Medicare IEP Guide: Understanding Parts A, B, C & D

Turning 65 soon and not sure what to do for the Initial Enrollment Period? Whether you’re doing research for yourself or your loved ones, knowing when to enroll in Medicare is extremely important.

More than 11,000 people become eligible for Medicare each day.

Your IEP lasts for seven months, starting three months before your 65th birthday and ending three months after.

Today, we’ll cover all Medicare IEP plan types such as Medicare A, B, C & D and give you useful tips for each plan so you feel prepared for this period.

Enroll in time!

Understanding Initial Enrollment Period (IEP) Your Initial Enrollment Period (IEP) is your first opportunity to sign up for Medicare, and making the right choices now can impact your healthcare and costs to come.

Key Points About IEP You might have some questions like:

Who is eligible? Anyone turning 65 and those under 65 with qualifying disabilities. What can you enroll in? Medicare Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), Part D prescription drug plan. and, if needed, a supplemental plan like When should you enroll? Enrolling during the three months before your birthday ensures your coverage starts without delay. Tip: If you're still working and have creditable employer coverage, check if you need to enroll in Medicare right away. Some people can delay Part B without penalties.

Medicare Part A: Hospital Insurance Essentials Medicare Part A provides hospital insurance, covering essential inpatient services that help beneficiaries manage hospital stays, skilled nursing care, and home health services.

What Does Medicare Part A Cover? Medicare Part A primarily covers hospital-related services, making sure you receive care when you need inpatient medical attention.

Medicare Part A covers:

Inpatient hospital stays: Covers semi-private rooms, nursing care, meals, and necessary treatments. Skilled nursing facility ( SNF ) care: Includes short-term rehabilitation after a qualifying hospital stay (minimum three days). Hospice care: Provides end-of-life care for those with a terminal illness. Home health care: Offers limited coverage for medically necessary services, such as part-time skilled nursing care or therapy. Tip: Hospital stays and SNF care under Part A require meeting specific conditions, like a doctor’s certification of medical necessity.

Understanding the 2025 Medicare Part A Deductible This one-time deductible per benefit period applies each time you're admitted to a hospital, rather than annually like most other insurance deductibles.

Here’s what to expect for 2025 Medicare Part A costs:

Inpatient hospital deductible: The amount you pay for each hospital stay before Medicare kicks in. Coinsurance costs: After 60 days in a hospital or 20 days in an SNF, daily co-payments may apply. Lifetime reserve days: If you exceed 90 days in the hospital, you’ll start using these limited extra coverage days, each requiring a copayment. Tip: To minimize costs, consider supplemental coverage like Medigap to help cover out-of-pocket expenses associated with Part A deductibles and copayments.

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Medicare Part B: Medical Insurance for Your Needs Medicare Part B covers outpatient and preventive healthcare services, helping beneficiaries manage routine medical expenses outside of hospital stays.

What Does Medicare Part B Cover? Medicare Part B covers a wide range of medically necessary services and preventive care to help you maintain your health and detect potential issues early.

Medicare Part B covers:

Doctor visits: Appointments with primary care physicians and specialists. If you need a routine colonoscopy screening or annual flu shot, Part B covers it at no cost as long as the provider accepts Medicare. Outpatient care: Medical services that don’t require hospital admission, including X-rays, MRIs, and physical therapy. Preventive service: Screenings for conditions like cancer, diabetes, and heart disease, along with flu shots and wellness visits. Durable medical equipment ( DME ): Walkers, wheelchairs, oxygen equipment, and other medically necessary supplies. Mental health services: Therapy, counseling, and psychiatric evaluations. Ambulance services: Emergency and, in some cases, non-emergency transportation. Tip : Have in mind that not all services are fully covered — Part B generally covers 80% of approved costs, and you pay the remaining 20% unless you have Medigap or another form of supplemental insurance.

If you need a routine colonoscopy screening or annual flu shot, Part B covers it at no cost as long as the provider accepts Medicare.

What Are the Costs for Medicare Part B in 2025? Medicare Part B costs include monthly premiums, an annual deductible, and coinsurance costs for covered services. These amounts are adjusted annually based on Medicare spending and inflation.

For 2025, here’s what you should expect:

Monthly premium: Standard premiums are $185 in 2025. Higher-income beneficiaries may pay an additional cost with the Income-Related Monthly Adjustment Amounts ( IRMAA ). Annual deductible: Before Medicare begins covering outpatient services, you must pay this set amount. Coinsurance costs: Once your deductible is met, you’ll generally pay 20% of the Medicare-approved amount for most doctor services and outpatient care. Tip: If the 2025 Part B deductible is $257, you’ll pay that amount out-of-pocket before Medicare covers any outpatient visits. After reaching the deductible, if a specialist visit costs $200, Medicare pays $160 (80%), and you owe $40 (20%).

Medicare Parts C and D: Expanded Coverage Options While Medicare Parts A and B provide essential hospital and medical coverage, Medicare Part C and Medicare Part D may offer additional benefits to supplement your healthcare.

What Is Medicare Advantage (Part C)? Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B) that bundles hospital, medical, and some prescription drug coverage into a single plan.

What does Medicare Advantage offer?

Integrated coverage: Combines hospital, medical, and sometimes Part D prescription drug coverage into a single plan. Extra benefits: Many plans include benefits not covered by Original Medicare. Fixed costs : Medicare Advantage plans often have lower premiums but may include copays and provider network restrictions. Provider networks: Plans typically operate as HMO or PPO networks, meaning you may need to use in-network doctors for the best coverage. Tip: If you’re looking for an all-in-one plan with prescription drug coverage, an HMO Medicare Advantage plan may be a cost-effective option — just make sure your doctors and hospitals are in-network.

Always look for new updates about your drug prescription plan, as they can change on a yearly basis

Choose the Right Part D Plan for Your Prescription Drugs Medicare Part D is designed to help cover prescription drug costs and is available as a standalone plan or included within a Medicare Advantage (Part C) plan.

What to consider when selecting a Part D plan:

Formulary coverage : Each plan has a list of covered drugs (formulary), so check if your medications are included. Tiered pricing: Part D plans categorize drugs into tiers — generic drugs are usually lower-cost, while brand-name and specialty drugs may have higher copays. Monthly premiums and deductibles: Costs vary by plan; some may offer low deductibles, while others may have higher premiums for broader coverage. Tip: If you take daily medications, compare formularies across plans to find the best coverage for your prescriptions at the lowest cost.

Explore Medicare Advantage, Medigap and Part D Plans With Healthpilot Enrolling in Medicare during your Initial Enrollment Period (IEP) is a really important step for your healthcare coverage and Healthpilot is here to make it easy for you.

With Healthpilot, you can get:

Personalized recommendations: Search for plans that include your doctors, medications, and healthcare needs. Easy plan comparisons: See the differences in costs, benefits, and coverage so you can make the best choice for you. Expert guidance: Our licensed, non-commissioned professionals are here to answer your questions — without sales pressure. Enroll on your terms: Explore, compare, and sign up online at your own pace. Your Medicare coverage should fit your life, not the other way around. Healthpilot is here to help you confidently navigate your Initial Enrollment Period and find a plan that works for you.

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