Medicare

Understanding Medicare

Medicare can be confusing, especially with all the parts, deadlines, and decisions involved. This page breaks it down in plain language, so you know what you're actually choosing between.

What is Medicare?

Medicare is federal health insurance for people 65 and older, and for some younger people with certain disabilities. It's made up of a few different parts, and how they fit together determines what's covered, what you pay, and which doctors you can see.

Most people don't find that out until they're already knee-deep in enrollment deadlines. We'd rather walk you through it before you have to guess. Understanding how they fit together is the first step to understanding your options.

The Parts

Part A covers care you receive as a hospital inpatient, like a hospital stay or time in a skilled nursing facility.

Part B covers outpatient care, like doctor visits, preventive screenings, and medical equipment you use at home.

Parts A and B together are called Original Medicare, the base coverage everyone starts with.

Part C, also called Medicare Advantage, is a different way to get your Medicare benefits. Instead of going through the government directly, you get them through a private insurance company, which often bundles in extra coverage like dental and vision.

Part D covers prescription drugs. It can be added on top of Original Medicare, or it can already be included in a Medicare Advantage plan.

Why is Part C so Confusing?

Since Part C already changes how you receive your benefits, this is usually where the real decision comes in. Most people end up choosing between two paths: staying on Original Medicare and adding a Medicare Supplement (also called Medigap) to help cover the gaps, or switching to a Medicare Advantage plan that combines everything into one private plan. Here's how they actually compare.

Medicare Supplements work alongside Original Medicare rather than replacing it. Instead of bundling in extra benefits, a supplement plan helps pay for the costs Original Medicare leaves you with, deductibles, copayments, and coinsurance. You keep the flexibility of seeing any doctor who accepts Medicare, nationwide, without needing referrals.

Neither one is "better." It depends on what matters more to you: lower monthly costs and bundled extras with Medicare Advantage, or broader doctor flexibility and more predictable costs with a Medicare Supplement.

Medicare Advantage replaces Original Medicare. You get your Part A and Part B benefits through a private insurance company instead, often with extras like dental, vision, or prescription drug coverage bundled in. These plans typically use a network of doctors and hospitals, similar to plans you may have had through an employer.

LEARN MORE ABOUT MEDICARE ADVANTAGE HERE

LEARN MORE ABOUT MEDICARE SUPPLEMENTS HERE

When Do I Sign Up?

Whichever path makes more sense for you, there's one thing that applies no matter what: timing matters. Missing the right window can mean delays in coverage or a permanent penalty added to your premium. Here's when you can actually enroll.

Initial Enrollment Period

Available if certain life events happen, most commonly losing coverage through an employer. This lets you enroll outside the usual windows without a penalty.

General Enrollment Period

Annual Enrollment Period

Special Enrollment Period

A 7-month window around your 65th birthday (3 months before, your birthday month, and 3 months after). This is when most people enroll for the first time.

January 1 - March 31 each year. If you missed your Initial Enrollment Period and don't qualify for a special exception, this is your next chance, though a late penalty may apply.

October 15 - December 7 each year. If you're already enrolled, this is when you can switch plans, such as changing from Original Medicare to Medicare Advantage, or adjusting your Part D coverage.

Do I have to pay anything?

Every situation is different, and the fastest way to know what your actual costs would look like is to talk it through with someone. If you'd like help mapping this out for your specific situation, we're happy to walk through it with you.

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Medicare isn't free, but understanding the basic cost categories makes the numbers much less intimidating.

Premium — the amount you pay, usually monthly, to keep your coverage active. Part A is often premium-free if you've worked and paid Medicare taxes long enough; Part B has a standard monthly premium.

Deductible — the amount you pay out of pocket before your coverage starts paying its share.

Coinsurance and copayments — your share of the cost after you've met your deductible, whether that's a percentage of the bill or a flat fee per visit.

Exactly how much you'll pay depends on which parts of Medicare you choose and which path you take, Original Medicare with a Supplement, or Medicare Advantage.

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