The Medicare Annual Enrollment Period is Now Open

Medicare provides health insurance for people 65 and older, as well as some younger individuals with disabilities. It’s divided into several parts, each offering specific types of coverage to meet your medical needs.

Original Medicare (Part A & Part B): Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Together, they cover:

Medicare Part A – Hospital Coverage
Helps pay for:

• Inpatient hospital stays
• Skilled nursing facility (SNF) care (short-term)
• Nursing home care (non-custodial)
• Hospice care
• Limited home healthcare services
• Inpatient mental healthcare
• Inpatient rehabilitation

Medicare Part B (Medical Coverage)
Helps pay for:

• Doctor visits and outpatient care
• Preventive services (such as screenings and vaccines)
• Medically necessary treatments
• Medical equipment (e.g., wheelchairs, oxygen)
• Outpatient mental health services
• Limited outpatient prescription drugs
• Some telehealth services

Medicare Advantage (Part C): an all-in-one alternative to Original Medicare offered by private insurance companies. These plans must cover everything in Part A and Part B, and can include:

• Prescription drug coverage
• Dental, vision, and hearing care
• Fitness benefits
• Wellness programs
• Over-the-counter allowances

Medicare Part D (Prescription Drug Coverage): sold by private insurers to help cover the cost of prescription medications. You can add a Part D plan to Original Medicare or get one included in a Medicare Advantage plan.

Medicare Supplement (Medigap): helps cover the out-of-pocket costs that Original Medicare doesn’t pay, such as copayments, coinsurance, and deductibles. Some Medigap plans also cover emergency care when traveling outside the U.S.

⚡Need to Know: Original Medicare covers 80% of approved healthcare costs, and it does not cover most dental, vision, hearing services, or routine prescription drugs.

Most Americans become eligible for Medicare when they turn 65, but you may qualify earlier due to certain health conditions or disabilities.

• Standard Medicare Eligibility (Age 65+): You’re eligible to enroll in Medicare if you’re 65 or older and a U.S. citizen or legal resident who has lived in the United States for at least five years.
• Medicare Eligibility (Under Age 65): You may qualify for Medicare before age 65 if any of the following apply:
  • You’ve received disability benefits from Social Security or the Railroad Retirement Board for 24 consecutive months.
  • You have Amyotrophic Lateral Sclerosis (ALS) and are receiving disability benefits.
  • You have End-Stage Renal Disease (ESRD) and require dialysis or have had a kidney transplant.

📞 Call (855) 797-3060 to talk to a licensed insurance agent and get the exact plan you need!

Medicare enrollment happens during specific periods throughout the year. Your eligibility and personal circumstances determine when you can sign up.

💡Smart Strategy: Signing up during the Initial Enrollment Period (IEP) allows you to avoid delays in coverage and potential late enrollment fees.

Medicare isn’t completely free, but many people qualify for premium-free coverage, especially for Medicare Part A (hospital insurance).

• Medicare Part A (Usually Premium-Free): Most people don’t pay a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes for at least 10 years. However, Part A is not entirely free. You’re still responsible for deductibles and copayments.
• Medicare Part B (Monthly Premium Required): requires a monthly premium of about $185, but it may be higher based on your income.
• Medicare Advantage (Part C): sometimes advertised as having $0 premiums, but you will still have deductibles, copays, out-of-pocket costs for services and prescriptions, and potential network restrictions.

📢 Hard Truth: A $0-premium plan doesn’t mean $0 healthcare costs. Always compare plan details and total expected costs, not just the premium.

Medicare isn’t a one-size-fits-all program; each part comes with its own premiums, deductibles, copayments, and coinsurance. Here’s a breakdown of what you can expect to pay:

Medicare Part A (Hospital Insurance): Most people get Part A premium-free if they (or their spouse) worked and paid Medicare taxes for at least 10 years.

• Monthly premium:
  • $0 (if you meet the work requirement)
  • $285-$518 (if you don’t qualify for premium-free Part A)
• Deductible: $1,676 per benefit period
• Coinsurance:
  • Days 1-60: $0
  • Days 61-90: $408 per day
  • Days 91+: $816 per “lifetime reserve day”

Medicare Part B (Medical Insurance): Everyone pays a monthly premium.

• Monthly premium: Starts at $185 (may be higher based on income)
• Deductible: $257 per year
• Coinsurance: 20% of Medicare-approved services
• Excess charges: Up to 15% if a provider charges more than Medicare’s approved amount

Medicare Part C (Medicare Advantage): offered by private insurers and include Part A and B coverage, often with extra coverage like drug, dental, or vision.

• Part A and Part B costs
• A separate monthly premium (some plans offer $0 premiums)
  Annual deductibles (medical and/or drug-related)
• Copayments or coinsurance for doctor visits, specialists, and prescriptions

Medicare Part D (Drug Coverage): helps pay for the cost of prescription medications.

• A monthly premium (amount varies by plan)
• A yearly deductible (up to $590)
• Copayments or coinsurance per prescription, depending on the drug tier

Medicare Supplement (Medigap): helps pay for out-of-pocket costs not covered by Original Medicare (Parts A and B).

• A separate monthly premium, which varies based on your age, location, plan type, and insurer
• Medigap can reduce or eliminate costs like deductibles, coinsurance, and copayments

💸Boost Your Savings: Call (855) 797-3060 and talk to a licensed insurance agent to help you compare costs and find the plan that fits your health needs and budget.

You can switch your Medicare plan during specific enrollment periods throughout the year. The most common time to make changes is the Medicare Annual Enrollment Period (AEP).

📅 Medicare Annual Enrollment: October 15 through December 7

During this annual window, you can:

• Switch from Original Medicare to a Medicare Advantage plan (Part C)
• Switch from Medicare Advantage back to Original Medicare
• Change from one Medicare Advantage plan to another
• Join, drop, or switch a Part D prescription drug plan

Changes made during this period go into effect on January 1 of the following year.

🔄 Other Times You Are Allowed To Switch Medicare Plans Without Penalty

Depending on your situation, you may also qualify to switch plans during the following time periods:

• Medicare Advantage Open Enrollment: January 1 to March 31
  • If you’re already enrolled in a Medicare Advantage plan, you can:
    • Switch to a different Medicare Advantage plan
    • Drop your Advantage plan and return to Original Medicare
    • Join a Part D plan if you switch to Original Medicare

• Special Enrollment Periods (SEPs)
  • You may qualify for a Special Enrollment Period if you:
    • Move out of your plan’s service area
    • Lose other coverage (such as employer or Medicaid coverage)
    • Experience certain life events (e.g., move into or out of a nursing facility)

🗓️ Mark Your Calendar: Review your current plan each year during the annual enrollment period to ensure it still fits your healthcare and budget needs.

Medicare and Medicaid are both government-run health programs, but they have varying eligibility rules and serve different groups of people.

Medicare: Federal Program for People Aged 65 and Older

• Also for people under 65 with specific disabilities or health conditions (including end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).
• Administered uniformly across the United States.
• You may have to pay premiums, deductibles, and coinsurance depending on the coverage you choose.

Medicaid: State Program for People With Limited Income or Resources

• Provides free or low-cost health coverage
• For people with limited income and resources, including children, pregnant women, seniors, and people with disabilities.
• Each state sets its own eligibility rules and benefits.

📌 Important to Note: Some people qualify for both Medicare and Medicaid, which is known as “dual eligibility” and can help cover even more healthcare costs.

See the table below for more details:

*Some eligibility requirements will change starting Oct ‘26 due to the One Big Beautiful Bill Act (OBBBA). 

👍 Good to Know: If you qualify for both, Medicaid can help cover Medicare costs like premiums, copays, and prescription drugs.

The primary difference between Original Medicare and Medicare Advantage is how your benefits are delivered and what’s included in your coverage.

Original Medicare (Parts A & B)

• Provided by the federal government
• Includes Part A (hospital) and Part B (medical) coverage
• You can see any doctor or hospital in the U.S. that accepts Medicare
• You pay 20% coinsurance for most services after meeting your deductibles
• Prescription drugs are not included (you need to add a separate Part D plan)
• Optional: You can purchase a Medigap plan to help pay for out-of-pocket costs

Medicare Advantage (Part C)

• Offered by private insurance companies approved by Medicare
• Combines Part A and Part B, and usually includes Part D
• Often includes extra benefits like dental, vision, hearing, and fitness
• Requires using in-network providers (HMO or PPO plans) in most cases
• You pay copays or coinsurance, which vary by plan
• Has an annual out-of-pocket maximum (Original Medicare doesn’t)

See the table below for a helpful side-by-side comparison:

Compare your health needs, travel habits, and provider preferences to decide which Medicare plan is right for you.

😕 Feeling Overwhelmed? We are here to help! Just call (855) 797-3060, and a licensed insurance agent can help you understand your options and find the plan that’s best for you.

Medicare Advantage (Part C) and Medicare Supplement (Medigap) are both options that help cover the costs Original Medicare doesn’t, but they work in very different ways.

Medicare Advantage (Part C)

• An all-in-one plan offered by private insurance companies
• Replaces your Original Medicare coverage with a bundled plan
• Often includes extra benefits like prescription drugs, dental, vision, and hearing
• You typically pay copays and use provider networks (HMOs or PPOs)
• Must be enrolled in Medicare Parts A and B

Medicare Supplement (Medigap)

• A separate insurance policy that works with Original Medicare
• Helps cover costs such as deductibles, coinsurance, and copays
• Does not include prescription drug coverage; you’ll need a separate Part D plan
• Plans are standardized based on coverage level
• Covers any doctor or specialist nationwide who accepts Medigap

⚠️ Be Aware: You can’t have both Medicare Advantage and Medigap at the same time; you must choose one or the other.

Deciding Which is Right for You

• Choose Medicare Advantage if you want an all-in-one plan with extra benefits and don’t mind using a provider network.
• Choose Medigap if you want the freedom to see any doctor and limit your out-of-pocket costs as much as possible.

Since you can’t enroll in both at the same time, it’s important to compare plans based on your health needs, budget, and travel plans.

📞 Just dial (855) 797-3060 and get advice from a licensed insurance agent in minutes!

Original Medicare covers a limited selection of prescription drugs. To get comprehensive drug coverage under Medicare, you need to enroll in either Part C or Part D.

Original Medicare (limited drug coverage):

• Medicare Part A: covers medications during inpatient hospital stays or hospice care. It may also cover certain medications during home healthcare.
• Medicare Part B: covers specific outpatient drugs, like those administered at a doctor’s office or clinic (e.g., injections or infusions). It also covers many preventive vaccines, such as flu and shingles shots.

🚫 Original Medicare does not cover most prescription drugs you take at home.

Medicare Advantage Plans (Part C) with Drug Coverage: Many include built-in prescription drug coverage, called MAPD plans (short for Medicare Advantage Prescription Drug plans). Key details about Medicare Part C:

• Each plan has its own list of covered drugs and guidelines
• Your costs may be higher if you use out-of-network pharmacies
• HMOs and PPOs may have different rules and restrictions

Medicare Part D – Prescription Drug Plans: helps cover the cost of your everyday prescriptions. Part D Medicare plans are:

• Sold by private insurance companies
• Designed to work with Original Medicare
• Required to cover at least two drugs in each major category

Each plan has a list of covered drugs, organized into tiers based on cost and brand name. Your out-of-pocket costs will depend on the tier of your prescribed medication and whether your pharmacy is in-network.

📞 A licensed insurance agent will guide you through your Medicare options and ensure you get the coverage you need. Just call (855) 797-3060!