New to Medicare?
New to Medicare?
What is Medicare?
Medicare is a federal health insurance program for eligible U.S. citizens and legal residents. It is funded in part by taxes you pay in while working. It is individual health insurance.
Medicare is a federal health insurance program for eligible U.S. citizens and legal residents. It is funded in part by taxes you pay in while working. It is individual health insurance.
Parts of Medicare
Medicare Part A
Your hospital status—whether you're an inpatient or an outpatient—affects how much you pay for hospital services. Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay. There are some things that you might think would fall under Part A but sometimes fall under Part B, such as outpatient surgeries. When it comes to determining if something is inpatient vs outpatient, it’s always a good idea to consult your Medicare insurance broker for guidance.
Medicare Part A: Hospital Insurance
Medicare Part A covers hospital stays and inpatient care, including:
Your hospital room and meals
Skilled nursing services
Care in special units, such as intensive care
Some blood transfusions
Drugs and medical supplies used during an inpatient stay
Hospice care, including medications to manage symptoms and pain
Lab tests, X-rays and medical equipment as an inpatient
Part-time, skilled care for the homebound after a qualified inpatient stay
Operating room and recovery room services
Rehabilitation services after a qualified inpatient stay
Medicare Part A
Your hospital status—whether you're an inpatient or an outpatient—affects how much you pay for hospital services. Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay. There are some things that you might think would fall under Part A but sometimes fall under Part B, such as outpatient surgeries. When it comes to determining if something is inpatient vs outpatient, it’s always a good idea to consult your Medicare insurance broker for guidance.
Medicare Part A: Hospital Insurance
Medicare Part A covers hospital stays and inpatient care, including:
Your hospital room and meals
Skilled nursing services
Care in special units, such as intensive care
Some blood transfusions
Drugs and medical supplies used during an inpatient stay
Hospice care, including medications to manage symptoms and pain
Lab tests, X-rays and medical equipment as an inpatient
Part-time, skilled care for the homebound after a qualified inpatient stay
Operating room and recovery room services
Rehabilitation services after a qualified inpatient stay
Medicare Part B
Medicare Part B also covers services that sometimes occur in the hospital. This includes things like physician’s services, surgeries, radiation or chemotherapy, diagnostic imaging, durable medical equipment, and even dialysis. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump. Otherwise, outpatient drugs fall under Part D.
Medicare Part B: Medical Insurance
Medicare Part B covers doctor visits and outpatient care, including:
Doctor visits, including when you are in the hospital
Diabetes screenings, education, and certain supplies
An annual wellness visit and preventive services, like flu shots
Mental health care
Clinical laboratory services, like blood and urine tests
Durable medical equipment for use at home, like wheelchairs and walkers
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Ambulatory surgery center services
Some health programs, like smoking cessation and obesity counseling
Ambulance and emergency room services
Physical therapy, occupational therapy and speech-language pathology services
Medicare Part B
Medicare Part B also covers services that sometimes occur in the hospital. This includes things like physician’s services, surgeries, radiation or chemotherapy, diagnostic imaging, durable medical equipment, and even dialysis. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump. Otherwise, outpatient drugs fall under Part D.
Medicare Part B: Medical Insurance
Medicare Part B covers doctor visits and outpatient care, including:
Doctor visits, including when you are in the hospital
Diabetes screenings, education, and certain supplies
An annual wellness visit and preventive services, like flu shots
Mental health care
Clinical laboratory services, like blood and urine tests
Durable medical equipment for use at home, like wheelchairs and walkers
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Ambulatory surgery center services
Some health programs, like smoking cessation and obesity counseling
Ambulance and emergency room services
Physical therapy, occupational therapy and speech-language pathology services
Medicare Part C
Medicare Part C is now known as Medicare Advantage. These plans are offered by private insurance carriers approved by Medicare. It combines Part A (hospital insurance) and Part B (medical insurance) in one plan. They usually include your prescription drug coverage (Part D) and may offer extra benefits that Original Medicare doesn’t cover. Medicare Advantage Plans (Part C) have annual out-of-pocket maximum to help protect against high costs.
Medicare Part C
Medicare Part C is now known as Medicare Advantage. These plans are offered by private insurance carriers approved by Medicare. It combines Part A (hospital insurance) and Part B (medical insurance) in one plan. They usually include your prescription drug coverage (Part D) and may offer extra benefits that Original Medicare doesn’t cover. Medicare Advantage Plans (Part C) have annual out-of-pocket maximum to help protect against high costs.
Medicare Part D
Medicare Part D is a federal program that began in 2006. Medicare Part D consists of prescription drug plans that help with the cost of prescription drugs. There are two ways to get coverage: add a standalone Part D plan to Original Medicare or choose a Medicare Advantage plan that includes prescription drug coverage. These plans are offered by private insurance companies.
Tiers - To lower costs, many plans place drugs into different “tiers” on their formularies (drug lists). Each plan can divide its tiers in different ways. Each tier costs a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier. Example of a drug plan’s tiers:
- Tier 1: Preferred generic drugs
- Tier 2: Generic drugs
- Tier 3: Preferred brand drugs and select insulin drugs
- Tier 4: Non-preferred drugs
- Tier 5: Specialty drugs
Your plan’s drug list might not include a drug you take. However, in most cases, you can get a similar drug that’s just as effective or your doctor can request a formulary exception.
Medicare Part D
Medicare Part D is a federal program that began in 2006. Medicare Part D consists of prescription drug plans that help with the cost of prescription drugs. There are two ways to get coverage: add a standalone Part D plan to Original Medicare or choose a Medicare Advantage plan that includes prescription drug coverage. These plans are offered by private insurance companies.
Tiers - To lower costs, many plans place drugs into different “tiers” on their formularies (drug lists). Each plan can divide its tiers in different ways. Each tier costs a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier. Example of a drug plan’s tiers:
- Tier 1: Preferred generic drugs
- Tier 2: Generic drugs
- Tier 3: Preferred brand drugs and select insulin drugs
- Tier 4: Non-preferred drugs
- Tier 5: Specialty drugs
Your plan’s drug list might not include a drug you take. However, in most cases, you can get a similar drug that’s just as effective or your doctor can request a formulary exception.
Medicare Part D Coverage Stages
Each Medicare Part D plan has four coverage stages. Throughout the year, your prescription drug plan costs may change depending on the coverage stage you are in. If you have a Part D plan, you move through the CMS coverage stages in this order: deductible (if applicable), initial coverage, coverage gap, and catastrophic coverage.
Each Medicare Part D plan has four coverage stages. Throughout the year, your prescription drug plan costs may change depending on the coverage stage you are in. If you have a Part D plan, you move through the CMS coverage stages in this order: deductible (if applicable), initial coverage, coverage gap, and catastrophic coverage.
Begins: with your first prescription of the plan year.
You pay the full cost of your prescriptions until your spending adds up to the amount of your deductible. So, if your plan has a $0 deductible, you skip straight to the next stage. Keep in mind that some deductibles may only apply to drugs on specific tiers, which means you may not have any deductible if you do not take any medications on those tiers. Any payments for your monthly premium or for medications on tiers that do not apply to the deductible are not counted toward reaching the deductible.
Begins: immediately if your plan has no deductible. Or, when the prescription payments you have made equal your plan's deductible.
Your plan pays for a portion of each prescription drug you purchase, as long as that medication is covered under the plan's formulary (list of covered drugs). You pay the other portion, which is either a copayment (a set dollar amount) or coinsurance (a percentage of the drug's cost). The amount you pay will depend on the tier level assigned to your drug. This stage ends when the amount spent by you and your plan on your covered drugs adds up to equal the initial coverage limit set by Medicare for that year. In 2024 that limit is $5,030. Your monthly premium payments do not count toward reaching that limit.
Begins: when you and your plan have collectively spent $5,030 on your covered drugs.
Not everyone will enter the coverage gap (also referred to as the "donut hole"). In the coverage gap, the plan is temporarily limited in how much it can pay for your drugs. If you do enter the gap, you'll pay 25% of the plan's cost for covered brand-name drugs and 25% of the plan's cost for covered generic drugs.
Keep in mind that while the percentage you pay for brand-name drugs is lower, the price of that drug may be much higher than the generic option. Calculate the amount you would owe for each to see which one really offers the best cost savings for you.
You exit the coverage gap when your total out-of-pocket cost on covered drugs (not including premiums) reaches $8,000. Your out-of-pocket cost is calculated by adding together all of the following: yearly deductible, coinsurance, and copayments from the entire plan year, and what you paid for drugs in the coverage gap (including the discounted amounts you didn't pay in that stage).
Begins: when your out-of-pocket costs reach $8,000 on covered drugs.
After your out-of-pocket cost totals $8,000, you exit the gap and get catastrophic coverage. In the catastrophic stage, you won't pay anything for Medicare Part D covered drugs for the rest of the plan year. You will remain in this phase until the end of the plan year.
Begins: with your first prescription of the plan year.
You pay the full cost of your prescriptions until your spending adds up to the amount of your deductible. So, if your plan has a $0 deductible, you skip straight to the next stage. Keep in mind that some deductibles may only apply to drugs on specific tiers, which means you may not have any deductible if you do not take any medications on those tiers. Any payments for your monthly premium or for medications on tiers that do not apply to the deductible are not counted toward reaching the deductible.
Begins: immediately if your plan has no deductible. Or, when the prescription payments you have made equal your plan's deductible.
Your plan pays for a portion of each prescription drug you purchase, as long as that medication is covered under the plan's formulary (list of covered drugs). You pay the other portion, which is either a copayment (a set dollar amount) or coinsurance (a percentage of the drug's cost). The amount you pay will depend on the tier level assigned to your drug. This stage ends when the amount spent by you and your plan on your covered drugs adds up to equal the initial coverage limit set by Medicare for that year. In 2024 that limit is $5,030. Your monthly premium payments do not count toward reaching that limit.
Begins: when you and your plan have collectively spent $5,030 on your covered drugs.
Not everyone will enter the coverage gap (also referred to as the "donut hole"). In the coverage gap, the plan is temporarily limited in how much it can pay for your drugs. If you do enter the gap, you'll pay 25% of the plan's cost for covered brand-name drugs and 25% of the plan's cost for covered generic drugs.
Keep in mind that while the percentage you pay for brand-name drugs is lower, the price of that drug may be much higher than the generic option. Calculate the amount you would owe for each to see which one really offers the best cost savings for you.
You exit the coverage gap when your total out-of-pocket cost on covered drugs (not including premiums) reaches $8,000. Your out-of-pocket cost is calculated by adding together all of the following: yearly deductible, coinsurance, and copayments from the entire plan year, and what you paid for drugs in the coverage gap (including the discounted amounts you didn't pay in that stage).
Begins: when your out-of-pocket costs reach $8,000 on covered drugs.
After your out-of-pocket cost totals $8,000, you exit the gap and get catastrophic coverage. In the catastrophic stage, you won't pay anything for Medicare Part D covered drugs for the rest of the plan year. You will remain in this phase until the end of the plan year.
Begins: with your first prescription of the plan year.
You pay the full cost of your prescriptions until your spending adds up to the amount of your deductible. So, if your plan has a $0 deductible, you skip straight to the next stage. Keep in mind that some deductibles may only apply to drugs on specific tiers, which means you may not have any deductible if you do not take any medications on those tiers. Any payments for your monthly premium or for medications on tiers that do not apply to the deductible are not counted toward reaching the deductible.
Begins: immediately if your plan has no deductible. Or, when the prescription payments you have made equal your plan's deductible.
Your plan pays for a portion of each prescription drug you purchase, as long as that medication is covered under the plan's formulary (list of covered drugs). You pay the other portion, which is either a copayment (a set dollar amount) or coinsurance (a percentage of the drug's cost). The amount you pay will depend on the tier level assigned to your drug. This stage ends when the amount spent by you and your plan on your covered drugs adds up to equal the initial coverage limit set by Medicare for that year. In 2024 that limit is $5,030. Your monthly premium payments do not count toward reaching that limit.
Begins: when you and your plan have collectively spent $5,030 on your covered drugs.
Not everyone will enter the coverage gap (also referred to as the "donut hole"). In the coverage gap, the plan is temporarily limited in how much it can pay for your drugs. If you do enter the gap, you'll pay 25% of the plan's cost for covered brand-name drugs and 25% of the plan's cost for covered generic drugs.
Keep in mind that while the percentage you pay for brand-name drugs is lower, the price of that drug may be much higher than the generic option. Calculate the amount you would owe for each to see which one really offers the best cost savings for you.
You exit the coverage gap when your total out-of-pocket cost on covered drugs (not including premiums) reaches $8,000. Your out-of-pocket cost is calculated by adding together all of the following: yearly deductible, coinsurance, and copayments from the entire plan year, and what you paid for drugs in the coverage gap (including the discounted amounts you didn't pay in that stage).
Begins: when your out-of-pocket costs reach $8,000 on covered drugs.
After your out-of-pocket cost totals $8,000, you exit the gap and get catastrophic coverage. In the catastrophic stage, you won't pay anything for Medicare Part D covered drugs for the rest of the plan year. You will remain in this phase until the end of the plan year.
Cost of Medicare
Medicare Part A Cost in 2024
The cost for Medicare Part A is premium free if you or your spouse worked and paid taxes for 10+ years (40 quarters) in the U.S.
If you buy Part A, you'll pay up to $505 each month in 2024. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $505. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278.
2024 Medicare Part A (Hospital) Costs
Premium
Deductible
Other Costs
Note
$0
for most people
$1,632
per benefit period (up to 60 days)
$408
per day for days 61-90 in one benefit period
$816
per lifetime reserve day (maximum of 60 days)
NO
out-of-pocket limit
Medicare Part A Cost in 2024
The cost for Medicare Part A is premium free if you or your spouse worked and paid taxes for 10+ years (40 quarters) in the U.S.
If you buy Part A, you'll pay up to $505 each month in 2024. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $504. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278.
2024 Medicare Part A (Hospital) Costs
Premium
Deductible
Other Costs
Note
$0
for most people
$1,632
per benefit period (up to 60 days)
$408
per day for days 61-90 in one benefit period
$816
per lifetime reserve day (maximum of 60 days)
NO
out-of-pocket limit
Medicare Part A Cost in 2024
The cost for Medicare Part A is premium free if you or your spouse worked and paid taxes for 10+ years (40 quarters) in the U.S.
If you buy Part A, you'll pay up to $505 each month in 2024. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $505. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278.
2024 Medicare Part A (Hospital) Costs
Premium
Deductible
Other Costs
Note
$0
for most people
$1,632
per benefit period (up to 60 days)
$408
per day for days 61-90 in one benefit period
$816
per lifetime reserve day (maximum of 60 days)
NO
out-of-pocket limit
Medicare Part B Cost in 2024
Most people new to Medicare will pay $174.70 for Part B premiums in 2024. This is the standard premium that most people pay based on income. If you are receiving Social Security benefits or Railroad Retirement Board (RRB), Social Security will deduct your Part B premium from your Social Security check monthly. If you have not enrolled in Social Security income benefits, they’ll bill you quarterly.
2024 Medicare Part B (Medical) Costs
Premium
Deductible
Other Costs
Note
$174.70
per month for most people
$240
for the year
20%
of approved amount for most covered services
Excess charges
(if any)
NO
out-of-pocket limit
Medicare Part B Cost in 2023
Most people new to Medicare will pay $174.70 for Part B premiums in 2024. This is the standard premium that most people pay based on income. If you are receiving Social Security benefits or Railroad Retirement Board (RRB), Social Security will deduct your Part B premium from your Social Security check monthly. If you have not enrolled in Social Security income benefits, they’ll bill you quarterly.
2024 Medicare Part B (Medical) Costs
Premium
Deductible
Other Costs
Note
$174.70
per month for most people
$240
for the year
20%
of approved amount for most covered services
Excess charges
(if any)
NO
out-of-pocket limit
Medicare Part B Cost in 2024
Most people new to Medicare will pay $174.70 for Part B premiums in 2024. This is the standard premium that most people pay based on income. If you are receiving Social Security benefits or Railroad Retirement Board (RRB), Social Security will deduct your Part B premium from your Social Security check monthly. If you have not enrolled in Social Security income benefits, they’ll bill you quarterly.
2024 Medicare Part B (Medical) Costs
Premium
Deductible
Other Costs
Note
$174.70
per month for most people
$240
for the year
20%
of approved amount for most covered services
Excess charges
(if any)
NO
out-of-pocket limit
Part B - IRMAA
(Income Related Monthly Adjustment Amount)
Part B - IRMAA
(Income Related Monthly Adjustment Amount)
Medicare Part B premiums are based upon your modified adjusted household gross income (MAGI). The Social Security office will pull your IRS tax return from two years prior to determine your MAGI. They use that tax return to determine what you’ll pay for Parts B & D. (Part D premiums are also based on income.)
Medicare Part B premiums are based upon your modified adjusted household gross income (MAGI). The Social Security office will pull your IRS tax return from two years prior to determine your MAGI. They use that tax return to determine what you’ll pay for Parts B & D. (Part D premiums are also based on income.)
2024 File Individual Tax Return
2024 File Joint Tax Return
2024 File Married & Separate Tax Return
2024 Monthly Premium
Less than $103,000
Less than $206,000
Less than $103,000
$174.70
$103,000 to $129,000
$206,000 to $258,000
Not Applicable
$244.60
$129,000 to $161,000
$258,000 to $322,000
Not Applicable
$349.40
$161,000 to $193,000
$322,000 to $386,000
Not Applicable
$454.20
$193,000 to $500,000
$386,000 to $750,000
$103,000 to $403,000
$559.00
Over $500,000
Over $750,000
Over $403,000
$594.00
Part B - IRMAA
(Income Related Monthly Adjustment Amount)
Part B - IRMAA
(Income Related Monthly Adjustment Amount)
Medicare Part B premiums are based upon your modified adjusted household gross income (MAGI). The Social Security office will pull your IRS tax return from two years prior to determine your MAGI. They use that tax return to determine what you’ll pay for Parts B & D. (Part D premiums are also based on income.)
Medicare Part B premiums are based upon your modified adjusted household gross income (MAGI). The Social Security office will pull your IRS tax return from two years prior to determine your MAGI. They use that tax return to determine what you’ll pay for Parts B & D. (Part D premiums are also based on income.)
2024 File Individual Tax Return
2024 File Joint Tax Return
2024 File Married & Separate Tax Return
2024 Monthly Premium
Less than $103,000
Less than $206,000
Less than $103,000
$174.70
$103,000 to $129,000
$206,000 to $258,000
Not Applicable
$244.60
$129,000 to $161,000
$258,000 to $322,000
Not Applicable
$349.40
$161,000 to $193,000
$322,000 to $386,000
Not Applicable
$454.20
$193,000 to $500,000
$386,000 to $750,000
$103,000 to $403,000
$559.00
Over $500,000
Over $750,000
Over $403,000
$594.00
2024 File Individual Tax Return
2024 File Joint Tax Return
2024 File Married & Separate Tax Return
2024 Monthly Premium
Less than $103,000
Less than $206,000
Less than $103,000
$174.70
$103,000 to $129,000
$206,000 to $258,000
Not Applicable
$244.60
$129,000 to $161,000
$258,000 to $322,000
Not Applicable
$349.40
$161,000 to $193,000
$322,000 to $386,000
Not Applicable
$454.20
$193,000 to $500,000
$386,000 to $750,000
$103,000 to $403,000
$559.00
Over $500,000
Over $750,000
Over $403,000
$594.00
The items that contribute to your modified adjusted gross income include any money earned through wages, Social Security benefits, interest, dividends from investments, tax-deferred pensions, and capital gains. Distributions from Roth IRAs and Roth 401(k)s, life insurance, reverse mortgages, and health savings accounts do not count in the MAGI calculation.
If you filed jointly with a spouse, Social Security will base your premiums for each of you based on that married income. However, you will EACH pay your own Part B premium.
Social Security will usually notify you of your next year’s premium annually in December or early January by mail.
The items that contribute to your modified adjusted gross income include any money earned through wages, Social Security benefits, interest, dividends from investments, tax-deferred pensions, and capital gains. Distributions from Roth IRAs and Roth 401(k)s, life insurance, reverse mortgages, and health savings accounts do not count in the MAGI calculation.
If you filed jointly with a spouse, Social Security will base your premiums for each of you based on that married income. However, you will EACH pay your own Part B premium.
Social Security will usually notify you of your next year’s premium annually in December or early January by mail.
Appealing Your Part B Premium
As a beneficiary, you have the right to appeal if you believe that an Income Related Monthly Adjustment Amount (IRMAA) is incorrect for one of the qualifying reasons. First, you must request a reconsideration of the initial determination from the Social Security Administration. A request for reconsideration can be done orally by calling the SSA 1-800 number (800.772.1213) or completing Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event Form SSA-44.
Appealing Your Part B Premium
As a beneficiary, you have the right to appeal if you believe that an Income Related Monthly Adjustment Amount (IRMAA) is incorrect for one of the qualifying reasons. First, you must request a reconsideration of the initial determination from the Social Security Administration. A request for reconsideration can be done orally by calling the SSA 1-800 number (800.772.1213) or completing Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event Form SSA-44.
Situation
Description
Tax return inaccurate or out of date
- A beneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision
- There was an error in the IRS data
- The IRS provided SSA with older data and the beneficiary wants to use newer information
- You had a major life-changing event that significantly reduced your income
Life-changing event that affects the beneficiary’s modified adjusted gross income
There are 8 qualifying life-changing events:
- Death of spouse
- Marriage
- Divorce or annulment
- Work reduction
- Loss of income from income producing property
- Loss or reduction of certain kinds of pension income
- Work stoppage and employer settlement payment
Situation
Description
Tax return inaccurate or out of date
- A beneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision
- There was an error in the IRS data
- The IRS provided SSA with older data and the beneficiary wants to use newer information
- You had a major life-changing event that significantly reduced your income
Life-changing event that affects the beneficiary’s modified adjusted gross income
There are 8 qualifying life-changing events:
- Death of spouse
- Marriage
- Divorce or annulment
- Work reduction
- Loss of income from income producing property
- Loss or reduction of certain kinds of pension income
- Work stoppage and employer settlement payment
Medicare Part D Costs in 2024
Most drug plans charge a monthly fee that varies by plan. If you don't sign up for Part D when you're first eligible, you may have to pay a Part D late enrollment penalty.
Most people only pay their Part D premium; however, if you have a higher income, you might pay more for your Medicare drug coverage. If your income is above a certain limit, you’ll pay an extra amount in addition to your plan premium (called “Part D-IRMAA”). You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. This doesn’t affect everyone, so most people won’t have to pay an extra amount.
Medicare Part D Costs in 2024
Most drug plans charge a monthly fee that varies by plan. If you don't sign up for Part D when you're first eligible, you may have to pay a Part D late enrollment penalty.
Most people only pay their Part D premium; however, if you have a higher income, you might pay more for your Medicare drug coverage. If your income is above a certain limit, you’ll pay an extra amount in addition to your plan premium (called “Part D-IRMAA”). You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. This doesn’t affect everyone, so most people won’t have to pay an extra amount.
2024 File Individual Tax Return
2024 File Joint Tax Return
2024 File Married & Separate Tax Return
2024 Monthly Premium
Less than $103,000
Less than $206,000
Less than $103,000
Plan Premium (P.P.)
$103,000 to $129,000
$206,000 to $258,000
Not Applicable
P.P. + $12.90
$129,000 to $161,000
$258,000 to $322,000
Not Applicable
P.P. + $33.30
$161,000 to $193,000
$322,000 to $386,000
Not Applicable
P.P. + $53.80
$193,000 to $500,000
$386,000 to $750,000
$103,000 to $403,000
P.P. + $74.20
Over $500,000
Over $750,000
Over $403,000
P.P. + $81.00
2024 File Individual Tax Return
2024 File Joint Tax Return
2024 File Married & Separate Tax Return
2024 Monthly Premium
Less than $103,000
Less than $206,000
Less than $103,000
Plan Premium (P.P.)
$103,000 to $129,000
$206,000 to $258,000
Not Applicable
P.P. + $12.90
$129,000 to $161,000
$258,000 to $322,000
Not Applicable
P.P. + $33.30
$161,000 to $193,000
$322,000 to $386,000
Not Applicable
P.P. + $53.800
$193,000 to $500,000
$386,000 to $750,000
$103,000 to $403,000
P.P. + $74.20
Over $500,000
Over $750,000
Over $403,000
P.P. + $81.00
Social Security will contact you if you have to pay Part D IRMAA, based on your income. The amount you pay can change each year. If you have to pay a higher amount for your Part D premium and you disagree (for example, if your income goes down), use this form to contact Social Security.
The extra amount you have to pay isn’t part of your plan premium. You don’t pay the extra amount to your plan. Most people have the extra amount taken from their Social Security check. If the amount isn’t taken from your check, you’ll get a bill from Medicare or the Railroad Retirement Board. You must pay this amount to keep your Part D coverage.
Getting Started With Medicare
Medicare Eligibility Checklist
Getting Medicare is a major milestone. In order to qualify, U.S. citizens and legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare. You also must meet one of the following requirements:
- Age 65 or older
- Younger than 65 with a qualifying disability
- At any age with a diagnosis of End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
- At any age with a diagnosis of Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease
Many people confuse their Medicare Eligibility date with their Social Security retirement age. They are completely different. There is no such thing as a Medicare retirement age. The normal Medicare eligibility age for Medicare is age 65, whether you have retired or not.
To confirm whether you are eligible and your expected premium, go the Medicare.gov eligibility tool.
Medicare Enrollment Periods
Application Timeframe
Coverage Begins
Plans Included
Initial Enrollment Period
(IEP)
7 month period: includes the month of your 65th birthday and the 3 months immediately prior to and following
Enrolled during first 3 months of IEP: day 1 of the month before you turn 65 OR Enrolled during last 4 months of IEP: Varies
Medicare Part A and/or Medicare Part B
Annual Enrollment Period
(AEP)
October 15th - December
January 1st
The specific actions you can take during AEP depend on your current coverage.
General Enrollment Period
(GEP)
January 1st - March 31st
July 1st
Original Medicare (Part A, Part B, or both)
General Enrollment Period
(GEP)
April 1st - June 30th
July 1st
Medicare Advantage (Part C) or prescription drug (Part D)
Medicare Advantage Open Enrollment
(MAOEP)
January 1st - March 31st
The first day of the month after your new plan gets your request for coverage
Switching to a different Medicare Advantage plan, enrolling in Original Medicare with a Part D plan
Special Enrollment Period
(SEP)
Any time a beneficiary has a qualifying event
Varies
Medicare A and B, Medicare Advantage and Part D
Medicare Supplement Open Enrollment
6 months prior to and immediately following Medicare Part B effective date *without answering health questions
Varies
Medicare Supplement Plan (Medigap)
Additional Notes
Initial Enrollment Period: If your 65th birthday is on the 1st of the month, then your Medicare is effective the 1st day of the prior month. Waiting until the last 4 months of your IEP could result in a delay or gap in your Part B coverage, plus a late enrollment penalty for the life of your policy.
Annual Enrollment Period: This set time each year is for changing your Medicare coverage choices if you choose to. AEP is also a great reminder to review your Medicare plan each year so you can make sure you have the coverage you need going forward.
General Enrollment Period: This is for those who missed the Initial Enrollment Period. Depending on your situation, you may have to pay late enrollment penalties for Medicare Part A, Part B, and/or Part D.
Medicare Advantage Open Enrollment: This period is for Medicare Advantage plan members only, and only one coverage change is allowed during this time.
Special Enrollment Period: This enrollment period can be used if you delayed Medicare past age 65 due to creditable coverage through active employment.
Medicare Supplement Open Enrollment: Enrollment attempts outside of this window/without a qualifying event may require you to answer health questions that could result in increased cost or denial of coverage.
Initial Enrollment Period
(IEP)
Annual Enrollment Period
(AEP)
General Enrollment Period
(GEP)
Application Timeframe
7 month period: includes the month of your 65th birthday and the 3 months immediately prior to and following
October 15th - December 7th
January 1st - March 31st
Coverage
Begins
Enrolled during first 3 months of IEP: day 1 of the month before you turn 65
OR
Enrolled during last 4 months of IEP: Varies
January 1st
July 1st
Plans
Included
Medicare Part A and/or Medicare Part B
The specific actions you can take during AEP depend on your current coverage.
Original Medicare (Part A, Part B, or both)
General Enrollment Period
(GEP)
Medicare Advantage Open Enrollment
(MAOEP)
Special Enrollment Period
(SEP)
Medicare Supplement Open Enrollment
April 1st - June 30th
January 1st - March 31st
Any time a beneficiary has a qualifying event
6 months prior to and immediately following Medicare Part B effective date *without answering health questions
July 1st
The first day of the month after your new plan gets your request for coverage
Varies
Varies
Medicare Advantage (Part C) or prescription drug (Part D)
Switching to a different Medicare Advantage plan, enrolling in Original Medicare with a Part D plan
Medicare A and B, Medicare Advantage and Part D
Medicare Supplement Plan (Medigap)
Initial Enrollment Period
(IEP)
Annual Enrollment Period
(AEP)
General Enrollment Period
(GEP)
Application Timeframe
7 month period: includes the month of your 65th birthday and the 3 months immediately prior to and following
October 15th - December 7th
January 1st - March 31st
Coverage
Begins
Enrolled during first 3 months of IEP: day 1 of the month before you turn 65
OR
Enrolled during last 4 months of IEP: Varies
January 1st
July 1st
Plans
Included
Medicare Part A and/or Medicare Part B
The specific actions you can take during AEP depend on your current coverage.
Original Medicare (Part A, Part B, or both)
General Enrollment Period
(GEP)
Medicare Advantage Open Enrollment
(MAOEP)
Special Enrollment Period
(SEP)
Medicare Supplement Open Enrollment
April 1st - June 30th
January 1st - March 31st
Any time a beneficiary has a qualifying event
6 months prior to and immediately following Medicare Part B effective date *without answering health questions
July 1st
The first day of the month after your new plan gets your request for coverage
Varies
Varies
Medicare Advantage (Part C) or prescription drug (Part D)
Switching to a different Medicare Advantage plan, enrolling in Original Medicare with a Part D plan
Medicare A and B, Medicare Advantage and Part D
Medicare Supplement Plan (Medigap)
Additional Notes
Initial Enrollment Period: If your 65th birthday is on the 1st of the month, then your Medicare is effective the 1st day of the prior month. Waiting until the last 4 months of your IEP could result in a delay or gap in your Part B coverage, plus a late enrollment penalty for the life of your policy.
Annual Enrollment Period: This set time each year is for changing your Medicare coverage choices if you choose to. AEP is also a great reminder to review your Medicare plan each year so you can make sure you have the coverage you need going forward.
General Enrollment Period: This is for those who missed the Initial Enrollment Period. Depending on your situation, you may have to pay late enrollment penalties for Medicare Part A, Part B, and/or Part D.
Medicare Advantage Open Enrollment: This period is for Medicare Advantage plan members only, and only one coverage change is allowed during this time.
Special Enrollment Period: This enrollment period can be used if you delayed Medicare past age 65 due to creditable coverage through active employment.
Medicare Supplement Open Enrollment: Enrollment attempts outside of this window/without a qualifying event may require you to answer health questions that could result in increased cost or denial of coverage.
Apply for Medicare
Applying for Medicare can feel a bit overwhelming, but enrolling in Medicare is easier than you think. Beneficiaries can enroll in Original Medicare (Part A and Part B) through Social Security Administration. You will automatically be enrolled in Medicare Part A & B if you are receiving Social Security benefits or Railroad Retirement Board (RRB) when you turn 65. If this is the case, you will receive your Medicare card in the mail 2-3 months before your 65th birthday.
If you are NOT receiving Social Security benefits then you will need to enroll in Medicare yourself. There are several ways to apply: online, by phone, or in person. Applying for Medicare doesn’t mean you have to apply for your Social Security benefits. Medicare is separate from your Social Security retirement benefits. However, you can apply for both at the same time if you would like. To apply for Social security retirement benefits and Medicare at the same time complete the online application.
Remember to enroll during an approved enrollment period to avoid penalties. If you have employer group coverage
you don’t necessarily need to apply for Medicare Part B. However, most of the time Medicare might be the better option. Once your enrollment is completed you will receive your card in the mail in about 4-6 weeks.
While you wait for your card to arrive, please
call 402-673-6950
so we can help you go through your additional coverage options.
Get a No-Cost Consultation From our Experts
Are you ready for Medicare but confused on where to start? I know there is a lot of information to consider when learning the ins and outs of Medicare, especially with all of the options available to you. We are here to help you understand your needs, explain your options and make Medicare as simple as possible to understand!
Get a No-Cost Consultation From our Experts
Are you ready for Medicare but confused on where to start? I know there is a lot of information to consider when learning the ins and outs of Medicare, especially with all of the options available to you. We are here to help you understand your needs, explain your options and make Medicare as simple as possible to understand!
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All Rights Reserved | Senior Insurance Advisors | Privacy Policy
We are licensed and represent plans and carriers in AZ, CO, IA, KS, MN, MO, NE, SC, SD, TX, and WA. The following disclaimer is for Lancaster county in Nebraska, where we reside.
We do not offer every plan available in your area. Currently we represent 8 organizations which offer 53 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.Not affiliated with or endorsed by the government or federal Medicare program. Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal. By providing the information above, I grant permission for a licensed insurance agent to contact me regarding my Medicare options including Medicare Supplement, Medicare Advantage, Prescription Drug plans.