Understanding Your Medicare Coverage

Health Line

4 hours ago

There are many Medicare options to consider, so understanding how to navigate them is important. You can begin considering Medicare options before you turn 65, which is when you first become eligible.
Medicare is government-funded health insurance available to people ages 65 and older.
If you have specific health conditions, including amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD), you'll be eligible before turning 65.
Medicare is different from Medicaid, which is specifically for people with low incomes and resources.
About Medicare
Before you turn 65, you may want to consider your current health insurance, when it will end, and whether you may need any new or additional benefits in the future.
Original Medicare has two main parts — Part A and Part B. These parts cover most inpatient and outpatient services.
Other parts of Medicare include Medicare Advantage (Part C), Part D prescription drug plans, and Medigap supplement insurance. Private insurers administer these plans and offer additional benefits and services.
You can choose a plan or combination of plans that will work best for you by considering:
budget
doctor, hospital, or clinic preferences
current and future health conditions
medications
Once you're eligible for Medicare, you may be automatically enrolled. If not, you can enroll online, by post, or in person at a local Social Security office.
Medicare coverage
The different Medicare parts include the following coverage:
Medicare Part A
Part A is for inpatient hospital care.
It covers the services you receive when you are admitted to a hospital or other inpatient healthcare facility.
It does not cover outpatient care, most hospital room extras, private, custodial care, or long-term care.
Medicare Part B
Part B covers outpatient services, including diagnostic tests related to your health conditions.
It also covers some preventive services and limited prescription drugs.
Medicare Part D prescription drug plans
If you have Original Medicare, you can enroll in a Part D drug plan.
Each Part D drug plan has a formulary, which is a list of covered medications.
As private insurers administer these plans, it's important to consider the covered medications when comparing the different options.
Medicare Advantage (Part C)
Medicare Advantage plans must include the same benefits as Original Medicare Part A and Part B.
Plans typically include additional benefits like fitness, vision, dental, and prescription medications.
You can use Medicare's plan finder to search for plans in your area.
Medigap
Medicare supplemental insurance can be added to Original Medicare only. It helps cover some of the associated out-of-pocket costs.
There are currently 10 different Medigap plans to choose from, although not all plans are available in all areas.
Medicare costs
Medicare costs will vary by plan but can include monthly premiums, deductibles, coinsurance, and copayments.
Part A
In 2025, Medicare Part A costs include:
Monthly premium: Most people pay $0 for Part A, but this will depend on your working history.
Deductible: It is $1,676 per benefit period. A benefit period begins when you're admitted to a hospital and ends when you haven't received any inpatient care for 60 days in a row.
Copayment: This ranges from $0 to the full cost of services, depending on the length of your hospital stay.
Part B
In 2025, Medicare Part B costs include:
Premiums: premiums start at $185 per month but can increase based on your income
Deductible: $257 per year
Coinsurance: 20% of the Medicare-approved amount for eligible Part B items or services
Part C
Medicare Advantage plan costs vary but can include:
monthly premiums
annual deductibles
copayments
coinsurance
According to the Centers for Medicare & Medicaid Services (CMS), the average monthly Part C premium is around $17 in 2025.
Part D
Premiums and other out-of-pocket costs for Medicare Part D prescription drug plans vary by plan, plan provider, and location.
The national 2025 base beneficiary premium is $36.78, and your plan price can increase based on your income.
Medigap
You'll pay a separate premium for a Medigap plan, which can vary by plan provider and location.
Medicare billing
Most people will not receive a bill from Medicare, as it generally operates a fee-for-service (FFS) model. This means that healthcare facilities, professionals, doctors, and clinics bill Medicare directly for each item or service.
Plan premiums may automatically be deducted from Social Security benefits, but if not, Medicare will bill you.
How to pay for Medicare premiums
There are various ways to pay your Medicare bills each month, including:
through Medicare's website, with a debit or credit card
by mail, using a check, money order, or payment form
Another way to pay your Medicare bill is through Medicare Easy Pay. This free service allows you to pay your monthly Medicare Part A and Part B premiums through automatic bank withdrawals. You can print and complete the Authorization Agreement for Preauthorized Payments form (SF-5510), which is available in English and Spanish.
Takeaway
Medicare can be complex, but understanding the basics can help you focus on your coverage needs.
Original Medicare covers inpatient and outpatient medical services. Additional plans can be added to cover take-home prescription drugs and some of Original Medicare's out-of-pocket costs. Other bundled plans are also available.
Medicare's website can help you browse the different plan options available in your area, and help you make the best choice for your healthcare needs.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.