Medicare is a federal health insurance program primarily for people age 65 and older. It also covers certain younger people with disabilities and people with End-Stage Renal Disease.

• Available to U.S. citizens or permanent residents who have lived in the U.S. for at least 5 years
• Most people qualify at age 65
• Younger people may qualify with certain disabilities after 24 months of Social Security disability benefits
• Medicare is NOT the same as Medicaid — Medicaid is based on income

Missing your enrollment window can result in permanent premium penalties. Understanding when to sign up is one of the most important Medicare decisions you’ll make.

• Initial Enrollment Period (IEP): 7-month window around your 65th birthday
• General Enrollment Period (GEP): January 1 – March 31 each year
• Special Enrollment Period (SEP): If you have qualifying life events
• Annual Enrollment Period (AEP): October 15 – December 7 to change plans

Original Medicare has two parts. Part A covers hospital stays and Part B covers doctor visits and outpatient care. Together they form the foundation of Medicare coverage.

• Part A: Hospital stays, skilled nursing, hospice, some home health care
• Part B: Doctor visits, outpatient care, preventive services, medical equipment
• Most people get Part A premium-free if they worked 10+ years
• Part B has a monthly premium (around $174/month in 2024)

Medicare Advantage plans are offered by private insurers approved by Medicare. They must cover everything Original Medicare covers, and often include extra benefits.

• Often includes dental, vision, and hearing coverage
• May include prescription drug coverage (Part D)
• Usually requires using a network of doctors
• May have lower out-of-pocket costs than Original Medicare

Part D helps cover the cost of prescription drugs. Plans are offered by private insurers and vary in which drugs they cover and what they cost.

• Each plan has a formulary (list of covered drugs)
• Plans have different tiers that affect your cost
• You can compare plans at Medicare.gov
• Late enrollment penalty applies if you go without coverage

Medigap policies help pay costs that Original Medicare doesn’t cover — like copayments, coinsurance, and deductibles. These are sold by private insurance companies.

• Standardized plans labeled A through N
• Works alongside Original Medicare (not Advantage)
• Best time to enroll: during your 6-month Medigap Open Enrollment Period
• Helps make healthcare costs more predictable

Understanding Medicare costs helps you budget and avoid surprises. Here are the key terms you need to know.

• Premium: Monthly amount you pay for coverage
• Deductible: Amount you pay before Medicare starts covering costs
• Copayment: Fixed amount you pay for each service
• Coinsurance: Your percentage share of costs after deductible
• Out-of-pocket maximum: The most you’ll pay in a year (Advantage plans)

With Original Medicare you can see any doctor who accepts Medicare. With Advantage plans, you may need to use a network of providers.

• Original Medicare: no referrals needed, see any Medicare-accepting provider
• HMO Advantage plans: require referrals and use a network
• PPO Advantage plans: more flexibility but higher costs out-of-network
• Always confirm your doctor accepts your specific plan

Medicare covers many preventive services at no cost to you when you see a Medicare-participating provider.

• Annual Wellness Visit (free)
• Cancer screenings: mammograms, colonoscopies, lung cancer screening
• Cardiovascular screenings
• Diabetes screenings and self-management programs
• Flu, pneumonia, and COVID-19 vaccines

Original Medicare generally does not cover care outside the U.S. Understanding your travel coverage options is important if you travel frequently.

• Original Medicare: limited to U.S. care only
• Some Medigap plans cover emergency care abroad (up to plan limits)
• Some Medicare Advantage plans offer international emergency coverage
• Travel insurance may fill remaining gaps

If you’re helping a parent or spouse with Medicare decisions, you’re not alone. Here’s how to get started and what to watch for.

• Review their current coverage every year during AEP
• Check if their doctors are still in-network
• Look for Extra Help programs to reduce drug costs
• Consider setting up a Medicare account for easy access

Medicare penalties are permanent premium increases added to your monthly costs when you don’t enroll on time. Here’s how to avoid them.

• Part B penalty: 10% for each 12-month period you delayed
• Part D penalty: 1% of national base premium for each month without coverage
• Exception: if you had creditable employer coverage you may be exempt
• Always get documentation when leaving employer coverage

Comparing plans carefully can save you thousands of dollars per year. Here’s a simple process to follow.

• List your current doctors and medications
• Use Medicare.gov Plan Finder tool
• Compare total annual costs — not just premiums
• Check if your preferred pharmacy is in-network
• Review plan star ratings for quality

If you have limited income, there are programs that can reduce or eliminate your Medicare costs. Many people who qualify never apply.

• Medicare Savings Programs (MSP) can cover Part B premiums
• Extra Help (Low Income Subsidy) helps with drug costs
• Apply through your state Medicaid office
• Income and asset limits vary by state

A licensed agent can help you compare plans, understand your options, and enroll — all at no cost to you. Agents are compensated by the insurance companies, not by you.

• Good time to call: 3 months before turning 65
• Also helpful: when losing employer coverage
• During Annual Enrollment Period (Oct 15 – Dec 7)
• When you move to a new state or zip code