Description of Medicare
Medicare is a federal health insurance program in the United States for people age 65 and older, certain younger people with disabilities, and individuals with End-Stage Renal Disease (ESRD). Medicare helps Americans pay for health care services, including hospital stays, doctor visits, preventive care, and some medical equipment, regardless of income or health status.
Medicare is divided into four main parts:
Part A – Original Medicare: Covers inpatient hospital care, skilled nursing facility care, hospice, physical therapy and some home health services.
Part B – Original Medicare: Covers doctor visits, outpatient care, preventive services, X-rays, lab tests, emergency room visits, mental healthcare, durable medical equipment, and some home health services.
Part C (Medicare Advantage) – Private insurance plans that provide all Part A and B services, often including Part D drug coverage, dental, and vision, sometimes with different rules and costs than Original Medicare.
Part D (Prescription Drug Coverage) – Helps cover the cost of prescription medications, available as a stand-alone plan or included in Medicare Advantage plans.
Medicare enrollment periods:
Medicare enrollment occurs during specific periods: Initial Enrollment, Special Enrollment, and the Annual Enrollment Period, each with distinct rules and timing. Timely enrollment is crucial to avoid coverage gaps and penalties.
Initial Enrollment Period (IEP)
The Initial Enrollment Period is a seven-month window around your 65th birthday. It begins three months before your birthday month, includes the month of your birthday, and ends three months after. If your birthday falls on the first of the month, the period starts one month earlier. Enrolling during this period ensures your Part A (hospital insurance) and Part B (medical insurance) coverage starts promptly, avoiding gaps and late penalties. If you are already receiving Social Security benefits, you may be automatically enrolled.
Special Enrollment Period (SEP)
A Special Enrollment Period allows you to sign up for Medicare outside the standard windows if you experience certain life events. Common qualifying events include losing employer coverage, moving to a new area, or qualifying for Medicaid. For example, if you continue working past 65 and have employer health insurance, you can delay enrollment without penalty and use an SEP when that coverage ends. Typically, the SEP lasts eight months after your employment or coverage ends.
Annual Enrollment Period (AEP)
Also called the Open Enrollment Period, the AEP occurs October 15 to December 7 annually. During this time, current Medicare beneficiaries can review and change their Medicare Advantage (Part C) or Part D prescription drug plans. Any changes made during AEP take effect on January 1 of the following year. This period is not for initial enrollment but for adjusting existing coverage.
Medicare does not cover all health care expenses; so many people purchase supplemental insurance or Medigap policies to fill gaps. Medicare Supplement Plans work WITH Original Medicare and cover most of the out-of-pocket costs that Original Medicare does not cover such as deductibles, copayments and coinsurance. You will have a monthly premium for the Medicare Supplement but with very little, if any, other healthcare costs. You will also need a Part D drug plan since the supplement does not cover prescription drugs.
Medicare Advantage Plans (Part C) are an “all-in-one” alternative to Original Medicare. They are offered by private insurance companies approved by Medicare. They take over the administration of your Medicare and usually include drug coverage, dental, vision, and over-the-counter benefits. Many plans are offered at a $0 premium, but you will pay deductibles, copayments and coinsurance for healthcare costs.
Medicare Supplement
- Works WITH Original Medicare
- See any doctor that accepts Medicare
- Predictable costs
- Monthly premium
- Need separate Part D drug plan
- Best for those who want flexibility, predictable costs, and nationwide provider access
Medicare Advantage
- Replaces Original Medicare
- Usually includes drug coverage
- May include dental, vision, and extra benefits
- Low or $0 monthly premium
- Network restrictions (HMO/PPO)
- Best for those who want low monthly premium, extra benefits, and are comfortable using network providers with potential copayments and coinsurance
Disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-Medicare for more information. We are not affiliated with or endorsed by the US government or federal Medicare program. This is a solicitation for insurance.