Medicare is federal health insurance mainly for:

• People age 65+

• People under 65 with certain disabilities

• People with End-Stage Renal Disease (ESRD) or certain other conditions (special rules)

Medicare isn’t one “single plan.” It’s a set of parts (A, B, C, D) plus optional supplemental coverage.

Think of Medicare like building blocks:

• Part A (Hospital): inpatient hospital stays, skilled nursing facility (limited), hospice, some home health.

• Part B (Medical): doctor visits, outpatient care, preventive services, durable medical equipment.

• Part C (Medicare Advantage): private plans that replace Original Medicare for A & B, and usually include drug coverage.

• Part D (Prescription drugs): outpatient prescription coverage (private plans).

Original Medicare = Part A + Part B (government-run)
You can add:

• A Part D drug plan

• A Medigap (supplement) plan to reduce your costs

Medicare Advantage (Part C) = private plan alternative that includes Part A & B coverage and often Part D, with plan rules like networks and prior authorization.

Simple way to explain it:

• Original Medicare = more freedom to choose providers (generally)

• Medicare Advantage = more structure (networks + rules), often extra benefits

Most people should consider both, but it depends on whether you’re still working and have credible employer coverage.

• Part A is often premium-free if you have enough work credits.

• Part B has a monthly premium for most people.

You generally need Part A and Part B before you can:

• Join a Medicare Advantage plan, or

• Buy a Medigap plan

Most people enroll during their Initial Enrollment Period (IEP):

• A 7-month window: starts 3 months before your 65th birthday month and ends 3 months after

If you miss it, you may have to use a different enrollment period and could face penalties (depending on your situation).

Delaying Part B can be fine if you have qualifying employer coverage (usually through active employment).

If you delay without qualifying coverage, you may face:

• Late enrollment penalties, and/or

• Gaps in coverage

As your broker, my job is to confirm what coverage you have now, and whether it protects you from penalties.

If you missed your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Part B during the General Enrollment Period: January 1 – March 31.

Coverage start timing depends on when you enroll, so planning matters.

A Special Enrollment Period lets you enroll or change coverage after certain life events—like losing employer coverage, moving, or other qualifying situations.

SEPs are extremely important because they often help you avoid penalties and avoid waiting until the next open enrollment.

Medigap (Medicare Supplement Insurance) helps pay the “gaps” in Original Medicare (like coinsurance, copays, and deductibles depending on plan type).

Medigap is usually best for people who want:

• Predictable medical costs

• Freedom to see providers who accept Medicare (generally)

• Less “plan rules” than Medicare Advantage

Your Medigap Open Enrollment Period is the most important window:

• It lasts 6 months, starting when you are 65+ and your Part B starts

During this time, you can generally buy any Medigap plan sold in your state even if you have health conditions.

Outside this window, you may face medical underwriting (depending on state rules and situation).

Medigap plans are standardized by letter in most states (A, B, C, D, F, G, K, L, M, N).

Plan G is Plan G in terms of benefits—no matter which company sells it.
The main difference is price and company factors (rate history, customer service, etc.).

Generally, no—Medigap is designed to work with Original Medicare, not Medicare Advantage.

If you choose Medicare Advantage, you typically don’t use Medigap to pay plan cost-sharing.

Part D covers outpatient prescription drugs through private plans.

Even if you don’t take medications now, many people consider Part D because:

• Medications can change suddenly

• There can be late enrollment penalties if you go without creditable drug coverage and enroll later

Every Part D plan (and many Medicare Advantage plans) has a formulary (covered drug list).

As your broker, we check:

• Is your drug on the formulary?

• What tier is it (cost level)?

• Are there restrictions (prior auth, step therapy, quantity limits)?

• Which pharmacies are preferred (lower cost)?

This step alone can save clients hundreds to thousands per year.

Often, yes.

Many Medicare Advantage plans require you to use in-network providers (except emergencies), and rules vary by plan type.

This is why we always do a provider check (your doctors + hospitals) before enrolling.

Prior authorization means the plan requires approval before covering certain services, procedures, or equipment.

• Original Medicare: usually less prior authorization

• Medicare Advantage: may require prior authorization for certain services

Practical impact: It can affect how quickly you get non-urgent services approved.

Medicare Advantage plans generally have a yearly limit on what you pay out of pocket for covered Part A and Part B services (limits vary by plan).

Original Medicare does not have a built-in out-of-pocket maximum, which is why many people add Medigap.

Original Medicare generally does not cover routine dental/vision/hearing the way employer plans do.

Many Medicare Advantage plans offer extra benefits like dental, vision, hearing, fitness, etc., but coverage details and limits vary by plan.

Often:

• Original Medicare + Medigap can be better for frequent travelers because it’s typically easier to use care across states (as long as providers accept Medicare).

• Some Medicare Advantage plans may be more restrictive due to networks (except emergencies).

We’d base this decision on where you live, how often you travel, and your preferred providers.

There isn’t one best plan for everyone. The best plan depends on:

• Your doctors/hospitals (provider access)

• Your prescriptions (formulary + pharmacy costs)

• Your budget (premium vs out-of-pocket tradeoff)

• Your health situation (predictability vs flexibility)

• Your travel habits

• Whether you want extra benefits (dental/vision)