FAQs

Part A is the portion of Medicare that covers inpatient care. This includes hospital stays, inpatient mental health care, hospice care, skilled nursing facility care, and blood transfusions. Most people don’t pay a monthly premium for Part A because they’ve already contributed through payroll taxes during their working years. While there’s no premium for most, there is a deductible and daily copays depending on the length of your hospital stay.

Part B covers outpatient medical services such as doctor visits, lab tests, preventive screenings, and outpatient procedures. In 2025, the standard monthly premium is $185, although higher earners may pay more due to income-based adjustments. Part B also has a deductible of $257. After you meet the deductible, Medicare typically covers 80% of approved costs, leaving you responsible for the remaining 20%.

Part C is also known as Medicare Advantage. These are private plans that bundle your Medicare Part A and B benefits, and often include additional perks like dental, vision, hearing, and prescription drug coverage. Medicare Advantage plans typically use HMO or PPO networks, meaning you may have to see in-network providers. Costs and coverage vary by plan; Pima County alone has over 50 options. Most plans have no additional premium beyond what you already pay for Part B.

Part D covers prescription drug costs. Before 2006, Medicare didn’t include drug coverage, but that changed, and in 2025, even more improvements were made. Medicare eliminated the “donut hole” (a coverage gap) and capped annual out-of-pocket drug costs at $2,000. Part D coverage can be included with a Medicare Advantage plan or purchased as a standalone plan if you have Original Medicare or a Medicare Supplement.

A Medicare Supplement plan works alongside Original Medicare (Parts A & B). Medicare remains your primary coverage, and the supplement pays for what Medicare doesn’t—like copays, coinsurance, and deductibles (except the Part B deductible). One major advantage is flexibility: you can visit any doctor or hospital in the U.S. that accepts Medicare. There are no networks or referrals needed, and budgeting is straightforward since your expenses are mostly predictable.

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies. When you enroll, Medicare pays the insurance company to manage your care. These plans usually require you to use a network of doctors and facilities and come with set copays for services. While coverage is limited to your home area, many plans include extra benefits like dental, vision, hearing, over-the-counter items, gym memberships, and drug coverage.

Part D plans help pay for prescription medications. You can get drug coverage through a Medicare Advantage plan (where it’s often included) or as a standalone plan if you have Original Medicare or a Supplement. Starting in 2025, Medicare capped drug-related out-of-pocket costs at $2,000 annually. Plans vary in their formulary (list of covered drugs), preferred pharmacies, and monthly premiums, so choosing the right one for your health needs is key.

Yes, you can work and enroll in Medicare, but we often recommend evaluating your options first. Medicare doesn’t always coordinate smoothly with employer insurance. You could run into billing issues if each plan assumes the other is responsible. Plus, why pay for two policies if one gives you the coverage you need? We recommend a one-on-one consultation to compare the costs and benefits of your employer plan vs. Medicare. We’ll help you make a decision based on the numbers, not emotion.

If you have TRICARE, you’re required to enroll in Medicare Parts A and B when eligible. Medicare becomes your primary insurance, and TRICARE acts as your secondary. Some clients with TRICARE also choose a Medicare Advantage plan specifically designed for veterans. These plans don’t include drug coverage (since TRICARE already provides that) but offer extra benefits like dental, vision, and hearing, and often come at no cost. In many cases, TRICARE covers your Advantage Plan copays as well.

Veterans with VA benefits are typically required to receive care at VA facilities. However, adding a Medicare Advantage plan can offer flexibility by giving you access to non-VA providers, at no additional cost. There are Advantage plans tailored specifically for veterans that exclude drug coverage (since VA benefits include prescriptions) but include extras like dental, vision, and hearing care.

You don’t have to sign up at 65, as long as you meet two conditions: 1. You’re actively employed (or covered under your spouse who is), and 2. You have creditable coverage (usually a group plan with 20 or more employees). If you meet both, you can delay enrolling in Part B without penalty. But if you don’t, and delay anyway, you could face a lifetime penalty of 10% for each year you were eligible and didn’t enroll. We’re happy to help you determine your eligibility and avoid unnecessary penalties.

Yes, even if you’re not taking any medications, you should still enroll in a Part D plan. Why? First, you never know when your health needs may change. Second, if you delay and go without creditable drug coverage, Medicare will charge a penalty – 1% of the national average premium for each month you’re uncovered. That penalty is permanent. The good news is that there are low-cost Part D plans that are available to help you avoid that risk.

Technically, yes, but we don’t usually recommend it. Medicare and employer insurance often don’t coordinate well, which can lead to confusion about who pays what. Plus, carrying two plans often means paying more than you need to. Medicare is often more cost-effective and comprehensive. We recommend scheduling a consultation to compare your employer coverage with Medicare, so you can decide what works best for you financially and medically.

IRMAA stands for Income-Related Monthly Adjustment Amount. If your income from two years ago exceeded $106,000 (individual) or $212,000 (couple), Medicare will increase your Part B and Part D premiums. If you’re now retired and your income has dropped, you can file an appeal using a form we’re happy to help you complete. But if your income is still above those thresholds, the additional IRMAA charges are unavoidable.

The standard Medicare Part B premium in 2025 is $185/month. If you’re already receiving Social Security benefits, the premium will be automatically deducted from your monthly check. If you’re not receiving Social Security, you have two options: 1. Set up automatic payments from your bank account monthly 2. Receive a quarterly bill (typically $555 for three months) Keep in mind that this premium may be higher if IRMAA applies based on your income.

Answers to the Questions We Hear Most Often