What Does Medicare Cost?

Certain Parts of Medicare Have A Monthly Cost And Some Individuals Will Pay More Than Others-

Original Medicare consists of Part A Hospital Coverage and Part B Medical Coverage. For most people Part A will be Free. Part B comes with a Base premium of $185.00 but some people will pay more.

Hospital Part A Monthly Premium–

Most individuals when nearing retirement age have worked more than 10 years, or 40 Quarters in Government Speak. It’s important because any time worked that adds up to less than 40 Quarters will result in a monthly premium and you’ll have to pay for your Part A Hospital coverage. For example in 2025
-If you worked between 30 to 39 Quarters then your Part A premium will be $285.00 per month.
-If you worked 29 Quarters or less your Part A premium will be $518.00 per month.

Hospital Part A Coverage–

Hospital Part A offers coverage for an Inpatient Hospital stay and time spent in a Skilled Nursing Facility following an Inpatient Hospital stay. An Inpatient Hospital stay is broken down into 60 day benefit periods. If you have to return to the Hospital for the same condition within 60 days the cost share will not apply. The costs are as follows:

Hospital Part A Cost Sharing-

In 2025 the Cost Share is as follows:
Days 1- 60- Beneficiaries will be responsible for a $1676 deductible.
Days 61- 90- $419.00 Coinsurance Per Day
Days 91- 150- $838.00 Coinsurance Per Day (Utilizing the 60 day Lifetime Allowance)
Days 151 and beyond- All Costs
Skilled Nursing Facility-
Following an Inpatient Hospital stay Medicare will cover 20 days. The costs are as follows:
Days 1- 20- $0 Coinsurance per day
Days 21- 100- $209.50 Coinsurance per day
Days 101 and beyond- All costs

Medical Part B Coverage-

Medicare Part B provides coverage outside of an Inpatient Hospital stay including the Emergency Room. Coverages include Primary Care and Specialist visits, testing, blood work, specialty injectable medications, durable medical equipment, diabetic supplies and testing materials. Doctor prescribed Medication is not covered. (Prescription Medications are covered by Medicare Part D at an additional cost.)

Medical Part B Monthly Premium–

Part B Monthly Premium- The Base Monthly Premium for 2025 is $185.00 depending upon income. Some will pay a higher amount-
Income Related Monthly Adjustment Amount (IRMAA) – Some individuals will pay a higher monthly premium due to a higher annual income. For 2025 the base annual income for a single filing individual is $106,000 or less and $212,000 for couples filing jointly. Any amounts above will result in a higher monthly premium and an increase in their Part D monthly premium. Social Security looks back 2 years so for some, their income is not being correctly represented resulting in a higher monthly premium based on wrong information. If your income has gone down you are able to get your monthly premium lowered by filing a “Life Changing EventForm.\”Please see the Income Chart Below. You can also download the adjustment form from our documents library, there is a link below as well.

Medical Part B Cost Sharing-

Additionally, Medicare Beneficiaries will have cost sharing when using Medicare Part B services. They are as follows:
Part B Deductible– $257.00. Individuals will be responsible for the first $257.00 of their Medical coverage. This is an annual deductible and only paid once.
Part B Coinsurance– 20%- Once the deductible is satisfied Medicare will pay 80% of all approved amounts and the Medicare Beneficiary will be responsible for 20%.

DOCUMENTS LIBRARY

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.