Medicare

My Medicare Choices

Special Benefits for the Military

My Medicare Choices offers benefits for individuals of 65 and below 65. We offer a special benefit for military veterans through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) that shares the cost of your health care and supplies that are covered.

Who Qualifies for Medicare

  • One qualifies for Medicare benefits at 65 by meeting the following criteria:
  • You are a citizen of the United States or a permanent legal resident who has resided in the United States for at least five years and have worked long enough to be eligible to receive social security benefits
  • You or your spouse is working as a government employee or has retired as a government employee and has paid Medicare payroll taxes
  • If you’re under 65 and meet the following criteria, you qualify for Medicare:
  • If you have been collecting social security benefits for 24 months
  • If you have been diagnosed with end-stage renal disease and are receiving dialysis for four months
  • If you have been diagnosed with ALS - Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's disease
My Medicare Choices

Original Medicare

Original Medicare is a fee-for-service plan comprising
Medicare Part A and Medicare Part B.

  • Part A is a hospital
  • Part B is medical

Original Medicare Part B covers some drugs like immunizations, insulin supplies, chemotherapy drugs, medications for organ transplant covered by Medicare, and medications used for end-stage renal disease. Original does not have a limit on your out-of-pocket costs for your health care. You can see any doctor that accepts Medicare.

 Not covered:

  • Dental
  • Hearing aids
  • Acupuncture
  • Long-term care
  • Eye exams
  • Course cosmetic surgeries

Part A

Most people don't pay a Part A premium because they or their spouse worked and paid taxes for 40 quarters/10 years.

  • If you or your spouse worked 30-39 quarters, Part A would cost you $274 per month
  • If you have worked less than 30 quarters, Part A will cost you $499
  • Part A is also known as hospital insurance and carries the following benefits:
  • Inpatient care in a hospital
  • If you are admitted to the hospital because of a doctor’s order, illness, or injury that requires hospitalization

Your Responsibility

You will be responsible for the $1,556 deductible for each benefit period. The deducible is what you will pay for hospitalization for the first 60 days.

  • 1 Days 1–60: $0 coinsurance for each benefit period
  • 2 Days 61–90: $389 coinsurance per day of each benefit period
  • 3 Days 91 and beyond: $778 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • 4 Each day after lifetime reserve days : All costs

Part B

Part B has a deductible in 2022 of $233.00. Once you pay the deductible, you will typically pay 20% of Medicare-approved amounts for most doctor services, including doctor services, while you’re in the hospital.

  • Outpatient therapy
  • Durable Medical Equipment (DME)
  • Part B covers:
  • Clinical research
  • Ambulance services
  • Mental health
  • Inpatient
  • Outpatient
  • Partial hospitalization
  • Limited outpatient prescription drugs

Part B costs everyone, and the amount you pay varies based on your income. The cost this year (2020) is:

  • $170.10 if your income as an individual for 2020 was $91,000 or less
  • $170.10 If you filed your income jointly for 2020, $182,000 or less
  • $238.10 if your income as an individual for 2020 $91,001 up to $114,000
  • $238.10 If you filed your income jointly for 2020 $182,001 up to $228,000
  • $340.20 if your income as an individual 2020 was $114,001 up to $142,000
  • $340.20 If you filed your income jointly for 2020 $228,001 up to $340,000
  • $442.30 if your income as an individual for 2020 was $142,001 up to $170,000
  • $442.30 If you filed your income jointly for 2020, $284,001 up to $340,000
  • $544.30 if your income as an individual for 2020 was $170,001 and less than $499,999
  • $544.30 If you filed your income jointly for 2020, $340,001 and less than $749,999
  • $578.30 if your income as an individual for 2020 was $500,000 and above
  • $578.30 If you filed your income jointly for 2020 was $750,000 or above
My Medicare Choices

Prescription aka Part D

Medicare Part D is for your prescription coverage. To qualify for a Part D plan with Medicare, you must have Part A or Part B. We offer four types of prescription drug coverage for Medicare recipients.

Stand-Alone Prescription Drug Coverage

It can be purchased through various private insurance companies. There is an option for people who are using:

  • Original medicare
  • Supplemental plans (Medi-gap Plans)
  • Cost plans
  • Private Fee For Service plans (PFFS)
  • Medical savings accounts

Most Medicare Advantage Plans offer prescription coverage (Part D). Please verify the plan you are enrolling in has prescription coverage. If the plan does not include prescription coverage, you cannot have a stand-alone prescription plan and a Medicare Advantage plan that does not include prescription coverage.

My Medicare Choices
My Medicare Choices

Employer/Group Coverage or Union Coverage

If you or your spouse continue working and you have a covered employer/group plan, this is creditable coverage, as long as the coverage is as good as Medicare prescription plans. Check with your benefits administrator.

Union coverage - If your coverage is through a Union, they will send you a notice each year to inform you if their coverage is still creditable.

VA Benefits Tricare/CHAMPVA

Veterans Benefits (VA) is for individuals who have served in the Military. If you decide to enroll in a Medicare drug plan, you cannot use both benefits to fill the same drug.

My Medicare Choices

Tricare

Tricare is for active and retired military personnel and their families. But we are focusing on Medicare recipients. If you are entitled to Tricare, you do not have to get enrolled in a Medicare plan, but you have to have both Medicare Part A & Part B to receive your Tricare drug benefits. If you do decide to enroll in a Medicare drug plan, your Medicare drug plan pays first.

CHAMPVA

If you purchase a Medicare prescription plan, you will not be able to receive the CHAMPVA meds by mail, where they send you the maintenance drugs you need at no cost to you at no copayments, no deductibles, and no premiums.

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