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Medicare Basics
Part A - Hospital Insurance
Covers inpatient hospital stays, skilled nursing care, hospice, and some home health services. Think of it as your safety net for major health events. Most people don’t pay a premium if they or their spouse paid Medicare taxes for at least 10 years. Otherwise, the 2025 premium is up to $518/month, plus a per-benefit-period deductible ($1,676) and possible coinsurance depending on your hospital stay.
Part B - Medical Insurance
Covers outpatient care — doctor visits, lab tests, imaging, mental health services, durable medical equipment, and preventive care. In 2025, the standard premium is $185/month, with an annual deductible of $257, plus generally 20% coinsurance after the deductible. Part B keeps your day-to-day healthcare running smoothly outside of hospital stays.
Part C - Medicare Advantage
A private-plan alternative to Original Medicare (A & B). These all-in-one plans cover everything Original Medicare does and often add extras like prescription drugs, vision, dental, hearing, and wellness programs. Costs and benefits vary, some plans have $0 premiums, though you still pay your Part B premium. Advantage plans include an annual out-of-pocket maximum, protecting you from high medical costs.
Part D - Prescription Drug Coverage
Helps pay for prescription medications through private Medicare-approved plans. Medications are grouped in tiers, with lower tiers usually costing less. In 2025, the average premium is $46.50/month. Copays or coinsurance vary by tier, and the “donut hole” has been eliminated. The 2025 annual out-of-pocket maximum is $2,000, keeping your prescription costs more predictable and manageable.
Medigap, or Medicare Supplement Insurance, helps cover out-of-pocket costs not covered by Original Medicare, such as deductibles, copayments, and coinsurance. Offered by private insurers, these standardized plans (labeled A through N) provide varying levels of coverage, with some plans offering additional benefits like foreign travel emergency care. Medigap plans do not include prescription drug coverage, so beneficiaries often pair them with a standalone Part D plan. Costs for Medigap policies vary depending on the plan type, insurer, and location, and premiums typically range from $50 to over $300 per month. Unlike Medicare Advantage, Medigap plans work with Original Medicare, giving beneficiaries the flexibility to see any provider that accepts Medicare.
From Hospital Stays To Prescriptions, We'll Help You Build The Health Care Plan That Fits Your Life
Medicare Eligibility
Medicare eligibility primarily applies to U.S. citizens or permanent residents aged 65 and older, as well as younger individuals with certain disabilities or medical conditions like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Most people become eligible at 65 if they or their spouse have worked and paid Medicare taxes for at least 10 years. Individuals under 65 may qualify if they’ve received Social Security Disability Insurance (SSDI) for 24 months or have specific medical conditions. Enrollment is automatic for some but others must sign up during their Initial Enrollment Period, which begins three months before their 65th birthday and ends three months after. Eligibility also determines access to different parts of Medicare, such as premium-free Part A for those who meet work history requirements.
Enrollment Periods
Medicare enrollment periods are specific windows when eligible individuals can sign up for or make changes to their Medicare coverage.
Initial Enrollment Period (IEP) - lasts seven months, starting three months before the month you turn 65 and ending three months after.
General Enrollment Period (GEP) - runs from January 1 to March 31 each year, allowing those who missed their IEP to sign up, with coverage starting July 1.
Annual Enrollment Period (AEP) - occurs from October 15 to December 7, enabling beneficiaries to change Medicare Advantage or Part D plans, effective January 1. You can also switch from a Medigap plan to a Medicare Advantage plan in this period.
The Medicare Advantage Open Enrollment Period (OEP) - runs from January 1 to March 31, and allows Medicare Advantage members to switch plans or revert to Original Medicare.
Special Enrollment Periods (SEP) - may apply for qualifying events, such as losing employer coverage or moving to a new area, letting beneficiaries make changes without waiting for standard enrollment periods.
