Health plans for older adults

Before a person turns 65, they may consider their current health insurance, when it will end, and whether they may need any new or additional health coverage in the future.

It’s also a good time to prepare for Medicare, which many Americans will be eligible for free of charge, depending on their working history.

Original Medicare comprises Part A and Part B, which cover most inpatient and outpatient services.

Other Medicare parts include Medicare Advantage (Part C), Part D prescription drug plans, and Medigap supplement insurance plans. Private insurers administer these plans, some of which also include additional benefits and services.

Individuals can choose a plan or combination of plans by considering:

• their budget
• whether they have doctor, hospital, or clinic preferences
• both their current and possible future health conditions
• their medications

Once eligible for Medicare, some people are automatically enrolled. If not, they can enroll online, by post, or in person at a local Social Security office.

• have been receiving disability benefits and will be turning age 65 in 4 months
• are not turning age 65 but have been receiving disability benefits for 2 years
• are not turning age 65, but they have received an ESRD or ALS diagnosis

To avoid late enrollment penalties, those not automatically enrolled need to sign up during an enrollment period.

The different Medicare parts include the following coverage:

Medicare costs will vary by plan but can include monthly premiums, deductibles, coinsurance, and copayments.

In 2025, Medicare Part A costs include:

• Monthly premiums: Most people do not pay a Part A premium, but this will depend on their working history.
• Deductible: Individuals must pay the Part A deductible of $1,676 per benefit period before the plan covers its share of costs. A benefit period begins when a person is admitted to the hospital and ends when they have not received any inpatient care for 60 consecutive days.
• Copayments: Depending on the length of a person’s hospital stay, copayments can range from $0 to the full cost of services.

2025 Medicare Part B costs include:

• Premiums: Premiums start from $185 per month and increase based on a person’s income.
• Deductible: People must pay a $257 deductible before the plan pays its share of eligible costs.
• Coinsurance: There is a 20% coinsurance that applies to the Medicare-approved amount for eligible Part B items or services.

Medicare Advantage plan costs vary but can include:

• monthly premiums
• annual deductibles
• copayments
• coinsurance

According to the Centers for Medicare & Medicaid Services (CMS), in 2025, the average Medicare Advantage monthly premium is around $17.

Premiums and other out-of-pocket costs for Medicare Part D prescription drug plans vary by plan, plan provider, and a person’s location.

In 2025, the national base premium is $36.78, and a person’s plan price can increase based on their income.

Individuals will pay a separate premium for a Medigap plan, which can vary by plan provider and location.

Most people will not receive a bill from Medicare, as it generally operates a Fee-For-Service (FFS) model. This means that doctors, healthcare professionals, facilities, hospitals, and clinics bill Medicare directly for each item or service they provide.

Medicare may automatically deduct plan premiums from Social Security benefits, but if not, it will send a bill.

There are various ways to pay Medicare bills each month, including:

• through Medicare’s website, with a debit or credit card
• by mail, using a check, money order, or payment form

This free service allows people to pay their monthly Original Medicare premiums through automatic bank withdrawals.

Individuals can print and complete the Authorization Agreement for Preauthorized Payments form (SF-5510), which is available in English and Spanish.

Medicare can be complicated, but understanding the basics can help individuals focus on their coverage needs.

Original Medicare parts A and B cover inpatient and outpatient medical services. A person can add other plans to cover take-home prescription medications and some of Original Medicare’s out-of-pocket costs. Other bundled plans are also available.

Medicare’s website allows people to browse the different plan options that are available locally, which can help them make the best choice for their healthcare.