Woman looking at laptop weighing her medicare options.

Medicare facts

We know Medicare can be confusing. We're here to help break it down.

6 facts about Medicare


Medicare eligibility

Medicare is health insurance for people who meet one of the following requirements:

  • Age 65 or older

  • Diagnosed with end-stage renal disease (regardless of age)

  • Diagnosed with a qualifying disability (regardless of age)

To qualify for Medicare, you must also be a legal resident living in the United States for at least five consecutive years.


There are four parts to Medicare coverage — A, B, C and D

Each part covers something different, but you may not need each depending on the coverage path best for you.

  • Part A: provides hospital insurance

  • Part B: covers costs for doctors' services, outpatient care and medical equipment

  • Part C: Medicare Advantage plans (includes Parts A and B, as well as extra benefits)

  • Part D: covers prescription drug costs

If you or your spouse paid Medicare taxes while working, you likely won't have to pay a monthly premium for Medicare Part A (inpatient/hospital insurance), but will for Medicare Part B (outpatient/medical insurance). This premium is based on your IRS tax return from two years prior.


Original Medicare vs. Medicare Advantage plans

Your Medicare choices can be divided into two options: Original Medicare or Medicare Advantage.

Original Medicare includes Parts A and B. Not all costs are covered, including some deductibles and copayments, but you can sign up for extra coverage with a Medicare supplement plan (or Medigap) or receive prescription drug coverage through a separate Part D plan.

Medicare Advantage plans are an all-in-one alternative to Original Medicare — they include Parts A, B and, usually, D, and provide extra benefits (like vision, hearing or dental care) not covered by Original Medicare.


Know your initial enrollment period

Turning 65? You have seven months to enroll. This timeline starts three months before the month you turn 65 and ends three months after the month you turn 65.

Older than 65 and plan to retire? You have eight months to enroll in Medicare after retirement or after your employer's health insurance coverage expires. If you enroll after your enrollment window, you may have to pay a penalty.


The annual enrollment period is Oct. 15 to Dec. 7

Why is this important? You can change or update coverage during this time. All changes take effect Jan. 1 of the following year.


How Social Security can help your enrollment process

If you're receiving Social Security benefits, you should be automatically enrolled in Parts A and B. And you'll likely receive your Medicare card in the mail around your 65th birthday.

We're here to help

To speak with one of our experts on Medicare, attend an upcoming Medicare seminar or give us a call at 858-943-7053.