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The Basics

What is Medicare?

 Medicare is a federal health insurance program designed for:

  • People age 65 and older
  • Individuals under 65 with certain disabilities 

It helps cover hospital care, medical services, and prescription drugs—and it can be customized based on your needs.

When to Enroll in Medicare

 Knowing when to sign up is just as important as understanding what to sign up for.

  • Initial Enrollment Period (IEP): A 7-month window around your 65th birthday
  • Annual Enrollment Period (AEP): October 15 – December 7 each year
  • Special Enrollment Periods (SEP): Available in certain situations, like losing employer coverage

Understanding the Parts of Medicare

Part A – Hospital Insurance

Part C — Medicare Advantage Plans

Part A – Hospital Insurance

 Part A helps cover the major things that happen inside a hospital setting. This includes:


  • Inpatient hospital stays
  • Skilled nursing facility care (short-term rehab, not long-term care)
  • Hospice care for terminal illnesses
  • Limited home health care (for medical needs—not full-time help)
     

If you or your spouse worked and paid Medicare taxes for a

 Part A helps cover the major things that happen inside a hospital setting. This includes:


  • Inpatient hospital stays
  • Skilled nursing facility care (short-term rehab, not long-term care)
  • Hospice care for terminal illnesses
  • Limited home health care (for medical needs—not full-time help)
     

If you or your spouse worked and paid Medicare taxes for at least 10 years, you likely won’t pay a monthly premium for Part A. But there are still other costs involved, like deductibles and possible copayments after longer hospital stays.

Think of Part A as your safety net for serious, facility-based care.

Part B — Medical Insurance

Part C — Medicare Advantage Plans

Part A – Hospital Insurance

 Part B covers the everyday healthcare services that help you stay well and manage ongoing conditions This includes:


  • Doctor visits and outpatient care
  • Preventive screenings (like mammograms, colonoscopies, and flu shots)
  • Durable medical equipment (DME), such as walkers, wheelchairs, and oxygen
  • Some types of home health care
     

Unlike Part A, Pa

 Part B covers the everyday healthcare services that help you stay well and manage ongoing conditions This includes:


  • Doctor visits and outpatient care
  • Preventive screenings (like mammograms, colonoscopies, and flu shots)
  • Durable medical equipment (DME), such as walkers, wheelchairs, and oxygen
  • Some types of home health care
     

Unlike Part A, Part B always has a monthly premium, and most people will need to enroll in it unless they have other qualified coverage (like through a job).


Once you’ve met the annual deductible, Medicare generally pays 80% of approved services, and you’re responsible for the rest.

 That’s where supplemental coverage like Medigap comes in.

Part C — Medicare Advantage Plans

Part C — Medicare Advantage Plans

Part C — Medicare Advantage Plans

Part C, also known as Medicare Advantage, is an all-in-one alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare.

What’s included in Medicare Advantage?


  • Everything that Original Medicare covers 
  • Many plans include prescription drug coverage 
  • Often include extras like visi

Part C, also known as Medicare Advantage, is an all-in-one alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare.

What’s included in Medicare Advantage?


  • Everything that Original Medicare covers 
  • Many plans include prescription drug coverage 
  • Often include extras like vision, dental, hearing, and fitness benefits 
  • Built-in limits on out-of-pocket costs (which Original Medicare doesn’t have)
     

But there are trade-offs:


  • You’ll usually need to see in-network providers 
  • You may need referrals to see specialists
  • Coverage varies by plan and location, so it’s important to compare
     

If you're looking for convenience and bundled benefits, Advantage plans are worth a look—but they’re not for everyone.

 That’s what we’ll explore together in your review.

Part D — Prescription Drug Coverage

Part D — Prescription Drug Coverage

Part D — Prescription Drug Coverage

 Original Medicare (Parts A & B) doesn’t cover most prescription drugs, so Part D was created to fill that gap. These plans are:


  • Offered through private insurers
  • Each plan has its own formulary (list of covered medications)
  • You’ll typically pay a monthly premium, plus possible copays/deductibles
     

Even if you’re not taking prescriptions today

 Original Medicare (Parts A & B) doesn’t cover most prescription drugs, so Part D was created to fill that gap. These plans are:


  • Offered through private insurers
  • Each plan has its own formulary (list of covered medications)
  • You’ll typically pay a monthly premium, plus possible copays/deductibles
     

Even if you’re not taking prescriptions today, enrolling when you're first eligible can help avoid future penalties. And you can always change plans during the Annual Enrollment Period if your needs change.

Medigap — Supplemental Insurance

Part D — Prescription Drug Coverage

Part D — Prescription Drug Coverage

 Medigap is optional coverage designed to help with the “gaps” left by Original Medicare (like copayments, deductibles, and coinsurance).

Medigap plans are:


  • Sold by private insurance companies
  • Only available if you’re enrolled in Original Medicare (A & B)
  • Not allowed with Medicare Advantage plans
     

With Medigap, you can see any provider who ac

 Medigap is optional coverage designed to help with the “gaps” left by Original Medicare (like copayments, deductibles, and coinsurance).

Medigap plans are:


  • Sold by private insurance companies
  • Only available if you’re enrolled in Original Medicare (A & B)
  • Not allowed with Medicare Advantage plans
     

With Medigap, you can see any provider who accepts Medicare, and it gives you predictable costs—especially helpful if you want nationwide flexibility and fewer surprises.

Medicare Can Be Confusing—Let’s Clear It Up Together.

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