Annual Enrollment Ends In:
Making Sense of
Medicare
What's Medicare?
Medicare is the federal health insurance program for Americans 65 and older, as well as certain people under 65 with qualifying disabilities or health conditions. It's been around since 1965 and covers tens of millions of Americans today.
Medicare has a reputation for being complicated — and honestly, it's not entirely undeserved. But once you understand how the pieces fit together, it's a lot more manageable than it looks. Think of each part as building blocks for your coverage:
Hospital
Helps cover the big stuff like inpatient hospital stays, skilled nursing, and some home health care. Most people pay no premium if they or a spouse paid Medicare taxes while working.
Medical
Helps cover everyday medical needs such as doctor visits, outpatient care, and preventive services. A monthly premium applies, set each year by CMS and varying by income.
Medicare Advantage
Often offers additional benefits to Original Medicare from Medicare-approved private insurers. Covers everything A & B do, often plus extras.
Prescriptions
Prescription drug coverage, either bundled into a Medicare Advantage plan or available as a standalone plan alongside Original Medicare.
What's Medicare Advantage?
Medicare Advantage is still Medicare. When you enroll, the federal government pays a Medicare-approved private insurer to provide your coverage. That plan has to cover everything Original Medicare covers, no exceptions.
Many plans may offer additional benefits. Depending on the plan and where you live, Medicare Advantage plans may include additional benefits that Original Medicare doesn't cover — things like routine dental, vision, and/or hearing care, which matter a lot as we get older but aren't part of Original Medicare.
Additional Benefits May Include One Or More Of The Following:
- Routine dental, vision and/or hearing
- Over-the-counter allowances (Varies by plan and location)
- Telehealth services
- Fitness and/or wellness programs
- Transportation to appointments
- Post-discharge meal support
The Detail Worth Remembering
Every Medicare Advantage plan includes an annual out-of-pocket maximum, so there's a built-in limit on what you'll spend on covered services in a given year, giving you a level of cost predictability that Original Medicare doesn't offer.
Weighing Original Medicare vs. Medicare Advantage?
A licensed insurance agent can compare what's available where you live — no cost, no obligation. Call us Mon-Sun 9a-8p EST.
(888) 312-5459 | TTY 711Medicare Advantage Plan Types
Medicare Advantage comes in a few different structures, which is useful — it means there's likely an option that fits how you prefer to receive care.
A primary care physician coordinates your care; you generally stay in-network and may need referrals for specialists. Lower costs in exchange for that structure.
More flexibility to see providers in or out of network, usually without referrals. Out-of-network care comes at a higher cost-share.
Tailored for people with certain chronic conditions, those who qualify for both Medicare and Medicaid, or specific care settings.
Note: Other types, such as HMO-POS and PFFS, may also be available depending on where you live.
Are You Eligible?
Medicare Advantage plans are available to anyone who's eligible for Medicare, but there are a few additional requirements to join one:
- You must have both Medicare Part A and Part B
- You must live within the plan's service area
You may be eligible for Medicare if any of the following apply to you:
- 65 or older and a U.S. citizen or qualifying permanent resident
- Under 65 and receiving SSDI for a qualifying period
- Any age with End-Stage Renal Disease (ESRD) or ALS
A Licensed Agent Can Help
With no cost & no obligation, we can tell you exactly where you stand and what happens next. Call us Mon-Sun 9a-8p EST.
(888) 312-5459 | TTY 711When Can You Enroll?
Enrollment in Medicare isn't open-ended. There are specific windows for joining, switching, and making changes, and missing one can have lasting consequences. Here are the most common enrollment periods you need to know.
The main yearly window for anyone on Medicare — switch plans, join Medicare Advantage, or return to Original Medicare. Effective Jan 1.
If you're already in a Medicare Advantage plan, you may make a one-time switch to a different MA plan or return to Original Medicare.
A 7-month window: the 3 months before your 65th birthday, the month of, and the 3 months after.
Triggered by events like losing employer coverage, moving to a new address, or moving outside of your plan's service area.
Missing an enrollment window such as the initial enrollment period can sometimes lead to late penalties. If you're uncertain about your timing, it's worth getting clarity sooner rather than later. Call (888) 312-5459 | TTY 711 (Mon-Sun 9a-8p EST) to speak with a licensed insurance agent.
Common Questions
This is usually the first question, and it's a smart question to ask. Every plan has its own network of doctors, specialists, and facilities, and whether your preferred providers are included can vary significantly. It's worth confirming before you enroll rather than after.
You may be able to delay certain parts of Medicare without facing a late penalty — but the rules depend on your employer's size and the type of coverage you have. It's one of those situations where getting it wrong can be costly, so a quick conversation is worth it.
You have options. The Annual Enrollment Period each year gives everyone with Medicare a chance to make changes. And if you're already in a Medicare Advantage plan, the MA Open Enrollment Period runs January 1 through March 31 and gives you an additional window to make a one-time switch.
There may be. Many Medicare Advantage plans include extra benefits, like dental, vision, and/or hearing coverage, that can offset out-of-pocket costs. Government Programs like Extra Help and Medicare Savings Programs may also reduce your costs if you qualify. A licensed agent can help you figure out what's available to you.
Not necessarily. Medicare Advantage plans can adjust their premiums, copays, covered benefits, and drug formularies each January 1. Even if you've been happy with your plan, it's worth taking a fresh look during AEP each year to make sure it still fits your needs.
Ready to Compare Plans?
A licensed agent can look at what's actually available in your area and help you find coverage that fits your situation. There's no cost to you and no obligation — just straightforward answers.
(888) 312-5459 | TTY 711