Original Medicare is healthcare for people over age 65 and disabled persons. Part A and Part B medical coverage is provided by the federal government and managed by the Social Security Administration through the Centers for Medicare & Medicaid Services, or CMS. Original Medicare is made of of two parts: Part A is your hospital coverage, as well as skilled nursing care and hospice care. Part B is your outpatient coverage, and includes care by your physician, some preventative services, and medical supplies.

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities* and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). *To qualify for Medicare due to disability, you must have been receiving Social Security Disability Income for 24 months.

Medicare begins the first day of the month you turn 65. If your birthday falls on the first day of the month, Medicare will begin on the first day of the month the month prior to your 65th birthday. If you are under 65 and have a disability, you automatically get Part A and Part B after you receive disability benefits from Social Security for 24 months. Some individuals may choose to delay their Medicare enrollment. There are times when it makes sense to do so, but there is a risks in doing so if you aren't careful. Contact us to learn more about whether you should consider delaying your enrollment.

If you are already receiving social security benefits when you turn 65, your enrollment will be automatic. In this case, you won't have to do anything except wait for your Medicare card to arrive. However, if you are automatically enrolled in Part B and you don't want the coverage because you have other, creditable coverage, you will need to contact your social security office to disenroll. If you aren't receiving social security benefits when you turn 65, you will need to actively enroll to trigger your Medicare Parts A and B start dates. Ideally, you will want to start this process at the very beginning of your IEP, three months before your birthday month. The best way to enroll in Medicare Part A and/or Medicare Part B is to go online at www.SocialSecurity.gov. You can also enroll by calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM. Contact us if you have questions about enrolling in Original Medicare.

Part A covers: Inpatient care in a hospital, skilled nursing facility care (following a qualifying hospital stay), nursing home care (inpatient care in a skilled nursing facility, but not custodial or long-term care), hospice care and home health care. Medicare has published guidelines and limitations to how and what will be covered within these benefit areas.

For 2022 you pay: Inpatient care in hospitals $1,556 deductible for each benefit period Days 1-60: $0 coinsurance for each benefit period Days 61-90: $389 coinsurance per day of each benefit period Days 91 and beyond: $778 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) Beyond lifetime reserve days: all costs Skilled nursing facility care Per day Days 1-20: $0 Per day Days 21-100: $194.50/ day Hospice care $0 for hospice care. You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you are at home. In the rare case your drug is not covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it is covered under Medicare prescription drug coverage (Part D) You may need to pay 5% of the Medicare-approved amount for inpatient respite care. Medicare does not cover room and board when you get hospice care in your home or another facility where you live (like a nursing home). Home health care $0 for home health care services. 20% of the Medicare-approved amount for Durable Medical Equipment (DME)

You pay a premium each month for Part B. The standard Part B premium amount in 2022 is $170.10. Most people pay the standard Part B premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium. In most cases, if you do not sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty. You will have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% of the standard premium for each full 12-month period that you could have had Part B but did not sign up for it. Also, you will likely have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B if you missed your initial enrollment opportunity. Coverage will start July 1 of that year. The best way to avoid late enrollment penalties is to contact us to discuss your situation approximately three months before you turn 65.

IRMAA (Income Related Monthly Adjustment Amount) is an adjustment to your Part B premium that occurs when your income exceeds a certain threshold amount. That amount is published annually by the Centers for Medicare and Medicaid Services (CMS.) The chart below indicates the IRMAA thresholds and premiums for 2022:

Generally speaking, Part B covers most doctor services, emergency or observation services, ambulance services, outpatient services, clinical research, durable medical equipment (DME) and limited mental health. Medicare Part B classifies and covers two types of services. Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services: Health care to prevent illness or detect it at an early stage when treatment is most likely to work best.

In 2022, your annual deductible under part B is $233. After you meet your deductible for the year, you typically pay 20% coinsurance on the Medicare-approved amount for covered services. You typically pay nothing for most covered preventive services if you get the services from a health care provider who accepts assignment.

If you are receiving social security benefits, your Part B premium will automatically be deducted from your monthly payment. If you are not yet receiving social security payments, you will get a "Medicare Premium Bill" (Form CMS-500) every 3 months, with the option to enroll online for a monthly "easy pay" option instead. You can learn more about easy pay here. NOTE: If you are one of the few individuals who pays for Part A; or if you owe Part B IRMAA (Income Related Monthly Adjustment Amount); you will receive a “Medicare Premium Bill” monthly.

If you receive Social Security or Railroad Retirement Board (RRB) benefits, your Part B (Medical Insurance) premium will get deducted automatically from your benefit payment. If you do not receive these benefits, you will get a bill to pay your premiums. You then have four options to pay: Pay online through your secure Medicare account — You can pay by credit card, debit card, or from your checking or savings account. Pay directly from your savings or checking account through your bank's online bill payment service, learn what information you need to have ready when you contact your bank to set up this service. Sign up for Medicare Easy Pay, a free service that automatically deducts your premium payments from your savings or checking account each month. Your premium from your bank account will usually be deducted on the 20th of the month. Mail your payment to Medicare — You can pay by check, money order, credit card, or debit card. Fill out the payment coupon that comes with your bill. Payments sent without the coupon may be delayed. If you pay by credit/debit card, enter the account information and expiration date as it appears on your card. Be sure to sign the coupon. Mail your Medicare payment coupon and payment to: Medicare Premium Collection Center PO Box 790355 St. Louis, MO 63179-0355

Medicare Easy Pay is a free, electronic payment option that lets you have Medicare premium payments automatically deducted from a savings or checking account each month. Learn more here.

Sign up for Medicare Easy Pay, which is a free, electronic payment option that automatically deducts premium payments from your savings or checking account each month it is due. To sign up, visit https://www.medicare.gov/medicare-easy-pay or call 1-800-MEDICARE (1-800-633-4227; TTY users, call 1-877-486-2048).

If you are wondering if your medical service will be covered by Original Medicare, you can talk to your doctor/ health care provider or go to https://www.medicare.gov/coverage.

Original Medicare does not usually provide sufficient coverage for beneficiaries. Original Medicare does not include prescription drug coverage, and it excludes other extra benefits like dental, vision and hearing aids. Most beneficiaries will need to add a Prescription Drug Plan, also called Part D. Many will also choose to purchase a supplemental insurance policy (often called Medigap insurance), or an Advantage Plan (Part C). In limited areas of Minnesota, you may also have the option of selecting a Cost Plan. Click here to learn more about your options in additional coverage.

Unless you have coverage through the VA, you will want to get prescription drug coverage at the time you enroll in Part B. If you fail to do so, you many have to pay a premium penalty when you do add the coverage, and the penalty applies every year for life. Prescription drug coverage is also called "Part D." To enroll in Part D, Medicare beneficiaries must also be enrolled in either Medicare Part A or Part B. Beneficiaries can participate in Part D through a stand-alone prescription drug plan or through a Medicare Advantage plan that includes prescription drug benefits. If you choose a Medicare Advantage plan, you'll need to be enrolled in both Part A and Part B; and when you go this route your drug coverage is combined with your health care coverage under one policy. If you've decided to stay with Original Medicare (whether or not you've enrolled in a Medicare supplement insurance plan,) you'll need to add a separate Part D plan. And for beneficiaries on a Medicare Cost plan; your plan may or may not include prescription drug coverage; and if it does not you will need a separate Part D policy. Learn more about prescription drug coverage here, or contact us for information.

A supplement insurance policy is a health insurance plan offered by private insurance companies. These policies are designed to fill the gaps left by Original Medicare. In other words, they will pay the deductibles, co-payments and co-insurance not covered by Original Medicare (within CMS guidelines.) Contact us to learn more about Medicare supplement policies, or read more about them here.

An Advantage plan is an “all in one” alternative to Original Medicare. It is provided by private insurance companies contracted with Medicare to provide all your Part A and Part B benefits. Many Medicare Advantage Plans also offer prescription drug coverage as well as extra coverage, like routine vision, hearing and dental coverage. Each Medicare Advantage Plan can charge different out-of-pocket costs. They also have different rules for how you get services, like whether you need a referral or if you need to stay in their network for care. What you pay for services depends on several factors and these amounts can be different than what you would pay under Original Medicare. Be sure to review the plan’s Summary of Benefits carefully to know what the plan rules are and what your costs will be. Learn more about Medicare Advantage Plans here. Or feel free to contact us for more information.

An MSA plan is provided by private insurance companies contracted with Medicare to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are like Health Savings Account Plans available outside of Medicare. You choose your health care services and providers. Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. Medicare MSA Plans do not cover Medicare Part D prescription drugs. The two parts of MSA plans include: High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C). The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan. Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money into your account. You can use money from this savings account to pay your health care costs before you meet the deductible.

Cost Plans are Medicare health plans that provide health care coverage that are not Medicare Advantage Plans but are still part of Medicare. Cost plans in Minnesota are limited in availability, based on the county where you live. If you live in one of these counties, please contact us for more information on how these plans work and whether you should consider enrolling: Aitkin Carlton Cook Goodhue Itasca Kanabec Koochiching Lake Le Sueur McLeod Meeker Mille Lacs Pine Pipestone Rice Rock Sibley St. Louis Stevens Traverse Yellow Medicine

There are three ways to find out. Talk to your doctor/ health care provider Talk to your plan’s Member Services department. Obtaining prior authorization or a pre-determination of benefits is advised. The phone number to call can be found on the back of your insurance card. Review your plan’s Evidence of Coverage (EOC) document. The EOC is the most comprehensive document that describes in detail the health care benefits covered by your health plan. It provides documentation of what that plan covers and how it works, including how much you pay.

Coverage of this type is designed to supplement Medicare by covering some hospital, medical and surgical services which are partially covered by Medicare but does not cover all medical expenses beyond those covered by Medicare. To determine if your test, services, or procedure is covered by Medicare there are two ways to find out. Talk to your doctor/ health care provider Go to https://www.medicare.gov/coverage. To then determine how your Medicare covered test, service, or procedure is covered by your Supplement plan, refer to your policy’s Outline of Coverage or contact your plan’s member services department. To determine if your test, service, or procedure which is not covered by Medicare but may be covered by your Supplement plan, refer to your policy’s Outline of Coverage or contact your plan’s member services department.

Original Medicare does not cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you are in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care is not covered. Inpatient care includes treatment you get in an acute care hospital, critical access hospital, inpatient rehabilitation facility, long-term care hospital, inpatient care as part of a qualifying research study, and mental health care. Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover - often including vision, hearing, or dental. Contact us to learn more.

Original Medicare does not cover hearing aids or exams for fitting hearing aids. Often Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover; including vision, hearing, or dental. Contact us to learn more.

Original Medicare does not cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Usually Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover; including vision, hearing, or dental. Contact us to learn more.