Medicare is a federal health insurance program managed by the Centers for Medicare and Medicaid Services (CMS). CMS is part of the Department of Health and Human Services.
Who is Eligible for Medicare?
- Individuals 65 years of age or older
- Individuals with End-Stage Renal Disease (Kidney Failure)
- Permanently disabled individuals that have been on disability for more than 24 months
Medicare has four parts that include deductibles and coinsurance:
Part A - Hospitalization, Part B - Doctor & Medical Coverage,
Part C - Medicare Advantage (Usually a combination of Part A, B & D),
Part D - Prescription Drug Plan (provided through insurance companies)
What is Medicare Part A?
Medicare Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care. In most cases, Medicare Part A covers only the cost of the facility. Part A does not cover the care received by doctors and healthcare professionals.
What is the Premium for Medicare Part A?
If you or your spouse paid taxes on income for 10 years you will not have to pay a premium for Medicare Part A. Most will qualify at 65 for Part A, but some will qualify earlier through disability. Individuals who are over 65 but did not work 10 years in the US may be eligible to purchase Part A for a premium.
Medicare Part A Co-pays - What You Pay:
Inpatient Hospital Stay:
- $1,216 Deductible for Days 1-60
- $304 Per Day for Days 61-90
- $608 Per "Lifetime Reserve Day" Days 91-150 (60 Maximum Per Lifetime)
Skilled Nursing Facility:
- $0 Per Day for Days 1-20
- $152.00 per Per Day 21-100 (100 Day Maximum Per Benefit Period)
Home Health Care & Hospice:
- $0 for Home Health Care and Hospice
- Must Be Approved by Medicare
Medicare Part B - Medical Insurance
What is Medicare Part B?
Medicare Part B covers medically-necessary services such as care from doctors, outpatient care, durable medical equipment, home health services etc. Primarily, Part B insurance enables you to receive care from doctors and pay 20% of the cost.
What is the Premium for Medicare Part B?
Medicare Part B premiums are based on your previous year's annual income:
Annual Income 2012
|Individual Tax Return||Joint Tax Return||Premium|
|$85,000 or less||$170,000 or less||$104.90|
|$85,001 to $107,000||$170,000 to $214,000||$146.90|
|$107,001 to $160,000||$214,001 to $320,000||$209.80|
|$160,001 to $214,000||$320,001 to $428,000||$272.70|
|Above $214,000||Above $428,000||$335.70|
Medicare Part B Co-insurance - What You Pay:
Part B Deductible:
- $147 per year
Medical Services: (includes care received from doctors when hospitalized)
- 20% of the Medicare-approved amount for most doctor's services
Durable Medical Equipment:
- 20% of the cost of medically necessary medical equipment
Mental Health Service:
- 40% of the Medicare-approved amount for most outpatient mental health care
Medicare Part C - Medicare Advantage
What is Medicare Part C?
Medicare Part C is Medicare Advantage plans like HMOs or PPOs. Medicare Advantage Plans (sometimes called "MA Plans") are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of you Part A and Part B coverage. Most plans also include prescription drug coverage (Part D). Medicare pays a fixed amount for your care every month to the insurance companies offering Medicare Advantage Plans. In return, these companies must offer equal or greater benefits than Original Medicare. Because these plans are usually part of a network such an HMO or PPO, they may require that you only go to doctors, facilities or suppliers that belong to their network. There are currently 4 insurance companies offering Medicare Advantage plans in the Las Vegas area.
What is the Premium for Medicare Part C?
Many Medicare Advantage plans in Las Vegas, Nevada have a $0 monthly premium. This is possible because Medicare pays the insurance company to cover the cost of your care.
Medicare Part C Co-pays - What you pay:
With Medicare Advantage plans you typically pay a co-pay for each medical service you receive. The co-pays are different for each of the Medicare Advantage plans in Las Vegas, NV. Medicare Advantage Plans have a stop-loss or annual maximum for co-pays. If you reach the maximum, you will no longer have to pay co-pays for health services for the remainder of the year.
Medicare Part D - Medicare Prescription Drug Coverage
What is Medicare Part D?
Medicare Part D offers prescription drug coverage to individuals on Medicare. Par D Prescription Drug Plans (PDPs) are only offered through private insurance companies. If you choose to stay on Original Medicare, you will need to purchase prescription drug coverage through an insurance company to have coverage for prescription drugs.
What is the Premium for Medicare Part D?
The monthly premium for Medicare Part D is based on the insurance company from which you receive coverage plus your income. If you have Part D as part of your Medicare Advantage plan, you are still responsible for the extra premium if your income is above $85,000 a year.
Annual Income 2012
|Individual Tax Return||Joint Tax Return||Premium|
|$85,000 or less||$170,000 or less||Your Plan Premium|
|$85,001 to $107,000||$170,000 to $214,000||$11.60 + Your Plan Premium|
|$107,001 to $160,000||$214,001 to $320,000||$29.90 + Your Plan Premium|
|$160,001 to $214,000||$320,001 to $428,000||$48.30 + Your Plan Premium|
|Above $214,000||Above $428,000||$66.60 + Your Plan Premium|
Medicare Part D Co-pays - What you pay:
Prescription Drug Plans (Medicare Par D) have varying co-pays. Prescription drugs are placed in tiers with different co-pays for each tier. All Prescription Drug Plans have the same structure. The differences are in what drugs are covered, how the insurance company places drugs into tiers, and what your premiums and co-pays are. Also, some companies will not require that you pay a deductible.
2014 Medicare Prescription Drug Plan Basic Coverage
|2014 Benefits||What You Pay|
|Deductible||$310||100% of the first $310 (Not all plans have a deductible)|
|Initial Coverage Period||$2,850||Maximum of 25% (or $635)|
|Coverage Gap||$3,605||47.5% of covered brand name drugs (min)72% of generic drugs until you reach the out of pocket threshold|
|Annual Out-of-Pocket Threshold $4,550*|
|Catastrophic Coverage||95% Coverage||Greater of $2.65 for generics and $6.60 for brand name drugs, or 5% coinsurance|
Help for Low-Income Medicare Beneficiaries in Las Vegas, NV
If you have limited income, you may qualify for assistance with your premiums, prescription drugs, and/or co-pays If you think you may qualify for assistance, contact one of the following for more information:
|The Medicare Hotline
24 hours a day, seven days a week
|The Social Security Office
Mon-Fri between the hours of 7 a.m. & 7 p.m.
|Las Vegas, NV State Medicaid Office