Costs and coverage

Medicare is the federal health insurance program primarily for individuals age 65 and older, as well as certain younger individuals with disabilities. It includes several parts, each covering different aspects of healthcare. Below is an overview of the main components:

Coverage Includes:

• Inpatient hospital stays
   
• Short-term care in a skilled nursing facility
   
• Hospice care
   
• Limited home health care services
   

Costs (2025):

• Monthly Premium: $0 for most (if you or your spouse paid Medicare taxes for at least 10 years); up to $518/month if not eligible for premium-free Part A
   
• Deductible: $1,675 per benefit period
   
• Additional Costs: Copayments may apply after a certain number of hospital days
   

Coverage Includes:

• Doctor visits and outpatient care
   
• Preventive services and lab tests
   
• Durable medical equipment (e.g., wheelchairs, walkers)
   

Costs (2025):

• Monthly Premium: Starts at $185/month (may be higher based on income)
   
• Annual Deductible: $257
   
• Coinsurance: Typically 20% of Medicare-approved services after the deductible
   

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans replace Original Medicare and often include additional benefits.

Coverage Includes:

• All benefits from Parts A and B
   
• Most plans include Part D (prescription drugs)
   
• Additional services may include:
   
  • Dental, vision, and hearing
     
  • Fitness and wellness programs
     
  • Over-the-counter (OTC) items
     

Costs:

• Monthly Premiums: Many plans offer $0 premiums, though you must still pay the Part B premium. Some plans have an additional plan premium
   
• Out-of-Pocket Costs: Copayments for services like doctor visits or hospital stays
   
• Protection: Annual out-of-pocket maximum limits help protect against high healthcare costs
   

Note: Coverage and costs vary by plan and ZIP code. We can help you compare available options in your area.
 

These standalone plans help cover the cost of prescription medications and can be added to Original Medicare or certain Medicare Advantage plans that do not include drug coverage.

Coverage Includes:

• Both brand-name and generic medications
   
• A formulary (list of covered drugs) that varies by plan
   

Costs (2025):

• Monthly Premiums: Vary by plan (national average ≈ $34/month)
   
• Annual Deductible: Up to $590 (some plans waive this)
   
• Cost Sharing: Copayments or coinsurance based on drug tier
   

Medigap plans are offered by private insurers and help cover the out-of-pocket costs not paid by Original Medicare, such as deductibles, coinsurance, and copayments.

Coverage Highlights:

• Helps reduce financial exposure from Original Medicare “gaps”
   
• Does not include prescription drug coverage or routine dental, vision, or hearing care
   
• No network restrictions: you can see any provider that accepts Medicare
   

Costs:

• Monthly Premiums: Vary by plan, age, location, and insurer (typically $50–$300+ per month)
   
• Eligibility: Must be enrolled in both Part A and Part B to purchase a Medigap plan
   

Even with Medicare, beneficiaries may still be responsible for:

• Monthly premiums (for Parts B, D, Advantage, or Medigap)
   
• Copayments and coinsurance for medical services
   
• Prescription drug expenses
   
• Dental, vision, or hearing services (unless covered by a specific plan)
   
• Costs associated with out-of-network care (especially in some Advantage plans)