Medicare 101
YOUR MEDICARE OPTIONS
Medicare enrollment can be confusing & overwhelming, but it doesn’t have to be.
Original Medicare is a federal health insurance program for people 65 & older and others with disabilities; while invaluable, the program alone may not suffice. Gaps in coverage, such as deductibles, copayments and prescription drugs, are not included under Original Medicare. To address these gaps and enhance coverage, Seniors often opt for additional plans, such as Part D, Medicare Advantage or Medigap...and that's where we can assist!
​
Our agency is independent and we use selected, reputable carriers to bring you the best coverage that suits both your needs and budget.
​
Your plan choices don’t have to be permanent; health, lifestyle and even budgets often change. Let us review your current coverage to make sure you have the best plan for you.
It’s important to know when & how you can enroll to avoid penalty and missed opportunity.
ANNUAL ENROLLMENT PERIOD
This is the designated time for anyone Medicare eligible, regardless of plan type, to enroll or change
​
Oct 15 – Dec 7
OPEN ENROLLMENT PERIOD
This is the designated time for anyone who is specifically on Medicare Advantage (Part C) to change plans or disenroll
​
Jan 1 - Mar 31
INITIAL ELECTION PERIOD
This timeframe depends on when you turn 65 - your enrollment window starts 3 months before, continues the month of and up to 3 months after your Birthday month
SPECIAL ELECTION PERIODS
There are various exceptions to the standard enrollment periods, known as SEP
- Leaving employer coverage
- Losing/Gaining Medicaid eligibility
- You change where you live
​
Original Medicare is provided by the federal government offering:
Hospital and Skilled Nursing
This is called Part A - generally premium free for most - there is a large deductible for inpatient stays and a daily copay for skilled nursing longer than 20 days
Doctor Visits and Other Medical Care
This is called Part B - you pay a monthly premium for it - there is a 20% coinsurance and an annual deductible
Original Medicare does NOT include prescription drug coverage.
Additional coverage is offered by private insurance companies ​
Depending on your needs and budget, you will choose to obtain that additional coverage in one of these two ways:
Option 1:
Medicare Advantage
Also called Part C - These plans combine Part A & Part B. Most Medicare Advantage plans also include Part D, so your hospital, medical & prescription drug insurance is all in one plan. Some plans will also include dental, vision and hearing benefits
Option 2:
Medicare Supplement
Also called 'Medigap' - Helps pay for most of the costs not covered by Original Medicare.
​
Supplement plans do not include Part D coverage (Rx), so you must purchase a separate policy (also known as PDP - prescription drug plan, this coverage is required to avoid penalty)
Medicare FAQs
Do I need to sign up for Medicare if I'm still working past 65?
It depends on how you get your health insurance and the number of employees that are in the company where you (or your spouse) work.
​
-If you're self employed and don't have 'group health coverage' (as defined by the IRS) then you will need to enroll in Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty that is assessed for life
​
-If your employer has less than 20 employees you will need to sign up for Medicare when you turn 65. Medicare will become your primary insurance and your employer based insurance will become secondary. Failing to enroll in Medicare in this scenario, could result in your employer coverage denying claims
-If your employer has more than 20 employees, you can wait until you (or your spouse) stop working but you will certainly want to compare the options available to you
​
-If you have COBRA you will need to sign up for Medicare when you turn 65 to avoid a monthly part B late enrollment penalty and likely, your options outside of COBRA will be less expensive
Do I need to get Medicare drug coverage (Part D) if I'm not taking any prescriptions?
YES! Even if you are not utilizing the benefits, you must maintain creditable drug coverage to avoid the Part D late enrollment penalty
How much does Medicare Cost?
Part A is premium-free for most. You usually get Part A for free if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters). If you haven’t met that requirement, you may have to pay a monthly premium for Part A. The amount depends on how many quarters you did work and pay into the system.
​
Part B - has a standard premium of $185.00 each month (2025) (higher income earners will also pay an Income Related Monthly Adjustment Amount (IRMAA) in addition to the standard premium); you might pay a penalty if you don't sign up for Part B when you're first eligible.
Parts C, D and Medigap which are your enhancements to Original Medicare, have varying monthly premiums vary based on which policy you buy, where you live, and other factors. The amount can change each year. It is very important to talk to a qualified professional to help you navigate these choices, you can CHECK HERE for an idea of costs in your area but it’s highly recommended you do not enroll on your own without guidance
How do I enroll in Medicare?
You only need to sign up for Part A and Part B once. Each year, you can choose which way you get additional coverage and switch plans, if necessary. Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse, either. It is recommended you review your Medicare options annually at the allotted time (Oct 15 - Dec 7)
​
You can enroll in Original Medicare online (preferred) at the Social Security Administration website, you can visit your local SS branch in-person or you can request a phone appointment