People are asking:
What is medicare?
Medicare is the federal health insurance program for people 65+ and for some under 65 with a disability, ESRD (kidney failure), or ALS. It’s run by Centers for Medicare & Medicaid Services (CMS) (within Department of Health and Human Services (HHS)) and many people enroll through Social Security.
The parts (plain English):
Part A = hospital/inpatient, SNF, hospice.
Part B = doctor visits, outpatient, preventive care.
Part C (Medicare Advantage) = an all-in-one private plan alternative that includes A+B and usually drugs; uses networks.
Part D = prescription drugs (if not already in your MA plan).
Who qualifies & how to start:
Most people become eligible at 65; some earlier with disability, ESRD, or ALS. If you’re already getting Social Security before 65, you may be enrolled automatically; otherwise you sign up through SSA.
When can I change coverage?
Medicare’s Open Enrollment runs Oct 15 – Dec 7 each year to review/switch Advantage or drug plans for the next year
What is Medicare Part A?
Short answer: Part A is Medicare’s hospital insurance. It helps pay for inpatient hospital care, skilled nursing facility (SNF) care after a qualifying hospital stay, hospice, and some home health. It’s one half of “Original Medicare” (the other half is Part B).
What it doesn’t cover: Long-term custodial care, most dental/vision/hearing, and most non-medical home help. (Doctor services are generally billed under Part B—even in the hospital.)
What is Medicare Part B?
Short answer: Part B is Medicare’s medical insurance. It helps pay for doctor visits, outpatient care, durable medical equipment, home health, and many preventive services (like screenings and shots).
What it covers:
Medically necessary services to diagnose/treat a condition
Outpatient care, labs, imaging, mental health
Durable medical equipment (wheelchairs, walkers, etc.)
Many preventive services—often $0 if the provider accepts assignment
What is Medicare Part C?
Short answer: Part C is Medicare Advantage—private, Medicare-approved plans that give you your Part A & Part B coverage (and usually Part D drugs) in one bundle. Plans use networks and their own rules, and they must follow Medicare’s standards.
How it works:
All-in-one coverage: Includes A + B; most plans also include Part D.
Networks & rules: HMOs, PPOs, PFFS, SNPs, and MSA plans; each has different provider rules and referrals.
Costs: You generally keep paying Part B, plus any plan premium/copays set by the plan. Every MA plan has a yearly medical out-of-pocket limit (after that, covered Part A/B services are $0 for the rest of the year).
Extras: Many plans add benefits Original Medicare doesn’t (e.g., limited dental/vision/hearing), but details vary by ZIP/county.
Not with Medigap: You can’t use a Medigap policy with a Medicare Advantage plan.
What is Medicare Part D?
Part D is Medicare’s prescription drug coverage. It’s offered by private insurers approved by Medicare, either as a stand-alone drug plan (PDP) with Original Medicare or built into many Medicare Advantage plans (MA-PD).
How it works (plain English):
Formulary = covered drug list. Each plan covers its own list of drugs and places them in tiers (lower tiers usually cost less). Plans must cover a broad range of drugs, including protected classes.
Pharmacy network matters. You’ll generally pay the least at preferred in-network pharmacies; some plans only cover drugs filled at in-network pharmacies. Mail-order may be an option.
Rules may apply. Some drugs have prior authorization, step therapy, or quantity limits—your cost and access can depend on these rules.
Timing & penalties: If you go 63+ days without Part D or other creditable drug coverage after you’re first eligible, you can owe a late enrollment penalty added to your premium, usually for as long as you have Part D.
What does Medicare coverage provide?
Medicare is health insurance from the federal government. It helps people 65 and older (and some younger with certain health problems).
Part A helps pay for hospital stays, skilled nursing, hospice, and some home health care.
Part B helps pay for doctor visits, tests, medical supplies, and outpatient care.
Part D helps pay for prescription drugs.
You can get Medicare directly from the government (Original Medicare) or through a private company (Medicare Advantage)
Can I still work with Part A coverage only?
Yes. Many people keep working and only sign up for Part A (hospital coverage) when they first turn 65, because it’s usually free if they’ve worked enough years. They can wait to add Part B (doctor coverage) until they stop working or lose their job’s health insurance, and they won’t get a late penalty if they sign up during their special enrollment period.
What’s the difference between Medigap and Medicare Advantage?
Medigap is supplemental insurance that helps pay Original Medicare’s costs; Medicare Advantage is an alternative way to get your Medicare through a private plan. You can’t have both at the same time.
Medigap (a.k.a. Medicare Supplement)
Works with Original Medicare (A & B); you keep nationwide access to any provider that accepts Medicare.
Helps pay copays/coinsurance/deductibles; plans are standardized A–N (benefits by letter). Drug coverage is separate (add Part D). Some plans include limited foreign travel emergency benefits.
Best time to buy is your 6-month Medigap Open Enrollment (starts when Part B begins at 65+). After that, medical underwriting may apply.
Medicare Advantage (Part C)
An alternative to Original Medicare run by private insurers (HMO, PPO, PFFS, SNP, MSA). Plans use networks and rules (referrals/authorizations vary).
Often bundles Part D and may include extras (e.g., dental/vision). Each plan has an annual out-of-pocket limit (MOOP) for Part A & B services.
You can’t use Medigap with Medicare Advantage (and it’s illegal to sell you Medigap while you’re in MA unless you’re switching back to Original Medicare).
Which to consider?
Choose Medigap if you want the broadest provider choice and more predictable cost-sharing with Original Medicare. Choose Medicare Advantage if you’re comfortable with networks and like an all-in-one plan (often with lower or $0 premiums and extras).
I travel. Which Medicare plan goes with me?
With Original Medicare, you can see any doctor or hospital in the U.S. that takes Medicare, so it travels with you across the country.
Some Medigap (supplement) plans even cover emergencies in other countries.
Medicare Advantage plans (like HMOs and PPOs) may only cover you in their service area, except for emergencies and urgent care, so you need to check before you travel.
I am about to retire. When should I apply for Part B to avoid a penalty?
You should sign up for Part B (doctor coverage) when you first turn 65 unless you still have qualifying health insurance from your job (or your spouse’s job). If you keep qualified job coverage, you can wait. Once that job coverage ends, you have 8 months to sign up for Part B without a penalty
How much does Medicare Advantage cost?
Short answer: It depends on your ZIP/county and plan. Most people keep paying the Part B premium (set annually by CMS; $185/month in 2025), plus whatever the plan charges (many are $0 premium). You’ll also have copays/coinsurance as you use care, up to your plan’s yearly out-of-pocket limit.
What is the best Medicare plan that covers everything?
Short answer: There isn’t one plan that literally “covers everything.” The “best” fit depends on your doctors, prescriptions, travel, and budget. Medicare gives you two main paths, each with trade-offs.
Your two main choices (plain English):
Original Medicare + Medigap + Part D
Pros: Widest provider choice (any doctor that takes Medicare); Medigap helps pay A/B deductibles & coinsurance; you add a separate drug plan.
Cons: Separate premiums (Part B, Medigap, Part D). Extras like dental/vision/hearing aren’t built in.
Medicare Advantage (Part C)
Pros: One-card coverage for A & B (usually includes Part D) and has a yearly medical out-of-pocket limit; may include extras like dental/vision.
Cons: Uses networks and plan rules (referrals/authorizations vary); benefits & provider access differ by ZIP/county.
Medicare Advantage 2026 plans?
2026 plans are local to your ZIP/county. The official, complete list for your area is on Medicare’s Plan Finder. Use it to see every plan, costs, doctors, drugs, and star ratings.
Open Plan Finder: Medicare.gov → “Find & compare plans” → enter ZIP → choose “Medicare Advantage.” (Plan types = HMO, PPO, PFFS, SNP, MSA.
What are Medicare Supplement (Medigap) plans?
Medigap is supplemental insurance you buy from a private insurer to help pay your share of Original Medicare (Parts A & B) costs—like deductibles, copays, and coinsurance. You must have Part A and Part B to buy one.
How Medigap works:
It works with Original Medicare—not a replacement for it. You can’t use Medigap with a Medicare Advantage plan.
Plans are standardized (lettered A–N) so benefits are comparable across companies; you pick the letter/benefits you want.
Medigap generally doesn’t include drugs; add a separate Part D plan if you need prescription coverage.
Each policy covers one person and is generally guaranteed renewable if you pay premiums on time.
Some plans include limited foreign travel emergency coverage.
Best time to buy: Your 6-month Medigap Open Enrollment Period starts the month you’re 65+ and enrolled in Part B. After that, insurers can usually use medical underwriting (state rules vary).
I received a call to update my Medicare card. What should I do?
Hang up. Medicare won’t call, text, or email you out of the blue to “update” your card or ask for your Medicare/Social Security number. If someone does, it’s a scam. Call 1-800-MEDICARE to verify and report it.
Do this instead (safe steps):
Don’t share info. Never give your Medicare Number, SSN, or payment info to an unsolicited caller.
Verify directly. If you actually need a new card or address change, use your Medicare.gov account to print a card or call 1-800-MEDICARE (TTY 1-877-486-2048). Social Security also links to replacement card options.
Report the call.
Medicare: 1-800-MEDICARE or online “Report Medicare Fraud.”
Senior Medicare Patrol (SMP): 1-877-808-2468 for local help.
HHS OIG Fraud Hotline: 1-800-HHS-TIPS (1-800-447-8477).
Already shared info? Call 1-800-MEDICARE right away, then watch your Medicare Summary Notices and report any suspicious charges.
Why we say this: Medicare’s official guidance says not to share your number with anyone who contacts you first and to hang up and call Medicare if someone asks for info, money, or threatens to cancel benefits
What questions about Medicare could we answer for you?
We are here to answer your questions at 651-303-8889.