New to Medicare —
Your Starting Point
If you’re turning 65 or retiring soon, you’re about to enter one of the most important stages of your healthcare journey.
Medicare is a federal health insurance program designed to help cover your medical expenses — but it comes with choices, timelines, and costs that can be confusing at first.
That’s where Vision Insurance Group helps simplify everything.
Don't fall into these traps!
| Part | What It Covers | How You Get It |
|---|---|---|
| Part A — Hospital Insurance | Inpatient Hospital Stays, Skilled Nursing Facility Care, Hospice Care, Home Health Care | Automatic for most when you apply for Medicare. No premium (for most beneficiaries) |
| Part B — Medical Insurance | Doctors Visits, Lab Tests, Medical Equipment, Outpatient Care, Preventive Services | Optional; monthly premium applies |
| Part C — Medicare Advantage | Private plans that combine Parts A & B (and usually D) + Extras (Dental, Vision, Hearing) and Other Benefits | Offered through private insurers |
| Part D — Prescription Coverage | Prescription Drugs Costs | Optional; add to Original Medicare or included in many Advantage plans |
You should enroll in Medicare when you first become eligible, usually around your 65th birthday, to avoid gaps in coverage or late-enrollment penalties.
| Period | Description | Timing |
|---|---|---|
| Initial Enrollment Period (IEP) | Your first chance to enroll in Medicare Parts A & B | 7-month window: 3 months before, your birthday month, and 3 months after |
| General Enrollment Period (GEP) | If you missed your IEP | January 1 – March 31 |
| Special Enrollment Period (SEP) | If you had employer coverage | Up to 8 months after coverage ends |
Medicare is NOT Free
Each part of Medicare has its own Base premiums, deductibles and coinsurance. The table below shows the cost of each part of Medicare.
| Part | Premium Cost | IRMAA Additional Premium | Late Enrollment Penalty | Deductibles | Co-Insurance | Max-Out-of-Pocket (MOOP) Limit |
|---|---|---|---|---|---|---|
| Part A — Hospital Insurance | Usually free for most people | No | Only if entitled to pay premium | $1,632 per benefit period (for 2025) | $0 after deductible for days 1–60. $408/day for days 61–90 | Not applicable |
| Part B — Medical Insurance | $185 (for 2025) | Applicable for Higher Income | 10% penalty per 12 months delayed | $257 (for year 2025) | 20% of cost | Unlimited |
| Part C — Medicare Advantage | Varies by plan | No | No | Medical and Rx Deductibles varies by plan | Varies by plan | Varies by plan |
| Part D — Prescription Coverage | Varies by plan | Applicable for Higher Income | 1% of national premium per month delayed if no creditable coverage | Rx deductible varies by plan | Varies by plan | $2,000 |
| Medigap Path (Original Medicare + Medigap + standalone Part D) | Medicare Advantage (MA/MAPD) | |
|---|---|---|
| Stays on Original Medicare (A & B). Medigap pays some/all Medicare cost-shares. Separate Part D plan for drugs. | How it works | Private plan replaces Original Medicare for most services; follows plan rules and networks. Many include Part D. |
| Usually higher premiums (Medigap + Part D). | Monthly cost | Usually lower premiums (often $0–low), single card. |
| Very predictable/low with richer Medigap plans (e.g., G, N). No MA MOOP applies; you pay Medicare + Medigap rules only. | Out-of-pocket risk | Capped by an annual in-network MOOP (but can be several thousand dollars). Costs vary by service and network. |
| Any doctor/hospital that takes Medicare nationwide—no referrals, no network. Great for travel/snowbirds. | Provider access | Networks (HMO/PPO). Some require referrals/authorizations. Out-of-network may cost more or not be covered. |
| Separate Part D (choose the one that fits meds). | Drug coverage | Often built-in Part D (MAPD); must follow plan’s formulary. |
| Typically not included (may buy stand-alone add-ons). | Extras (dental/vision/OTC, gym) | Often included or offered as riders (varies by plan). |
| Minimal plan management; Medicare rules apply. | Care management | More care coordination (prior authorization, step therapy possible). |
| Strong—Medicare nationwide + Medigap. Foreign travel limited (only some plans offer small emergency benefit). | Travel / living in multiple states | Mixed—Emergencies covered; routine care limited to network/service area (PPOs more flexible than HMOs). |
| People who value maximum choice, predictability, and travel flexibility. | Best for | People who prefer lower premiums, bundled benefits, and can use provider networks. |
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