Do I have to pay a deductible?

Yes. The Part A deductible for 2022 is $1,556. That means you will not receive any Medicare Part A benefits unless you fully pay off the deductible. This is a per-visit deductible, meaning that if you go to the hospital on Monday and then again on Wednesday for a different reason, you will have to pay for the deductible twice!

What happens after my deductible is met?

Great question! Once your deductible is met, you need to be admitted to a 2-night stay in a hospital before your hospital benefits kick in. After the 2 nights, you are fully covered at a 100% rate for nights 3 through 60.

What happens after 60 days?

Between days 61 and 90 at the hospital, you are responsible for a daily deductible of $352.

Am I covered after 90 days at all?

Yes, however, the daily deductible after day 90 becomes a whopping $704! This continues until day 150 at the hospital.

Am I covered after day 150?

You are not covered under Medicare Part A after day 150. This means that any incurred costs after day 150 needs to be fully covered out of pocket by the patient!

Am I eligible for Medicare Part B?

Anyone who is eligible for Medicare Part A is also eligible for Medicare Part B. Enrollment is required for Part B and the current 2020 premium is $144.60 (varies depending on income and marital status - see chart below for details).

That's the monthly premium. Is there also a deductible?

Yes, there is also a deductible for Part B. The current annual deductible for Part B is $198, so your Part B coverage won't start until that is fully paid.

That's a really low deductible!

Yes, it is! However, once the deductible is met, you have to pay a 20% coinsurance fee for every visit uncapped -which means you could be responsible to pay large sums of money for ongoing outpatient care and/or significant surgeries!

How can I protect myself and my wealth from this?

To protect from these excessively high medical bills, many seniors will consider purchasing private insurance called Medicare Supplement insurance policies (also known as Medigap policies).

Whew. Where can I learn more about these Medicare Supplement policies?

Click on the Medicare Supplement tab to learn more, or schedule a free appointment/consultation with one of our experienced agents by calling 855.200.6335 or by scheduling a free consultation session with us!

When Can I Switch Back To Original Medicare?

If you are currently on a Medicare Advantage plan and you're trying to switch back to traditional Medicare, you have two times to do so: Annual Enrollment Period - (October 15th – December 7th) Medicare Advantage Disenrollment Period (MADP) - (January 1st – February 14th)

Where can I learn more about Medicare Part C?

If you have any questions about switching your plans, feel free to contact us at 855.200.6335 or schedule your free consultation now!

How do I enroll in Medicare Part D?

here are two ways to enroll in a Part D Plan: A stand-alone Medicare Part D Plan (PDP). A Medicare Advantage plan that includes drug coverage (MAPD).

What is Donut Hole (Coverage Gap)?

The "donut hole" is a gap in coverage that can occur in certain Medicare prescription drug plans (Part D) when an individual's total drug costs reach a certain threshold. During the coverage gap, known as the "donut hole," the individual must pay more out-of-pocket for their drugs before their plan's coverage kicks in again. The Affordable Care Act (Obamacare) has closed this coverage gap over time so that by 2020, beneficiaries will pay no more than 25% of the cost of their drugs while in the coverage gap.

How much coverage does Medicare Part D give me?

Medicare can only give a certain amount of drug coverage for each person, so once your full cost (a combination of what you pay and the insurance company pays) reaches $4,020, you will go into the coverage gap where you would pay 25% of the cost of both brand name medication and generic medication. Once you reach $6,350 out-of-pocket, you will get out of the Coverage Gap and reach Catastrophic coverage and the costs of your medications will drop significantly to just 5% or $3.35 for generics and $8.35 for brand-name drugs, whichever is greater.

What is a late enrollment penalty?

Choosing not to enroll in Medicare Drug coverage when you are first eligible could lead to a late enrollment penalty. The penalty does not apply if you had other creditable drug coverage (such as employer/union coverage, VA benefits) or if you get Extra Help. The late enrollment penalty is 1% of the average cost of a Medicare Part D plan. That average for 2020 is about $32.74, which would be around $.30. That small penalty accumulates for the number of months you go without drug coverage. Once you do enroll in a drug plan, that extra penalty is added on to your monthly cost. For example, if you go two years without drug coverage and then enroll in a plan, Medicare would add on about $7.20 a month to the cost of your drug plan.

Can I get additional help for Medicare Part D?

You may qualify for very little to zero premium and co-pays on your prescription plans if you meet certain income and resource qualifications. You may qualify if in 2019 your annual income was below $18,735 if you're single ($25,365 for married) and your resources add up to $14,390 if you’re single ($28,720 for married). Resources that count are money in a checking or savings account, stocks, and bonds. Resources that don’t count are your home, one car, burial plot, furniture, and other household and personal products. If you’re on Medicaid or other state programs, you may automatically qualify for Extra Help. To find out more about Extra Help and to see if you qualify, fill out an application with Social Security.

Jawad Bushnaq
- May 9, 2023
- 2 min read

Understanding the Difference Between Medicare and Medicaid

Updated: Sep 12, 2023

Medicare and Medicaid are two of the largest government-funded healthcare programs in the United States. While both programs provide healthcare coverage to eligible individuals, there are key differences between them. In this blog, we'll explore the differences between Medicare and Medicaid, including eligibility requirements, benefits, and funding.

Eligibility Requirements:

Medicare is a federal health insurance program for individuals over the age of 65, people with certain disabilities, and people with end-stage renal disease (ESRD). Eligibility is based on age, disability status, or ESRD, and beneficiaries must have paid into the program through payroll taxes. Additionally, individuals who are eligible for Social Security or Railroad Retirement Board benefits are also eligible for Medicare.

Medicaid, on the other hand, is a joint federal and state program that provides healthcare coverage to low-income individuals and families. Eligibility requirements vary by state, but generally, individuals must meet certain income and asset requirements to qualify for coverage.

Benefits:

Medicare offers a range of healthcare benefits, including hospital insurance (Part A), medical insurance (Part B), and prescription drug coverage (Part D). Beneficiaries can also choose to enroll in Medicare Advantage (Part C) plans, which are offered by private insurance companies and provide additional benefits, such as vision and dental coverage.

Medicaid provides comprehensive healthcare coverage, including doctor visits, hospital stays, prescription drugs, and dental and vision services. Coverage varies by state, but all states are required to provide certain essential benefits, such as preventive care and mental health services.

Funding:

Medicare is funded through payroll taxes, premiums, and general tax revenues. Beneficiaries pay a premium for Part B coverage, and those with higher incomes may pay a higher premium. Part D coverage is provided by private insurance companies, and beneficiaries pay a premium for this coverage as well.

Medicaid is jointly funded by the federal government and the states. The federal government pays a portion of the cost, and the states are responsible for the remaining costs. The amount of federal funding a state receives is based on the state's per capita income, with poorer states receiving a higher percentage of federal funding.

According to the Kaiser Family Foundation, in 2020, Medicare covered approximately 62 million people, while Medicaid covered approximately 76 million people. Additionally, in 2019, Medicare spending accounted for 15% of the federal budget, while Medicaid spending accounted for 10% of the federal budget. In summary, while Medicare and Medicaid are both government-funded healthcare programs, they have different eligibility requirements, benefits, and funding structures. It's important to understand the differences between these programs and determine which program best meets your healthcare needs. If you have any questions or need further guidance, please contact us at Ikhlas Insurance Group.

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Understanding the Difference Between Medicare and Medicaid

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