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    • Medicare Plans Overview

Understanding Medicare: How it works and your coverage options

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Medicare is the federal health insurance program for people age 65 and older, and for younger individuals with certain disabilities. It provides essential healthcare coverage — but understanding how it all fits together can be confusing at first.

Let’s break down the basics of Original Medicare, and then explain how Medicare Advantage and Medicare Supplement (Medigap) plans connect to it.

What is Original Medicare

Original Medicare is made of two parts:

  1. Part A ( Hospital Insurance ): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  2. Part B ( Medical Insurance ): Covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services.

IMPORTANT:

Original Medicare does not cover 100% of your medical costs. You are responsible for deductibles, coinsurance, and copayments — with no out-of-pocket maximum to protect you.

What Does Original Medicare Cover?

Part A:

What it covers:

Hospital stays, skilled nursing facility care, hospice, limited home health care

Your Costs:

Deductibles, daily coinsurance for extended stays


Part B:

What is covers:

Doctor visits, outpatient care, preventive services, lab work, durable medical equipment

Your Costs:

Monthly premium, deductible, 20% coinsurance

Key Points:

  • Most people get Part A premium-free if they worked and paid Medicare taxes for at least 10 years.
  • Everyone pays a Part B premium, which can vary based on income.

What Are the Standard Costs for Medicare?

Part A:

Coverage:

Inpatient hospital care, skilled nursing facility care, hospice care

2025 Standard Costs

$1,632 deductible per benefit period; Days 1–60: $0 coinsurance; Days 61–90: $408/day; Lifetime reserve days: $816/day


Part B:

Coverage:

Doctor visits, outpatient services, preventive care

2025 Standard Costs

$174.70 standard monthly premium; $240 annual deductible; 20% coinsurance after deductible


Part C:

Coverage:

Medicare Advantage (private insurance plans)

2025 Standard Costs

Premiums vary by plan and location; copays and network restrictions may apply


Part D:

Coverage:

Prescription drug coverage

2025 Standard Costs

Premiums vary by plan; higher-income individuals may pay more (IRMAA surcharge)


Note:

Medicare costs are updated annually by the federal government. Individual costs may vary based on income and location.

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607-364-8101

We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options. Health Insurance sold on mastersonassociates.com is processed through the licensed entity: Masterson & Associates.

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