Medicare Part A

Medicare Part B is a core part of Original Medicare, administered by the Centers for Medicare & Medicaid Services (CMS). It helps cover medically necessary services and preventive care that are essential for diagnosing, treating, and managing your health.

Part B covers two main types of services:

These are services or supplies needed to diagnose or treat a medical condition and meet accepted standards of medical practice.

✅ Examples include:

• Doctor and specialist visits
   
• Outpatient care and procedures
   
• Mental health services
   
• Durable medical equipment (DME)
   
• Ambulance services
   
• Diagnostic tests (e.g., X-rays, MRIs, lab work)
   

These are services to detect or prevent illness early when treatment is most effective.

✅ Examples include:

• Annual “Wellness” visit
   
• Flu, pneumonia, and COVID-19 vaccines
   
• Cancer screenings (mammograms, colonoscopies, prostate exams)
   
• Cardiovascular screenings
   
• Diabetes screenings and self-management training
   
• Depression screening
   

Note: Most preventive services are covered at no cost to you if your provider accepts Medicare.
 

You are eligible for Part B if:

• You are 65 or older, or
   
• Under 65 and qualify through disability, ALS, or End-Stage Renal Disease (ESRD)
   
• You are a U.S. citizen or legal permanent resident who has lived in the U.S. for at least 5 continuous years
   

You must enroll in Part B — it is not automatic unless you’re already receiving Social Security or Railroad Retirement Board benefits before age 65.

Here are the standard costs for 2025:

• Monthly premium:
  $174.70 (standard)
  Higher-income individuals may pay more based on Income-Related Monthly Adjustment Amount (IRMAA)
   
• Annual deductible:
  $240 in 2025
   
• Coinsurance:
  After meeting the deductible, you typically pay 20% of the Medicare-approved amount for most services and supplies
   

There is no out-of-pocket maximum under Original Medicare alone.
 

Initial Enrollment Period (IEP):

• Starts 3 months before you turn 65
   
• Ends 3 months after your 65th birthday month
   

If you miss your IEP and don’t qualify for a Special Enrollment Period, you may have to wait until the General Enrollment Period (Jan 1–Mar 31) and pay a late enrollment penalty.

If you delay enrollment and don't have creditable coverage, your monthly premium may increase 10% for each full 12-month period you were eligible but didn’t enroll — and the penalty lasts for life.

Part B does not cover:

• Most prescription drugs (covered under Part D)
   
• Long-term or custodial care
   
• Dental, vision, and hearing (unless medically necessary)
   
• Cosmetic surgery
   
• Routine foot care
   

To help cover these gaps, many people consider:

• Medicare Supplement Insurance (Medigap)
   
• Medicare Advantage Plans (Part C)
   

• You must have Part A and Part B to buy a Medigap policy or enroll in most Medicare Advantage Plans.
   
• Always use providers who accept Medicare assignment to avoid extra charges.
   

Navigating Medicare Part B can be confusing — but you don’t have to do it alone. If you’re approaching 65 or helping a loved one with Medicare decisions, get personalized help from a licensed Medicare advisor or visit Medicare.gov.

Medicare Part D is the part of Medicare that helps cover the cost of prescription drugs, including many recommended vaccines. It is available to anyone who has Medicare Part A and/or Part B and is offered through private insurance companies approved by the Centers for Medicare & Medicaid Services (CMS).

Part D plans help lower your prescription costs and protect against higher future drug expenses.

Each Part D plan has its own formulary (list of covered drugs), which typically includes:

• Generic and brand-name drugs
   
• Drugs in protected classes (e.g., cancer, HIV/AIDS, antidepressants)
   
• Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP)
   

Note: Formularies vary by plan and can change annually. It's important to review your plan's formulary each year.
 

You're eligible for Medicare Part D if you:

• Are enrolled in Medicare Part A and/or Part B
   
• Live in the service area of a Part D plan
   

You can get Part D coverage in two ways:

1. Stand-alone Prescription Drug Plan (PDP) – added to Original Medicare
    
2. Medicare Advantage Plan with drug coverage (MA-PD) – includes medical and drug coverage
    

Costs for Part D plans vary, but may include:

• Monthly premium: Varies by plan; the national average is approximately $46.50
   
• Annual deductible: Up to $590
   
• Copayments/coinsurance: Varies depending on the drug tier and pharmacy
   
• Income-Related Monthly Adjustment Amount (IRMAA): Higher-income beneficiaries may pay an additional amount
   

Note: Plan premiums are not included in the $2,000 out-of-pocket cap.
 

Starting in 2025, Medicare Part D has a simplified structure with three coverage phases: Centers for Medicare & Medicaid Services

1. Deductible Phase:
    
   • You pay 100% of your drug costs until you meet your plan's deductible (up to $590).
      

1. Initial Coverage Phase:
    
   • After meeting the deductible, you pay 25% of the cost for your medications, and your plan pays the remaining 75%.National Council on Aging+1Medicare+1
      

1. Catastrophic Coverage Phase:
    
   • Once your out-of-pocket spending reaches $2,000 (including deductible, copayments, and coinsurance), you pay nothing for covered Part D drugs for the rest of the year.Medicare
      

Note: The previous "donut hole" or coverage gap has been eliminated in 2025.
 

You can enroll in or change your Medicare drug plan during:

• Initial Enrollment Period (IEP): 3 months before to 3 months after your 65th birthday month
   
• Annual Enrollment Period (AEP): October 15 – December 7
   
• Special Enrollment Periods (SEPs): Triggered by specific life events (e.g., moving, losing other coverage)
   

If you don't enroll in Part D when first eligible and don't have other creditable prescription drug coverage, you may pay a late enrollment penalty:

• The penalty is 1% of the national base premium ($34.50 in 2025) multiplied by the number of full months you were eligible but didn't enroll.
   
• This amount is added to your monthly premium for as long as you have Part D coverage.
   

 Tips for Choosing a Part D Plan

• Review the formulary: Ensure your medications are covered.
   
• Check pharmacy networks: Using preferred pharmacies can lower costs.
   
• Compare plan ratings: CMS provides Star Ratings to help assess plan quality.
   
• Consider total costs: Look at premiums, deductibles, and copayments—not just one factor.
   

You can compare plans using the Medicare Plan Finder at Medicare.gov.

 Need Help finding a Plan?

Navigating Medicare Part D can be complex, but resources are available:

• Speak with a licensed Medicare advisor - 407-592-6958 - Brad Bryant
   
• Visit Medicare.gov for tools and information
   
• Contact your State Health Insurance Assistance Program (SHIP) for free counseling