Are you approaching retirement age or dealing with a qualifying disability? Getting a grip on the complex world of healthcare coverage can be daunting, but if you meet certain criteria, you may be eligible for the Medicare health insurance program. Let’s delve into the details and explore the different parts of Medicare to help you make informed decisions about your healthcare needs.

Who is Eligible for Medicare?

You may be eligible for Medicare if you meet any of the following criteria:

  • You are 65 years or older.
  • You are younger than 65 but have a qualifying disability.
  • You have End-Stage Renal Disease, regardless of age.


Understanding the Parts of Medicare

Medicare is divided into four parts, labeled A, B, C, and D, each covering specific healthcare services:

Medicare Part A: Hospital Insurance
  • Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. No monthly premium for most beneficiaries if they or their spouse have worked and paid Medicare taxes for at least 40 quarters (about 10 years).
  • Depending on how long you are an inpatient, there are deductibles and coinsurance.
  • Doesn’t cover custodial or longterm care if that’s the only type needed.


Medicare Part B: Medical Insurance
  • Covers outpatient care, physician services, and certain home health services.
  • Covers some things that Part A doesn’t, including occupational, physical, and speech therapy, as well as certain home healthcare services.
  • Requires a monthly premium, annual deductible, and coinsurance/copayments. Part B pays 80% of the final approved cost. You’re responsible for the balance after covering your annual deductible.
  • Provides coverage for services that are considered “medically necessary.” The healthcare provider must accept Medicare assignment.


Medicare Part C: Medicare Advantage
  • Offered by private insurance companies to eligible beneficiaries as an alternative to Original Medicare (Part A and Part B).
  • Provides the same coverage as Parts A and B, often with additional benefits like prescription drug coverage, dental, vision, and hearing care.
  • Requires adherence to the plan’s network of healthcare providers in many instances.


Medicare Part D: Prescription Drug Coverage
  • Stand-alone plans available through private insurance companies or bundled with Medicare Advantage plans. 
  • Covers prescription drugs with varying coverage allowances, limits, and costs. 
  • Plans may have monthly premiums, deductibles, and copayments.


Choosing the Right Coverage

Let’s look at the basic differences between the Parts…

Original Medicare (Parts A and B)

offers flexibility in choosing healthcare providers. It requires supplemental coverage (Medigap) for additional benefits and cost-sharing.

Medicare Advantage (Part C)

bundles coverage under one plan with potentially lower out-of-pocket costs. It provides additional benefits beyond Original Medicare, but may have restrictions on healthcare providers.

Prescription Drug Coverage (Part D)

is essential for those requiring regular medications. It offers varying levels of coverage and costs depending on the plan.


Navigating the complexities of Medicare can seem like a daunting task, but understanding the different parts of the program is crucial in selecting the right coverage for your healthcare needs. Whether you opt for Original Medicare or choose a Medicare Advantage plan, weighing the benefits, costs, and restrictions can help you make an informed decision. Take the time to compare Medicare options available in your area to ensure you receive the coverage that best suits your needs and budget. Your health and well-being deserve nothing less.

Making the decision of when and how to file for Medicare can be one of the most confusing and stressful choices retirees have to face. And rising healthcare expenses could have a major impact on how fast you are going through your retirement savings. There’s a lot you’ll need to know, and you may have questions to ask your financial advisor. Here are 3 of the most commonly asked questions about Medicare and some information that will help you be prepared.



You can sign up for Medicare during a seven-month window, called your initial enrollment period, which includes the three months before the month you turn 65, your birthday month and the full three months following your birthday month.It’s a little known fact that even if you are not planning on receiving your monthly SS benefits at age 65, you still need to SIGN UP FOR MEDICARE B as you turn 65 if you want this coverage without paying a penalty. 

Many people are confused as to whether or not they should sign up for Part B at the same time as Part A. Naturally, most folks don’t want to end up paying premiums for Part B if they don’t need the coverage. But timing Part B enrollment is a bit trickier and late enrollment can cause a permanent premium increase. If you DON’T sign up for Medicare Part B (medical insurance) when you’re first eligible, your coverage may not start right away & you may have to pay a late enrollment penalty for as long as you have Medicare Part B.

One important thing you should think about is if you are covered under a group health plan based on current employment or not. If you don’t have employer group coverage, then you should apply during your seven-month initial enrollment period.

If you are covered under a group health plan – whether your own employer or your spouse’s – you could qualify for a special enrollment period (often abbreviated as SEP). The eight-month SEP starts the month after the end of either employment or the group health insurance coverage based on that employment – whichever happens first. It is crucial that you keep in mind that COBRA coverage does not qualify as employer coverage.

There are other things you should consider as well. For example, sometimes smaller employers require Part B coverage to be integrated with their existing insurance plans, though larger employers may not. You can always talk to your human resources department or insurance specialist to know whether Part B coverage is necessary.




Medicare has four parts: A, B, C, and D… each with different costs. This simplified breakdown below will give you a better sense of what each part entails.

Part A is hospital insurance, including in-patient care, skilled home care and hospice services.

A majority of seniors who paid taxes into Medicare during their working years do not have to pay premiums for Part A coverage.

Part B is medical insurance, including doctor visits, lab tests and some medical equipment.

Most people paid the standard monthly amount of $109 for Part B insurance in 2017. The cost may be higher for people with higher reported incomes.

Part C is known as Medicare “Advantage.” These are health insurance plans offered by private companies that are approved and regulated by Medicare.

With an Advantage plan, you get complete Part A and Part B coverage, and you have the same rights and protections of original Medicare. Advantage plans usually charge higher monthly premiums because they offer additional services and broader coverage. For instance, Medicare does not cover routine dental care, hearing aids or vision care, and many Advantage plans do. And, most Advantage plans offer prescription drug coverage as part of their main plan, so you don’t have to buy this coverage separately.

Part D is for prescription drug plans (PDPs).

PDPs provide insurance coverage for your prescription drug therapies, and most plans are structured with premiums, deductibles and cost-sharing guidelines. Many PDPs classify their list of covered drugs into “tiers” each priced differently. In general, drugs in lower tiers, such as generic drugs, cost less than those in higher tiers, such as brand-name drugs. Drug lists and costs can vary greatly from plan to plan, so it’s imperative to find out if your prescription drugs are covered and how much they cost when you choose a PDP.



Regardless of whether or not you think you’re enrolled in the right plan, you should be reviewing your Medicare plan regularly to ensure you’re getting the right coverage at the right price. You could find that you are indeed enrolled for your desired Medicare plan, but what if you enrolled in the wrong plan? Not to worry, you can always change your Medicare coverage. You can actually revise your Medicare plan once a year during open enrollment, a set period when you can review your health and prescription drug plans and change them if you want to. Medicare open enrollment typically takes place from Oct. 15 to Dec. 7, and any changes you elect to make will take effect on Jan. 1 of the following year.

To find out how you can make the most of your Medicare benefits, talk with your advisor about your health care needs in retirement today.


We’re dedicated to helping you make the right choice about your Medicare plan.
Through Complete Medicare Services, our advisors can give you a 1-on-1 consultation to review your needs.
There is never a fee for this consultation!

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