As you approach age 65, you may be worrying about how you will handle unexpected medical costs. Luckily, Medicare can help. Understanding your options, and what is available to you can help you manage your health expenses as you age. There are only two ways to get Medicare coverage for things like doctor visits, outpatient care, and inpatient hospital care—through Original Medicare (Part A and Part B) or a Medicare Advantage Plan. The costs associated with each vary considerably, and the choices you make directly influence how much you will pay out-of-pocket for coverage.
Costs in 2024
The exact amount you pay for Medicare coverage is based on several factors, including your income. Original Medicare typically carries a monthly premium along with a few other out-of-pocket expenses, such as a deductible, coinsurance, and copay. While there are five different income tiers used to calculate costs, Part A is typically free for most people. Part B is not, and carries a standard premium of $174.70 per month. There is also a Part B deductible of $240 per year. Once this is met, you can expect to pay a copay for most doctor services, outpatient therapy, and durable medical equipment equal to 20 percent of Medicare-approved costs.
How You Pay for Medicare
Whether you have Original Medicare or a Medicare Advantage Plan, if you receive Social Security benefits, Railroad Retirement benefits, or Office of Personnel Management benefits, your Part B premium will be deducted automatically each month from your benefits check. If you do not receive these benefits, you will receive a bill for Medicare coverage. Again, in 2024, most Original Medicare recipients pay the standard Part B premium amount, and you can expect $174.70 to be taken from your benefits check. Retirees with higher incomes pay a higher premium, calculated using the modified adjusted gross income on the most recent tax return.
Financial Help Is Available
The good news is, that there are several programs available to help people with limited income and resources get the coverage they need and deserve.
Medicaid is a joint federal/state program that helps pay for medical costs for people with limited income and resources. In many cases, Medicaid offers additional benefits not provided by Medicare, such as nursing home care and prescription drug coverage. Eligibility rules differ by state. Be sure to call your state Medicaid program to see if you qualify.
State Medicare Savings Programs were created to help seniors pay for premiums and out-of-pocket costs like deductibles, coinsurance, copays, and even prescription drug coverage costs. Eligibility is based on income.
The PACE program was created to help elderly seniors in need of nursing home-level care receive services at home or in a PACE center rather than at a nursing home or elder care facility. To qualify, you must be at least 55 years old, live in the service area of a PACE organization, and need nursing home-level care. PACE often covers dental care, prescription drugs, meals, preventive care, emergency services, and more.
If you qualify for Medicaid, you pay nothing for PACE coverage. If you do not qualify for Medicaid, you pay a monthly premium for prescription drugs along with a monthly premium to cover the costs of long-term care. However, there is no deductible or copayment.
Extra Help paying for prescription drug coverage is available for those who meet certain income and resource limits. If you qualify, you may pay a reduced amount for your Medicare drug plan premium and deductible.
References:
Medicaid:
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
Medicare Savings Program
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html
PACE
https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
Extra Help with Part D
https://www.medicare.gov/your-medicare-costs/help-paying-costs/save-on-drug-costs/save-on-drug-costs.html
https://www.medicare.gov/your-medicare-costs/
https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html
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