5 Medicare

Question 1

Medicare Part A

Answer 1

Most particips pay no extra premium to get it.

Reqs:
- ≥ 65, paid into it ≥ 10 years

Covers:
- Inpatient hospital stays (flat per instance days 1-60, copay 61-90, > 90 uses lifetime reserve days up to 60 add’l days with a higher copay, > 150 paid by indiv)
- Care in a skilled nursing facility
- Hospice care
- Some home health care

Not covered
- Regular doctor visits or prescription drugs
- Custodial care

Question 2

Medicare Part B

Answer 2

• Optional but highly rec’d
• Requires premium (most pay standard, higher-income pay more)
• Annual deductible and then 20% copay (you pay 20%)

Covers more regular medical stuff - doctors’ services, outpatient care, medical supplies, preventive services

Question 3

Medicare Part C

Answer 3

• Aka “Medicare Advantage”
• All-in-one alternative to A & B with lower premiums, sometimes no premiums. Combined with a Medicare Supplement (Medigap) insur policy.
• Uses “gatekeeper” concept where Dr must refer and must use network providers
• Covers everything in original medicare, sometimes also dental, vision, OTC, & prescriptions

Question 4

Medicare Part D

Answer 4

• Covers prescription drugs.
• Optional & recommended.
• Requires a premium.
• Some plans offered by medicare-approved private companies

Question 5

IRMAA

Answer 5

Income-Related Monthly Adjustment Amount
Higher-income medicare benes under Pt B or Pt D may pay add’l premium if MAGI exceeds thresholds (Medicare-specific MAGI = AGI + Tax-Exempt Income)