MAKING SENSE OUT OF MEDICARE

Michael T. Braden August 30, 2025 MEDICARE 101

MAKING SENSE OUT OF MEDICARE OR MAKING MEDICARE MAKE SENSE

Medicare can be confusing, and it is challenging to put all the pieces together.

We wrote this to help you better understand Medicare concisely and transparently.

      

       

           

HOW DO WE MAKE SENSE OF MEDICARE? LET’S START WITH WHAT IS MEDICARE

Braden Medicare Insurance’s Medicare Poster

 Medicare consists of four parts. Medicare Part A,  Part B, Part C, and Part D

           

• MEDICARE PART A – Pays for Inpatient Hospitalization, Hospice, and Skilled Nursing                                      Care.
• MEDICARE PART B – Pays for outpatient doctor visits, Lab Tests, Screenings, and                                       Durable Medical Equipment (DME).
• MEDICARE PART C – Is referred to as Medicare Advantage
• MEDICARE PART D – Prescription Drug Coverage

           

ORIGINAL MEDICARE 

Original Medicare includes Medicare Part A and Medicare Part B.

ORIGINAL MEDICARE – Is basically an 80/20 Health Plan where the Government

(Medicare) pays 80% of all of your covered Medical Expenses, and you are responsible for

the other 20%.  With Original Medicare, there are no Networks, so you can see any Doctor and use any Hospital in the United States that accepts Medicare (about 94% of all doctors accept Medicare).

           

MEDICARE PART C (MEDICARE ADVANTAGE)

Takes the place of Original Medicare, but instead of working with the   Government, you work with Private Insurance companies.  Instead of it being an 80/20 Plan like Medicare,

you will have a lot of Co-Insurance and Copays. There are Co-Pays for Hospitalizations,

Physical Therapy, Doctor Visits, MRIs, Lab Work, Referrals, Prescriptions, etc.

Some of these private insurance companies will offer additional ancillary benefits as a way

of enticing people to join their plan.  They may say they offer free things like Dental,

Vision, Hearing, Rides to your doctor appointments, and even Free meals, but PLEASE

read the fine print. Every Medicare Advantage plan is different.  Some have stronger

ancillary plans, and others have stronger health-related plans. 

Every Medicare Advantage plan has a MOOP (Maximum Out-of-Pocket) limit that ranges from $2,800 to $12,000 per year.  This means that you can spend $2,800 – $12,000 every year out of your own pocket.

               

Often, they define Free Dental Coverage as an Annual Benefit Amount, then divide that amount by 4 and provide a limit for each quarter: 1 or 2 cleanings and x-rays per year.

The dollar amount by 4, and then you have a Quarterly benefit. Instead of $1,000 in Dental Benefits, it is actually a benefit of $250 per quarter.

                 

Free Vision may include an Eye Exam and a credit of $100-$250 towards glasses each

year, but you usually need to see an Optometrist in their network.

Most Medicare Advantage plans include a free Gym Membership.

                                 

               

MEDICARE PART D

Prescription Drug Coverage.  These are plans offered by individual

private insurance companies that provide various plans to Medicare beneficiaries.

These plans require a monthly premium to be paid to the plan in exchange for having

 access to their pharmacy networks, their Formularies (Drug Lists), and their pricing

 structure.  There are NO Part D plans that include the cost of your medications.

               

Some Medicare Advantage Plans include Part D Prescription Drug coverage.  But, here again, there are NO Medicare Advantage (MAPD) plans that include the cost of your medications. They only pay your premium for access to the plan.  But you must use the plan’s network, their pharmacy, and their formulary.

               

STAND-ALONE PART D DRUG PLANS

This refers to any Part D Drug Plan that is not included in a Medicare Advantage Plan. For example, if you have Original Medicare or Original Medicare with a Medicare Supplement

 or a Medigap Plan.

               

PART D DRUG TIERS

All Prescription Drug plans are divided into six tiers within each plan.  And each individual

The company sets the price and structure of what is included in each Tier based on their

formulary.

               

 PART D DRUG FORMULARY

It is a formal list of Drugs and Medications available on a particular Medicare Part D Drug Plan.  Every plan sets its own formulary. Formularies are not the same.  And even though Medicare states that at least two drugs must be available in each class of medications, a particular plan may not have your exact medicines. So, finding the right plan is essential.

               

PART D LATE ENROLLMENT PENALTY

Every person who joins Medicare should enroll in a Medicare Part D Prescription Drug Plan as soon as they sign up for Medicare Part B.

If you do not sign up within the approved timeframe (within 63 Days Of Your Part B Effective Date), you will incur a penalty that will be added to your monthly Part D premium every month in the future. The penalty is roughly 38 cents per month for each month you went without having Creditable Part D Drug Coverage. This amount is added to your monthly plan premiums by your Insurance company. Now, while you may think 38 cents per month is a small price to pay, remember that the penalty stays with you for the rest of your life.

               

PART D PREMIUM COSTS

In Arizona, Part D Premiums can cost between $0 -$98.00 a month.  And just because a plan is more expensive, it does not mean it is the best one for you.  Most people with little or no Medications can easily get by with a $0 Premium Part D Drug plan, while someone with several Brand-Name medications may be better suited for a higher-priced plan.

PART D PREFERRED PHARMACY

Every drug plan specifies a list of “Preferred ” pharmacies in its network. This is very important.  You can only get the plans at the lowest price on your prescriptions if you fill your prescription at their “Preferred” pharmacy. Prices for medications can increase rapidly, so be cautious.

               

MEDICARE SUPPLEMENT PLANS & MEDIGAP PLANS ARE THE SAME THING

               

MEDICARE SUPPLEMENTS

They are used in conjunction with Original Medicare.  These Medicare Supplement, or Medigap, plans are designed to fill the gaps that Original Medicare leaves behind. So, depending on which plan you choose, you could have all of the 20% that you are responsible for with Original Medicare paid for by your Medicare Supplement plan, and you will owe nothing. There are no networks with Medicare Supplement plans; you can see any Doctor in the US that accepts Medicare!

               

MOST POPULAR MEDICARE SUPPLEMENT PLANS

There are 11  Medicare Supplement plans. All of the plans are identified by a corresponding letter. And they are the same plans nationwide. A Plan N in Iowa is the same as a Plan N in Florida. The most popular Medicare Supplement plans in the US are Plan F, Plan G, and Plan N.

Braden Medicare Insurance Services Medicare Supplement Plan Comparison Chart

               

MEDICARE SUPPLEMENT PLAN COSTS

With 11 different choices, Medicare Supplement plan premiums can vary from $50 – $500 a month, depending on your age, location, and other factors. Plan G has been the most popular Medigap/Medicare Supplement plan in America since 2020. Plan G is the most comprehensive Medigap plan available, and the average cost for a new Medicare beneficiary is $120 – $140 per month. And, with this plan, you will most likely

never receive a bill for any services, because Medicare pays 80% And Your Medicare Supplement Plan will pay the other 20%. The supplement will pay the other 20%, plus your Part A Deductible of $1,676.

               

LOOK AT YOUR MEDICARE SUPPLEMENT PREMIUM AS YOUR MOOP COST

If you choose a Medicare Plan G, you will never receive a bill, so your maximum out-of-pocket costs (your MOOP) are your premium.  If your premium is $140 per month, that is

$1,680 per anno.  You should have peace of mind knowing you will not have any

out-of-pocket costs over that amount, except for the Annual $257 Part B Deductible.

               

WHAT MEDICARE COVERS

Anything that is deemed to be medically necessary as stated by any provider who accepts Medicare’s Assignment. (Medicare Assignment refers to Medicare’s Fee Schedule).  

Note: This information applies to Original Medicare; for those with a Medicare Advantage plan or Medicare Part C, what is and is not covered is determined by your plan’s discretion.

               

WHAT MEDICARE DOES NOT PAY FOR

Medicare (Original or Traditional Medicare) does not cover Routine Eye Exams, Eyeglasses, or Contact Lenses. However, Medicare will cover cataract surgery and injections for certain other eye diseases and conditions, such as macular degeneration and Glaucoma. Medicare will pay for certain ear surgeries if they are deemed medically necessary. Think of it like this: Ophthalmologists are covered, Optometrists are not covered.

Medicare does not cover Routine Dental Care. They will cover TMJ and some Dental Issues caused by an accident. But, if you choose Original Medicare with or without a Medicare Supplement or Medigap plan, you will need to purchase a Separate Dental plan, or pay for your dental out-of-pocket.

Medicare does not cover Routine Hearing Exams or Hearing Aids. If you are a Veteran, your VA benefits are excellent for Hearing.

Note: Due to Medicare not covering routine dental, vision, or hearing, many Medicare beneficiaries turn to DVH Policies. DVH covers Dental/Vision/Hearing at rates that are more affordable than Dental Insurance itself.

Medicare does not cover plastic surgery or Botox injections.

There is a limited number of Chiropractic and Acupuncture treatments allowed each year.                

               

WHAT IS THE GUARANTEED ISSUE PERIOD FOR MEDICARE

During your IEP (Initial Enrollment Period), which runs from 3 months before your birth month when you turn 65, through 3 months after your birth month.   During this period (IEP), you are guaranteed to purchase any Medicare Supplement Plan, regardless of Medical History, as long as you do not have end-stage renal Disease or ALS (Lou Gehrig’s Disease).

Braden Medicare Insurance’s Medicare Initial Enrollment Period Poster

Anyone 65 and older who’s enrolled in both Medicare Part A and Part B can be accepted into Original Medicare, or into any Medicare Advantage Plan at any time, as long as they do not have Lou Gehrig’s Disease (ALS) or End Stage Renal Disease.

               

After your IEP, Anyone can apply for a Medicare Supplement Plan; however, they will be subject to Underwriting approval and must answer a few Medical Questions.

               

Many people think they can start with a Medicare Advantage Plan and switch to a              Medicare Supplement Plan later, which may be proper; however, it is not guaranteed past the

Guaranteed Issue Period.

               

BREAKING DOWN THE COSTS OF MEDICARE

               

MEDICARE PART A

Most people qualify through their work experience (Having worked for a minimum of 40 Quarters) or their spouse.  All of the Taxes taken out for Medicare pay for your Medicare Part A premiums. So, most people pay $0 for their Part A coverage. For those who do not qualify for Medicare Part A, the premium for Part A in 2025 is a whopping $518 per month.

               

Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. Approximately 99% of Medicare beneficiaries do not have a Part A premium, as they have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration. 

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,676 in 2025, an increase of $44 from $1,632 in 2024. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2025, beneficiaries must pay a coinsurance amount of $419 per day for the 61^st through 90^th day of a hospitalization ($408 in 2024) in a benefit period and $838 per day for lifetime reserve days ($816 in 2024).

For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $209.50 in 2025 ($204.00 in 2024). 

Note:   Most of these Part A Deductibles are paid if you have a Medicare Supplement Plan.

Braden Medicare Insurance’s Medicare Part A Chart for 2025

               

 

 MEDICARE PART B

There are two costs associated with Medicare Part B. The first of these is the Monthly Premium for Medicare Part B, which is $185.00 per month in 2025. EVERYONE must pay this amount, whether you choose a Medicare Advantage plan, Original Medicare, or Original Medicare with a Medigap/Medicare Supplement policy.

The second Part B Deductible is the Annual Part B deductible, which everyone with Original Medicare is subject to. Essentially, for your first $257 of Part B services, you will pay out of pocket. Then, after the deductible is met each Calendar year, Medicare will cover 80% of all Part B charges. If you choose a Medicare Supplemental Plan F, Plan C, Plan G, or Plan N, your Supplemental insurer will pay the additional 20% for you.

               

Your total combined Medicare Part B costs are $185.00 Per Month for 2025. That is a total of $2,220 for your Part B Premiums, plus the Annual Medicare Part B Deductible of $257 ($206.41 Per Month average for all Part B expenses).

               

Braden Medicare Insurance’s Medicare Part B Chart for 2025

MEDICARE PART C

This depends on whether a monthly premium cost is associated with a particular Part C plan/Medicare Advantage plan.

Everyone with a Medicare Advantage plan must pay the $185.00 Monthly Premium to the Government, plus any additional plan premiums that may be associated with the Medicare Advantage Plan they choose.

Each Medicare Advantage plan will have an MOOP. Moop stands for Maximum-Out-Of-Pocket Expense. Each Medicare Advantage Beneficiary is responsible for paying the amount of their MOOP through a combination of copays and coinsurance. Once the MOOP has been satisfied, your plan will cover all costs for the remainder of the Calendar Year.

               

MEDICARE SUPPLEMENT COSTS

If you bolster Original Medicare by purchasing a Medigap or Medicare Supplement policy, your costs will vary, depending on which lettered plan you choose. We have found that a good average amount to use for a single individual in Arizona is $140 per month $1,680 annually. If you are single, and $130 per month, if you are married.

You will most typically be asked to pay your Medicare Supplement Premiums via EFT debits to your banking account every month. There are options to pay your bill quarterly, semi-annually, or annually.       

MEDICARE PART D

If you have a Medicare Advantage plan, your Part D coverage is included. So you will have no additional Part D costs to budget for, except for the costs of your Prescription Medications.     

If you have chosen a Stand-Alone Medicare Part D Prescription Drug plan that works alongside Original Medicare, you will pay between $0 and $98 per month. IF you do not take any medications or if your medications are Generic or preferred generic medications, you should be fine with one of the $0 Premium Part D plans that should be available in your State.

If you use brand-name medications, you will most likely be looking at a Part D plan that carries a Monthly Premium of $24 – $98 per month. It just depends on your medications. We compare your Drug list with every plan and then present to you the three lowest-cost options, taking both premiums and the cost of your medications into account.

WRAPPING THINGS UP

All of us at Braden Medicare Insurance hope you found this article helpful, especially for those of you turning 65 in the following year. Our greatest passion is genuinely helping our friends and neighbors find the best possible Medicare plans based on their own wants, needs, and desires, at the lowest price. We can do this because of our unparalleled carrier list, our in-depth industry knowledge, and our extensive experience, not just as a Medicare Broker, but as a Certified Medicare Planner. Please feel free to call, Text, Email, or request a call from our website at www.bradenmedicare.com