Home > Medicare
.png)
Medicare
Written By Bill O'Hara 6/20/2025
Key Points
-
Medicare is a federal health insurance program for those 65+ or with disability status
-
Medicare has 4 Parts - A, B, C and D which cover different health needs
-
Medicare enrollments happen around your Initial Enrollment Period, Annual Enrollment (Oct 15th-Dec 7th) or during Special Enrollment Periods triggered during life event
What is Medicare?
Medicare is a federal health insurance program for individuals that are 65 and older, have been on disability for more than 24 months, or have ESRD or ALS. Having Original Medicare is defined as having Part A, known as Hospital Coverage, and Part B, known as Medical Coverage. In total, Medicare has four standard parts: A, B, C, and D.
Medicare ABC's
Medicare Part A will cover hospital, skilled nursing, hospice, and home health care. It does not have a monthly premium for the vast majority of Medicare beneficiaries.
Medicare Part B helps covers medically necessary services like doctors, outpatient care, home health services, and more. Part B also covers some preventive services. Part B can be delayed to 65 if you have work insurance.
The standard monthly Part B premium in 2025 starts at $185 a month but can increase depending on your income.
Medicare Part C is known as Medicare Advantage. In its most basic form, Medicare Advantage is an equivalent to Medicare Parts A & B from Medicare-approved private insurance companies.
Medicare Advantage plans often offer coverage for things Original Medicare doesn’t cover such as prescriptions, vision, dental, gym memberships, and more.
Part D of Medicare is prescription drug coverage. It is offered to everyone with Medicare Parts A and/or B. This can be obtained by purchasing a stand-alone Prescription Drug Plan (PDP) alongside a Medicare Supplement Plan, or by enrolling in a Medicare Advantage plan with Prescription drug coverage (MAPD). You sign up for Part D through Medicare approved private insurance companies.
Medicare Supplements
Medicare Supplements or "Medigap" insurance is made to supplement or "fill the gaps" of Original Medicare (Parts A and B). Original Medicare on its own has high deductibles, copays and coinsurances. Medicare Supplements help cover these extra costs and help limit large medical bills for an additional monthly premium. A beneficiary must be enrolled in both Parts A & B to apply.
Full Article: Medicare Supplements
Medicare Advantage
Medicare Advantage is an equivalent to Medicare Parts A & B from Medicare-approved private insurance companies. It is also known as Medicare Part C. Medicare Advantage plans often offer coverage for things Original Medicare doesn’t cover such as prescriptions, vision, dental, gym memberships, and more.
Full Article: Medicare Advantage
Medicare Prescriptions
Medicare Part D offers prescription coverage through standalone prescription drug plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MAPDs). These plans often have a monthly premium as well as copays for your prescriptions that vary in price depending on what type of drug you are taking.
Medicare Disability
Medicare Disability is offered to those who are under 65 who have been receiving Social Security Disability Income for 24 consecutive months or have been diagnosed with ESRD or ALS. Medicare Disability is the same as Original Medicare, but the secondary plans available to you may be slightly different compared to those 65 and older.
Full Article: Medicare Disability
Medicare and Medicaid
People who receive both Medicare and Medicaid are known as “Dual-Eligible”. People with Dual Eligible status can be offered additional secondary options such as D-SNP (Dual Eligible Special Needs Plans) depending on their locations. Dual Eligible plans often provide benefits Original Medicare does not, such as Care Coordinators, Grocery benefits, Utility benefits, and more.
Full Article: Medicare and Medicaid
Medicare Enrollment Periods
Initial Enrollment Period - Your Initial Enrollment Period is when you first take Medicare Parts A and B. This can be due to turning 65, retiring after 65, or going onto Medicare Disability. The Initial Enrollment Period is an amazing time that allows you to take just about any Medicare secondary plan available in your area regardless of your health and pre-existing conditions.
Most people sign up for Medicare in the 3 months before their 65th birthday, and start on the 1st of their 65th birthday month.
Annual Enrollment Period - This period is from October 15th to December 7th every year. During this time, you can evaluate your health and financial needs and decide what Medicare plans you would like to have in the upcoming calendar year. What plans you can switch to and what plans require health questions for enrollment often depends on your state and zip code.
Special Enrollment Periods - these are designed to help you switch Medicare options if you are affected by major life events. Some common Special Enrollment Periods (SEPs) include moving, losing work insurance, losing Medicaid, and more. Each Special Enrollment Period has a unique time window and options for changing your Medicare coverage.
About the Author
Bill O'Hara is a licensed broker life and health insurance broker at NJ Life and Health. He has personally helped hundreds of people with their Medicare needs across several states.