You are generally eligible for Medicare if you are a U.S. citizen or a legal resident who has lived in the U.S. for at least five continuous years, and you meet one of the following criteria:

You are age 65 or older.

You are under age 65 but have a qualifying disability and have received Social Security Disability Insurance (SSDI) benefits for 24 months.

You have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.

You have Amyotrophic Lateral Sclerosis (ALS).

Medicare Part A is your hospital insurance. It helps cover the costs of inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.

 Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working for at least 10 years. Because of this, there is typically no penalty for late enrollment. However, if you are required to pay a premium for Part A and you don’t sign up when you’re first eligible, your monthly premium may increase by 10% for twice the number of years you didn't have coverage.

Medicare Part B is your medical insurance. It covers doctor’s services, outpatient care, medical supplies, and preventive services like flu shots.

The Deductible: For those with Original Medicare, there is an annual deductible you must pay each year before your coverage begins. In 2025, the Part B deductible is $257.00. After you meet this deductible, Original Medicare typically pays 80% of the Medicare-approved amount for services, and you are responsible for the remaining 20%.

The Cost: The standard monthly premium for Medicare Part B in 2025 is $185.00 for those whose income is under a certain threshold. If your income exceeds that amount, you will pay a higher premium.

The Penalty: If you don’t sign up for Part B when you are first eligible and don't have other creditable coverage (like from an employer), you may have to pay a 10% premium penalty for each full 12-month period you were eligible but didn’t enroll. This penalty is added to your monthly Part B premium for the rest of your life.

Getting Help with Costs: If you have limited income and resources, you may qualify for a program like Medicaid, which can help pay your monthly Part B premium. I can help you determine if you are eligible for assistance programs.

Medicare Part C, also known as Medicare Advantage, is a different way to get your Medicare benefits. These plans are offered by private insurance companies approved by Medicare. Medicare Advantage plans must cover everything Original Medicare (Parts A and B) covers, and they often include extra benefits like dental, vision, hearing, and prescription drug coverage (Part D).

Medicare Part D is your prescription drug coverage. This is a separate plan you can enroll in to help cover the cost of your prescription medications. It is offered by private insurance companies that are approved by Medicare.

The Penalty: If you go 63 days or more in a row without a Medicare Part D plan or other creditable prescription drug coverage, you may have to pay a late enrollment penalty. The penalty is calculated based on the number of months you went without coverage and is added to your Part D premium for the rest of your life.

Understanding Medicare enrollment periods is crucial to avoid late penalties and gaps in coverage. Here’s a simple breakdown of the process.

The "When" to Enroll

There are three main times you can enroll:

Initial Enrollment Period (IEP): This is your first chance to sign up for Medicare. It's a 7-month window that begins 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after your birthday month.

Tip: If you are already receiving Social Security benefits, you will be automatically enrolled in Parts A and B. Your Medicare card will arrive in the mail about 3 months before your 65th birthday.

General Enrollment Period (GEP): If you miss your IEP and don't qualify for a Special Enrollment Period, you can sign up for Part A and/or Part B between January 1 and March 31 each year. Your coverage will begin the month after you sign up, and you may have to pay a late enrollment penalty.

Special Enrollment Period (SEP): You may be eligible for an SEP if you or your spouse are still working past age 65 and are covered by a group health plan. You have an 8-month period to enroll after your employment or group health coverage ends, whichever comes first. This allows you to avoid the late enrollment penalty.

The "How" to Enroll

Online: The easiest and fastest way to enroll is online through the Social Security Administration's website. You can apply for just Medicare even if you're not ready to apply for retirement benefits.

By Phone: You can call Social Security's national toll-free number.

In Person: You can visit your local Social Security office. It's recommended to call ahead to make an appointment.

Helpful Resources:

Social Security Administration (SSA): To enroll in Medicare, visit www.ssa.gov or call 1-800-772-1213.

Medicare.gov: The official U.S. government site for Medicare. You can get comprehensive information and tools here. Visit www.medicare.gov.

Need Help with Enrollment? Navigating this process can be complicated. As your trusted broker, I can help you understand your options, verify your eligibility, and walk you through the enrollment process step-by-step at no cost to you.

How do I enroll in Medicare?

Enrolling in Medicare is a crucial step, and the process can depend on your individual situation. Here is a breakdown of the key steps and enrollment periods.

Automatic Enrollment-

You will be automatically enrolled in Original Medicare (Part A and Part B) if you are:

Already receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least four months before you turn 65.

Under age 65 and have been receiving Social Security Disability Insurance (SSDI) or RRB disability benefits for 24 months.

Diagnosed with Amyotrophic Lateral Sclerosis (ALS) and receiving SSDI.

If you are automatically enrolled, your Medicare card will be mailed to you about three months before your 65th birthday or your 25th month of disability.

Manual Enrollment-

If you are not automatically enrolled, you will need to sign up yourself. The most common way to do this is through the Social Security Administration.

Online: The easiest way is to apply online at the Social Security website (www.ssa.gov/medicare).

Phone: You can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

In-Person: You can visit your local Social Security office.

Key Enrollment Periods-

Understanding the enrollment periods is critical to avoid potential late enrollment penalties.

Initial Enrollment Period (IEP): This is a 7-month window around your 65th birthday. It includes the three months before your birthday month, your birthday month, and the three months after. This is when most people should sign up for Part A and Part B.

General Enrollment Period (GEP): If you miss your IEP and are not eligible for a Special Enrollment Period, you can sign up for Part B (and premium Part A) during the GEP, which runs from January 1 to March 31 each year. Your coverage will not begin until July 1, and you may face late enrollment penalties.

Special Enrollment Period (SEP): You may qualify for a Special Enrollment Period if you or your spouse are still working and have employer-sponsored group health coverage. This allows you to delay signing up for Medicare Part B without penalty.

Don't Forget to Check for Additional Help-

Navigating the cost of Medicare can be challenging, but there are programs available to help. When you are considering your options, you should also check to see if you are eligible for Low-Income Subsidy (LIS), also known as "Extra Help," and Medicaid.

LIS (Extra Help): This federal program helps pay for the costs of Medicare Part D prescription drug coverage, including premiums, deductibles, and co-payments.

Medicaid: This joint federal and state program can help with Medicare premiums, deductibles, and co-insurance. Many people who qualify for both Medicare and Medicaid (often called "dual-eligibles") can save a significant amount on their healthcare costs.

Helpful Resources-

Medicare.gov: The official government site for all things Medicare. It has a wealth of information, a plan finder tool, and resources to help you.

Social Security Administration (SSA): The SSA manages Medicare enrollment and can help you with eligibility questions.

State Health Insurance Assistance Programs (SHIP): These programs offer free, unbiased counseling on Medicare topics. You can find your local SHIP office by searching on the Medicare.gov website.

The Medicare enrollment process can feel overwhelming, but you don't have to go through it alone. I am here to help you navigate this process, understand your options, and ensure you are enrolled in the right plan for your needs. We can also review your financial situation to see if you qualify for any of these valuable assistance programs.

A Medigap plan, also known as a Medicare Supplement plan, is a type of health insurance policy sold by private companies to help cover the "gaps" in Original Medicare (Part A and Part B).

Original Medicare pays for most but not all of your health care services and supplies. The "gaps" you would otherwise be responsible for include:

Copayments

Coinsurance

Deductibles

A Medigap policy works by paying for these out-of-pocket costs after Original Medicare has paid its share. It's a way to get more predictable and comprehensive coverage, as it helps to limit your out-of-pocket expenses for services that are already covered by Medicare.

How Original Medicare Costs Work

To understand the value of a Medigap plan, it helps to know what Original Medicare covers and what you are responsible for:

Medicare Part A (Hospital Insurance):

Deductible: For 2025, the Part A deductible is $1,676 per benefit period. A "benefit period" starts the day you're admitted as an inpatient in a hospital and ends when you haven't received any inpatient hospital care or skilled nursing facility care for 60 days in a row. You could have more than one benefit period in a year.

Coinsurance: After you meet your deductible, you pay $0 for the first 60 days of an inpatient stay. For days 61-90, you pay $419 per day, and for days 91 and beyond, you pay $838 per day (using your lifetime reserve days).

Medicare Part B (Medical Insurance):

Deductible: For 2025, the annual Part B deductible is $257. You must pay this amount before Medicare starts to pay its share.

Coinsurance: After your deductible is met, you are generally responsible for 20% of the Medicare-approved amount for most doctor's services, outpatient therapy, and durable medical equipment. Medicare pays the remaining 80%.

This is where a Medigap plan comes in, as it can help cover those deductibles and the 20% coinsurance, leaving you with very few or no out-of-pocket costs for Medicare-approved services.

How Original Medicare Costs Work

To understand the value of a Medigap plan, it helps to know what Original Medicare covers and what you are responsible for:

Medicare Part A (Hospital Insurance):

Deductible: For 2025, the Part A deductible is $1,676 per benefit period. A "benefit period" starts the day you're admitted as an inpatient in a hospital and ends when you haven't received any inpatient hospital care or skilled nursing facility care for 60 days in a row. You could have more than one benefit period in a year.

Coinsurance: After you meet your deductible, you pay $0 for the first 60 days of an inpatient stay. For days 61-90, you pay $419 per day, and for days 91 and beyond, you pay $838 per day (using your lifetime reserve days).

Medicare Part B (Medical Insurance):

Deductible: For 2025, the annual Part B deductible is $257. You must pay this amount before Medicare starts to pay its share.

Coinsurance: After your deductible is met, you are generally responsible for 20% of the Medicare-approved amount for most doctor's services, outpatient therapy, and durable medical equipment. Medicare pays the remaining 80%.

This is where a Medigap plan comes in, as it can help cover those deductibles and the 20% coinsurance, leaving you with very few or no out-of-pocket costs for Medicare-approved services.

An important factor for those who already have a Medigap policy is the "Birthday Rule." This is a state-specific law that allows you to change your Medigap plan around your birthday each year without having to go through medical underwriting.

What it does: It gives you a special window (typically 30-60 days around your birthday) to switch to another Medigap plan of equal or lesser benefits.

Why it's important: Without this rule, you would typically have to answer health questions, and an insurance company could deny you coverage or charge you a higher premium based on pre-existing health conditions. The Birthday Rule allows you to shop for a more competitive premium on the same or a similar plan without fear of being denied due to your health.

Who it applies to: This rule is only available in certain states, so it's crucial to check if your state has this rule and understand the specific window and rules for that state.

It's important to understand the different types of Medigap plans and how they align with your health needs and financial situation. I can help you navigate the different plans and compare them side-by-side to find one that provides the best coverage for your specific needs, all while fitting within your budget. Feel free to reach out to discuss your situation and explore the options available to you.