Medicare Eligibility

Think of Part A as hospital insurance.

It covers charges for being admitted to the hospital and for rehab in a skilled nursing facility after a hospital  stay.

It also covers hospice care.

For most people Part A does not have a premium.  If you, or your spouse, has worked and paid taxes 40 quarters, 10 years, you are eligible for Part A without additional cost.

If you are not eligible for premium free Part A you can buy it.  In 2025 the premium is either $285 or $518 per month depending on how many quarters you worked and paid taxes.

Part B covers things outside the hospital. Think doctor visits, lab tests, emergency room, ambulance, etc.

There is a premium for part B.  For 2025, it is $185 per month and is usually deducted from your monthly Social Security check.

In rare instances, depending on your income, you may qualify for a subsidy to help pay your premium, or you may have to pay a surcharge that increases your monthly premium.

Yes, only the federal government would put D before C.  We'll get to C later.

Part D is prescription coverage, think D for drugs.

Drug coverage was not part of "Original Medicare," but as medication prices have skyrocketed, insurance coverage has become necessary for the vast majority of seniors.

Though highly regulated by Medicare, Part D must be purchased through private companies.  Each Part D plan is slightly different, but they all have premiums.  For 2025, the average premium for Part D is $39 per month.

This is the Medicare All-In-One plan.  It offers all the coverage of Medicare Parts A and B combined with dental, vision, hearing, and fitness coverage.  Part C usually includes Part D coverage, but can be purchased without Part D for individuals with Part D coverage from another source.

Plans differ, but all offer some combination of additional benefits such as a spending card, transportation, or post-hospital meal service.  Premiums are usually $0 or low after your $185 Part B premium.  There are copays and deductibles with a set maximum, at which point you pay no more out-of-pocket costs.

These plans tend to have networks and sometimes require referrals.

These plans, sometimes called Medigap, are designed to fill the gaps in coverage left by Original Medicare, such as deductibles, copays, and coinsurance to a greater or lesser degree.  They are identified by alphabet, Plan A through N.  They are standardized, meaning that a plan from company ABC has the same coverage as the same plan from company 123.  The most popular plan is Plan G, which covers the Part A deductible and copays as well as Part B coinsurance. These plans do not pay the Part B deductible.*  These plans do not cover medication or extra benefits.  Coverage for medication, dental, vision, and hearing must be purchased separately if desired.  The premiums for these plans tend to be more expensive, but you can see any provider that accepts Medicare, and out-of-pocket costs are more predictable.

*If you were eligible for Medicare before 2020, you have the additional option of Plan F, which pays your Part B deductible.

These plans are designed to protect you from high out-of-pocket expenses.  They can be coupled with Original Medicare, High Deductible Medicare Supplement plans, or Part C plans.

They generally cover the more expensive out-of-pocket deductibles and copays associated with inpatient hospital stays, outpatient surgery, emergency care, or expensive diagnostic testing.  They are highly customizable. The premiums vary but usually range from $30 to $90 per month.