Key Takeaways

• Medicare is divided into different parts, each covering specific healthcare services. Understanding these parts helps you make an informed enrollment decision.

• Costs, coverage, and enrollment timing can impact your benefits, so reviewing your options before enrolling is essential.

Medicare’s Different Parts: Understanding What They Cover

Medicare isn’t a one-size-fits-all program. Instead, it’s divided into different parts, each serving a unique purpose. When you enroll, knowing what each part covers can help you get the healthcare you need without unexpected costs or gaps in coverage. Let’s break down the essentials.

Medicare Part A: Hospital Coverage

Medicare Part A focuses on inpatient hospital care, covering hospital stays, skilled nursing facilities, hospice care, and some home health services. While most people don’t pay a premium for Part A if they have worked and paid Medicare taxes for at least 10 years, there are still costs involved, such as deductibles and coinsurance.

What You Need to Know Before Enrolling

• Part A covers hospital-related expenses but doesn’t include routine doctor visits.

• The inpatient hospital deductible is $1,676 per benefit period in 2025.

• If you need extended care in a skilled nursing facility, coinsurance applies after 20 days.

• Those who haven’t worked enough quarters may need to pay a monthly premium.

• Coverage for home health care under Part A is limited to medically necessary services.

• Hospice care is available under Part A but must be certified by a doctor.

Medicare Part B: Medical Coverage

Medicare Part B handles outpatient services, including doctor visits, preventive screenings, lab tests, and durable medical equipment. It also covers mental health services and some home health care.

What You Need to Know Before Enrolling

• Part B has a monthly premium, which is $185 in 2025 for most beneficiaries.

• The annual deductible is $257 in 2025, after which you typically pay 20% of covered services.

• Late enrollment penalties can increase your premium permanently if you don’t sign up when first eligible.

• Certain preventive services, such as screenings and vaccinations, are covered at no cost.

• Part B covers ambulance services in emergencies or if no other transport is appropriate.

• Some home health services are covered under Part B when deemed medically necessary.

Medicare Part C: Medicare Advantage Plans

Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A and B). These plans, offered by private insurers, often bundle hospital and medical coverage, plus additional benefits like dental, vision, and hearing.

What You Need to Know Before Enrolling

• Medicare Advantage plans must cover everything Original Medicare does but may have different costs and network restrictions.

• Many plans include prescription drug coverage (Part D).

• You must still pay the Part B premium in addition to any plan-specific costs.

• Some plans may require referrals to see specialists.

• Medicare Advantage plans often have provider networks that may limit out-of-network care.

• Additional benefits such as wellness programs or meal delivery may be included in some plans.

Medicare Part D: Prescription Drug Coverage

Medicare Part D provides coverage for prescription medications. Each plan has a formulary (list of covered drugs) and varying costs depending on tiers and pharmacy networks.

What You Need to Know Before Enrolling

• In 2025, Medicare Part D has an out-of-pocket cap of $2,000, offering relief for high prescription costs.

• The annual deductible for Part D plans can be up to $590 in 2025.

• Plans have different formularies, so ensure your medications are covered before enrolling.

• Some plans have preferred pharmacy networks that may lower prescription costs.

• Higher-income enrollees may have to pay an additional premium surcharge for Part D.

Costs and Coverage: What You Should Consider

Each part of Medicare has costs associated with it, including premiums, deductibles, copays, and coinsurance. Understanding these expenses ensures you choose a plan that fits your budget and healthcare needs.

Medicare’s Cost Structure in 2025

• Part A premium: $0 for most but up to $518/month for those without enough work history.

• Part A deductible: $1,676 per benefit period.

• Part B premium: $185/month.

• Part B deductible: $257 per year, then 20% of most services.

• Part D deductible: Up to $590, plus copays and coinsurance.

• Medicare Advantage costs: Vary by plan and coverage level.

• Out-of-pocket maximums can differ significantly by plan and type of Medicare coverage.

Enrollment Timelines: When to Sign Up

Medicare enrollment isn’t automatic for everyone. Knowing when to enroll can help you avoid penalties and ensure you have the coverage you need when you need it.

Initial Enrollment Period (IEP)

Your first opportunity to sign up for Medicare is during the 7-month Initial Enrollment Period surrounding your 65th birthday. It includes:

• 3 months before your birthday month.

• Your birthday month.

• 3 months after your birthday month.

General Enrollment Period (GEP)

If you miss your IEP, you can sign up during the General Enrollment Period (January 1 – March 31) each year, but late penalties may apply. Coverage starts July 1.

Special Enrollment Periods (SEP)

If you have employer-sponsored coverage past age 65, you may qualify for a Special Enrollment Period to enroll in Part B without penalties when that coverage ends.

Medicare Advantage and Part D Enrollment

• If you want to join, switch, or drop a Medicare Advantage or Part D plan, you can do so during Open Enrollment (October 15 – December 7).

• Medicare Advantage Open Enrollment (January 1 – March 31) allows you to switch or return to Original Medicare.

Need Help Choosing the Right Plan?

Medicare decisions can be complex, but you don’t have to make them alone. Speak with a licensed agent listed on this website for personalized guidance. They can help you compare options and ensure you enroll in the plan that best suits your needs.