Medicare Plans
Let us empower you to make informed decisions about your healthcare options. Whether you’re new to Medicare or need supplemental plans, our expert team is here to assist you every step of the way. We thoroughly research available plans in your area, narrowing your options to two or three tailored selections that fit your needs.
As your dedicated advocates, we’re committed to answering all your questions and helping you understand the intricacies of Medicare plans, various carriers, claims processes, and Social Security integration. Let us guide you to the best Medicare solutions that support your health and financial well-being.
What is Medicare?
Medicare is a federal health insurance program designed for Americans 65 and older. It assists eligible individuals by covering medical expenses and ensuring access to vital healthcare services.
Over the years, Medicare has evolved into one of the most significant healthcare programs in the USA, serving millions of beneficiaries and delivering essential medical coverage when it matters most.
Parts of Medicare
Medicare consists of several parts, each addressing different healthcare needs:
- Part A: Hospital insurance from Original Medicare.
- Part B: Medical insurance from Original Medicare.
- Part C: Medicare Advantage plans that provide an alternative way to receive Medicare benefits through private insurers.
- Part D: Prescription drug coverage, available as a standalone plan or through Medicare Advantage.
Eligibility
Medicare eligibility begins at age 65. Individuals under 65 may qualify if they’ve received Social Security Disability Insurance for 24 months or were diagnosed with End-Stage Renal Disease, which provides immediate eligibility.
Enrollment
To enroll in Medicare, you can either auto-enroll or self-enroll:
- Automatic Enrollment – If you receive Social Security benefits at age 65, you’ll be automatically enrolled in Parts A and B. You will receive your Medicare card about three months before your birthday, detailing your coverage options.
- Self-Enrollment – The Initial Enrollment Period (IEP) allows for a seven-month sign-up window if you’re not automatically enrolled. This includes three months before your birthday month and three months after turning 65. You can enroll in Original Medicare and consider supplemental coverage like Medicare Advantage or Medigap.
Original Medicare
Original Medicare consists of Part A and Part B but has financial gaps that can lead to significant out-of-pocket expenses, including deductibles, copayments, coinsurance, and excess charges. Fortunately, there are options available to help cover these costs.
Cost and Coverage
Part A
Most beneficiaries don’t pay a premium for Medicare Part A if they or their spouse have paid Medicare taxes for at least 40 quarters (10 years). However, it does include a deductible and coinsurance for hospital stays. In 2025, the Part A deductible is $1,676 per benefit period, with coinsurance applying for hospital stays exceeding 60 days.
Medicare Part A provides extensive coverage for inpatient care, including:
- Inpatient hospital stays (covers semi-private rooms, meals, nursing care, and medications).
- Skilled nursing facility care following a qualifying hospital stay.
- Hospice care for terminal illnesses.
- Some home health care services.
Part B
Medicare Part B has more direct costs. The standard monthly premium for 2025 is $185, with higher-income beneficiaries paying more due to the Income-Related Monthly Adjustment Amounts (IRMAA). Additionally, there’s an annual deductible of $257, after which beneficiaries typically pay 20% of the approved amount for covered services.
Medicare Part B focuses on outpatient and preventive services, covering:
- Regular doctor visits and routine check-ups.
- Preventive services like flu shots and cancer screenings, often at no cost.
- Medically necessary services and supplies include durable medical equipment (wheelchairs, walkers).
- Medications administered by a healthcare provider, while most prescriptions fall under Part D.
Medicare Advantage
Medicare Advantage plans, or Part C, are an alternative way to receive Medicare benefits through private insurance companies approved by Medicare. These plans provide all the coverage of Original Medicare while often including additional benefits such as dental, vision, hearing, and prescription drug coverage.
Many Medicare Advantage plans also offer wellness perks like fitness programs and transportation to medical appointments, enhancing the benefits unavailable through Original Medicare.
Medicare Supplement
Medicare Supplement Insurance, or Medigap, is designed to fill the financial gaps in Original Medicare coverage. These private plans help cover out-of-pocket costs like copayments, coinsurance, and deductibles. Medigap plans are standardized in most states and are labeled A through N, offering various levels of coverage to meet different needs and budgets.
