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Medicare

Medicare, without the mailers

You are going to receive a lot of envelopes. This page is the version underneath all of that: what the parts are, what the two real choices are, and which dates you cannot get back once they pass.

Would you rather just talk to a person? That is usually faster than reading, and it costs nothing.

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Annual EnrollmentOctober 15 to December 7

Plans change every year, even when you do not. Drug lists, networks, and premiums all reset in January. A short review in the fall is the cheapest insurance there is.

Schedule a review

The building blocks

What the four parts actually do

Medicare is not one product. It is four pieces, and your choice is really about how you assemble them.

Hospital insurance

Part A

Inpatient hospital stays, skilled nursing after a qualifying stay, hospice, and some home health care.

  • Usually no premium if you or a spouse paid Medicare taxes for ten years
  • Has a deductible per benefit period
  • Most people are enrolled automatically at 65 if drawing Social Security

Medical insurance

Part B

Doctor visits, outpatient care, lab work, preventive services, and durable medical equipment.

  • Monthly premium set by the government, not by an insurer
  • Higher earners pay a surcharge based on income from two years prior
  • You generally must have Part B before anything else can be added

Medicare Advantage

Part C

A private plan that takes the place of Original Medicare and usually folds in drug coverage.

  • Offered by insurance companies, approved by Medicare
  • Built around networks and service areas
  • Benefits and costs are reset by the plan each January

Prescription drugs

Part D

Coverage for medications, either as a standalone plan or built into an Advantage plan.

  • Standalone plans pair with Original Medicare
  • Every plan has its own list of covered drugs
  • Going without creditable coverage builds a penalty

The real decision

Two roads, and you pick one

Nearly every Medicare conversation comes down to this fork. Neither road is better in the abstract. They are better or worse for a specific person with specific doctors, specific prescriptions, and a specific tolerance for paperwork.

Road one

Original Medicare with a Supplement and Part D

You keep Parts A and B, add a Medicare Supplement to cover most of what Medicare does not, and add a standalone drug plan.

  • Any provider in the country who accepts Medicare
  • No networks, no referrals, no prior authorization for most care
  • Very predictable out of pocket costs once it is in place
  • Travels with you, which matters if you split the year
The trade
  • You pay the Part B premium plus a Supplement premium plus a drug plan
  • Routine dental, vision, and hearing are not bundled in
  • After your one time window, a Supplement can require underwriting

Road two

Medicare Advantage

A private plan takes over your Part A and Part B coverage, usually includes drugs, and often adds extras.

  • Frequently little or no premium beyond Part B
  • Drug coverage and extra benefits are often built in
  • One plan, one card, one company to call
  • An annual cap on what you can spend out of pocket
The trade
  • Care runs through a network and a service area
  • Referrals and prior authorization apply to some services
  • Costs arrive as you use care rather than as a level premium
  • Moving back to a Supplement later may require underwriting

Deadlines

The dates you cannot get back

Most of Medicare can be corrected later. These windows cannot, and two of them carry penalties that follow you permanently.

Turning 65Initial Enrollment Period
Seven months long. The three months before your birth month, your birth month, and the three months after. Enrolling in the first three months gets coverage started on the first day of your birthday month. Waiting until the back half delays it.
One chance onlyMedigap Open Enrollment
A single six month window that opens when you are 65 or older and your Part B begins. During it, any Medicare Supplement sold in your area must accept you regardless of health history. Once it closes, insurers can review your health and decline you or charge more.
Every fallAnnual Enrollment Period
October 15 through December 7. This is when you change Advantage plans, change or add Part D, or move between Original Medicare and Advantage. Changes take effect January 1.
Early in the yearMedicare Advantage Open Enrollment
January 1 through March 31, and only if you are already in an Advantage plan. You can move to a different Advantage plan or return to Original Medicare.
Leaving a jobSpecial Enrollment Period
If you kept working past 65 with employer coverage, you generally have eight months after that employment or coverage ends to take Part B without a penalty. COBRA does not count as employer coverage for this purpose, and that catches people every year.
If you missed itGeneral Enrollment Period
January 1 through March 31 for people who missed their Initial Enrollment Period and have no qualifying Special Enrollment Period. Coverage begins July 1, and a late penalty usually applies.
If you read one thing on this page, read this

The six month Medigap window happens once. It opens when you are 65 or older and your Part B begins, and during it a Supplement carrier cannot turn you down or charge you more because of your health. After it closes, in most states they can do both.

That single fact sits underneath the biggest decision you make at 65, because choosing Medicare Advantage now and switching to a Supplement later is not guaranteed to be available to you. Nobody puts that on a mailer.

What goes wrong

Four mistakes we see every year

None of these come from carelessness. Every one is a reasonable assumption that happens to be wrong.

Timing Treating COBRA like employer coverage

This is the most expensive misunderstanding in Medicare, and it is an entirely reasonable one. You leave a job at 66, elect COBRA, and assume you are covered and can deal with Medicare when COBRA runs out.

COBRA does not count as active employer coverage for the Part B Special Enrollment Period. The eight month clock started when your employment ended, not when COBRA ends. People discover this after the window has closed, and by then the only route is the General Enrollment Period with coverage starting July 1 and a penalty attached.

What to do: before electing COBRA at 65 or older, find out how it interacts with your Part B timing. One phone call.

Health Letting the Medigap window close

The six month Medigap window is the only period in your life when a Supplement carrier must take you regardless of health. Miss it and every future application is subject to medical underwriting in most states.

This matters most for someone who chooses Medicare Advantage at 65 and later wants to move to Original Medicare with a Supplement. That door is open now and may not be open in five years, because by then a diagnosis can stand between you and the plan you want.

What to do: understand at 65 that this is a one time decision with a long shadow. A minority of states add extra guaranteed issue rights each year, and we will tell you whether yours is one of them.

Drugs Skipping Part D because you take nothing

It feels obviously correct. You take no prescriptions, so why pay for drug coverage.

The penalty accrues for every month you go without creditable coverage after your Initial Enrollment Period, and once it attaches it stays on your premium for as long as you have Part D. Someone who skips it for six years and then needs a medication pays that surcharge for the rest of their life.

What to do: price the least expensive plan available to you and treat it as insurance against the penalty, not against your current pharmacy bill.

Autopilot Assuming this year's plan is next year's plan

Your plan renews automatically, so nothing appears to need attention. Meanwhile the plan itself changed. Drug lists get revised, doctors leave networks, copays move, and the premium adjusts.

The plan that fit you best in 2024 may not be a reasonable fit now, and nobody sends a letter saying so in plain language. The annual notice of change arrives in September and mostly goes in the recycling.

What to do: a short review each fall with your current prescriptions and doctors in hand. Most years it confirms you are fine. The years it does not are the ones that pay for the habit.

No cost for this

Bring your doctors and your prescriptions

A useful Medicare review takes about half an hour and needs two things: the doctors you want to keep and the medications you actually take. Everything else follows from those.

We will compare what is available to you, tell you plainly where each option would pinch, and say so if the plan you already have is the right one. That happens often, and it is a fine result.

Schedule a Medicare review