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What is Medicare?

As a United States citizen who has reached the age of 65 or above, you have the opportunity to enroll in Medicare, the federally provided healthcare program. Medicare consists of Parts A and B, commonly known as Original Medicare, which provide coverage for fundamental hospital and doctor expenses.

However, Original Medicare leaves certain expenses uncovered, resulting in potential out-of-pocket expenses. To safeguard against these gaps in coverage, Medicare supplements or Medicare Advantage plans are available, offering additional protection. Our team has extensive experience assisting clients in comprehending the coverage provided by Original Medicare and identifying plan options that align with their individual circumstances. We are dedicated to helping individuals make informed decisions about their healthcare coverage.

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How Does Medicare Work?

Medicare is a federal health insurance program that provides coverage for eligible individuals, primarily those aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions.

It is divided into different parts, including Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Medicare enrollment occurs during specific periods, and there are costs involved such as deductibles and co-payments.

To choose the right coverage, individuals can consider options like Original Medicare, Medicare Advantage, or supplemental coverage like Medigap plans.

However, Original Medicare leaves certain expenses uncovered, resulting in potential out-of-pocket expenses. To safeguard against these gaps in coverage, Medicare supplements or Medicare Advantage plans are available, offering additional protection. Our team has extensive experience assisting clients in comprehending the coverage provided by Original Medicare and identifying plan options that align with their individual circumstances. We are dedicated to helping individuals make informed decisions about their healthcare coverage.

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Part A (Hospital Insurance)

Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. Most people don’t have to pay for Part A if they or their spouse paid Medicare taxes while working.

Part B (Medical Insurance)

Covers outpatient medical services, including doctor visits, preventive care, diagnostic tests, durable medical equipment, and some outpatient treatments. Part B requires a monthly payment.

Part C (Medicare Advantage)

Offers an alternative way to receive Medicare through private insurance companies approved by Medicare. Medicare Advantage plans often combine coverage for Parts A and B. These plans have their own price and rules.

Part D (Prescription Drug Coverage)

Provides coverage for prescription drugs. Part D plans are offered by private insurance companies and can be added to Original Medicare or included in Medicare Advantage plans. Part D plans have their own copayments and formularies (lists of covered drugs).

Medicare Basics

Medicare is not free

There are over 56 million
people on Medicare.

There are over 800,000
providers who accept
Medicare in the US.

In some cases, people
under the age of 65
can qualify based on
health conditions or
disability.

Your initial enrollment
period is 7 months long
and begins 3 months
before your turn 65.

There are some penalties
if you miss the enrollment
period and don’t have
any other credible health
coverage.

Enrollment Opportunities

Initial Election Period for Part C & D:

When you first turn 65 (or become eligible for Medicare prior to age 65 through special circumstance) and have enrolled in Part A & B of Medicare, you will have a 7-month window to enroll in a Medicare Advantage Plan (Part C) or Prescription Drug Plan (Part D).
This 7-month window is the 3 months prior to your Part A & B starting, the month they take effect, and the 3 months following that effective month.

Open Enrollment for Medigap:

If someone would like to purchase a Medigap Plan (Medicare Supplement) instead of a Medicare Advantage Plan, they have a 6 month “Open Enrollment window” starting the day their Part B takes effect where they can do so without being subjected to medical underwriting by an insurance carrier.
Medigap Plans can also be purchased at any time throughout the year, but they would be subject to underwriting if outside of the Open Enrollment.

Annual Enrollment Period (AEP) for
Part C & D:

For Medicare Recipients that have Medicare Part A and/or Part B they are eligible to enroll into or change their Medicare Prescription Drug Plan (Part D) between October 15th and December 7th and all those enrollments will take effect on January 1st.
For Medicare Recipients that have Medicare Part A and Part B they are eligible to enroll into or change their Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) between October 15th and December 7th and all those enrollments will take effect on January 1st.

When are the Enrollment Periods?

AEP: Annual Enrollment Period:

The Medicare Annual Enrollment Period (AEP) is October 15th-December 7th and all plans will take effect January 1st. Medicare recipients can add, switch, or drop a plan. You are also allowed to enroll in as many plans as you want and typically the last enrollment completed during the enrollment period will be the one that goes into effect January 1st of the following year.