What’s Changing for Medicare in 2024?
The Medicare Open Enrollment Period (OEP) kicked off on October 15th and runs through December 7th. During this yearly window, Medicare enrollees can make changes to their healthcare coverage. Whether you’ve got Original Medicare or Medicare Advantage, it’s your chance to take a look at your current coverage, decide whether it’s still working for you and compare your options for next year.
Most Medicare enrollees don’t take that chance. According to research from the Kaiser Family Foundation, only about a third of people with Medicare bother to shop for coverage during open enrollment. That’s a potential mistake, for two important reasons: coverage and cost can both change from year to year.
Because Medicare Advantage and standalone Part D drug plans are sold by private companies, coverage and cost vary widely. You may pay more for the same plan next year, or you might lose access to your preferred doctors or the prescriptions you need. Taking the time to look at your choices in 2024 may save you money in the long run.
But private Medicare coverage isn’t the only thing that changes. Costs for Original Medicare, including premiums and deductibles, change, too.
Here’s what you need to know for annual enrollment.
Premiums are going up.
Original Medicare includes Part A and Part B. Both will see higher costs in 2024, though the difference is slight for Part A.
Most people don’t pay a premium for Part A since it’s covered through work taxes. But for those who do, the monthly premium depends on how many work credits they have when they qualify for Part A. For 30 to 39 work credits, the Part A premium is $278 a month in 2024, same as it was in 2023. For fewer than 30 work credits, the full monthly premium for Part A actually decreases by $1 to $505 in 2024.
Even without a premium, Part A requires cost sharing in the form of a benefit period deductible and per-day coinsurance. In 2024, that deductible increases from $1,600 to $1,632. The per-day coinsurance for days 61-90 in a hospital increases from $400 to $408. And if you hit the lifetime reserve days, that coinsurance rate increases from $800 in 2023 to $816 in 2024.
Standard Part B premiums will see a 6% bump in 2024, going from $164.90 in 2023 to $174.70 next year. The annual deductible also increases, from $226 to $240. Coinsurance for Part B remains the same at 20% of Medicare-approved amounts after you meet the deductible.
Most people will have access to lots of Medicare Advantage & Part D plans.
The Centers for Medicare and Medicaid Services (CMS) releases a state-by-state landscape each year that covers expected premium averages and availability for Medicare Advantage and standalone Part D plans. In our analysis of that data, we found that most people will have access to private Medicare options in 2024.
On average, there are about 21 Part D plans per state. Not only that, but most (78.8%) of the people with a standalone Part D plan in 2023 will have access to a plan in 2024 that costs less than their current coverage.
For Medicare Advantage, it’s a similar story, with almost every Medicare enrollee (99.7%) having access to at least one Medicare Advantage plan in 2024. Alaska is the notable exception, since Advantage plans are not available here.
Altogether, there are over 6,000 Medicare Advantage plans available across the country, though availability depends on where you live. The average is 123 plans per state, with wide variation when you look at actual figures. For example, there are 613 Advantage plans in Florida but only 15 in Wyoming. Where you live makes a difference.
Medicare Advantage premiums are slightly higher next year, but Part D could be lower.
Medicare Advantage premiums will rise in 2024, but it’s almost negligible. According to our analysis of CMS data, the average in 2023 was $19.35 a month. In 2024, that average increases by about $1.50, to $20.90 a month. And most people (99.6%) still have access to a Medicare Advantage plan with a $0 premium in 2024, down slightly from 99.8% in 2023.
For standalone Part D plans, there’s potential good news. The average for lowest-cost plans has gone drastically down for 2024. In 2023, the average lowest-cost plan for Part D was a little under $6 a month. In 2024, that decreases to just $0.64.
Of course, those figures are for averages for the lowest-cost plan, not the average for all plans. But there’s good news here, too. In 2024, CMS is projecting that the average total premium for Part D plans will be $55.50, a decrease of about 1.8% over the total premium in 2023 ($56.49).
Part D enrollees won’t pay anything in the catastrophic phase.
In previous years, Part D had a coverage gap known as the “donut hole.” It was triggered when you reached the initial coverage limit and ended once you hit the catastrophic spending threshold. Both of these amounts are set by the government each year. As of 2020, the donut hole is officially closed, but you’re still responsible for 25% of the cost of your medication while you’re between those amounts (initial limit and catastrophic coverage). Once you reach the catastrophic limit, your coinsurance drops to 5% of the cost of medications.
Starting in 2024, coinsurance in the catastrophic phase will be eliminated. That means once your drug spending reaches the catastrophic threshold ($8,000 in 2024), your drug plan will pay for 100% of your covered medication. For people with specialty drugs, this could mean substantial savings.
Note that you don’t have to personally spend $8,000 to reach the catastrophic phase. That threshold includes what you pay out of pocket (your copays and coinsurance) plus the value of the discounts the manufacturer covers on brands while you’re in the donut hole.
Medicare Annual Enrollment runs now through December 7th. Take the time to review your plan, make sure it’s still working for you and compare your options in 2024.
Looking for more news on Medicare? Click the following for previous updates:
October 2022 | November 2021 | October 2020 | July 2020
Most Common Misconceptions About Medicare
Signing up for health insurance is tough enough without realizing too late that you missed an important step. Medicare is no different, in fact Medicare and the various parts, can be even more confusing. Medicare currently provides health insurance benefits for over 64.5 million people in the U.S. comes with its own mile-long list of rules to follow. Forgetting or ignoring or ignoring an important detail could prevent you from maximizing your benefits. Even worse, it could leave you on the hook for thousands of dollars in unpaid claims or facing high monthly premiums with added penalties.
One of the best ways we can be helpful, especially with respect to anyone who might have question for this upcoming annual enrollment season, is to help clear up some of the most common myths surrounding Medicare.
Eight Of The Most Common Myths About Medicare
#1 – You can sign up or make changes anytime.
Like any other type of health insurance, Medicare has enrollment periods. The Initial Enrollment Period starts three months before the month you turn 65. If your birthday is June 12, then your enrollment period starts on March 1. It ends three months after the month you turn 65, so in our scenario here, that means it would end on September 30 for you. In other words, you get seven full months to sign up for Medicare when you first become eligible.
If you don’t sign up for Medicare when you first become eligible, then you could face penalty fees if you decide to enroll later. There are special enrollment provisions, though. Those who aren’t retired at 65 and want to keep job-based health insurance can keep it until they retire or lose the coverage, which triggers a special enrollment period.
As for making changes, you can only modify your Medicare coverage at certain points throughout the year. These include:
- January 1 to March 31: This is the General Enrollment Period for Medicare. If you don’t have Medicare coverage at all, your initial signup period has ended, and you don’t qualify for a special enrollment period, then this is when you can sign up for original Medicare (Parts A and B, not Medicare Advantage). This is also the Medicare Advantage Open Enrollment Period, a specific period when people with Medicare Advantage can make a one-time change to their coverage.
- April 1 to June 30: During this period, you can add a Part D prescription drug plan if you signed up for Medicare Part B during the general enrollment window. You can also use this period to sign up for Medicare Advantage if you have Part A already and used the general enrollment period to enroll in Part B.
- October 15 to December 7: This is the open enrollment period, which differs from general enrollment. There are several things you can do during this period, including change from original Medicare to Medicare Advantage, join a Part D plan, switch from an Advantage plan that doesn’t offer drug coverage to one that does, and drop your Part D coverage altogether.
Pay close attention to when you can sign up for Medicare for the first time. This will be your best shot for securing the plan that you want without having to worry about penalty fees for missing your enrollment window.
#2 – Original Medicare is your only option.
Original Medicare, which was established in 1965, sought to ensure that seniors would have access to low-cost health insurance after they retired. Before the program got started, aging Americans had trouble finding affordable coverage at a time when they needed it most. Medicare changed that. And while it’s a great program that has stood the test of time, it’s not your only option. You can sign up for a private plan under Medicare Advantage, also known as Medicare Part C. There are also other options under Medigap and Medicare Supplement plans.
Medicare Advantage (MA) was introduced in 1997 and has been gaining popularity ever since, particularly in the last decade. In 2022, nearly half of Medicare enrollees (45%) chose private plans over original Medicare, according to the Centers for Medicare and Medicaid Services (CMS), which administers the program. These plans are sold through private insurance companies. By law, they must cover the same essential services as Medicare Parts A and B. But where original Medicare excludes a host of covered benefits, Medicare Advantage offers more robust coverage in many cases.
Costs vary for MA plans, but you’ll have an out-of-pocket maximum (OOP) if you choose this route. The OOP limits how much you’ll have to spend of your own money on covered benefits for the plan year. In 2023, the limit will be $8,300 – again, that’s the maximum. Each company sets its own limit up to the maximum allowable amount. For people with heavy medical costs, having a cap on out-of-pocket expenses is beneficial. Original Medicare doesn’t set a cap.
There are other benefits and drawbacks to Medicare Advantage, so read the fine print carefully before signing up for a plan. Original Medicare could work well for you, but you should know that a private option exists that may offer better features at better rates.
#3 – You’ll get enrolled automatically when you turn 65.
This is true for a select portion of Medicare enrollees. There are four reasons you might get automatically enrolled into Medicare:
- You’re under 65 and have a disability;
- You have ALS (Lou Gehrig’s disease);
- You already receive benefits from Social Security or the Railroad Retirement Board; or
- You live in Puerto Rico and get benefits from Social Security or the Railroad Retirement Board.
People who qualify for automatic enrollment will get a Medicare card in the mail either the 25th month of disability payments or three months before they turn 65, whichever applies to their situation.
There’s also a process called seamless conversion that allows private health insurers to automatically enroll current customers into their Medicare Advantage plans once customers become eligible as long as the companies give notice to customers about the conversion. As you’re nearing 65, check your mail carefully for a notice like this. You can opt out of automatic enrollment.
Barring seamless conversion into Medicare Advantage or one of the conditions listed above, you will need to sign up for Medicare. Generally, it doesn’t happen automatically.
#4 – You won’t have to pay anything.
Because Medicare is administered by the federal government, some people think it’s a free entitlement program. It’s not. Medicare is a low-cost health insurance option that includes premiums, deductibles, copayments, coinsurance and more. How much you pay for Parts A and B depends on your work history and income level. In general:
- Most people do not pay a monthly premium for Medicare Part A (hospital insurance). This is because work-based taxes pay for this portion of Medicare. If you don’t have enough work credits, then you may be charged a monthly premium for Part A. This isn’t common.
- Medicare Part B requires a monthly premium from everyone, but the amount varies based on your income level and when you sign up. The monthly premium for new enrollees in 2022 was $170.10 for people (single tax filers) who earn up to $91,000 a year. That drops slightly to $164.90 a month in 2023. Above that income threshold, Medicare charges more per month for Part B. The highest earners ($500,000 a year as a single filer in 2022) pay the most. Medicare uses tax records from two years prior to calculate your monthly premiums. In 2023, your income from 2021 will be used to determine your premium tier.
Along with monthly premiums for Part B, Parts A and B both include cost-sharing, meaning you will be responsible for a portion of your medical bills after Medicare pays its share based on your plan. Medicare Advantage, which is sold through private companies, also costs money, and amounts vary by plan. Part D prescription drug coverage includes a monthly premium and cost-sharing as well. Bottom line: Medicare isn’t free.
#5 – Medicare covers all of your healthcare services.
No health insurance plan will cover 100 percent of your medical care, and Medicare is no exception. Original Medicare covers many services related to hospital and skilled nursing care (Part A) and medical care (Part B). Trips to the doctor, hospitalization, annual wellness screenings, lab testing, durable medical equipment and other types of essential health benefits are also covered since these services are mandated by the Affordable Care Act.
But there are gaps in coverage that you would need to supplement with a Medigap policy, Part D prescription drug coverage or a Medicare Advantage plan. Traditional Medicare does not cover things like long-term (custodial) care, eye exams for prescriptions, cosmetic surgery, routine foot care or acupuncture. Dental care, including dentures, and hearing aids and hearing aid exams are also notable exclusions from original Medicare.
Don’t assume that your Medicare plan covers all of the services that you’ll need, particularly if you’re enrolled in original Medicare. Evaluate your needs ahead of time so you can put the right coverage in place. Otherwise, you’ll have to pay for uncovered benefits completely out of pocket.
#6 – You don’t have to worry about Medicare if you have a marketplace plan.
This is an important fact to get right. If you’re eligible for Medicare but you’ve chosen not to sign up because you have a plan through the Affordable Care Act marketplace, there are some things you need to know.
- Marketplace enrollees who are eligible for Medicare cannot get tax subsidies to reduce the cost of monthly premiums. Once you’re eligible for Medicare, you will stop receiving subsidies. This could make your monthly premiums for the exchange plan unaffordable.
- Your health insurance company could deny claims if you’re eligible for Medicare because they deem certain services as Medicare’s responsibility.
- If you decide to enroll in Medicare after your eligibility window closes, you may be charged penalty fees – and some penalties last for as long as you have Medicare. Having a marketplace plan does not excuse you from the penalty fees associated with late enrollment.
This latter point is a big concern, to the point that Medicare is addressing the problem this summer. Thousands of seniors miss their initial eligibility window each year, but officials and consumer advocates are concerned that part of the reason is that people assume that having a marketplace plan will prevent them from incurring fees if they enroll in Medicare after the fact. This isn’t true. Unless you have job-sponsored coverage or approved special circumstances, you must enroll in Medicare during your initial eligibility if you want to avoid paying fees later.
Earlier this year, Medicare implemented a waiver program for people who didn’t sign up for Medicare when they could because they erroneously believed that their marketplace coverage would protect them from fees if they signed up later. The deadline to apply for a waiver from penalty fees and the late enrollment waiting period was September 30.
One important thing to note is that while insurers can – and are required to – cancel the subsidies for your marketplace plan once you become eligible for Medicare, they are prohibited from canceling your coverage. That means you could be charged the higher, unsubsidized premium once you become eligible for Medicare. If you have a marketplace plan and you reach Medicare eligibility, talk to a health insurer adviser about your options.
#7 – Medicare is bankrupt or going bankrupt.
You may have heard that Medicare is out of money. Rest assured that it’s not – at least not yet. It is true that a portion of original Medicare’s finances are in trouble, especially if the government doesn’t implement appropriate changes to funding, taxation or benefits soon. But the program itself is far from bankrupt. The most recent report projects Medicare to become insolvent by 2028, but “insolvent” doesn’t mean benefits stop altogether.
In 2015, for example, the Medicare Hospital Insurance Trust Fund had a balance of $197.3 billion. That same year, expenditures hit nearly $279 million, most of which got funded through payroll taxes and interest on the fund itself. Medicare only had to take $3.5 billion from the reserves to cover the deficit.
Drawing $3.5 billion from a limited reserve isn’t a good thing, but it’s a far cry from bankruptcy. Still, estimates assert that the trust fund will be depleted by 2028. At that point, tax revenue will be the only source of income for the program unless changes get made before then.
Once the trust fund goes insolvent, Medicare Part A will operate at 87 percent financing. This 13 percent cut to Part A, the hospital portion of Medicare, could be especially burdensome to beneficiaries. It translates to thousands of dollars a year in added out-of-pocket expenses. Changes to the program are already being discussed to prevent this worst-case scenario. These could include increasing the eligibility age, raising payroll taxes or cutting benefits, among other things.
When discussing Medicare’s finances, it’s also important to note that we’re only talking about Part A funding. Medicare Parts B gets funded from the Supplementary Medical Insurance Trust Fund, which includes general revenue and beneficiary premiums. Part B’s finances aren’t in trouble.
#8 – Healthcare reform will eliminate the program entirely.
Over the years, political unrest regarding healthcare reform cast doubt over the future of the Medicare program. To date, few politicians have addressed Medicare directly – other than to suggest that it be privatized – and none of the Republican-backed bills that went before Congress included specifics about the Medicare program. The focus has instead been on the private market for health insurance (non-group coverage) and Medicaid, which is the federal-state program for low-income Americans. Previous proposals, such as the AHCA, could have impacted Medicare indirectly because about 11 million Medicare enrollees are dual-eligible with Medicaid.
If you’re hesitant to sign up for Medicare because you think the program might be eliminated, don’t worry. Healthcare reform will not eliminate Medicare, not least of which because it’s a popular program among consumers regardless of political affiliation. If you would like to review your options for coverage under Original Medicare, Medicare Advantage or a Medicare Supplement plan at any point you can quickly connect to a licensed insurance agent who can answer your questions and help you make an informed decision.
Who is eligible for Medicare?
Medicare is only available for certain people. Among these are:
- Those over the age of 65
- Those under the age of 65 who have a disability that qualifies them to get Social Security Income
- Those who are 65 years or older or who are under 65 and have certain disabilities and who receive benefits from the Railroad Retirement Board (RBB)
- Those with end-stage renal disease (ESRD)
- Those with amyotrophic lateral sclerosis (AML, or Lou Gehrig’s Disease)
Medicare.gov, the official governmental website for Medicare, offers a questionnaire to determine whether a person is eligible for Medicare benefits. People who receive benefits from Social Security or from the RRB are automatically enrolled in Medicare. However, those who qualify due to one of the previously mentioned illnesses must sign up for a Medicare policy.
Medicare Updates in 2023
- Premiums for Part B, Part C and Part D will be slightly lower in 2023.
- Medicare will continue to cover the cost sharing associated with the public health emergency, including tests, vaccines and treatments.
- Adult immunizations covered under Part D will no longer include cost sharing starting next year.
- Part D plans will also now be required to cap out-of-pocket insulin costs at $35 a month for the types of insulin that the plan covers.
- There are new qualifying events for special enrollment period, so if you missed your initial window, check with Medicare to see if you qualify for a new SEP based on a natural disaster, incarceration, loss of Medicaid coverage or other reasons.
- If you enroll during the General Enrollment Period (January 1 to March 31), coverage now starts on the first of the month after you enroll, instead of in July.
- And people with end-stage renal disease (ESRD) who lose eligibility for Medicare because of a successful kidney transplant can now buy a limited Part B policy that covers immunosuppressive drugs only.
Medicare Enrollment Information
What are the different parts of Medicare?
Medicare Part A
Medicare Part A is the hospital coverage portion of Medicare. And while Part A covers a portion of inpatient hospital and skilled nursing facility costs, it’s usually used in combination with another insurance policy, such as Medicare Part B, which covers general medical services.
Part A – Original Medicare
Hospital Insurance that covers hospital care & prolonged stays.
PARTIAL COVERAGE FOR:
- Inpatient hospital stays
- Skilled nursing care
- Hospice
- Home health care
- Inpatient mental health care
Medicare Part A covers inpatient hospital stays, hospice, home health care, inpatient mental health stays and skilled nursing facility care.
Each of these services requires you to meet the Part A deductible (per benefit period) and may include a coinsurance cost. These amounts change each year. In 2023, the Part A deductible is $1,600 per benefit period.
For hospice care, Medicare will cover a lot of these services, but it won’t cover everything. Check out this guide for more detailed information about how Medicare works with hospice.
For skilled nursing facility care, the guidelines are specific as to when Medicare will cover these services. For example, you have to have a qualifying hospital stay of at least three days, and your doctor has to determine that you need skilled nursing care. Medicare covers the first 20 days of skilled nursing facility care completely. For days 21-100, you’ll have a daily coinsurance rate that changes each year. In 2023, it’s $200 per day. Starting at day 101, you’ll pay the full cost of care yourself.
For inpatient hospital stays, Medicare requires patients to be admitted for two consecutive midnights for medically necessary reasons before it will pay a claim. You will also need to meet a deductible per benefit period before your benefits start.
Under Original Medicare, Part A covers the first 60 days of your hospital stay with no additional copayment (once you meet the deductible). From days 61 to 90, you’ll be responsible for a copay per day. In 2023, it’s $400 per day. After day 90, you’ll have to use your “lifetime reserve days” to cover any additional time, but you only get 60 of these days total. During the lifetime reserve days, you’ll pay a copay per day. It’s $800 per day in 2023. Once you’ve used up your reserve days, Medicare will not cover any additional hospital stays. With the exception of lifetime reserve days, your benefits will start over once the plan year ends and a new one starts.
Unless medically necessary, Medicare Part A will not cover the costs of a private duty nurse, a private room, or any extra perks during a hospital stay, such as television, phone or personal care items. In addition to the actual bed and medical care, Part A will also cover the cost of meals, general nursing care, medicines prescribed while in the hospital, inpatient rehab facilities and mental health care.
You should enroll for Medicare Part A when you first become eligible. Eligibility factors are:
- Reaching age 65
- Receiving disability benefits through Social Security (SS) or Railroad Retirement Benefits (RRB)
- Receiving disability for end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease)
Those eligible due to age may first enroll three months before their 65th birthday, during the month of their 65th birthday, and for the three months following their 65th birthday, for a total of seven months. Those eligible due to receiving disability benefits will be automatically enrolled into original Medicare (Parts A and B) on the 25th month of receiving disability benefits.
If you miss the deadline for Original Medicare, you can enroll during the General Enrollment Period, which runs from January 1 and March 31 each year. If you don’t enroll in Part A when you’re first eligible, and you don’t qualify for premium-free Part A (most people don’t pay a premium), then you may be charged a penalty fee for signing up later. There are also special circumstances that will trigger a Special Enrollment Period (SEP). This allows a participant to enroll outside of the normal deadlines.
Part B – Original Medicare
Medical Insurance that covers medically necessary outpatient care.
Medicare Part B is considered the medical portion of your Medicare coverage. This portion of Medicare generally covers medically necessary outpatient care, like regular doctor visits, strep tests, flu shots and ambulance rides.
PARTIAL COVERAGE FOR:
- Doctor visits
- Preventative care
- Outpatient services
- Lab testing
- Medical equipment
- Surgery & more
Medicare Part B covers medically necessary outpatient services, like lab tests, vaccines, surgeries and doctors visits. There’s an annual deductible before benefits start.
In 2023, the Medicare Part B deductible is $226. Once you meet the deductible, you’ll pay 20 percent of the Medicare-approved amount for your medical care. There’s no cap in place in Original Medicare, which means you’ll pay this cost sharing amount no matter how high it gets each year.
Similar to Part A, you can sign up for Medicare Part B as soon as you reach the age requirement or the 25th month of receiving disability benefits. The required enrollment period starts three months before your 65th birthday or 25th month anniversary. It includes the actual month of your birthday or anniversary and ends three months after the birthday and anniversary month, for a total of seven months.
Again, if you miss the initial deadline, you can enroll during the General Enrollment Period (GEP), which runs from January 1 to March 31. There will likely be a penalty fee for not signing up for Medicare when first eligible, which lasts for as long as you have Medicare.
You may also be able to enroll in Part B outside of your initial window during a Special Enrollment Period (SEP). An SEP occurs if someone is receiving health insurance through their employer. Or, they can qualify for an SEP if they sign up for Medicare Part B within eight months after their employment ends, or if their insurance through their former employer terminates, whichever comes first.
Again, any person who wishes to sign up for a Medicare Part B plan must do so through the SSA office. This agency handles the enrollment process for CMS.
Part C – Medicare Advantage
Private Insurance plan that combines Medicare Parts A & B with additional coverage.
Medicare Part C is also known as Medicare Advantage or MA. This is the private portion of Medicare.
OFTEN COVERS:
- Prescription drugs
- Dental care
- Vision exams
- Hearing exams
MAY ALSO COVER:
- Eyewear/lenses
- Hearing aids
- Telehealth
- Fitness benefits
- Nonmedical benefits that aid in a diagnosis (like air filters or meal delivery services)
- Other benefits designed by the plan
By law, all Medicare Advantage plans must cover, at minimum, the same benefits as Original Medicare (Parts A and B together). Beyond that, these individually sold plans from private companies can offer a host of other benefits, including coverage for prescription drugs, routine dental and vision, hearing aids, telehealth, gym memberships and more.
Medicare gives insurance companies money each month, per member, to offset the overall cost of coverage to the participant. This is different than Original Medicare plans (Part A and B), which are managed by and claims are paid directly by the CMS. Therefore, the cost of Part C is typically as affordable as Part A and B. And in some cases, it may save you money since cost sharing tends to be lower with MA plans. In other words, you may pay less out of pocket for your actual medical care.
MA plans vary in cost and coverage, based on the company selling the plan. Read your policy limits carefully to understand what you’re buying, such as whether a procedure is covered, whether you have a deductible and whether a doctor is within your plan’s network.
You can enroll in Medicare Advantage once you sign up for Medicare Parts A and B, ideally during your initial enrollment window as outlined above (7 months surrounding and including the month you turn 65). You can also enroll in an MA plan during the Open Enrollment Period that runs from October 15 through December 7 each year.
Part D – Drug Coverage
Private Insurance that covers prescription drugs.
Medicare Part D is used to cover prescription drugs. This portion of Medicare, like Medicare Advantage, is sold by individual companies.
COVERS SOME:
- Generic drugs
- Brand name drugs
- Specialty drugs
DOES NOT COVER:
- Vitamins & minerals
- Weight loss drugs
- Non-FDA drugs
Standalone Part D policies cover some or all of the cost of prescription drugs. While many Medicare Advantage plans include Part D coverage, standalone Part D plans are available only to people with Original Medicare.
Medicare Part D plans can have a deductible, but not all of them do. The government caps what the deductible can be each year. In 2023, it’s $550. That’s the highest deductible a Part D plan can have. Cost sharing (copays or coinsurance) for actually filling a prescription vary widely by plan.
As with any portion of Medicare, the best time to get a Part D plan is when you’re first eligible. Outside of this 7-month window, you may pay a penalty fee for signing up late. You can join a Part D drug plan during Open Enrollment as well. And if you signed up for Medicare late (during General Enrollment), you can enroll in a Part D plan from April 1 through June 30. Coverage then starts July 1.
Part D used to have an issue called the “donut hole.” You can read more about that here. But as of 2020, the donut hole is technically closed. Plus, most people never reach the coverage limit in the first place to land in this stage.
Medicare Costs
What are the monthly premiums for the different of Medicare?
$0 to $506.00 Cost per month for 2023
Medicare Part A Cost
Medicare Part A is typically referred to as “premium-free” Part A because most enrollees don’t pay a monthly premium for coverage. If you or your spouse worked for 10 years and paid Medicare taxes along the way, then you most likely have the required work credits needed (40) to receive premium-free Part A. Enrollees are also eligible for premium-free Part A if they receive Social Security or Railroad Retirement Board disability benefits or have an end-stage renal disease.
If, however, you did not pay Medicare taxes while working or haven’t earned enough credits, you will pay a premium for Part A. In 2023, premiums are $278 a month for people who earned 30 to 39 work credits and $506 a month for people who earned fewer than 30 credits.
Medicare Part B Cost
Most people pay the standard monthly premium for Medicare Part B. In 2023, it’s $164.90 a month. The annual deductible is the same for everyone. It’s $226 for the year in 2023.
For higher-income Part B beneficiaries, Medicare charges an income-based surcharge (called the “IRMAA”). These income charges are based on tax returns from two years prior. So in 2023, IRMAA surcharges are based on the income you reported on your taxes in 2021. The income tiers are as follows:
- Up to $97,000 ($194,000 for couples)
- Between $97,001 and $123,000 ($194,001 to $246,000 for couples)
- Between $123,001 and $153,000 ($246,001 to $306,000 for couples)
- Between $153,001 and $183,000 ($306,001 to $366,000 for couples)
- Between $183,000 and $500,000 (366,000 to $750,000 for couples)
- Over $500,001 ($750,001 for couples)
You can appeal the decision if you can prove that your income from two years ago isn’t the same as it is now. For more information on appealing or disputing IRMAA charges, contact Medicare directly. Note that you still need to pay your premiums while Medicare processes your appeal. You can lose Part B coverage for not paying your premiums, even while you’re appealing the charges.
Medicare Part C Plan Cost
As stated before, the cost of a Medicare Advantage plan will vary depending on the company and type of plan. You will need to compare plans and prices to get the best rate for your area.
Remember that you must have Medicare Parts A & B in order to enroll in a Medicare Advantage plan.
Medicare Part D Plan Cost
The monthly premium for Medicare Part D also varies depending on plan and income level. As with Part B, income determinations are made using tax returns from two years prior, and the same income tiers that Part B has are used to determine additional charges for prescription drug coverage. The full breakout is below:
| If your individual income is… | If your joint income is… | This is what you’ll pay for Medicare Part D: |
| Up to $97,000 a year | Up to $194,000 a year | The plan’s premium |
| Between $97,000+ and $123,000 a year | Between $194,000+ and $246,000 a year | $12.20 + plan premium |
| Between $123,000+ and $153,000 a year | Between $246,000+ and $306,000 a year | $31.50 + plan premium |
| Between $153,000+ and $183,000 a year | Between $306,00o+ and $366,000 a year | $50.70 + plan premium |
| Between $183,000+ and less than $500,000 a year | Between $366,000+ and less than $750,000 a year | $70.00 + plan premium |
| $500,000 or more a year | $750,000 or more a year | $76.40 + plan premium |
Supplemental Medicare Plans
Medigap policies are offered by private insurance companies and help pay for some of the out-of-pocket costs associated with Parts A and B, such as the Part A deductible and Part B coinsurance of 20 percent. Some Medigap plans may offer partial coverage for emergency care received while outside of the United States as well.
The monthly premiums for the different Medicare plans are generally seen as affordable. However, what can be unaffordable and financially taxing is the deductibles and copayments. For this reason, many enrollees opt to take on Medigap insurance, in addition to their traditional Medicare plans. The cost of the Medigap policy varies, depending on the insurance company and the type of coverage offered.
If a person has a Medicare Savings Account (MSA) or a Medicare Advantage plan, they cannot have a Medigap insurance policy. It is against the law for an insurance company to write a Medigap policy if the participant also has an MSA. Medigap is also not available to people with Medicare Advantage.
Medicare Savings Account
Some Medicare Part C plans offer high deductibles and will not begin full coverage of claims until the deductible is satisfied. In these instances, many participants also choose to take on a Medicare Medical Savings Account. An MSA is a special type of savings account designed to help pay high annual deductibles.
An MSA is set up with a private insurance company, and the actual account is set up with a bank of the plan’s choosing. The plan then deposits some money into the account. The participant is also encouraged to deposit money in the account as available. Money in the account is safe and secure and is also not taxed upon withdrawal, so long as the money is used to cover healthcare-related expenses, such as deductibles or copays. Participants are required to submit a special form with their annual tax return that explains how the money was used in order to avoid taxation.
At the end of the year, any money left over in the MSA will either roll over to the next year, or it can be withdrawn. If withdrawn and not used for healthcare-related purposes, the money will be taxed as income.
Are dental and vision care covered by Medicare?
Generally, neither dental nor eye care is covered under Medicare Part A or B. However, these benefits can be covered if there is some special type of care received during a hospital stay, in which case, it would fall under Part A coverage.
Some Medicare Part C plans may cover dental and eye care. If so, you can use money from a Medicare Medical Savings Account to cover the costs of dental and eye care. Otherwise, you may have to pay for a private dental or eye care insurance policy in order to get these types of services covered.
Why Medicare works with private insurance companies
In some instances, you may choose to have insurance through both Medicare and a private insurance company to maximize your coverage. When that happens, there are specific rules to determine which policy will pay a claim first. This is also called a “coordination of benefits.” Traditionally, the primary payer, which is oftentimes the private insurance company, will pay up to their policy limits on a claim. Then, they will send the remaining amount on the bill to the secondary payer, the Medicare policy.
The History of Medicare
The concept and design of Medicare has remained the same for over 55 years.
Under the leadership of President Lyndon B. Johnson, Congress passed Medicare in 1965. Medicare was part of the Social Security Act. It was designed to benefit and promote the health and wellness of citizens who were over the age of 65, without consideration of their income level and medical history. Prior to the creation of Medicare, senior citizens faced exorbitant medical bills and high health insurance premiums, often with little recourse in addressing these costs.
The concept of Medicare has remained the same for over 55 years. However, the quality of coverage has increased over the years as amendments have been passed requiring Medicare to cover more for participants. For instance, hospice care only became a requirement in 1984, and the eligibility requirements were expanded in 2001 to allow persons younger than 65 who had certain disabilities and medical conditions to obtain Medicare coverage.
Medicare Part A is funded in large part by the payroll tax levied on employers and employees (the Medicare Tax). Part B and Part D costs are partially funded by the premiums paid by participants. The portion of the federal budget allocated to Medicare spending is growing each year as more BabyBoomers become eligible to enroll in Medicare. Additionally, the average life expectancy of the nation’s senior citizens is increasing thanks to medical and scientific advancements.