Home / Medicare
Medicare, explained once and properly.
There is a lot of mail, a lot of television advertising, and a short window in which some of these decisions are easy to reverse. This part does not have to be confusing.
A local broker, not a call center.
The advertising you are seeing is largely national. It is bought by organizations with no particular knowledge of which doctors and hospital groups in San Diego County take which plan, which is the detail that decides whether a plan is any good for you specifically.
There is no charge for this. Brokers are paid by the carrier, and the premium is the same whether you enroll with help or on your own.
The four parts, in one page.
Part A, hospital
- Inpatient hospital stays, skilled nursing facility care, hospice and some home health care. Most people have paid for this through payroll taxes and owe no monthly premium for it.
Part B, medical
- Doctor visits, outpatient care, preventive services, lab work and durable medical equipment. This one carries a monthly premium, and it is the part most affected by enrolling late.
Part C, Medicare Advantage
- A private plan that delivers your Part A and Part B benefits, usually with prescription cover and extras bundled in, through a defined network. This is where the network question matters most.
Part D, prescriptions
- Drug coverage, either standalone alongside Original Medicare or built into an Advantage plan. The right one depends entirely on the medications you actually take.
Medicare Supplement, also called Medigap, is a separate product that sits alongside Original Medicare and pays some of what Medicare does not. It cannot be combined with an Advantage plan, and the two routes are worth comparing before you commit to either.
The windows that matter.
Missing one of these is the single most expensive Medicare mistake, because some of the penalties are permanent rather than one time.
- Initial Enrollment Period. Seven months in total: the three months before the month you turn 65, your birthday month, and the three months after. Enrolling in the first three is what avoids a gap in cover.
- Annual Enrollment Period, October 15 to December 7. The yearly window to change Advantage or Part D plans, with changes effective January 1. Plans change their drug lists and networks every year, so a plan that fitted last year may not this year.
- Medicare Advantage Open Enrollment, January 1 to March 31. A second chance, if you are already in an Advantage plan, to switch to another or return to Original Medicare.
- Special Enrollment Periods. Triggered by qualifying events, most commonly losing employer coverage, moving out of a plan's service area, or a change in Medicaid eligibility.
Late enrollment penalties for Part B and Part D are generally calculated for every month you could have had coverage and did not, and in most cases they stay attached to your premium for as long as you have that coverage. That is why the timing conversation is worth having before your birthday rather than after it.
For the full official rules, and for every plan available in your area rather than only the ones any single broker offers, go to Medicare.gov or call 1-800-MEDICARE.
Still working at 65?
This is the question worth asking early, and it is the one where having a broker who also does group benefits actually changes the answer. If you are covered by a qualifying employer plan you may be able to delay Part B without a penalty, and pick it up later through a Special Enrollment Period.
Whether you should is a different question. It depends on how large the employer is, what the group plan costs you and your spouse, and what the coverage looks like next to Medicare. Because Strategy Matters places the group plans as well, both sides of that comparison can be looked at honestly rather than from one direction only.
If you run the company and your employees are hitting 65, that same question is on your desk too. Group benefits.
Bring your medications and your doctors.
A list of what you take and who you see is enough to have a real conversation about which route fits. There is no charge, and no obligation to enroll in anything.