Last updated November 19, 2024
For Medicare Savings Programs and LIS/Extra Help, see Financial Assistance for people with low to modest income.
Medicare Part A:
| Medicare Part A | 2025 | 2024 |
| Deductible (days 1-60) | $1,6376benefit period | $1,632/benefit period |
| Coinsurance (days 61-90) | $419/benefit period | $408/benefit period |
| Lifetime reserve (days 91-150) | $838/benefit period | $816/benefit period |
| SNF coinsurance (days 21-100) | $209.50/benefit period | $204/benefit period |
| Premium (29 or less quarters) | $518/month | $505/month |
| Premium (30-39 quarters) | $285/month | $278/month |
Medicare Part B:
| Medicare Part B | 2025 | 2024 |
| Monthly premium* | $185 | $174.70 |
| Annual deductible | $257 | $240 |
| Part B-ID Benefit | $110.40 | $103 |
| Coinsurance | 20% for most services after deductible is met, except preventive care, which has $0 for most services | 20% for most services after deductible is met, except preventive care, which has $0 for most services |
Medicare Part D:
NEW in 2025: $2,000 cap on out-of-pocket prescription drug costs:
Beginning January 1, 2025, Medicare beneficiaries will have an annual $2,000 limit on out-of-pocket prescription drugs. In most states, including Minnesota, it is estimated that tens of thousands of Medicare beneficiaries will save money due to the $2,000 cap.
Action to take: Advise callers on the $2,000 cap as most beneficiaries do not know anything about the $2,000 cap. The $2,000 cap is automatic and the beneficiary does not need to enroll or opt into it.
What counts towards the $2,000 cap?
- Prescription drugs covered by Part D plan
- Please note:
- Drugs that are not covered by the plan do not count toward the $2,000 cap
- The monthly premium does not count toward the $2,000 cap. The premium must continue to be paid after the $2,000 cap is reached.
- The dispensing fee paid to the pharmacist does not count toward the $2,000 cap.
- The annual deductible does count toward the $2,000 cap.
- Payments paid on the beneficiary's behalf as part of Extra Help (LIS) do count toward the $2,000 cap.
- The Medicare doughnut hole, also known as the coverage gap, is gone beginning January 1, 2025.
- In 2025, the beneficiary will pay 25% of the drug cost until the amount reaches $2,000.
| 2024 | 2025 | |||
| Deductible phase | Cost sharing: 100% | Cost sharing: 100% | ||
| Deductible: $545 | Deductible: $590 | |||
| Initial coverage phase | Cost sharing: 25% Plan pays: 75% | Applicable drugs Cost sharing: 25% Plan pays: 65% Discount: 10% | Non-applicable drugs Cost sharing: 25% Plan pays: 75% | |
| Initial coverage limit: $5,030 | Initial coverage limit: N/A | |||
| Coverage gap | Applicable drugs Cost sharing: 25% Plan pays: 65% Discount: 10% | Non-applicable drugs Cost sharing: 25% Plan pays: 75% | N/A | |
| Out-of-Pocket threshold: $8,000 | Out-of-Pocket threshold: $2,000 | |||
| Catastrophic phase | Plan pays: 20% Reinsurance: 80% | Applicable drugs Plan pays: 60% Discount: 20% Reinsurance: 20% | Non-applicable drugs Plan pays: 60% Reinsurance: 40% | |
| Medicare Part D | 2025 | 2024 | 2023 |
| Benchmark amount | $50.63 If the beneficiary enrolls in a low-premium Medicare Part D plan with "enhanced" features, they may also pay a partial premium, even when the plan premium is below the benchmark since the plan is not considered "basic". | $42.16 | $39.87 |
| Annual standard deductible | $590 | $505 | |
| Initial coverage limit | Applicable Drugs: | $4,660 | |
| Coverage gap (donut hole) | N/A |
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| Catastrophic coverage | $2,000 out-of-pocket maximum | When out-of-pocket spending reaches $8,000 you move to catastrophic coverage. The following count toward Troop (true out of pocket costs):
| After coverage gap ends, catastrophic coverage begins:
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| Benchmark plans |
*ClearSpring has a benchmark plan but they are under sanction and cannot enroll anyone. |
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Medigap:
2025 Medigap policy coverage in Minnesota:
| Basic | Extended | $20 & $50 similar to plan N | High similar to plan F* | 50% similar to plan M | 50% similar to plan K | 75% similar to plan L | |
| Annual out-of-pocket limit | none | $1,000 | none | $2,870* | none | $7,220 | $3,610 |
| Part A deductible | 100% if rider purchased | 100% | 100% | 100%* | 50% | 50% | 75% |
| Part A coinsurance | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Skilled nursing facility coinsurance | 100% | 100%** | 100% | 100%* | 100% | 50% | 75% |
| Part B coinsurance | 100% | 100% | $20 & $50 copays | 100%* | 100% | 50% | 75% |
| Part B excess | 100% if rider purchased | 100% | - | - | - | - | - |
| Medicare preventive care | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Preventive services | 100% up to $120 if rider purchased | 100% up to $120 | - | - | - | - | - |
| Foreign travel - emergency | 80% | 80% | 80% | 100%* | 80% | - | - |
| Foreign travel - hospital and medical expenses and supplies | - | 80% | - | - | - | - | - |
*You must pay for the Medicare-covered costs up to $2,870 before the policy pays.
**Extended Basic plan provides up to 120 days of skilled nursing facility care.
2024 Medigap policy coverage in Minnesota:
| Basic | Extended | $20 & $50 similar to plan N | High similar to plan F* | 50% similar to plan M | 50% similar to plan K | 75% similar to plan L | |
| Annual out-of-pocket limit | none | $1,000 | none | $2,800* | none | $7,060 | $3,530 |
| Part A deductible | 100% if rider purchased | 100% | 100% | 100%* | 50% | 50% | 75% |
| Part A coinsurance | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Skilled nursing facility coinsurance | 100% | 100%** | 100% | 100%* | 100% | 50% | 75% |
| Part B coinsurance | 100% | 100% | $20 & $50 copays | 100%* | 100% | 50% | 75% |
| Part B excess | 100% if rider purchased | 100% | - | - | - | - | - |
| Medicare preventive care | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Preventive services | 100% up to $120 if rider purchased | 100% up to $120 | - | - | - | - | - |
| Foreign travel - emergency | 80% | 80% | 80% | 100%* | 80% | - | - |
| Foreign travel - hospital and medical expenses and supplies | - | 80% | - | - | - | - | - |
*You must pay for the Medicare-covered costs up to $2,800 before the policy pays.
**Extended Basic plan provides up to 120 days of skilled nursing facility care.
Medicare Appeals:
| Medicare appeals | |
| Administrative Law Judge threshold | $180 |
| Medicare appeal judicial review | $1,850 |
| Medicare therapy |
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Medicare Part B and D monthly adjustment amounts (IRMAA):
2025 Medicare Parts A & B Premiums and Deductibles | CMS
See Medicare: Appeals quick reference for IRMAA appeal and reconsideration information.