Obtaining Medicare coverage may sound simple, but there are many plans and providers to choose from. To make matters more complicated, Medicare plans include different parts of the Medicare program that cover different things, and this can sometimes make it difficult for seniors with complex health issues to find exactly what they need.

On top of all of this, you want to get the most coverage for the price out of your Medicare plan, including any premiums you will pay each month and any deductibles you will need to meet. Many Medicare plans also include the need to pay coinsurance or copayments when visiting certain medical providers for certain healthcare items. While the Medicare program standardizes some of these costs, others can vary from plan to plan.

The Downsides of Shopping on Your Own

In order to alleviate the above concerns, you’re encouraged to shop around to look for the right plan at the right price. Doing this, however, can be time-consuming, and you never really know if you’re getting the best deal.

After all, an insurance agent who is employed by a provider is being paid to sell a particular product, so it only makes sense that each provider-specific representative is going to point you in the direction of the products they sell. This may result in you getting a plan that meets your needs, but it may also cause you to miss some other plans on the market that may be right for you. 

How Can Medicare Insurance Agents Help Me Find a Plan?

To avoid the hassles detailed above while also getting the benefit of shopping around for the right plan at the right price, many seniors choose to partner with Almond Insurance advisors instead. We are licensed independent advisors providing many of the same services as a traditional Medicare insurance agent, but with some key differences.

Joe and Serenity Almond are not employed by any one provider, so they are able to impartially shop plans from a range of providers. This results in unbiased information that can help you choose the plan that meets your needs. 

Additionally, Joe and Serenity Almond of Almond Insurance offer specific information about insurance regulations in your area that may pertain directly to your situation. This can be helpful when trying to plan out your Medicare strategy, and it can help you avoid making common Medicare mistakes.

A Single Point of Contact

Many seniors also find that having a single point of contact for all their Medicare needs is an advantage. When you shop for plans on your own, you may find yourself overwhelmed and left with questions. 

Joe and Serenity Almond of Almond Insurance provide a more personalized experience, meaning you are more likely to get the answers you need faster and with fewer hassles. Whether you’re changing a plan during Medicare’s Open Enrollment Period, or you simply want to know about coverage for a particular healthcare item, Joe and Serenity Almond of Almond Insurance get you the answers you need.

Medicare is a federal health insurance program for:

• People age 65 or older;

• People with certain disabilities; or

• People with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant.)

Medicare has four parts:

MEDICARE PART A

(Hospital Insurance)

Helps cover inpatient care in a hospital or skilled nursing facility (following a hospital stay), home health care services, and hospice care services. Co-payments, coinsurance, and deductibles may apply for each service. You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.

MEDICARE PART B

(Medical Insurance)

Helps cover doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Copayments, coinsurance, and deductibles may apply for each service. You can find out if you have Part B by looking at your Medicare card. You pay the Part B premium each month. Part A and Part B are often referred to as “Original Medicare”.

MEDICARE PART C

(Medicare Advantage)

A health coverage option run by private insurance companies approved by and under contract with Medicare. Includes Part A, Part B, and, usually, other coverage like prescription drugs. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. In addition to your Part B premium, you usually pay one monthly premium for the services provided.

MEDICARE PART D

(Medicare Prescription Drug Coverage)

A prescription drug option run by private companies approved by and under contract with Medicare. Helps cover the cost of prescription drugs, may help lower your prescription drug costs and help protect against higher costs in the future. Part D is available to everyone with Medicare.

If you are soon to be one of the 62.6 million people in the U.S. who are enrolled in Medicare, you might be wondering what it’s all about. Medicare is run by the federal government and provides health insurance benefits for people 65 and older, and for younger people who are living with certain disabilities and illnesses. 

There are four different parts of Medicare – A, B, C, and D – which cover different aspects of health care. Each of the four parts helps beneficiaries cover some medical expenses, but they don’t pay for everything. Choosing which parts of Medicare you should sign up for depends on your health care needs and your budget, but they can be confusing. Here’s a quick look at what the differences are between Medicare Part A, Part B, Part C, and Part D.

Original Medicare benefits

Original Medicare includes Part A which is inpatient hospital insurance, and Part B which is outpatient medical insurance. If you have Original Medicare and want prescription drug coverage, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan.

Medicare Part A is premium-free for most recipients and covers your health care services while you are an inpatient in a hospital, skilled nursing care facility, or hospice facility that accepts Medicare assignment. These services can include a semi-private room, general nursing care, meals, medications, and others. Part A also covers some home health care services. 

For Medicare Part A to begin covering its share of covered health care expenses, you are responsible for paying a deductible of $1556.00 (in 2022). This deductible amount covers a benefit period that begins at the start of your inpatient stay and ends after you have been out of the hospital for at least 60 days. 

Part A also has coinsurance, the amount of which is increases with the number of days you are in the hospital. For example, there is $0 coinsurance for days 0 through 60. Days 61 through 90 carry a $389.00 (2022) coinsurance charge per day, and so on.  

Medicare Part B is the other half of Original Medicare. Part B covers medically necessary health care services and preventive care services. 

Original Medicare Part B covers visits to any physician or specialist in the country, but only if they accept Medicare assignment. This is one of the differences between Original Medicare and Medicare Advantage which is explained in more detail below. 

Medicare Part B typically pays 80 percent of the final approved cost for covered services and supplies. You pay the remaining 20 percent of the cost after you cover your annual Part B deductible.

Medicare Part D prescription drug coverage

If you are enrolled in Original Medicare, you can also purchase a stand-alone prescription drug plan. These Part D plans are sold by private insurance companies that are Medicare-affiliated. Each plan has its own list of drugs that it covers, its own copayment charges, deductibles, and monthly premiums. Alternatively, you can choose to enroll in a Medicare Advantage plan that includes prescription drug coverage.

Medicare Advantage or Medicare Part C

Shortly after the Medicare program began in the United States, private-sector health insurers began offering Medicare Advantage (Part C) plans as an alternative to Original Medicare Parts A and B. These private insurance providers are required by the federal government to provide all the same benefits that Medicare Parts A and B cover. But the providers also have the option to include additional benefits. 

Today, many Medicare Advantage plans include prescription drug coverage as part of their core coverage. Many providers also give beneficiaries extra benefits such as routine dental, vision, and hearing care, as well as bonus perks like fitness club memberships. 

If you enroll in a Medicare Part C plan you typically pay a monthly premium to your private provider, in addition to your Medicare Part B premium. While there is no out-of-pocket spending limit with Original Medicare, Medicare Part C plans typically have an annual spending limit for covered Medicare expenses. 

Another difference is that Medicare Advantage plans generally require that beneficiaries use health care providers, medical suppliers, and medical facilities that are in a specific network of providers that the plan provider sets. Depending on the plan you choose, you may be able to go out of network for a higher cost.

In the United States, the full retirement age was 65 for many years, and this is probably why most people associate the age of 65 with retirement. However, in 1983 the U.S. Congress raised the age for full retirement, affecting people who had been born as early as 1938. Now, the full retirement age increases gradually by a few months for every birth year, making the oldest age for retirement 67 for those who were born in 1960 and later. 

Also associated with 65, is the age for Medicare benefits. Medicare is health care insurance that is funded by the U.S. federal government. It’s healthcare for retirees who are 65 and meet certain requirements, as well as for younger people who have certain qualifying disabilities. The eligibility criteria for Medicare enrollment at age 65 are:

Being a United States citizen or a permanent legal resident who has lived in the country for at least five years. 

Currently receiving retirement benefits from the Social Security Administration or the Railroad Retirement Board. Or having worked long enough (at least 40 quarters) to qualify for these benefits even if you aren’t receiving them yet. 

Being a current or former government employee, or the spouse of one, who paid into the Medicare system while employed. 

If you are receiving retirement benefits from Social Security or the Railroad Retirement Board when you turn 65, the Social Security Administration automatically enrolls you in Medicare Parts A and B. 

But, if you are still employed, or not eligible for retirement benefits yet, you have the option to enroll in Medicare on your own at age 65, or you can opt-out until later under certain circumstances. This article can help you understand more about whether you need to retire to get Medicare coverage, or how you can enroll whenever you finally stop working.

Do you have to be retired to get Medicare? 

Even if you’re still working when you turn 65, you have the right to enroll in Medicare insurance benefits if you meet the eligibility requirements mentioned above – you don’t need to be retired to get them. 

While most people enroll in Medicare Parts A and B at age 65, regardless of whether they’re retired or not, there are many who still have employer health benefits. 

Depending on your personal situation, you may choose to hold off until retirement (later than 65) to enroll in Medicare. Here’s a look at what you should consider before making your final decision:

Even if you have group health insurance, you should consider enrolling in Medicare Part A (hospital insurance) as soon as you are eligible if you qualify for premium-free Part A. It won’t cost you anything and you can avoid possible penalties later.  

Medicare Part B (medical insurance) has a monthly premium. So if you don’t need it, you might not want the added expense. If you have comparable insurance through your employer, you qualify for a special enrollment period to sign up for Medicare Part B when your employer coverage ends. 

If Medicare is going to be your primary insurance you should enroll at age 65 when you first become eligible, even if you’re still working. However, if Medicare is going to be your secondary payer after your current insurance pays, you can hold off until your employer coverage ends. 

Although Medicare is a budget-friendly way to pay for medical expenses in retirement, the program itself is not without costs. For many seniors, premium payments must be made monthly in order to utilize benefits, and many plans also have deductibles that must be met before benefits begin to apply toward healthcare costs.

Before taking a look at premiums and their costs, however, it’s important to note that Medicare is broken down into different parts. Medicare Part A, which supplies inpatient coverage, is usually provided premium-free to retirees who have contributed enough through payroll deductions over their working lives. In most cases, enrollment in Medicare Part A is automatic, so even if you don’t use your coverage, it will still be there for you if you need it without requiring any type of premium to keep your coverage active.

What Medicare Monthly Premiums Will I Have to Pay?

If you don’t qualify for premium-free Medicare Part A, a monthly premium will be required to carry this coverage. Your cost can vary based on the year, but for 2022, you can expect to pay up to $499 per month for inpatient coverage.

Medicare Part B Premiums

Part B monthly Medicare premiums are for outpatient coverage, and Part B is optional coverage. This is the coverage you use to pay for doctor visits, surgery and lab work. It also covers durable medical equipment like wheelchairs and some diabetic supplies.

For 2022, the standard cost of Medicare Part B premiums starts at $170.10 and goes up based on your modified adjusted gross income. This amount is calculated by taking your household income after any tax-exempt interest income and subtracting tax deductions. For households with a modified adjusted gross income over $500,000, Medicare Part B can cost as much as $578.30 per month.

Medicare Part D Premiums

Part D monthly premiums pay for coverage of prescription medications that you are able to purchase from retail pharmacies. This is optional coverage, and your base price can vary depending on your provider and the options offered in your plan.

For most people, you can expect to pay more as your household income level rises. For example, if your household income falls below $91,000 as a single tax filer or $182,000 when filing jointly, you can expect to pay your plan premium price. If your income is above $500,000 annually, you can expect to pay your plan premium as well as an additional $77.90 per month.

Don’t Forget Deductibles

Although premiums are the out-of-pocket costs associated with Medicare coverage that concern retirees the most, it’s important to remember that deductibles should be factored into your healthcare budget as well. A deductible is an amount that you need to spend in a given benefit period in order to begin accessing your Medicare benefits

Essentially, you pay out-of-pocket for all expenses until you have reached your plan’s deductible. After that, your benefits will apply toward your plan’s stated coverage limits until the next benefit period begins.

Even if you don’t take a lot of prescription drugs now, you should still consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage (for example from an employer or union that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage), you will likely pay a late enrollment penalty (higher premiums) if you join later.

Note: Discount cards, doctor samples, free clinics, drug discount Web sites, and manufacturer’s pharmacy assistance programs are not considered prescription drug coverage and are not considered creditable coverage.

Although Medicare is often the medical insurance program of choice for retired individuals and those who qualify due to disability, there are many Medicare recipients who rely on the program while still working and earning a paycheck. In most circumstances, Medicare Part D, the prescription drug benefit, is optional coverage for prescription medications that you can  purchase from a retail pharmacy and take at home. Part D prescription drug coverage usually comes at a monthly premium, and the cost of this premium can be affected by different factors.

Does My Part D Premium Depend on My Income?

According to Medicare, individuals who make above $85,000 per year and married couples who file taxes jointly making above $170,000 may need to pay additional costs on Part D premiums. The amount can change based on the year’s federal budget, but in 2019, the additional cost was $12.40 per month per person in addition to the regular premium average of $34 per month.

The additional cost may rise based on salaries up to $500,000 annually. Individuals who fall into the highest income bracket can expect to pay around $77.40 per month on top of the regular Part D premium amount. For married couples who file taxes jointly, the combined income minimum to meet this standard is $450,000 and above.

Why Do I Have to Pay More?

If you do fall into one of the higher income brackets that require a larger premium, you may be wondering why you are being singled out. The Medicare program is designed to pay out benefits based on money taken in through taxes from those currently working. This also means that the program receives a larger amount of funding from those who are in the top earning spots. If you’re still drawing an income and you’re taking advantage of Medicare at the same time, you are being required to contribute more for your share as well as the other shares that would normally be taken out to fund other recipients of the program.

Can I Reduce My Tax Liabilities?

If you’re still receiving an income and you’re having to pay more for your monthly Medicare Part D premium, you may want to speak with a financial advisor who specializes in taxes. While you can’t avoid paying the taxes you owe, you may be able to reduce liabilities by taking advantage of programs provided by the Internal Revenue Service to assist in relieving financial burdens on high-income individuals.

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.

The Medicare Prescription Drug Coverage Gap (the “Doughnut Hole”)

Most Medicare Part D plans have a coverage gap, sometimes called the “Doughnut Hole.” This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for the drugs, up to a yearly limit. Your yearly deductible, coinsurance or copayments, and what you pay while in the coverage gap all count toward this out-of-pocket limit. The limit does not include the drug plan’s premium or what you pay for drugs that are not on your plan’s formulary or prescription drug list.

There are plans that offer some 250coverage during the gap, like for generic drugs. However, plans with gap coverage may charge a higher monthly premium. Check with the plan first to see if your drugs would be covered during the gap.

Once a person reaches the plan’s out-of-pocket limit during the coverage gap, “catastrophic coverage” automatically kicks in. Catastrophic coverage assures that once a person has spent up to the plan’s out-of-pocket limit for covered drugs, he or she will only pay a small coinsurance amount or a copayment for the rest of the year.

It is important to note that people who get Extra Help paying drug costs will not have a coverage gap and will pay a small or no copayment once they reach catastrophic coverage

You can join, switch, or drop a Medicare drug plan at these times:

When you are first eligible for Medicare (the 7-month period begins 3 months before the month you turn age 65, includes the month you turn age 65, and ends 3 months after the month you turn age 65).

If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability. You will have another chance to join 3 months before the month you turn age 65 to3 months after the month you turn age 65.

The Annual Enrollment Period, between October 15-December 7. Your coverage will begin on January 1 of the following year, as long as the plan gets your enrollment request by December 31.

Anytime, if you qualify for Extra Help or if you have both Medicare and Medicaid.

In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans during a special enrollment period (like if you move out of the service area, lose other creditable prescription drug coverage, or live in an institution).

Depending on your circumstances, you can switch to a new Medicare drug plan simply by joining another drug plan during one of the times listed above. You don’t need to cancel your old Medicare drug plan or send them anything. Your old Medicare drug plan coverage will end when your new drug plan begins. You should get a letter from your new Medicare drug plan telling you when your coverage begins.

Original Medicare Part A, which is inpatient hospital insurance, covers mental health services that you get in a hospital once you’re formally admitted into a hospital or skilled nursing facility. These services can be provided at a general hospital or a psychiatric hospital that specifically cares for mental health conditions. Your benefits cover these services if the facility accepts Medicare assignment.

Part A benefits cover the following:

A semi-private room and your meals

Nursing care that isn’t custodial care

Treatment or therapy for your condition

Lab tests

Medications you take while an inpatient

Various other services and supplies

Medicare Part A doesn’t cover the following:

A private room unless it’s medically necessary 

Private nursing care 

Personal items 

Telephone or television in your room

If you receive mental health care as an inpatient in a general hospital or a psychiatric hospital that accepts Medicare assignment, you are responsible for paying the following expenses:

The Part A deductiblefor the current benefit period. In 2022, the deductible is $1556.00 per benefit period. One benefit period begins on the first day of your admission as an inpatient and ends after 60 consecutive days of not receiving any inpatient hospital care. If you are re-admitted before 60 days have passed, you don’t pay another deductible because the original benefit period is still current. However, if you return to the hospital after 60 consecutive days of non-inpatient care have passed, you begin a new benefit period and must pay another deductible fee. 

Medicare Part A doesn’t limit the number of benefits periods for mental health care in a general hospital. But it’s important to note that if you are getting care in a psychiatric hospital, you are limited to 190 lifetime care days. 

Coinsurance for mental health benefits under Part A

Your Part A deductible covers your share of costs for inpatient hospital care for the days 0 through 60. From day 61 to day 90, you are responsible for paying $389.00 per day (in 2022). 

After day 90, you pay $778.00 per day for lifetime reserve days (60 days). After you use your lifetime reserve days, you are responsible for 100 percent of the costs for every day of care as an inpatient. 

What Are My Medicare Physical Therapy Benefits?

What does Medicare pay for when it comes to physical therapy? The answer depends on how physical therapy is administered and where.

In the majority of cases, physical therapy is covered by Medicare through Part B. To enjoy the Medicare benefits of Part B, you will need to meet your deductible, and a copay or coinsurance may apply. For most people, Medicare will cover 80% of Part B costs, leaving the remaining 20% to be covered by you or your Medigap policy if you have one. This only applies after you have met your plan’s deductible.

Physical Therapy Benefits Under Medicare Part B

Part B is the outpatient portion of Original Medicare, and it covers visits to doctors and specialists. Since most physical therapy takes place during outpatient visits in a clinical setting, Medicare benefits under Part B apply to care. In order to be considered for coverage by Medicare Part B, your physical therapist will need to be a Medicare-participating healthcare professional. Additionally, not all treatment that is deemed as physical therapy is covered.

For example, some healthcare specialists provide massage therapy as a form of physical therapy. While massages may or may not have a therapeutic effect on physical rehabilitation after an injury or illness, Original Medicare does not cover massage therapy. Therefore, you are encouraged to speak with your plan provider prior to seeking out physical therapy services to ensure that your specific treatment is covered.

Physical Therapy Benefits Under Medicare Part A

Inpatient physical therapy takes place while admitted to a hospital or skilled nursing facility. Medicare benefits offered through Part A can be utilized for up to 60 days per benefit period at 100% cost coverage. If you require further inpatient care, you can receive an additional 30 days of coverage at a discounted rate. Beyond 90 days, you will need to use lifetime reserve days until the next benefit period begins.

As a result, your coverage for physical therapy services while admitted to a Medicare-participating hospital or skilled nursing facility will be covered according to the length of time you have spent in inpatient care. If a physical therapist is brought in from outside of the facility’s staff to administer care, Medicare benefits may be offered through Part B for these services specifically.

What Does Medicare Pay for When Receiving At-Home Physical Therapy?

If you are homebound and require physical therapy, Medicare benefits may cover home health services that include physical therapy. These will be covered by Medicare Part B in most cases, but some services may be billed through Medicare Part A if staff from a Medicare-participating hospital visit your home to provide care.

Hospice care comes at a time when families need help the most. A hospice program not only provides palliative health care services for the terminally ill patient, but it also provides support to the patient’s loved ones. 

Palliative care focuses on providing comfort, quality of life, and pain relief rather than life-prolonging care that can be onerous and too difficult for the patient and family members. 

For family members who have a loved one ready for hospice, it’s comforting to know that Medicare provides assistance for the beneficiary during hospice care. This article has important information about what services are included in Medicare’s coverage, qualification requirements, and what Medicare pays for. 

Qualification requirements for Medicare hospice care

If you or your loved one is terminally ill and needs hospice care, they must be enrolled in Medicare Part A (hospital insurance) and meet all the following conditions to qualify for it:  

The beneficiaries’ hospice physician and regular physician must certify that they are terminally ill – a six-month or less life expectancy. 

The beneficiary must accept palliative care rather than curative care for the illness. 

The beneficiary must sign a statement that clearly states they choose hospice care over other care covered by Medicare for treatment of the terminal illness and other related conditions. 

How does Medicare cover hospice care? 

If you have Medicare and qualify for hospice care, you can get it at home, in another facility where you live, such as a nursing home, or in an inpatient hospice care facility. 

While you are in hospice care, if you need medical services that are unrelated to your terminal illness, your Original Medicare benefits cover them.  

When you are in hospice care you have a team of health care professionals who create a plan for your care that includes all, or some, of the following services:

Doctor’s care

Nursing and medical care

Durable medical equipment needed for pain relief and symptom management

Medical supplies such as catheters, etc. 

Pain management drugs

Nursing aide and homemaker assistance

Physical therapy, occupational therapy, and/or speech-language pathology

Social services care

Diet and nutrition counseling

Spiritual and grief counseling for the patient and family members

Inpatient care for pain and symptom management on a short-term basis in a facility that accepts Medicare assignment. 

Inpatient respite care in a Medicare-associated facility. This is provided to give your main caregiver a rest and is arranged by your hospice provider. Respite care length is up to five consecutive days. You can get this benefit more than once, but only on an occasional basis. 

Miscellaneous services that Medicare covers for pain and symptom management when related to your terminal illness and related conditions. These services must be recommended by your hospice care team. 

It’s important to note that your Original Medicare benefits don’t cover the following services when your hospice care coverage begins:

Curative treatment for your terminal illness or related conditions. 

Prescription drugs to cure your terminal illness or related conditions. 

Care from a hospice provider that hasn’t been set up by your hospice team. 

Room and board at your home or other facility you consider your home. 

Hospital outpatient care, hospital inpatient care, and/or transportation by ambulance unless it has been arranged by your hospice team, or it is necessary to treat a condition that is unrelated to your terminal illness or related conditions. 

What does Medicare pay for regarding hospice care? 

If you have coverage through Original Medicare, your benefits pay 100 percent of the cost of your hospice care. You are responsible for a copayment of up to $5.00 for your prescriptions for outpatient drugs necessary for pain and symptom management. 

While it isn’t common, if your hospice benefit doesn’t cover a prescription drug you need, the hospice provider can check on whether you have coverage through your Medicare Part D plan. You should be notified by your hospice provider if your drugs aren’t covered. In some instances, you may need to pay 100 percent of the cost of the drugs. 

For inpatient respite care, Medicare pays for 95 percent of the final, approved cost of the care, and you are responsible for the remaining five percent.

When you retire, you begin seeing a monthly deposit from the Social Security Administration. The amount of these benefits is determined based on your age at retirement, your income, and your work history. But, after retirement, questions that commonly pop up include: Do I still have to pay taxes, and do I have to pay taxes on my Social Security benefits? The simple answer to these questions is yes. Retirement benefits are technically still taxable income; however, the amount of taxes owed depends on your benefit amount and your additional income sources.

Now, it may seem odd that you might have to pay taxes on benefit income that you are finally receiving after paying Social Security taxes for years or even decades prior to retirement. Surprising or not, you may be forced to pay taxes on your benefits, especially if you continue to work.

Determining if your Retirement Benefits are Taxable

If Social Security benefits serve as your primary or only source of income, it is likely that you will have no tax requirements. However, no matter your income streams, you can run a quick test to determine if you will be liable for tax payments on your benefits come April.

First, you will determine your combined income. This is calculated by adding your adjusted gross income, nontaxable interest, and half of your social security benefits. Then, once you have your combined income, you will need to compare the amount to the IRS rules.

You should begin by comparing your income level to the base amounts provided by the IRS. For individuals, heads of household, and qualifying widows or widowers with a dependent child, this amount is $25,000. For married individuals filing jointly, the base amount is increased to $32,000. If the combined income you calculated is lower than this amount, it is likely that you will not be responsible for paying any taxes on your benefit amount.

If you are filing as an individual and your combined income falls between $25,000 and $34,000, you will be forced to pay taxes on up to 50 percent of your Social Security benefits. For those with an annual combined income exceeding $34,000, up to 85 percent of your retirement benefits are susceptible to taxation.

This process works similarly for those who are married and filing a joint return. For these amounts, you will need to combine the amounts of you and your spouse. If your income is between $32,000 and $44,000, up to 50 percent of benefits are taxable, and for combined incomes over $44,000, up to 85 percent of your benefits may be taxed. For those who are married and filing separate tax returns, it is likely that you will be forced to pay taxes on your benefits.

Calculating your Taxes

If you fall into one of the above categories where up to 50 percent of your benefits are taxable, you will need to determine the amount of half of your Social Security benefits and half of the difference between your combined income and the base amount set by the IRS. You will be taxed on the lower of these two amounts.

For example, let’s say you are filing as an individual with an adjusted gross income of $21,000 and benefits of $1,500 per month. This would give you total annual benefits of $18,000, half of which would be $9,000. Your combined income would be $30,000. This number falls between the $25,000 and $34,000 range, meaning you are susceptible to tax payment on up to 50 percent of your benefits.

To calculate the taxable amount, you will first take your annual benefits and divide them by two. Dividing $18,000 by two gives you $9,000. Then, you would determine half the difference between your income, $30,000, and the base amount, $25,000. Half of this $5,000 difference is $2,500. Since $2,500 is less than $9,000, this would be your taxable amount. For those making more than the upper range, the formula is slightly more complex, but follows a similar concept.

Health Maintenance Organization (HMO)

In HMO Plans, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except:

• Emergency care
• Out-of-area urgent care
• Temporary out-of-area dialysis

HMO Point-of-Service (HMOPOS) plans are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

You must get your care and services from doctors, other health care providers, or hospitals in the plan's network.

HMO plans have prescription drug coverage built into the plan.

Many plans require you to choose a primary care doctor for an HMO Plans.

Usually Yes, Certain services, like yearly screening mammograms, don't require a referral.

PPO Plans are offered by private insurance companies. You pay less if you use doctors, hospitals, and other health care providers that belong to the PPO network . Going to a provider outside of the network will usually cost more.

You maychoose to use the doctors and health care facilities in the plan or pay more and use doctors and facilities outside the plan.

Prescription drugs are covered by PPO Plans most of the time. If you want Medicare drug coverage, you should consider joining a PPO Plan that offers prescription drug coverage.

PPO plans usually do not require you choose a primary care doctor.

PPO plans do not generally require you to get a referral to see a specialist. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.

A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a State licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services (CMS) to provide beneficiaries with all their Medicare benefits, plus any additional benefits the company decides to provide. The PFFS plan:

• Pays providers on a fee-for-service basis without placing the providers at financial risk;

• Varies provider payment rates only based on the specialty or location of the provider or to increase utilization of certain preventive or screening services;

• Does not restrict members' choices among providers that are lawfully authorized to furnish services and accept the plan's terms and conditions of payment; and

• Does not permit the use of prior authorization or notification.

PFFS plans can offer full or partial networks of providers, or, in

In some cases, you get your health care from any doctor, other health care provider, or hospital in PFFS Plans. You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but you may pay more.

Prescription drugs may be covered in PFFS Plans. If your PFFS Plan doesn't offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

You don't need to choose a primary care doctor in PFFS Plans.