Original Medicare

Medicare is a federal health insurance program managed by the Centers for Medicare and Medicaid Services (CMS). CMS is part of the Department of Health and Human Services.

Who is Eligible for Medicare?

  • Individuals 65 years of age or older
  • Individuals with End-Stage Renal Disease (Kidney Failure)
  • Permanently disabled individuals that have been on disability for more than 24 months

Medicare has four parts that include deductibles and coinsurance:

  1. Part A – Hospitalization
  2. Part B – Doctor & Medical Coverage
  3. Part C – Medicare Advantage (Usually a combination of Part A, B & D)
  4. Part D – Prescription Drug Plan (provided through insurance companies)
 

What is Medicare Part A?

Medicare Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care.  In most cases, Medicare Part A covers only the cost of the facility. Part A does not cover the care received by doctors and healthcare professionals.

What is the Premium for Medicare Part A?

If you or your spouse paid taxes on income for 10 years you will not have to pay a premium for Medicare Part A.  Most will qualify at 65 for Part A, but some will qualify earlier through disability.  Individuals who are over 65 but did not work 10 years in the US may be eligible to purchase Part A for a premium.

Medicare Part A Co-pays – What You Pay in 2019:

Inpatient Hospital Stay:

  • $1,364 Deductible for Days 1-60
  • $341 Per Day for Days 61-90
  • $682 Per “Lifetime Reserve Day” Days 91-150 (60 Maximum Per Lifetime)

Skilled Nursing Facility:

  • $0 Per Day for Days 1-20
  • $170.50 per Per Day 21-100 (100 Day Maximum Per Benefit Period)

Home Health Care & Hospice:

  • $0 for Home Health Care and Hospice
  • Must Be Approved by Medicare

Medicare Part B – Medical Insurance

What is Medicare Part B?

Medicare Part B covers medically-necessary services such as care from doctors, outpatient care, durable medical equipment, home health services etc. Primarily, Part B insurance enables you to receive care from doctors and pay 20% of the cost.

What is the Premium for Medicare Part B?

Medicare Part B premiums are based on your previous year’s annual income:

If your yearly income in 2017 (for what you pay in 2019) wasYou pay each month (in 2019)
File individual tax returnFile joint tax returnFile married & separate tax return
$85,000 or less$170,000 or less$85,000 or less$135.50
above $85,000 up to $107,000above $170,000 up to $214,000Not applicable$189.60
above $107,000 up to $133,500above $214,000 up to $267,000Not applicable$270.90
above $133,500 up to $160,000above $267,000 up to $320,000Not applicable$352.20
above $160,000 and less than $500,000above $320,000 and less than $750,000above $85,000 and less than $415,000$433.40
$500,000 or above$750,000 and above$415,000 and above$460.50

Medicare Part B Co-insurance – What You Pay:

Part B Deductible:

  • $185 per year

Medical Services: (includes care received from doctors when hospitalized)

  • 20% of the Medicare-approved amount for most doctor’s services

Durable Medical Equipment:

  • 20% of the cost of medically necessary medical equipment

Medicare Part C – Medicare Advantage

What is Medicare Part C?

Medicare Part C is also known as Medicare Advantage. It includes plans types of HMO and PPO. Medicare Advantage Plans (sometimes called “MAPD Plans”) are offered by private insurance companies approved by Medicare.  If you join a Medicare Advantage Plan, the plan will provide all of you Part A and Part B coverages. Most plans also include prescription drug coverage (Part D). Medicare pays a fixed amount for your care every month to the insurance companies offering Medicare Advantage Plans. In return, these companies must offer equal or greater benefits than Original Medicare. Because these plans are usually have networks, they may require that you only go to doctors, facilities, and suppliers that are in their network. There are a number of insurance companies offering Medicare Advantage plans in the Las Vegas area.

What is the Premium for Medicare Part C?

Many Medicare Advantage plans in Las Vegas, Nevada have a $0 monthly premium. This is possible because Medicare gives the insurance company money to cover the cost of your care.

Medicare Part C Co-pays – What you pay:

With Medicare Advantage plans you typically pay a co-pay for each medical service you receive.  The co-pays are different for each of the Medicare Advantage plans in Las Vegas, NV.  Medicare Advantage Plans have a stop-loss or annual maximum for co-pays.  If you reach the maximum, you will no longer have to pay co-pays for health services for the remainder of that calendar year.

Medicare Part D – Medicare Prescription Drug Coverage

What is Medicare Part D?

Medicare Part D offers prescription drug coverage to individuals on Medicare. Many people get their Part D from their Medicare Advantage plan, but if you choose to stay with Original Medicare, you will need to purchase a Prescription Drug Plan to avoid being penalized by Medicare. Part D Prescription Drug Plans (PDPs) are only offered through private insurance companies. 

What is the Premium for Medicare Part D?

The monthly premium for Medicare Part D is based on the insurance company from which you receive coverage plus any applicable income adjustments. 

If your filing status and yearly income in 2017 was
File individual tax returnFile joint tax returnFile married & separate tax returnYou pay each month (in 2019)
$85,000 or less$170,000 or less$85,000 or lessyour plan premium
above $85,000 up to $107,000above $170,000 up to $214,000not applicable$12.40 + your plan premium
above $107,000 up to $133,500above $214,000 up to $267,000not applicable$31.90 + your plan premium
above $133,500 up to $160,000above $267,000 up to $320,000not applicable$51.40 + your plan premium
above $160,000 and less than $500,000above $320,000 and less than $750,000above $85,000 and less than $415,000$70.90 + your plan premium
$500,000 or above$750,000 and above$415,000 and above$77.40 + your plan premium

Medicare Part D Co-pays – What you pay:

Medicare gives the structural outline for Prescription Drug Plans. Companies offering drug plans can improve on the basic coverage, but have to meet these minimum benefits. There are three important differences to look at when you are deciding between plans:

  1. Where did the insurance company place your drugs into their tiers
  2. What is the monthly premium?
  3. What are the co-pays for the prescriptions you are taking?  

2019 Medicare Prescription Drug Plan Basic Coverage

 2019 BenefitsWhat You Pay
Deductible$415100% of the first $415 (Not all plans have a deductible)
Initial Coverage Period$3,405Co-payments based on plan and drug tiers
Coverage Gap$3,82025% of covered brand name drugs and 37% of generic drugs until you reach the out of pocket threshold
Annual Out-of-Pocket Threshold                                          $5,100.00*
Catastrophic Coverage Nominal amounts for your medications

get help with medicare

Help for Low-Income Medicare Beneficiaries in Las Vegas, NV

If you have limited income, you may qualify for assistance with your premiums, prescription drugs, and/or co-pays. If you think you may qualify for assistance, contact one of the following for more information:

The Medicare Hotline
24 hours a day, seven days a week

  • 1.877.486.2048  (TTY Users)

The Social Security Office
Mon-Fri between the hours of 7 a.m. & 7 p.m.

  • 1.800.325.0778  (TTY Users)

Las Vegas, NV State Medicaid Office

  •  1210 S. Valley View Blvd, #104    Las Vegas, NV 89102
  • 702.668.4200