Medicare Coverage Options & Guidance

Medicare is a vital lifeline for seniors and individuals with disabilities

Health insurance is essential for protecting your well-being and financial stability, offering coverage for medical expenses that can arise unexpectedly. With the right plan, you gain access to quality care, preventive services, and timely treatments, all while minimizing the financial burden of healthcare costs. Whether you're managing a chronic condition

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Comprehensive coverage: Medicare Advantage plans provide all Part A (hospital) and Part B (medical) services of Original Medicare, while often including additional benefits such as prescription drug coverage, vision, dental, and hearing services

Cost savings: Many Medicare Advantage plans offer $0 premium options and have an out-of-pocket maximum, which caps your annual healthcare expenses. In 2025, this maximum will be $9,350 for in-network services, providing financial predictability

Additional health and wellness benefits: Medicare Advantage plans often offer extra perks not available with Original Medicare, such as fitness club memberships, medically necessary transportation, and access to brain games for mental health

Prescription drug coverage: Many Medicare Advantage plans include Part D prescription drug coverage, eliminating the need for a separate plan and potentially lowering costs. Starting in 2025, there will be a $2,000 out-of-pocket cap for prescription drugs, saving enrollees an estimated $400 per year

Convenience: Medicare Advantage plans often combine hospital, medical, and prescription drug coverage into a single plan, simplifying healthcare management for beneficiaries

Frequently Asked Questions

Who is eligible for Medicare?

Generally, you are eligible for Medicare if you are:

A U.S. citizen or legal resident who has lived in the country for at least 5 consecutive years

Age 65 or older

Under 65 with a qualifying disability (after receiving Social Security disability benefits for 24 months)

Diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) at any age

What does Medicare cover?

Medicare coverage includes:

Part A: Inpatient care in hospitals, skilled nursing facilities, hospice care, and some home healthcare

Part B: Outpatient care, doctor visits, medical supplies, preventive care, and screening services

Part C (Medicare Advantage): An alternative to Original Medicare that may offer additional coverage

Part D: Prescription drug coverage

How much does Medicare cost?

Medicare costs in 2021 included:

Part A: Free for most people who have paid Medicare taxes for at least 10 years; otherwise, $259 or $471 per month

Part B: Standard premium of $148.50 per month (or higher depending on income) with a $203 annual deductible

Part D: Monthly premium varies by plan

Will I be automatically enrolled in Medicare when I turn 65?

If you are receiving Social Security or Railroad Retirement benefits, you will be automatically enrolled in Medicare Part A and Part B about 3 months before your 65th birthday.