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Medicare is a federally-sponsored health insurance program for people age 65 and older; people younger than 65 with a disability; people diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease; and those with end-stage renal disease (ESRD).  Medicare provides coverage for hospital care (Part A) and medical services (Part B).

Medicare Part A helps pay for four kinds of medically necessary care:

  • inpatient hospital care
  • inpatient care in a skilled nursing facility following a hospital stay
  • home health care
  • hospice care

Part A has deductibles and coinsurance, but most people do not have to pay premiums for Part A.

Medicare Part B covers a portion of outpatient medical services such as doctor's services, outpatient hospital care, laboratory tests, outpatient physical and speech therapy, certain home health care, certain ambulance services, and certain medical equipment and supplies.  Part B has premiums, deductibles, and coinsurance amounts that you must pay yourself or through coverage by another insurance plan.

Part B coverage is optional.  If you or your spouse are still working and are covered by your employer group health plan, you may not need this part of Medicare until you or your spouse retires.

You pay a premium each month for Part B.  If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment.  If you don't get these benefit payments, you'll get a bill.  Most people will pay the standard premium amount.  However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA).  IRMAA is an extra charge added to your premium.

Important: The standard Part B premium amount is $121.80 in 2016 (or higher depending on your income). However, most people who receive Social Security benefits will continue to pay the same Part B premium amount as they paid in 2015.  This is because they did not receive a cost-of-living increase for their 2016 Social Security Benefits.  You'll pay a different premium amount if:

  • You enroll in Part B for the first time in 2016.
  • You don't receive Social Security money benefits.
  • You're directly billed for your Part B premiums.
  • You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium of $121.80)
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.

To view your Part A premium costs go to: Your Part A Medicare Costs

To view your Part B premium costs go to: Your Part B Medicare Costs

If a beneficiary needs help with paying premiums, deductibles, and coinsurance, there are Medicare Savings Programs Eligibility is based on income and resource limits.

  • Qualified Medicare Beneficiary (QMB) - Pays the Medicare Part B premium and Parts A & B deductibles and co-insurance.
  • Specified Low-Income Medicare Beneficiary and Plus (SLMB and SLMB+/QI-1) - Pays the Medicare Part B premium only.
  • Qualified Disabled Working Individual (QDWI) - QDWI pays for the Medicare Part A premium, but it doesn't pay for the Part B premium

Click here for more Information on Medicare Savings Programs.




Last Modified:   7/27/2016 9:48:25 AM   
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Board on Aging & Long Term Care
1402 Pankratz Street, Suite 111
Madison, Wisconsin  53704-4001
FAX:  608 246 7001