ORIGINAL MEDICARE 101

PART A & B COVERAGE

The simple explanation is that Medicare Part A covers hospital treatment and services.

Medicare Part B covers outpatient services, such as doctor visits, diagnostic tests, labs, x-rays, mammograms, CAT scans, MRIs, and outpatient surgery outside of the hospital. It also includes procedures in your doctor’s office and durable medical equipment. Medicare Parts A and B will cover 80% of these services, as stated in their policy. CMS (Centers for Medicare & Medicaid) states it can also cover most doctors’ services in the hospital. However, 20% of the cost for these services can be paid out of pocket. Or you can purchase a Medicare Supplement known as a “Gap” Plan, which will cover the 20% “Gap”, providing 100 % coverage for all services allowed by CMS guidelines.

COST OF PART A & PART B

Part A is free to most people unless they have not worked 40 quarters (10 years) over their lifetime. This year, 2025, Part B has a monthly premium of $185.00; this figure will increase $17.90 per month to $206.50. (unless you are a high-income earner, which is based on your taxable income two years before the date you enrolled in Medicare) This year’s Part B annual deductible of $257.00 will change to $288.00 on January 1st. Once you reach the deductible, 80% of the costs for services provided by Medicare doctors and facilities will be paid, or 100% will be covered by choosing a Medicare Supplement/Gap Plan.

MEDICARE SUPPLEMENT/GAP PLAN

Your Medicare Supplement will pay for the 20% that Original Medicare Parts A & B do not cover. Several Gap plan types are available, and I have found two specific plan designs that are the most popular and best suited for Coloradans. I can assist you once you receive your Medicare A & B card. When you age into Medicare, the cost will vary based on your age and the county and zip code of your residence. Depending on which plan you choose this year, we have seen GAP plan prices ranging from $100.00 to $170.00 per month.

MEDICARE PART D

Medicare Part D is your drug plan. There are many drug plans to choose from online. You will find them on the Medicare.gov website. Once purchased, your drug plan will automatically be renewed on January 1st if you do not notify the carrier to discontinue your drug plan. You can shop for a new drug plan each year starting on October 15th and ending on December 7th. In 2025, the average national cost of a drug plan was $46.50 per month, but higher-priced drug plans can cost as much as $120.00 per month. If you are a high-income earner, you will pay an additional IRMAA fee per month for your drug plan. In 2024, the maximum out-of-pocket cost could have been over $6,000.00 if you purchased mostly brand-name and/or higher-tiered medications. If you purchased mostly generic drugs, Medicare recipients paid between $3,300 and $3,800 for out-of-pocket costs. This year, Part D plans have a much lower cap (maximum) for out-of-pocket prescription costs. Medicare recipients cannot pay more than $2,000 for out-of-pocket prescription expenses. In 2026, the maximum out-of-pocket prescription expense will be $2,200. Also, instead of paying the total cost of one’s prescriptions this year, 2025 marks the first time Medicare members can make monthly payments for their medications during the calendar year, rather than paying at the time of purchase. See https://www.medicare.gov/prescription-payment-plan.

ORIGINAL MEDICARE PREMIUMS PER MONTH

To summarize, Original Medicare is defined by Medicare Part A & B, coupled with a Medicare Supplement/GAP plan, and a Part D drug plan. The total monthly cost will usually be less than $450. This differs significantly from the cost of an individual health plan for those aged 55-65. In addition, you have access to more than ninety-five percent of our nation’s hospitals, clinics, and medical provider*. You will not need a referral from your primary care physician to see any other provider. As always, you will want to verify that your providers and facilities accept Original Medicare. Original Medicare includes a maximum lifetime amount for international healthcare insurance. Coverage is 80% of $50,000 after the $250 per calendar year deductible is met. However, coverage is usually limited to emergency care only. Please ask us to review your international travel plans. We can also provide international health insurance, trip delay and cancellation coverage, lost baggage coverage, and other concierge services, with or without emergency evacuation coverage. We are happy to help whether your trip is short-term or long-term, or if you are traveling to one or multiple foreign countries.

*CMS states that only 1 percent of all doctors, hospitals, and clinics do not take original Medicare.