ASK THE MEDICARE GUYS
Understanding Medicare.
Medicare is the federal health insurance program for people 65 and older, as well as certain individuals with qualifying disabilities. It is administered by the Centers for Medicare & Medicaid Services (CMS).
What are the parts of Medicare?
PART A
HOSPITAL INSURANCE
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people qualify for Part A at no premium cost.
PART B
MEDICAL INSURANCE
Covers doctor visits, outpatient care, preventive services, and medical equipment. Part B requires a monthly premium that varies based on your income.
Navigating Your Coverage Options.
Original Medicare (Parts A & B) covers a lot — but not everything. Most people choose to add additional coverage to help with out-of-pocket costs.
You do not need to make this decision before enrolling in Medicare. This is something we will walk through together once you have your Medicare card.
Here is a preview of what you will be choosing from:
OPTION ONE
Medicare Supplement (Medigap) + Part D Drug Plan
A Medicare Supplement plan helps pay costs that Original Medicare does not cover — like copayments, coinsurance, and deductibles. You will need a standalone Part D drug plan.
OPTION TWO
Medicare Advantage (Part C)
Medicare Advantage plans bundle Parts A, B, and usually D into one plan offered by a private insurer. Many include extra benefits like dental, vision, and hearing.
We created an easy and FREE step-by-step guide on how to enroll into Medicare through Social Security. Click the link below to request the guide now!
Medicare Advantage vs. Medicare Supplement
This is one of the most important decisions you’ll make.
We created a simple side-by-side comparison to help explain the major differences.
Medicare Advantage | Medicare Supplement (Medigap) | |
|---|---|---|
Referrals Required | Often required with a HMO, varies with a PPO. | Never required |
Prior Authorizations | Yes, for certain services. | Generally, not required. |
Prescription Drug Coverage | Usually included (Part D) | Separate purchase of Part D plan required |
Dental / Vision / Hearing | Often Included | Not included, separate purchase required |
Out-of-Pocket Maximum | Yes — set annually by plan | Depends on plan — Plan G & N covers most costs |
Not sure which is right for you? That’s exactly what we’re here for. Schedule a free consultation, and we’ll help you decide.
Medicare Enrollment Periods.
Enrolling at the right time matters. Missing a window can result in gaps in coverage or lifetime penalties.
Initial Enrollment Period (IEP)
7-month window: starts 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after. This is the best time to enroll.
General Enrollment Period (GEP)
January 1 – March 31 each year. For those who missed their IEP. Coverage begins July 1. Late penalties may apply.
Special Enrollment Period (SEP)
Available if you or your spouse are still working and covered by employer insurance. You have 8 months to enroll in Part B after that coverage ends — without penalty.
Annual Enrollment Period (AEP)
October 15 – December 7 each year. Switch plans, add or drop Part D, or change between Original Medicare and Medicare Advantage. Changes take effect January 1.
Medicare Advantage Open Enrollment (OEP)
January 1 – March 31. If you’re already in a Medicare Advantage plan, you can switch plans or return to Original Medicare.
Late Enrollment Penalties
Part B: If you miss your enrollment window without a qualifying SEP, your Part B premium increases by 10% for every 12 months you delayed. This penalty is permanent.
Part D: If you go 63 or more days without creditable drug coverage, a late penalty is added to your Part D premium for as long as you have it.
Ready to begin?
You might feel overwhelmed now, but I promise we are here to help.
Fill out the contact form below and start your Medicare journey with someone you can trust to make it easy.
