Key Takeaways

• Before enrolling in Medicare, double-check that your plan covers your essential healthcare needs, including hospital stays, medical services, and prescriptions.

• Costs can add up quickly, so review premiums, deductibles, and out-of-pocket expenses to avoid unexpected financial burdens.

Coverage Check: Are You Getting the Benefits You Need?

Medicare offers a range of coverage options, but not every plan provides the same benefits. Before signing up, make sure you understand what is covered under different parts of Medicare so you don’t face surprises down the road.

Hospital Stays and Medical Services

• Medicare Part A covers hospital stays, skilled nursing facility care, and hospice services, but it doesn’t include unlimited coverage.

• Medicare Part B covers outpatient services, preventive care, and doctor visits, but some services may have cost-sharing.

Prescription Drug Coverage

• Medicare Part D provides prescription drug coverage, but each plan has a different list of covered medications (formulary).

• If you take regular medications, check whether they are included in your plan’s formulary to avoid unexpected costs.

Additional Benefits and Limitations

• Not all Medicare plans cover vision, dental, or hearing services. If you need these benefits, review your options carefully.

• Medicare does not cover long-term custodial care, so if you need extended nursing home care, consider how you will cover those costs.

What Are Your Out-of-Pocket Costs?

Medicare is not entirely free, and understanding the costs before signing up can save you from financial headaches later. Here are some key expenses you need to review:

Monthly Premiums

• Medicare Part A is premium-free for most people, but if you haven’t worked long enough, you may have to pay for coverage.

• Medicare Part B requires a monthly premium that changes annually. In 2025, the standard Part B premium is $185 per month.

Deductibles and Copayments

• The Medicare Part A hospital deductible is $1,676 per benefit period in 2025.

• Medicare Part B has an annual deductible of $257 before coverage begins.

• Coinsurance for hospital stays can add up quickly after the first 60 days.

Prescription Drug Costs

• Medicare Part D plans have a deductible of up to $590 in 2025.

• A major change in 2025 is that once your out-of-pocket drug costs reach $2,000, your plan will cover all additional prescription costs for the rest of the year.

Provider Networks and Coverage Area

Not every doctor or healthcare facility accepts Medicare, and not all plans offer nationwide coverage. Before you sign up, make sure your preferred healthcare providers are in-network.

Doctor and Hospital Participation

• Medicare Part A and B allow you to see any provider that accepts Medicare, but some doctors may not accept new Medicare patients.

• If you have additional coverage, make sure your providers accept your plan to avoid unexpected bills.

Travel and Relocation Considerations

• If you travel frequently or live in multiple states during the year, check if your Medicare coverage applies nationwide.

• Some plans offer emergency care coverage outside the U.S., but standard Medicare does not.

Enrollment Timing Matters More Than You Think

When you sign up for Medicare affects your costs and coverage. Enrolling at the wrong time could mean late penalties or gaps in coverage.

Initial Enrollment Period (IEP)

• Your IEP starts three months before the month you turn 65 and lasts for seven months.

• If you enroll after your IEP ends, you may face lifetime late enrollment penalties for Medicare Part B and Part D.

Special Enrollment Periods (SEPs)

• If you are still working at 65 and have employer coverage, you may qualify for a SEP to enroll in Medicare later without a penalty.

• SEPs are also available for life changes like losing employer coverage or moving to a new area.

General Enrollment Period (GEP)

• If you miss your IEP, you can sign up between January 1 and March 31 each year.

• Coverage starts July 1, and you may have to pay late penalties for delayed enrollment.

Avoid Surprises: Take These Final Steps Before You Enroll

Enrolling in Medicare is a big decision, and missing key details can cost you. Before finalizing your choice, make sure you:

• Compare different Medicare options to find the best fit.

• Review all costs, including premiums, deductibles, and copayments.

• Check if your preferred doctors and hospitals accept your plan.

• Confirm whether your prescription medications are covered.

• Sign up at the right time to avoid penalties.

If you need professional guidance, speak with a licensed agent listed on this website to make sure your Medicare choices align with your healthcare needs and budget.