Medicare Options
Understanding Medicare's Options
Part A, B, C & D
Medicare can be quite confusing and complex. Let's break down the four basic parts.
4 Parts
What are Medicare's 4 Parts?
Navigating Medicare can be confusing—but it doesn’t have to be! Here’s a quick, easy-to-understand breakdown of Medicare’s four main parts, what they cover, and how they work together to help you stay healthy and protected.
original Medicare
What is Original Medicare Part A & Part B?
Original Medicare is broken into two parts, Part A and Part B.
Medicare Part A - Hospital Insurance
What it covers:
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Inpatient hospital stays
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Skilled nursing facility care (short-term)
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Hospice care
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Limited home health care
Who gets it:
Most people get Part A for free if they or their spouse paid Medicare taxes while working. If not, you may pay a monthly premium.
Medicare Part A (Hospital Insurance):
Premiums: Most beneficiaries qualify for premium-free Part A. However, if you or your spouse haven’t paid Medicare taxes for at least 10 years, you might need to pay a premium. In 2025, this premium is either $285 or $518 each month, depending on your work history. Medicare
Inpatient Hospital Deductible: $1,676 per benefit period.
Original Medicare
Medicare Part B – Medical Insurance
What it covers:
Doctor visits
Outpatient care
Preventive services (like flu shots and screenings)
Lab tests, X-rays, and durable medical equipment
What you pay:
You’ll pay a monthly premium, an annual deductible, and typically 20% of the cost for covered services after the deductible.
Medicare Part B (Medical Insurance):
Standard Monthly Premium: $185, an increase from $174.70 in 2024. Social Security+6RRB+6MarketWatch+6
Annual Deductible: $257, up from $240 in 2024. RRB+1Centers for Medicare & Medicaid Services+1
Income-Related Monthly Adjustment Amount (IRMAA): Beneficiaries with higher incomes may pay additional amounts. For example, individuals earning above $106,000 and up to $133,000 may have higher premiums.
Part D
Medicare Part D
Prescription Drug Plans
Now that we have covered the foundation to Original Medicare Part A and Part B, you can see that your responsibility for co-payments and co-insurance can be expensive. You have options to help support the portion of Medicare that you are required to pay but how do you know what plan to choose? All your healthcare plan choose should be based on your healthcare needs and budget.
Medicare Part D is a voluntary prescription drug benefit for people with Medicare that is obtained through private insurance companies. This coverage can help to cover the cost of some of your prescription drugs. You should enroll in Part D when you first enroll in Medicare to avoid coverage gaps or enrollment penalties. If you do enroll in Part D when you are first eligible, you will be able to access retail prescription drugs at a more affordable rate and enjoy protection against high costs in the event you need a very expensive medication.
Medicare Part D (Prescription Drug Coverage):
Premiums: The average monthly premium decreases to $46.50 (down from $53.95 in 2024).Reuters+1HealthPartners+1
Deductibles: The maximum allowable deductible increases to $590 (up from $545 in 2024).Medicare Advantage+1Fiscal Report+1
Coverage Gap (Donut Hole): The coverage gap was eliminated in 2025. Beneficiaries will pay no more than $2,000 out-of-pocket for covered prescription drugs; after reaching this threshold, catastrophic coverage begins, reducing costs for the remainder of the year
Part C
Medicare Part C
Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage, is an alternative way to get your Medicare benefits. Instead of getting your Part A (Hospital Insurance) and Part B (Medical Insurance) directly from the government, you receive them through a private insurance company that contracts with Medicare.
What Does Medicare Part C Cover?
Medicare Advantage plans must cover all services that Original Medicare (Part A and Part B) covers, but many also offer additional benefits, such as:
Vision (e.g., eye exams, glasses)
Dental (e.g., cleanings, exams)
Hearing (e.g., hearing aids)
Wellness programs (e.g., fitness memberships)
Prescription drugs (Part D coverage may be included)
Some plans may also offer over-the-counter benefits (e.g., for health products) or transportation services to medical appointments.
How Does Medicare Part C Work?
You still have Part A and Part B coverage, but you receive them through the private insurer offering the Medicare Advantage plan.
You pay your Part B premium (usually deducted from your Social Security check).
You may also pay an additional monthly premium to the private insurer offering the plan.
You generally pay copayments, coinsurance, and deductibles for services, but the plan will have an annual limit on your out-of-pocket costs for medical services.
Premiums: The average monthly premium decreases to $17 (down from $18.23 in 2024).
Out-of-Pocket Maximum: The maximum annual out-of-pocket limit increases to $9,350 (up from $8,850 in 2024). However, many plans offer lower limits.
Medicare Part C offers a comprehensive and flexible way to receive your Medicare benefits, combining hospital, medical, and sometimes prescription drug coverage, along with additional services that aren’t included in Original Medicare. It’s important to compare the plans available in your area to find one that fits your healthcare needs and budget.
Medicare FAQ's
Got questions? We've got answers
You are eligible to apply for Medicare during your initial enrollment period which is a 7 month window. 3 months before turning 65, the month you turn 65 and 3 months after turning 65.
The easiest way to sign up for Medicare is online through SSA.gov or by Calling Social Security at 1-800-772-1213. You can also visit your local Social Security Office.
If you are already receiving Social Security Benefits you will be automatically enrolled into Original Medicare, otherwise you will be eligible to enroll during your initial enrollment period that starts 3 months before your 65th birthday.
If you miss your Initial Enrollment Period you can sign up during the General Enrollment period that occurs every year January 1st through March 31st. Coverage becomes effective the month following your enrollment date.
Yes, there are penalties for not signing up for Part B but only if you do not have qualifying coverage.
If you need a new Medicare card you can order a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call.