Confused about what Medicare Part A and B actually cover, or how they fit into your healthcare plan?
You’re not alone, and I’m here to help. In this article, we will go over the basics step by step, so you can feel confident about your coverage and make choices that work best for you.
1.) Medicare Alone Doesn’t Cover All Your Medical Costs
Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Part A covers inpatient hospital care, doctors’ services, tests, and preventive services. You pay for services and items as you receive them. Eligibility for Medicare coverage for Part A and B services requires lawful presence in the U.S.
While Medicare Part A covers certain hospital expenses without a premium, Medicare Part B requires a monthly premium.
In 2025, the standard Part B premium is $185.00 per month, an increase from $174.70 in 2024. Additionally, the annual deductible for Part B has risen to $257 in 2025, up from $240 in 2024.
These amounts do not include costs for a Part D prescription drug plan, copayments, or coinsurance.
Because of this most people pay way more out of pocket than they expect to. Planning for these costs is essential for anyone looking to protect their savings account.
2.) Medigap Can Help Cover Medicare Gaps
With a Medigap plan, it’s possible to get low-cost coverage for the things that Original Medicare doesn’t cover.
This includes common out-of-pocket expenses including:
- More time in the hospital if you need it (Original Medicare has a limit)
- Your Part B coinsurance or copayments
- Your Medicare Parts A and B deductibles
- First 3 pints of blood if you need a transfusion
- Foreign travel emergencies (Original Medicare doesn’t cover overseas medical expenses)
- Covers the coinsurance amount for skilled nursing facility care, which Medicare covers only for a limited time.
- Some plans cover expenses for recovery at home following a hospital stay.
- Certain plans may cover coinsurance or copayments for Medicare-covered preventive services not fully covered by Medicare alone.
There are a number of Medigap plans to choose from, each with a different set of additional benefits.
Click here to learn more about Medicare Supplement insurance plans.
3.) Medicare Advantage (Part C) Offers an All-in-One Alternative
While Medigap plans are standalone, Medicare Advantage (MA) plans combine the benefits of Original Medicare with additional coverage, all in one comprehensive plan.
In addition to Part A’s hospital care and Part B’s basic doctor services, MA plans can also cover:
- Vision care: This may include routine eye exams, glasses, or contact lenses.
- Dental care: Coverage for routine dental exams, cleanings, and other dental services.
- Hearing care: Benefits for hearing exams, hearing aids, and related services.
- Prescription drug coverage (Part D): Many MA plans include prescription drug coverage, unlike Original Medicare, which requires a separate Part D plan.
MA plans are offered by private insurance companies approved by Medicare. They may also offer additional benefits like fitness memberships or telehealth services.
It’s essential to review the details of each plan, including costs, coverage, and provider networks, to choose the one that best meets your healthcare needs.
Click here to learn more about Medicare Advantage plans.
4.) Your Medicare Costs Depend on Your Income
The cost of Medicare Part B and Part D premiums varies based on your income, determined by the Income-Related Monthly Adjustment Amount (IRMAA).
2025 Medicare Part B Premiums by Income
Single Filers:
- $106,000 or less: Standard Part B premium of $185.00; Part D premium varies by plan.
- $106,001 to $133,000: Part B premium of $259.00; additional Part D IRMAA of $13.70 plus plan premium.
- $133,001 to $167,000: Part B premium of $370.00; additional Part D IRMAA of $35.80 plus plan premium.
- $167,001 to $200,000: Part B premium of $480.90; additional Part D IRMAA of $58.20 plus plan premium.
- $200,001 to $500,000: Part B premium of $591.90; additional Part D IRMAA of $85.80 plus plan premium.
- Above $500,000: Part B premium of $628.90; additional Part D IRMAA of $85.80 plus plan premium.
Married Couples Filing Jointly:
- $212,000 or less: Standard Part B premium of $185.00 each; Part D premium varies by plan.
- $212,001 to $266,000: Part B premium of $259.00 each; additional Part D IRMAA of $13.70 plus plan premium.
- $266,001 to $334,000: Part B premium of $370.00 each; additional Part D IRMAA of $35.80 plus plan premium.
- $334,001 to $400,000: Part B premium of $480.90 each; additional Part D IRMAA of $58.20 plus plan premium.
- $400,001 to $750,000: Part B premium of $591.90 each; additional Part D IRMAA of $85.80 plus plan premium.
- Above $750,000: Part B premium of $628.90 each; additional Part D IRMAA of $85.80 plus plan premium.
It’s important to note that the Part D IRMAA is an additional amount you pay on top of your plan’s premium.
5.) Medicare Has Multiple Enrollment Periods You Need to Know About
Understanding Medicare enrollment periods is crucial to ensure you get the coverage you need without unnecessary delays or penalties.
Key Medicare Enrollment Periods
- Initial Enrollment Period: This period begins three months before you turn 65 and extends for three months after your birthday. If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Parts A and B. If not, you must enroll yourself to avoid delays in coverage.
- General Enrollment Period: Medicare’s General Enrollment Period is from January 1st to March 31st each year. It is for individuals who missed their Initial Enrollment Period for Part B. Coverage begins on July 1st of the same year. Late enrollment may result in a penalty unless you qualify for a Special Enrollment Period.
- Open Enrollment Period: Annually from October 15th to December 7th, the Medicare Open Enrollment Period allows you to make various changes to your coverage.
You can switch from Original Medicare to Medicare Advantage, switch between different Advantage plans, or switch back to Original Medicare. You can also add, drop, or change your Part D prescription drug plan.
- Special Enrollment Period: You may qualify for a Special Enrollment Period if certain life events occur, such as losing employer group health coverage or moving to a new area with different Medicare plan options. This period typically lasts for eight months from the date of the qualifying event.
Become a Medicare Parts A and B Expert with MediGap Advisors
Want to stay informed about Medicare Parts A and B so you can make confident decisions about your healthcare?
Visit the MediGap Advisors Blog for the latest updates, expert tips, and practical advice on Medicare, Medigap, Medicare Advantage, and retirement planning. It’s your go-to resource for navigating the complexities of healthcare coverage.
For personalized advice, you can also contact one of our Personal Benefits Manager.
For an in-depth guide, check out The Medicare Playbook on Amazon. Packed with clear explanations and actionable insights, it simplifies Medicare like never before. Take charge of your healthcare journey today!
For Further Reading:
- The Medicare Annual Open Enrollment Period is Almost Here – What You Need to Know
- What’s the Difference Between an MSA and a Medicare MSA Plan?
- Whether You’re New to Medicare or Not, Know Your Medicare Supplement Options
- Medicare 101: How Does Medicare Work
- Medicare Premiums, Deductibles, Co-Pays, and Limits for 2025
Tom Lockwood is a Personal Benefits Manager at MediGap Advisors. Tom has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Tom on his Bio page.