New to Medicare

Myth #1: "Medicare is free."
Part A is often $0 premium, but Part B has a monthly premium, and all parts have deductibles/copays.
Myth #2: "Everyone is automatically enrolled at 65."
Only if you’re already taking Social Security/RRB. Otherwise, you must sign up.
Myth #3: “I can enroll anytime with no penalty.”
Part B and Part D have late-enrollment penalties unless you had creditable coverage or qualify for a Special Enrollment Period.
Myth #4: "If I choose Advantage, I’m stuck forever.” / “Advantage is always better.”
You can switch plans during AEP (Oct 15–Dec 7) and MA OEP (Jan 1–Mar 31). Advantage vs. Medigap is about trade-offs (costs, networks, extras).
Myth #5: “I don’t take meds, so I can skip Part D.”
Skipping Part D without creditable drug coverage can trigger a lifetime penalty—and you won’t be covered if a new prescription is needed.

Here are the 4 parts of Medicare—what each covers and how they fit together:

Part A (Hospital Insurance): Inpatient hospital stays, skilled nursing facility care (short-term/rehab), some home health, and hospice. Most people pay no premium if they or a spouse worked and paid Medicare taxes long enough.
Part B (Medical Insurance): Doctor visits, outpatient care, preventive services, labs, imaging, durable medical equipment, some home health. Has a monthly premium and cost-sharing (deductible/coinsurance). Late enrollment can trigger a penalty if you delay without qualifying coverage.
Part C (Medicare Advantage): Private plans that bundle your Part A + Part B (and usually Part D). Often include extra benefits (e.g., dental/vision/hearing, fitness). You still must be enrolled in A & B and live in the plan’s service area; you pay the Part B premium and any plan-specific costs.
Part D (Prescription Drug Coverage): Stand-alone drug plans (for people on Original Medicare) or built into many Advantage plans. Covers outpatient prescriptions via a plan formulary; enrolling late without other creditable drug coverage can cause a penalty.

Summary Table for Medicare Parts

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

Knowing when to enroll in Medicare is essential to avoid penalties and ensure continuous coverage. Most people first become eligible at age 65, which begins a seven-month Initial Enrollment Period (IEP) —starting three months before the month you turn 65, including your birthday month, and lasting three months after.

If you’re already receiving Social Security benefits, you’re usually enrolled automatically in Parts A and B. However, if you’re still working and have employer coverage, you may be able to delay Part B without penalty. Missing your enrollment window can lead to higher premiums or gaps in coverage, so it’s important to review your situation early and sign up on time to make sure your health and financial needs are fully protected.

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

Part	Premium Cost	IRMAA Additional Premium	Late Enrollment Penalty	Deductibles	Co-Insurance	Max-Out-of-Pocket (MOOP) Limit
Part A — Hospital Insurance	Usually premium free for most people	No	Only if entitled to pay premium	$1,736 per benefit period (for year 2026)	$0 after deductible for days 1–60. $434/day for days 61–90	Not applicable
Part B — Medical Insurance	$202.90 (for year 2026)	Applicable for Higher Income	10% penalty per 12 months delayed	$283 (for year 2026)	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	$615 Maximum annual deductible (for year 2026). Rx deductible varies by plan	Varies by plan	$2,100 (for year 2026)

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.
Widest provider choice (any Medicare provider). Very predictable costs with Plan G/N. Strong for frequent travelers/snowbirds. No referrals, minimal prior authorization.	Pros	Low/zero premiums common. Bundled extras (dental/vision/hearing, OTC, fitness). Annual chance to change plans without health questions. In-network MOOP limits worst-case costs.
Higher monthly premiums (plus separate Part D) Dental/vision/OTC typically not included. Outside GI periods, Medigap may require underwriting to enroll or upgrade.	Cons	Network rules, possible referrals/prior authorization. Cost-sharing can add up when using services. Travel/living in multiple states can be tricky. Benefits, formularies, and networks can change yearly.

🧠 Step 1 — Learn the Top 5 Medicare Mistakes to Avoid

🎨 Step 2 — Learn about the 5 Medicare Myths!

🧭 Step 3 — Understand the 4 Parts of Medicare

Summary Table for Medicare Parts

⏰ Step 4 — Know When to Enroll

💰 Step 5 — Understand Medicare Costs

🧩 Step 6 — Choose How You Want to Get Coverage

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