The U.S. healthcare system is confusing, but Medicare can be particularly hard to figure out. This is true for retirees and soon-to-be retirees. From gaps in coverage to having to enroll even if they don’t want to, many elements of the federal healthcare program can be frustrating.
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Personal finance guru Dave Ramsey and the Ramsey Solutions team offered some thoughts on the Medicare program that might be useful to hear — even if you’re already enrolled. Here are some of the big ones.
It helps to start with the basics.
Generally speaking, U.S. workers become eligible for Medicare when they turn 65. Those with a qualifying disability can enroll sooner.
Original Medicare — Parts A and B — covers a host of things, including doctors’ services, inpatient hospital care and preventive services. Coverage is based on state and federal law, but the program generally covers services deemed “medically necessary.”
Original Medicare doesn’t cover everything, however. Common exclusions are long-term care, routine physicals and dentures.
There’s also Medicare Part D, which covers prescription medications and has its own coverage limitations. Those who need additional coverage can purchase Medicare Supplement Insurance (Medigap) or a Medicare Advantage Plan (Part C). This might cover things like vision, dental or hearing services.
Medicare isn’t mandatory, but most people end up enrolling in it at some point. People with Part A generally don’t have to pay a premium, though it depends. Those with Part B paid an average premium of $175.70 a month in 2024. There’s also a yearly deductible — $1,676 for Part A and $257 for Part B in 2025.
Part D renews automatically, which is convenient, but it is an extra cost. Similarly, Medicap and Part C have additional costs, and you’ll have to re-enroll manually every year for these.
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According to Dave Ramsey — and even just the general rules of the program — Medicare can be “confusing.”
Why?
“Well, it was created by the government, so that might be your first clue,” the Ramsey Solutions post reads. “And second, it’s just a lot to understand.”
This goes for both Original Medicare and Medicare Advantage plans. Advantage plans act similarly to traditional health care plans: Both have limits in terms of their network providers.
Sometimes, an insurance company offering a Medicare Advantage plan won’t cover things like specialists — even if the enrollee was referred to them. This makes it so the enrollee must pay out of pocket for all associated costs of seeing that specialist.
