What is Medicare?
Medicare is the U.S. federal health insurance program for people 65+, plus some younger folks with disabilities or conditions like End-Stage Renal Disease (ESRD) or ALS. It’s run by the Centers for Medicare & Medicaid Services (CMS).
Part A (Hospital Insurance):
Covers inpatient hospital stays, skilled nursing facilities (up to 100 days per benefit period), hospice, and some home health care. Most get it premium-free with 40 quarters of Social Security work history. For those who don’t, the 2025 premium is $518/month (up from $505 in 2024) or $285/month with 30-39 quarters. Deductible: $1,676 per benefit period (up $44 from 2024). Coinsurance: $419/day for days 61-90, $838/day for lifetime reserve days, $209.50/day for skilled nursing days 21-100.
Part B (Medical Insurance):
Covers outpatient care, doctor visits, preventive services, and durable medical equipment. Standard 2025 premium: $185/month (up $10.30 from $174.70 in 2024). Deductible: $257 (up $17 from $240). After that, you pay 20% coinsurance. Individual’s with high-income (over $106,000 single/$212,000 joint, based on 2023 income) pay more—up to $628.90/month.
Part C (Medicare Advantage):
Private plans bundling A, B, and often D, with extras like vision or dental. Premiums vary (many are $0 beyond Part B), but the average is slightly down for 2025. Out-of-pocket max: $9,350 for in-network, $14,000 combined in/out-of-network. Fewer plans are available this year, and some benefits (e.g., over-the-counter items) are less common.
Part D (Prescription Drug Coverage):
Private plans for drug costs. Big 2025 change: out-of-pocket cap at $2,000/year (thanks to the Inflation Reduction Act), eliminating the “donut hole.” After a $590 deductible, you pay 25% coinsurance until hitting $2,000, then $0. Premiums average $36.78/month (up $2.08, capped at 6% increase). Optional Payment Plan lets you spread costs monthly (max $166.67/month). High-income surcharges range from $13.70-$85.80.
Enrollment:
Initial Enrollment: 7-month window around your 65th birthday (3 months before, month of, 3 after).
Open Enrollment: October 15–December 7, 2024, for 2025 coverage starting January 1.
General Enrollment: January 1–March 31 if you missed initial signup (penalties may apply).
Special Enrollment: For life events (e.g., losing job coverage).
Costs in 2025:
Premiums, deductibles, and coinsurance are up slightly due to rising healthcare costs. Part D’s $2,000 cap is a game-changer for drug expenses. Individual’s with lower-income can get Extra Help or Medicaid assistance.
For further questions, please feel free to contact me.
