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What is Medicare?

Original Medicare, Parts A and B, was created in 1965 to help seniors pay for their hospital and doctor bills.

Once you’ve signed up for Original Medicare, you can consider Parts C and D for additional coverage.

Parts A and B are offered and run by the federal government. Parts C and D are offered by private insurance companies like Simply.

Medicare has four parts

Part A (hospital insurance) — Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care. Part A is important in case you have an unexpected injury or sudden illness that requires inpatient care.

Part B (medical insurance) — Helps cover services from doctors and other healthcare providers. Part B is your coverage for healthcare like:

  • Doctor visits.
  • Many preventive services, such as screenings, vaccines, and yearly wellness visits.
  • Medical tests, X-rays, and lab work.
  • Outpatient care.
  • Home health care.
  • Durable medical equipment, like wheelchairs, walkers, hospital beds, and other equipment. 
     

Part C (Medicare Advantage) — Medicare Advantage is a Medicare-approved plan from a private insurance company like Simply. It offers an alternative to Original Medicare for your health and drug coverage. These plans include Part A and B, and usually Part D (prescription drugs). Medicare Advantage plans may also offer additional benefits that Original Medicare doesn’t, like routine dental, vision, and hearing coverage. These plans often have different out-of-pocket costs from Original Medicare.

All Simply Medicare Advantage plans include Part D and routine dental, vision, and hearing coverage, as well as an allowance for over-the-counter items.4

Many of our plans also include additional benefits like transportation1 to plan-covered services and allowances for groceries 2,3 and utilities.2,3 Plans and benefits may vary based on the county where you live, your eligibility, and the plan you choose.4

Learn more about our Medicare Advantage plans

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

Simply does not offer standalone Part D plans, but all our Medicare Advantage plans include Part D coverage.

This is a summary of what Medicare covers. For more detailed information, visit What Original Medicare covers | Medicare and Parts of Medicare | Medicare.

What does Medicare cost?

Medicare costs can vary based on your income, when you first enroll in Medicare, and what type of Medicare plan you select. This section has an overview of common factors and costs.

Terms and definitions

Here are the most common terms you’ll come across as you look for Medicare plans.

  • Premium — The amount you pay for your Medicare plan every month.
  • Deductible — The amount you pay for covered healthcare services before your Medicare plan starts to pay.
  • Copay — A fixed fee you pay at time of service for medical expenses covered by your Medicare plan.
  • Coinsurance — A percentage of the costs you pay for Medicare-covered services after you have paid your deductible.

Medicare Advantage vs. Original Medicare costs

All Medicare Advantage (Part C) plans must include Original Medicare Part A and Part B coverage. To be enrolled in a Medicare Advantage plan, you must continue to pay your Part A and Part B monthly premiums. For most people, the Part A monthly premium is $0.

If you choose to enroll in a Medicare Advantage plan, you will not pay any Part A or Part B deductibles, copays, or coinsurance. Medicare Advantage plan premiums, deductibles, copays, and coinsurance costs vary based on the plan you choose and the services you receive.

What if I have both Medicaid and Medicare (also called Dual Eligible)?

If you have both Medicaid and Medicare, you may be eligible for a Dual Eligible Special Needs Plan (D-SNP). Medicaid is a state-run program for people with limited incomes and resources.

Depending on your level of assistance from Medicaid, it may cover part or all of your healthcare costs. This includes your Part A and Part B monthly premiums and costs associated with your Medicare Advantage D-SNP.

Part A (hospital insurance) costs

Part A monthly premium — $0 for most people

The monthly premium for Part A is $0 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters). This is often referred to as "premium-free Part A." If you did not pay Medicare taxes for 10 years, you might still be eligible for Part A, but your monthly premium could be as high as $518.

Part A deductible — $1,676 per benefit period

A benefit period begins the day you're admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven't gotten any inpatient hospital care for 60 days in a row or 100 days in a row for inpatient care at a skilled nursing facility.

You must pay the Part A deductible for each benefit period. There is no limit to the number of benefit periods.

Part A copays

For inpatient hospital stays:

  • Days 0–60: $0 after you pay your Part A deductible
  • Days 61–90: $419 each day
  • Days 91–150: $838 each day while using your 60 lifetime reserve days
  • After day 150: You pay all costs 
     

For inpatient skilled nursing facility stays:

  • Days 0–20: $0 after you pay your Part A deductible
  • Days 21–100: $209.50 each day 
     

Part A premiums, deductibles, and copays can change each year. There may be penalties that add to these costs if you don’t enroll in Part A when you are first eligible, typically when you turn 65. There may also be small coinsurance and copay costs for hospice care.

Part B (medical insurance) costs

Part B monthly premium — $185 for most people

The monthly premium for Part B depends on your income. Most people pay $185.00. If your annual income is greater than $106,000, you could pay up to $628.90 per month.

Part B deductible — $257

This is the annual deductible for Part B. This is what you will pay before Original Medicare starts to pay.

Part B coinsurance costs for services — 20%

You’ll usually pay 20% of the cost for each Medicare-covered service or item after you’ve paid your deductible.

Part B premiums, deductibles, coinsurance, and copays can change each year. There may be penalties that add to these costs if you don’t enroll in Part B when you are first eligible, typically when you turn 65.

Part C (Medicare Advantage) costs

When you join a Medicare Advantage Part C plan, you need to continue to pay your Part A and Part B monthly premiums. Because Part C plans include Parts A and B, other costs associated with Parts A and B don’t apply to Medicare Advantage Part C plans. Your premiums, deductibles, copays, and coinsurance costs can vary depending on the Part C plan you choose and the services you receive.

These Part C costs apply to all Simply Medicare Advantage plans. All our Medicare Advantage plans also include prescription drug (Part D) coverage.

Part C monthly premium — $0

You must keep paying your Part A and Part B monthly premium to stay in your plan. For most people, the Part A monthly premium is $0.

Part C deductible — $0 in-network medical deductible

Part C copays and coinsurance

  • $0 copays for in-network doctor visits.
  • There are different copays and coinsurance costs for various types of services and care depending on the Simply Medicare Advantage plan you choose.
  • Part C premiums, deductibles, coinsurance, and copays can change each year.
  • All Medicare Advantage (Part C) plans have a limit on your annual maximum out-of-pocket costs. Once you reach it, you will not have to pay any additional cost sharing for covered services for the rest of the year. 
     

Learn more about Simply Medicare Advantage plans

Shop Medicare Plans

Part D (prescription drug plan) costs

Simply does not offer standalone Part D plans, but all our Medicare Advantage (Part C) plans include Part D coverage. All our Medicare Advantage plans have $0 copays for tier 1 covered drugs.

What if I still have employer healthcare coverage?

If you still have healthcare coverage from your or your spouse’s employer, be careful before enrolling in Medicare. Your employer coverage might be better than Medicare. In some cases, if you leave your employer coverage, you may not be able to get back on it. You may also start paying for Medicare when you don’t need to.

If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), when you first sign up for Original Medicare, your Part A monthly premium will be $0. This is also known as “premium-free Part A.” If you are eligible for premium-free Part A, you should enroll in Medicare Part A as soon as you are eligible, even if you have employer healthcare coverage. For most people, this is during their Initial Enrollment Period: the three months before their 65th birthday month, the month they turn 65, and the three months after their 65th birthday month.

In addition, there are rules based on the size of your employer and if their plans include prescription drug coverage equal to Part D. It’s very important to understand your options or you might have to pay late enrollment penalties for Parts A, B, and D.

Call us. We have licensed insurance agents here to help. Talk to a licensed insurance agent and the health plan administrator for your or your spouse’s employer before you leave that employer coverage.

What if I can’t afford a Medicare plan?

Many states offer Medicare Savings Programs (MSPs) that can help pay for your healthcare costs. There is also Extra Help, a federal program that helps people with limited incomes pay for Medicare prescription drugs.

Visit MSP or Extra Help to find out if you qualify. 
 

 
 

1 Transportation services are issued as one-way trips and provided on an annual basis. Benefits vary by plan.

2 Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved groceries and utilities. Unused amounts will expire at the end of the month or quarter. Benefits vary by plan.

3 Depending on your plan, the benefits listed may be available through the Medicare Advantage Value-Based Insurance Design Model or to eligible members as Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as chronic kidney diseases, chronic lung disorders, cardiovascular disorders, chronic heart failure, or diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan's Evidence of Coverage.

4 Plan availability, premiums, benefits, and benefit amounts may vary based on where you live, the plan you choose, and your eligibility. 
 

Y0114_25_3015400_0000_U_M CMS Accepted 4/7/2025