Medicare coverage helps millions of Americans pay for health care. Understanding Medicare coverage means knowing the five main parts—A, B, C, D, and Medigap—and what each part includes. This guide breaks down what services are covered, what you pay in 2025, and where gaps may exist.
Part A: Hospital Insurance
What It Covers:
- Inpatient hospital stays (semiprivate room, meals, nursing)
- Skilled nursing facility care (after a hospital stay)
- Hospice care for terminal illness
- Home health care (limited services)
Costs for 2025:
- Premium: Most people pay $0 if they or a spouse worked 40 quarters. Others pay up to $506 per month.
- Deductible: $1,676 per benefit period Humana.
- Coinsurance: Days 1–60: $0; Days 61–90: $419/day; Days 91+ (lifetime reserve): $838/day.
Part B: Medical Insurance
What It Covers:
- Doctor visits and outpatient care
- Preventive services (shots, screenings)
- Durable medical equipment (walkers, wheelchairs)
- Mental health services and some home health
Costs for 2025:
- Premium: $185.00 per month standard CMS.
- Deductible: $257 per year CMS.
- Coinsurance: Most services cost 20% of the Medicare-approved amount after the deductible.
Part C: Medicare Advantage Plans
What They Are:
Medicare Advantage (MA) plans are offered by private insurers. They bundle Parts A and B and often include Part D (drugs) plus extras like vision, dental, and fitness programs. CMS
Key Features:
- All-in-One: Hospital, medical, and usually drug coverage.
- Extras: Many plans cover hearing aids, dental cleanings, and wellness programs.
- Networks: HMOs and PPOs may limit you to in-network providers.
Costs:
- Premiums & Cost-Sharing: Vary by plan but average premiums are stable or slightly lower in 2025 CMS.
- Out-of-Pocket Cap: Plans set their own maximum; once reached, you pay nothing for covered services.
Part D: Prescription Drug Coverage
What It Covers:
- Brand-name and generic prescription drugs at pharmacies or by mail order.
Costs for 2025:
- Premiums: Vary by plan.
- Deductible: Up to $505 per year.
- Coverage Phases:
- Deductible Phase: You pay full cost until deductible.
- Initial Coverage: You and plan share costs until total drug costs reach $4,660.
- Coverage Gap: You pay 25% of drug costs until your out-of-pocket hits $7,400.
- Catastrophic Phase: You pay small copays for the rest of the year.
- Out-of-Pocket Cap: $2,000 per year on covered drugs Medicare.
Medigap: Medicare Supplement Insurance
What It Does:
Medigap policies sold by private insurers fill “gaps” in Original Medicare (Parts A & B), such as deductibles, coinsurance, and excess charges.
Key Points:
- Standardized Plans: Plans A–N offer different levels of coverage.
- Separate Premium: You pay a monthly premium in addition to your Part B premium.
- Guaranteed Renewability: As long as you pay the premium, the policy can’t be canceled.
What Medicare Doesn’t Cover
Even with all parts, some services aren’t covered under standard Medicare:
- Long-term custodial care (assistance with daily living)
- Most dental care and dentures
- Routine vision and hearing exams
- Cosmetic surgery
- Routine foot care
You may need separate dental, vision, hearing, or long-term care insurance to fill these gaps.
How to Use Your Medicare Coverage
- Original Medicare (A & B): Present your red, white, and blue Medicare card at hospitals and doctor offices that accept Medicare.
- Medicare Advantage (C): Use your MA plan’s card and follow its rules—choose in-network providers if required.
- Part D: Show your drug plan card at the pharmacy. Mail-order options often cost less.
- Medigap: Use it to pay your share of Medicare-approved costs—your insurer bills Medicare first.
Frequently Asked Questions
Q1: Can I have Part C and Medigap?
No. Medigap only works with Original Medicare (Parts A & B).
Q2: Do I need Part D if I have a Medicare Advantage plan with drug coverage?
No. You cannot have stand-alone Part D if your MA plan includes drugs.
Q3: How do I choose between Original Medicare and Advantage?
Compare costs, provider choice, and extra benefits. Original plus Medigap may cost more but offers wider provider choice.
Q4: Can Medicare cover my spouse?
No. Each person enrolls in their own Medicare plan.
Q5: What if I travel often?
Original Medicare covers emergency care nationwide. Medicare Advantage may limit you to its network, though many plan networks span multiple states.
Q6: How do I enroll?
- Parts A & B: Enroll online at Medicare.gov, by phone (1-800-MEDICARE), or at your local Social Security office.
- Part C & D: Enroll during Annual Election Period (Oct 15–Dec 7) or Special Enrollment Periods if eligible.
Conclusion
Understanding Medicare coverage means knowing what Parts A, B, C, D, and Medigap include—and what they don’t. With 2025 costs set (Part A deductible $1,676 Humana; Part B premium $185, deductible $257 CMS; Part D out-of-pocket cap $2,000 Medicare), you can plan your budget and choose the right mix of coverage to protect your health and finances.
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