The standard Medicare Part B premium jumped to $202.90 per month in the current plan year — nearly a $17 monthly increase — while millions of eligible seniors are enrolled in programs that could eliminate or dramatically reduce that bill entirely. Choosing the wrong plan type, or missing a free savings program, can cost $2,000 to $6,000 a year or more. This guide walks through every major option, the real numbers, and exactly where to call.
These are the questions seniors ask most — and most often get wrong answers to, because the answers come from agents who earn a commission. Plain answers follow.
Original Medicare is the federal program directly — the government pays your providers, you can see any doctor who accepts Medicare nationwide, and there is no network. Medicare Advantage is a private insurance alternative that must cover everything Original Medicare covers, but does so through a network of providers and adds extras like dental, vision, and hearing that Original Medicare excludes. The trade-off: Advantage plans often have $0 monthly premiums (beyond the Part B premium you pay regardless), but require copays for services and restrict you to network providers. Medigap policies attach to Original Medicare and eliminate most of its cost-sharing — but cost $110–$200+ monthly and are purchased separately from drug coverage. Neither is universally better. The best plan is the one matched to your specific doctors, prescriptions, and how much you travel.
Yes — and for millions of seniors it already does. Medicare Savings Programs, run by state Medicaid offices, pay the $202.90 monthly Part B premium for qualifying enrollees. The most comprehensive — the Qualified Medicare Beneficiary (QMB) program — also eliminates Part A and Part B deductibles and all copays. About 10 million seniors are enrolled, but CMS estimates several million more qualify and don’t know it. Income eligibility at the federal baseline is up to $1,350 per month for a single person for QMB, with higher limits in many states. These programs are never advertised on Medicare.gov’s main pages and are only accessible by applying through your state Medicaid office or calling 1-800-Medicare.
The cap is real and it is a major change from earlier years. Under the Inflation Reduction Act, your annual out-of-pocket spending on Part D covered prescription drugs is capped at $2,100. Once you hit that number, you pay $0 for covered drugs for the rest of the calendar year — the plan covers 100%. If you also qualify for the Extra Help (LIS) program, your copays are capped at $5.10 for generics and $12.65 for brand-name drugs regardless, and every dollar Extra Help pays counts toward the $2,100 threshold, accelerating when you reach $0 copays. For someone on insulin, cancer medications, or multiple brand-name drugs, this cap can represent thousands of dollars in savings over the old catastrophic coverage structure.
Extremely permanent. The Part B late enrollment penalty is 10% of the standard monthly premium for every full 12-month period you were eligible but didn’t enroll — and it attaches to your premium for life. At current rates, a three-year delay adds a 30% surcharge on top of the $202.90 base premium, every month, forever. Part D has its own late penalty: 1% of the national base beneficiary premium for each uncovered month, also permanent. The only valid reason to delay Part B enrollment without penalty is continuous coverage under an employer group health plan from current employment — not COBRA, not retiree insurance, not a spouse’s plan if you’re retired. Verify your delay qualifies in writing with Social Security before you miss the window.
The comparison depends entirely on your health usage, not your premium. A $0 Advantage plan becomes expensive the moment you use it heavily: copays accumulate quickly, and the in-network maximum out-of-pocket can reach $9,250. Medigap Plan G averages $110–$200 monthly for a 65-year-old non-smoker but covers almost all cost-sharing after the Part B deductible ($283/year) — turning your Medicare spending into a predictable number with no network restrictions. If you see specialists regularly, travel often, have a chronic condition, or want certainty over surprises, Medigap typically wins on total annual cost in bad health years. If you’re healthy, local, and want the extras (dental, gym membership), a top-rated Advantage plan may cost less overall. Never compare premiums alone — compare total estimated annual cost including expected usage.
Yes, and you should do it immediately. Medicare calculates IRMAA surcharges based on your tax return from two years prior — so a retirement in the current year doesn’t automatically reduce your premium until two years later. If your income dropped because of retirement, divorce, death of a spouse, reduction in work hours, or another qualifying life-changing event, you can file Form SSA-44 with the Social Security Administration to request a recalculation based on your current, lower income. This can reduce your monthly premium by $81 to $487 immediately rather than waiting two years for the tax return to cycle through. Call Social Security at 1-800-772-1213 and ask specifically about filing SSA-44 for IRMAA appeal.
Your Initial Enrollment Period is a 7-month window: it opens 3 months before the month you turn 65, includes your birthday month, and closes 3 months after. The timing within this window matters: enrolling in the first three months gives you Part B coverage starting the month your coverage begins; enrolling in your birthday month or later delays coverage by one to three months. Sign up during the first three months before your birthday for no-gap coverage. If you’re still working with employer group coverage, you may delay without penalty — but verify this in writing with Social Security and confirm your employer plan qualifies. After you lose employer coverage, you get a Special Enrollment Period of 8 months to sign up penalty-free.
Yes — legally required ones. Original Medicare covers no routine dental, vision, or hearing. Medicare Advantage plans are permitted to offer these and many now do: Humana includes an over-the-counter benefit of $250 per quarter for health-related items; many plans include SilverSneakers or similar gym memberships; some include transportation to medical appointments, meal delivery after hospitalization, and telehealth visits with $0 copays. These extras matter most if you need dental work, hearing aids (which run $1,000–$7,000 at retail), or regular eye care — Original Medicare with a Medigap plan covers none of those, and you’d pay out of pocket regardless of how comprehensive your Medigap coverage is.
These are official figures from the Centers for Medicare & Medicaid Services. Every number below is what you will pay in the current plan year unless you have a supplemental plan or qualifying savings program that covers it.
This is the most misunderstood cost in Medicare. After you meet the $283 Part B annual deductible, you owe 20% of every Medicare-approved charge — with no annual ceiling. A $100,000 cancer treatment course creates $20,000 in coinsurance. A $40,000 surgery leaves you with an $8,000 bill. This is exactly what Medigap Plan G covers (minus the deductible), and why comparing a Medigap premium to “what I’ve paid in coinsurance this year” is the wrong calculation — you’re also insuring against the years when a serious diagnosis arrives.
Every option available to seniors — what it covers, what it costs, and who it fits best. Use this to narrow down, then scroll to the full section for the details that actually determine the right choice.
| Plan Type | Monthly Premium | Networks? | Dental/Vision? | Drug Coverage? | Best For |
|---|---|---|---|---|---|
| Original Medicare (A+B) | $202.90 (Part B only) | None — any Medicare provider | No | No (add Part D) | Those who want full provider choice |
| Medicare Advantage (HMO) | Often $0 extra | Yes — HMO network required | Often yes | Often included | Healthy, local, want extras |
| Medicare Advantage (PPO) | $0–$80+/mo | Yes — out-of-network costs more | Often yes | Often included | Want flexibility + extras |
| Medigap Plan G | $110–$200+/mo (est.) | None — any Medicare provider | No | No (add Part D) | Specialist users, travelers, predictable costs |
| Medigap Plan N | $80–$150+/mo (est.) | None — any Medicare provider | No | No (add Part D) | Lower-premium alternative to Plan G |
| Medicare Part D (standalone) | Avg $34.50/mo | Pharmacy network applies | No | Yes — prescriptions | Original Medicare enrollees adding drug coverage |
| Medicare Savings Program (QMB) | $0 (state pays Part B) | Same as Original Medicare | No | No (triggers Extra Help) | Low-income — income under ~$1,350/mo |
| Extra Help / LIS | $0 Part D premium | Pharmacy network applies | No | Yes — $5.10 generic copay | Income under ~$2,015/mo, high drug costs |
The foundation of senior health coverage in the U.S. — and the source of more uncovered costs than most enrollees expect when they sign up.
Part A covers inpatient hospital stays, skilled nursing facility care following a hospital admission, some home health services, and hospice care. Most people pay $0 monthly because they — or a spouse — worked and paid Medicare taxes for at least 40 quarters. The catch is the per-benefit-period deductible of $1,736, which is not annual. If you’re hospitalized, discharged for more than 60 days, and hospitalized again, a second $1,736 deductible applies. Extended stays add daily coinsurance on top: $434/day for days 61–90, $868/day for lifetime reserve days. There is no Part A out-of-pocket maximum in Original Medicare — only a Medigap plan or Medicare Advantage plan creates one.
Part B is where most seniors’ spending occurs. It covers medically necessary physician services, outpatient care, lab work, imaging, physical therapy, durable medical equipment, and preventive services. The standard monthly premium is $202.90, with higher-income beneficiaries paying more through IRMAA surcharges (starting at income over $109,000 for individuals). After the $283 annual deductible, Medicare pays 80% of approved costs — leaving you responsible for the remaining 20% with absolutely no annual ceiling. A single hospitalization, surgery, or cancer diagnosis can generate tens of thousands in 20% coinsurance. This uncapped exposure is the core reason most financial planners recommend adding either Medigap or Medicare Advantage rather than staying on Original Medicare alone.
Part D is purchased separately from Original Medicare — either as a standalone plan or bundled inside a Medicare Advantage plan. Plans vary widely in what they cover and at what cost, which is why comparing your specific medications across available plans at Medicare.gov/plan-compare is essential before selecting. The current-year cap on out-of-pocket drug spending is $2,100: once you hit that amount on covered drugs, you pay nothing more for the rest of the year. The maximum annual deductible is $615 (plans may set it lower). Enroll in Part D as soon as you’re Medicare-eligible even if you take no medications — skipping it and enrolling later creates a permanent late penalty of 1% of the national base premium per uncovered month.
Medicare Advantage is now chosen by more than half of Medicare beneficiaries. The appeal is real — the trade-offs are real too. Here is what the plans that consistently earn top ratings offer in the current plan year.
UnitedHealthcare has the highest Medicare Advantage enrollment in the country and sells plans in every state except Alaska, South Dakota, and Vermont. It consistently earns 4–5 star CMS ratings. Key extras in many plans: $0 telehealth visits, rewards for completing health activities, fitness program access, and SilverSneakers gym membership. Plans are marketed under the AARP/UnitedHealthcare brand — but you do not need an AARP membership to enroll, a common misconception. Many UHC plans offer $0 monthly premiums beyond the standard Part B premium you pay regardless. Compare available plans at Medicare.gov/plan-compare using your ZIP code — plan availability and cost vary significantly by county.
Humana is widely recognized for the depth of its supplemental benefits — extras that Original Medicare does not cover. Many Humana Medicare Advantage plans include an over-the-counter (OTC) benefit of $250 per quarter ($1,000/year) for health-related items purchasable at major pharmacies: bandages, vitamins, over-the-counter medications, dental products. Dental coverage on many plans includes cleanings, X-rays, and a contribution toward major dental work — a significant benefit given that dental implants or dentures can run $3,000–$10,000 at retail. For seniors who need dental care and OTC health supplies, Humana’s benefits package frequently wins the total-value comparison against competitors in the same market.
Kaiser Permanente consistently earns the highest CMS star ratings of any major Medicare Advantage carrier — frequently 4.5 to 5 stars across its markets. Its advantage is a fully integrated care model: Kaiser employs its own physicians, operates its own hospitals, and manages its own pharmacy, creating coordination that fragmented fee-for-service models struggle to match. The limitation is geography: Kaiser operates in eight states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington) plus Washington D.C. If you live in a Kaiser service area and your preferred doctors are Kaiser physicians, this is typically the highest-quality Medicare Advantage option available to you — and member satisfaction scores consistently support that claim.
Aetna, now part of CVS Health, offers Medicare Advantage plans with one of the broader PPO networks in the country — important for seniors who see multiple specialists or travel seasonally. Many Aetna plans include dental, vision, and hearing benefits and carry $0 premiums in numerous markets. The CVS integration also means many members can have prescriptions reviewed by a CVS pharmacist as part of a broader care coordination benefit. Aetna PPO plans are particularly worth comparing for seniors who split time between states — a Florida winter and a northern summer home, for instance — because PPO plans cover out-of-network care (at higher cost-sharing) rather than requiring a network transfer.
- Your doctors: Verify every physician you see is in the plan’s network for the year ahead — in-network status changes annually, and your doctor being in-network this year does not guarantee next year.
- Your drugs: Every plan uses its own formulary. Run your medication list through Medicare.gov/plan-compare to find which plan covers all your prescriptions at the lowest combined cost — the cheapest-premium plan often isn’t the cheapest total plan for someone on multiple medications.
- The out-of-pocket maximum: The CMS-set ceiling is $9,250 in-network, but most plans set their own lower limit. Compare actual MOOP, not just the premium — a plan charging $30/month with an $8,000 MOOP is more expensive than a $50/month plan with a $4,000 MOOP if you have a major health event.
Medigap policies are standardized by federal law — Plan G from any carrier covers identical benefits as Plan G from every other carrier. You’re not shopping for coverage when you compare Medigap; you’re shopping for price and financial stability of the carrier.
Plan G is the most comprehensive Medigap policy available to new Medicare enrollees (Plan F, which also covered the Part B deductible, closed to new enrollees in 2020). Plan G covers the Part A deductible, Part A coinsurance, Part B coinsurance (the uncapped 20%), Part B excess charges, foreign travel emergency care (up to plan limits), and skilled nursing facility coinsurance. The only cost it doesn’t cover: the $283 Part B annual deductible. After that $283 annual deductible, a Plan G holder typically pays $0 in cost-sharing for the rest of the year on covered services — turning Medicare’s unpredictable 20% exposure into a flat monthly premium. Premiums currently run roughly $110–$200 per month for a 65-year-old non-smoker, varying by state and carrier. Because benefits are identical regardless of carrier, use a comparison tool or independent broker to find the lowest price from a financially stable insurer in your state.
Plan N covers the same major categories as Plan G but with two differences: you pay up to a $20 copay for office visits and up to $50 for emergency room visits that don’t result in an inpatient admission. It also does not cover Part B excess charges — the amount a provider bills above the Medicare-approved rate when they don’t accept Medicare assignment. Plan N premiums typically run 15–25% lower than Plan G in the same market, which can add up to $20–$50 per month. For seniors who see their primary care doctor occasionally and rarely visit the emergency room, Plan N often comes out cheaper in total annual cost than Plan G — but run the math for your own usage pattern before deciding.
Your Medigap open enrollment period is a one-time, 6-month window that opens the month you turn 65 and are enrolled in Part B. During this window, insurers must sell you any Medigap policy at standard rates regardless of your health history — no medical underwriting, no denial, no surcharge for pre-existing conditions. Outside this window, most states allow insurers to reject your application or charge significantly more based on your health. This is not like annual Medicare Advantage enrollment. Once your Medigap open enrollment window closes, you generally cannot switch back to Medigap (or get a new policy at standard rates) unless your state has specific guaranteed issue protections or you experience a qualifying life event. Enroll during this window even if you’re considering Advantage — you can switch to Advantage later, but you may not be able to switch back.
These programs exist specifically to reduce what Medicare costs seniors with limited income — and millions of eligible people are not enrolled because they don’t know to ask. Every program below is free to apply for, and applying does not affect your Social Security benefits.
QMB is the most valuable Medicare Savings Program for low-income seniors. It pays the $202.90 monthly Part B premium, pays the Part A premium if you owe one, and eliminates all Medicare Part A and Part B deductibles, coinsurance, and copays. In practical terms: a QMB enrollee may pay $0 at the doctor’s office, $0 for an outpatient procedure, and $0 for a hospital stay. Providers who accept Medicare are legally prohibited from billing QMB enrollees for Medicare cost-sharing — if a provider bills you and you have QMB, they are violating federal law. The federal baseline income limit is approximately $1,350 per month for a single person and $1,824 for a married couple — but many states set higher limits, and most exclude the first $20 of income in their calculation. QMB enrollment also automatically qualifies you for Extra Help on prescription drugs. Apply through your state Medicaid office — not Medicare.gov.
SLMB pays the $202.90 monthly Part B premium and nothing else — no deductibles, no copays. That is still $2,434.80 in annual savings, which for someone on a fixed Social Security income represents a meaningful reduction in monthly costs. The income limit is higher than QMB: approximately $1,616 per month for an individual and $2,184 for a couple at the federal baseline, with many states setting higher thresholds. SLMB enrollment also automatically triggers Extra Help for Part D prescription drug costs, meaning your Part D premium may drop to $0 and copays cap at $5.10 for generics. Apply through your state Medicaid office. If you aren’t sure whether you qualify for QMB or SLMB, apply for both on the same form and let your state determine which program applies.
Extra Help, also called the Low-Income Subsidy (LIS), pays most or all of your Part D prescription drug costs. For those who qualify for full Extra Help: the Part D monthly premium is paid up to the regional benchmark amount (often meaning $0 out of pocket), the annual deductible is waived entirely, and copays are capped at $5.10 for generic drugs and $12.65 for brand-name drugs. Income must be at or below about $2,015 per month for an individual ($2,725 for a couple). If you receive Medicaid, SSI, or are enrolled in a Medicare Savings Program, you’re automatically enrolled in Extra Help — no application needed. Otherwise, apply through the Social Security Administration at any time of year (there is no enrollment window). Call SSA at 1-800-772-1213 or apply online at ssa.gov/extrahelp.
Do three things first, in this order. One: confirm whether you have qualifying employer coverage through a current job that allows you to delay Part B without penalty — call Social Security at 1-800-772-1213 and confirm in writing. If not, enroll in Part B during the first three months of your Initial Enrollment Period. Two: go to Medicare.gov/plan-compare and enter your ZIP code and list of medications to compare available Advantage plans and Part D plans — do this before defaulting to whatever plan a TV ad promotes. Three: call your State Health Insurance Assistance Program (SHIP) at shiphelp.org for free, unbiased counseling — SHIP counselors earn no commissions and are not selling anything. Do not buy a Medigap policy from an agent without first checking prices from at least three carriers for identical Plan G benefits — the benefits are the same; the price difference can be $50–$80 per month.
Three parallel steps — run them simultaneously, not one at a time. First, apply for Extra Help through Social Security at 1-800-772-1213 or ssa.gov/extrahelp — the income limit is roughly $2,015 per month for an individual, and if you qualify, your drug copays drop to $5.10 for generics immediately. Second, use Medicare.gov/plan-compare to check whether a different Part D plan covers your specific medications at lower cost — formularies vary enormously and switching during Open Enrollment (October 15–December 7) is often worth hundreds of dollars. Third, ask your physician whether a therapeutic equivalent generic is clinically appropriate — many branded medications have generics that cost 80–90% less. Under the current Part D structure, once you spend $2,100 out of pocket on covered drugs, you pay $0 for the rest of the year — Extra Help helps you reach that threshold faster.
Original Medicare, with or without a Medigap plan, covers no routine dental, vision, or hearing. Your options are to add standalone dental and vision insurance separately, or to switch to a Medicare Advantage plan that bundles these benefits. The critical step before switching to Advantage: verify that every doctor you currently see is in the plan’s network for the upcoming plan year. Losing access to your primary care physician or specialist in exchange for dental coverage is not a good trade for most people. If your doctors are in-network and you’re otherwise healthy, an Advantage plan with strong dental and $0 premium can save $1,500–$4,000 annually over paying out of pocket. If your doctors aren’t in-network, add a standalone dental insurance plan instead — major carriers like Delta Dental, Guardian, and AARP-endorsed plans offer individual dental coverage for $35–$60 per month, which is less than most dental procedures cost without coverage.
This is a critical distinction that most Advantage plan enrollees don’t discover until they need care. HMO Medicare Advantage plans generally cover only emergency care outside their service area — a winter in Florida on a New York HMO plan means no regular doctor visits, no prescription refills except emergency, and no specialist access in Florida. PPO Medicare Advantage plans cover out-of-network providers at higher cost-sharing, giving more flexibility. Original Medicare with a Medigap plan is the cleanest solution: any provider who accepts Medicare nationwide accepts Medigap, with no network changes needed when you cross state lines. For seniors who genuinely split time between states, Original Medicare plus Medigap is almost always the better structural fit than any Advantage plan, despite the higher monthly premium — because you only have one plan with one set of rules in both locations.
Yes — if your income dropped due to a qualifying life event. IRMAA surcharges use your tax return from two years prior, which means a retirement, job loss, divorce, death of a spouse, or reduction in work hours that lowered your income may not reduce your premium automatically for two years. File Form SSA-44 with Social Security to request a reduction based on your current, more recent income. Bring documentation of the income-reducing event: a retirement letter, a death certificate, a separation agreement. The reduction can be retroactive to the start of the plan year in some cases. Surcharges at the first IRMAA tier add $81.20 per month to your Part B premium — filing SSA-44 successfully removes that surcharge immediately, saving $974.40 per year. Call Social Security at 1-800-772-1213 and ask specifically about the IRMAA life-changing event appeal process.
Three programs are designed specifically for this situation — and they stack. First, apply for a Medicare Savings Program through your state Medicaid office (not Medicare.gov): QMB eliminates your Part B premium, all deductibles, and all copays if your income is under roughly $1,350 per month as a single person. SLMB covers just the premium if your income is slightly higher. Second, apply for Extra Help through SSA to reduce drug costs to nominal copays. Third, apply for your state’s SHIP counseling at shiphelp.org — counselors will review your complete situation and identify every program you qualify for that you may not know exists, including state-specific programs that go beyond the federal programs listed here. A senior who qualifies for QMB plus Extra Help can reduce monthly Medicare spending by $250–$350 or more — the Part B premium, drug premium, and most cost-sharing all disappear. These programs do not affect your Social Security check, your Medicare eligibility, or any other benefit.
This guide is for general educational purposes only and does not constitute financial, legal, or medical advice. Medicare costs, plan availability, and program eligibility thresholds are updated annually by CMS and SSA — verify all figures directly at Medicare.gov, SSA.gov, or with your State Health Insurance Assistance Program (SHIP) before making enrollment decisions. Medicare plan benefits, premiums, and networks change each year. This content is entirely original and does not reproduce or paraphrase content from any single external source. Program eligibility and savings estimates are based on federal baseline figures — state-specific limits may differ.