How does Medicare work in California?

woman wondering how does Medicare work

How does Medicare work?

You don't automatically get Medicare when you become eligible. You must sign up. You can enroll in Medicare during the initial enrollment period that begins three months before the month you turn 65 and ends three months after the month you turn 65.

To apply, call or visit your local Social Security office, or call Social Security at 1-800-722-1213, 7 a.m. to 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.

If you have health insurance through your employer or your spouse’s employer, look at your options before signing up for Part B. Be aware that Part B has a monthly premium.

Ask your broker, human resources representative, or benefits administrator for help with choosing the right option for you.

Cost of Original Medicare

Part A (inpatient hospital, skilled nursing facility, limited home health and hospice care)

Most people don’t need to pay monthly premiums for Part A. You won't pay a premium if you or your spouse paid Medicare taxes for at least 10 years while working.

However, you will need to help cover the cost of some fees when you receive care. These expenses come in the form of deductibles and copayments.

2019 Medicare Part A Deductible and Coinsurance Amounts1
(inpatient hospital bill service and skilled nursing facility plan benefits table)

Service Deductible Coinsurance
Hospital Visit
$1,364 per stay up to 60 days in a benefit period $341 each day (per stay) for days 61 through 90 in a benefit period. $682 coinsurance per each "lifetime reserve day" (per stay) for days 91 through 150 in a benefit period.2 you pay all costs for each day after the lifetime reserve days.
Nursing Facility
- $0 for the first 20 days in a benefit period. $170.50 each day for days 21 through 100 in a benefit period. You pay all costs beyond the 100th day in a benefit period.
1 2019 amounts may change for 2020.
2 Days 91 through 150 are considered Lifetime Reserve days, which can only be used once during your lifetime.

Part B (doctor's services and outpatient hospital services)

Voluntary Medicare Part B has a monthly premium. In 2019, most people pay $135.50 each month. Some people pay a higher premium, depending on their income.

Part B has a $185 deductible in 2019. After you meet the deductible, you will pay a coinsurance for many services. Generally, you will pay 20% of the amount approved by Medicare for the service.

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