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Although there are millions of people on Medicare, many find it a confusing subject especially since there are so many different parts to it. For individuals approaching 65 or anyone who or just wants to understand more about how this insurance works, here’s a brief answer to the question; what is Original Medicare and what does it cover.

What Is Original Medicare

The federal government established Original Medicare, a federal health insurance program, in 1965. The following individuals may qualify for Medicare benefits:

• People age 65 or older
• Certain younger people with qualifying disabilities
• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There are 2 parts of Original Medicare: Part A and Part B.

Medicare Part A

Medicare Part A is sometimes referred to as hospital insurance. It provides coverage for:

• Inpatient hospital care (once the enrollee is formally admitted)
• Skilled nursing facility care (following a qualifying hospital stay)
• Home health care (limited and medically necessary services)
• Hospice care for individuals with a terminal illness

For most people, Part A is free,there is no premium payment as long as eiither the beneficiary or thier spouse worked and paid Medicare taxes for a minimum of 10 years.

Please note: Although Part A covers hospital stays, it doesn’t cover long-term care such as; nursing homes, custodial care or unlimited days in a hospital or facility. There are limits to what it pays; beneficiaires must pay a portion of their expenses (cost-sharing), such as deductibles and coinsurance and copays.

Medicare Part B

Medicare Part B is also known as medical insurance. It provides coverage for the following:

• Doctor visits and outpatient medical care
• Preventive services such as; wellness visits, flu shots and cancer screenings
• Durable medical equipment (DME) this include things like; walkers, wheelchairs, oxygen as well as some diabetes supplies and more
• Lab tests and diagnostic imaging
• Mental health services
• Some home health care

Unlike Part A, beneficiaries do pay a monthly Part B premium. Fo rmost people, this is a standard amount although higher-income beneficiaries may pay an additional cost.

Click here to learn more about Part B eligibility

Part B coverage includes an annual deductible (this amount is adjusted annually). Typically beneficiaries pay 20% coinsurance for most covered services; in other words, Medicare pays about 80% of the cost leaving enrollees responsible for the remaining 20%.

What Original Medicare Doesn’t Cover

Original Medicare provides coverage for many medical expenses; although, they do not cover everything. Some important things to know about what Medicare does not cover:

• Prescription drugs (beneficiaries must enroll in separate Part D plan)
• Routine dental, vision, and hearing care
• Long-term custodial care
• Most care received outside the U.S.

In order to fill some of these coverae gaps, many people purchase additional insurance. Some of the plans people choose are; Medicare Supplement (Medigap) plans, Stand-alone PDP (prescprion Drug) plans, Medicare Advantage (Part C) plans. Beneficiaries also may opt for ancillary coverage like dental, vision and hearing or cancer heart attack and stroke plans.

Medicare agents; learn how to sell ancillary products with Medicare – watch a quick video.

Original Medicare provides valuable health coverage for millions of Americans, but it’s important to understand what it cover and what it doesn’t. Knowing the basics helps beneficiaries make informed decisions and avoid unexpected costs.

Navigating the world of Medicare can be overwhelming, especially when it comes to choosing the right supplemental coverage. That’s why it is important to understand what Medigap standardized benefits are and how they work.

Medigap is a type of private insurance that helps beneficiaries cover the “gaps” in Original Medicare (Parts A and B). Medigap plans cover things like; deductibles, coinsurance, and copays. What many people don’t realize is that Medigap policies are standardized, meaning the benefits for each plan type are the same, no matter which insurer you choose.

What “Standardized” Means

Starting in 1992, federal law requires all Medigap policies to adhere to standardized benefit structures, designated by letters: Plans A through N. The only real difference in plans is the premium each carrier charges for the plan. Although insurance companies charge different premiums, the benefits for each plan letter must be identical no matter who the provider is. In other words, every Plan N has to provide the exact same coverage for medical expenses no matter what company offers it.

Standardization makes it easy for beneficiaries to compare plans without worrying about differences in coverage. They can simply compare cost and company ratings to find the best options.

Examples of Medigap Plan options

• Plan A: This is the most basic plan option. It provides coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance, and the first three pints of blood.
• Plan G: The most comprehensive plan available to those who turned 65 after 1-1-2020. It covers all Medicare approved expsnes with the exception of the Part B deductible.
• Plan N: Offers lower premiums than Plan G and covers a portion of the copays for doctor visits and hospital visits. The enrollee will still have a small copay for Medical services. This plan does not cover the Part B deductible or excess charges.

Some States Have Different Medigsp Standards

Although most states follow the federal standardization model, Massachusetts, Minnesota, and Wisconsin have their own versions of standardized Medigap plans. These states use their own benefit structures however, they still follow the principle of offering consistent benefits across insurers within their states.

Please Note

• Plan C and Plan F are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. These plans provided coverage for the Medicare Part B deductible, which new legislation phased out to cut back on the overuse of services.
• Beneficiaries must have both Medicare Part A and Part B to enroll in a Medigap plan. There is a premium for Medigap plans in addition ot the Part B premium.
• Medigap works with Original Medicare, beneficiaires cannot use a Medigpa plan with a Medicare Advantage (Part C) plan.

Why Standardization is Important

Standardization simplifies decision-making for Medicare beneficiaries. It eleiminates the need to decipher insurnace benefits accross multiple insurance companies; instead, the focus is on price, company reputation, and rate increase history.

Watch a quick YouTube video on Medicare Supplement Underwriting

This helps foster competition between companies based on cost and service quality instead of confusing plan designs.

Choosing a Medigap plan doesn’t have to be a guessing game. With standardized benefits, benficiaries can make apples-to-apples comparisons between insurers and choose the coverage that meets both healthcare and financial needs.

Agents, are you ready to join the team at Crowe; click here

Now that is 2025, both Medicare beneficiaries and agents need to know what the Medicare premiums and deductibles 2025 are so that everyone can plan accordingly. 2025 is the same as previous years; CMS has made changes to both Medicare Part A & Part B premiums and deductibles.

Medicare Part A costs 2025

The majority of beneficiaries do not have to pay a Part A premium if they have worked for at least 40 quarters (10 years) and paid Medicare taxes. Although if they do not qualify for premium free Part A, there are a couple different premium amounts they can pay if they want Part A benefits.

When either the beneficiary or their spouse worked and paid Medicare taxes between 30 and 39 quarters, the monthly premium cost is $285 in 2025. This is an increase of $7 from the 2024 cost of $ 278.

If the beneficiary or their spouse worked at a job and paid Medicare taxes for less than 30 quarters, the premium in 2025 is $518. This an increase of $13 from the cost of $505 in 2024

Part A Deductible and Coinsurance 2025

Part A covers inpatient hospital costs. In 2025, the Part A deductible has gone up $1,676 for each benefit period. This is an increase of $44 from the cost of $1,632 in 2024.

On original Medicare once the beneficiary meets the deductible, the cost for a hospital stay is $0 for days 1-60. The cost for days 61-90 is $419 per day. This is $11 over the cost of $408 in 2024. Once the beneficiary reaches day 91 and over, they start to use their lifetime reserve days and pay $838 per day. that is up from $816 in 2024.

There is no coinsurance charge for days 1-20 in skilled nursing facility stays. The cost for days 21-100 are $209.50 per day in 2025. This is a $5.50 increase from the 2024 cost of $204.

Click here to learn about the Part D drug cap

Part B costs 2025

In contrast to the Part A premium, almost all beneficiaries have to pay a Part B premium. In special circumstances, if a beneficiary qualifies for extra help due to limited income and resources, they may not have to pay the Part B premium.

Part B Premiums & Deductibles

For 2025, the standard monthly premium has gone up $10.30 to $185.00. The premium was $174,70 in 2024.

Learn more about Part B costs

Those with an income level over a specified amount pay an IRMAA. The CMS adds the IRMAA to the standard monthly premium amount. The premium amount each beneficiary pays ranges from $259 to $628.90 per month if the beneficiary pays an IRMAA. The amount is based on their specific income level.

If you have been incorrectly charged an IRMAA, learn how to file an appeal.

The deductible amount for Part B in 2025 is $257, an increase of $17 from the 2024 cost of $240.

It is important for beneficiaries to stay updated on healthcare costs each year to manage their budgets and avoid surprises. CMS makes decisions on Medicare costs based on the projected rise in costs and use of healthcare.

Agents who want to join the team at Crowe, click here for contracting.

Medicare income limits 2024

The Medicare income limits 2024 effect about 7% of Medicare beneficiaries.  Each year, the Social Security Administration determines the income limit that the IRMAA is based on.  It’s crucial to stay up to date on the annual income limits weather you are an agent or a beneficiary. In this post, we go over Medicare income limits for 2024 and how they can impact beneficiaries.

Why Medicare income limits matter

Medicare enrollment dates

If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.

Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65.  During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.

Learn more about enrollment periods

Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:

Loss of Employer Coverage

If a beneficiary is covered under a group health plan through their own  or their  spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.

Moving out of the plans service area

When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.

Becoming Eligible for Extra Help

Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.

General Enrollment Period (GEP)

For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll.  it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.

Click here to learn about late enrollment penalties LEPs

Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage.  This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.

How to best use the Medicare enrollment dates

1. Stay Informed: Keep track of your eligibility and enrollment periods to ensure you don’t miss important deadlines.
2. Review Your Coverage Needs: Regularly assess your healthcare needs to determine if  current coverage is still suitable or if changes are necessary.  Agents make sure you contact your clients regularly, especially during AEP to go over coverage options for the following year and ensure they are happy.
3. Seek Assistance if Needed: If you have questions or need guidance regarding Medicare enrollment, it is best to reach out to a licensed insurance agent.

Medicare agents be sure to maintain your book of business, click here for some ideas.

Agents, are you ready to join a winning team, click here for Crowe contracting!

Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.

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How to get a replacement Medicare card

If you find yourself in need of a replacement Medicare card due to loss, damage, or a name change, the process is straightforward. We will go over the process to get a replacement Medicare card, ensuring you have access to your necessary healthcare information when you need it.

Find out about Medicare premiums.

The importance of a Medicare card

Before we dive into the replacement process, it’s essential to recognize the significance of your Medicare card. This card contains valuable information, such a as your Medicare number as well as the effective dates of your Part A and Part B coverage. Beneficiaries need to have access to it as proof of Medicare coverage when they require necessary medical services. Whether you’ve lost your card, or it’s been damaged, it is important to obtain a replacement card quickly.  This will help enrollees maintain their access to healthcare.

Ensure eligibility

If you are eligible for Medicare but have not enrolled yet, you need to complete the initial enrollment process before you request a replacement card. Once you complete your initial enrollment, you will receive your card within a few weeks.

Click here to learn about Medicare enrollment periods.

Ways to obtain a new Medicare card

There are a couple different ways to obtain a replacement Medicare card.  Because of this, beneficiaries can choose the method that they are most comfortable with. The two ways to get the new card are:

Online:

Beneficiaries can log into their personal account on the official Medicare website www.medicare.gov.  Once they are logged in, it is easy to follow the prompts and request the replacement card. This method is convenient and typically provides a quicker turnaround. Beneficiaries can print an official copy of their card from their online account to retrieve an immediate copy.

Over the phone:

To request a replacement card over the phone, contact Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778). Beneficiaries need to have their Medicare number as well as other pertinent information to verify your identity.

Provide necessary information

No matter what method you opt for, you need to provide personal information to verify your identity and facilitate the replacement of your card. It is imperative that you use only official channels to request the new card.  Medicare will need details such as your full name, Social Security number, date of birth, and even your Medicare number to verify your identity before they can process the request.

Confirm Your Address

Because Medicare will send the replacement card to the address on record, it is important to make sure you update your current address in the Medicare system if you move.  Keeping your records up to date will ensure you receive your new card a quickly as possible.

Learn the difference between Medicare Advantage and Medicare Supplement plans – watch a quick YouTube video

Be Patient

Once you submit your request your replacement card, it will take time for the request to be processed and sent out to you. The time required to process the request will vary depending on how busy the Medicare office is, so you need to be patient while you wait for the Medicare card to arrive.

Obtaining a replacement Medicare card is a straightforward process.  Following these steps and keeping your information current, will ensure the process is smooth should you need a replacement card.

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How to find my Medicare ID number

There are times when you need to have your Medicare ID number. For example, when it is time to enroll in a new Medicare plan, you need to have your Medicare ID to enter on the application.  If you are a Medicare beneficiary, you may be wondering; how to find my Medicare ID number.

Please note:  if you need to sign up for Medicare Part A and or Part B, you go through Social Security. Once you are enrolled, you will need to manage your benefits through Medicare.

Click here to learn about Medicare enrollment periods

How to get your Medicare ID number

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Late Medicare enrollment

Medicare can be confusing; understanding the rules and guidelines for enrollment is important to ensure you have access to the healthcare coverage you need. Although many people are aware of the initial enrollment period, there are situations when individuals may apply for late Medicare enrollment.  We will go over some reasons for late enrollment, the rules surrounding late enrollment, and how to apply for Medicare.

Reasons for Late Medicare Enrollment

Missing your IEP (Initial Enrollment Period) – If you neglected to sign up for Medicare during your IEP, which begins three months before your 65th birthday and extends to three months after, you may need to wait for the GEP to sign up.

Missed a SEP (Special Enrollment Period) – In some cases, a qualifying event such as loss of employer coverage or moving can trigger an SEP.  If you miss this opportunity, you may have to wait for the GEP.

You have employer Coverage after the age of 65 – If either you or your spouse continue to work past the age of 65 and have employer-sponsored health coverage, you may delay Medicare enrollment. Late enrollment is allowed without a penalty as long as you enroll in Medicare within eight months of losing the employer coverage.

Rules and Guidelines for late Medicare enrollment

General Enrollment Period (GEP) – The GEP runs from January 1 through March 31 each year. Those who enroll during this period may face a late enrollment penalty (LEP).  The LEP is added to your Medicare Part A, if you do not qualify for premium free Part A, and Part B monthly premium amount.   For each 12-month period you delay enrollment in Part B, there is a 10% penalty applied.  The penalty lasts for as long as the beneficiary has Part B coverage. That is one reason to enroll in Medicare as soon as you are eligible.

Learn more about the Part B LEP

Medicare Advantage with prescription coverage (MAPD) and stand-alone Part D plans – Individuals who did not have creditable prescription coverage while they were eligible, will also have to pay a Part D penalty for late enrollment.

How to apply for Medicare

Go to the Official Medicare Website – In some instances, beneficiaries can enroll in Medicare online.  This is the easiest way to enroll.  Just visit medicare.gov and you will see options to enroll.  This website provides comprehensive information for those enrolling in Medicare or if you have Medicare questions.

Visit your local Social Security Office – Beneficiaries can either apply for Medicare over the phone by calling 1-800-772-1213 Monday – Friday 8 am – 7 pm.  Tell the representative if you want to apply for Medicare A & B or Part A only.  Hearing impaired beneficiaries can call TTY 1-800-325-0778.

If you want to apply in person, click here to find a local social security office.

Once you have your Medicare coverage in place, it is important to get the help of a licensed Medicare agent who can guide you through the different coverage choices available to supplement your coverage.

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Eligibility for Medicare Part B

Part B of Medicare provides coverage for medical services like doctors’ visits, preventative services, outpatient medical services, and other medically necessary items and services.  In this post, we will go over the rules for eligibility for Medicare Part B.

To be eligible for Medicare Part B, individuals must meet certain criteria

Medicare Part B is one part or original Medicare. and Part B is an integral part of this coverage. In General, individuals who are 65 or older qualify for Medicare.  However, there are other scenarios when an individual may be eligible to enroll.

Turning 65

The most common way to qualify for Medicare is when an individual turns 65 and is a U.S. citizen or legal permanent resident living in the U.S. for at least 5 continuous years.  This period of time is referred to as the IEP.  It is a good idea to enroll during the IEP (Initial Enrollment Period) to avoid a late enrollment penalty.

Disability

In some instances, individuals under 65 with a qualifying disability are eligible to enroll in Medicare Part B.  Individuals who receive either SSDI (Social Security Disability Insurance) or some Railroad Retirement Board (RRB) disability benefits for a period of at least 24 months may qualify for benefits.

End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Individuals who suffer from either permanent kidney failure requiring dialysis or a transplant (ESRD) or Lou Gehrig’s disease (ALS) usually qualify for Medicare coverage.  This coverage includes Medicare Part B.

Watch a YouTube video on SEPs. OEP and Late Part B Enrollment

Enrollment periods

When enrolling in Medicare Part B, there are a few different enrollment periods available.  Once you are eligible to enroll in Medicare Part B, it is important to understand when and how to enroll.

IEP (Initial Enrollment Period)

The IEP is the seven-month period that begins three months before the individual turns 65.  It includes the month of their birthday and continues for three months after. As we stated earlier, enrolling during this period is recommended to avoid a late penalty.

SEP (Special Enrollment Period)

Some individuals may qualify for a Special Enrollment Period.  For those who delayed enrollment in Part B due to having employer coverage through their employment or a spouse’s employment an SEP allows them to enroll without facing a penalty.

Learn more about SEPs

GEP (General Enrollment Period)

If an individual missed their IEP and doesn’t qualify for a SEP, they can enroll during the General Enrollment Period.  This enrollment opportunity runs from January 1 to March 31 each year.   It is important to note; late enrollment penalties may apply for those who wait to enroll during this time.

Additionally, Medicare Part B is an important part of healthcare coverage for seniors and other qualifying individuals. Understanding the eligibility criteria and enrollment process is essential to ensure timely access to the benefits that Medicare coverage provides.

Medicare agents, click here to become part of the team at Crowe

A licensed Medicare agent can help navigate the ins and outs of Medicare coverage and ensure beneficiaries receive all the benefits necessary for their healthcare needs and budget.

Click here to see why a licensed Medicare agent is a great asset.

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Medicare premiums

If you are either a Medicare beneficiary or a Medicare agent, you need to know the cost of Medicare premiums.  Each year the costs are subject to change.  Both enrollees and agents should stay updated on cost and coverage changes. Not having the correct information can be a costly mistake.

Medicare Part A

There is no premium ($0) for Part A for the majority of people most people.  Beneficiaries who worked or had a working spouse who paid Medicare taxes for at least 40 quarters (10 years) receive premium free Part A.

Those who do not qualify for the $0, premium free Part A may be eligible to purchase it.  Beneficiaries must sign up for Part B in order to purchase Part A.  For 2024, the monthly premium is either $278 or $505.  This depends on the length of time either the beneficiary or their spouse worked and paid Medicare taxes.

Please note:  Beneficiaries who do not purchase Part A when they are eligible (in most cases at 65 years old), may pay a penalty.  The penalty adds 10% to the monthly Part A premium and lasts for twice the number of years that you neglected to sign up for Part A.

Medicare Part B

The monthly premium for Part B is $174.70 in 2024.  This amount usually changes on January 1st each year. This premium may be higher for some individuals with a higher income level. This additional charge is called an IRMAA, and it effects about 8% of Medicare beneficiaries.  The Additional charge ranges from $69.90 up to $419.30 added to the monthly premium.

Medicare may charge a late enrollment penalty to anyone who did not enroll in Medicare Part B when they were first eligible or did not have creditable coverage in place at that time.  The LEP for failing to enroll in Part B is 10% for every year the beneficiary did not sign up for Part B.  This penalty is different than the Part A penalty; it will last for as long as the beneficiary has Part B.

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