Coverage

Medicare, the federal health insurance program primarily for individuals aged 65 and older, offers comprehensive coverage through its various parts:

Medicare Part A (Hospital Insurance):

Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most beneficiaries do not pay a premium for Part A if they or their spouse have paid Medicare taxes for a sufficient period. However, there are associated costs such as deductibles and coinsurance.

Medicare Part B (Medical Insurance):

Part B covers outpatient care, preventive services, ambulance services, and durable medical equipment. Beneficiaries pay a monthly premium for Part B, which is $185.00 in 2025. After meeting the annual deductible of $257 in 2025, beneficiaries typically pay 20% of the Medicare-approved amount for most services.

Medicare Part C (Medicare Advantage):

Part C, or Medicare Advantage, allows beneficiaries to receive their Part A and Part B benefits through private insurance plans approved by Medicare. These plans often include additional benefits such as vision, dental, and hearing services, and many also offer prescription drug coverage. Costs and coverage details vary by plan and location.

Medicare Part D (Prescription Drug Coverage):

Part D provides prescription drug coverage through private plans. In 2025, a significant change is the implementation of a $2,000 cap on out-of-pocket spending for prescription drugs, enhancing affordability for beneficiaries.

Medicare Supplement Insurance (Medigap):

Medigap policies are sold by private companies to help cover costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. These plans can provide financial predictability by reducing unexpected out-of-pocket expenses.

Key Changes in 2025:

• Prescription Drug Cost Cap: Starting in 2025, out-of-pocket spending for covered Part D drugs will be capped at $2,000, providing significant financial relief to beneficiaries.
• Medicare Prescription Payment Plan: Beneficiaries will have the option to spread out their out-of-pocket prescription drug costs over the year through monthly payments, easing the financial burden of high-cost medications.

Frequently Asked Questions:

1. What services are covered under Medicare Part A?

   Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services.

2. Does Medicare cover preventive services?

   Yes, Medicare Part B covers various preventive services, including screenings, vaccines, and annual wellness visits, to help prevent or detect illnesses early.

3. Are prescription drugs covered under Original Medicare?

   Original Medicare (Parts A and B) does not cover most prescription drugs. To obtain prescription drug coverage, beneficiaries can enroll in a Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.

4. What is the difference between Medicare Advantage and Medigap plans?

   Medicare Advantage (Part C) plans are an alternative way to receive Medicare benefits through private insurers and often include additional services. Medigap plans, on the other hand, supplement Original Medicare by covering certain out-of-pocket costs like copayments and deductibles.

5. How can I manage high prescription drug costs under Medicare?

   Starting in 2025, Medicare Part D will cap out-of-pocket prescription drug costs at $2,000. Additionally, beneficiaries will have the option to spread these costs over the year through the Medicare Prescription Payment Plan. Reviewing plan options annually during the open enrollment period can also help in selecting a plan that offers the best coverage for your medication needs.