The Medicare trust was enacted by Congress in 1965. If you have a Medicare card with Part A and Part B, then you have original Medicare. However, you are responsible for yearly deductibles for Part A and Part B, co-pays and 20% of all health care costs.
Most Advantage health plans pay for yearly deductibles. All Supplemental plans have riders that you can add to the policy to cover deductibles.
Part A covers anything that happens inside a Hospital. Part A is at no cost to you because you have already paid into the plan during your working life.
Part A has a $1,364 deductible for hospitalization and a $341 per day co-pay for days 61-90. Additionally, it has a $170.50 per day co-pay for days 21-100 for skilled nursing.
Part B covers anything that happens outside the Hospital. Part B has a monthly premium that is deducted from you Social Security check.
Part B has a yearly deductible of $185 per year and co-pays. The monthly premium is $135.50 per month for joint-filing of less than $170,000 income per year. High income earners will pay a higher premium.
Part C is your Medicare Advantage or Supplemental policy.
To qualify, you must be a US citizen or permanent legal resident who has resided in the United States for five continuous years and be age 65 or have been on Social Security disability for longer than two years.
Part D is your prescription medication policy. Prescription drugs are not covered in original Medicare. Part D is optional and if can choose to not have it but there is a penalty.
Part D has a yearly $315 deductible. The deductible is Tier based and many prescription plans wave the deductible for Tier I and Tier 2.
Part A covers inpatient hospital care and services, skilled nursing facility care, home health care and hospice care.
In 2018 the Hospital deductible is $1,340 (per benefit period) and covers days 1-60 then days 61-90 you pay $335 per day then days 91-150 you pay $670 per day.
Skilled nursing is covered up to 100 days after a 3-day (admitted) hospital stay and they pay for days 1-20 then on days 21-100 you pay $167.50 per day.
Medicare (approved) home health care is covered in full and hospice care is covered provided it’s in a Medicare-certified facility.
The premium for Part B for 2016 is $183 unless you’re a high-income earner then the premium can go as high as $428.60 per month.
Once the deductible is paid, you are responsible for 20% of all medical costs and Medicare is responsible for 80% for most covered services.
Outpatient care, doctor services, hospital or clinic care, office and home visits, diagnostic X-rays, lab tests, radiation therapy, medical supplies and services, durable medical equipment, outpatient diagnosis or treatment services, ambulance transportation, outpatient rehabilitation (physical, speech and occupational therapy), home health visits (when ordered by a doctor), and ambulatory surgical centers are covered.
Your annual preventive care (physical) is at no cost. Certain cancer screenings, immunizations and flu shots are covered if approved by Medicare.