Medicare Solutions
Medicare, explained without the sales pitch.
Turning 65? Already enrolled and unsure you're in the right plan? Start here. Everything below is education first — you can read the whole page and never talk to us, and that's fine.
Start Here
Medicare basics in four parts
Almost all of Medicare's confusion comes from one thing: there are four parts, and they don't work the way people assume. Here they are.
| Part | What it covers | What people miss |
|---|---|---|
| Part A Hospital | Inpatient hospital stays, skilled nursing, hospice, some home health. | Usually premium‑free if you or your spouse worked 40 quarters — but it still has a deductible. |
| Part B Medical | Doctor visits, outpatient care, lab work, preventive services, durable medical equipment. | It has a monthly premium and covers roughly 80% after the deductible. The other 20% has no cap. |
| Part C Medicare Advantage | A private plan that replaces A and B and usually bundles drug coverage and extras. | Networks and prior authorization apply. Your doctor must be in the plan. |
| Part D Prescriptions | Outpatient prescription drugs through a private plan. | Each plan has its own formulary. The right plan depends on your exact medication list. |
The single most important thing on this page
Original Medicare (Parts A and B) has no annual out‑of‑pocket maximum. That 20% coinsurance on Part B keeps going with no ceiling. Everything else — Advantage plans, Supplements — exists to solve that one problem. Understand that and the rest of Medicare makes sense.
Turning 65
Your Initial Enrollment Period
You get a seven‑month window built around your 65th birthday month. Miss it without a valid exception and you can face a late enrollment penalty that lasts as long as you have Medicare.
Three months before your birthday month
Your window opens. This is the best time to enroll — coverage starts the first day of your birthday month with no gap.
Your birthday month
Still open, but coverage now starts the following month. You may have a gap.
Three months after your birthday month
Last chance in your initial window. Coverage starts the month after you sign up.
Still working past 65 with employer coverage?
You may be able to delay Part B penalty‑free through a Special Enrollment Period — but the rules depend on your employer's size and whether the coverage is creditable. Get this one checked before you decide. It's the most expensive mistake we see.
Other enrollment periods worth knowing
- Annual Enrollment Period, October 15 – December 7. Change your Advantage or Part D plan for the coming year.
- Medicare Advantage Open Enrollment, January 1 – March 31. If you're already in an Advantage plan, you get one change.
- Special Enrollment Periods. Moving, losing employer coverage, and certain other life events can open a window outside the normal dates.
- Medigap open enrollment. The six months starting when your Part B begins, when you can buy any Supplement without medical underwriting. This window does not come back.
The Big Decision
Medicare Advantage or Medicare Supplement?
This is the fork in the road. Neither one is better. They're built for different priorities, and the right answer depends on your doctors, your health and your budget.
Medicare Advantage (Part C)
A private plan that takes over for Parts A and B, usually with drug coverage built in.
Tends to fit people who
- Want a low or $0 monthly premium
- Are comfortable using a network of doctors
- Want dental, vision, hearing or fitness extras bundled in
- Want a single card and one plan to manage
Trade‑offs to understand
- You pay as you go — copays at each visit, up to an annual maximum
- Provider networks and referral rules apply
- Some services need prior authorization
- Benefits and networks can change every January
Medicare Supplement (Medigap)
Keeps you on Original Medicare and pays the gaps it leaves behind. Drug coverage is bought separately.
Tends to fit people who
- Want predictable costs and very few surprise bills
- See specialists often or travel frequently
- Want to use any provider in the country who takes Medicare
- Would rather pay a higher premium than face variable bills
Trade‑offs to understand
- Higher monthly premium, and premiums generally rise with age
- No dental, vision, hearing or fitness extras included
- You need a separate Part D plan
- Outside your one‑time open enrollment window you can be medically underwritten and declined
The question that decides it for most people
Would you rather pay more every month and almost never get a bill, or pay little every month and handle copays as they come? There is no wrong answer. There is only the one that matches how you want to live.
Part D
Prescription drug plans
Choosing a Part D plan on premium alone is the most common and most expensive Medicare mistake. The cheapest plan is frequently the costliest one for your actual prescriptions.
Every plan publishes a formulary — its own list of covered drugs, sorted into tiers with different copays. Two plans with nearly identical premiums can differ by thousands of dollars a year depending on whether your specific medications sit on tier 2 or tier 4, and whether your pharmacy is preferred.
What we need to run this properly for you
- Every prescription you take, with the exact dosage
- How often you take each one
- The pharmacy you prefer
- Whether you use mail order
With that list we can compare total annual cost — premium plus deductible plus your actual copays — across the plans available in your county, and tell you which one genuinely costs you least.
Late enrollment penalty
If you go 63 days or more without creditable drug coverage after your Initial Enrollment Period, a permanent penalty is added to your Part D premium for as long as you have Part D. Even people who take no medications usually should enroll in an inexpensive plan to avoid it.
Every Fall
Your annual review
Plans change every January. Your health changes too. A plan that was perfect two years ago may be the wrong plan today — and you'd never know unless someone checked.
What changes without you doing anything
- Premiums, deductibles and copays adjust
- Drug formularies get reshuffled — your medication can move tiers or drop off entirely
- Provider networks add and remove doctors and hospitals
- Extra benefits get added or quietly reduced
- Some plans leave your county completely
Every fall during the Annual Enrollment Period, October 15 through December 7, we sit down with our clients and re‑run the numbers against their current medications and doctors. Sometimes the answer is "stay where you are." That's a good outcome too, and we'll tell you so.
Read your Annual Notice of Change
Your plan mails it every September. It is the document that tells you exactly what is changing on January 1. Most people throw it away. Bring it to us instead.
Common Questions
Medicare FAQ
Does it cost me anything to work with you?
No. Our services are free to you. When you enroll in a plan, the insurance carrier compensates us. Your premium is exactly the same whether you enroll through us, through another agent, or directly with the carrier.
Do you represent every plan available in my area?
No, and no agent does. We represent a specific set of carriers, disclosed in the footer of this site. For a complete picture of every option, contact Medicare.gov, call 1‑800‑MEDICARE, or reach your State Health Insurance Assistance Program. We'll say plainly if the best fit for you is something we don't carry.
I'm still working at 65. Do I have to enroll?
It depends on your employer's size and whether their coverage is considered creditable. Getting this wrong can mean lifetime penalties or a gap in coverage. Please have it reviewed before your birthday month rather than after.
Can I switch from Medicare Advantage to a Supplement later?
Sometimes, but not freely. Outside your one‑time Medigap open enrollment window, most Supplement applications are medically underwritten and can be declined. This is why the initial decision deserves real thought.
What does Medicare not cover?
Original Medicare generally does not cover routine dental, routine vision, hearing aids, or long‑term custodial care. Some Advantage plans include limited dental, vision and hearing benefits. Standalone supplemental products can cover others. We'll map your gaps together.
What should I bring to our first meeting?
Your red, white and blue Medicare card if you have it, a complete list of your prescriptions with dosages, a list of the doctors you want to keep, and any Annual Notice of Change letter you received. That's enough to give you a real answer.
Let's find out what actually fits your situation.
No cost. No pressure. A straight conversation about what you have, what you need, and what it really costs.