What are my Medicare Options?

Part A - Original Medicare

  • Medicare Part A is your hospital insurance. It helps cover inpatient care when you're admitted to a hospital, skilled nursing facility care (after a qualifying hospital stay), hospice care, and some home health services.

    • Inpatient hospital stays

    • Skilled nursing facility care (after a 3-day qualifying hospital stay)

    • Hospice and palliative care

    • Some home health visits

  • Most people don't pay a monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters).

Part B - Original Medicare

  • Medicare Part B is your medical insurance. It covers outpatient services — the care you receive without being admitted to a hospital.

    • Doctor visits and specialist appointments

    • Preventive screenings and annual wellness visits

    • Lab tests, X-rays, and imaging

    • Durable medical equipment (wheelchairs, walkers, etc.)

    • Outpatient mental health services

    • Some home health and ambulance services

  • Part B has a standard monthly premium (adjusted based on income) plus an annual deductible. After the deductible, Medicare typically covers 80% of approved costs — you pay the remaining 20%.

Part C - Medicare Advantage

  • Medicare Advantage — also called Part C — is an all-in-one alternative to Original Medicare. These plans are offered by Medicare-approved private insurance companies and bundle Part A and Part B coverage together, often with additional benefits.

    • Includes all Part A and Part B benefits

    • Often includes prescription drug coverage (Part D)

    • May offer extras like dental, vision, and hearing coverage

    • Typically uses a network of doctors and providers (HMO or PPO)

    • May have lower out-of-pocket costs depending on the plan

  • You must still pay your Part B premium even with a Medicare Advantage plan. Some plans have $0 additional premiums on top of that.

Part D - Prescription drug coverage

  • Medicare Part D helps cover the cost of prescription medications. You can get Part D coverage either as a standalone plan (paired with Original Medicare) or it may be included in a Medicare Advantage plan.

    • Covers a wide range of brand-name and generic drugs

    • Each plan has its own formulary (list of covered drugs)

    • Costs vary by plan, drug tier, and pharmacy used

    • Available through Medicare-approved private insurers

  • If you don't sign up for Part D when you're first eligible and don't have other creditable drug coverage, you may pay a permanent late enrollment penalty added to your monthly premium.

Supplemental Coverage

  • Medigap (also called Medicare Supplement) policies are sold by private insurers to help cover the gaps in Original Medicare — things like copayments, coinsurance, and deductibles that you'd otherwise pay out of pocket.

    • Works alongside Original Medicare (Parts A & B), not Medicare Advantage

    • Helps with copays, coinsurance, and deductibles

    • May cover care when traveling outside the U.S.

    • Standardized plans (Plan G, Plan N, etc.) offer predictable benefits

  • Original Medicare generally does not cover routine dental, vision, or hearing care. However, there are ways to get these benefits:

    • MediGap open enrollment runs for 6 months from the 1st day of the month of your 65th birthday. 

    • Medicare Advantage plans often include dental, vision, and hearing as part of their benefit package

    • Standalone dental/vision/hearing plans are available from private insurers

    • Coverage and benefit limits vary significantly by plan and location

    * These benefits can make a big difference in your overall health and quality of life — it's worth comparing plans that include them.

Enrollment Information

  • There are several enrollment windows to be aware of:

    • Initial Enrollment Period (IEP): A 7-month window starting 3 months before the month you turn 65

    • General Enrollment Period (GEP): January 1 – March 31 each year, for those who missed their IEP

    • Annual Enrollment Period (AEP): October 15 – December 7, to switch or change Medicare Advantage or Part D plans

    • Special Enrollment Periods (SEP): Available if you have qualifying life events, like losing employer coverage

    Tip: Missing your enrollment window can result in permanent late penalties on your premium. It's important to enroll on time or understand your exceptions.

  • Medicare is available to certain groups of people, regardless of income:

    • U.S. citizens or permanent legal residents aged 65 or older

    • People under 65 with certain disabilities who have received Social Security Disability Insurance (SSDI) for 24 months

    • People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease), at any age.

    Not sure if you qualify? Our team can help you check your eligibility and explore your options at no cost to you.

Not sure which option is right for you?

CONTACT US!