All about Medicare

Medicare Basics

The Four Parts
Part Coverage Cost Key Details
Part A
Hospital Insurance		 Inpatient hospital care, skilled nursing facility care, hospice care, home health care $0 premium for most people who paid Medicare taxes while working
  • $1676 deductible (2025) for each benefit period
  • Covers up to 90 days in hospital per benefit period with 60 lifetime reserve days
  • Doesn't cover long-term care
Part B
Medical Insurance		 Doctor service, outpatient care, preventive services, and some home health services Sliding scale based on your income starting at $185 a month
  • $257 deductible (2025) before coverage begins
  • After deductible, you typically pay 20% coinsurance for covered services
  • Welcome to Medicare preventive visit in first 12 months
  • Annual Wellness visits thereafter
Part D
Prescription Drug Coverage		 Prescription medications Varies by plan, plus potential income-related surcharge
  • Each plan has its own formulary (covered drug list)
  • Out-of-pocket spending limit of $2000 (2025)
  • Late enrollment penalty applies if you don't sign up when first eligible
  • Don't enroll in Part D in you select a Medicare Advantage plan with drug coverage
Part C
Medicare Advantage		 Combines Parts A, B, and usually D, often with additional benefits Varies by plan (some have $0 premium)
  • Replaces Original Medicare (Parts A & B)
  • Usually requires using network providers
  • May include extra benefits like gym memberships, dental, vision, and hearing aids coverage
  • Still pay your Part B premium
Supplemental Coverage Options
Option 1: Original Medicare (Parts A & B) + Part D + Medigap Option 2: Part C (Medicare Advantage)
  • Part A & B provides your base hospital and medicare coverage
  • Medigap helps cover costs Original Medicare doesn't cover.
  • Part D provides prescription drug coverage
  • All-in-one alternative to Original Medicare
  • May include prescription drug coverage
  • Often includes additional benefits not covered by Original Medicare
  • May have network restrictions
What is Medigap?
  • Medigap is private insurance that helps pay for costs not covered by Original Medicare (Parts A and B). It's designed to fill the "gaps" in Medicare coverage, such as copayments, coinsurance, and deductibles.
  • You must be enrolled in Medicare Part A and Part B to purchase Medigap.
  • You cannot have Medigap if you're enrolled in a Medicare Advantage plan (Part C).
  • Medigap policies are standardized and labeled with letters (A, B, C, D, F, G, K, L, M, and N). Each plan type offers the same benefits regardless of which insurance company sells it, though prices may vary. (Plan C and F are no longer available to those new to Medicare after 1/1/2020. Plan G is often recommended as an alternative.)
  • Medigap does not cover prescription drugs, long-term care, vision or dental care, hearing aids, eyeglasses, or private nursing care.

Medicare Costs

Part B Premiums (2025)
Individual Income Joint Filing Income Monthly Premium
$106,000 or less $212,000 or less $185.00
$106,001 ~ $133,000 $212,001 ~ $266,000 $259.00
$133,001 ~ $167,000 $266,001 ~ $334,000 $370.00
$167,001 ~ $200,000 $334,001 ~ $400,000 $480.90
$200,001 ~ $500,000 $400,001 ~ $750,000 $591.90
$500,001 + $750,001 + $628.90
Potential Out-of-Pocket Costs
  • Deductibles: Part A ($1,676 per benefit period), Part B ($257 annually)
  • Coinsurance: Typically 20% for Part B services
  • Copayments: Vary by service and plan
  • Premiums: Part B and either Part D and Medigap, or Medicare Advantage

Medicare Timeline

Timeline for Medicare Planning
3~6 months before 90 days before After retirement
  • Review your retirement date and health insurance transition plan
  • Request the CMS-L564 form from Human Resources (for those who delayed Medicare enrollment while working) right before you reach 90 days from your retirement date
  • Enroll in Medicare Part A & B no earlier than 90 days before your retirement date
  • Ensure effective date is the day after your official retirement date (typically July 1 or January 1)
  • Supply the Social Security or CMS team with your completed CMS-L564 document
  • Gather necessary documentation (Social Security number, birth certificate, employment records)
  • Begin researching Medicare options. Contact Via Benefits for Medicare planning advice
  • Ensure providers are updated with your new plan information (pharmacies, facilities, doctors)
  • Review coverage details and identify any gaps
  • Mark calendar for future enrollment periods if you want to consider changes
Medicare Enrollment Period
Period Description
Initial Enrollment Period (IEP)
  • 7-month period that begins 3 months before you turn 65, includes the month you turn 65, and extends 3 months after your 65th birthday.
  • This is when you first become eligible to enroll in Medicare Parts A and B.
  • If your birthday is on the first of the month, your 7-month period starts 4 months before the month you turn 65 and ends 2 months after.
General Enrollment Period
  • Runs from January 1 to March 31 each year for people who missed their Initial Enrollment Period.
  • Coverage begins July 1, and you may face late enrollment penalties if you don't have creditable coverage.
Medicare Open Enrollment Period (OEP)
  • Runs from October 15 to December 7 each year.
  • This is when you can make changes to your Medicare coverage, including switching between Original Medicare and Medicare Advantage plans, changing Medicare Advantage plans, or adding/dropping Medicare Part D prescription drug coverage.
  • Changes are effective on January 1
Medicare Advantage Open Enrollment Period
  • Runs from January 1 to March 31 each year.
  • If you're enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare (and add a Part D plan) during this time.
Special Enrollment Period (SEP)
  • 8-month period after employment or employer coverage ends
  • Allows enrollment without penalty if you delayed Medicare due to qualifying situations such as moving to a new area, losing employer coverage, qualifying for extra help with prescription costs, or being in a plan that's ending.
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