Understanding Medicare 2023
Part A Hospitalization
No Cost for most Americans
The deductible for Part A for 2023 is $1600.00 which covers the 1st 60 days
In the hospital. Day 61-90 is $400 per day. Lifetime reserve is $800 per day
Buy in to Part A is $278 per month premium for people with 30 quarters of
coverage and $506 per month premium for those with less than 30
quarters of coverage. Coverage refers to # of quarters of participation in
Part B Outpatient
$164.90 Month for anyone new to Medicare in 2023; anyone on Medicare plus any income related surcharge on Parts B & D
Part D Prescriptions
Price varies, based on plan chosen
Part C Offered from Private Insurance & Includes Parts A, B & D
Original Medicare is a fee for service program where the recipient pays 20% and Medicare pays 80%. There is no maximum out-of-pocket under Original Medicare. If you have a claim for $100,000, you owe $20,000. You can see any Doctor, in any hospital, if they take Medicare. With Original Medicare you also must contend with Medicare Assignment of Benefits which means the Doctor or facility bills Medicare directly. If they do not, they can bill you the excess charges that Medicare disallows. (Usually around 15%)
Original Medicare requires Parts A & B and a separate drug plan
If you are working beyond age 65 and your employer has more than 20 employees, you can keep your group health plan and take Medicare Part A only. This is because your group health plan will pay first, and Medicare will pay second. If your employer has less than 20 employees, you must take Medicare Part A & B because then Medicare pays first. The group insurance must also include a creditable drug plan. If not, there are lifetime fines of 10% of the Part B premium calculated each year.
Part C is run by private insurance companies and is referred to as an MAPD (Medicare Advantage Prescription Drug plan)
3 Types of Plans in Nevada
HMO Must have a primary care physician. Referrals are required to see a specialist. If you go out of network, you pay the entire bill. These plans typically have no premium. For 2023 there are two HMOs that do not have a referral requirement.
PPO No referrals required, see any physician if they take the plan. In Nevada monthly premiums range from $0-130 per month depending upon the carrier.
If you go out of network, the cost sharing is greater than staying in network. Some plans have a deductible and additional maximum out of pocket for seeing non-network providers. These plans also have nationwide networks.
MSA There is also a new MSA MAPD plan. MSA stands for Medical Savings Account. The government gives each recipient about $3400 yearly to use to pay medical bills. Once that money is used, there is a maximum out of pocket that must be met; then the plan pays all medical charges above that amount. Typically, this plan is for people who are healthy.
Medicare Advantage plans are run by insurance companies and the plans are based on the county where you live. If you move out of the home county, you must change your plan.
There are a combined 20 different MAPD plans offered in Nevada. They include HMO’s, PPO’s, MSA’s and SNP (Special Needs Plans). These SNP are offered for medical conditions such as Diabetes, Heart Conditions, COPD, or other breathing problems and for End Stage Renal Disease or Kidney Dialysis.
Understanding Medicare Supplements
Medicare Supplements are plans that work with Original Medicare and pay part or all of what Original Medicare does not cover.
Medicare Supplement plans are designated by a letter; the plans range from plan A through plan N. The government decides what each plan’s benefits are and the insurance carriers decide what rate to charge. Therefore, rates can vary as much as $100 per month for the same plan.
Plan F appears to be the most popular plan (Plan F, High Deductible F & C are being grandfathered in 2021 and will no longer be available. Anyone on those plans may keep them.) If you had any of these plans prior to 1/1/2020 you can keep them.
If you are Medicare eligible prior to 2020 you can buy a Plan F, High Deductible F or C after January 2020, otherwise you cannot buy any of these plans.
With Plan F, when you visit a provider, you need your Original Medicare card and your Medicare Supplement card. All Medicare approved services are covered without any payments from you. Also, all excess charges that Medicare disallows are covered in Plan.
There is also a high deductible Plan F, & G. Their pricing varies by carrier. The deductible for 2023 is $2700. You pay the first $2700 and the plan pays everything else for the calendar year.
Some carriers offer a G Plan. The G Plan has the Part B deductible which for 2023 is $233 annually. Once that deductible is satisfied, there are no other charges. The difference in premium between Plan F & G is around $30-70 per month, depending upon the carrier. It is anticipated that since Plans C & F & High Deductible F are exiting the market that Plan G will become the plan of choice. Remember those that have Plan C, F or High Deductible F can keep it. Plan C, F and High Deductible F will ultimately end up costing more because the pool of participants will decrease over time, thus rates will increase. The impact on the high deductible plans will be less due to the high deductible.
Plan N has 3 charges. The 1st is the annual Part B deductible of $233; then Doctor Visits are $20. (Remember that the Doctor will have to take Medicare Assignment of benefits, or the Doctor can bill you what Medicare does not pay.) Lastly, emergency room services are $50 and waived if you are admitted. All other services are covered at 100%. The cost difference between Plan F and Plan N are about $50-$70 per month. Some Plan N’s in Nevada are guaranteed issued while others are not.
When you take Medicare Part B after retiring; you are in an open enrollment or guarantee issue period where there are no medical questions asked to obtain coverage. That is an 8-month window.(For those already 65)
If you are turning 65 and go onto Medicare there is a 7 month window which means 3 months before your birthday month, the month of your birthday and 3 months after your birthday month where you can apply for Medicare without lifetime penalties.
Choosing the right plan for you is critical to your financial future. Make sure you have the right information before deciding. Unlike Medicare Advantage, you are required to prove insurability if not in the guaranteed issue period.
Since Medicare Supplements do not cover prescription medications, you will need a separate drug plan.