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Medicare in Cincinnati, OH: Coverage & Cost




As you are approaching the age of 65, you are probably getting overwhelmed with the amount of mail, phone calls and emails pertaining to Medicare. One of the first things you should consider is getting help from a local Cincinnati medicare insurance agency.


At Wilson Insurance Group, we have 25+ years of experience helping individuals with Medicare both here in the Cincinnati area and nationally. Now, we want to share our expertise with you.


There are many benefits to Medicare, such as four different “parts” to it. Read more to find out all the great things about Medicare.


Medicare Part A


Medicare Part A is often called hospital insurance. True to the nickname, Medicare Part A deals with associated hospital services. More specifically, it covers:

  • Skilled nursing care facilities

  • Hospital visits

  • Hospice

  • Home health services

  • Care at nursing homes (assuming that you need more than custodial care)

How Much Does Medicare Part A Cost?


Good news! If you or your spouse paid Medicare taxes for at least 40 quarters (10 years), then Medicare Part A is completely free! If you and your spouse did not pay into Medicare taxes, then the rate in 2020 is about $458 per month.


You can expect to pay more money if you get certain types of care, such as requiring skilled nursing or even going to the hospital. Look below to find more specific information:

  • Each benefit period has a deductible of $1,408.

  • Days 1 – 60: $0 coinsurance pay.

  • Days 61 – 90: $352 coinsurance pay per day for each benefit period

  • Day 91 and beyond: $704 coinsurance per every “lifetime reserve day” that is after day 90 for each benefit period. This can be anywhere up to 60 days over your lifetime.

  • If you are out of “lifetime reserve days,” then you have to pay the full cost.

Medicare Part B


Medicare Part B is sometimes called medical insurance or doctor insurance.



A partial list of what is covered by Part B can be found below:

  • Outpatient doctor visits

  • Outpatient medical and surgical services and supplies

  • Home health services

  • Durable medical equipment

  • Other medical services

Click here to view a more detailed list of what Medicare Part B covers.


How Much Does Medicare Part B Cost?


Medicare Part B has a standard annual deductible. In 2020, the deductible is $198. It also has a monthly premium -- similar to life insurance -- of about $144.60. However, depending on your income, you may be subject to a higher premium. You can view this chart to find out if you will have a surcharge. Please note: The Part B premium is based on your income from two years prior. As an example, if you elect Part B coverage in 2020, then your premium will be based on your 2018 income. Then, when you get to 2021, your premium would be based on your 2019 income (and so on).


Next, let’s talk about the Part B deductible. After your deductible is met, Medicare pays for 80% of the cost of services. Know that while you are paying the additional 20%, there is no cap to that 20%. Keep reading to learn how Wilson Insurance Group can set up a Medicare Supplement plan to offset this exposure!


Medicare Part C


Medicare Part C is better known as “Medicare Advantage,” or “MA.” These are plans that are approved by private health insurance companies, like Aetna, Humana, United Healthcare, and Anthem.



MA plans provide the same basic coverage as Part A and Part B while featuring extra perks. Some perks include vision, dental, and fitness memberships. Many MA plans, called Medicare Advantage Prescription Drug plans (MAPDs) include coverage for prescriptions. Please note that Medicare Advantage plans have networks. In some cases, like HMO’s, you will have to use network providers for medical services to be covered (aside from emergency situations).


How Much Does Medicare Part C Cost?


This all depends on a number of different factors based on what is important to you. Medicare Advantage plans can range from $0/month to over $100/month.


In general, Medicare Advantage plans include:

  • Monthly premiums

  • Copays and/or coinsurance

  • Annual deductibles

  • Out-of-pocket maximum

  • Networks for coverage (HMO’s and PPO’s)

Please note that during the annual enrollment period (October 15th - December 7th), insurance companies can make changes to their MA plans, which would mean costs and benefits can change.


Medicare Supplements (Also Known As Medigap)


One of the most important decisions regarding Medicare coverage is choosing a Medicare Supplement plan to cover gaps in Medicare A & B coverage. Please note that you cannot have both Medicare Part C and a Medicare Supplement plan. These supplements are sold by private insurance companies such as Aetna, Anthem, Humana, Medical Mutual and United Healthcare.


Three important reasons you should consider a Medicare Supplement Plan:

  1. Medicare Supplement plans do not have networks. If a hospital or doctor accepts original Medicare A & B, they have to accept your Medicare Supplement plan too! Medicare Supplement plans “follow” Medicare itself. Therefore, you are not restricted to a network of providers!

  2. As mentioned earlier, Medicare Part A coverage has a $1,408 deductible per benefit period. Rather than paying this deductible, a Medicare Supplement plan can fully cover the $1,408 amount.

  3. After meeting the $198 calendar year deductible, Medicare Part B coverage has a 20% co-insurance exposure with no cap. A Medicare Supplement plan be designed to completely eliminate this unlimited 20% exposure. For example, let’s say you have a Medicare approved surgery cost of $20,000. Medicare Part B will pay 80%, which is $16,000. You are responsible for the remaining 20%, which is $4,000 in this case. A Medicare Supplement plan can be designed to fully cover the above mentioned $4,000 exposure.

Medicare Supplement carriers are required to sell “standardized” policies. This means the plan designs are the same from carrier to carrier. Therefore, your choice really comes down to the quality of the carrier and the price of the plan.


Lastly, Medicare Supplements do not offer Part D prescription benefits. If you choose to buy a Medicare Supplement, you should also enroll in a Part D prescription drug plan to cover prescriptions.


How Much Do Medicare Supplements Cost?


Generally speaking, at age 65 a Medicare Supplement plan will be about $115/month for females and $125/month for males in the tri-state area. However, each plan varies on a number of factors. The costs and benefits can also change from year to year. These changes are not tied to Medicare’s open enrollment, unlike plans through Medicare Advantage. Instead, these changes are unique to your insurance company and your specific plan.


If you choose to buy a supplement, both the chosen supplement and Medicare work together. This allows Medicare to pay what it can, and then the rest of the bill is sent to your supplemental coverage. Your supplement pays for the remainder of the bill, as long as the services and procedures are qualified.


Be aware – you must be enrolled in Part A and Part B to qualify for a Medicare Supplement.


Medicare Part D


Medicare Part D is a prescription drug plan (PDP). If you have Part A, Part B or both, then you are entitled to have Part D. Similar to Medicare Advantage plans, Part D plans are offered through private insurance companies.



Many Medicare Advantage plans offer Part D coverage and are referred to as MAPDs. Medicare supplements do not include prescription coverage; therefore, if you are part of a supplement program, you would need to purchase Part D separately.


How Much Does Medicare Part D Cost?


Part D premiums usually cost anywhere from $20-$80/month.

In general, Part D plans include the following:

  • Monthly premiums

  • Annual deductible

  • Prescription drug formulary (list of prescription drugs covered by your plan)

  • Coverage phases

  • the initial coverage phase

  • the coverage gap also called the “donut hole” phase

  • the catastrophic coverage gap phase


Costs will change based upon the medications you use. Just like the Medicare Advantage plans and the Supplement plans, insurers can change the costs and benefits to their prescription drug plans.

If your income is above $87,000 per individual or $174,000 per married couple who are filing jointly, you will pay a Part D surcharge. This surcharge is on top of the monthly premium.


Potential Issues with Medicare


Make sure you sign up for Medicare within your initial enrollment period, which goes from three months before you turn 65 to three months after. If you don’t enroll during this time, you can sign up between January 1 and March 31 of the next year… but you won’t be covered until July 1.


Also, make sure that you understand how your job’s insurance interacts with Medicare. Some job-based plans dedicate Medicare as your primary insurance when you turn 65. However, if your job-based insurance is primary, then sign up for Medicare for it to become secondary. If you are not sure whether your job-based insurance is primary or secondary, contact your human resources department or call 1-800-MEDICARE.


Medicare Cincinnati: Get Local Help


We understand the Medicare decision making process can be confusing for people. You are not alone! There is a lot of information about Medicare. At Wilson Insurance Group, we are happy to help you sign up for the correct insurance that is uniquely for you. Then, you can sit back and relax, knowing you’re in good shape. Please call us at (513) 984-5991. You can also find us online by clicking on this link.


We are also happy to help you in person. Our address is 9200 Montgomery Rd. 19A, Cincinnati, OH 45242. Whether you want to chat on the phone, through the web or in-person, we are confident we’ll be able to help you!