Original Medicare - Part A and Part B


There are 2 parts to Original Medicare

Part A of Original Medicare
Part B of Original Medicare

Original Medicare in Colorado


Original Medicare is a government program that is your foundation. In addition there are three types of Medicare products available to you from private insurance companies.
Medigap—also known as Medicare Supplements

Part C: Medicare Advantage Plans

Part D: Prescription Drug Plans

Although marketed by private insurance, all three products are tightly regulated by government agencies.

It's a great start: Original Medicare in Colorado is a start but most people purchase additional coverage as there is significant financial exposure with Original Medicare alone. The good news is that the vast majority of doctors and hospital accept Medicare.

Part A:

Part A is inpatient hospital coverage, skilled nursing home, and home health care. There is no cost for people who paid Medicare payroll taxes for the required 40 quarters.

If you are hospitalized in 2016, you will pay a deductible of $1288. After 60 days in the hospital, you must pay a copay of $322 per day, and after 90 days you would pay a copay of $644 per day.

Part B:

Part B is outpatient medical coverage for doctor visits, lab and X-rays, outpatient surgery, therapy, durable medical equipment, and more. There is a premium to pay for Part B of Medicare.

If you have outpatient medical expenses in 2016, you will first pay a deductible of $166 for the year. After that you must pay 20% of “Medicare approved” amounts. In addition, you would be responsible for up to 15% of the doctor’s charges above what Medicare approves, unless the doctor accepts “Medicare assignment.” There is no limit to how much you would be responsible to pay if you only had Medicare by itself. That is why most people sign up for a Medigap plan or a Medicare Advantage.

How Do I Enroll in Medicare in Colorado?

If you are already drawing Social Security benefits, it’s done for you! You will automatically receive your red, white & blue Medicare card in the mail about 3 months before your birthday month.

However, if you are not in the Social Security system yet, you will need to actively enroll yourself. You can enroll for Medicare in Colorado online, by phone, or in person at your local Social Security office.

If you worked past 65 and are just now enrolling for Original Medicare, there is some additional paperwork required that takes away the online enrollment option. You will need to have your employer submit proof that you had group insurance since turning 65 in order to avoid late enrollment penalties.

Here is a detailed discussion of how to apply for how to apply for Medicare.


What do the letters mean on my Medicare Card?

Your Medicare claim number includes a letter that signifies a beneficiary type. Here is a list of the most common letters:

A — Primary Claimant (wage earner) Most frequently used code.

B — Spouse (spouse of retired worker)

B6 — Divorced Wife, age 62 or older

C1-C9 — Child (includes minor, student or disabled)

D — Aged Widow, age 60 or over

D6 — Surviving Divorced Wife, age 60+

HA — Receiving Disability Benefits

T — Enrolled in Medicare but temporarily delayed SS retirement benefits


Drawing Social Security Disability?

If you are drawing Social Security because of a disability, you should receive your Medicare card about 3 months before your 25th month of disability benefits.

We can help you find a Medigap policy during your one-time 6-month open enrollment period, which starts with the month in which your Colorado Medicare begins.

If you miss this deadline, all is not lost. We can still get you enrolled into a Medicare Advantage Plan each year from October 15th through December 7th.


HAVE HIGHER INCOME?

For individuals whose Medicare Part B started in December 2016 or anytime in 2017, the standard Part B premium will be $134.00 (or higher depending on your income).

However, most people whose Medicare Part B AND Social Security checks began in November of 2016 or earlier, will pay less than $134.00 due to the “hold harmless” provisions. Social Security will tell you the exact amount you will pay for Part B.

You’ll pay the standard premium of $134.00 if:

You enroll in Part B any time in 2017 or December of 2016 You don't get Social Security benefits.

You're billed directly for your Part B premiums.

You have Medicare and Medicaid, and Medicaid pays your premiums.
(Your state will pay the standard premium amount of $134.)

You’ll pay more than the standard premium of $134.00 if:

Your modified adjusted gross income (MAGI) as reported on your IRS tax return from 2015 is above a certain amount. If so, you’ll pay the standard premium amount plus an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your Part B premium and Part D drug premium. The chart below shows how Medicare Part B & D premiums will be increased in all states including Colorado for high income earnings.

The "look back" is two years so your 2017 premium is based on your MAGI income from 2015.

Nationwide Medicare Part B & Part D Premiums for 2017 (including Colorado)

Individual Tax Return

Joint Tax Return

For Part B:

You Pay

Part D Drug Surcharge:

2015 income is less than or equal to $85,000

2015 income is less than or equal to $170,000

$134.00

No high income surcharge

2015 income is $85,000 - $107,000

2015 income is $170,000 - $214,000

$187.50

$13.30 + plan premium

2015 income is $107,000 - $160,000

2015 income is $214,000 - $320,000

$267.90

$34.20 + plan premium

2015 income is $160,000 - $214,000

2015 income is $320,000 - $428,000

$348.30

$55.20 + plan premium

2015 income is greater than $214,000

2015 income is greater than $428,000

$428.60

$76.20 + plan premium


HAVE LOWER INCOME?

In Colorado, Medicare premiums and prescriptions can be lowered by applying at your local county human services office. There are two categories of programs if your income is low.

Medicare Savings Programs (Usually pays for Medicare Part B premium)

Low Income Subsidy (LIS); more commonly called “Extra Help” Usually pays for Part D drug premiums and some other out-of-pocket drug expenses, such as deductibles, copays, and coinsurance.

Four Kinds of “Medicare Savings Programs” to help those with lower incomes

Qualified Medicare Beneficiary (QMB) Program

Specified Low-Income Medicare Beneficiary (SLMB) Program

Qualifying Individual (QI) Program

Qualified Disabled and Working Individuals (QDWI) Program

If you have income from working, you may still qualify for one of these four programs even if your income is higher than the income limits listed below.

If you qualify for a QMB, SLMB or QI program, you automatically qualify for Extra Help (Low Income Subsidy, or LIS) - which provides assistance paying for your Part D prescription premium and possibly for deductibles and copays for the drug costs.

If you do not qualify for a Medicare Savings Program, you may still qualify for Extra Help, aka Low Income Subsidy, to assist you with the cost of your prescriptions.

Colorado Medicare Savings Program: Asset & Monthly Income Limits

Medicare Savings Program

Individual Income Limit

Married Income Limits

Helps Pay For

QMB

$1,010

$1,355

Part A deductible and Part B Premium plus other deductible, and co-payments

SLMB

$1208

$1,622

Part B Premium Only

QI

$1357

$1,823

Part B Premium Only

NOTE: ASSET LIMITS FOR ALL LEVELS OF ASSISTANCE IS $8780 FOR AN INDIVIDUAL & $13,930 FOR A COUPLE

Extra Help - Could You Use Some, Colorado Residents?

For individuals who receive Part D prescription drug coverage and are low-income, there is assistance available for the costs of deductible and co-pays.

This Extra Help is also known as the Low-Income Subsidy (LIS). If you do not qualify for Medicare Savings Plan, you may qualify for Extra Help (LIS) to assist with the cost of your prescriptions.

Who is eligible? To receive Extra Help, persons must be eligible for Medicare Part D and have income less than 100% of the Federal Poverty Level for a full benefit or less than 150% for a partial benefit.

NOTE: When evaluating your assets, Medicare excludes the value of your home, car, personal possession, burial plot, or cash value of insurance policies. Many people qualify for Extra Help and don’t know it!

Extra Help with Medicare Part D (aka LOW INCOME SUBSIDY, or LIS)

Individual

Couple

Income Limits

$1,472 per month

$1,992 per month

Asset Limits

$13,640

$27,250