Medicare

Hospital (Mainly Room and Board)

Part A covers all care you receive after being admitted into a hospital by a physician for up to 90 days each benefit period. You receive 60 lifetime reserve days that can be stored and used as needed. Part A also covers up to 100 days in a skilled nursing facility each benefit period granted you qualified by spending three consecutive days in a hospital within 30 days of admission. Home healthcare may be covered by Part A but is normally covered by Part B. Hospice care is also covered by Part A. Part A usually has no cost if you worked for 10 years or more in your lifetime in the US.

Medical (Doctors Visits, Surgery, DME, labs)

Part B covers the gaps on services between hospital stays and prescriptions. The standard monthly premium is $185. Premiums increase with higher incomes. It has a calendar year deductible of $257 in 2025. This is a one time payment and after it is made Part B turns into 80/20 coverage. This means that Part B will cover 80% of the cost of services you receive and you will be responsible for 20% of the charge. The glaring issue is there is no cap on the 20% so expenses can continue to rack up.

Medicare Advantage

Part C is referred to as Medicare Advantage and consists of plans that commonly have a lower cost option to having a Maximum out of Pocket on your Medicare coverage and can stop expenses from getting past a certain level in a catastrophic scenario. Three common plans seen in Medicare Advantage are PPO plans, HMO plans, and MSA plans. These plans are held through private health companies and can include both prescription drug coverage, dental, vision, and hearing benefits.

Prescription Drug Coverage

Part D consists of your prescription drug coverage in original Medicare and has four phases of coverage: Deductible, Initial Coverage, Coverage Gap, and the Catastrophic Phase. The standard deductible in 2025 is $590. Your prescription medications are categorized into tier levels 1-5. Tiers 1 and 2 can be as low as a $0 copay during the initial coverage phase while 3-5 warrant higher copays and sometimes a percentage of the total MSRP. Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out of pocket for prescription drugs covered by your plan. Once your spending reaches the $2,000 threshold you automatically get catastrophic coverage and won’t pay out of pocket for any Part D covered drugs for the remainder of the calendar year.

Gaps in Medicare coverage can be covered by purchasing Medicare supplement or Medigap plans. These plans range from A-N and can help cover out of pocket costs.

Disclaimer: "We do not offer every plan available in your area. Currently we represent 3 organizations which offer 20 products in your area. Please contact Medicare.gov, 1‐800‐MEDICARE, or your local State Health Insurance Program to get information on all of your options."