Medicare 101

Everything You Need to Know About Medicare

Plain-language explanations with no confusing terminology. We promise.

The Basics

The Parts of Medicare Explained

Medicare is divided into parts — each covering different types of care.

Hospital Insurance

Covers inpatient stays, skilled nursing, hospice, and home health.

✓ Hospital stays
✓ Skilled nursing facility
✓ Hospice care
✓ Home health care

Medical Insurance

Covers doctor visits, outpatient care, preventive services and equipment.

✓ Doctor visits
✓ Outpatient services
✓ Preventive screenings
✓ Medical equipment

Medicare Advantage

Private plans combining Parts A & B, often with dental and vision extras.

✓ All Part A & B benefits
✓ Dental & vision options
✓ Drug coverage
✓ Fixed out-of-pocket max

Prescription Drug

Standalone drug coverage that works alongside Original Medicare.

✓ Brand-name drugs
✓ Generic medications
✓ Specialty drugs
✓ Vaccines

Timing Matters

Key Enrollment Periods

Missing a window can mean coverage gaps or lifetime penalty fees.

Turning 65

Initial Enrollment Period

A 7-month window around your 65th birthday — 3 months before, the month of, and 3 months after.

Every Fall

Annual Open Enrollment

October 15 – December 7 each year. Switch plans or adjust drug coverage for the coming year.

Special Situations

Special Enrollment Period

Triggered by life events like losing employer coverage, moving, or qualifying for Extra Help.

Jan 1 – Mar 31

Medicare Advantage OEP

Switch once to another MA plan or return to Original Medicare during this window.

Common Questions

Frequently Asked Questions

The questions we hear most from people just like you.

Sign up during your Initial Enrollment Period — starting 3 months before the month you turn 65. If you still have employer coverage, you may delay without penalty. Call us before you turn 64 and we'll map out the best timing for your situation.

Medicare Supplement (Medigap) works alongside Original Medicare, covering costs it doesn't — like deductibles and coinsurance. Medicare Advantage replaces Original Medicare with a private plan that typically has lower premiums but uses a provider network. The right choice depends on your health, budget, and lifestyle.

Original Medicare generally does not cover routine dental, vision, or hearing. Many Medicare Advantage plans (Part C) include these benefits. We'll help you find the right combination for your needs.

Part A is usually free if you paid Medicare taxes for 10+ years. Part B has a standard monthly premium. Medicare Advantage plans can have $0 premiums with copays. Medicare Supplement has higher premiums but more predictable costs. We'll walk you through all the numbers before you commit.

With Original Medicare and a Supplement plan, you can see any doctor who accepts Medicare — no referrals needed. With Medicare Advantage, you'll typically use a provider network. Before recommending any plan, we always verify your doctors are in-network.

Yes — completely free to you. Agents are compensated by insurance carriers, not clients. You pay the same plan price whether you enroll through an agent or on your own — so there's no reason not to use our help.

Key Terms

Medicare Glossary

Common terms decoded into plain English.

Premium

Your monthly payment to have Medicare coverage, even when you don't use healthcare.

Deductible

The amount you pay out-of-pocket before your insurance starts sharing costs.

Copay

A fixed dollar amount you pay for a service — like $20 per doctor visit.

Coinsurance

Your percentage share of costs after meeting your deductible, typically 20%.

Out-of-Pocket Maximum

The most you'll pay in a year — after that, your plan covers 100%.

Formulary

A plan's approved list of covered medications.

Medigap

Another name for Medicare Supplement — fills the gaps Original Medicare leaves.

Network

Doctors and hospitals that have agreed to accept a particular plan's rates.

IRMAA

Income-Related Monthly Adjustment Amount — higher earners pay more for Parts B and D.

Still have questions? We're here.

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