America: Is learning about Medicare’s options stressing you?

on Jun 19, 2025

Dear Toni,

I am an American turning 65 in September and am confused about my Medicare decision. I don’t know where to start or what to do.

Can you please help me with what my Medicare options are? Thanks, Toni.

—Stephanie from Orlando, Fla.

Hi Stephanie:

Don’t feel alone, because there is a person entering Medicare every 8 seconds every day for approximately the next 10 years. Most Americans feel an urgency to learn their Medicare options and are stressed over getting it right, because they know that one wrong move can jeopardize the retirement savings they worked so hard to build.

Below are some facts that those entering Medicare need to know:

1. Enroll on time: The only way Medicare is automatic for someone turning 65 is when they are already receiving a Social Security check. If you are not receiving your Social Security check and not working full-time with employer benefits from either your or your spouse’s work, then you will want to enroll in Medicare Parts A and B online at www.ssa.gov/medicare/sign-up. Those who are working full-time with employer benefits or are covered under their spouse’s benefits may want to delay enrolling in Medicare Part A (especially if a Health Savings Account (HSA) is an employee benefit; important Medicare rules apply) and Medicare Part B until they retire or lose their benefits for any other reason.

2. Medicare is NOT free: Medicare covers a lot, and there is a cost associated with Medicare Parts A and B. You have been paying tax dollars for Medicare, and the premium for Part A is at no cost. Medicare Part B has a premium that is means-tested, depending on how much you have earned for that year. In 2025, an average Medicare beneficiary pays $185 each month for the Part B premium. The 2025 Medicare Part A (hospital) deductible is $1,676 not once a year but every 60 days, or 6 times a year. The 2025 Medicare Part B deductible is $257 once a year, with Medicare paying 80% of the Medicare-approved amount and you paying the remaining 20% (and many individuals purchase insurance to cover this 20% “gap”).

3. Learn Medicare’s alphabet soup … Parts A, B, C and D: Medicare Parts A and B cover hospital, medical and provider expenses. Medicare Part C, known as Medicare Advantage plan, is another way of receiving your Medicare benefits. Part D is a Medicare Prescription Drug plan that can be enrolled in as a stand-alone plan with Original Medicare and a Medicare Supplement or bundled in a Medicare Advantage plan.

4. Medicare covers plenty: Medicare Part A covers in-patient hospital, skilled nursing facility care, home health and hospice care. Medicare Part B covers physicians’ services, outpatient surgery/services, lab/X-rays, MRIs, durable medical equipment, and preventative services, etc.

5. Medicare doesn’t cover everything: Medical services not covered under Medicare include vision, hearing, or dental expenses as well as long-term care.

6. There’s no network with Original Medicare (with Medicare Supplement/Medigap): Your health care professional or facility bills Medicare directly.

7. Medicare Advantage may be a good option: Know that you can choose between Original Medicare (Parts A and B) or Medicare Advantage plans offered by private insurance companies.

8. Medicare also serves Americans under 65: Those under 65 on Social Security Disability or with end-stage renal disease (ESRD) qualify when they meet Medicare’s requirements.

When someone visits www.tonisays.com for a Medicare consultation, whether in-person at the Sugar Land office or online via Zoom nationwide, the Toni Says Medicare team advises the client to forget everything they know about their old health insurance plans because Medicare is totally different!

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.