Medicare 101

Part A — Hospital Insurance

Most people pay $0 premium (if you paid Medicare taxes for 10+ years)

Part A covers inpatient care when you're admitted to a hospital, skilled nursing facility care (up to 100 days after a qualifying hospital stay), hospice care for the terminally ill, and some home health care services.

Part B — Medical Insurance

Part B covers two types of services: medically necessary services (services or supplies needed to diagnose or treat your medical condition) and preventive services (healthcare to prevent illness or detect it at an early stage).

Part D — Prescription Drug Coverage

Premiums vary by plan — typically $7 to $100+/month

Part D plans help cover the cost of prescription drugs, including many recommended shots and vaccines. These plans are offered by private insurance companies approved by Medicare. Each plan has its own list of covered drugs (called a formulary) and its own network of pharmacies.

Medigap (Medicare Supplement)

Helps cover out-of-pocket costs from Original Medicare

Part C (Medicare Advantage)

An alternative to Original Medicare

3 Months Before

Your Initial Enrollment Period begins. Sign up for Part A and Part B through Social Security (www.ssa.gov/medicare or your local office).

2 Months Before

Get educated with a professional designated broker that has the highest credentials in the industry and has access to a wide array of plans. Get properly educated and only afterwards, review supplemental options between Medigap and Medicare Advantage plans. Review Part D prescription drug plans.

1 Month Before

Work with your certified Medicare planner and enroll in proper coverage. Coordinate with your HR department if you are currently employed.

Your Birthday Month

Your Medicare coverage begins on the first day of your birthday month (or the month before if born on the 1st).

3 Months After

Your Initial Enrollment Period ends. After this, you may face penalties or limited enrollment options.

Mistake #1: Missing your Initial Enrollment Period

Late enrollment penalties can increase your Part B premium by 10% for each 12-month period you were eligible but didn't enroll. This penalty lasts for life. Working with a certified professional planner ensures you never miss these critical deadlines and avoid costly lifelong penalties.

Mistake #2: Assuming Medicare covers everything

Original Medicare (Parts A & B) only covers about 80% of approved costs. Without supplemental coverage, you're responsible for the remaining 20% — which has no annual cap. A certified professional planner can help you find the right supplemental coverage to protect your savings from unexpected medical bills.

Mistake #3: Not reviewing your plan annually

Plans change every year. Benefits, copays, and drug formularies can shift significantly from one year to the next. We strongly stress the importance of seeing a certified professional planner such as ourselves because just reviewing things on paper is not enough. We know the inside scoop of which plans are having network contraction, which plans are having more prior authorization headaches, and which plans have customer service issues.

Mistake #4: Choosing a plan based on premium alone

A $0 premium plan sounds great until you need care and face high copays and deductibles. Look at total out-of-pocket costs, not just the monthly premium. A certified professional planner helps you calculate the true potential cost of a plan based on your specific health needs, medications, and risk tolerance.

Mistake #5: Not checking if your doctors accept the plan

Medicare Advantage plans use networks. If you see an out-of-network provider, you may pay full price for the visit. Seeing a certified professional planner such as ourselves gives you insight because we know which plans are probably going to drop doctors mid-year and which plans are potentially in contract negotiations. The government does not provide a special election period if a doctor is dropped mid-year.