All you need to know about Medicare

By Bill Schmick • February 2, 2017

More of us are signing up for Medicare every day. And like social security, there are plenty of unanswered questions for those of us who are beginning the process. There are plenty of places to seek answers, but how to separate facts from sales pitches from health insurance brokers is part of the problem. Here is a primer that may help you navigate these muddy waters.

Presidents as far back as Teddy Roosevelt in 1912 toyed with the idea of a government-sponsored health insurance program. Harry S. Truman and John F. Kennedy both tried and failed to get an act passed. But in 1965, under the administration of Lyndon B. Johnson, Medicare was finally passed.

You qualify for Medicare at age 65, or older, if you are a citizen or permanent legal resident who has lived in the U.S. for at least five years. Here are the qualification rules: You (or your spouse) need to have worked long enough to qualify for Social Security or railroad retirement benefits, or worked as a government employee or retiree who may not have paid into Social Security, but has paid Medicare payroll taxes while working.

In addition, you qualify for Medicare if you are disabled and have received Social Security benefits for at least two years. A disability pension from the Railroad Retirement Board or Lou Gehrig’s disease, permanent kidney failure, and a kidney transplant also counts toward Medicare benefits as long as you or your spouse have paid some Social Security taxes over a certain length of time.

Last year, nearly 165 million American workers were contributing to Medicare through payroll taxes and roughly 57 million people are receiving Medicare benefits, with 9.1 million of them disabled.

For those who don’t know it, Medicare has two main parts: Medicare Part A, which is hospital insurance that helps pay for inpatient hospital care as well as short-term care in a skilled nursing facility. It will also partially cover in-home care and/or hospice care.

Medicare Part B is medical insurance that helps pay for outpatient care: things like doctor visits, tests, medical equipment, supplies and some home health services. Many preventive health services such as screening for cancer, heart disease and diabetes are free under Part B.

As long as you or your spouse paid Medicare taxes during your working life, you don’t have to pay a monthly premium for “A,” but you will have to pay some costs like co-payments, coinsurance and hospital deductibles. The Medicare system is based on benefit periods. For example, a hospital stay is a “benefit” that begins on the day you’re admitted. It ends when you haven’t received any inpatient care for 60 days.

You will need to pay a deductible of $1,316 (in 2017) for every benefit period. You pay nothing after that for up to 60 days, but for every day after that you remain in the hospital, you are charged a co-pay that starts at $329/day.

You do pay a monthly premium for Part B, which is based on your yearly income. For those filing a joint tax return of $170,000 or less ($85,000 or less as an individual) you will pay $134/month. Your payments increase on a sliding scale with those who are making more than $428,000/year paying the top premium of $428.60/month ($214,000 or more as an individual). In addition, there is a $183 deductible you will pay for Part B in 2017.  After that, you will typically pay 20% of the cost of any medical care.

The bottom line here folks is that Medicare, contrary to many reader’s impressions, is not free and costs can mount up quickly depending on your health problems. Remember too that there is no yearly limit on how much you might be required to pay. In my next column, I will explore two kinds of insurance that you can buy that will protect you from any gaps between your health care costs and your income. If you are interested in Medicare planning for your retirement, give us a call today.

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