JustCare

Tag: Medicare Part B

  • What Medicare covers

    What Medicare covers

    In order to plan for your care as you get older, it is good to know what Medicare covers and what it does not cover. You can then budget for your out-of-pocket costs. Because Medicare generally does not provide full coverage and does not cover some high-cost services, annual out-of-pocket health care costs with Medicare average $5,500. And, if you need to pay for long-term care services, unless you have Medicaid as well as Medicare, your costs will likely be much higher.

    Services Medicare covers: Medicare Part A–which is generally premium-free if you or your spouse paid Medicare taxes–covers hospital, skilled nursing facility, skilled rehabilitation facility, hospice and other inpatient services. Medicare Part B–which has a standard monthly premium of about $134, though people with higher incomes pay more–covers medical services from doctors, therapists and other Medicare-certified health care providers, along with medical equipment and supplies. (To be enrolled in traditional Medicare or a commercial Medicare Advantage plan, you need Medicare Parts A and B.) Medicare Part D–which has a monthly premium that varies depending upon the plan you choose–covers prescription drugs and is optional.

    Note: People who enroll in a commercial Medicare Advantage plan also have Medicare Part C.

    Click on the links below to learn more about Medicare’s benefits and the services it does not cover.

    Keep in mind that some costly services are expressly excluded from Medicare coverage.

    Services Medicare does not cover:

    If you qualify for Medicaid as well as Medicare, Medicaid may cover some of these services.

    Here’s more from Just Care:

  • What’s the Medicare Part B premium in 2018?

    What’s the Medicare Part B premium in 2018?

    The 2018 standard monthly Medicare Part B premium, which covers medical and outpatient care, remains at $134.00, the same as in 2017, for people with incomes of $85,000 or less. But, only about three in ten people with Medicare have been paying that standard premium. Now, millions of other people who have been paying a lower monthly Medicare Part B premium will see a large increase in their premium because their Social Security benefits are increasing 2 percent.

    If you are among the 70 percent or so of people with Medicare who has been paying a premium of $109 (far lower than the standard premium), you may see a $25 a month Medicare premium increase to $134.  You and millions of others have had little or no Medicare Part B premium increase these last few years because your Social Security benefits did not increase or increased only a small amount. A “hold harmless” provision in the Social Security Act protected you and others from paying more in Medicare premiums than the increase in your Social Security monthly benefits.

    Since Social Security benefits are increasing in 2018, up 2 percent from last year (in 2017 they were up only 0.3 percent and in 2016 they did not increase at all), Medicare monthly premiums can increase that much for everyone with Medicare who had been protected by the “hold harmless” provision. Put differently, the majority of people who had been paying $109 a month for their Part B Medicare premium will see it rise to $134; their Social Security benefit after the Medicare premium is deducted will be the same as, or only slightly higher than, in 2017.

    About three in ten people with Medicare (28 percent) will pay higher Medicare Part B premiums but less than $134 a month. Their monthly premiums will average $130. They will be “held harmless” to the extent that the increase in their Social Security monthly benefits does not cover the difference between the $109 they had been paying and the standard premium of $134.

    Some people with incomes of $133,500 and above will also see a Part B premium increase because the income level for paying more than the standard premium contribution for Part B is adjusted downward in 2018.   The 2018 Part B premium remains the same for people with incomes over $85,000 and below $133,500. In 2018, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about six percent of the Medicare population–pay:

    • $187.50 a month, if their income is above $85,000 and no more than $107,000.
    • $267.90 a month, if their income is above $107,000 and no more than $133,500
    • $348.30 a month, if their income is above $133,500 and no more than $160,000
    • $428.60 a month, if their income is above $160,000

    To arrive at the premium amount for married people filing a joint tax return, double the income.

    The 2018 Part B annual deductible is the same as in 2017: $183.

    People with incomes up to 135 percent of the federal poverty level, ($1,377 in monthly income for an individual and $1,847 for a couple in 2017; these amounts may increase in 2018) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2018 Part A costs:

    • The Part A hospital deductible is $1,340 and coinsurance for hospitalizations after day 60 is $335 a day in a benefit period; coinsurance for lifetime reserve days  is $670 a day.
    • The Part A coinsurance for skilled nursing facility stays after day 20 is $167.50.

    Here’s more from Just Care:

  • 2018 Social Security benefits should rise, but checks may not

    2018 Social Security benefits should rise, but checks may not

    One of the strengths of Social Security is that benefits are adjusted annually to offset increases in inflation, so that the modest, but vital, benefits do not erode over time. Unfortunately, the government’s cost of living adjustment for Social Security is based on inflation experienced by workers and not by retirees and people with disabilities receiving Social Security benefits. Older people and people with disabilities generally experience higher costs of living than workers, so Social Security adjustments are often inappropriately low.

    Indeed, Social Security benefits have increased microscopically or not at all in the last several years. For 2018, however, the Medicare and Social Security Trustees project an increase of 2.2 percent.  (We won’t know the actual adjustment for another month.) That adjustment of 2.2 percent would make it the biggest increase in Social Security benefits in six years.

    The good news is that if this increase goes into effect, benefits for individuals should increase on average $28 each month The bad news is that millions of people likely will not see that full increase in their Social Security checks  — and some may not see any increase at all because their Part B Medicare premiums may increase.

    Most people with Medicare who receive monthly Social Security benefits have their Medicare Part B premiums deducted directly from those Social Security payments.  For these people, Congress has provided that the annual increase in the Medicare Part B premium must be no larger than the Social Security cost of living adjustment.

    People whose Medicare Part B premiums did not increase these last few years when their Social Security benefits did not increase–thanks to that so-called hold-harmless provision in the law–will likely now see an  increase in their Part B premium. They no longer will be held harmless. Unfortunately, the Medicare premium increase may absorb part or all of their Social Security inflation adjustment.  Consequently, the 70 percent of people with Medicare who have been paying an average monthly premium of $109 because their Social Security benefits have barely increased over the last few years will likely see no bigger Social Security checks despite the automatic increase.

    The solution is three-fold. First, Congress should enact a better, more accurate measure of inflation for people receiving Social Security benefits. In addition, benefits, which are modest, but vital, should be increased. Finally, Congress should expand and improve Medicare and move toward a more efficient health care system, with lower premiums. Though Medicare covers the most expensive part of the population, older adults and people with disabilities, it is much more efficient than private sector health insurance.

    With these solutions in place, Social Security benefits will be more adequate, will not erode over time, and will not be swallowed up by expensive health care costs.

    If you would like Congress to expand Social Security, please sign this petition.

    Here’s more from Just Care:

  • No projected 2018 increase in standard Medicare premium

    No projected 2018 increase in standard Medicare premium

    [Editor’s note: Medicare 2018 premium information released, November 20, 2017.]

    The July annual report of the Medicare Trustees to Congress on the financial state of the program shows no projected 2018 increase in the standard Medicare premium, which is $134 today; indeed, the Part B premium may fall. But, two groups of people with Medicare are projected to pay a higher 2018 Part B premium. People with 2017 Medicare monthly premiums of $109 are likely to pay higher premiums in 2018 because their Social Security benefits are projected to increase. And, some people with annual incomes above $85,000 also will likely pay higher premiums because the income level for paying more than the standard 25 percent of income contribution will be adjusted downward in 2018.

    A projected 2 percent increase in people’s Social Security checks–an average monthly increase of $27.20–means that people paying the standard 2018 Medicare monthly premium of $134 will likely see a reduction in their Part B premium. But, the 70 percent of people with Medicare who have paid a lower premium because their Social Security benefits have barely increased over the last two years–people who have been paying an average monthly premium of $109–will likely see an increase in their Part B premium.

    The income adjustment for calculating the Part B premium in 2018 for people with annual incomes above $85,000 stems in part from increasing costs in Part B, which covers doctors visits, durable medical equipment, outpatient therapy and other outpatient care. In 2016, Part B spending was 2.1 percent of GDP.  The Trustees project it to increase to 3.4 percent by 2037.

    The Trustees report shows intermediate projections that in both 2018 and 2019 individuals will pay a standard monthly premium of:

    • $134.00 if their income is $85,000 or less
    • $187.50 if their income is between $85,001 and $107,000
    • $267.90 if their income is between $107,001 and $133,500
    • $348.30 if their income is between $133,500 and $160,000
    • $428.60 if their income is more than $160,001

    You can calculate the premium amounts for higher-income couples by doubling the incomes listed.

    Beginning in 2007, people with annual incomes above $85,000 (couples more than $170,000) pay Part B premiums that are far higher than people with annual incomes below $85,000. About one in 16 people with Medicare (6 percent) have annual incomes above $85,000. That percentage is projected to grow to 8.3 percent by 2019, according to the Kaiser Family Foundation.

    People with Medicare are notified of 2018 Part B premium changes in the fall, before the Medicare open enrollment period from October 15 through December 7. The annual Part B deductible is expected to remain at $183. The Medicare Part D premium is projected to drop by about $1.2o a month.

    The Medicare Trustees estimate that Part B and Part D out-of-pocket costs, including premiums and copays, account for about 25 percent of a typical individual’s Social Security benefits in 2017.

    The Medicare Trustees now project the Medicare hospital insurance trust fund (Part A of the program) to be insolvent by 2029, one year later than the Trustees projected last year. The Trustees project lower hospital insurance spending than they projected last year, because of lower inpatient hospital utilization assumptions and lower than expected spending in 2016.

    Here’s more from Just Care:

  • Your Medicare costs in 2017

    Your Medicare costs in 2017

    Most people don’t realize that Medicare only covers about half of a typical person’s total health care costs. On average, people with Medicare spend about $5,000 a year on health care costs Medicare does not pay for. And, people needing long-term care services and supports can pay a lot more for their care each year. What are your Medicare costs in 2017?

    Your predictable Medicare costs–premiums and deductibles–depend upon your income, whether you enroll in traditional Medicare or a commercial Medicare health plan (click here to learn the difference), and the health care you need.

    Whether you’re enrolled in traditional Medicare or a commercial Part C Medicare health plan, you must have Medicare Part A and Part B to get hospital and medical coverage. You will have coverage for most preventive care services as well as virtually all medically reasonable and necessary services (except vision, hearing and dental services). Here’s what you’ll pay for them:

    • Most people who have worked at least 40 quarters or whose spouse has worked at least 40 quarters get Medicare Part A for free. If you need to purchase Part A, which covers inpatient care, you’ll pay up to $413 each month. 
    • Medicare Part B premium is $109 a month for about 70 percent of people, but some people with annual incomes under $85,000 pay $134.00. You will pay $134 a month if you’re not receiving Social Security benefits, enrolling in Part B for the first time in 2017 or have Medicaid as well as Medicare, in which case your state Medicaid agency will pay the premium. If your annual income is above $85,000, you also will pay more. To determine your premium, click here.

    With traditional Medicare, the government-administered option, and supplemental insurance to fill gaps in coverage–retiree coverage from a former employer, private supplemental insurance or Medicaid–you can see almost any doctor and use almost any hospital with few if any out-of-pocket costs for Medicare-covered services. Without supplemental coverage—which can cost a small amount each month up to about $250 a month depending upon where you live and what coverage you choose–your out-of-pocket costs can be substantial if you need a lot of costly care. Without supplemental coverage, you must pay:

    • $1,316 deductible for each inpatient hospital benefit period, up to 90 days (with 60 days outside the hospital or skilled nursing facility before a new benefit period begins).
      • $0 coinsurance for the first 60 days of each hospital benefit period.
      • $329 coinsurance a day for each benefit period beginning on day 61 through 90.
      • $658 coinsurance for each of your 60 “lifetime reserve days” of coverage after day 90.
      • All costs after your lifetime reserve days are used up.
    • No deductible for skilled nursing facility care but $164.50 a day for days 21-100.
    • No deductible or coinsurance for home health care or hospice care.
    • $183 deductible each year before Medicare covers medical services from doctors and other health care providers, plus:
      • coinsurance representing 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment, after you meet your deductible.
    • If you want prescription drug coverage, you also pay a premium and coinsurance for a Medicare Part D prescription drug plan.

    With a commercial Medicare Part C health plan, like Humana or United Healthcare, sometimes called “Medicare Advantage,” you still need Medicare Part A and Part B, and you may need to pay an additional Medicare Part C premium for your health plan and/or for drug coverage. Some Part C commercial plans require you to enroll in Part D for prescription drug coverage. You will have coverage for care from network doctors and hospitals provided you follow your health plan’s rules; you generally will need a referral to see a specialist. You cannot buy supplemental coverage to fill gaps. What you will pay out of pocket depends on the health plan you choose and the care you need.

    • You may have to pay a deductible before your coverage kicks in, which varies based on the health plan you choose; and,
    • You will have to pay a copay–a fixed amount–or coinsurance–a percentage of the cost–for each service you receive in the plan’s network, which also depends on the health plan you choose.
    • Your out-of-pocket costs depend on which health plan you choose, how much care you need and whether you use in-network doctors and hospitals, up to $6,850 out of pocket in 2016. (Medicare.gov does not list the out-0f-pocket limit for 2017.)
    •  If you use doctors and hospitals that are out of network (as about one in three people with Medicare need to do if they have a complex condition), you will generally need to pay the full cost of your care except in emergencies and urgent care situations; there is no out-of-pocket limit for out-of-network care.

    Keep in mind that no matter which option you choose, you generally need to pay out of pocket for health care costs that Medicare does not pay for. If you need to pay for long-term supports and services, such as custodial care in a nursing home or home care, you can easily spend between $20,000 and $80,000 a year out of pocket. Seven out of 10 people over 65 will need long-term care at some point in their lives. Medicaid will cover many of these costs if you qualify. In 2010, the 10 percent of the Medicare population with the highest costs, spent an average of nearly $20,000 a year for health care Medicare did not cover.

    And, you generally will need to pay out of pocket for dental care, hearing care and vision care. You also will need to pay out of pocket for care when you travel outside the United States. Here are some ways to keep these costs down.

    Here’s more from Just Care:

  • What’s the Medicare premium in 2017?

    What’s the Medicare premium in 2017?

    The monthly Medicare Part B premium in 2017 technically is $134.00, up 10 percent from this year, for people with incomes of $85,000 or less. It’s a big increase, but half as much as the Trustees suggested it might be. More importantly, because Social Security benefits are barely increasing, the vast majority of people with Medicare are seeing a far smaller premium increase.

    In late June, in the Medicare Trustees’ annual report to Congress on Medicare’s financial state, the Trustees projected as much as a 20 percent increase in Medicare premiums for some people because of rapidly rising health care costs. However, about 70 percent of people with Medicare are seeing a premium increase of $4.00 a month from last year’s premium of $105. That’s because of a “hold harmless” provision in the Social Security Act that protects most people with Medicare from paying more in Medicare premiums than the increase in their Social Security monthly benefits.

    Since Social Security benefits are barely increasing in 2017, up just 0.3 percent or about $4.00 a month, Medicare monthly premiums can only increase that much for the majority of people with Medicare. But, about three in ten people with incomes of $85,000 or less will pay the full $134.00 monthly premium. They include people not receiving Social Security benefits, people enrolling in Part B for the first time in 2017 and people with Medicare and Medicaid, whose state Medicaid agencies will pay the higher premium.

    The Part B premium is a lot more for people with incomes over $85,000. People whose modified adjusted gross income from two years ago as reported on their federal tax return–about six percent of the Medicare population–will pay:

    • $187.50 a month, if their income is above $85,000 and no more than $107,000.
    • $267.90 a month, if their income is above $107,000 and no more than $160,000
    • $348.30 a month, if their income is above $160,000 and no more than $214,000
    • $428.60 a month, if their income is above $214,000

    To arrive at the premium amount for married people filing a joint tax return, double the income.

    The Part B annual deductible is $183.00, a $17 increase from 2016.

    People with incomes up to 135 percent of the federal poverty level, ($1,357 in monthly income for an individual and $1,823 for a couple in 2016) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Right now, Congressman Paul Ryan and others in Congress are considering Medicare reforms that would privatize Medicare and turn it into a voucher program; it would drive up costs for people with Medicare significantly. Right now, people with Medicare typically spend about $5,000 out of pocket for care that Medicare does not cover, and people with costly conditions spend about $10,000. If you oppose such reforms, please sign this Social Security Works petition.