Hospital Insurance

Doctor & Outpatient Visits

• $185 monthly premium (may be higher based on income)
• Physician services
• Outpatient hospital services
• Ambulance
• Outpatient mental health
• Laboratory services
• Durable medical equipment (wheelchairs, oxygen, etc.)
• Outpatient physical, occupational therapy
• Some preventive care
• You can get care throughout the U.S., but generally not outside the country
• Participating physicians who accept Medicare patients
• $257 annual deductible for 2025
• Medicare pays 80%, you pay 20% of Medicare-approved cost
• No Maximum-Out-of-Pocket (MOOP)
• No RX Coverage

• Designed to cover what Medicare Parts A & B doesn't – such as deductibles, co-payments, and co-insurance.
• Plans are named A, B, C, D, F, G, K, L, M, N and HDF (except WI, MN, MA).
• Pay-Upfront Type of Plan

Pros

• If plan is put together correctly you will have little to no out-of-pocket costs for medical care.
• Goes with you anywhere in the U.S.
• No networks.
• Guaranteed renewable as long as you pay your premium on time and not made any material misrepresentation on your application for insurance.

Cons

• Premium at age 65 starts at $160+ per month. The more comprehensive coverage, the higher the premium.
• In most cases, premiums are based on gender, ZIP code and age.
• Average increase: 6-7%/year.
• Premiums nearly double every 10 years.
• No RX Coverages included

• Helps with cost of outpatient prescription drugs
• Only offered through private insurance companies
• Most states have 25-30 plans
• Each plan has a list of drugs it covers (formulary)
• Make sure your drugs are covered before you enroll in the plan. The list of 
  drugs changes yearly.
• Coverage is not automatic.
• Penalties may apply if you enroll late (1% per month accumulating).
• Average cost for Part D is $35-45 per month

• Combines Part A and Part B and, in most cases, includes Part D into one plan
• Offered by private insurance companies (HMO PPO, PFFS, SNP, MSA-No RX)
• Pay-As-You-go Type of Plan

Pros 

• Plan premiums start as low as $0 per month
• Eliminate all deductibles associated with Medicare Part A and Part B
• Pay a small copay for all Medicare-covered services
• All plans have a max-out-of-pocket
• Some plans offer additional benefits not covered by Medicare like dental and vision preventive care and gym memberships

Cons

• Most plans use networks of doctors and hospitals.
• Coverage may be limited outside the networks unless emergency room (ER) or urgent care.
• Possible to spend more if you reach out-of-pocket (OOP) maximum.

*There are special rules for ESRD. People with ESRD may be able to join a Medicare Special Needs Plan (SNP) if one is available in their area