• Part A is generally free for most beneficiaries. Part A addresses the cost of inpatient care in a hospital or skilled nursing facility, but not long-term care in a nursing home. It also covers hospice and some home health care.
• Medicare Part A pays all but $1,632.00 for the first 60 days of Hospital Inpatient services. For days 61 through 90 Medicare pays all but $408.00 per day, and for days 91 – 150 Medicare pays all but $816.00 per day. Beyond 150 days of inpatient hospital care, Medicare Part A pays nothing for Hospital Inpatient services.
• Medicare Part A pays 100% of the first 20 days of Skilled Nursing / Home Care charges. After 20 days Medicare Part A pays all but $204.00 per day for an additional 80 days. Beyond 100 days of Skilled Nursing care, Medicare pays nothing; that’s when Long Term Care insurance would take over.

• Part B of Medicare has a standard monthly premium of $174.70. Individuals who have high incomes are subject to an Income Related Monthly Adjustment Amount (IRMAA). The premium paid for Part B helps cover doctor services, medical tests, hospital outpatient care, some home health care and durable medical equipment. Part B coverage includes many preventive services, such as flu shots and mammograms. It also covers a few medications, such as shots you get in a doctor’s office and certain oral cancer drugs.
• The Medicare Part B Annual Deductible for calendar 2024 is $240.00.
• In general Medicare Part B pays 80% of physician’s services and other Part B covered expenses, after the deductible has been met.

• This is an alternative to original Medicare (Parts A & B). Medicare Advantage plans are administered by private insurance companies and cover the same benefits as Parts A, B, and usually D. Some also include extra benefits, such as dental, vision or hearing services.
• Typically there are a number of restrictions with a Medicare Advantage plan; PPO / HMO networks, geographical service areas, etc.
• If an individual elects to utilize a Medicare Advantage plan, that individual cannot enroll in a Medicare Supplement plan.

Medicare drug plans are managed by private insurance companies in partnerships with pharmacies. This coverage can be obtained two ways: If you are eligible for Medicare Part A, you can enroll in a Stand-alone Part D plan. If you have a Medicare Advantage plan (Part C), prescription drug coverage often is included in the package.

• Monthly premiums and price lists (called Formularies) differ with each plan. The plan with the least expensive monthly premium is often not the most cost effective alternative. The “best” prescription drug plan will normally be the one with the lowest total annual cost, including all the monthly premiums and the cost of your prescriptions at the pharmacy.
• There is a penalty for not enrolling in a Part D plan when you are first eligible to do so, unless you have a “creditable” coverage alternative.
• Acceptable creditable alternatives include the VA and most employer / union insurance plans.

• Plans are designated by letters ranging from “A” through “N” and must follow federal and state laws to protect you. The plans are defined at the federal level by the Center for Medicare and Medicaid Services (CMS) and are monitored for compliance by the Illinois Department of Insurance. The most popular Medicare Supplements are Plans F, G and N. Here is an Overview of how these three plans address the charges not covered by Medicare. Note: Plan F is only available to individuals who became eligible for Medicare prior to January 1, 2020.
• Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which insurance company sells it.
• Cost is usually the only difference between Medicare Supplement policies sold by different insurance companies.
• All policies are “individual” policies – there are no “family” or “group” policies, although a few companies offer a “household” discount if spouses / partners are both enrolled.
• Here is a Chart describing the benefits of all the currently available Medicare Supplement plans, and the most recently published booklet “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare” from CMS.

• Most individuals enroll in a Medicare Supplement plan during their “Open Enrollment” period when they become eligible for Medicare. The Open Enrollment period is defined as a six-month period starting on the Effective Date of Medicare Part B. Individuals who start Medicare Part B prior to age 65 (individuals who are on Social Security disability, for example) have a second Open Enrollment period when they turn 65. During the Open Enrollment period, individuals can apply for any plan at the lowest premium rate from any insurance company, without consideration of medical issues or tobacco use.
• Some individuals enroll in a Medicare Supplement plan during a “Guaranteed Issue” period. These are special time periods that exist under special circumstances.
• Individuals can apply for Medicare Supplement coverage at any time during the year. If the individual is not in an Open Enrollment or Guaranteed Issue period, medical questions may limit which companies will approve an application.

• Medicare Supplement Policies address “Approved” charges that are not paid for by Medicare. Not all “medically required” charges are “Approved” as part of the covered charges of Medicare.
• Some examples of medically required charges that are not covered by Medicare (and by extension, are not covered by Medicare Supplement policies) include routine Dental, Vision, Hearing, and Long Term Care costs. Other Insurance policies are available for these areas, and are described elsewhere on this website.
• Other examples of non-covered or partially-covered charges include Chiropractic services, physical therapy, third surgical opinions, health care needed when traveling outside the United States, etc. For more details, review the most recently published official U.S. Government Medicare Handbook “Medicare & You”.