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My Medicare Pilot
  • Home
  • All About Medicare
    • Medicare for Beginners
    • Medicare Enrollment Help
    • Medicare Plan Comparisons
  • Resources
    • Helpful Blog Articles
    • Resources for Seniors
    • Wellness Essentials
    • Financial & Legal Tools
    • Tech for Seniors
    • Aging In Place
  • About Medicare Pilot

New to Medicare? Start Here.

We break it all down — what Medicare is, how it started, and what each part (A, B, C, D) covers — in language that actually makes sense.


Need Help Enrolling? Click Below.

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Medicare 101

What is Medicare?

A Quick History of Medicare

A Quick History of Medicare

medicare is a federal health insurance program

Medicare is the federal government’s health insurance program for:

  • People age 65 and older
     
  • People under 65 with certain disabilities
     
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
     

It helps cover hospital stays, doctor visits, medical procedures, and prescription drugs — depending on the type of plan you choose.

A Quick History of Medicare

A Quick History of Medicare

A Quick History of Medicare

Medicare began in 1965, when President Lyndon B. Johnson signed it into law. Before then, many older Americans couldn’t afford health insurance — or were denied coverage due to age or health conditions.


The goal of Medicare was simple:

To give older Americans and people with disabilities access to affordable, reliable health care.
 

Since then, the program has expanded to include more services and choices — including Medicare Advantage plans and prescription drug coverage.

The Purpose of Medicare

A Quick History of Medicare

The Purpose of Medicare

beneficiaries eligible for Medicare

Medicare is here to protect you from the high cost of medical care as you age or if you live with a qualifying condition. It gives you access to:


  • Doctors, hospitals, and specialists
     
  • Preventive care and screenings
     
  • Prescription medications
     
  • Emergency and inpatient care
     
  • Chronic illness management
     

But not all coverage is automatic — and not all options are right for everyone. That’s where guidance can help.

Understanding Medicare Parts A, B, C and D

Medicare is broken down into "parts" which cover different types of services. Here’s a simplified breakdown of the four parts of Medicare:

Covers:


  • Inpatient hospital stays
     
  • Skilled nursing facilities
     
  • Hospice care
     
  • Some home health care
     

Usually free if you or your spouse paid Medicare taxes for 10+ years.


Covers:


  • Doctor visits
     
  • Outpatient care
     
  • Preventive services (like screenings)
     
  • Durable medical equipment (like walkers or oxygen)
     

You pay a monthly premium for Part B (standard amount in 2025: $185 – varies by income).


Covers:


  • Everything in Parts A and B
     
  • Often includes prescription drug coverage
     
  • May include dental, vision, and hearing
     
  • Managed by private insurance companies
     

You must be enrolled in Parts A and B to join a Part C plan.


Covers:


  • Prescription medications
     
  • Tiered formularies (generic vs brand name)
     
  • Often included in Part C plans or purchased separately
     

Enrolling in Part D late may result in a lifelong penalty — don’t delay.


The "Medicare" vs Original Medicare Debate

Referring to "Medicare" without context can (and often does) create confusion. Two beneficiaries can both be enrolled in Medicare, but their coverage look completely different. Kind of like the image to the right: two individuals can both be eating apples, but the look, texture and flavor provide very different experiences.


When beneficiaries enroll in Medicare for the first time, they are enrolling in Medicare Parts A and B only. This is called Original Medicare. 


Enrolling in other Parts (like C and D) is a separate event, and does not happen automatically. 


Be cautious when taking advice from other Medicare beneficiaries — their situation may be very different from yours. That’s why working with a licensed, experienced Medicare advisor can make all the difference in getting guidance tailored to your needs.

apples of different varieties, similar to Medicare of different varieties

What Medicare Doesn't Cover (And What to Do About It)

Medicare (specifically Original Medicare) does not typically cover:


  • Long-term care (nursing homes)
     
  • Dental care
     
  • Vision or hearing aids
     
  • Routine foot care
     
  • Overseas medical coverage
     

Solution: Many people choose a Medicare Supplement (Medigap) or a Medicare Advantage Plan to help fill these gaps.

Have a specific need, and want to know if it's covered?

That's where our guidance comes in handy.

Schedule a Consultation

Countdown to AEP

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Now is the time to elect coverage for 1/1/2026

What Does Medicare Cost?

Breaking Down Medicare Costs

With most any insurance plan, there are two primary costs to consider:


  • Monthly Premiums


  • Out-Of-Pocket Costs (like deductibles, copays and co-insurance)


The costs below can be found on Medicare.gov. When estimating your own costs, be sure to included premiums and OOP costs for all coverage, including Original Medicare and supplemental coverage costs. Request help from a trusted guide to find out how the costs below may apply to you.

Confused about how much you'll pay?

I can help you figure out the costs based on your unique needs and situation.

Schedule a Consultation

Cost Overview

Part A - Hospital Insurance

Part D - Prescription Drug Coverage

Part A - Hospital Insurance

Monthly Premium:


  • $0 for most people (if you or your spouse worked and paid Medicare taxes for at least 10 years)
     
  • Up to $518/month if you haven’t met the work requirement
     

Out-of-Pocket Costs:


  • Inpatient Hospital Deductible: $1,676 per benefit period
     
    • Days 1–60: $0 per day
       
    • Days 61–90: $419 per day
       
    • Days 91+ (Lifetime Reserve Days): $838 per day
       
  • Skilled Nursing Facility (after 20 days): $209.50/day (days 21–100)

Part B - Medical Insurance

Part D - Prescription Drug Coverage

Part A - Hospital Insurance

Monthly Premium:


  • $185/month (standard for 2025; higher if your income is above $103,000 for individuals or $206,000 for couples)
     

Out-of-Pocket Costs:


  • Annual Deductible: $257
     
  • Coinsurance: 20% of approved Medicare charges (after deductible)
     
  • No out-of-pocket maximum unless you have supplemental coverage

Part D - Prescription Drug Coverage

Part D - Prescription Drug Coverage

Part D - Prescription Drug Coverage

Monthly Premium:


  • Varies by plan and location
     
  • Higher-income individuals may pay an additional IRMAA surcharge
     

Out-of-Pocket Costs:


  • Annual deductible: Varies by plan
     
  • Copays/coinsurance based on drug tier
     
  • Catastrophic coverage kicks in after ~$8,000 in total drug spending (no more 5% coinsurance in 2025 due to Inflation Reduction Act)

Part C - Medicare Advantage Plans

Part C - Medicare Advantage Plans

Part D - Prescription Drug Coverage

Monthly Premium:


  • Varies by plan — some as low as $0/month, though some charge additional premiums
     
  • You must still pay your Part B premium
     

Out-of-Pocket Costs:


  • Varies by plan — may include:
     
    • Copays for doctor visits, hospital stays, prescriptions
       
    • Out-of-pocket maximum: Each plan sets its own
       
    • May include coverage for vision, dental, hearing, fitness, etc.

Medicare Supplement (Medigap)

Part C - Medicare Advantage Plans

Medicare Supplement (Medigap)

Monthly Premium:


  • Varies by plan, location and other variables


  • You must still pay your Part B premium


  • Does not include drug coverage (separate premium)
     

Out-of-Pocket Costs:


  • Medigap usually helps pay your portion of the costs (like deductibles and coinsurance) for services that Part A and Part B cover in Original Medicare. 


  • The amount you’ll pay for Part A and Part B services if you have a Medigap policy varies depending on the policy you buy.

What Happens After Your Learn The Basics?

Once you understand the basics of Medicare, it's time to:

  1. Figure out when you’re eligible to enroll
     
  2. Discuss your eligibility with a licensed advisor
     
  3. Participate in a thorough Needs Analysis (more on that later)
     
  4. Choose your coverage option(s)

Notice how we didn't say "do it on your own"

That's because your health coverage in retirement is too important to leave up to chance.

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