Medicare Options

Understanding Medicare's Options
Part A, B, C & D

Medicare can be quite confusing and complex. Let's break down the four basic  parts. 

original Medicare

What is Original Medicare Part A & Part B?

Original Medicare is broken into two parts, Part A and Part B. 

Medicare Part A: 

When you apply for Medicare you will automatically be enrolled in Part A. Medicare Part A is all about your hospital coverage. Medicare Part A will help you pay for services such as Inpatient Hospital Stay, Home Health Care that you may need after being hospitalized for a stroke, a broken hip or any illness that requires rehabilitation it also covers Hospice.  Most people do not have to pay a premium for Part A if you have paid into the system while working.

Original Medicare

What is Original Medicare
Part A & Part B?

Medicare Part B: 

Medicare Part B is the component of Original Medicare that covers your outpatient medical services: doctor visits, lab tests, diagnostic screenings, durable medical equipment, ambulance transportation, and other outpatient care.

Unlike Medicare Part A (which covers hospital/inpatient care and is often premium-free for those who qualify), Part B generally requires you to pay a monthly premium and cost-sharing. If you’re still covered under a spouse’s employer health plan, you might consider delaying Part B enrollment — but if you don’t have other creditable coverage, delaying can result in a higher monthly premium or a late enrollment penalty.

Here are the projected 2026 cost details to keep in mind:

  • The standard monthly premium for Part B is projected to be $206.50 for most enrollees, up from $185.00 in 2025. 
  • The annual deductible (the amount you must pay each year before Medicare starts paying its share) is projected to increase to $288 in 2026 (up from $257 in 2025). 
  • After the deductible is met, you generally pay 20% coinsurance for most covered Part B services (so Medicare pays 80% of the Medicare-approved amount for services from providers who accept assignment). 
  • If you are collecting Social Security benefits, your Part B premium will usually be deducted from your monthly check.
  • If you delay enrolling in Part B when you’re first eligible and you don’t have other credible coverage, you may face a late-enrollment penalty, which increases your monthly premium for as long as you’re enrolled. 
  • Also note: Original Medicare (Parts A & B) does not cover routine prescription drugs, most dental care, routine vision or hearing exams, or routine eyeglasses/contacts (except in certain situations such as one pair of glasses after cataract surgery). You may want to explore supplemental coverage (e.g., a Medigap policy) or a Medicare Advantage plan for more complete coverage.

Part C

Medicare Part C
Medicare Advantage Plans

Now that we have covered the foundation to Original Medicare Part A and Part B, you can see that your responsibility for co-payments and co-insurance can be expensive. You have options to help support the portion of Medicare that you are required to pay but how do you know what plan to choose? All your healthcare plan choose should be based on your healthcare needs and budget.

What is a Medicare Advantage Plan?

Medicare Advantage plans are the most commonly type of private insurance plans that work with Medicare. Medicare Advantage plans or Medicare Part C is a combination of your Medicare Part’s A and B benefits with additional coverage such as prescription drug coverage. Medicare Advantage Plans are based on your county, state, and zip code, giving you options on the type of plan that would work for you. This allows your lower premiums that other private insurance options. Medicare Advantage plans are based on network, just like an HMO or PPO. Medicare Advantage plans will ask you to pay a co-payment or co-insurance based on your plan selected. Your co-payments or co-insurance under a Medicare Advantage plan can be lower than what Original Medicare may require you to pay. Medicare Advantage plans can also include benefits like vision, dental and hearing. If you are looking for a comprehensive plan, a Medicare Advantage plan may be an option for you. All your benefits are wrapped up into one plan for you with a Medicare Advantage plan.

Part D

Medicare Part D
Prescription Drug Plans

Medicare Part D is a voluntary prescription drug benefit for people with Medicare that is obtained through private insurance companies. This coverage can help to cover the cost of some of your prescription drugs. You should enroll in Part D when you first enroll in Medicare to avoid coverage gaps or enrollment penalties.  If you do enroll in Part D when you are first eligible, you will be able to access retail prescription drugs at a more affordable rate and enjoy protection against high costs in the event you need a very expensive medication.

Medicare FAQ's

Got questions? We've got answers

You are eligible to apply for Medicare during your initial enrollment period which is a 7 month window. 3 months before turning 65, the month you turn 65 and 3 months after turning 65. 

The easiest way to sign up for Medicare is online through SSA.gov or by Calling Social Security at 1-800-772-1213. You can also visit your local Social Security Office.

If you are already receiving Social Security Benefits you will be automatically enrolled into Original Medicare, otherwise you will be eligible to enroll during your initial enrollment period that starts 3 months before your 65th birthday.

If you miss your Initial Enrollment Period you can sign up during the General Enrollment period that occurs every year January 1st through March 31st. Coverage becomes effective the month following your enrollment date.

Yes, there are penalties for not signing up for Part B of Medicare and will be added to your premium.

If you need a new Medicare card you can order a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call.

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