Medicare 101

What is Medicare?

Medicare is health insurance for individuals age 65 and over
Medicare is also available to individuals under the age of 65 in the 25th month of receiving Social Security Disability Benefits

When are you eligible for Medicare?

Individuals are eligible on the first of the month that they turn age 65
Turn 65 on June 24? You are eligible June 1
Turn 65 June 1? You are eligible May 1
Eligible due to disability? Your eligibility begins the first of the month of the 25th month that you are receiving disability benefits.

Signing Up – Already Receiving Social Security Benefits

Already receiving Social Security Retirement Benefits?
You will be automatically enrolled in Medicare Part A and Medicare Part B
Your Medicare Part B Premium will be automatically deducted from your Social Security Retirement Benefits
Your Medicare benefits will become effective on the first of the month that you turn 65.

Signing Up – Not Receiving Social Security Benefits

You are turning 65 and have not signed up for Social Security. When can you sign up?
Sign up period: 7 months
3 months before your 65th birthday month
The month of your 65th birthday
Three months after your 65th birthday month

When you sign up for Medicare	When your Medicare will begin
Automatically enrolled/signed up before your 65th birthday month	First day of your birth month.
Automatically enrolled/signed up before 65th birthday month BUT your birthday falls on the 1st	Your coverage will start on the 1st day of the month prior to your birthday
During the 1st month you turn 65	Medicare will start 1 month after you sign up
One month after you turn 65	Medicare will start 2 months after you sign up
2 months after you turn 65	Medicare will start 3 months after you sign up
3 months after you turn 65	Medicare will start 3 months after you sign up
After that time, you can usually only apply during the General Election Period (1/1-3/31)	Medicare will start July 1st

How to Sign Up

Sign Up Online
ssa.gov/benefits/medicare

Sign Up Over The Phone
800-772-1213

Social Security Office – Buncombe County
800 Centre Park Drive, Asheville, NC 28805
(866) 572-8361
Monday – Friday	9 AM – 4 PM

Social Security Office – Henderson County
205 S Grove St, Hendersonville, NC 28792
(866) 964-5053
Monday – Friday	9 AM – 4 PM

Medicare Parts A and B

Medicare Part A Hospital Insurance Premiums

No Cost! (If you have worked for at least 10 years for which you paid Medicare taxes)
If you have worked less than 10 years, you will share in the cost of your Medicare Part A premium.
If you are not eligible for a no cost or reduced cost Part A premium, you will have to pay the entire amount. The full cost of the Medicare Part A Premium for 2025 is $520.00

A non-working spouse can qualify for no cost Part A at age 65 if their spouse has worked 10 years and is at least age 62.

Medicare Part B Medical Insurance Premiums

Monthly Part B premiums are determined by the Social Security Administration and are based on your household taxable income from two years prior (2025 premiums are based on 2023 income)
If your income has been reduced due to retirement, working less, changing careers or any other reason, you can appeal this determination. Click here for the form and instructions
Why it is important to enroll in Medicare Part B
Financial assistance for paying your Medicare Part B premium

Yearly Income and Filing Status for 2023			Part B Premium for 2025
File individual tax return	File joint tax return	File married & separate tax return	Part B Premium for 2025
$106,000 or less	$212,000 or less	$106,000 or less	$185.00
$106,000 to $133,000	$212,000 to $266,000	Not applicable	$259.00
$133,000 to $167,000	$266,000 to $334,000	Not applicable	$370.00
$167,000 to $200,000	$334,000 to $400,000	Not applicable	$480.90
$200,000 to $500,000	$400,000 to $750,000	$106,000 to $394,000	$591.90
Greater than $500,000	Greater than $750,000	Greater than $394,000	$628.90

2025 Medicare Benefits
Medicare Part A Hospital Insurance Benefits Inpatient Hospital Care Skilled Nursing Facility Care Hospice Care Some Home Health Care Part A Benefits do not cover all costs. You will pay: In Patient Hospital $1676 deductible for each benefit period $419 per day for days 61 – 90 of a hospital stay $838 per day after day 90 subject to a 60-day lifetime limit Beyond the lifetime limit: you are responsible for all costs Skilled Nursing Facility Day 1 – 20: $0 Day 21 – 100: $209.50 per day Beyond Day 100: 100% of all costs	Medicare Part B Medical Insurance Benefits Physician Services Outpatient Hospital Services Ambulatory Surgical Centers Comprehensive Outpatient Rehabilitation Centers Preventive Care Ambulance Durable Medical Equipment Limited Outpatient Prescription Drugs Part B Benefits do not cover all costs. You will pay: $257 Annual Deductible Typically, 20% of the Medicare Approved Amount for Part B Covered Services

2025 Medicare Benefits

Medicare Part A Hospital Insurance Benefits

Inpatient Hospital Care
Skilled Nursing Facility Care
Hospice Care
Some Home Health Care

Part A Benefits do not cover all costs. You will pay:

In Patient Hospital

$1676 deductible for each benefit period
$419 per day for days 61 – 90 of a hospital stay
$838 per day after day 90 subject to a 60-day lifetime limit
Beyond the lifetime limit: you are responsible for all costs

Skilled Nursing Facility

Day 1 – 20: $0
Day 21 – 100: $209.50 per day
Beyond Day 100: 100% of all costs

Medicare Part B Medical Insurance Benefits

Physician Services
Outpatient Hospital Services
Ambulatory Surgical Centers
Comprehensive Outpatient Rehabilitation Centers
Preventive Care
Ambulance
Durable Medical Equipment
Limited Outpatient Prescription Drugs

Part B Benefits do not cover all costs. You will pay:

$257 Annual Deductible
Typically, 20% of the Medicare Approved Amount for Part B Covered Services

Medicare Supplemental Coverage

• There is no out of pocket limit for Medicare Part A and Medicare Part B.
• Medicare Part A and Medicare Part B do not provide prescription drug coverage
• Medicare Supplemental coverage can help you limit your out of pocket medical and help you pay for prescriptions

Path 1	Path 2
Original Medicare Medicare Supplement and a Part D Prescription Drug Plan	Medicare Advantage
Medicare Supplement Plans Covers your out of pocket costs for Medicare Part A and Medicare Part B. To enroll in a Medicare Supplement plan, you must be enrolled in Medicare Part A and Medicare Part B You will have guaranteed insurability if you enroll within six months of enrolling in Medicare Part B (no medical questions) You must answer medical questions if you change insurance carriers or if you apply outside the six-month window No network. Freedom to choose providers and hospitals. A Medicare Supplement Plan is accepted by any provider that accepts Medicare If the provider does not accept Medicare, you can file a claim with Medicare and the Medicare Supplement insurance plan Medicare Part D Prescription Drug Plans Medicare Part D is subsidized and tightly regulated by CMS A Medicare Part D Prescription Drug Plan is a private insurance plan Plans compete with premiums, formulary and copays Individuals and couples with higher incomes will pay a higher Part D plan premium Individual: $106,000 and above Couple: $212,000 and above Additional premium ranges from 35% to 85% of the cost of the plan Final cost is determined by CMS If you enroll in a Medicare Supplement Plan, you will need a Medicare Part D Prescription Drug Plan to cover the costs of your outpatient prescription drugs If you do not enroll in a Part D Prescription Drug Plan, you will be accessed a penalty when you do enroll in a plan for each month you were eligible but were not enrolled The penalty is 1% per month of the Part D National Base Beneficiary Premium. The 2025 Part D National Base Beneficiary Premium is $36.78. You can shop for and enroll in a Medicare Part D Prescription Drug Plan through the Medicare Plan Finder at medicare.gov Enter your zip code, prescriptions and pharmacy Website will display all available plans in your zip code and your total out of pocket costs for prescriptions and your premium Click enroll next to the plan you select After you determine your plan, you can also enroll through these pathways Call 1-800 MEDICARE (800-633-4227) Call the insurance company Annual Open Enrollment You can change plans every year The Annual Notice of Coverage for your current plan will arrive by September 30 You can start shopping for coverage on October 1 Open Enrollment is October 15 – December 7	Medicare Advantage Plans Replaces Medicare Part A and Medicare Part B with traditional medical plan benefits from a private insurance company. A Medicare Advantage Plan has: Copays Coinsurance Out of pocket maximums With a Medicare Advantage Plan You still pay your Medicare Part B Premium You can enroll in a plan with or without prescription coverage You must use a provider that is in the plan network Most insurance companies offer a HMO and PPO plan design Some plans cover out of network benefits If you enroll in a plan without prescription coverage (Medical Only Plan), you cannot enroll in a Medicare Part D Plan If you enroll in a Medical Only Plan, you will be subject to the Part D penalty when you enroll in a Medicare Part D Prescription Plan or a Medicare Advantage Plan that includes prescription coverage. The penalty is 1% per month of the Part D National Base Beneficiary Premium. The 2025 Part D National Base Beneficiary Premium is $36.78. If you enroll in a Medical Only Plan and then enroll in a Medicare Part D Prescription plan, you will be dis-enrolled from the Medical Only Plan. How do I enroll? A local insurance agent can: Help you decide if a Medicare Advantage Plan is right for you Check your providers to make sure they are in the plan network Check your prescriptions Explain benefits and out of pocket costs Annual Open Enrollment You can change plans every year The Annual Notice of Coverage for your current plan will arrive by September 30 You can start shopping for coverage on October 1 Open Enrollment is October 15 – December 7 Your local agent can help you with your Annual Open Enrollment decisions

Path 1

Path 2

Original Medicare
Medicare Supplement and a Part D Prescription Drug Plan

Medicare Advantage

Medicare Supplement Plans

Covers your out of pocket costs for Medicare Part A and Medicare Part B.
To enroll in a Medicare Supplement plan, you must be enrolled in Medicare Part A and Medicare Part B
You will have guaranteed insurability if you enroll within six months of enrolling in Medicare Part B (no medical questions)
You must answer medical questions if you change insurance carriers or if you apply outside the six-month window
No network. Freedom to choose providers and hospitals.
A Medicare Supplement Plan is accepted by any provider that accepts Medicare
If the provider does not accept Medicare, you can file a claim with Medicare and the Medicare Supplement insurance plan

Medicare Part D Prescription Drug Plans

Medicare Part D is subsidized and tightly regulated by CMS
A Medicare Part D Prescription Drug Plan is a private insurance plan
Plans compete with premiums, formulary and copays
Individuals and couples with higher incomes will pay a higher Part D plan premium
Individual: $106,000 and above
Couple: $212,000 and above
Additional premium ranges from 35% to 85% of the cost of the plan
Final cost is determined by CMS
If you enroll in a Medicare Supplement Plan, you will need a Medicare Part D Prescription Drug Plan to cover the costs of your outpatient prescription drugs
If you do not enroll in a Part D Prescription Drug Plan, you will be accessed a penalty when you do enroll in a plan for each month you were eligible but were not enrolled
The penalty is 1% per month of the Part D National Base Beneficiary Premium. The 2025 Part D National Base Beneficiary Premium is $36.78.
You can shop for and enroll in a Medicare Part D Prescription Drug Plan through the Medicare Plan Finder at medicare.gov
Enter your zip code, prescriptions and pharmacy
Website will display all available plans in your zip code and your total out of pocket costs for prescriptions and your premium
Click enroll next to the plan you select
After you determine your plan, you can also enroll through these pathways
Call 1-800 MEDICARE (800-633-4227)
Call the insurance company

Annual Open Enrollment

You can change plans every year
The Annual Notice of Coverage for your current plan will arrive by September 30
You can start shopping for coverage on October 1
Open Enrollment is October 15 – December 7

Medicare Advantage Plans

Replaces Medicare Part A and Medicare Part B with traditional medical plan benefits from a private insurance company.

A Medicare Advantage Plan has:

Copays
Coinsurance
Out of pocket maximums

With a Medicare Advantage Plan

You still pay your Medicare Part B Premium
You can enroll in a plan with or without prescription coverage
You must use a provider that is in the plan network
Most insurance companies offer a HMO and PPO plan design
Some plans cover out of network benefits
If you enroll in a plan without prescription coverage (Medical Only Plan), you cannot enroll in a Medicare Part D Plan
If you enroll in a Medical Only Plan, you will be subject to the Part D penalty when you enroll in a Medicare Part D Prescription Plan or a Medicare Advantage Plan that includes prescription coverage. The penalty is 1% per month of the Part D National Base Beneficiary Premium. The 2025 Part D National Base Beneficiary Premium is $36.78.
If you enroll in a Medical Only Plan and then enroll in a Medicare Part D Prescription plan, you will be dis-enrolled from the Medical Only Plan.

How do I enroll? A local insurance agent can:

Help you decide if a Medicare Advantage Plan is right for you
Check your providers to make sure they are in the plan network
Check your prescriptions
Explain benefits and out of pocket costs