The following is for Original Medicare Parts A, B and D.
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What is Covered and What You Pay
Skilled Nursing Facility
*A benefit period begins the first day you’re admitted into a hospital or covered SNF stay and ends when you’ve been home for 60 days with readmittance into either type of facility.
|Part B Monthly Premium for 2016
*except $104.90 if your Part B premium was withheld from your Social Security check in 2015
There is also a Part B premium adder for those with higher incomes. See below under the Part D section.Annual Deductible
What Part B Covers and What You Pay
If you don’t enroll in Medicare Part B when you’re first eligible during what is known as your Initial Enrollment Period (IEP), you may face delays getting coverage as well as a late enrollment penalty. The only time you can safely defer enrollment past your IEP is if you or your legal spouse are working for what is considered a large employer and you have group health coverage through that same employer. In this case you have what’s called a Special Enrollment Period (SEP) to apply for Part B without penalty.
Your SEP is 8 months from the end of your active employment or the end of the group coverage, whichever comes first. Note that retiree coverage and COBRA don’t count as active employer coverage and will not allow you a SEP. They are typically not considered primary coverage either and are secondary to Medicare whether or not you’ve actually enrolled in Medicare. That means that if you stop active employment and you’re eligible for Medicare but haven’t signed up, you will be without primary coverage even if you have a retiree plan or COBRA. These plans can recoup payments made in error.
Should you miss your IEP and not have a SEP then your only opportunity to enroll in Part B is during the General Enrollment Period (GEP). This is only during the first quarter of each year, Jan. 1 – March 31 and your coverage won’t start until July 1 of that year. Most people who enroll during the GEP will have a permanent late enrollment penalty added to their monthly Part B premium. The penalty is equal to 10% of the current year’s base Part B premium for each 12 month period that you were eligible for Medicare but not enrolled and did not have active employer group coverage.
It can be complicated so see HICAP for assistance. HICAP Counseling
|If your yearly modified adjusted gross income from your 2014 tax return is:||Part B Monthly Adjustment||Total Part B Monthly Premium||Part D Monthly Premium Adjustment *|
|File Individual Tax Return:||File Joint Tax Return:|
|$85,000 or less||$170,000 or less||$.0.00||$104.90/$121.80||$0.00|
|$85,001 to $107,000||$170,001 to $214,000||$48.70||$170.50||$12.70|
|$107,001 to $160,000||$214,001 to $320,000||$121.80||$243.60||$32.80|
|$160,001 to $214,000||$320,001 to $428,000||$194.90||$316.70||$52.80|
|Above $214,000||Above $428,000||$268||$389.80||$72.90|
|Married filing separately with modified adjusted gross income:||Part B Monthly Adjustment||Total Monthly Part B premium||Part D Monthly Adjustment|
|$85,000 or less||$0||$104.90/$124.80||$0.00|
|$85,001 to $129,000||$194.90||$316.70||$52.80|
|How much is the Part D penalty? What is creditable coverage?
Medicare calculates the Part D penalty by multiplying 1% of the “national base beneficiary premium” (which is $34.10 in 2016) times the number of full, uncovered months you didn’t have Part D or creditable coverage (another drug plan that has at least the benefits offered by Part D). The national base beneficiary premium may increase each year, so the amount of your penalty may also increase each year. The Part D penalty is permanent unless you qualify for Extra Help. The penalty is added to your monthly base premium for your prescription drug or Medicare Advantage plan.
Avoid the Part D penalty by making sure you have a Stand-Alone Part D drug plan, or a Medicare Advantage plan with prescription drug coverage, or another plan, such as an employee medical plan or an employee retirement plan that includes creditable prescription drug coverage, in force from the month when you reach age 65.
You can meet with a HICAP counselor to review your current prescription drug coverage and help you determine if it is creditable coverage and what steps you can take.
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