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Understanding Medicare
Everything below is what we'd tell you on the phone. Read it first if you like — then call and we'll apply it to your doctors, your prescriptions, and your zip code.
The building blocks
Medicare comes in four parts.
A and B are Original Medicare, run by the government. C and D come from private companies.
Hospital
Inpatient stays, skilled nursing, hospice, some home health. Most people pay no premium because they paid in while working.
Medical
Doctor visits, outpatient care, lab work, equipment, preventive care. Everyone pays a monthly premium for this one.
Advantage
A private plan that bundles A and B, usually with drugs and extras. It replaces how you receive your benefits.
Prescriptions
Drug coverage. Bought separately alongside Original Medicare, or built into most Advantage plans.
The gap nobody mentions
A and B alone leave a hole.
Original Medicare pays roughly 80% of approved costs for Part B services. The remaining 20% has no annual cap — which is the whole reason the other options exist.
- Part A deductibleCharged per benefit period, not per year. A second hospital stay later in the year can mean paying it twice.
- Part B premiumMonthly, usually deducted from Social Security. Higher earners pay a surcharge called IRMAA.
- The 20% coinsuranceNo yearly maximum on Original Medicare by itself. This is the hole a Medigap plan or an Advantage plan is meant to close.
The whole board
Your two real paths — including what's wrong with each.
Most agents show only the side they sell. Both are right for some people and wrong for others.
Path A
Original Medicare + Medigap + a drug plan
Medicare pays first. A supplement covers most of what's left. A separate plan covers prescriptions.
Better if
- You want any doctor in the country who takes Medicare — no networks, no referrals.
- You travel, or you'd rather pay a steady premium than face surprise bills.
- You have a condition that means frequent specialist care.
Harder if
- The monthly premium is a stretch — you pay it whether you see a doctor or not.
- You want dental, vision, and hearing bundled in. Those are separate here.
- You wait past your six-month window and later have to answer health questions.
Part B premium + a Medigap premium that rises with age + a small drug premium.
Path B
A Medicare Advantage plan
A private company runs your Medicare benefits in one bundled plan, usually with drugs and extras included.
Better if
- You want a low or $0 monthly premium beyond Part B.
- Your doctors are in the network and you stay close to home.
- Extras matter — dental, vision, hearing, fitness, over-the-counter allowances.
Harder if
- You get sick. You pay copays as you go, up to a yearly maximum.
- Your doctor leaves the network, or care needs the plan's approval first.
- You spend part of the year in another state.
Part B premium, often little or nothing more monthly, then copays when you use care.
Sometimes the answer is neither.
Still working with good coverage? VA or TRICARE? We'll tell you to change nothing — even though we earn nothing.
Prescriptions
Part D is where people lose the most money.
Every plan covers a different list of drugs at different tiers, and the lists change each January. The cheapest premium is often the most expensive plan once your actual prescriptions are priced out. Bring us your bottles and we'll run the real numbers.
- If you skip itA late penalty is added to your premium permanently — 1% of the national base premium for every month you went without creditable coverage.
- If you have Path AYou buy a standalone Part D plan alongside your supplement.
- If you have Path BDrug coverage is usually built into the Advantage plan already.
Timing
The windows that matter.
Missing one of these is the single most expensive mistake in Medicare, and the penalties usually last for life.
- Turning 65Seven months total: the three months before your birthday month, that month, and the three after.
- Medigap open enrollmentSix months from the day Part B starts. No health questions in most states. This one does not come back.
- October 15 – December 7Annual enrollment. Change Advantage or drug plans for the coming year.
- January 1 – March 31Advantage open enrollment. One switch, if you're already on an Advantage plan.
- Life changesMoving, losing employer coverage, or qualifying for assistance can open a special window any time of year.
What happens next
Three steps. No paperwork until you've decided.
We talk it through
About twenty minutes. Your doctors, your prescriptions, how you like to use care. We explain how Medicare works — no jargon, no rush.
You see every option in writing
A plain side-by-side of the plans available where you live, with real numbers, and whether your doctors and drugs are covered. Yours to keep.
You choose — and we stay
We handle the paperwork the same day. Then we're your first call for billing questions, denied claims, and a free review each fall.
Straight answers
Questions we get every day
What does this cost me?
Nothing. The advice, the comparison, the enrollment, and the years of help afterward are free. Your premium doesn't change by a penny because you used us.
Are you part of Medicare or the government?
No. We're an independent licensed agency, not connected with or endorsed by the U.S. government or the federal Medicare program. You can always go to Medicare.gov or call 1-800-MEDICARE.
Do you show me every plan that exists?
Honestly, no agency can — anyone who claims otherwise is stretching it. We show you everything we can offer where you live, including the plans we earn less on. If the right plan isn't one of ours, we'll point you to Medicare.gov.
Will I get sales calls afterward?
No. We don't sell, rent, or share your information. You'll hear from your advisor and no one else.
What if I have a problem with a claim later?
Call us before you call the insurance company. Sorting out billing errors and denied claims is part of what we do, for as long as you have the plan, at no charge.
Now let's apply all of that to you.
Your doctors, your prescriptions, your zip code. Twenty minutes on the phone and you'll know where you stand.