All About Medicare

Part A

Part B

Part C

Part D

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Medicare Part A

Hospital Coverage

Inpatient Hospital Care

In 2025 You Pay	Under Original Medicare Part A
$1,676	Deductible for each benefit period
$0	For the first 60 days
$419	Per day for days 61-90
$838	Per “lifetime reserve day” after covered day 90 (up to a max of 60 days in your lifetime)

Skilled Nursing Facility Care

In 2025 You Pay	Under Original Medicare Part A
$0	For the first 20 days of eligible coverage
$209.50	Per day for days 21-100 of eligible coverage
All Costs	For each day after day 100 of eligible coverage

Hospice Care

To qualify your doctor must certify you as terminally ill. You pay nothing for hospice care.

Coverage includes:

All items and services needed for pain relief and symptom management

Medical, nursing and social services

Drugs – you may need to pay a co-pay of no more than $5 for each prescription drug

Certain durable medical equipment

Aide and homemaker services

Other covered services, like spiritual and grief counseling

Home Health Care

To qualify you must be home bound due to an illness or injury. A doctor must order your care and a Medicare certified home health agency must approve it. You pay nothing for covered home health care services and 20% of the Medicare approved amount for durable medical equipment.

Coverage includes medically necessary:

Part time or intermittent skilled nursing care

Physical therapy

Speech – language pathology services

Occupational therapy

Part A Premium

Most people do not pay a Part A premium because they paid Medicare taxes while working. If you don’t qualify for premium free Part A, you can pay up to $518 each month.

Medicare Part B

Medical Insurance

Part B Covers:

Services from doctors and other health care providers
Outpatient care
Home health care
Durable medical equipment
Some preventative services

Under Original Medicare, if the Part B deductible ($257 in 2025) applies, you must pay all costs, up to the Medicare approved amount until you meet the yearly Part B deductible before Medicare begins to pay its share.

After your deductible is met you typically pay 20% of the Medicare approved amount of the service. You will pay nothing for most covered preventative services if you receive the service from a doctor who accepts assignment.

Part B Premium

You pay a Part B premium each month. The standard Part B premium amount in 2025 is $185.00 (or higher depending on your income).

Social Security will tell you the exact amount you will pay for Part B in 2025.

You will pay a different premium amount in 2025 if:

You have Medicare and Medicaid, and Medicaid pays your premium
Your modified adjusted gross income reported on your IRS tax return from 2 years ago is above a certain amount. If so, you will pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA) which is an extra charge added to your premium.

Yearly Income in 2023 (for what you pay in 2025)
File individual tax return	File joint tax return	File married & separate tax return	You pay each month (in 2025)
$106,000 or less	$212,000 or less	$106,000 or less	$185.00
Above $106,000 up to $133,000	Above $212,000 up to $266,000	N/A	$259.00
Above $133,000 up to $167,000	Above $266,000 up to $334,000	N/A	$370.00
Above $167,000 up to $200,000	Above $334,000 up to $400,000	N/A	$480.90
Above $200,000 and less than $500,000	Above $400,000 and less than $750,000	Above $106,000 and less than $394,000	$591.90
$500,000 or above	$750,000 and above	$394,000 and above	$628.90

Part B Late Enrollment Penalty

If you do not sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty. You will have to pay the penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% of the standard premium for each 12 month period you could have had Part B but didn't sign up.

Usually, you don't have to pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.

Medicare Part C

Medicare Advantage Plans

What Does Part C Include?

All benefits and services covered under Original Medicare Part A and Part B
Part D Prescription drug coverage (in most plans)
Offered by Medicare approved private insurance companies
Extra benefits and services the Original Medicare does not cover sometimes for an additional cost

You Can Join a Medicare Advantage Plan If:

You have Part A and Part B
You live in the plan's service area
You do not have End-Stage Renal Disease (ESRD)
You are a U.S. citizen or lawfully present in the United States

If you enroll in a Medicare Advantage Plan, the carrier providing that coverage is PRIMARY, NOT Medicare directly!

Click Here To Compare Part C Plans in Monroe County

Part C Premium

If you join a Medicare Advantage Plan you will still have to pay your Part B monthly premium in addition to the plan premium.

Medicare Part D

Prescription Drug Coverage

Helps cover the cost of prescription drugs
Run by Medicare and Medicare approved private insurance companies
May help lower your prescription drug costs and help protect against higher costs in the future
If you decide not to join a Medicare drug plan when first eligible and you don’t have other creditable prescription drug coverage you will likely pay a late enrollment penalty if you join a plan later.

The Part D Coverage Gap or “Donut Hole” has been eliminated for 2025!

How Part D coverage works:

Stage 1: Deductible
You pay 100% of the cost of the drug until the plan deductible is met.	If your plan does not have a deductible you move into initial coverage stage

Stage 2: Initial Coverage
The plan pays its share of the cost of drugs and you pay your share of the cost.	You stay in this stage until your total cost for drugs (the co-pay amount you pay and the cost the plan pays) totals $2,000

Stage 3: Catastrophic Coverage
You pay $0 for generic or brand name drugs.	You pay $0 for generic or brand name drugs.

Part D Premium

Part D premium varies by plan. If your income is higher you will have to pay more for Part D just like Part B. See the chart below for estimated monthly premiums based on income as reported on your IRS tax return from 2 years ago and last year. If you income is above a certain limit, you will have to pay an Income Related Monthly Adjustment Amount (IRMAA) in addition to your plans premium.

If your filing status and yearly income in 2023 was:
File individual tax return	File joint tax return	File married & separate tax return	You pay each month (in 2025)
$106,000 or less	$212,000 or less	$106,000 or less	Your plan premium
Above $106,000 up to $133,000	Above $212,000 up to $266,000	N/A	$13.70 + your plan premium
Above $133,000 up to $167,000	Above $266,000 up to $334,000	N/A	$35.30 + your plan premium
Above $167,000 up to $200,000	Above $334,000 up to $400,000	N/A	$57.00 + your plan premium
Above $200,000 and less than $500,000	Above $400,000 and less than $750,000	Above $106,000 and less than $394,000	$78.60 + your plan premium
$500,000 or above	$750,000 or above	$394,000 or above	$85.80 + your plan premium

Part D Late Enrollment Penalty:

You may owe a late enrollment penalty if at any time after your Initial Enrollment Period ends; you go 63 or more days in a row without Part D or other creditable coverage.
The penalty depends on how long you lack creditable prescription drug coverage
It is calculated by multiplying 1% of the national base beneficiary premium ($36.78 in 2025) by the number of full uncovered months that you were eligible but didn’t join a drug plan and went without other creditable prescription drug coverage.