Enroll in Medicare: 2025 Open Enrollment

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Health insurance is complicated – and that includes Medicare. But what’s not complicated is the importance of taking care of yourself to live a long and healthy life.

The annual open enrollment period for Medicare runs from October 15 – December 7 each year, with coverage beginning on January 1 of the next year. During this time, you can join, drop, or switch to another Medicare Advantage plan. You can also add or drop drug coverage during this time.

What is Medicare?

Medicare is the federal health insurance program for people 65 or older, although you may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).

Medicare is funded by payroll taxes, premiums, and federal funding. Most people qualify for Medicare after working and paying taxes for at least 10 years.

When can I sign up for Medicare?

For most people, the first time you can sign up for Medicare is three months before you turn 65 and three months after the month you turn 65. When you first sign up for Medicare and during certain times of the year, like Open Enrollment or a special enrollment period, you will choose which combination of coverage options you want.

What are the different parts of Medicare?

customize their coverage based on their healthcare needs and budget. Each part is designed to cover specific types of care:

• Part D (Prescription Drug Coverage)
• Part A (Hospital Insurance)
• Part B (Medical Insurance)
• Part C (Medicare Advantage)

Medicare Part A: What does it cover?

Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

How much is Medicare Part A?

Most people will end up paying $0 for their premium because they paid Medicare taxes long enough while working – generally at least 10 years. This is sometimes called “premium-free Part A.” However, if you don’t qualify for a premium-free Part A, you might be able to buy it.

In 2024, the premium for Medicare Part A was either $278 or $505 each month, depending on how long you or your spouse worked and paid Medicare taxes. You also have to sign up for Part B to buy Part A. But, if you don’t buy Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty. 

You also have to pay a deductible each time you’re admitted to the hospital per benefit period before Original Medicare starts to pay. In 2024, the deductible was $1,632.

Medicare Part B: What does it cover?

Medicare Part B (Medical Insurance) helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment), and many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits).

How much is Medicare Part B?

In 2024, the premium for Medicare Part B was $174.70 each month (or higher depending on your income) and the deductible was $240, which you have to pay once each year before Original Medicare starts to pay. Again, these amounts can change each year.

When it comes to costs for services and coinsurance, you’ll usually pay 20% of the cost for each Medicare-covered service or item after you’ve paid your deductible.

Medicare Part C: What does it cover?

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

• Whether the plan charges a monthly premium. Many Medicare Advantage Plans have a $0 premium. If you enroll in a plan that does charge a premium, you pay this in addition to the Part B premium (and the Part A premium if you don’t have premium-free Part A).
• Whether the plan pays any of your monthly. Medicare Part B (Medical Insurance) premium.  Although not available in all areas, some plans will help pay all or part of your Part B premium. This is sometimes called a “Medicare Part B premium reduction.”
• Whether the plan has a yearly deductible or any additional deductibles.
• How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
• The type of health care services you need and how often you get them. Whether you go to a doctor or supplier who accepts assignment if you’re in a PPO, PFFS, or MSA plan; or, you go out-of-network.
• Whether you follow the plan’s rules, like using network providers.
• Whether you need extra benefits and if the plan charges for them.
• The plan’s yearly limit on your out-of-pocket costs for all medical services.
• Whether you have Medicaid or get help from your state.

Medicare Part D: What does it cover?

Medicare Part D (Drug coverage) helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

How much is Medicare Part D?

Monthly premiums for Medicare Part D vary based on which plan you join. The amount can change each year. You may also have to pay an extra amount each month based on your income.

Most plans charge a deductible, an amount you pay before the plan starts to pay, for prescriptions you fill. The deductible amount varies based on which plan you join. Your actual costs vary depending on the medicines you take, if they are on your plan’s list of covered drugs, and which pharmacy you use.

Medicare Extra Help Program

There is also assistance available for people with limited income and resources to help pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.

In 2024, prescription costs for eligible participants in the Medicare Extra Help Program were capped at $4.50 for generic drugs and $11.20 for brand-name drugs.

Medicare through Woligo

Understanding the various parts of Medicare is crucial for making informed decisions about your healthcare.

Woligo has a dedicated team of Medicare specialists who are product trained and AHIP-Certified (a Medicare sales requirement). To speak with an agent, simply complete this short questionnaire. The information you provide will help us connect you with the agent best suited to meet your needs.

Additional Medicare FAQ:

When does Medicare Open Enrollment end?

Medicare Open Enrollment ends December 7 each year, with coverage beginning on January 1 of the next year.

Do you have to enroll in Medicare every year?

For the most part, no. As long as you pay your premiums (if applicable) on time, then your plan will automatically renew each year. However, changes in your income or circumstances may warrant you to reevaluate your plan selections.

What income is used to determine Medicare premiums?

The income Medicare uses to determine your premiums differs by the plan. For example, Medicare Part A (Hospital Insurance) is based on the amount of taxes paid during your working years.

For Medicare Parts B and D, the amount of your premium is based on your modified adjusted gross income or MAGI. Generally, the higher your MAGI, the higher your premium.

What happens if you don’t sign up for Medicare at 65?

If you don’t sign up for Medicare when you turn 65 and aren’t covered by a qualifying health plan, you may face late enrollment penalties and gaps in coverage.

However, if you’re still working and have employer-sponsored health coverage (or your spouse does), you can delay Medicare without penalty. You’ll qualify for a Special Enrollment Period (SEP) when you or your spouse stop working or lose employer coverage.

What is Medicare tax?

The Medicare tax is a federal payroll tax that helps fund the Medicare program. Since 1986, the tax has remained at 2.9%.

If you work for an employer, the employer is responsible for half of the tax (1.45%) while you (the employee) are responsible for the other half.

If you are self-employed, then you are responsible for the full 2.9% as both the employer and employee, but you’re able to deduct the employer-equivalent portion when filing taxes.

Note: In 2013, an additional Medicare Tax for high-income earners was implemented as part of the Affordable Care Act. High-income earners are subject to an additional 0.9% on income exceeding certain thresholds:

• $125,000 for married individuals filing separately
• $200,000 for single filers
• $250,000 for married couples filing jointly

Who qualifies for Extra Help Medicare?

must meet specific income and resource limits, which are determined annually.

• Income: Your income cannot exceed $22,590 for an individual or $30,660 for a married couple living together.
• Resources: Your resources must not exceed $17,220 for an individual or $34,360 for married couples.
• Location: You must live in one of the 50 states or the District of Columbia.

Note: You automatically qualify for Extra Help with Medicare if you are eligible for full Medicaid coverage.

What is Medigap?

Medicare Supplemental Insurance, commonly referred to as Medigap, is extra insurance you can buy from a private company that helps pay for some of the health care costs you’re responsible for, like copayments, coinsurance, and deductibles. However, it’s important to note that Medigap doesn’t cover everything. Medigap policies generally don’t cover long-term care, vision or dental services, hearing aids, eyeglasses, and private-duty nursing.

Still have questions? We are here to help!

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