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Medicare A & B
What is Medicare?
Medicare was signed into law by President Lyndon Johnson on July 30, 1965, in Independence, MO. It is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Original Medicare covers many health care services and supplies, but there are many costs (“gaps”) it doesn’t cover. It is divided into different parts “A,B,C,D” which are explained below and on the next page. You can also visit: www.medicare.gov for more information.
Medicare Part A
Medicare Part A covers your inpatient Hospital stays, Skilled nursing facilities, Hospice, Home care and blood if deemed Medically necessary with co pays and coinsurance. The cost for Part A is normally $0.00 if you or your spouse worked 40 quarters or 10 years into the Social Security system.
Hospital Benefits:
Days 1-60 – You pay a deductible of $1632.00
This is a benefit period deductible (60 days between stays you owe it again)
Days 61-90 – You pay $408.00 per day
Days 91-150th day – You pay $816.00 per day
After 151st day – You pay all charges
Skilled Nursing Benefits:
After a 3-day Inpatient Hospital stay
Days 1-20 – You pay $0.00
Days 21-100 – You pay $204.00 per day
Days 101 and beyond – You pay all charges
Hospice Benefits:
Medicare pays majority of all costs except for a small co pay or coinsurance
Home Care Benefits:
Medicare pays all approved costs
Lab Benefits:
Medicare pays all approved costs
Blood Benefits:
You pay the first 3 pints of Blood
Medicare pays all charges thereafter
Medicare Part B
Medicare Part B helps cover Medically necessary doctors’ services in or out of the hospital, outpatient care, home health services, durable medical equipment and other medical services as well as Preventative services.
2024 CHANGES IN COST OF MEDICARE PART B & PART D
The standard Part B premium amount in 2024 is $174.70. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
You’ll pay a Higher Amount if: *Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you will also pay a Higher Amount for Part D your prescription plan.
If your yearly income in 2022 (for what you pay in 2024) was | You pay each month (in 2024) | ||
File individual tax return | File joint tax return | File married & separate tax return | |
$103,000 or less | $206,000 or less | $103,000 or less | $174.70 |
above $103,000 up to $129,000 | above $206,000 up to $258,000 | Not applicable | $244.60 |
above $129,000 up to $161,000 | above $258,000 up to $322,000 | Not applicable | $349.40 |
above $161,000 up to $193,000 | above $322,000 up to $386,000 | Not applicable | $454.20 |
above $193,000 and less than $500,000 | above $366,000 and less than $750,000 | above $103,000 and less than $397,000 | $559.00 |
$500,000 or above | $750,000 and above | $397,000 and above | $594.00 |
Medicare Part B – Benefits
You have an Annual Deductible of $240.00.
Medicare pays 80% of Approved amounts.
You pay 20% of Approved amounts.
If the Doctor does not take assignment you can pay up to an additional 15% above the Approved amount.
*The Service must be Approved by Medicare to receive payment
*Certain Preventative Care is Paid at 100% by Medicare.
Whether you’re exploring insurance options, seeking eldercare solutions, or addressing concerns like elder abuse, SIA of Maine is ready to assist you every step of the way, ensuring your golden years are supported by a foundation of care, respect, and informed choice.