MARKETPLACE FAQ

The comprehensive health care reform law enacted in March 2010 (also known as “Obamacare”) that prevents health insurers from denying individuals with pre-existing conditions. ACA also provides qualifying consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.

Deductible: The amount you pay for your health care services before your health plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay a smaller copayment or coinsurance for covered services, and your insurance company pays the rest. All Marketplace health plans pay the full cost of certain preventive benefits even before you meet your deductible. Some plans have separate deductibles for certain services, like prescription drugs. Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles. Copay: A fixed amount ($15, for example) you pay for a covered health care service. In most cases, copays apply only after you’ve paid your deductible. Though in some cases, they are applied immediately. Example: Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor’s visit is $15. If you’ve paid your deductible: You pay $15, usually at the time of the visit.If you haven’t met your deductible: You pay $100, the full allowable amount for the visit. Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Generally, plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments. Coinsurance : Instead of paying a fixed amount up front (a co-pay), the co-insurance is a percentage of the total cost you may be required to pay. For example, you might have to pay 20% of the cost of a surgery over and above a deductible, while the insurance company pays the other 80%.

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Marketplace, cost-sharing reductions are also called “extra savings.” If you qualify, you should enroll in a plan in the Silver category to get the most savings.

The 2024 federal poverty level (FPL) income numbers below are used to calculate eligibility for Medicaid and the Children's Health Insurance Program (CHIP) $15,060 for individuals $20,440 for a family of 2 $25,820 for a family of 3 $31,200 for a family of 4 $36,580 for a family of 5 $41,960 for a family of 6 $47,340 for a family of 7 $52,720 for a family of 8 "Income" above refers to "modified adjusted gross income" (MAGI). For most people, it's the same or very similar to "adjusted gross income" (AGI). MAGI isn't a number on your tax return.

We’re here to help – shop and enroll now! During the annual Open Enrollment Period from November 1st – December 15th, almost all Americans can enroll in health insurance through the Federal Marketplace. If you enroll by December 15th, your coverage will begin January 1st. Outside of the Open Enrollment Period, you can only enroll if you have a Qualifying Life Event, such as losing your job, losing your health insurance, adopting a baby, or getting married.

A tax credit provided by the IRS that you can take in advance of filing your taxes for the current tax year to lower your monthly health insurance payment (your premium). If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you’ll have to pay back the excess when you file your federal tax return. If you’ve taken less than you qualify for, you’ll get the difference back. Am I eligible? You may be eligible of APTC if: • You have an annual household income between 100 and 400 percent of the Federal Poverty Line • You are not claimed as a dependent by another person • You are enrolled in coverage (excluding Catastrophic coverage) through a health Exchange • Your employer does not offer insurance that costs less than 9.5 percent of your income and pays at least 60 percent of covered benefits. • You are not eligible for coverage through a government program like Medicaid, Medicare, or CHIP • You do not file a Married Filing Separately tax return

Medicare is the federal health insurance program for: - People who are 65 or older - Certain younger people with disabilities - People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

The different parts of Medicare help cover specific services: Medicare Part A (Hospital Insurance) Medicare Part B (Medical Insurance) Medicare Part D (prescription drug coverage) These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Learn more about your options in this video.

When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D). There are specific times when you can sign up for these plans, or make changes to coverage you already have. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans. ​ ENROLLMENT PERIODS ​ When you first get Medicare (Initial Enrollment Periods for Part C & Part D) You are eligible to enroll for Medicare at age 65. Your Initial Enrollment Period (IEP) is 7 months long. It includes the month you turn 65, the 3 months before, and the 3 months after. It begins and ends a month earlier if your birthday is the 1st day of the month. ​ During certain times each year (yearly enrollment periods for Part C & Part D) Each year, you can make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year: Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. January 1-March 31 Medicare Advantage Open Enrollment Period. October 15-December 7 Special Circumstances (Special Enrollment Period) You moved into a different service area You lose your current coverage You have Medicaid or Extra Help You have a chronic health condition You're enrolling into a 5 star plan You have a chance to get other coverage Your plan changes its contract with Medicare Other special circumstances

Medicare coverage is based on 3 main factors 1. Federal and state laws. 2. National coverage decisions made by Medicare about whether something is covered. 3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

In general, Part A (hospital insurance) covers: Inpatient care in a hospital Skilled nursing facility care Inpatient care in a skilled nursing facility (not custodial or long-term care) Hospice care Home health care

2 ways to find out if Medicare covers what you need Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that's usually covered but your provider thinks that Medicare won't cover it in your situation. If so, you'll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply. Find out if Medicare covers your item, service, or supply.

Part A Benefits Breakdown Inpatient hospital care $1,632 deductible for each benefit period No coinsurance for days 1 to 60 $408 daily coinsurance for days 61 to 90 $816 daily coinsurance for 60 lifetime reserve days Skilled nursing facility (SNF) care No deductible for each benefit period No coinsurance for days 1 to 20 $204 daily coinsurance for days 21 to 100 Home health care No deductible or coinsurance Hospice care No deductible Small copayment for outpatient drugs and inpatient respite care

Medicare Part A is free if you: ​ Have at least 40 calendar quarters of work in any job where you paid Social Security taxes in the U.S. Are eligible for Railroad Retirement benefits Or, have a spouse that qualifies for premium-free Part A You may also be eligible for premium-free Part A if you were a federal employee anytime after December 31, 1982, or a state or local employee anytime after March 31, 1986. If you do not meet the criteria above, you will likely pay a monthly premium for Part A. Your monthly Part A premium will depend on how many years you or your spouse worked in any job at which you paid Social Security taxes in the U.S. ​ In 2024, your monthly Part A premium will be: ​ $0: If you or your spouse worked for 40 quarters (10 years) or more or you were a federal employee on January 1, 1983, or a state or local employee anytime after March 31, 1986. $278: If you or your spouse worked between 30 and 39 quarters (7.5 and 10 years) $505: If you or your spouse worked fewer than 30 quarters (7.5 years) If your income is low, you may be eligible for the Qualified Medicare Beneficiary (QMB) program, which pays for your Medicare Part A and B premiums and other Medicare costs.

2 ways to find out if Medicare covers what you need 1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that's usually covered but your provider thinks that Medicare won't cover it in your situation. If so, you'll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply. 2. Find out if Medicare covers your item, service, or supply.

Part B Premium for 2024 starts at $174.70. Read more here.

Medicare coverage is based on 3 main factors 1. Federal and state laws. 2. National coverage decisions made by Medicare about whether something is covered. 3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Part B covers 2 types of services Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts Assignment. ​ Part B covers things like: Clinical research Ambulance services Durable medical equipment (DME) Mental health Inpatient Outpatient Partial hospitalization Getting a second opinion before surgery Limited outpatient prescription drugs

Part C Premium The Part C monthly premium varies by plan.

Part B Premium Some people automatically get Medicare Part B (Medical Insurance), and some people need to sign up for Part B. Learn how and when you can sign up for Part B. ​ If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty. ​ The standard Part B premium amount in 2024 is $174.70. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

You usually don't pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called "premium-free Part A." Most people get premium-free Part A. You can get premium-free Part A at 65 if: You already get retirement benefits from Social Security or the Railroad Retirement Board. You're eligible to get Social Security or Railroad benefits but haven't filed for them yet. You or your spouse had Medicare-covered government employment. If you're under 65, you can get premium-free Part A if: You got Social Security or Railroad Retirement Board disability benefits for 24 months. You have End-Stage Renal Disease (ESRD) and meet certain requirements.

Part A premiums ​ If you don't qualify for premium-free Part A, you can buy Part A. ​ If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $505. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278. ​ In most cases, if you choose to buy Part A, you must also: Have Medicare Part B (Medical Insurance) Pay monthly premiums for both Part A and Part B ​ Contact Social Security for more information about the Part A premium.

Part D Premium The Part D monthly premium varies by plan (higher-income consumers may pay more). If you don't sign up for Part D when you're first eligible, you may have to pay a late enrollment penalty.

Countable resources include: Money in a checking or savings account Stocks Bonds Countable resources don't include: Your home One car Burial plot Up to $1,500 for burial expenses if you have put that money aside Furniture Other household and personal items

You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions. ​ There are 4 Medicare Savings Programs; Qualified Medicare Beneficiary Specified Low Income Beneficiary Qualifying Individual Program Qualified Disabled and Working Individuals

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Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

Extra Help Benefits ​ The Extra Help program offers the following benefits: -Pays for your Part D premium up to a state-specific benchmark amount -Lowers the cost of your prescription drugs - Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans (You cannot use the Extra Help SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.) - Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment ​ Depending on your income and assets, you may qualify for either full or partial Extra Help. Both programs provide assistance with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network. ​ Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

Extra Help Eligibility Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted, in addition to the $20 mentioned above. ​ If your yearly income is up to $22,590 ($30,660 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart below). These limits include a $20 income disregard that the Social Security Administration (SSA) automatically subtracts from your monthly unearned income (e.g., retirement income). If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.

Making an Extra Help decision when you have other forms of prescription drug coverage If you are eligible for Extra Help and already have other creditable drug coverage, you should evaluate your costs and coverage when deciding whether to enroll in Part D and Extra Help or to keep your current drug coverage. Be sure to ask your former employer or union if you can get a Part D plan without losing the retiree benefits you want to keep, and check if disenrolling from retiree drug coverage makes you ineligible for other retiree health benefits. If you cannot have Part D and your retiree benefits, or if keeping both is not cost-effective, think carefully about whether you should get a Part D plan, especially if your retiree plan also covers your spouse or dependents. If you later want Part D, you will have a two-month SEP after you lose creditable coverage. ​ Finally, those with Medicaid and certain kinds of employer, union, or retiree drug coverage may in some cases not be enrolled in Extra Help or can ask not to be. Contact your local Medicaid office to learn how to decline Part D without losing your Medicaid coverage. If you later want Part D, you can enroll at any time without penalty if you are still enrolled in Medicaid or eligible for Extra Help.

If you’re currently enrolled in Original Medicare, Part A and Part B, you’ll know that there can be gaps in your coverage that you must pay out of pocket. Copayments, coinsurance, and deductibles are expenses that you are responsible for paying. ​ That’s where Medicare Supplement insurance comes in. Also known as Medigap, Medicare Supplement insurance plans work alongside your Original Medicare coverage to help fill in some of those coverage gaps. These plans may pay for certain costs that Original Medicare doesn’t cover, including cost sharing and benefits like emergency overseas health coverage and Medicare Part B excess charges (the 15% extra amount that non-participating providers may charge you over what Medicare will pay for a covered service). ​ When it comes to Medicare Supplement insurance, the timing of your enrollment can greatly determine the options available to you and how easy it is for you to find coverage. It can also affect how much you pay for coverage and whether insurance companies can charge you more or deny you coverage altogether based on pre-existing conditions. Read on to learn more about how enrollment works and the best time to enroll in a Medigap plan.

A closer look at the standardized plans: Medicare Supplement Plan A: A bare-bones Medigap plan that covers the basics. ​ Medicare Supplement Plan B: This plan is the same as Plan A except it covers the Medicare Part A deductible. ​ Medicare Supplement Plan C: A very comprehensive plan that covers almost all the same bases as Plan F, except any excess costs that arise after the Medicare Part B deductible. In other words, your deductible is covered, but anything above that you must pay out of pocket. ​ Medicare Supplement Plan D: Almost identical to Plan C, but you must pay both the Medicare Part B deductible and any excess costs beyond that. ​ Medicare Supplement Plan G: A popular plan because it covers almost all the expenses left over from Medicare Part A or Part B, but it does not cover the Part B deductible. This is the sole difference between Medigap Plans G and F when looking over the Medicare Supplement plans comparison chart. ​ Medicare Supplement Plan F: As discussed above, Plan F is popular because it leaves no gap – or, covers 100 percent of the costs – after the benefits from Medicare Parts A and B have reached their limit. For example, Medicare Plan F helps with Part B excess charges, hospital costs, Part B coinsurance, skilled nursing facility costs, nursing facility care, hospice care coinsurance and more. It also covers the Medicare Part B deductible, which sets it apart from the other most popular plans. Like Plans C, D, G, M, and N, Plan F covers some of the expenses incurred if you have a foreign travel emergency. ​ Medicare Supplement Plans K, L, M: Typically, these plans are lumped together for two reasons. One, they’re similar, and two, they’re not very popular. None of these plans covers either the Medicare Part A or Part B deductible, and only cover a percentage of the other costs. ​ Medicare Supplement Plan N: Although Plan N offers lower premium rates than Plans G and F, it does require you to cover the Part B deductible, as well as your co-pays for your doctor and emergency room visits. ​ While viewing the Medicare Supplement plan comparison chart, it’s important to note some changes that are on the horizon. In 2020, federal regulations will stop allowing Medigap plans to cover the Medicare Part B deductible, thereby precluding any new Medicare beneficiaries from enrolling in Plan F or Plan C. It’s predicted that, as a result, Plan G will be a much more popular choice among the 10 plans in 2020. ​ How to Enroll in a Medicare Supplement Plan Now that you’ve reviewed the Medicare Supplement plan comparison chart and decided on which plan offers you the most cost-effective and comprehensive coverage, we can help you begin the process of enrollment. ​ Naturally, that starts with how much it’s going to cost you. Rates vary depending on a number of factors, including where you live and your specific health insurance company, but we can help you find out what’s offered in Florida. We can also help you compare rates from company to company. ​ To address your questions and concerns about the Medicare Supplement plan comparison chart or Medicare Supplement insurance in general, call our licensed insurance professionals today.

You’re generally eligible for Medigap coverage if you’re enrolled in Original Medicare, Part A and Part B. ​ If you are under 65 and have Medicare, you may not be able to enroll in Medicare Supplement insurance; federal law doesn’t require states to offer Medigap coverage to beneficiaries under 65. However, some states do offer certain Medigap plans to beneficiaries under 65 with disabilities or certain conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease). Your eligibility and Medigap options will depend on your specific state, so contact your state’s insurance department to learn whether you qualify for Medicare Supplement insurance coverage.

Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.

As mentioned, the timing of your enrollment may affect your coverage choices and costs. In general, the best time to enroll in a Medicare Supplement insurance plan is during your Medigap Open Enrollment Period. This is the six-month period that starts on first day of the month that you are both 65 or older and enrolled in Medicare Part B. Throughout this period, you can enroll in any Medigap plan offered in your service area with guaranteed issue. This means that insurance companies aren’t allowed to use your medical history or pre-existing conditions as the basis for charging you more for coverage or denying you altogether. If you have medical issues or disabilities, it’s especially important to take advantage of this period: Your Medigap Open Enrollment Period may be one of the few times that you have a guaranteed right to enroll in any Medicare Supplement insurance plan in your area. ​ Once your Medigap Open Enrollment Period passes, you may not be able to enroll in a Medicare Supplement insurance plan as easily if you’re doing so for the first time. If you’re already enrolled in a Medigap plan, you may not be able to switch plans with guaranteed issue (except in certain situations). Without guaranteed-issue rights, you may be subject to medical underwriting and charged higher premiums based on your health status. Insurance companies can also deny you coverage if you have health problems. It’s usually more difficult to find Medicare Supplement insurance coverage after your Medigap Open Enrollment Period has passed if you have disabilities or pre-existing conditions; even if you can find a Medigap plan that will accept you, your premium costs may be higher.

There are some situations when you may still be able to enroll in a Medicare Supplement insurance plan with guaranteed issue. Those situations may include, but aren’t limited to: - Your Medigap insurance company goes bankrupt or misled you. - Your Medigap coverage ends through no fault of your own. - You’re enrolled in Original Medicare and an employer-sponsored group plan, and your employer coverage is ending. - You’re enrolled in a Medicare SELECT plan (a type of Medigap plan that uses provider networks), and you move out of your plan’s service area. - You’re enrolled in a Medicare Advantage plan and move out of the plan’s service area, or your Medicare Advantage plan leaves the Medicare program. - You enrolled in a Medicare Advantage plan at age 65 when you were first eligible for Medicare Part A, but changed your mind within the first year and want to return to Original Medicare. - You dropped your Medigap plan to enroll in a Medicare Advantage plan for the first time, but changed your mind within the first year and want to return to Original Medicare. ​ This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

Medicare Advantage plans may limit your freedom of choice in health care providers With the federally administered Medicare program, you can generally go to any doctor or facility that accepts Medicare and receive the same level of Medicare benefits for covered services. In contrast, Medicare Advantage plans are more restricted in terms of their provider networks. If you go out of network, your plan may not cover your medical costs, or your costs may not apply to your out of pocket maximum. ​ Medicare Advantage plans’ coverage for some services and procedures may require doctor’s referral and plan authorizations. ​ Medicare Advantage plans try to prevent the misuse or overuse of health care through various means. This might include prior authorization for hospital stays, home health care, medical equipment, and certain complicated procedures. Medicare Advantage plans often also require your primary care doctor’s referral to see specialists before they will pay for services. Medicare Advantage plans have specific service areas. ​ Most Medicare Advantage plans have regional (rather than nationwide) networks of participating providers. To enroll, you must reside in the Medicare Advantage plan’s service area at least 6 months of the year. If you divide your time between homes located in different areas, this requirement may be difficult to meet. ​ The bottom line is that Medicare Advantage plans may provide more affordable coverage than you would receive otherwise. The trade-off is that you have to follow the Medicare Advantage plan’s rules to receive payment for covered services. ​ Do you have other questions about Medicare Advantage? Contact us and speak with a licensed insurance agent about finding Medicare Advantage plans in your area and your Medicare coverage options. OUR SERVICES ARE COMPLETELY FREE

Pros of Medicare Advantage Plans ​ Medicare Advantage plans often provide more benefits than you would receive under Original Medicare. ​ Medicare Advantage plans must offer at least the same level of coverage as Medicare Part A and Part B and many plans offer added benefits. These may include coverage for routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership. Medicare Advantage plans may cost you less. ​ If you enroll in a Medicare Advantage plan, you continue to pay your Medicare Part B premium and you may pay an additional premium. The insurer determines the Medicare Advantage plan’s premium, which can vary from one Medicare Advantage plan to another. Some Medicare Advantage plans may have premiums as low as $0. ​ Your cost sharing may also be less under Medicare Advantage. For, example, if you visit a primary care physician under Medicare Advantage, you may pay a copayment of $0. However, if you visit a primary care physician under Original Medicare, you may have a coinsurance of 20%, which could be more than $10. ​ Also, a Medicare Advantage plan limits your maximum out-of-pocket expense. Once you have spent that maximum, you pay nothing for covered medical services for the remainder of the year. Original Medicare does not provide a maximum out-of-pocket cap, so your potential expenses are limitless. Often a Medicare Advantage plan can be less expensive than comparable coverage you would receive if you stayed with Original Medicare. To get all the benefits of Medicare Advantage with Original Medicare, you would also need to enroll in a stand-alone Medicare Part D Prescription Drug Plan as well as a Medicare Supplement plan. ​ Medicare Advantage plans coordinate care among your health care providers. Typically Medicare Advantage plans are managed care and have networks of contracted health care providers. Example would be Health Maintenance Organization (HMO) Medicare Advantage plans. These HMO plans require you to select a Primary Care Physician (PCP) who helps to coordinate your care. ​ Medicare Advantage plans that include prescription drug coverage may also have medication therapy management. This care coordination can be a convenience and a valuable aid to your health. Medicare Advantage plans can serve as your “one-stop” center for all your health and prescription drug coverage needs. ​ Most Medicare Advantage plans combine medical and Part D prescription drug coverage. Many also coordinate the delivery of added benefits, such as vision, dental, and hearing care. You may prefer the convenience of working with one plan administrator.

Medicare Advantage, also known as Medicare Part C, makes it possible for people with Medicare Part A (hospital insurance) and Part B (medical insurance) to receive their Medicare benefits in an alternative way. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and provide at least the same level of coverage that Medicare Part A and Part B provide. You may be wondering which is the better choice: sign up for a Medicare Advantage plan or Original Medicare. There isn’t a simple answer because Medicare Advantage plans have key features that many people find attractive and other characteristics that may not match with your personal preferences and/or lifestyle.

Part B LEP ​ If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage. Note: Although your Part B premium amount is based on your income, your penalty is calculated based on the base of Part B premium. Part D LEP ​ The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these: A Medicare Prescription Drug Plan (Part D) A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage Creditable prescription drug coverage ​ The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($34.70 in 2024) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may change each year, so your penalty amount may also change each year.

PART B IRMAA ​ The standard Part B premium amount in 2024 is $174.70. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

PART D IRMAA ​ Most people only pay their Part D premium. If you don't sign up for Part D when you're first eligible, you may have to pay a Part D late enrollment penalty. ​ If your modified adjusted gross income is above a certain amount, you may pay a Part D income-related monthly adjustment amount (Part D IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS). You'll pay the Part D IRMAA amount in addition to your monthly plan premium, and this extra amount is paid directly to Medicare, not to your plan. The chart below lists the extra amount costs by income. Social Security will contact you if you have to pay Part D IRMAA, based on your income. The amount you pay can change each year

Some Medicare beneficiaries may be responsible for extra premiums or fees aside from their Medicare Part B premium due to an IRMAA (Income Related Monthly Adjustment Amound) or an LEP (Late Enrollment Penalty).