Medicare 101
The parts, the two main paths, and the dates that matter, in plain language.
By calling this number, you will be connected with a licensed insurance agent. Calls are answered by Dora or her office.
The four parts of Medicare
Hospital insurance
Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people pay no premium for Part A.
Medical insurance
Doctor visits, outpatient care, lab work, preventive services, and medical equipment. Part B has a monthly premium.
Medicare Advantage
Plans from private insurance companies that provide your Part A and Part B benefits, often with drug coverage built in.
Prescription drugs
Drug coverage from private insurance companies, either as a standalone plan or included in a Medicare Advantage plan.
Two main paths
Most people end up choosing one of these two approaches. Neither is right for everyone.
Original Medicare, plus a Medicare Supplement and a drug plan
- See any doctor or hospital in the U.S. that accepts Medicare
- No referrals needed for specialists
- A Medicare Supplement plan helps pay the costs Original Medicare leaves behind
- Add a standalone Part D plan for prescriptions
- Usually higher monthly premiums, more predictable costs when you use care
Medicare Advantage
- One plan in place of Original Medicare, run by a private insurance company
- Usually uses a network of doctors and hospitals
- Many plans include drug coverage
- Extra benefits such as dental, vision, or hearing may be available, depending on the plan
- Often lower monthly premiums, with copays when you use care and a yearly out-of-pocket limit
When you can enroll or make changes
- Initial Enrollment Period. Seven months around your 65th birthday month.
- Annual Enrollment Period. October 15 to December 7 each year, for Medicare Advantage and drug plan changes.
- Medicare Advantage Open Enrollment. January 1 to March 31, for people already in a Medicare Advantage plan.
- Special Enrollment Periods. Certain life events, like moving or losing employer coverage, can open a window outside the usual dates.
- Medicare Supplement Open Enrollment. Six months starting the month you're 65 or older and enrolled in Part B.
Still working past 65?
If you or your spouse have coverage through a current employer, you may be able to delay Part B without a penalty. The rules depend on the size of the employer and the type of coverage, so it's worth a conversation before you decide.
Help with costs. If your income is limited, you may qualify for Extra Help with drug costs, a Medicare Savings Program, or Medi-Cal. Dora can point you in the right direction.
Free, unbiased counseling. California's Health Insurance Counseling & Advocacy Program (HICAP) offers free Medicare counseling. Call 1-800-434-0222 or visit Medicare.gov for more.
Turning 65 soon?
Dora can map out your timeline, what to sign up for, and when, so nothing is missed.
By calling this number, you will be connected with a licensed insurance agent. Calls are answered by Dora or her office.