Medicare is health insurance for individuals 65 years of age or older and some individuals with a disability. Eligibility to sign up for Medicare starts 3 months prior to your 65th birthday. Below is an outline of some basics regarding Medicare expenses and various options for coverage.

Please keep in mind: It is best to discuss your individual situation with a Health Insurance Specialist to determine the best fit for you.

Medicare Expenses 

While many Medicare costs are subsidized, you will still be responsible for various costs after enrollment. Think of it as enrolling in a new insurance plan that has its own guidelines and coverage limitations. 

So what can you expect to spend? This depends, in part, on the type of plan you select. Part C offers you the option to seek coverage through a private health insurance company, which will have its own rates and inclusions. This is also known as Medicare Advantage. If this is something you’re interested in, feel free to contact me and we can look at plans, options, and costs together. 

When it comes to Parts A, B, and D, the government updates the coverages and costs on a yearly basis. That said, here’s what you can generally expect for 2022 enrollment: 

Part A: $1,556 deductible and variable coinsurance fees 
Part B: $170.10 monthly premium and $233 deductible, with 20% of costs after the deductible is met. 
Part D: Monthly premiums can range between $10-$40 with a $480 deductible.

These figures can give you a ballpark idea of how much you can expect Medicare coverage to cost. 

However, there are other factors that can affect your out-of-pocket expenses. 

Income level and Medicaid eligibility 
Geographic location

Part C selections 
Participating providers 
Approved vs. denied claims 
Supplemental insurance

To this end, it’s important to remember that while Medicare can seem like a clear-cut, government-provided solution, you’ll benefit the most from putting together a customized approach. This will ensure you pay the least for the coverages you need the most with fewer surprise costs along the way. 

Medicare Supplemental Plans (Medigap) 

Medigap plans supplement original Medicare, filling in the gaps Medicare Parts A and B don’t cover. Rather than replacing Parts A and B, original Medicare still provides these coverages while the Medigap plan covers your copays and deductibles. Like Advantage (discussed below), you still pay the Part B premium; however, you also pay a monthly Medigap premium.  

Under this option you do not have a provider network which allows flexibility to seek care at any medical facility that accepts Medicare. Most Medigap policies do not cover Part D. If you choose a Part D plan, you are responsible for the deductible and copays which are separate.  

Pros: 

No Provider networks, covers you anywhere that accepts Medicare 
Pays out-of-pocket costs after original Medicare.  
Covers all services approved by Medicare, no prior authorizations required

Cons: 

Monthly Premium 
Does not cover Part D 
Does not provide any extra routine services not covered by original Medicare

 Medicare Advantage 

A lower cost option which combines parts A, B, and D is Medicare Advantage plans. This alternative replaces original Medicare and MAY have some extra benefits including routine dental and hearing. Oftentimes individuals opt for a $0 premium plan with Advantage; however, this means you still pay the part B premium.  

Under this plan you typically pay a copayment and deductible like a traditional health insurance plan, but the plan comes with a maximum limit for out-of-pocket expenses. Medicare Advantage has provider networks, and some services are required to be pre-approved.  

Pros: 

Low cost 
Wraps all parts into one plan, usually including part D 
Out-of-pocket limits

Cons: 

Requires provider networks 
Typically requires copays and deductibles 
Some additional services must be pre-approved

It’s important to understand your coverage whether you decided to enroll in original Medicare, original Medicare with additional Medigap, or a Medicare Advantage (Part C) Plan. If you also enrolled in Medicare Part D, I am here to answer your prescription drug reimbursement questions. 

Reach out to me at any time to review your Medicare coverage or discuss your options for future coverage. I want to ensure that you make the most of your benefits.   Please don’t hesitate to reach out to me with any questions.

2022 Medicare Expenses & Coverage

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