Understand Medicare at a Glance
This single‑page brochure summarizes Medicare Parts A–D and Medigap (supplement) plans, with 2025 costs, income-related amounts (IRMAA), and enrollment steps with Social Security.
Need Help by Phone?
- Medicare: 1‑800‑MEDICARE (1‑800‑633‑4227) • TTY 1‑877‑486‑2048
- Social Security: 1‑800‑772‑1213 • TTY 1‑800‑325‑0778
Key Enrollment Windows
- IEP: 7‑month window around your 65th birthday.
- GEP: Jan 1–Mar 31 (if you missed IEP/SEP).
- SEP: After certain life events (e.g., loss of job‑based coverage).
- AEP: Oct 15–Dec 7 — change MA or Part D plans; join, switch, or drop. New plan starts Jan 1.
- OEP: Jan 1–Mar 31 — if already in MA, make one change or return to Original Medicare (add Part D).
Medicare Overview
Medicare is federal health insurance for people 65+ and some under 65 with certain disabilities or ESRD. Original Medicare (Parts A & B) is managed by the federal government. Most people add either a Medigap supplement + Part D drug plan, or enroll in an all‑in‑one Medicare Advantage (Part C) plan (usually includes drug coverage).
Part A — Hospital Coverage
Covers inpatient hospital care, skilled nursing facility (short‑term rehab), hospice, and some home health.
What you pay in 2025
- Deductible (per benefit period): $1,676
- Hospital coinsurance: Days 1–60 $0 after deductible
- Days 61–90: $419/day
- Days 91–150 (lifetime reserve): $838/day
- SNF (days 21–100): $209.50/day
Premiums
- Most people: $0/mo (premium‑free with 40+ quarters of work).
- Buy‑in (if not eligible): up to $518/mo (reduced $285/mo with 30–39 quarters).
Part B — Medical Coverage
Covers doctor visits, outpatient services, preventive care, lab work, imaging, durable medical equipment, and some home health.
What you pay in 2025
- Standard premium: $185/mo
- Annual deductible: $257
- After deductible: typically 20% coinsurance for Medicare‑approved services.
IRMAA — Income‑Related Monthly Adjustment Amount (2025)
If your 2023 MAGI was above $106,000 (single) or $212,000 (married filing jointly), you pay the standard premium plus an IRMAA add‑on below.
| 2023 MAGI (Single) | 2023 MAGI (Joint) | Part B Add‑On | Total Part B/mo | Part D Add‑On |
|---|---|---|---|---|
| ≤ $106,000 | ≤ $212,000 | $0 | $185.00 | $0 |
| $106,001–$133,000 | $212,001–$266,000 | $74.00 | $259.00 | $13.70 |
| $133,001–$167,000 | $266,001–$334,000 | $185.00 | $370.00 | $35.30 |
| $167,001–$200,000 | $334,001–$400,000 | $295.90 | $480.90 | $57.00 |
| $200,001–< $500,000 | $400,001–< $750,000 | $406.90 | $591.90 | $78.60 |
| ≥ $500,000 | ≥ $750,000 | $443.90 | $628.90 | $85.80 |
IRMAA is based on your IRS‑reported income from two years prior and may be reconsidered after certain life‑changing events.
Part C — Medicare Advantage (MA)
Private plans that bundle Part A and Part B, usually include Part D, and may offer extras like dental/vision, fitness, and over‑the‑counter allowances. You still pay your Part B premium, and you use the plan’s provider network and rules.
- Common types: HMO, PPO, PFFS, SNP.
- Annual in‑network MOOP (max out‑of‑pocket) varies by plan (federal cap applies); check plan documents.
- Copays/coinsurance are set by the plan for hospital, doctor, and drug costs.
- You can only enroll/switch during specific enrollment periods (see below).
Part D — Prescription Drug Coverage
Offered by private insurers as a stand‑alone plan (PDP) with Original Medicare, or embedded in many MA plans (MAPD). Premiums vary by plan and location; higher incomes pay an IRMAA add‑on (see table above).
- Standard benefit redesigned for 2025: $2,000 annual out‑of‑pocket cap (some plans allow monthly “smoothing” payments).
- Formularies, tiers, and preferred pharmacies affect your costs—compare before enrolling.
- Late enrollment penalty may apply if you go 63+ days without creditable drug coverage after you’re first eligible.
Medigap (Medicare Supplement) — Plans A–N
Medigap policies are standardized supplements (A–N) sold by private insurers to help pay costs Original Medicare doesn’t (like deductibles, coinsurance). You can’t have Medigap and Medicare Advantage at the same time.
Popular options
- Plan G: Comprehensive for new enrollees (does not cover Part B deductible). High‑deductible G available.
- Plan N: Lower premiums; copays for some visits; no Part B excess charge coverage.
- Plans K & L: Cost‑sharing with annual out‑of‑pocket limits; lower premiums.
- Plan F: Closed to those newly eligible after 1/1/2020 (still available if eligible before).
What Medigap generally covers
- Part A coinsurance & hospital costs (all plans).
- Part B coinsurance/copays (most plans; Plan K 50%, L 75%).
- Blood (first 3 pints) and hospice coinsurance/copays.
- Skilled Nursing Facility coinsurance (not Plan A/B).
- Part A deductible (all except A & B; K covers 50%, L 75%).
- Part B deductible: Only Plan C/F (not for those newly eligible after 1/1/2020).
- Part B excess charges: Plans F & G.
- Foreign travel emergency (C, D, F, G, M, N up to plan limits).
- No Network, go to any doctor Nationally that contracts (takes “Assignment”) with Medicare.
Medigap benefits are federally standardized, but availability and pricing vary by state and carrier. Some states have extra protections (e.g., birthday rules). Always review a plan’s outline of coverage.
How & When to Enroll in Parts A & B (through Social Security)
- Initial Enrollment Period (IEP): A 7‑month window around your 65th birthday (3 months before, your birth month, and 3 months after). If you’re already getting Social Security, you’re usually enrolled automatically.
- Special Enrollment Periods (SEP): If you delayed Part B due to qualifying job‑based coverage, you can enroll later without a penalty (documentation required; see SSA/CMS forms such as CMS‑L564).
- General Enrollment Period (GEP): Jan 1–Mar 31 each year if you missed IEP/SEP; coverage begins the first of the month after you sign up.
Enroll Online
Apply for Medicare Part A & Part B through Social Security’s online application.
Key Tips
- Have your employer complete CMS‑L564 if using a SEP after job‑based coverage.
- If you live in Puerto Rico or outside the U.S., you may need to actively enroll in Part B.
- Enrolling in Part B late may trigger a lifetime penalty unless you qualify for a SEP.
Annual & Open Enrollment Periods
AEP — Annual Election Period
October 15–December 7 each year.
- Join, switch, or drop a Medicare Advantage (MA) plan.
- Join, switch, or drop a Part D prescription drug plan (PDP).
- Changes take effect January 1 of the following year.
Tip: Review your ANOC (Annual Notice of Change) and compare plans on Medicare.gov during AEP.
OEP — Medicare Advantage Open Enrollment
January 1–March 31 each year.
- Available only if you are currently enrolled in an MA plan on January 1.
- You may make one change: switch to a different MA plan or return to Original Medicare and optionally enroll in a stand‑alone Part D plan.
- Coverage generally begins the first of the month after the plan receives your request.
Note: OEP does not allow switching from one PDP to another if you have Original Medicare.
Important Contacts
This brochure is a summary. It’s not a plan contract or legal advice. Always confirm details with Medicare, SSA, your plan, and your state’s SHIP.