Medicare 101 Review

• Federal health insurance for people 65+ and some under 65 with disabilities.
• Part A: Hospital insurance (inpatient, skilled nursing, hospice, some home health).
• Part B: Medical insurance (doctor visits, ambulance, equipment).
• Not covered: vision, dental, hearing, long-term care, most prescriptions.

The federal government provides Part A and Part B, also known as Original Medicare. You must be enrolled in Original Medicare before you can sign up for additional coverage (Medicare Supplement, Part D, or Medicare Advantage).

Part A is hospital insurance. It helps cover:

• Inpatient hospital care
• Short-term skilled nursing facilities
• Hospice care
• Some home health care services
• Part A does not have a cost for most people
• Part A deductible is $1736.00 per hospital admit

The federal government provides Part A and Part B, also known as Original Medicare. You must be enrolled in Original Medicare before you can sign up for additional coverage (Medicare Supplement, Part D, or Medicare Advantage).

Part B is medical insurance. It helps cover:

• Doctor visits
• Tests and Labs
• Ambulance services
• Durable medical equipment
• The Part B deductible is $283.00/year
• The standard cost for Part B is $202.90/month but can be higher based on your income from 2 years ago. Click here to view current IRMA rates. 2026 IRMA
• Part B only covers 80% of the Medical costs with No Out of Pocket Max

Part A and Part B have monthly premiums, deductibles and coinsurance. Most people don’t pay the Part A premium thanks to the Medicare taxes they paid while working.

Everyone pays the Part B premium currently $202.90 per month. This amount changes yearly and varies based on income. 2026 IRMA

If you enroll late in Part B, you could have a penalty fee added. Plus, there is no limit on what you pay out of pocket with Original Medicare.

• While Original Medicare provides coverage for hospital and medical services, it doesn’t cover everything.
• In general, Original Medicare pays for only 80% of covered health care costs. It’s up to you to pay the remaining 20%. And it does not have an out of pocket maximum. Meaning you could pay 20% of a $500,000 medical bill.
• Plus, Original Medicare doesn’t cover most prescription drugs or other benefits such as vision, dental, hearing services, or long-term nursing and home health care.

• Many choose to buy additional insurance to help cover the 20%. Some choose a Medicare Supplement (Medigap) plan and/or a Part D prescription drug plan, while others choose a Medicare Advantage plan.
• Let’s take a closer look at additional coverage by starting with Medicare Supplement and Part D.

• Medicare Supplement (Medigap) work alongside Original Medicare. These plans are made available through private health insurance companies, although they are regulated by the government.
• They help pay most of the out-of-pocket costs that come with Original Medicare
• You pay a monthly premium for 100% coverage
• No provider networks
• Good in all 50 states
• International travel coverage
• Supplements are secondary payers behind Medicare
• Most plans cover 100% of the 20% you are expected to pay
• Plan G covers the Part A deductible, the 20% but not the Part B deductible which is $283.00 for the year.
• There are No Networks and they work in every state

• Part D prescription drug plans (PDPs) are stand-alone plans that help pay for medications you buy from a pharmacy or through a mail-order pharmacy service.
• PDPs have their own monthly premium, plus a yearly deductible, copays, and coinsurance.
• While Part D is technically optional coverage, if you sign up late for a PDP, you may face a permanent late enrollment penalty tacked on to your premium.
• If you decide to go the path of Original Medicare plus additional coverage, you should consider enrolling in Part D as soon as you’re eligible to avoid penalties.

• Health insurance companies set the prices for these types of coverage. Costs can be determined by things such as age, whether you use tobacco, and your location (ZIP Code). Medigap plans have monthly premiums (starting around $90.00 for a Plan N), but do increase each year.
• Your costs are predictable. With Plan G, you’ll only pay the annual Part B deductible (currently $283).
• There are 10 standardized Medigap plans available in most states. However, most new enrollees find their needs are met by either Plan G or Plan N. For further explanation click here.

• Health insurance companies provide Medicare Advantage plans that are regulated by the government. These plans are sometimes referred to as an “all-in-one” option. They combine Original Medicare services with benefits such as vision, dental, hearing, or prescription drug coverage.
• These plans don’t replace Part A and Part B. You still need to enroll in Original Medicare before you enroll in a Medicare Advantage plan. Advantage plans are Medicare replacement plans, meaning they replace your original Medicare Part A and B They are privatized Medicare. Meaning insurance companies pay the claims and do the claim management.
• Medicare Advantage comes in different flavors, but mostly are HMO plans using specific provider networks.

• Provide Part A and Part B benefits (hospital and medical insurance)
• Typically offer prescription drug coverage they also have a Max out of pocket that can range from $3200 to $7100 depending on the plan
• Have networks for provider and pharmacies
• Require you to have Original Medicare and live in service area*
• Feature out-of-pocket maximums, unlike Original Medicare

* You must keep paying your Part B monthly premium; a Medicare Advantage plan’s monthly premium doesn’t replace the Part B premium.

• Medicare Advantage plans are sometimes called Part C.
• Includes Part A & B benefits plus extras (vision, dental, hearing, drugs).
• Requires enrollment in Parts A & B first.
• Types: HMO (low cost, restricted) and PPO (flexible, higher cost).

• Supplement + Part D vs Medicare Advantage.
• Both help pay what Original Medicare doesn’t cover.
• Consider flexibility, costs, and coverage when choosing.

MEDICARE SUPP / PART D

• Separate monthly premiums for Medicare Supplement, Part D
• Limited out-of-pocket costs for hospital and medical care
• No network restrictions seeing a doctor or going to the hospital
• Extra benefits (dental, vision, hearing, etc.) purchased separately

These may be good for those who:

• Are comfortable paying higher monthly premiums in order to limit out-of-pocket spending on health care
• Want the freedom to access doctors/hospitals throughout the US
• Can afford to buy extra benefits separately
• Would appreciate the International Travel coverage

MEDICARE ADVANTAGE

• Premiums as low as $0
• A maximum out-of-pocket limit for hospital and medical care
• Network restrictions for seeing doctors or going to the hospital
• Prescription drug plan and extra benefits are often included

These may be good for those who:

• Want a lower monthly premium and are comfortable paying copays and deductibles for health care services
• Are comfortable seeking care within a defined provider network
• Want prescription drug coverage and extra benefits (dental, vision, hearing, etc.) included

• Supplement + Part D: Higher premiums, limited OOP costs, nationwide access.
• Medicare Advantage: Low or $0 premiums, OOP maximum, extra benefits included.
• For more information on the differences click here: Key Differences Between Medicare Advantage and Medigap

Let’s move on to another important topic: how (and when) you should sign up for Medicare.

• In general, people become eligible to sign up for Medicare 3 months before and 3 months after their 65th birthday month. As you near 65, you should ask yourself “Do I need Medicare coverage right now?”
• Some people have health insurance through an employer and want to continue that coverage. Others may be coming off their health insurance and need to switch to Medicare.
• If you plan to make Medicare your primary source of health insurance, you should enroll in Part A and Part B as soon as you become eligible and start considering the additional options we’ve covered.
• We recommend you contact our Support Services Team for assistance in enrolling in Part A and Part B
• If you already receive Social Security retirement benefits, you’re automatically enrolled in Part A and Part B when you turn 65.

• Eligibility: 3 months before and after your 65th birthday.
• Automatic enrollment if already on Social Security.
• If working, you may delay Part B with employer coverage.
• Enroll via Social Security (online, phone, or in person).

• Now that you’ve explored the basics, let’s talk.
• Professional advisors can answer your unique questions.
• Make sure your Medicare decision fits your health and budget needs.