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Did you know?
- Medicare may impose financial penalties if you don’t enroll when you are first eligible
- Some of these penalties can apply for the life of your Medicare coverage
- Each component of Medicare (Part A, Part B and Part D) has its own penalty calculation
Enroll in a Medicare Advantage plan that best meets your healthcare needs during your Initial Enrollment Period.
What You Need To Know
Medicare services are offered in parts. Parts A and B are often called original Medicare.
This covers hospital care, skilled nursing facilities for a limited time, and hospice. You can choose the doctors and hospitals you want, as long as they accept Medicare payments.
This part covers doctor visits and services such as wheelchairs, walkers, lab tests, and surgeries. It also covers preventive care, such as flu shots, mammograms, colorectal screenings, and yearly wellness visits.
Also known as Part C, which includes Original Medicare, Parts A and B, as well as Part D, prescription coverage.
These affordable plans typically include prescription drug coverage. Some also cover dental and vision care.
Medicare Advantage works like a traditional HMO where you choose a primary care doctor to help you manage your health care, including referrals to specialists.
A Medicare Advantage HMO plan is a Medicare plan offered by a private company that contracts with Medicare to provide you all your Part A and Part B benefits.
Premiums, deductibles and co-pays (costs that you have to pay to be covered) vary from plan to plan. Sutter Health recommends shopping for the best Medicare Advantage plan that is best for you.
With Medicare Advantage you may receive:
- Low or no co-pays for office visits
- Limited annual out-of-pocket costs
- Prescription drug coverage for most plans
- Preventive services, including annual physicals
- X-ray and lab services
- Emergency room and urgent care nationwide
|Medicare Original||Medicare Advantage||Prescription Drug Coverage||Medicare Supplement|
|Inpatient Hospital Stays||X||X||X|
|Doctor office visits||X||X||X|
Age 65+: $0
Deductible per hospitalization: $1,316
|Monthly premium: $109||
Monthly Premiums: $0-$92
Annual Deductible: $0
Monthly Premiums: $17-$159
Annual Deductible: $0-$400
Monthly Premiums: $0-$92
Annual Deductible: $0-$2,200
This is not a complete description of benefits. Eligibility may be limited to certain times of the year.
1) To receive premium-free Part A at 65: · You receive or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board · You or your spouse had Medicare-covered government employment. 2) Your monthly premium, on average, if you pay your Part B premium through your monthly Social Security benefit. 3) Monthly premiums and annual deductibles are based on a Medicare eligible patient in the Sacramento area This is not a complete description of benefits. Benefits, premiums, and copayments will vary based on the plan options for which you qualify, and may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Medicare has neither reviewed nor approved this material. For more information, please visit medicare.gov.
Do you have to pay for Medicare?
A monthly payment, or premium, is not required for people (including spouses) who are 65 or older and paid Medicare taxes while they were working. You don't pay a premium if you are 65 or older and you get retirement benefits from Social Security or the Railroad Retirement Board. You also don't pay a premium if:
- You are younger than 65 and have received Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have end-stage renal disease (kidney failure) and need dialysis or a transplant.
- If you are 65 or older and don't qualify for premium-free Medicare, you can buy Part A with a monthly premium. If you buy Part A, you also need to pay a premium for Part B. Check online at www.medicare.gov for details on premium amounts.
You usually need to pay some amount (deductibles or co-pays) for services before Medicare pays. But if you have a Medigap policy, it may cover your deductibles and co-pays. (See "What is Medigap?" for more information.)
Most people pay a standard monthly premium and an annual deductible. Above a certain income, you pay more based on the amount of your income. Most preventive services-such as flu shots, mammograms, colorectal screenings-are free if the provider accepts Medicare.
These plans have different costs depending on the plan you choose. You may have monthly premiums, as well as deductibles and co-pays.
You pay a premium for the drug plan, which can vary based on what is covered in the plan.
When You Can Enroll
Singing up for Medicare during your Initial Enrollment Period is one way for you to avoid late-enrollment penalties.
Medicare’s Annual Election Period
Medicare’s Annual Election Period (also known as Medicare’s Open Enrollment) is October 15 – December 7. This may be the only opportunity you have each year to change your Medicare health or prescription drug coverage, if you decide to.
Follow these six steps to help you make informed decisions when getting started with Medicare.
Review this comprehensive guide to get answers to the most frequently asked questions about Medicare.
Avoid Medicare’s Part A, B and D late enrollment penalties.
Part A late enrollment penalty
Unlike Medicare’s Part B and D late enrollment penalties which can last as long as you have Medicare Part B and prescription drug coverage, respectively, Part A penalties last for twice the number of years you could have had Part A, but didn’t sign up.
Part B late enrollment penalty
10% increase for every full 12-month period that you could have had Part B, but didn’t sign up for it. This penalty is incurred for as long as you have Part B. Avoid these life-long penalties. Enroll as soon as you are eligible.
Part D late enrollment penalty
Part D late enrollment penalty: 1% (per month) of the national base beneficiary premium ($35.02 for 2018), times the number of full, uncovered months you didn’t have Part D or creditable coverage. This penalty is not only added to your monthly Medicare drug plan premium for as long as you have prescription coverage, it may also continue to increase each year if the national base beneficiary premium increases.
What to expect when you start on Medicare.
As a Medicare or Medicare Advantage member you are eligible for free, annual visits with your doctor. During these visits, you, your doctor and your care team, will partner to develop a comprehensive, personalized plan for improving your health and preventing disease. It’s a great opportunity to talk about your health care goals—for today and into the future.
Who is eligible for Medicare visits?
If you are a new member of Medicare, you are eligible for a one-time Welcome to Medicare Visit during the first 12 months of enrollment. If you’ve had Medicare for longer than 12 months, you are eligible for an annual Medicare Wellness Visit.
What is the difference between a wellness visit and an annual physical?
Your Wellness Visit is not a physical examination. It is a time for you and your doctor or care team to create a personalized plan for improving your health and preventing disease.
What is my cost?
Your one-time Welcome to Medicare Visit and your annual Medicare Wellness Visit are covered by Medicare. However, if your doctor or other health care provider performs additional tests or services during the same visit that are not covered under these preventive benefits, you will be responsible for your usual co-pay or deductible.
What preventive medical visits does Medicare cover?
Medicare pays for two types of wellness visits: a one-time Welcome to Medicare Visit and an annual Medicare Wellness Visit1.
Welcome to Medicare Visit
Medicare covers this one-time visit within the first 12 months of joining Medicare. Your doctor will review your medical and social history and provide education and counseling about preventive services such as health screenings, immunizations and referrals for other care, if needed.
Your Welcome to Medicare Visit also includes:
- Height, weight and blood pressure measurements
- A calculation of your body mass index
- A simple vision test
- A review of your potential risk for depression and your level of safety
- A discussion about creating an end-of-life care plan
- A written overview of screenings, immunizations and other preventive services
1 Preventive visit and yearly wellness visit. www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
Annual Medicare Wellness Visits
If you’ve had Medicare for longer than 12 months, you’re eligible for an annual Medicare Wellness Visit. These visits are designed to develop or update a personalized plan to help prevent disease and disability based on your current health and risk factors and answers from your Medicare questionnaire. At the end of your visit, your health care provider will print a copy of your plan, which will include a list of upcoming screenings and visits.
You may also find a copy of your plan on My Health Online.
Your Medicare Wellness Visit also includes:
- Height, weight and blood pressure measurements
- A review of your medical and family history
- Screening for cognitive impairment
- A screening schedule for appropriate preventive services
- Time to develop or update your list of care providers and medications
- Time to review a list of risk factors and treatment options—personalized for you
These visits are problem-related and address or manage illnesses. You will be responsible for your usual co-pay or deductible for these visits.
Preparing for your wellness visit
Before your visit, your health care provider will send you a questionnaire—via mail or through your My Health Online account. Answering these questions will help you and your doctor develop a personalized prevention plan for improving your health.
Please remember to also bring:
- All of your medications in their original bottles, including over-the-counter medications and supplements
- Medicare card or other insurance card
- Photo ID
- Documents outlining end-of-life care wishes*
- Power of attorney*