Medicare

So, You Received Your Medicare Card, Now What?
Has Medicare Confusion Set In With All The Mailers?
Do You Wish You Had Someone To Cut Through The Clutter?

If you are having these questions, you are not alone. For over 20 years, Al Crouse and Associates has assisted individual Medicare beneficiaries from all across North Carolina in selecting a Medicare health plan that best suits their needs. We offer Medicare Supplements and Medicare Advantages from multiple companies that we represent. We have been recognized by multiple insurance carriers for outstanding sales and service achievements. If you would like to be contacted by us, please complete the Request For More Information, and one of our licensed health agents will contact you. We pride ourselves in not engaging in high pressure sales tactics, and truly working with you in selecting a Medicare health plan that suits your needs.

In the meantime, please see the Medicare information below that may be helpful to answer some of your questions.

The A, B, C and D’s of Medicare

What is Medicare?

  • Medicare is health insurance for individuals age 65 and over
  • Medicare is also available to individuals under the age of 65 in the 25th month of receiving Social Security Disability Benefits
  • Medicare has 4 parts:
  • Part A- Hospital Insurance
  • Part B- Medical Insurance
  • Part C- Medicare Advantage
  • Part D- Prescriptions

When can you enroll in Medicare?

  • Beneficiaries are eligible on the first of the month they turn age 65, unless your birthday falls on the 1st of the month, then you are eligible the 1st of the month prior to your 65th birthday.
  • If you are eligible due to disability? Then your eligibility begins the first of the month of the 25th month that you are receiving disability benefits.

Enrolling In Medicare-Currently Drawing Social Security Income

  • Are you drawing Social Security Income?
  • You will be automatically enrolled in Medicare Part A and Medicare Part B
  • Your Medicare Part B Premium will be automatically deducted from your Social Security Retirement Benefits
  • Your Medicare benefits will become effective on the first of the month that you turn 65.
  • Your Medicare Card will arrive approximately 90 days before your 65th birthday.

Enrolling In Medicare-Not Drawing Your Social Security Income

  • You are turning 65 and have not started drawing your Social Security Income, your sign up period is 7 months:
  • 3 months before your 65th birthday month
  • The month of your 65th birthday
  • Three months after your 65th birthday month

When you apply for Medicare

  • Automatically enrolled/signed up before your 65th birthday month
  • Automatically enrolled/signed up before 65th birthday month BUT your birthday falls on the 1st
  • During the 1st month you turn 65
  • One month after you turn 65
  • 2 months after you turn 65
  • 3 months after you turn 65
  • After that time, you can usually only apply during the General Election Period (1/1-3/31)

Your Medicare enrollment will be effective

  • First day of your birth month.
  • Your coverage will start on the 1st day of month prior to your birthday
  • Medicare will start 1 month after you sign up
  • Medicare will start 2 months after you sign up
  • Medicare will start 3 months after you sign up
  • Medicare will start 3 months after you sign up
  • Medicare will start July 1st

How to apply for Medicare Part A and Part B

Sign Up Over The Phone
800-772-1213

Sign Up at Your Local
Social Security Office

Medicare Parts A and B

Medicare Part A Hospital Insurance Premiums

Most beneficiaries qualify for “Premium Free” Medicare Part A if you have worked for at least 10 years and paid Medicare taxes.

If you have worked less than 10 years, you will share in the cost of your Medicare Part A premium.

If you are not eligible for “Premium Free” Part A, the full cost of the Medicare Part A premium for 2020 is $ 458.00

Spouses may qualify for no cost Part A at age 65 if their spouse has worked 10 years and is at least age 62.

Medicare Part B Medical Insurance Premiums

Monthly Part B premiums are determined by the Social Security Administration and are based on your household taxable income from two years prior (2020 premiums are based on 2018 income)

Most beneficiaries will pay the standard Part B premium of $ 144.60 in 2020

Please See Chart Below:

Yearly Income and Filing Status for 2018 Part B Premium
for 2020
File individual tax return File joint tax return File married & separate tax return
$87,000 or less $174,000 or less $87,000 or less

$144.60

$87,000 to $109,000 $174,000 to $218,000Not applicable

$202.40

$109,000 to $136,000$218,000 to $272,000Not applicable

$289.20

$136,000 to $163,000$272,000 to $326,000Not applicable

$376.00

$163,000 to $500,000$326,000 to $750,000$87,000 to $413,000

$462.70

Greater than $500,000Greater than $750,000Greater than $413,000

$491.60

Original Medicare Benefits

Medicare Part A Hospital Benefits

  • Inpatient Hospital Care
  • Skilled Nursing Facility Care
  • Hospice Care
  • Some Home Health Care

Part A Benefits do not cover all costs. To Your cost:

  • In Patient Hospital
  • $1408 deductible for each benefit period
  • $352 per day for days 61 – 90 of a hospital stay
  • $704 per day after day 90 subject to a 60-day lifetime limit
  • Beyond the lifetime limit: you are responsible for all costs

Skilled Nursing Facility

  • Day 1 – 20: $0
  • Day 21 – 100: $176.00 per day
  • Beyond Day 100: 100% of all costs

Medicare Part B Medical Benefits

  • Physician Services
  • Outpatient Hospital Services
  • Ambulatory Surgical Centers
  • Comprehensive Outpatient Rehabilitation Centers
  • Preventive Care
  • Ambulance
  • Durable Medical Equipment
  • Limited Outpatient Prescription Drugs
  • Infusion/Chemotherapy

Part B Benefits do not cover all costs. You will pay:

  • $198 Annual Deductible
  • Typically, 20% of the Medicare Approved Amount for Part B Covered Services

Medicare Health Plan Options

There is no out of pocket limit for Medicare Part A and Medicare Part B.

Medicare Part A and Medicare Part B do not provide prescription drug coverage

Medicare Health Plan options can help you limit your out of pocket medical and help you pay for prescriptions

Option 1

Original Medicare + Medicare Supplement + Stand Alone Part D Drug Plan

Medicare Supplement Plans

  • Covers most of your out of pocket costs for Medicare Part A and Medicare Part B.
  • To enroll in a Medicare Supplement plan, you must be enrolled in Medicare Part A and Medicare Part B
  • Guaranteed Issued if you enroll within 6 months of your Medicare Part B effective date
  • You may have to answer health questions if you apply after 6 months of your Medicare Part B effective date
  • No network. Freedom to choose providers and hospitals.
  • A Medicare Supplement Plan is accepted by any provider that accepts Medicare.

Medicare Part D Prescription Drug Plans

  • Medicare Part D prescription plans are regulated by CMS
  • Part D prescription plans are provided by private insurance companies contracted by Medicare
  • Part D prescription plans can have different premiums, formulary (list of covered RX), and benefits
  • Individual and couples with higher incomes may have to pay a higher plan premium Individuals earning above $ 87,000 and couples earning above $ 174,000 will have Income Related Monthly Adjusted Amount (IRMAA) added
  • If you enroll in a Medicare supplement plan and need outpatient prescription coverage, you will need to enroll in a standalone Part D prescription plan
  • To If you do not enroll in a Part D prescription plan when you are first eligible, you will be penalized when you do enroll in a Part D prescription plan if you did not have credible coverage
  • The penalty is 1% per month of the Part D National Base Beneficiary Premium. The 2020 Part D National Base Beneficiary Premium is $32.74.

Medicare Annual Enrollment Period

  • You may change RX plans each year
  • The Annual Notice of Coverage for your current plan will arrive by September 30
  • You can start shopping for coverage on October 1
  • You may submit applications from October 15-December 7th for a January 1st effective date

Option 2

Medicare Part C-Medicare Advantage

Medicare Advantage Plans

Medicare Part C-Medicare Advantage plans are provided by private insurance companies contracted by Medicare to offer benefits of Part A, Part B, and usually Part D in an all-in-one plan

Medicare Part C-Medicare Advantage Benefits Contain:

Co-pays for physicians, coinsurance, and out-of-pocket maximums along with other benefits not provided by original Medicare such as: dental, vision, etc.

With a Medicare Advantage Plan

  • You will continue to pay your Medicare Part B premiums along with any plan premiums
  • You can enroll in a plan with or without Part D prescription coverage
  • You may be required to see a provider that is in the plans network
  • Most insurance companies offer a HMO and PPO plan design
  • Some plans cover out of network benefits i.e. a PPO
  • You cannot enroll in a standalone Part D plan with a Medicare Advantage- even a Medicare Advantage without RX coverage- if you do, you will be disenrolled from one of the plans

Annual Enrollment Period-AEP

  • You may change plans each year
  • The Annual Notice of Coverage for your current plan will arrive by September 30
  • You can start shopping for coverage on October 1
  • Annual Enrollment Period is from October 15th-December 7th for January 1st effective dates

Medicare Part C-Medicare Advantage and Medicare Part D Income Related Monthly Adjusted Amounts For Higher Income Earners

Like Medicare Part B, monthly plan premiums for Medicare Part D and Medicare Advantage with Part D (MAPD) are determined by the Social Security Administration and are based on your household taxable income from two years prior (2020 premiums are based on 2018 income)

Please see Chart Below:

Yearly Income and Filing Status for 2018 Part D and Medicare Advantage with Part D Income Related Monthly Adjusted Amount 2020
File individual tax return File joint tax return File married & separate tax return
$87,000 or less $174,000 or less $87,000 or less

$0

$87,000 to $109,000 $174,000 to $218,000Not applicable

$12.20

$109,000 to $136,000$218,000 to $272,000Not applicable

$31.50

$136,000 to $163,000$272,000 to $326,000Not applicable

$50.70

$163,000 to $500,000$326,000 to $750,000$87,000 to $413,000

$70.00

Greater than $500,000Greater than $750,000Greater than $413,000

$76.40

Resource Documents To Assist You

  • Medicare and You This is the official U.S. government Medicare handbook.
  • Choosing a Medigap Policy A Guide to Health Insurance for People with Medicare. Published by the Centers for Medicaid and Medicare services and the National Association of Insurance Commissioners.
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