Medicare 101
Medicare, explained simply
Medicare is our country’s health insurance program for people 65 or older and younger people receiving Social Security disability benefits. It helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.
The parts of Medicare
A, B, C and D at a glance
Original Medicare is Parts A and B. Most people then choose how to fill the gaps: a Medicare Advantage plan, or a Supplement plus drug coverage.
Hospital insurance
Inpatient hospital stays, skilled nursing facility care, hospice and some home health care. Most people pay no monthly premium for Part A if they or a spouse worked and paid Medicare taxes long enough.
Medical insurance
Doctor visits, outpatient care, preventive services and medical equipment. Part B has a monthly premium.
Medicare Advantage
Plans from private companies approved by Medicare that combine Parts A and B, and often Part D, usually through a network of doctors such as an HMO. Many include extra benefits.
Prescription drugs
Drug coverage offered by private plans, either on its own alongside Original Medicare or built into a Medicare Advantage plan.
Path one
Medicare Advantage
- One plan in place of Parts A and B
- Often includes drug coverage
- Uses a network of doctors and hospitals
- May include extra benefits
Path two
Original Medicare + Supplement
- Parts A and B from Medicare
- A Supplement (Medigap) helps pay deductibles and coinsurance
- A separate Part D plan for drugs
- See any doctor who accepts Medicare
Key dates
When you can enroll or make changes
Around your 65th birthday
A 7 month window: the 3 months before the month you turn 65, that month, and the 3 months after.
Annual Enrollment
Join, switch or drop a Medicare Advantage or drug plan. Changes start January 1.
Medicare Advantage Open Enrollment
If you are in a Medicare Advantage plan, you can make one change to another plan or return to Original Medicare.
Special Enrollment
Life events like moving, retiring or losing employer coverage can open a window to change coverage.
Questions
Common Medicare questions
Every situation is different. Dora is happy to answer yours one on one.
Do I have to sign up for Medicare at 65?
It depends. If you are still covered by an employer plan you may be able to delay Part B without a penalty. If not, signing up during your Initial Enrollment Period helps you avoid late enrollment penalties. Dora can look at your situation with you.
What is the difference between Medicare Advantage and a Supplement?
Medicare Advantage replaces how you receive Parts A and B through a private plan, usually with a network. A Supplement works alongside Original Medicare and helps pay your share of the costs.
What is Extra Help?
Extra Help, also called the low income subsidy, is a Medicare program that helps people with limited income and resources pay prescription drug costs. Dora assists with the application.
Can I have Medicare and Medi-Cal?
Yes. Some people qualify for both, and there are plan types designed for people who do. Dora can explain how they work together.
Does it cost anything to meet with Dora?
No. Your consultation is free and there is no obligation.
Free consultation
Questions about your own coverage?
Tell Dora a little about your situation and she will call you back to set up a free, no obligation consultation. Prefer to talk now? Just call.
- No cost and no obligation to talk it through
- Meet in person or by phone from home
- English or Spanish, whichever you prefer