Hospitals

Hospitals provide medical, surgical, and psychiatric care to people who are sick or injured. Services are ordered by a doctor. These types of hospitals can be found here using the “Hospital type” filter:

Acute care: Give inpatient medical care and other related services for surgery, acute medical conditions, or injuries (usually for a short-term illness or condition).

Children’s: Inpatient care is mostly for people under age 18.

Critical access: Small facilities that give outpatient and limited inpatient services to people in rural areas.

Psychiatric: Specialty facilities that mainly give inpatient psychiatric services to diagnose and treat mental illness on a 24-hour basis, by or under the supervision of a physician.

Nursing homes

Nursing homes are facilities for people who need 24-hour care. Most nursing homes provide both short-term and long-term care, including:

• Short-term care for people who need rehabilitation after surgery, like physical therapy after a hip or knee replacement
• Short-term care for people who need skilled nursing to recover from an illness, like pneumonia
• Long-term care for people who need help with activities of daily living, like bathing, dressing, or eating

Some nursing homes offer specialized care for people with Alzheimer’s disease and other types of dementia. The nursing homes here are certified by Medicare and/or Medicaid.

Home health services

Home health care provides skilled, short-term services in-home. These services are typically ordered by a doctor to help with recovery following an inpatient hospital stay, rehabilitation, or a stay at a facility providing skilled nursing care. In general, the goal of home health care is to help you get better, regain your independence, and be as self-sufficient as you can.

Home health agencies that serve your area are based on the ZIP code you enter in your search, regardless of where their office is located.

Hospice care

Hospice offers care and support that focuses on the quality of life for people and their caregivers who are experiencing an advanced, life-limiting illness. This type of care is most often provided where patients live, whether it’s at home, an assisted living facility, or a nursing home. Hospice care uses a team of healthcare providers who care for patients’ medical, physical, social, emotional, and spiritual needs.

Depending on the illness or condition, the hospice team creates a plan of care that can include some or all of these services:

Nursing care

• Hospice aide and homemaker services
• Social worker services
• Medical equipment and supplies
• Doctor/Physician Assistant services
• Prescription drugs for symptom control or pain relief
• Dietary counseling
• Physical and occupational therapy
• Speech-language pathology services (like to help with swallowing)
• Grief and loss counseling

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During the week of July 15, CMS released additional guidance regarding Medicare Prescription Payment Plan (MPPP) outreach and education. The MPPP, sometimes referred to as “smoothing,” was established in the Inflation Reduction Act (IRA) and allows Medicare beneficiaries with Part D to opt into an alternative payment structure for their cost-sharing for covered Part D medications.

Starting in 2025, people enrolled in a Part D plan will have the option to spread their out-of-pocket Part D costs over the calendar year rather than paying directly at the pharmacy counter. It is critical to keep in mind that the program does not reduce or increase a person’s Part D cost-sharing obligations–it only shifts them. This program launches at the same time as other Part D restructuring changes included in the IRA, most notably the establishment of a $2,000 out-of-pocket cap.

As described by the IRA and CMS, when someone opts into the MPPP, their plan will communicate that election to their chosen pharmacy as part of their payment transaction. At the point of sale, the person will not be charged. Instead, the plan will pay the beneficiary’s cost-sharing obligation–deductible, coinsurance, or copay, depending on their plan details–to the pharmacy. Then, using a formula outlined in the IRA statute, the plan will send the beneficiary a monthly bill. Opting into the program does not change how enrollees move through the Part D benefit or what counts toward their deductible or $2,000 out-of-pocket cap.

Whether the MPPP will be a good choice for a particular beneficiary will depend on a variety of individual circumstances and preferences. In the most recent guidance, CMS requires plans to identify and conduct outreach to individuals who are likely to benefit from the program–those who incurred $2,000 in Part D cost-sharing expenses between January 1 and September 30 of 2024, and those who, in 2025, incur out-of-pocket costs for a single prescription that equal or exceed $600. The guidance also provides some examples of beneficiaries less likely to benefit from the MPPP. For example, people with relatively low or stable Part D cost-sharing across the plan year and those who are unlikely to reach the $2,000 cap could see a less even distribution of costs under the MPPP, with higher bills in the later months of the year. This is due to the cumulative effect of one’s prescription drug costs and the MPPP’s monthly billing structure. The guidance also notes that people are unlikely to experience significant benefit from opting into the program late in the year, since their costs could only be spread over the remaining calendar months and directs plan outreach to focus on pre-plan year and early month education.

CMS also released model materials and a MPPP timeline. This and previous guidance is available on the CMS page devoted to the Inflation Reduction Act, under the “Part D Improvements” tab. CMS also announced that Medicare Plan Finder will feature a cost preview feature that incorporates the MPPP as an option and plans for training for SHIPs and other partners to take place this summer and in early fall.

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Extra Help is a cost-assistance program that helps you pay for prescription drugs while on Medicare. It works by paying for your Part D premium (up to a state-specific benchmark amount) while lowering the cost of your prescription drugs.

Note: You pay no premium if you have a basic Part D drug plan with a premium at or below the Extra Help premium limit for your area. You will likely still owe a premium if you have an enhanced Part D plan, even if the premium is below the benchmark.

Some extra perks are that if you qualify for Extra Help and have a Part D late enrollment penalty, it will eliminate that fee. It also gives you Special Enrollment Periods to enroll in Part D or switch between plans throughout the year.

You should automatically be enrolled in Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program. If that’s not the case for you, you might still be eligible if you have limited assets and your income is below $1,903 per month as an individual or $2,575 as part of a couple.

Apply online through the Social Security Administration or contact the Medicare Rights Center for assistance applying.

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Here’s a breakdown of the costs you can expect in 2024: 

Part A (Hospital Insurance)

Premium:

• Free if you’ve worked 10 years or more 
• $278 per month if you’ve worked 7.5 to 10 years 
• $505 per month if you’ve worked fewer than 7.5 years 

Deductible:

• $1,632 each benefit period 

Coinsurance:

• $0 for the first 60 days of inpatient care each benefit period 
• $408 per day for days 61-90 each benefit period 
• $816 per lifetime reserve day after day 90 in a benefit period (You have 60 lifetime reserve days that can only be used once. They’re not renewable.) 

Skilled Nursing Facility:

• $0 for the first 20 days of inpatient care each benefit period  $204 per day for days 21-100 each benefit period 

Part B (Medical Insurance)

• Premium: $174.70 is the standard premium 
• Deductible: $240 per year 
• Coinsurance: 20% for most services Part B covers 
• Part D (Prescription Drug Insurance)
• National Average Part D Premium: $32.74/month
• Maximum Deductible: $545 per year
• Coverage Gap Begins: $5,030 (you and your plan together)
• Catastrophic Coverage Begins: $8,000 (your costs, including brand coverage gap discounts)

Costs after catastrophic limit: $0For more details, check out our Guide to Medicare Costs in 2024 here: Medicare Costs in 2024. 

You can also review your Medicare & You 2024 handbook (contact 1-800-MEDICARE (633-4227) to receive one) if you have Original Medicare. If you have a Medicare Advantage Plan, contact your plan directly to learn about changes in 2024 that might affect you.

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If you think you’re being discharged from the hospital too soon, you do have the right to file an appeal. 

You should’ve gotten a notice that explains this right titled, Important Message from Medicare when you were admitted. If you were there more than 3 days, you should receive another copy of the same notice between 4 hours and 2 days before you are to be discharged. 

The Important Message from Medicare notice will have instructions for filing a fast (expedited) appeal. This appeal will be sent to the Quality Improvement Organization (QIO), a company that is contracted to evaluate discharge appeals. For a fast appeal, you must appeal by no later than midnight on the day of your scheduled discharge. Once you file the appeal, the hospital must give you a Detailed Notice of Discharge, which must explain, in specific detail, why the hospital believes that Medicare coverage for your stay is ending, and that discharge is appropriate. You can also send additional information about why you, and your care team, if applicable, believe the discharge is too soon. The QIO should call you within 24 hours with their decision.

If the QIO agrees with the hospital that Medicare coverage of your hospital stay should end, you have the right to continue to appeal to higher levels of review. If you stay in the hospital after the QIO decision agreeing with the hospital, however, you may be responsible for the full cost of your care from the date of that decision forward if you don’t win at a higher level of appeal. There are five levels of appeal, and instructions for the next steps are included in each decision. Keep in mind that at each level there is a separate time limit for when you must file the appeal and when you’ll receive a decision.

Here are a few tips to help you succeed: 

• Follow the appeal timelines for each level.
• Take good notes throughout the process & keep original copies of all documents.
• Include a letter from your doctor or other care team member explaining why your specific circumstances require additional hospital care to support your appeal.
• Contact your State Health Insurance Assistance Program (SHIP) for more guidance on your appeal.

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Many people with Medicare Part D drug coverage—in particular those who reach the catastrophic coverage phase—may experience unexpected costs and significant confusion as their out-of-pocket obligations change throughout the year.

The Inflation Reduction Act (IRA) brings much-needed consumer protections and predictability to these coverage phases, limiting financial exposure for everyone and generating significant savings for those with extreme costs.

As of 2024, Part D enrollees are no longer required to pay 5% coinsurance after they reach catastrophic coverage. This threshold is set at $8,000 in what’s called “true out-of-pocket,” or TrOOP costs. These amounts include what the beneficiary spends on covered prescriptions, what others, like family members, friends or certain charitable organizations spend on their behalf, and any manufacturer discounts during the coverage gap phase. This calculation is different than what’s called “total drug costs,” which includes TrOOP amounts plus what the Part D plan has paid.

Most people will pay roughly $3,400 of their own money by the time they reach $8,000 in TrOOP costs. After this point, they will pay $0 for covered Part D drugs for the rest of 2024. Exactly how much a person will pay before they reach the TrOOP limit of $8,000 depends on their plan design, and the mix of brand name and generic drugs they take – this is because while the brand-name manufacturer discount in the coverage gap is included in TrOOP, the government-funded generic discount is not.  If a person takes only brand-name medications, they will pay around $3,300 before they hit the catastrophic cap, while a person who takes an average amount of brand and generic drugs will pay about $3,400. A person who takes only generic drugs will pay close to the full $8,000 before they reach the catastrophic phase.

Further savings and simplifications are coming. Starting in 2025, beneficiary drug costs will be capped at $2,000, indexed annually for growth in Part D. There will be no change of payment responsibility in the coverage gap, and no differential treatment of the manufacturer discounts for brand and generic drugs. Instead, out-of-pocket expenses will be defined in a way that more closely matches the usual understanding of that term, and once a beneficiary spends $2,000 in the deductible and initial coverage phases, they will pay $0 out-of-pocket for the rest of the year.

To illustrate the impact of these changes, a recent KFF report examined three commonly taken cancer drugs, each priced at well over $100,000 a year. In 2023, Medicare Part D enrollees who used any of these drugs for the entire year faced nearly $12,000 in out-of-pocket costs. In 2024, they will no longer be responsible for $8,000 to $9,000 of that amount. And next year, when the $2,000 cap takes effect, they’ll save even more.

The IRA’s Part D redesign will help millions of current and future enrollees afford needed care. These reforms come on top of the law’s other beneficiary cost-saving provisions, many of which have flown under the radar—such as vaccines without cost sharing, reduced insulin costs, expanded access to “Extra Help,” and the drug negotiation program that is already underway and in 2026 will bring down prices for some of the most expensive Part D drugs.

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There are indeed some changes coming in 2025, and you might’ve received an eligibility letter about it earlier this year. A new program called the Postal Service Health Benefits (PSHB) program will be offering health insurance to eligible Postal Service employees, retirees, and their eligible family members. PSHB will replace your current FEHB coverage beginning January 1, 2025. It’ll be the only health benefits program available through the Postal Service to employees, retirees, and their eligible family members. Here’s what you need to know:

Some eligible members will have to enroll in Medicare to keep their PSHB:

• Active employees that are under the age of 64 (as of 12/31/24) and are participating in FEHB as of 12/31/24
• Covered family members of retirees when the primary PSHB enrollee is enrolled in Medicare Part B
• Note: Those who are enrolled in Medicare Part B as of 1/1/2025 must remain enrolled to continue participating in the PSHB program.
• Some eligible members do not have to enroll in Medicare:
• Retirees who retired on or before 12/31/24 and who are participating in FEHB as of 12/31/24.
• Covered family members of retirees who are participating in FEHB as of 12/31/24 (unless the primary PSHB enrollee is enrolled in Medicare Part B, see above list)
• Active employees age 64 or older (as of 12/31/24) who are participating in FEHB as of 12/31/24
• Some retirees eligible for PSHB might still wish to enroll in Medicare as they transition from FEHB to PSHB.

Even though it isn’t required, enrolling in Medicare Part B may reduce a retiree’s overall healthcare costs. 

You can learn more about the upcoming changes in the USPS’s fact sheets for current Postal employees and their documents for retirees.

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The quick answer is no. Employees covered under the Federal Employees Health Benefits (FEHB) program can keep their benefits after retirement if they’ve had FEHB for at least 5 years and the whole time they have been eligible for that coverage. Unlike other employer-based coverage, FEHB will continue to operate as a primary payer after your retirement if you don’t enroll in all or part of Medicare. However, declining Medicare Part B when you’re not covered as a result of current work means that you’ll likely owe a late enrollment penalty (LEP) if you enroll later.

The decision to enroll in Medicare when you retire from federal employment depends on your unique circumstances and preferences. Here are your options:

• Keep FEHB and turn down Medicare.
• FEHB is unlike most other retiree coverage in that it can remain as your primary insurance if you don’t enroll in Medicare. 
• If you decide to do this, you might still want to enroll in Medicare Part A, while declining Part B, since Part A is premium-free for many.
• If you enroll in Medicare Part B later, you will likely have to pay a late enrollment penalty. 
• Keep FEHB and enroll in Medicare Part A and Part B.
• You’ll have to pay both premiums. 
• Medicare will be primary, and the FEHB plan will cover your deductibles and cost-sharing.
• FEHB may cover some things that Medicare does not, and vice versa.
• Your FEHB drug coverage is creditable for Part D, and you will not need to enroll in a separate Part D plan. 

Note that FEHB drug coverage cannot be suspended separately from FEHB health coverage. If you want to keep your FEHB health coverage, you must keep drug coverage, even if you enroll in Part D.

Disenroll from FEHB and enroll in Medicare.

Keep in mind that you may lose the option of signing up for FEHB again in the future. Speak to the office of Personnel Management (OPM) to learn more about your FEHB-specific rights and options.

When you think about the pros and cons for each option, you might want to ask yourself the following questions:

• Which insurance do my providers (and providers I wish to see in the future) accept?
• What would be my costs for the health care services I use the most?
• Which option offers flexibility for the future if I need it? 

You can contact the U.S. Office of Personnel Management (OPM) if you’re a federal employee or retiree and want to learn more about your health benefits by calling 317-212-0454.

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In the first week of April, the Centers for Medicare & Medicaid Services (CMS) announced the 2025 payment rates for Medicare Advantage (MA) and Part D plans. The final policies largely align with those proposed in the Advance Notice and are expected to increase Medicare payments to MA plans by 3.7%—over $16 billion—next year.

The Medicare Rights Center appreciates the finalization of provisions that would help rein in soaring and unnecessary MA costs and continues to urge additional, comprehensive reforms.

The research from independent experts is clear: Medicare overpays MA plans by billions of dollars each year, negatively impacting Medicare’s finances while driving up beneficiary premiums and taxpayer costs. In 2024 alone, the Medicare Payment Advisory Commission (MedPAC) projects that MA plans will be paid 123% of Original Medicare costs, inflating Part B premiums by $13 billion. Curbing this wasteful spending becomes more urgent by the day. Overpayments will only grow as MA plan and enrollment numbers do, and both are surging.

Policymakers must effectively respond to these realities and to the concerns many have about rising Medicare costs, the program’s future, and the need for solutions.

In our comments on the 2025 Advance Notice, we encouraged CMS to do just that. We applaud the agency’s responsiveness through the continued phase-in of planned changes to the MA risk adjustment model. Once fully in place, those modernizations will better align MA with current healthcare practices and yield more accurate plan payments.

However, as in prior years, we are disappointed that CMS will again apply the 5.9% statutory minimum coding intensity adjustment in 2025, rather than a higher and more effective rate. Unchanged since 2018, this minimum amount is not keeping pace with coding intensity or the resulting excess plan payments. In 2020, risk scores for MA enrollees were already 13% higher than they should have been, generating $16 billion in overpayments. By 2022 scores and additional payments had jumped to 18% and $37 billion, respectively. In 2024 MA coding intensity is expected to be 20% higher than OM, resulting in an extra $54 billion. CMS must meaningfully intervene without delay.

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During the week of March 25, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to make enrolling and staying in Medicaid easier, especially for older adults and people with disabilities. This rule is a companion to one finalized last fall that streamlined enrollment into Medicare Savings Programs (MSPs).

Medicaid is a joint federal and state program with many different categories of coverage, each with its own eligibility rules and processes. These pathways include coverage for pregnant people, children, low-income adults between 19 and 64 who are not Medicare eligible (expansion Medicaid), and older adults and people with disabilities.

That last category, usually called “Aged, Blind, and Disabled” (ABD) Medicaid, has onerous enrollment and redetermination processes that can impede access to care. Administrative hurdles can include state requirements that applicants schedule in-person interviews or complete multiple rounds of redetermination paperwork within 12 months. Such barriers can make applying for or keeping benefits more difficult and often undermine healthcare goals and outcomes.

CMS aims to alleviate some of these challenges in the newly finalized rule by clarifying federal minimum standards for ABD Medicaid application and redetermination processes. The rule bars in-person interviews for ABD Medicaid and requires states to provide a full year of eligibility before requiring redetermination paperwork. In addition, the rule simplifies other enrollment and verification processes, including requiring states to use prepopulated renewal forms and available data to make eligibility determinations, creating new timelines for applicants to submit needed documentation and for states to process applications, and establishing consumer protections around returned mail and address changes. The rule also clarifies existing policies to ensure state-to-state consistency and reduce non-compliance.

These regulations, coupled with the MSP streamlining rule, eliminate some of the barriers that impede access to important financial assistance programs and will protect the health, economic stability, and well-being of older adults and people with disabilities.

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