benefits kick in. The deductible will reset after you remain out of the hospital or other care facility for 60 consecutive days. The 2024 Part A deductible is $1,632. 

 

Part A Coinsurance

The Part A coinsurance amount varies based on the length of your hospital stay and also whether you have a supplement policy. It also varies based on the type of facility you go to. See below for details on copayments.

 

Hospital Inpatient stay

  • Days 1-60:        $0 after the deductible.

  • Days 61-90:      $408 copayment each day.

  • Days 91-150:    $816 copayment each day 

  • After day 150: You pay all costs.

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Skilled nursing facility stay 

  • Days 1-20:       $0 copayment.

  • Days 21-100:   $204 copayment each day.

  • After day 100:  You pay all costs.

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Home health care 

$0 for covered home health care services.

20% of the Medicare-approved amount for durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

 

Hospice care 

$0 for covered hospice care services.

You may also pay:

  • A copayment of up to $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home.
    What if my hospice care doesn't pay for my drug? 

  • 5% of the Medicare-approved amount for inpatient respite care

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Medicare Part B (Medical Insurance):
​Medicare Part B is an optional medical insurance program that helps cover a wide range of outpatient services, including doctor visits, preventive care, and some prescription drugs. Part B is not free, and there are some costs that you may have to pay, such as a monthly premiums, deductibles, and copays.
 
An important note about Medicare Part B: if you do not sign up when you become eligible, you may face increasing penalties that last for the lifetime of your coverage.
 
What is covered by Medicare Part B?  ​
Medicare Part B covers a wide range of outpatient services including:
  • Doctor visits
  • Preventive care
  • Some prescription drugs
  • Outpatient surgery
  • Diagnostic tests
  • Immunizations
  • Durable medical equipment (DME), such as wheelchairs, walkers, and hospital beds
  • Home health care
  • Hospice care
Part B covers certain doctors' services, outpatient care, medical equipment, preventive services, and some home health care.
 
Cost per month for Medicare Part B
In 2024, the monthly premium for Medicare Part B is $174.70 or more depending on your income. The premium amount may change from year to year. If you subscribe to Medicare Part B, you'll pay the premium each month even if you don’t use any Part B-covered services.
 
Part B Deductible
The Part B deductible is $240. You must meet your deductible amount once each year before your benefits begin.

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Part B Coinsurance 

The part B coinsurance payment is usually 20% of the cost for each Medicare-covered service or item after you’ve paid your deductible so long as your doctor "accepts" the Medicare approved amount and the good news is that about over 90% of doctors do. If your doctor does not accept assignment, then you may have to pay more than 20% of the Medicare approved amount.

See below for the cost of various covered services:

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Clinical laboratory services: $0 for covered services.

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Home health care: $0 for covered home health care services & 20% of the Medicare-approved amount for durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment).

 

Inpatient hospital care: 20% of the Medicare-approved amount for most doctor services while you’re a hospital inpatient.

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Outpatient mental health care: 

  • $0 for a yearly depression screening.

  • 20% of the Medicare-approved amount for visits to diagnose & treat your condition. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional amount to the hospital.

 

Partial hospitalization mental health care:

  • 20% of the Medicare-approved amount for partial hospitalization services you get in a hospital outpatient setting or community mental health center

 

Outpatient hospital care

  • Usually 20% of the Medicare-approved amount for doctor and other health care providers’ services.

  • You’ll also pay a copayment to the hospital for each service you get in a hospital outpatient setting (except for certain preventive services). In most cases, your copayment won’t be more than the Part A hospital stay deductible amount.
     

    This additional hospital copayment means you may pay more for an outpatient service you get in a hospital than you’d pay if you got the same service in a doctor’s office.

Medicare Part C (Medicare Advantage):
Part C is an alternative to Original Medicare (Parts A and B) and is offered by private insurance companies that are approved by Medicare. Part C plans must cover everything that is included in Parts A and B, and may offer additional benefits such as vision, dental, and prescription drug coverage.
 
Premiums & other costs (like deductibles, copayments, & coinsurance) vary by plan. These amounts can change each year. You must have Part B and keep paying your Part B premium to stay in your plan.
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Medicare Part D (Prescription Drug Coverage):

Part D covers prescription drugs. This coverage can be obtained through a Medicare Part D plan offered by private insurance companies that are approved by Medicare.

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