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Table of Contents
Resources

Understanding Medicare: The Cost of Coverage and Benefits

Selah Lee
Reviewed by:
Selah Lee

Key Takeaways

  • By understanding the differences between Medicare plans, you will identify which plan’s services and costs will work for your loved one.
  • Keep important enrollment dates in mind to avoid penalties and late fees.
  • You’ll want to know how much you’ll pay for premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. , copaymentsA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you’ll pay $20 to your doctor whenever you have an appointment. , coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. Your insurance company pays the remaining amount. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you’ll pay $200. Your insurance company will cover the final $800. , and deductiblesA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. .

If you’re responsible for caring for a loved one or choosing their Medicare plan, you should know there are many health insurance options available to meet their specific needs.

When families and caregivers know where to look for healthcare resources, they are empowered to manage their loved one’s health needs.

Here is a compilation of information to help you find the right plan.

Start your Medicare PlanFit CheckUp today.

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Eligibility Basics: What to Know

Most people 65 years of age or older are eligible for Medicare when they turn 65, but there are some things to keep in mind:

  • They will receive enrollment cards and information about three months before their birthday.
  • If they are not automatically enrolled, they can sign up in-person at any local Social Security office.
  • Also, they can enroll online or over the phone with the Social Security Administration.

Types of Medicare Plans & Coverage

Comparing options is essential to determine if someone you’re caring for has the right plan or if different coverage may work for their health needs. GoHealth licensed insurance agents can help you determine which plan type will work for their unique needs.

These are the Medicare options and cost information (including annual changes in premiums and deductibles):

  • Original Medicare (Part A and Part B) provides some coverage for hospital and medical needs. Medicare beneficiaries will still be responsible for 20% of medical bills and other hospital coinsurance that can be costly.
  • Medicare Advantage (Part C) combines Original Medicare (Part A and Part B) and may include Part D, vision and dental, and other benefits all in one plan. We will dive deeper into the details of Medicare plans and coverage to help you better understand your options.
  • Medicare Part D provides prescription drug coverage. It is offered as either a standalone plan that can be added to Original Medicare or beneficiaries can enroll in a Medicare Advantage plan with prescription drug coverage.
  • Medicare Supplement Plan (Medigap) will help cover the remaining 20% of what Original Medicare does not cover. These policies can help with deductibles, copays and coinsurance.

Find the Medicare Plan that works for you.

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Premiums, Deductibles, & Copayments

Medicare’s payment rates typically change each year. Here’s a breakdown of the standard premium, copayment and deductible costs for Medicare in 2025:

Medicare Part A

Premium payment

  • $0 if you paid into Medicare for 40 or more quarters
  • $285 a month if paid into Medicare for 30-39 quarters
  • $518 a month if you paid into Medicare for 0-29 quarters

Deductible

  • $1,676 for each hospital benefit period

Copayment

  • Hospital Stays by Day:
    • 1-60: $0 copay after the deductible is met
    • 61-90: $419 a day
    • 91-150: $838 per lifetime reserve day
  • Skilled Nursing Facility by day:
    • 1-20: $0 for each benefit period
    • 21-100: $209.50 coinsurance per day for each benefit period
    • 100+: all costs

Medicare Part B

Premium payment

  • $185 a month for most people
  • Additional charge per month for people with incomes over a certain level
  • The cost could be less for people with incomes below a certain level

Deductible

  • $257

Copayment

  • None for most preventative services
  • 20% of the Medicare-approved costs for other services

Medicare Part D

Premium payment

  • Varies by Part D plan. There may be an additional monthly charge for people with higher income levels.

Deductible payment

  • Varies by plan, but no more than $590 in 2025

Copayment

  • Varies by plan, with drugs assigned to various tiers.

Medicare & Medicaid

An individual under the age of 65 receiving Social Security Disability Insurance can have Medicaid and later enroll in Medicare after 24 months of receiving Social Security Disability benefits, or upon reaching the age of 65.

Individuals who are receiving both Medicare and Medicaid (with cost-share protection) are considered to be dual-eligible beneficiaries. The cost-share protection expands coverage to assist with out of pocket costs like copays and deductibles. Some people qualify for Low-Income Subsidy (LIS or Extra Help) which helps lower the costs of their prescription drugs and helps with the cost of premiums on plans with prescription drug coverage.

Find out more about how Medicare and Medicaid work together and including a few of Medicare’s subsidy programs.

Important Enrollment Dates

You don’t need to re-enroll the person you care for each year, but you should review their coverage each year since plans can change annually.

If you provide care for someone new to Medicare, they have an Initial Enrollment Period (IEP) to select benefits when they are first eligible for Medicare. The IEP is three months before and after their 65th birthday month. If they miss the enrollment deadline, they can enroll in Part A and/or Part B during the General Enrollment Period, which is January 1 to March 31 each year.

Get real Medicare answers and guidance – no strings attached.

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Enrollment Periods

Enrollment Period  Dates What You Can Do Coverage Begins
Initial Enrollment Period (IEP)

Starts 3 months before you turn 65 and ends 3 months after you turn 65 (7 months total).

  Sign up for a Medicare Advantage or Medicare Part D prescription drug plan.

On the first day of your birth month if you enrolled before your birth month. Otherwise, the first of the following month.
General Enrollment Period January 1-March 31  Sign up for Medicare Part A and/or Part B July 1
Medicare Advantage Open Enrollment Period January 1-March 31 If you have a Medicare Advantage plan on 1/1 of the year, you can make a one-time switch to another MA plan or to Original Medicare. The first day of the following month after you make the change
Special Enrollment Period SEPs are available all year and depend on specific qualifications. Sign up for a Medicare Advantage or Medicare Part D prescription drug plan. The first day of the following month
Annual Enrollment Period October 15-December 7  Sign up for a Medicare Advantage or prescription drug plan for the following plan year  January 1 of the following year

FAQs

Most people over the age of 65 or older are eligible for free hospital insurance (Medicare Part A) if they have worked and paid Medicare taxes long enough. Medicare Part B has a standard monthly premium and deductible. The Part B deductible may be waived for certain plans. Also, some people can have their Part B premium paid by Medicaid.
If someone has other creditable medical coverage, such as employer insurance, union insurance, etc., they can delay enrolling in Part B. Once the creditable coverage ends, they can enroll in Part B during a Special Enrollment Period without being penalized.
Most people choose to apply for secondary health insurance such as Medicare Supplement Insurance (Medigap) or a Medicare Advantage plan. Medigap plans help to cover the additional 20% not covered by Medicare. They can be combined with standalone prescription drug plans. Medicare Advantage (also known as Part C) combines Parts A and B and usually Part D. Most Medicare Advantage plans also offer benefits like dental, vision, hearing and more.

Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.