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How Does Traditional Medicare Factor Into Your Healthcare Coverage in Retirement?

Posted by Michael J. O'Connor | CWS®, Vice President Investments
September 18, 2013

Traditional Medicare is another name for Medicare Parts A and B. Most people are automatically enrolled in Parts A and B and receive their benefit cards 3 months before their 65th birthday. You’ll be automatically enrolled if you’re already receiving Social Security retirement benefits when you turn 65.1

If you’re not automatically enrolled and want to apply, there is a seven month window to join:  three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday. If you miss that window, there is “General Enrollment” every year between January 1 and March 31.1

Below we’ll break down the differences between Medicare Part A and Part B.

Medicare Part A: Costs and Benefits

Part A usually requires no premium payments, though there are some deductibles and coinsurances associated with coverage (more on these costs below). Part A covers hospitalization, or inpatient care. This includes hospital care, nursing facility care, nursing home care, hospice, and home health services.2

  • Examples include:  semi-private rooms, meals, general nursing, inpatient treatment drugs, critical access hospitals, inpatient rehab facilities, and mental health care. To note, Part A does have a deductible, which is currently $1,184 for each benefit period.1

Medicare Part B: Costs and Benefits

Part B does carry a cost to you. The premium is determined by your taxes two years prior to the year you enroll (this is the most recent tax information the Social Security Administration has available).

  • Example:  If you made $85,000 or less in 2011, the monthly premium in 2013 is $104.90 with a $147.00 annual deductible. If you made over $85,000 in 2011, the premiums go up and are determined by pre-set breakpoints with fixed premiums. The highest premium is $335.70 for those who made $214,000 or more.1

As far as benefits are concerned, Medicare Part B covers medically necessary treatment and services, or outpatient care.

  • Examples include:  doctor’s visits, medical equipment, physical therapy, and ambulance services.3

As mentioned above, there are deductibles and coinsurance costs associated with Medicare Parts A and B. For a full table of possible expenses associated with Traditional Medicare, take a look at the tables on Medicare’s website here.

Important: Medicare Coverage Differs by State

Because Medicare is dictated by both State and Federal laws, what is or isn’t covered differs state by state.1 However, if you are traveling within the United States and need medical attention, your Traditional Medicare plan will cover you.3

Is Having Medicare Part A and B Going To Cover All of Your Medical Needs?

It depends on your situation. For that reason, there are supplemental insurance plans such as Medicare Advantage, Medicare Part D, and Medigap that help you round out your health coverage as well as help you cover some of the out-of-pocket costs.

In our future posts on Medicare supplemental plans, we’ll discuss these options and how they work. In the meantime, we’re here to help you navigate the various options available to you as you build your comprehensive plan. Call one or our Wealth Managers today at 1-800-541-7774 to ask questions and learn more.

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1 Medicare.gov

2 CNN Money

3 Medicare Interactive

Retirement Planning Medicare Healthcare in Retirement