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New to Medicare
If Medicare is new to you, read this page top to bottom. It's the same ground we'd cover on the phone, in the same order.
Start here
What Medicare actually is
Medicare is federal health insurance for people 65 and older, and for some younger people with disabilities. It is not free, it does not cover everything, and it does not enroll you automatically unless you are already drawing Social Security.
The one sentence that matters: once you have Parts A and B, you choose one of two ways to fill the gaps they leave — a supplement plus a drug plan, or a Medicare Advantage plan. Everything else is detail.
The building blocks
Medicare comes in four parts
A and B are Original Medicare, run by the government. C and D come from private insurance companies.
Hospital
Inpatient stays, skilled nursing after a qualifying hospital stay, hospice, some home health. Most people pay no premium because they paid in while working.
Medical
Doctor visits, outpatient care, lab work, durable equipment, preventive care. Everyone pays a monthly premium for this one.
Advantage
A private plan that bundles A and B together, usually with drug coverage and extras. It changes how you receive your benefits, not whether you have them.
Prescriptions
Drug coverage. Bought as a standalone plan alongside Original Medicare, or built into most Advantage plans.
Eligibility
Who qualifies, and when
- At 65You qualify if you're a U.S. citizen or have been a lawful permanent resident for at least five continuous years.
- Premium-free Part AYours if you or your spouse worked and paid Medicare taxes for about ten years — 40 quarters. Fewer quarters means you can still buy Part A.
- Under 65 with a disabilityYou qualify after 24 months of Social Security Disability benefits.
- ALSCoverage begins the month disability benefits begin — no 24-month wait.
- End-stage renal diseaseSpecial rules apply and the timing depends on dialysis or transplant. Worth a phone call rather than a guess.
Timing
Every window, and what it's for
Missing one of these is the most expensive mistake in Medicare, and the penalties usually last the rest of your life.
- Initial enrollmentSeven months around your 65th birthday: the three months before your birthday month, that month, and the three after.
- General enrollmentJanuary 1 – March 31, for people who missed their initial window. Coverage starts the month after you sign up, and a penalty may apply.
- Medigap open enrollmentSix months from the day your Part B starts. No health questions in most states. This one does not come back.
- Annual enrollmentOctober 15 – December 7. Change Advantage or drug plans for the coming year.
- Advantage open enrollmentJanuary 1 – March 31. One switch, if you're already on an Advantage plan.
- Special enrollmentMoving, losing employer coverage, or qualifying for assistance can open a window any time of year.
Money
What Medicare costs you
Part A is usually premium-free. Everything after that has a price, and a few of them are means-tested.
- Part B premiumMonthly, usually deducted from your Social Security payment. The standard amount changes every January.
- DeductiblesPart B has an annual deductible. Part A's is charged per benefit period rather than per year — a second hospital stay later in the same year can mean paying it twice.
- The 20% coinsuranceOriginal Medicare pays roughly 80% of approved Part B costs. The remaining 20% has no annual cap, which is the entire reason supplements and Advantage plans exist.
- IRMAAHigher earners pay a surcharge on Parts B and D, based on the tax return from two years ago.
Still working
Medicare and employer coverage
This is where good people lose real money, and the rule is not intuitive.
- 20 or more employeesYour group plan usually pays first, and you can generally delay Part B without penalty while you're actively working.
- Fewer than 20 employeesMedicare usually pays first. Delaying Part B can leave you with large uncovered bills. Ask your benefits administrator, in writing.
- COBRA and retiree plansThese do not let you delay Part B without penalty. A common and costly misunderstanding.
- Health savings accountsYou must stop contributing before Medicare starts. Part A can be backdated up to six months, so contributions in that window can trigger a tax penalty.
Before you decide anything: call us. Often the answer is "keep exactly what you have," and we'll tell you that even though there's nothing in it for us.
Signing up
How to actually enroll
If you already get Social Security
You're enrolled in Parts A and B automatically, and your card arrives about three months before your 65th birthday. Watch the mail.
If you're not yet drawing benefits
You apply through Social Security — online at ssa.gov, by phone, or at a local office. Start about three months before you want coverage to begin.
Then comes the real decision
Parts A and B alone leave a hole. Choosing how to fill it is the part we help with, and it should happen before your coverage starts, not after.
Now let's apply this to you.
Your doctors, your prescriptions, your zip code. Twenty minutes on the phone and you'll know where you stand.