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Medicare 101 2024 updated version

Robin Lee
October 31, 2023

Medicare 101 2024 updated version

Everything you need to know about Medicare in 2024

Robin Lee

October 31, 2023
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  1. MEDICARE 101
    RLee Insurance Solutions

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  2. LET’S START FROM THE BEGINNING…
    President Johnson signing the Medicare program into
    law, July 30, 1965. Shown with the President (on the
    right in the photo) are (left to right) Mrs. Johnson; former
    President Harry Truman; Vice-President Hubert
    Humphrey; and
    Mrs. Truman.
    At the bill-signing ceremony President Johnson enrolled President
    Truman as the first Medicare beneficiary and presented him with
    the first Medicare card. This is President Truman's application for
    the optional Part B medical care coverage, which President
    Johnson signed as a witness.
    Back then:
    The average person retiring was male, and his average life expectancy was only 68 years!
    Part B cost just $3.00 a month!
    19 million people signed up that first year.

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  3. TODAY WE SEE…
    Today there are over 64 million
    people on Medicare
    By 2030 that number will rise to 80
    million!
    People are living much longer, and life expectancy keeps
    going up!

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  4. WHEN DO I APPLY FOR MEDICARE?
    If you’re already getting benefits from Social Security or the Railroad
    Retirement Board (RRB), you’ll automatically get Part A and Part B starting
    the first day of the month you turn 65. (If your birthday is on the first day
    of the month, Part A and Part B will start the first day of the prior month.)
    If you’re under 65 and have a disability, you’ll automatically get Part A
    and Part B after you get disability benefits from Social Security or certain
    disability benefits from the RRB for 24 months.
    If you are not getting social security benefits currently, you should
    contact the Social Security administration 90 days before your eligible for
    benefits to start on time.
    *If your birthday is on the first of the
    month, your coverage will start on the
    first day of the month before your
    birthday month. For example, if you
    turn 65 on Aug. 1, your coverage will
    start July 1.

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  5. WHAT IF I WAIT?
    Part B Late Enrollment Penalty
    In most cases, if you don't sign up for Part B when you're first eligible, you'll
    have to pay a late enrollment penalty for as long as you have Part B. Your
    monthly premium for Part B may go up 10% for each full 12-month period that
    you could have had Part B but didn't sign up for it. Also, you may have to wait
    until the General Enrollment Period (from January 1 to March 31) to enroll in
    Part B, and coverage will start July 1 of that year.

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  6. WHAT ARE MY COST?
    Part A cost: For 2023, for those that don’t get Part A at no cost, they pay $505.00/month
    Part B cost: Tax Filing Status 2022 Part B Premiums 2024
    Single
    Married
    $102,000 or less
    $205,00 or less
    $174.80
    Single
    Married
    $102,001 - $130,000
    $205,001 - $260,000
    $244.70
    Single
    Married
    $130,001 - $162,000
    $260,001 - $324,000
    $349.60
    Single
    Married
    $162,001 - $193,500
    $324,001 - $387,000
    $454.40
    Single
    Married
    $193,501 – $500,000
    $387,001 – $750,000
    $559.52
    Single
    Married
    $500,001 or above
    $750,001 or above
    $560.50

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  7. 2024 Medicare part A
    When you are
    Hospitalized for:
    Medicare Covers:
    You Pay:
    (per benefit period)
    Days 1-60
    (Each Benefit Period)
    Most confinement cost after
    The required Medicare
    Deductible
    $1632 Deductible
    Days 61- 90 All eligible expenses, after the
    patient pays a per-day copayment.
    $408 a day
    copayment
    as much as $12,240
    Days 91 - 150
    All eligible expenses, after the
    patient pays a per-day copayment
    (These are Lifetime Reserve Days
    which may never be used again).
    $816 a day copayment
    as much as $48,960
    Days 151 or more Nothing You Pay All Cost
    At least 3-day hospital
    stay, must be a Medicare
    approved skilled nursing
    facility, be within 30 days
    after hospital discharge.
    All eligible expenses, for the first 20
    days; then all eligible expenses for
    21-100, after patient pays a per-day
    copay
    After 20 days
    $204.00 a day
    copayment, as much as
    $16,320
    The way that Original
    Medicare measures your use
    of hospital and skilled nursing
    facility (SNF) services. A
    benefit period begins the day
    you're admitted as an
    inpatient in a hospital or SNF.
    The benefit period ends when
    you haven't gotten any
    inpatient hospital care (or
    skilled care in a SNF) for 60
    days in a row. If you go into
    a hospital or a SNF after one
    benefit period has ended, a
    new benefit period begins.
    You must pay the inpatient
    hospital deductible for each
    benefit period. There's no
    limit to the number of benefit
    periods.

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  8. 2024 Medicare part B
    Part B is medical
    insurance that
    covers physician’s
    services, outpatient
    care, test, and
    supplies
    On expenses
    Incurred for:
    Medicare covers:
    You pay $240
    Annual deductible
    Plus:
    Physician’s services, inpatient, outpatient
    medical/surgical services, physical/speech
    therapy, diagnostics test and durable
    medical equipment
    80% of approved amount
    (subject to Part B deductible)
    20% of approved
    amount
    Clinical laboratory Services
    Blood test for diagnostic services
    100% of approved amount
    (not subject to Part B deductible)
    Nothing for services
    Home health care
    Part-time or intermittent skilled care, home
    health aide services, durable medical
    supplies and other services
    100% of the approved amount
    (not subject to Part B deductible)
    80% or the approved amount for durable
    medical equipment
    (subject to Part B deductible)
    Nothing for services;
    20% of approved amount
    for
    Durable medical equipment
    Outpatient hospital treatment
    Services for diagnosis or treatment
    Of an illness or injury
    80% of approved amount
    (subject to Part B deductible)
    20% of billed amount
    Blood
    After first three pints of blood, 80% of
    approved amount
    (subject to Part B deductible)
    First three pints plus 20%
    Of approved amount for
    additional pints

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  9. WHAT ARE THE GAPS?
    They include…
    • Part A deductible ($1632.00)
    • Part B deductible ($240.00)
    • Part B 20% including the first 3 pints of blood
    • Part B Excess charges (15% of the Medicare approved amount)
    • Skilled nursing facility co-pay
    • Drug coverage

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  10. WHAT ARE
    PART B
    EXCESS
    CHARGES?
    Medicare assigns a price and code for any
    procedure you might have. If they accept the
    assigned price, they are “accepting
    assignment”, most places do. Some doctors
    and facilities, usually specialist and specialty
    hospitals, can charge 15% more than the
    Medicare approved amount. These charges
    are referred to as “excess charges”. If having
    the option to go to any facility you choose is
    important to you, make sure your plan covers
    this benefit.

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  11. RECENT CHANGES TO THE MEDICARE LAWS YOU
    NEED TO KNOW ABOUT
    The White House Office of the Press Secretary
    For Immediate Release April 16, 2015
    Statement by the Press Secretary on H.R. 2
    On Thursday, April 16, 2015, the President signed into law:
    H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently
    replaces Medicare's sustainable growth rate system for physician payments and reforms
    Medicare physician payment policies to encourage efficient, high-quality care; extends for two
    years funding for the Children's Health Insurance Program; extends numerous other expiring
    health provisions and the Secure Rural Schools program; and removes Social Security numbers
    from Medicare cards and makes other Medicare improvements.

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  12. WHAT ARE THE IMPACTS ON MEDICARE FROM H.R. 2?
    1.Qualified Individual (QI) program is now permanent. Provides low-income folks help paying for part B. To qualify for
    QI, your monthly income cannot exceed $1,325 if you are single ($15,890/yr.) or $1,793 ($21,506/yr.) if you are
    part of a couple.
    2. No more Social Security numbers on Medicare cards. Provides $320 million in funding to remove Social Security
    numbers from beneficiaries’ Medicare cards and produce a new numbering system within the next 4 years.
    3. The exceptions process for Medicare therapy caps extended 2 years. The new law provides for extending the
    Medicare therapy cap exceptions process for another 2 years.
    4. How the new law affects beneficiary costs. Over the next 8 years the standard Part B premium is projected to
    increase from $104.90 to $156.20, a difference of over $50.
    5. Higher Part B & D premiums for higher income beneficiaries. Starting in 2018, individuals with annual incomes of
    $133,501 to $160,000 (for couples, annual income from$267,001 to $320,000) will pay 65% of program costs for
    their Part B and D premiums instead of the 50% they currently pay. Individuals with annual incomes of $160,001 and
    above (couples $320,001 and above) will pay 80% of program costs for their Part B and D premiums.
    6. Restrictions on Medigap policy benefits. Effective January 1, 2020, any newly eligible Medicare beneficiary will not
    be able to buy Medigap plans C or F with Part B deductible coverage.

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  13. WITH ALL THE CHANGES WHAT ARE MY OPTIONS?
    Medicare first eligible
    before 2020 only
    Plan N has a $20
    copayment per office visit
    and a $50 copayment
    each ER visit (Waived if
    admitted)

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  14. NOW WE FILL THE DRUG BENEFIT GAP
    Part D cost:
    Tax Filing Status 2022 Part B Premiums 2024
    Single
    Married
    $102,500 or less
    $205,00 or less
    Your plan premium
    Single
    Married
    $102,501 - $130,000
    $205,001 - $260,000
    $12.90 +
    Your plan premium
    Single
    Married
    $103,001 - $162,000
    $260,001 - $324,000
    $33.30 +
    Your plan premium
    Single
    Married
    $162,001 - $193,500
    $324,001 - $387,000
    53.80 +
    Your plan premium
    Single
    Married
    $193,501 – $500,000
    $387,001 – 500,000
    $74.20 +
    Your plan premium
    Single
    Married
    $500,001 or above
    $750,000 or above
    $81.00 +
    Your plan premium

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  15. WHAT IF I WAIT FOR PART D?
    The cost of the late enrollment penalty depends on how long you went without Part D
    or creditable prescription drug coverage.
    Medicare calculates the penalty by multiplying 1% of the "national base beneficiary
    premium" ($34.70 in 2024) times the number of full, uncovered months you didn't have
    Part D or creditable coverage. The monthly premium is rounded to the nearest $.10
    and added to your monthly Part D premium.
    The national base beneficiary premium may increase each year, so your penalty
    amount may also increase each year.

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  16. 2023 BASIC PART D COVERAGE
    2023 Basic Medicare Drug Coverage
    2023 Basic Benefits You Pay
    Deductible $505 100% of first $505
    Initial Coverage Limit $4,660 Various co-pays
    Coverage Gap $7,400 25% of the drug cost
    Catastrophic coverage Medicare and Plan pays
    95%
    The greater of 5% or $10.35
    for Brand name $4.15
    for generic
    “ Keep in mind, this is the minimum coverage a plan has to include
    as required by the government, MOST do better in this competitive market”

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  17. 2024 BASIC PART D COVERAGE
    2024 Basic Medicare Drug Coverage
    2024 Basic Benefits You Pay
    Deductible $545 100% of first $545
    Initial Coverage Limit $5,030 Various co-pays (25% max)
    Coverage Gap $8,000 25% of the drug cost
    Catastrophic coverage Medicare and plan pays
    100%
    $0 for the remainder of 2024
    “ Keep in mind, this is the minimum coverage a plan has to include
    as required by the government, MOST do better in this competitive market”

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  18. ANOTHER OPTION
    It is our belief, as well as others in the industry, that as the cost of the Part B premiums rise so will the
    Part B deductible from its current $240.00 a year level. Many folks may select to go the Medicare
    Advantage route to cover their healthcare needs in trying to Reduce their "upfront" cost.

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  19. THE MOST POPULAR OPTIONS
    *Remember you can do one or the other,
    NOT both.

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  20. WHAT IS PART C OR ADVANTAGE PLANS?
    What Are Advantage Plans (cont.)
    • Most plans offer health and drug coverage, as well
    as extra benefits
    • Most have lower out-of-pocket costs than with
    Original Medicare
    • You may have to use certain healthcare providers
    • You do not need a Medicare Supplement

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  21. WHAT IS PART C OR ADVANTAGE PLANS?
    What Are Advantage Plans?
    • Medicare Advantage (MA) plans are health plan
    options that are part of the Medicare program.
    • MA plans are not the same as Medicare Supplement
    insurance.
    • Medicare pays the plan (the insurance company) a set
    amount every month for your care.
    • MA plans must offer all benefits of Original Medicare
    and can include Part D prescription drug coverage.

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  22. IS AN ADVANTAGE PLAN RIGHT FOR YOU?
    Things to consider before deciding on an Advantage Plan
    • What is the current state of your health?
    • How often do you visit the doctor or hospital?
    • Will the cost savings in monthly premium offset the co-pays?
    • Where is the plan coverage area?
    • Are the added benefits important to you?
    • Can you return to “traditional Medicare” if you are not happy?
    **Remember, in most cases, you must use the card from your Medicare Advantage Plan
    to get your Medicare-covered services. Keep your Medicare card in a safe place because
    you’ll need it if you ever switch back to Original Medicare.
    **2021 Medicare and you pg.57

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  23. SOMETHING NOT TO CONSIDER…
    Health insurance rate increases
    are calculated on a statewide
    basis, not on individual's claim
    experiences.
    When you need healthcare your
    Medicare coverage will be there
    for you.

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  24. OUR FULL LINE OF SERVICES
    SERVICES AVAILABLE
    • Medicare Supplements
    • Medicare Advantage Plans
    • Part D Drug Cards
    • Dental, Vison, and Hearing
    • Life Insurance
    • Annuities
    • Short Term Care
    • Long Term Care Insurance
    • Supplemental Health
    • Travel Insurance

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