Medicare Basics
At Extra Help Agency, we are driven by teaching and helping those in our communities.
Think of Medicare as a Two Step Process:
Your Guide to Understanding the Essentials
Navigating Medicare can be overwhelming, but at Extra Help Agency, our mission is to simplify the process and empower our community. We were created to meet the local need for clear and accessible Medicare education. Our focus is on helping beneficiaries understand their benefits and all available options, ensuring you make informed decisions.
We break Medicare down into two simple steps: enrolling in Original Medicare, and exploring additional coverage options. Whether it’s understanding Medicare Part A and Part B or choosing the right supplemental coverage, we’re here to guide you every step of the way. Our commitment is to make Medicare easy to understand, so you can confidently navigate your healthcare journey.
Our Mission & Vision.
We are driven by teaching and helping those in our communities. The Extra Help Agency was created because of the need at the local level to Help Medicare Beneficiaries Understand Medicare Benefits. Explaining Medicare in a way that makes sense and helping beneficiaries understand what all of their options are, that’s our focus, our mission, and our primary business.
Step 1:
Getting Started With Medicare
Enroll in Original Medicare, which includes Part A and Part B, to cover your hospital and medical expenses. Learn about the benefits, costs, and enrollment periods, so you can start your Medicare journey with confidence.
Enroll into Original Medicare consisting of Medicare Part A & Medicare Part B.
Original Medicare, also known as traditional Medicare, is a government-administered health insurance program consisting of Part A (Hospital Insurance) and Part B (Medical Insurance). It provides a foundation of coverage for eligible individuals, typically those aged 65 and older, and younger individuals with disabilities (SSDI). Original Medicare allows you to use any doctor or hospital that accepts Medicare, anywhere in the U.S. For those that are aging into Medicare, you have a 7-month window called the initial enrollment period (IEP) to set your Medicare up. If you miss this window (unless you have creditable coverage), you might have a lifetime late enrollment penalty (LEP) so it is very important to get this right. You will be automatically enrolled if you are collecting your Social Security retirement benefits for at least four months before the month you turn 65. Your Medicare card will be mailed to the address that Social Security has on file. Anyone on SSDI will be automatically enrolled as well. If you are not drawing Social Security benefits yet, you will need to apply for Medicare. You can contact our office and we can assist with this process, we have helped hundreds in our community to enroll into Medicare. Or you can contact Social Security to set an appointment, request to enroll over the phone or go online to your Social Security account and enroll online. You have many choices, if you feel overwhelmed just give us a call. The service we provide is free to you and we are happy to help. Original Medicare does not cover prescription medications, you will need to look at step 2 for your drug coverage options.
Medicare Part A helps you cover your hospital expenses...like when you are admited into a hospital.
Medicare Part A (Hospital): Medicare Part A primarily covers inpatient hospital care, including semi-private rooms, meals, nursing care, and necessary medications. It also covers care in skilled nursing facilities, hospice care, and some home health care. Importantly, Part A only covers inpatient care when a doctor officially admits you to the hospital.
Let’s look at some of the costs you may have with Medicare Part A, see below.
Part A Premium – 2025
• $0 (Premium-free): Most people (99% of beneficiaries) qualify for this, meaning they paid Medicare taxes for at least 40 quarters (10 years).
• $285/month: For those who worked and paid Medicare taxes for at least 30 quarters but less than 40 quarters.
• $518/month: For those who worked and paid Medicare taxes for less than 30 quarters.
Part A – Hospital Stay in 2025:
Inpatient hospital coverage has a 90-day benefit period that will reset if you are readmitted after being discharged for at least 60 consecutive days.
• $1,676.00 deductible per benefit period
• $0.00 for the first 60 days of inpatient hospitalization
• $419.00 co-pay per day for days 61–90 of inpatient hospitalization
• $838.00 co-pay per “lifetime reserve day” after your inpatient hospital benefit period is exhausted. You have 60 reserve days to use over your lifetime. Once the lifetime reserve days are used, you will pay 100% of the hospital cost.
Part A – Skilled Nursing Facility (rehab) in 2025:
Original Medicare requires a minimum 3-night stay as an inpatient at a hospital for Medicare to pay for skilled nursing facilities. If you do not meet the requirements, you will be responsible for the skilled nursing facility costs. Skilled nursing has a benefit period of 100 days; you will be responsible for all costs if you exhaust your skilled nursing benefit period. As with hospital coverage, you will need to be discharged for 60 days to reset your benefit period.
• $0.00 charge for the first 20 days of each benefit period
• $209.50 per day for days 21–100 of each benefit period
• You pay all costs for each day after day 100 of the benefit period
Part A – Hospice in 2025: Generally, no cost for hospice care services, but there may be copayments for medications.
Part A – Home Health Care in 2025: Generally, no cost for covered home health care services.
As you can see, the costs can increase quickly. Medicare is a fee-for-service set up, so this means you will continue to pay as you need medical services. There is no maximum out-of-pocket or “safety net” built into Medicare, which can financially ruin retirement plans. Do not worry too much because there are ways to protect yourself and your loved ones from possible financial hardships. You will learn about this in Step 2.
Medicare Part B helps you cover your medical expenses, like doctor office visits and outpatient surgeries.
Generally Medicare Part B is a 80/20 coinsurance. This means that Medicare pays 80% of your medical expenses and you will pay the remaining 20%. Medical expense examples include: doctor visits, out-patient surgery, ambulance, emergency room and durable medical equipment like oxygen tanks and diabetic testing supplies. Below are the bullet points of your costs when it comes to Medicare Part B
- $185.00/month is the standard premium that most will pay for Medicare Part B.
- If your income is over a certain amount, you will pay more for Part B
- If your income is under a certain amount, you may receive help paying for Part B
- You generally pay 20% of all medical bills. Medicare Part B does not have a maximum out-of-pocket or a financial “safety net” set up. This means that as you need services, you will be billed for those services. For example, if you go to your primary doctor and Medicare allows the doctor to charge $140 for the office visit, then Medicare will pay $112 (80%) of the bill, and you will pay $28, the remaining 20%. Since there is no maximum out of pocket, if you happen to need services that amount to $300,000.00, then Medicare will pay the 80% and that will leave you with the 20% or a bill of $60,000.
As you can see, the costs can increase quickly. Medicare is a fee-for-service set up, so this means you will continue to pay as you need medical services. There is no maximum out-of-pocket or “safety net” built into Medicare, which can financially ruin retirement plans. Do not worry too much because there are ways to protect yourself and your loved ones from possible financial hardships. You will learn about this in Step 2.
Step 2:
Exploring Additional Coverage Options
If Original Medicare doesn’t fully meet your needs, explore options like Medicare Part D for prescription drugs, Medigap plans to cover out-of-pocket costs, or Medicare Advantage plans for comprehensive coverage. We simplify these choices so you can find the best fit for your health care needs.
Option 1: Keep original Medicare and add the following
PRESCRIPTION DRUG PLAN…MEDICARE PART D
- Helps pay for prescription drug costs.
- Average National Cost Usually Ranges between $30.00 & $40.00
- Avoid the Late Enrollment Penalty (LEP)…Enroll in Part D.
AND/OR
MEDICARE SUPPLEMENT INSURANCE (MEDIGAP)
- Upsides: Covers some or all of the costs that are not covered by Original Medicare…fills in the “gaps.”
- Downsides: Monthly premiums are paid if you need to use your insurance or not. And monthly premiums generally increase every year.
Option 2: Manage your Medicare Benefits with Part C.
MEDICARE PART C…MEDICARE ADVANTAGE PLANS
- Part C Plans are private health plans that are contracted with Medicare to manage your Medicare Part A and Part B benefits. Most plans are structured as a PPO or HMO…just like you probably had with your employer while working. Since they manage your Medicare benefits, all Part C plans give you the same benefits as Original Medicare, plus more.
- Many Part C plans also include Part D, Prescription Drug Coverage so you will avoid the late enrollment penalty.
- Part C plans usually have a low or no monthly premium.
Additional benefits can include: dental services, vision services, hearing services, health screening tests, gym access and nurse helplines are some of the items that are often included in Medicare Advantage plans. Plans also cap your out-of-pocket expenses for the year. The maximum out of pocket limit provides a financial “safety net” for members.
Understanding Your Options
Your Medicare Choices: Simplified
After having gone through Medicare basics STEP ONE and STEP TWO options above, you might feel a little overwhelmed. So let’s keep it simple. Once you are enrolled into Medicare you have one of two options.
1. Purchase a stand alone prescription drug plan with a Medicare supplement policy to help cover the gaps in Original Medicare.
2.Enroll into a Medicare Advantage plan with a no or low monthly premium that also provides prescription drug coverage.
Simple Right?
For help on deciding on how to set Medicare up for you or to help a loved one, check out our Setting Up Your Medicare page for more information about how to decide what is the best fit for you…or you can contact us and speak to someone that is local, licensed and certified. We will be happy to help educate and guide you on your options and choices so that you can make an informed decision on what is right for you.
Note: If you have limited income & assets please take the time to visit the Extra Help With Medicare Costs page for information about programs that are built into Medicare to help you pay for your health & drug costs.
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Senior Agent
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Medicare Expert
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