Education
Medicare Basics
What you actually need to know — in plain English.
The Four Parts
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people do not pay a premium for Part A if they (or a spouse) worked and paid Medicare taxes for at least 10 years.
Covers doctor visits, outpatient care, preventive services, and some medical equipment. Part B has a monthly premium (set by the government each year) and an annual deductible.
An alternative way to get your Medicare benefits, offered by private insurers approved by Medicare. These plans typically bundle Parts A, B, and often D into one plan, often with lower premiums but network restrictions.
Standalone drug coverage that works alongside Original Medicare (Parts A and B) or some Medicare Advantage plans. Formularies (covered drug lists) vary significantly by plan — this is where comparison shopping matters most.
Medicare Advantage vs. Medicare Supplement (Medigap)
The most important choice most people face — and it depends entirely on your situation.
Medicare Advantage
- • Often $0 or low monthly premium
- • Must use in-network providers (HMO) or pay more (PPO)
- • Has an out-of-pocket maximum (cost ceiling)
- • Generally covers prescription drugs (Part D)
- • May include dental, vision, hearing extras
Medicare Supplement (Medigap)
- • Higher monthly premium
- • Any provider who accepts Medicare — nationwide
- • No referrals needed
- • Pays costs Original Medicare doesn't cover
- • Separate Part D plan required for drugs
Neither is universally better. The right answer depends on your health, your doctors, your prescriptions, and your financial tolerance for uncertainty. This is exactly the kind of decision Daniel walks through with you.
Enrollment Windows
⚠ Missing the wrong window can result in permanent late enrollment penalties. Don't guess on timing — call Daniel.
Missing this without a valid Special Enrollment Period can result in permanent late enrollment penalties.
This is when you can switch Medicare Advantage or Part D plans.
Losing employer coverage, moving, losing Medicaid eligibility, etc.
During this window, carriers cannot deny you or charge more based on health conditions. Outside it, medical underwriting applies in most states.
Bottom Line
Medicare is not one-size-fits-all. The plan with the lowest premium is not always the best plan. The plan your neighbor has may be wrong for you. Getting an independent expert to compare your options costs you nothing — and the difference in coverage and cost can be significant.
Schedule a Free Consultation with Daniel