Understanding Medicare: The Cost of Coverage and Benefits

If you’re responsible for caring for a loved one or choosing their Medicare plan, you should know there are many health insurance options available to meet their specific needs.

When families and caregivers know where to look for healthcare resources, they are empowered to manage their loved one’s health needs.

Here is a compilation of information to help you find the right plan.

Most people 65 years of age or older are eligible for Medicare when they turn 65, but there are some things to keep in mind:

• They will receive enrollment cards and information about three months before their birthday.
• If they are not automatically enrolled, they can sign up in-person at any local Social Security office.
• Also, they can enroll online or over the phone with the Social Security Administration.

Comparing options is essential to determine if someone you’re caring for has the right plan or if different coverage may work for their health needs. GoHealth licensed insurance agents can help you determine which plan type will work for their unique needs.

These are the Medicare options and cost information (including annual changes in premiums and deductibles):

• Original Medicare (Part A and Part B) provides some coverage for hospital and medical needs. Medicare beneficiaries will still be responsible for 20% of medical bills and other hospital coinsurance that can be costly.
• Medicare Advantage (Part C) combines Original Medicare (Part A and Part B) and may include Part D, vision and dental, and other benefits all in one plan. We will dive deeper into the details of Medicare plans and coverage to help you better understand your options.
• Medicare Part D provides prescription drug coverage. It is offered as either a standalone plan that can be added to Original Medicare or beneficiaries can enroll in a Medicare Advantage plan with prescription drug coverage.
• Medicare Supplement Plan (Medigap) will help cover the remaining 20% of what Original Medicare does not cover. These policies can help with deductibles, copays and coinsurance.

Medicare’s payment rates typically change each year. Here’s a breakdown of the standard premium, copayment and deductible costs for Medicare in 2024:

Medicare Part A

Premium payment

• $0 if you paid into Medicare for 40 or more quarters
• $278 a month if paid into Medicare for 30-39 quarters
• $505 a month if you paid into Medicare for 0-29 quarters

Deductible payment

• $1,632 for each hospital benefit period

Copayment

• Hospital Stays by Day:
  • 1-60: $0 copay after the deductible is met
  • 61-90: $408 a day
  • 91-150: $816 per lifetime reserve day
• Skilled Nursing Facility:
  • 1-20: $0 for each benefit period
  • 21-100: $204 coinsurance per day for each benefit period
  • 100+ days: all costs

Medicare Part B

Premium payment

• $174.70 a month for most people
• Additional charge per month for people with incomes over a certain level
• The cost could be less for people with incomes below a certain level

Deductible payment

• $240

Copayment

• None for most preventative services
• 20% of the Medicare-approved costs for other services

Medicare Part D

Premium payment

• Varies by Part D plan. There may be an additional monthly charge for people with higher income levels.

Deductible payment

• Varies by plan, but no more than $545 in 2024

Copayment

• Depends on plan charges for each drug and which phase of coverage

An individual under the age of 65 receiving Social Security Disability Insurance can have Medicaid and later enroll in Medicare after 24 months of receiving Social Security Disability benefits, or upon reaching the age of 65.

Individuals who are receiving both Medicare and Medicaid (with cost-share protection) are considered to be dual-eligible beneficiaries. The cost-share protection expands coverage to assist with out of pocket costs like copays and deductibles. Some people qualify for Low-Income Subsidy (LIS or Extra Help) which helps lower the costs of their prescription drugs and helps with the cost of premiums on plans with prescription drug coverage.

Find out more about how Medicare and Medicaid work together and including a few of Medicare’s subsidy programs.

You don’t need to re-enroll the person you care for each year, but you should review their coverage each year since plans can change annually.

If you provide care for someone new to Medicare, they have an Initial Enrollment Period (IEP) to select benefits when they are first eligible for Medicare. The IEP is three months before and after their 65th birthday month. If they miss the enrollment deadline, they can enroll in Part A and/or Part B during the General Enrollment Period, which is January 1 to March 31 each year.