Each year Medicare makes changes to premiums, deductibles, benefits, and more. It is easy to overlook these changes if you think they do not relate to you. However, when you know all your options and the costs, you may find other plans that could help you save money. You may find Medicare Advantage plans that offer additional benefits in your area or a Part D plan that participates in the new model that could help with insulin costs.
Many people think Medicare taxes cover their Medicare costs in full. However, that is not the case. Once you are Medicare-eligible and have worked at least 40 quarters in the United States, you qualify for a $0 premium for Part A only. Everyone must pay for Part B unless Medicaid pays the premium for you. The premiums for both Part A and Part B can go up each year, along with other costs such as deductibles and coinsurance related to each part of Original Medicare.
Medicare beneficiaries that have worked less than 40 quarters in the United States will have to pay a premium for hospital coverage. Beneficiaries that worked for 30-39 quarters would have a monthly premium of $259, while those who worked less than 30 would pay $471. You are responsible for other Part A costs, as well, such as the deductible and coinsurance when you are an inpatient in the hospital.
The deductible is per benefit period, which means it is not annual. If you are hospitalized as an inpatient more than once a year, you could pay the $1,484 deductible each time. Medicare Part A will cover the first 60 days as an inpatient for you, but for days 61-90, you have to pay $371 per day in each benefit period. The lifetime reserve days start after day 90, and you must pay $742 per day for those days.
Outpatient medical services are covered by Medicare Part B. Part B has a standard base premium of $148.50 in 2021. However, if you have a higher income, you will pay more for Part B. Services covered by Medicare Part B include doctor visits, surgeries, lab work, tests, and most medically necessary outpatient services.
There is a $203 annual deductible that needs to be satisfied before Medicare pays 80% of the approved amount. A Medicare beneficiary will pay the full cost of services until the amount reaches $203, then 20% beyond that.
Senior Savings Model
A standalone Part D plan provides drug coverage for Medicare beneficiaries. These plans are offered through private carriers and have a separate deductible. The maximum deductible allowed for Part D plans in 2021 is $445, but the carriers can set the deductible below that limit. Most plans will exclude the lower tiers, which typically include generic medications, from the deductible.
Some Part D plans are now participating in a new model as of 2021. The Senior Savings Model benefits those who use insulin. This model helps with insulin costs by putting a maximum copay of $35 for a 30-day supply of various insulin types. This is a considerable savings for insulin-dependent diabetics.
Medicare Advantage plans
According to Kaiser Family Foundation, there was a 13 percent increase nationwide in the number of Medicare Advantage plans available in 2021. There have been some adjustments to Medicare Advantage plans as of 2021. Before, plans could ask if you have End-Stage Renal Disease and if you answered yes, you were denied coverage. That question is no longer on the application and having End-Stage Renal Disease cannot prevent you from getting coverage from a Medicare Advantage plan.
Additional benefits have been added to many plans. There has been an increase in Medicare Advantage plans that offer telehealth benefits and credit for over-the-counter items. According to the Kaiser Family Foundation, 85% of Special Needs Plans offer transportation benefits for those enrolled.
The year 2020 was not easy. Many lives were changed dramatically, and Medicare beneficiaries could have overlooked some of the new Medicare changes. It is important to do your due diligence with your Medicare coverage to know all the available options. Some of the yearly changes may make a difference in costs.