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Medicare Programs By State

Medicare can be confusing, even for those whose job it is to know about it.  It changes all the time, and from state to state.  Knowing what applies to you specifically with regards to your locality can be a challenge, and online resources, while helpful, may not always have the answers you need.  In this article, we are hoping to change that.  

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While some people may be under the impression that Medicare is free for everyone who qualifies, this isn’t true.  Medicare is usually less expensive than regular insurance, but there are still premiums to pay. The cost of premiums can vary wildly, and fluctuate from state to state and  year to year.  They can change due to a variety of factors, including the beneficiary’s health, where they live, whether the government or insurance providers have tinkered with price increases, as well as what services and medications they choose to cover, the amount they are willing to cover for these things, changes in income requirements, and of course what plans and coverage they choose to get.  

Medicare also still comes with deductibles, copays, out-of-pocket costs and (for some) the cost of coinsurance.  After adding everything up, the average Medicare enrollee may find themselves reeling at the total sticker price.  But the bill is still somewhat in the beneficiary’s control, as they can choose what plan they get and how much coverage they want.  Premiums are also mainly income-based, so what you can reasonably afford is also taken into consideration by insurers and the federal government.  So how do these premiums apply?

What Changes State By State?

While certain Medicare premiums are the same everywhere in the country, other types of medicare premiums can change depending on:

  • Where you move
  • What type of Medicare coverage you have
  • Which Medicare-approved health insurance company offers the plan

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Medicare Premiums By Part

Medicare comes broken down into Parts. Here are the changes you may see to each individual Medicare part, varying by state.  Here’s a breakdown of each individual part: 

  • Part A – For most people, Part A is fully covered and doesn’t cost anything. However, if you don’t qualify for Part A, you may be able to buy it.  Typically, you don’t pay a premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years or 40 quarters.  Typically, you don’t pay a premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years or 40 quarters. 

If you paid these taxes for less than 30 quarters, your monthly premium for Part A is $458 in 2020. If you paid Medicare taxes for 30-39 quarters, your monthly premium is $252 in 2020. These rates are the same across the country.

  • Part B – Everyone is subject to a premium of some kind for Part B.  While Medicare Part B is optional, you are likely to be enrolled automatically if you are auto-enrolled in Part A, but you have the option to drop it.  The Medicare premium for Part B varies based on your income level, rather than your location. The standard monthly premium is $144.60 in 2020. Your Part B premium may be more if your income is above a certain level. As with Part A, the Part B premium doesn’t change across the states.

Many people are automatically enrolled in Original Medicare A and B when they become eligible. 

  • Part C – Premiums for Part C are sold in the private marketplace, which means they vary by provider, plan, and location.  Private, Medicare-approved health insurance companies offer Medicare Advantage plans. Premiums and other out-of-pocket costs can vary from plan to plan. 
  • Part D – Because Medicare Part D strictly covers prescription drugs only, it is sold by private insurance providers.  This means the premiums will vary plan to plan and can also change by location. In order to qualify for Medicare Part D, you will also need to enroll in a Medicare-approved plan.  That being said, all plans come with a standard amount of coverage set by Medicare.  

If you’re moving to another state, you might be able to buy a similar or even the same plan type that you currently have in the new state.  However, the premiums you pay may be different.  As for your original medicare benefits, they will remain the same no matter where you are or where you move to. 

 There are so many details and difficulties to enrolling, navigating the system, and keeping up with what plan will be right for you.  Opportunities to save money may go amiss, and certain coverage needs may be overlooked.  Don’t go it alone.  Get a quote and talk to an insurance specialist today.  

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Disclaimers: Outside of the Medicare Annual Enrollment Period, members can enroll in a plan only if they meet certain criteria. A licensed insurance agent can help you determine whether you are eligible. Plan availability varies by region and state. Callers will be directed to a licensed insurance agent with a third-party partner of MedicareGap.org who can provide more information about Medicare Advantage plans offered by one or several Medicare-contracted carrier(s). Enrollment in any plan depends on contract renewal. Medicare has neither reviewed nor endorsed the information contained in this advertisement. Not connected with, or endorsed by, the U.S. government or the federal Medicare program. This information is not a complete description of benefits. For a complete listing of Medicare plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, or consult www.medicare.gov.