Medicare
Medicare, explained in plain language
The parts, the plan types, the timing and the costs, walked through at your pace by an independent licensed broker. Learn how it fits together first; decide later.
Getting started
A few facts make the rest easier
Medicare is the federal health insurance program for people 65 and older and for some younger people with qualifying conditions. It arrives in parts, each covering a different kind of care, and private plans can be added to or wrapped around the government pieces.
For most people the first window to sign up opens three months before the month they turn 65 and closes three months after it. Understanding the parts and the plan types before that window opens is what turns a stressful decision into a clear one.
The building blocks
The four parts of Medicare
Parts A and B come from the federal government. Parts C and D are offered by private insurance companies that contract with Medicare.
Part A
Hospital insurance
Helps cover inpatient hospital stays, care in a skilled nursing facility after a hospital stay, hospice care and some home health care.
Part B
Medical insurance
Helps cover doctor visits, outpatient care, preventive services, lab tests, durable medical equipment and many other services outside the hospital.
Part C
Medicare Advantage
Plans from private companies approved by Medicare that bundle Part A and Part B, usually with prescription drug coverage. They have provider networks and their own cost-sharing rules.
Part D
Prescription drug coverage
Helps pay for outpatient prescription drugs. Offered through private plans, either as a stand-alone plan alongside Original Medicare or built into a Medicare Advantage plan.
Two ways to put it together
Most people end up on one of two paths
Neither path is right for everyone. The one that fits depends on the doctors you want to keep, how you prefer to pay for care, where you live and how often you travel.
Original Medicare plus a Medicare Supplement
Parts A and B, a Medigap policy and a Part D plan
You keep Original Medicare and add a Medicare Supplement (Medigap) policy to help with the share of costs Medicare leaves to you, plus a separate Part D plan for prescriptions.
- See any provider in the country who accepts Medicare
- Costs are more predictable; the monthly premium covers more up front
- Prescription coverage is a separate plan
A Medicare Advantage plan
Part C, usually with Part D included
A private plan takes the place of Original Medicare for your care. Most include prescription drug coverage and some include extra benefits, within a network of providers and a plan-specific set of rules.
- One plan and one card for most of your care
- Provider networks and referral rules vary by plan
- Copays and coinsurance apply as you use care, up to a yearly limit
Medicare Supplement (Medigap) policies are sold by private insurance companies. They are not Medicare and are not endorsed by Medicare.
A plain-language review of your Medicare options, with no obligation
Bring your questions, your doctors' names and your prescription list. We go through what each path would mean for you and leave the decision where it belongs: with you.
Eligibility
Who is eligible for Medicare?
Medicare is available to people 65 and older who are U.S. citizens or permanent residents of at least five continuous years. Most people qualify for Part A without a premium if they or a spouse paid Medicare taxes long enough while working.
Some people qualify before 65. We never ask about your health; if one of these situations applies to you, the rules below are the ones we would walk through together.
Before 65, Medicare generally becomes available to people who:
- Have received Social Security disability benefits for 24 months
- Have end-stage renal disease, under rules specific to that diagnosis
- Have ALS, with Medicare starting the same month disability benefits begin
Timing
Medicare enrollment periods
Medicare uses set windows for signing up and for changing coverage. These are the published windows for most people; your situation may add others.
Initial Enrollment Period
A seven-month window around your 65th birthday: the three months before the month you turn 65, that month, and the three months after. This is when most people sign up for Parts A and B and choose how to add Part D or a Medicare Advantage plan.
Annual Enrollment Period
October 15 to December 7
Each fall you can join, switch or drop a Medicare Advantage plan or a Part D plan. Changes made in this window take effect on January 1. Plans mail their yearly change notices beforehand; bring yours.
Medicare Advantage Open Enrollment Period
January 1 to March 31
If you are already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan once, or return to Original Medicare and add a Part D plan.
General Enrollment Period
January 1 to March 31
For people who did not sign up for Part A or Part B when first eligible and do not qualify for a Special Enrollment Period. Coverage begins the month after you enroll, and a late-enrollment penalty may apply.
Special Enrollment Periods
Certain life events open a window outside the usual dates: losing employer coverage, moving out of a plan's service area, or a change in a plan's contract, among others. The length of the window depends on the event.
Medicare Supplement Open Enrollment
A six-month period that begins the month you are 65 or older and enrolled in Part B. During it, companies must sell you any Medigap policy they offer regardless of health history. Some states add further protections.
How we help
Five steps, at your pace
Step 1: Reach out
Call or send a message and tell us what you'd like to understand better.
Step 2: You talk, we listen
You describe where you are today, what worries you and what you hope to achieve.
Step 3: We explain
We walk through the options that apply to you, in everyday language, trade-offs included.
Step 4: You choose
With the facts in front of you, the decision is yours to make on your own timeline.
Step 5: We stay with you
Choosing coverage isn't the end. We remain available for questions, reviews and changes down the road.
Common questions
Medicare questions we hear most
Do I have to sign up for Medicare at 65 if I am still working?
Not always. Many people with coverage through a current employer (their own or a spouse's) can delay Part B without a penalty and get a Special Enrollment Period later. The rules depend on the size of the employer and the type of coverage, so this is worth checking before your Initial Enrollment Period closes.
What is the difference between Medicare Advantage and a Medicare Supplement?
A Medicare Advantage plan replaces how your Part A and Part B care is delivered and usually bundles prescription coverage, within a network. A Medicare Supplement (Medigap) policy works alongside Original Medicare to help pay the share of costs Medicare leaves to you, and you keep access to any provider who accepts Medicare. They cannot be combined.
Does Medicare cover prescription drugs?
Original Medicare covers very few outpatient prescriptions. Prescription coverage comes through Part D, either as a stand-alone plan or built into a Medicare Advantage plan. Going without creditable drug coverage for an extended period can lead to a late-enrollment penalty later.
Can I change my mind later?
Yes, within the published windows. The Annual Enrollment Period each fall and the Medicare Advantage Open Enrollment Period each winter allow changes, and certain life events open Special Enrollment Periods. Changing from a Medicare Advantage plan to a Medigap policy later may involve health questions, which is one reason the first choice deserves a careful look.
What does a conversation with Robert cost?
Nothing. Independent brokers are paid by the insurance companies whose plans they place, and the premium you pay is the same whether or not a broker helps you. We represent a number of organizations and plans; the footer of this site lists how many, and Medicare.gov lists every option in your area.
We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Not affiliated with or endorsed by the government or federal Medicare Program
Medicare Supplement (Medigap) policies are sold by private insurance companies. They are not Medicare and are not endorsed by Medicare.
Calls about Medicare Advantage or Part D plans are recorded, as required by the Centers for Medicare & Medicaid Services.
Information on this site is general education, not personalized insurance, legal, tax or investment advice. Plan availability, premiums and benefits are set by insurers and Medicare and change each year.
Ready to talk it through?
A conversation with Robert starts with your questions, not a sales pitch. Call, send a message, or answer a few quick questions to find the right starting point.