Medicare in Clinton, North Carolina (2025 Update)

Edited by Kayla Price https://priceservicesgroup.com/

Clinton (pop. ~8,000), nestled in Sampson County, remains a peaceful, community‑oriented town relying on agriculture and manufacturing. As with many small towns, healthcare access is limited. Here’s an updated breakdown of Medicare options in 2025—who qualifies, costs, and local resources.

🌟 Why Clinton, NC Is Still a Great Place to Live

Clinton’s strong sense of community, modest cost of living, and accessible healthcare services make it appealing for retirees and families. Local favorites—Woody’s Place, the Gristmill, Salemburg Pizza—continue serving residents. The weather varies, featuring hot summers, occasional snow, and hurricane threats (e.g., Fran, Matthew, Florence), and amenities like the YMCA and nearby recreational areas support active lifestyles.

Part A (Hospital Insurance)

2025 deductible: $1,676 per benefit period (up $44 from 2024’s $1,632) barrons.com+7kiplinger.com+7medicare.gov+7medicare.gov+10cms.gov+10ncoa.org+10

Coinsurance:

Days 61–90: $419/day (up from $408) humana.com+3cms.gov+3medicareresources.org+3

Lifetime reserve days (91–150): $838/day medicareresources.org+3cms.gov+3en.wikipedia.org+3

Skilled Nursing Facility (days 21–100): $209.50/day panfoundation.org+15cms.gov+15kiplinger.com+15

Premiums: Most who’ve earned 40 work quarters pay $0; others may pay reduced premiums (~$285/month) cbsnews.com+15cms.gov+15medicareguide.com+15

Local providers include Sampson Regional Medical Center (146 beds) and Southwood Rehabilitation, both Medicare‑accepting.

Part B (Medical Insurance)

Monthly premium: $185 standard (up $10.30 from $174.70 in 2024) en.wikipedia.orgcms.gov+11medicare.gov+11ahcancal.org+11

2025 deductible: $257 annually (up $17 from $240) panfoundation.org+15medicare.gov+15ahcancal.org+15

Coinsurance: Typically 20% of Medicare‑approved amounts; clinical lab services are $0 humana.com+5medicare.gov+5ncoa.org+5

Local clinics (like Clinton Medical Clinic and Sampson Medical Group) accept Medicare, offering primary and specialty care. Free counseling through SHIIP remains available.

Part D (Prescription Drug Coverage)

Big changes in 2025 under the Inflation Reduction Act:

No more “donut hole.” The coverage gap is eliminated, so beneficiaries pay normal coverage through to the out-of-pocket cap ahcancal.org+12ncoa.org+12washingtonpost.com+12cbsnews.com+4cms.gov+4ncoa.org+4

Annual out-of-pocket cap: $2,000 for prescription drugs, after which plans pay 100% ncoa.org

Monthly premium: National base premium ~$36.78; average Part D premium ~$46.50 kiplinger.com+2medicare.gov+2kiplinger.com+2

IRMAA surcharge (if high income): $13.70–$85.80/month based on 2023 tax returns rrb.gov+2kiplinger.com+2kiplinger.com+2

New options: “Smoothing” feature allows spreading drug costs over the year washingtonpost.com

As a result, beneficiaries in Clinton now enjoy predictable prescription drug costs.

Medicare Advantage (Part C)

Continues as a popular alternative, bundling Parts A, B, and often D, plus extras like vision/dental/gym.

Average monthly premium: ~$17 (ranges from $0–$240+) ncoa.org

Out‑of‑pocket max: $9,350 (in‑network) for 2025 medicareresources.org+1kiplinger.com+1

Expect ~20 plans from several providers (e.g., Humana, Devoted, Liberty Medicare Advantage, UnitedHealthcare, BlueCross NC).

Medicare Supplement (Medigap)

Fill coverage gaps left by Original Medicare.

Requires enrollment in Parts A & B.

Medigap open enrollment lasts six months starting when you turn 65 or enroll in Part B.

Spouses must enroll individually.

Available plans in Clinton via independent agents and SHIIP.

Working with a Medicare Agent in Clinton

Licensed agents like Kayla Price continue to offer invaluable help:

Matching plans to individual needs—e.g., selecting Medigap + Part D vs. Advantage.

Explaining premiums vs. out-of-pocket vs. coverage of specific meds or providers.

Providing ongoing help with billing, claims, and annual policy reviews.

🗓️ Enrollment & Resources

Annual Open Enrollment: Oct 15 – Dec 7, 2025 (for Advantage & Part D plans).

Special Enrollment Periods available for qualifying changes.

Local agents: Knowledgeable about SAMC, Southwood, local pharmacies, and regional providers and provide free, unbiased planning reviews.

Summary Table of 2025 Costs

Medicare Part 2025 Standard Costs

Part A deductible$1,676 per benefit period Part A coinsurance (61‑90 days)$419/day Part B premium$185/month (before IRMAA)Part B deductible$257/year Part B coinsurance 20%Part D premium Avg. ~$46.50/month Part D out-of-pocket cap $2,000Advantage out‑of‑pocket max$9,350 in-network

Final Thoughts

2025 brings significant cost stability to Medicare in Clinton, especially eliminating the Part D donut hole and capping prescriptions’ out-of-pocket costs. However, costs have risen for Parts A and B. To manage your healthcare efficiently, work with a local Medicare agent or SHIIP counselor, review your coverage each fall, and stay informed about plan changes.

Let me know if you'd like help comparing local plan options or connecting with trusted agents in Clinton!

Resources & References

For more information on Medicare options and updates:

Medicare Official Site – https://www.medicare.gov

2025 Medicare Costs (CMS) – https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles

NC SHIIP (Senior Health Insurance Information Program) – https://www.ncdoi.gov/consumers/medicare-and-seniors-health-insurance-information-program-shiip

Medicare Part D 2025 Changes (KFF) – https://www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit

Out-of-Pocket Medicare Costs in 2025 (NCOA) – https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2025

Medicare Advantage FAQs – https://www.medicareresources.org/faqs

Prescription Drug Price Smoothing Info – https://www.cms.gov/newsroom/fact-sheets/cms-releases-2025-medicare-part-d-bid-information-and-announces-premium-stabilization-demonstration

Contact Kayla Price – Price Services Group – https://priceservicesgroup.com