Medicare
Medicare 101
Four letters, two paths, and a handful of dates that matter. Here is the whole map on one page.
The four parts
Parts A and B are Original Medicare, run by the federal government. Parts C and D are sold by private insurance companies under contract with Medicare.
| Part | What it covers | What it costs |
|---|---|---|
| Part A | Inpatient hospital stays, skilled nursing facility care, hospice, some home health care. | Usually no premium if you or a spouse paid Medicare taxes for at least 10 years. A deductible applies to each benefit period. |
| Part B | Doctor visits, outpatient care, lab work, durable medical equipment, preventive services. | A monthly premium set each year, plus an annual deductible and generally 20% of the Medicare‑approved amount. Higher incomes pay more. |
| Part C | Medicare Advantage. A private plan that replaces how you receive Parts A and B, often bundling drug coverage and extras. | You keep paying the Part B premium. The plan may add its own premium, and it sets its own copays and out‑of‑pocket maximum. |
| Part D | Prescription drugs, through a standalone plan or built into a Medicare Advantage plan. | A monthly premium, a possible deductible, and copays that depend on each drug’s tier. Higher incomes pay a surcharge. |
Two paths, and you pick one
Almost everyone ends up on one of these two routes. Neither is universally better — they fail in different directions.
Original Medicare plus a supplement
Parts A and B, a Medicare Supplement policy to cover most of the cost sharing, and a standalone Part D drug plan. Any provider in the country who accepts Medicare, no referrals, no network. You pay more in monthly premium in exchange for very predictable costs.
Medicare Advantage
A private plan that takes over your Part A and B benefits, usually with drug coverage included. Lower or no plan premium, but you use a network and pay copays as you go, up to an annual out‑of‑pocket maximum. Extra benefits may be available.
The dates that matter
Miss a window and you may wait a year, pay a penalty, or have to answer health questions.
Initial Enrollment Period
Seven months around your 65th birthday — the three months before, your birthday month, and the three months after. Enrolling before your birthday month is what keeps coverage from starting late.
Medicare Supplement open enrollment
Six months starting when you are 65 and enrolled in Part B. During this window a supplement company cannot turn you down or charge you more for your health history. Outside it, in most states, they can.
Annual Enrollment Period — October 15 to December 7
Change your Medicare Advantage or Part D plan for the coming year. This is the window where reviewing matters, because plans change their networks, formularies, and copays every January.
Medicare Advantage Open Enrollment — January 1 to March 31
If you are already in a Medicare Advantage plan, you get one change during this window, including a switch back to Original Medicare.
Special Enrollment Periods
Moving, losing employer coverage, qualifying for Extra Help, and certain other life events can open a window outside the normal calendar. Call us and we will check whether one applies to you.
Common questions
Do I have to take Part B at 65 if I am still working?
Not necessarily. If you have coverage through active employment at a large enough employer, you may be able to delay Part B without penalty. The rules depend on employer size and whether the coverage is creditable, so this is worth a phone call rather than a guess.
Does Medicare cover long‑term care?
No. Medicare covers limited skilled nursing care after a qualifying hospital stay. Ongoing custodial care — help with daily living — is not a Medicare benefit.
What does Medicare not cover?
Routine dental, routine vision and eyewear, hearing aids, and most care outside the United States are not covered by Original Medicare. Some Medicare Advantage plans may include benefits in these areas, and standalone dental and vision plans are another route.
Can I have a Medicare Advantage plan and a Medicare Supplement at the same time?
No. A supplement only works alongside Original Medicare. Choosing one path means leaving the other.
Not sure which path fits?
That is the conversation we have every day. Fifteen minutes on the phone usually settles it.
By calling this number, you will be connected with a licensed insurance agent who can answer questions about the plans we offer. There is no cost or obligation to talk.