Important Medicare Forms
Medicare and Social Security use different forms for different situations. We will help you understand what each form does, when you might need it, and what to do next.
Start With Why You Need the Form
You do not need to memorize Medicare form numbers. Start with what you are trying to accomplish. You might need to enroll in Medicare Part B, prove you had health coverage through an employer, ask Social Security to review a higher Medicare premium, or appoint someone to represent you in a Medicare matter.
Find the Form You Need
Find the situation that sounds like yours. Click the blue form heading or the Learn More link to go directly to the explanation.
CMS-40B
Request for Enrollment in Medicare Part B
You Already Have Part A and Need to Enroll in Part B
CMS-40B is the form used to request enrollment in Medicare Part B when you already have Medicare Part A. Part B is the part of Medicare that helps cover doctors, outpatient care, and many other medical services.
If you delayed Part B because you had health insurance through your current job or your spouse's current job, you may also need CMS-L564 to show that you had employer group health coverage.
CMS-L564
Request for Employment Information
You Delayed Part B Because You Had Employer Coverage
CMS-L564 helps show Social Security that you had health insurance through your current job or your spouse's current job. Your employer completes part of this form to confirm your employment and health coverage.
This information may help show that you qualify for a Medicare Part B Special Enrollment Period. A Special Enrollment Period gives people who meet the rules another time to enroll in Part B.
SSA-44
Medicare Income-Related Monthly Adjustment Amount
Your Income Went Down After a Life-Changing Event
Some people with higher incomes pay an extra amount for Medicare Part B and Medicare prescription drug coverage. This extra amount is called the Income-Related Monthly Adjustment Amount, or IRMAA.
If you had a qualifying life-changing event and your income went down, SSA-44 lets you ask Social Security to use more recent income information when reviewing your IRMAA.
CMS-1696
Appointment of Representative
You Want Someone to Represent You in a Medicare Matter
CMS-1696 lets you appoint someone to represent you in certain Medicare matters, such as a claim, appeal, or grievance.
Depending on the situation, your representative might be a family member, attorney, doctor, advocate, or another person you choose.
Not Sure Which Form You Need?
Start with what you are trying to do, not the form number. Your enrollment timing, work history, employer health coverage, income, and reason for contacting Medicare or Social Security all matter. The sections below explain each form step by step.
Did You Delay Part B Because You Had Employer Coverage?
If you delayed Medicare Part B because you had health coverage based on current employment, you may qualify for a Special Enrollment Period that lets you enroll in Part B after your Initial Enrollment Period.
Two Forms Often Work Together
CMS-40B tells Social Security that you want to enroll in Medicare Part B. CMS-L564 helps document the employment and employer group health plan coverage you had. If you are using employer coverage to qualify for a Part B Special Enrollment Period, these forms are commonly submitted together.
CMS-40B
Request for Enrollment in Medicare Part B
This Form Tells Social Security You Want Part B
If you already have Medicare Part A and want to enroll in Medicare Part B, CMS-40B is used to request Part B enrollment.
The form asks for basic information about you. If you delayed Part B because of employer coverage, it also asks about your employment and health coverage dates.
Think of CMS-40B as the form that says, “I already have Medicare Part A. I now want to enroll in Part B.”
Opens the official Centers for Medicare & Medicaid Services form.
CMS-L564
Request for Employment Information
This Form Helps Document Your Employer Coverage
CMS-L564 provides Social Security with information about your employment and employer group health plan coverage.
You complete Section A. Your employer completes Section B and provides information about your employment and health coverage. The completed form is then submitted with CMS-40B when required.
Think of CMS-L564 as the form that helps show, “I delayed Part B because I had health coverage based on current employment.”
Opens the official Centers for Medicare & Medicaid Services form.
How the Process Usually Works
Your situation may be different, but this is the common process when CMS-40B and CMS-L564 are used together.
Complete CMS-40B
Fill out the form requesting enrollment in Medicare Part B.
Complete Section A of CMS-L564
Provide the information CMS needs so your employer can identify your employment and health coverage.
Your Employer Completes Section B
Your employer provides information about your employment and employer group health plan coverage and signs the form.
Submit the Forms
Submit the required forms to Social Security. Social Security reviews your information and determines your Part B enrollment.
What Is a Special Enrollment Period?
A Special Enrollment Period, or SEP, is an enrollment opportunity available outside the normal Medicare enrollment periods when you meet specific requirements.
One Part B Special Enrollment Period applies to certain people who delayed Part B while they or their spouse were working and they had employer group health plan coverage based on that current employment.
Employer Coverage Rules Matter
Having health insurance does not automatically mean delaying Medicare Part B is the right choice. The type of coverage, whose employment the coverage is based on, employer size, and when the employment or coverage ends may affect how Medicare works with your employer plan.
Important: COBRA and Retiree Coverage Are Different
COBRA and retiree health coverage are not the same as group health plan coverage based on current employment for the Part B Special Enrollment Period. If your employment is ending, review your Medicare enrollment timing before assuming COBRA or retiree coverage lets you delay Part B.
Did Your Income Go Down After a Life-Changing Event?
If you are paying more for Medicare because of your income and your income has gone down after certain life-changing events, you may be able to ask Social Security to use more recent income information.
Your Medicare Premium May Be Based on Older Income
Social Security generally uses tax information from an earlier year when deciding whether you must pay an Income-Related Monthly Adjustment Amount, or IRMAA. If your income later drops because of a qualifying life-changing event, that older tax return may no longer reflect your current financial situation.
SSA-44
Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event
What Does SSA-44 Do?
SSA-44 is used to ask Social Security to use more recent income information when a qualifying life-changing event has reduced, or is expected to reduce, your income.
If Social Security approves your request, your Income-Related Monthly Adjustment Amount may be reduced or eliminated based on the information Social Security reviews.
Social Security may be charging you more for Medicare based on income from an earlier tax year. If a qualifying life event caused your income to drop, SSA-44 lets you ask Social Security to look at more recent income information.
Which Life-Changing Events Does Social Security Recognize?
SSA-44 lists eight types of life-changing events. Your income change must meet Social Security's requirements for the event you report.
Marriage
Divorce or Annulment
Death of Your Spouse
Work Stoppage
Work Reduction
Loss of Income-Producing Property
Loss of Pension Income
Employer Settlement Payment
How the SSA-44 Process Works
The form walks you through the life-changing event, your more recent income information, and the documents Social Security needs to review your request.
Identify the Life Event
Tell Social Security which qualifying life-changing event occurred and when it happened.
Report Your Income
Provide the more recent income information Social Security asks for on the form.
Provide Evidence
Provide documentation supporting the life-changing event and your more recent income information.
Social Security Reviews It
Social Security reviews your request and decides whether your IRMAA should change.
A Lower Income by Itself Does Not Always Qualify
SSA-44 is designed for specific life-changing events recognized by Social Security. A drop in income for another reason does not automatically qualify as one of these events. Social Security makes the final determination based on your circumstances and documentation.
Need to Understand IRMAA First?
Our IRMAA section explains why some people pay more for Medicare Part B and Medicare prescription drug coverage, which income Social Security looks at, and how the income brackets work.
Learn How IRMAA Works →Do You Want Someone to Help You With a Medicare Matter?
Medicare lets you appoint another person to represent you for certain claims, appeals, grievances, or requests. CMS-1696 is the form used to give that person permission to act on your behalf.
You Choose the Person You Want to Represent You
Your representative might be a family member, friend, attorney, doctor, advocate, or another person you trust. Once properly appointed, that person may communicate and take certain actions for you concerning the Medicare matter covered by the appointment.
CMS-1696
Appointment of Representative
What Does CMS-1696 Do?
CMS-1696 gives another person authority to represent you in a Medicare claim, appeal, grievance, or request.
For the matter covered by the appointment, your representative may make requests, present evidence, get information, and receive communications about your case.
Think of CMS-1696 as telling Medicare, “I want this person to speak and act for me on this Medicare matter.”
Who Might You Choose as Your Representative?
The person you choose depends on your situation. Choose someone you trust to help with the Medicare matter involved.
Family Member
Trusted Friend
Attorney or Advocate
Doctor or Other Person You Trust
Your Representative May See Your Personal Medical Information
Choosing a representative gives that person access to information needed to handle the Medicare matter. This may include personal medical information. Choose someone you trust and understand what authority you are giving them.
How the CMS-1696 Process Works
The form is designed so both you and the person you choose take part in the appointment.
Choose Your Representative
Decide who you trust to represent you for the Medicare matter.
Complete Your Information
Complete Section 1 with the required information and sign and date the form.
Your Representative Accepts
Your representative completes Section 2 and signs and dates the form to accept the appointment.
Submit It With Your Matter
Follow the instructions for the claim, appeal, grievance, or request to determine where the appointment information needs to be sent.
CMS-1696 Is for Representation
This form appoints someone to represent you in a Medicare matter. It does not by itself decide whether Medicare will approve a claim, coverage request, grievance, or appeal.
Not Sure Which Medicare Form You Need?
Start with what you are trying to do. Our Important Medicare Forms page explains the common forms and when each one is used.
Return to Important Medicare Forms →What Does Medicare Part D Cost?
Your prescription drug costs depend on the Part D plan you choose, the medications you take, and where you fill your prescriptions.
Monthly Premium
Part D premiums vary by plan. Your premium is what you pay to have prescription drug coverage.
Varies by PlanAnnual Deductible
A Part D plan may charge an annual deductible before the plan begins sharing certain prescription costs. Some plans have a lower deductible or no deductible.
2026 Maximum DeductibleCopays & Coinsurance
What you pay for a covered prescription depends on the plan, medication, drug tier, pharmacy, and coverage stage.
Varies by Drug and PlanAnnual Out-of-Pocket Limit
Part D has an annual out-of-pocket limit for covered Part D prescription drugs.
2026 Part D LimitHow Your Part D Costs Work During the Year
Medicare Part D uses coverage stages. Your share of prescription costs changes as you move through these stages during the calendar year.
Deductible Stage
If your plan has a deductible, you generally pay the cost of covered prescriptions until the applicable deductible is met. A plan may have a lower deductible or no deductible.
Initial Coverage
After the deductible, if applicable, you pay your plan's copayments or coinsurance for covered prescriptions. Your costs depend on the medications you take and your plan's rules.
Catastrophic Coverage
Once you reach the annual Part D out-of-pocket limit, you pay $0 out of pocket for covered Part D drugs for the remainder of the calendar year.
Part D Has an Annual Out-of-Pocket Limit
For 2026, your annual out-of-pocket spending for covered Part D drugs is capped at this amount. Once you reach the limit, you pay $0 out of pocket for covered Part D drugs for the rest of the calendar year.
What Determines What You Pay for Your Prescriptions?
Your Medications
Each plan has its own formulary. Your medications and their drug tiers have a major effect on your costs.
Drug Tiers
Plans group medications into cost-sharing tiers. Different tiers often have different copays or coinsurance.
Your Pharmacy
Preferred and standard network pharmacies may charge different amounts for the same covered prescription.
Your Plan
Premiums, deductibles, formularies, pharmacy networks, drug tiers, and cost-sharing rules differ among plans.
Higher Income May Increase What You Pay for Part D
People with higher incomes may pay a Part D Income-Related Monthly Adjustment Amount, commonly called IRMAA, in addition to their plan premium. We'll explain IRMAA and the income brackets later on this page.
Your Part D Premium Is Only One Piece of Your Prescription Cost
A plan with a low monthly premium isn't necessarily the lowest-cost plan for you. Compare your prescriptions, formulary coverage, drug tiers, deductible, copays or coinsurance, pharmacy network, and estimated annual prescription costs before choosing a Part D plan.
What Does Medicare Advantage Cost?
Medicare Advantage costs vary by plan. Looking beyond the monthly premium helps you understand what the plan might cost when you receive healthcare.
Plan Premium
Some Medicare Advantage plans have a $0 monthly plan premium. Other plans charge an additional monthly premium.
Varies by PlanPart B Premium
You generally continue paying your Medicare Part B premium while enrolled in Medicare Advantage.
2026 Standard Part B PremiumCopays & Coinsurance
Your plan may charge copays or coinsurance when you receive covered healthcare services. Costs differ by service and plan.
Varies by ServiceOut-of-Pocket Maximum
Medicare Advantage plans have an annual limit on what you pay out of pocket for covered Medicare Part A and Part B services.
Check the Specific PlanA $0 Plan Premium Does Not Mean $0 Healthcare Costs
A Medicare Advantage plan with a $0 monthly plan premium may still have deductibles, copays, coinsurance, prescription costs, and other out-of-pocket expenses. You also generally continue paying your Medicare Part B premium.
How Medicare Advantage Costs Work
Your total cost depends on both the amount you pay to have the coverage and how much healthcare you use during the year.
Pay Your Premiums
You generally continue paying your Part B premium. If your Medicare Advantage plan charges its own premium, you pay that amount as well.
Pay When You Use Care
Depending on the plan and service, you may pay a deductible, copayment, or coinsurance when you receive healthcare.
Your Medical Costs Have an Annual Limit
The plan places an annual maximum on your out-of-pocket spending for covered Medicare Part A and Part B services. The amount depends on the specific plan.
Understanding the Medicare Advantage Out-of-Pocket Maximum
Every Medicare Advantage plan has a maximum amount you may pay out of pocket for covered Medicare Part A and Part B services during the year. Once you reach your plan's applicable limit, the plan pays 100% of the cost for covered Part A and Part B services for the remainder of the calendar year.
Don't Compare Medicare Advantage Plans by Premium Alone
Look at Your Expected Costs
Monthly plan premium
Medical deductible, if applicable
Primary care and specialist copays
Hospital and outpatient costs
Prescription drug costs
Look at Your Financial Exposure
Annual medical out-of-pocket maximum
In-network versus out-of-network costs
Provider network and hospital access
Prescription formulary and pharmacy network
Prior authorization and plan rules
Remember Your Medicare Part B Premium
Medicare Advantage replaces how you receive your Original Medicare Part A and Part B benefits, but it does not eliminate your Medicare Part B premium. The standard 2026 Part B premium is $202.90 per month. Higher-income beneficiaries may pay more.
Compare the Total Cost, Not Just the Monthly Premium
When comparing Medicare Advantage plans, review the premium, deductibles, copays, coinsurance, prescription costs, provider network, and annual out-of-pocket maximum. A plan with a lower premium is not automatically the plan with the lowest overall cost for you.
What Does Medicare Supplement Insurance Cost?
Medicare Supplement insurance, also called Medigap, works with Original Medicare. Your costs depend on the plan you choose, the insurance company offering it, and other pricing factors.
Medigap Premium
You pay a monthly premium to the private insurance company for your Medicare Supplement policy.
Varies by Policy and CompanyPart B Premium
Your Medigap premium is separate from Medicare. You continue paying your Medicare Part B premium.
2026 Standard Part B PremiumPart B Deductible
Plans G and N do not cover the Medicare Part B deductible. You are responsible for this annual deductible.
2026 Part B DeductibleOther Costs
Your remaining out-of-pocket costs depend on the standardized Medigap plan you choose.
Depends on PlanWith Medigap, Your Healthcare Costs May Be More Predictable
Medicare Supplement insurance works alongside Original Medicare to help pay certain Medicare cost-sharing amounts. You pay a separate Medigap premium for the policy, and your remaining healthcare costs depend on the standardized plan you select.
How Costs Differ Between Popular Medigap Options
The monthly premium is only one part of the comparison. Different standardized plans leave you responsible for different Medicare costs.
Plan G
Broad CoverageMonthly Premium
Premiums vary by insurance company and other pricing factors.
Part B Deductible
You pay the annual Medicare Part B deductible of $283.
After the Deductible
Plan G generally covers the standardized Medicare cost-sharing benefits included in the policy after the Part B deductible is met.
Plan N
Lower Premium Potential With Some Cost SharingMonthly Premium
Plan N often has a different premium than Plan G. Premiums vary by insurance company.
Part B Deductible
You pay the annual Medicare Part B deductible of $283.
Office and ER Copays
Plan N may require up to a $20 copayment for certain office visits and up to $50 for certain emergency room visits that do not result in an inpatient admission.
Part B Excess Charges
Plan N does not cover Medicare Part B excess charges. In states where excess charges are permitted, a provider who does not accept Medicare assignment may charge up to 15% above the Medicare-approved amount. Some states prohibit or limit Part B excess charges.
High-Deductible Plan G
Lower Premium Potential With Higher Upfront CostsMonthly Premium
High-Deductible Plan G generally trades a lower monthly premium for greater upfront healthcare costs.
Annual High Deductible
You pay Medicare-covered costs up to $2,950 before the policy begins paying its standardized benefits.
After the High Deductible
Once the annual high deductible is satisfied, the policy provides the standardized Plan G benefits for the remainder of the calendar year.
Why Do Medicare Supplement Premiums Differ?
Plan Letter
Different standardized Medigap plans provide different levels of coverage, which affects what you pay.
Insurance Company
Insurance companies set their own premiums. Two companies may charge different premiums for the same standardized plan.
Where You Live
Medigap premiums vary by location. Rates available to you depend in part on where you live.
Other Pricing Factors
Discounts, pricing method, tobacco use, age, and medical underwriting when permitted may affect your premium.
The Same Plan Letter May Have Different Premiums
The Medicare benefits of a standardized Plan G are the same regardless of which insurance company sells the policy. The premium is not necessarily the same. This is why comparing the insurance companies offering the same plan letter matters.
Think Beyond Today's Premium
Medicare Supplement premiums may increase over time. When comparing policies, consider the current premium along with the insurance company's pricing approach, available discounts, financial strength, customer service, and your ability to change Medigap policies later.
Compare the Coverage and the Company, Not Just the Premium
A lower starting premium does not automatically make one Medicare Supplement policy a better fit. Compare the standardized benefits, current premium, potential future rate changes, insurance company, discounts, and the healthcare costs you would still be responsible for under the plan.
What Is IRMAA?
Some people with higher incomes pay more for Medicare Part B and Medicare Part D. This additional amount is called the Income-Related Monthly Adjustment Amount, or IRMAA.
Your Income May Affect What You Pay for Medicare
IRMAA is an additional amount added to your Medicare Part B premium and, if you have Medicare prescription drug coverage, your Part D costs. The amount is based on your modified adjusted gross income and tax filing status.
Part B IRMAA
If your income is above the applicable threshold, an income-related adjustment is added to the standard Medicare Part B premium of $202.90 per month.
Part D IRMAA
If your income is above the applicable threshold, you pay an additional monthly IRMAA amount for Medicare prescription drug coverage. This amount is separate from your Part D plan premium.
Why Medicare Looks Back at an Earlier Tax Return
Social Security generally uses income information from your federal tax return from two years earlier to determine your IRMAA.
2024 Tax Return
For 2026 Medicare premiums, Social Security generally uses your 2024 modified adjusted gross income.
Your MAGI Is Reviewed
Your modified adjusted gross income and tax filing status determine whether an income-related adjustment applies.
Your 2026 Medicare Premium
If your income falls within an IRMAA bracket, the applicable adjustment is added to your Medicare costs.
2026 IRMAA Income Brackets
The table below shows the 2026 income thresholds and monthly amounts for people filing an individual return or a married joint return.
| 2024 MAGI Individual |
2024 MAGI Married Filing Jointly |
2026 Part B Monthly Premium |
2026 Part D Monthly IRMAA |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| Above $109,000 through $137,000 | Above $218,000 through $274,000 | $284.10 | $14.50 |
| Above $137,000 through $171,000 | Above $274,000 through $342,000 | $405.80 | $37.50 |
| Above $171,000 through $205,000 | Above $342,000 through $410,000 | $527.50 | $60.40 |
| Above $205,000 and below $500,000 | Above $410,000 and below $750,000 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 |
The Part B column shows the total monthly Part B premium. The Part D column shows the monthly IRMAA amount added to your Part D plan premium. Different thresholds apply to certain people who are married filing separately.
Example: IRMAA Is Added to Your Medicare Costs
If a married couple filing jointly had 2024 MAGI above $218,000 through $274,000, each spouse enrolled in Part B would pay a 2026 Part B premium of $284.10 per month. If enrolled in Medicare prescription drug coverage, each would also pay a $14.50 monthly Part D IRMAA in addition to the premium for their Part D coverage.
What If Your Income Has Gone Down?
Your tax return from two years ago may not reflect your income today. If you experienced a qualifying life-changing event that reduced your income, you may be able to ask Social Security to use more recent income information.
Marriage
Divorce or Annulment
Death of a Spouse
Work Stoppage
Work Reduction
Loss of Income-Producing Property
Loss of Pension Income
Certain Employer Settlement Payments
Form SSA-44 May Help After a Life-Changing Event
If you received an IRMAA determination and experienced a qualifying life-changing event that reduced your income, you may request a new determination from Social Security. Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event, is used to report the event and provide more recent income information.
Don't Assume an IRMAA Decision Is the End of the Story
If the income Social Security used no longer reflects your financial situation, review why your IRMAA was assessed and whether a qualifying life-changing event or other permitted reason supports requesting a new determination.
What Might Medicare Cost Me?
There isn't one Medicare price that fits everyone. Your total cost depends on how you receive your Medicare benefits, the coverage you choose, the healthcare you use, and your prescriptions.
Compare More Than the Monthly Premium
A useful Medicare cost comparison looks at two things: what you expect to pay for your coverage and what you might pay when you need healthcare. A lower monthly premium does not always mean lower total costs.
Original Medicare
Part A + Part B
Monthly Premiums
Most people pay $0 for Part A. You pay your monthly Part B premium.
Deductibles
Part A and Part B have separate deductibles and cost-sharing rules.
Healthcare Costs
For many Part B services, you generally pay 20% of the Medicare-approved amount after meeting the Part B deductible.
Prescription Coverage
If you want outpatient prescription drug coverage, you generally add a separate Medicare Part D plan.
No Annual Medical Out-of-Pocket Limit
Original Medicare by itself does not place an annual limit on what you may pay out of pocket for covered Part A and Part B services.
Medicare Advantage
Part C
Monthly Premiums
You continue paying your Part B premium. Your Medicare Advantage plan may have a $0 monthly premium or charge an additional premium.
Pay as You Use Care
Depending on the plan and service, you may pay deductibles, copays, or coinsurance when you receive healthcare.
Prescription Coverage
Most Medicare Advantage plans include Part D prescription drug coverage. Drug costs depend on the specific plan and medications.
Annual Medical Out-of-Pocket Limit
Medicare Advantage plans have a yearly limit on your out-of-pocket costs for covered Part A and Part B services. The limit varies by plan.
Plan Rules Matter
Provider networks, copays, coinsurance, prior authorization, prescription coverage, and other plan rules affect your costs.
Original Medicare + Medigap + Part D
Supplemental Coverage Strategy
Monthly Premiums
You pay your Part B premium plus the premium for your Medicare Supplement policy and generally a separate Part D premium.
Medigap Helps With Cost Sharing
Your Medicare Supplement policy helps pay certain Medicare-approved deductibles, copayments, and coinsurance according to the standardized plan you choose.
Part D Is Separate
Medigap policies sold today do not include outpatient prescription drug coverage. You generally choose a separate Part D plan.
Remaining Costs Depend on the Plan
What you pay for Medicare-covered services depends on the Medigap plan letter you select and the benefits it provides.
Premiums May Change
Medigap, Part D, and Medicare premiums may change over time, so both current and future costs matter.
Where Is Your Financial Exposure?
Each Medicare strategy handles your costs differently. Consider both the premiums you know you will pay and the healthcare costs you may face during the year.
Original Medicare Alone
You have Part A and Part B cost sharing, and Original Medicare alone has no annual out-of-pocket maximum for covered Part A and Part B services.
Medicare Advantage
Your plan places an annual limit on your out-of-pocket costs for covered Part A and Part B services. Your actual limit and cost sharing depend on the plan.
Original Medicare + Medigap + Part D
Your Medigap policy helps cover certain Original Medicare cost sharing. Your remaining medical costs depend on the standardized plan you choose.
Four Questions to Ask Before Comparing Medicare Costs
What Will I Pay Every Month?
What Will I Pay When I Use Healthcare?
What Will My Prescriptions Cost?
What Is My Potential Financial Exposure?
The Right Medicare Coverage Depends on Your Situation
The better comparison is how each option fits your doctors, prescriptions, healthcare needs, travel, budget, and comfort with potential out-of-pocket costs. Your Medicare Blueprint brings those pieces together so you can compare the whole picture.
Medicare Costs & Coverage FAQs
Here are answers to some of the most common questions people have about Medicare premiums, deductibles, out-of-pocket costs, and IRMAA.
Most people qualify for premium-free Medicare Part A based on their own or their spouse's Medicare-covered work history. Premium-free does not mean all Part A healthcare is free. Deductibles and coinsurance may apply when you receive inpatient hospital or skilled nursing facility care.
Yes. You generally continue paying your Medicare Part B premium when enrolled in Medicare Advantage. Your Medicare Advantage plan may also charge its own monthly premium, although some plans have a $0 plan premium.
No. A $0 plan premium means the Medicare Advantage plan does not charge an additional monthly plan premium. You generally continue paying your Part B premium, and the plan may have deductibles, copays, coinsurance, prescription costs, and other out-of-pocket expenses.
No. Original Medicare by itself does not have an annual out-of-pocket maximum for covered Part A and Part B services. Medicare Supplement insurance is one way people with Original Medicare help manage certain Medicare cost-sharing expenses.
A deductible is an amount you may need to pay before your coverage begins paying according to its rules. An out-of-pocket maximum is a yearly limit on certain covered costs you pay. Reaching a deductible does not mean your healthcare costs are finished for the year.
One reason is IRMAA, the Income-Related Monthly Adjustment Amount. People with income above certain thresholds pay an additional amount for Medicare Part B and Medicare Part D. Social Security generally uses income information from your federal tax return from two years earlier when determining IRMAA.
If your income decreased because of a qualifying life-changing event, you may be able to ask Social Security to use more recent income information. Form SSA-44 is used in certain situations to request a new IRMAA determination.
There is no single answer for everyone. Your total cost depends on your coverage, premiums, healthcare use, prescriptions, providers, plan rules, and potential out-of-pocket expenses. Compare both what you expect to pay every month and what you might pay when you use healthcare.
Many Medicare costs may change from year to year. Medicare premiums, deductibles, Part D costs, Medicare Advantage plan costs, prescription coverage, and private insurance premiums may change. Reviewing your coverage each year helps you understand what will change for the coming year.
Your Costs Depend on More Than Medicare's Annual Numbers
Medicare's premiums and deductibles are only part of the picture. Your doctors, prescriptions, healthcare needs, coverage choice, and financial preferences all affect what Medicare may cost you.
You Don’t Have to Figure This Out on Your Own
Your Medicare decision is about more than the monthly premium. We help you compare your coverage, expected costs, financial exposure, doctors, prescriptions, and healthcare needs
We’ll review the Medicare options available to you, answer your questions, and help you make an informed decision.
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