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Free Education Guide
Medicare 101
Everything you need to understand Medicare — Parts A through D, enrollment windows, costs, and the most common mistakes to avoid. Free, clear, and no pressure.
The Basics
What Is Medicare?
Medicare is a federal health insurance program primarily for people age 65 and older. It is also available to some younger individuals with certain disabilities or health conditions.
Age 65+
Most people become eligible when they turn 65, regardless of health status.
SSDI Recipients
Those who have received Social Security Disability Insurance for 24 months automatically qualify.
Certain Conditions
People with End-Stage Renal Disease (ESRD) or ALS may qualify at any age.
The Building Blocks
Medicare Parts A, B, C & D
Medicare is divided into parts, each covering different types of care. Understanding what each part covers — and what it costs — is the foundation of making good coverage decisions.
Part A
Hospital Insurance
What It Covers
- Inpatient hospital stays
- Skilled nursing facility care (after qualifying hospital stay)
- Hospice care
- Some home health services
What It Does NOT Cover
- Private room upgrades
- Long-term custodial care
Cost Overview
Most people pay $0 premium if they or their spouse worked 40+ quarters. Deductibles and coinsurance apply.
Part B
Medical Insurance
What It Covers
- Doctor visits and outpatient care
- Preventive services (screenings, vaccines)
- Durable medical equipment
- Mental health services
- Some home health care
What It Does NOT Cover
- Dental, vision, hearing (routine)
- Cosmetic procedures
Cost Overview
Standard premium is $185/month in 2025. Higher earners pay more (IRMAA). Annual deductible applies.
Part C
Medicare Advantage
What It Covers
- Everything in Parts A & B
- Often includes dental, vision, hearing
- May include fitness benefits
- Prescription drug coverage (usually)
What It Does NOT Cover
- Out-of-network providers (in some plans)
- Coverage outside the plan's service area
Cost Overview
Offered by private insurers. Premiums vary — some plans are $0/month. You still pay your Part B premium.
Part D
Prescription Drugs
What It Covers
- Prescription medications on the plan's formulary
- Vaccines not covered under Part B
What It Does NOT Cover
- Drugs not on the formulary
- Some over-the-counter medications
Cost Overview
Premiums vary by plan. Late enrollment penalty applies if you go without creditable coverage.
Timing Is Everything
Enrollment Periods Explained
When you enroll in Medicare matters. Missing the right window can result in permanent penalties or gaps in coverage.
Initial Enrollment Period (IEP)
Most CommonA 7-month window centered around your 65th birthday — 3 months before, your birthday month, and 3 months after.
Enrolling in the first 3 months ensures your coverage starts on time.
General Enrollment Period (GEP)
January 1 – March 31 each year. For those who missed their IEP. Coverage starts July 1.
Late enrollment penalties may apply if you missed your IEP without a qualifying reason.
Special Enrollment Period (SEP)
If you have employer coverage through active work, you can delay Medicare without penalty and enroll later when that coverage ends.
Retirement coverage (COBRA, retiree insurance) does NOT qualify for SEP — only active employer coverage does.
Annual Enrollment Period (AEP)
October 15 – December 7 each year. Switch between Original Medicare and Medicare Advantage, or change Part D plans.
Changes made during AEP take effect January 1 of the following year.
What to Watch For
5 Common Medicare Mistakes
These are the most frequent — and most costly — errors people make when navigating Medicare for the first time.
Missing your enrollment window
Enrolling late without a qualifying Special Enrollment Period can result in permanent premium penalties for Part B and Part D.
Assuming Medicare covers everything
Original Medicare does not cover routine dental, vision, hearing, or long-term care. Planning for these gaps is essential.
Relying on COBRA or retiree insurance
These do not count as active employer coverage and will not qualify you for a Special Enrollment Period.
Choosing a plan without checking your doctors
Medicare Advantage plans have networks. Always verify your preferred doctors and hospitals are in-network before enrolling.
Confusing Medicare Advantage with Medigap
These are very different products. Medicare Advantage replaces Original Medicare; Medigap supplements it. They cannot be used together.
Plain Language
Medicare Glossary
Medicare comes with a lot of terminology. Here are the key terms explained in plain language.
Premium
The monthly amount you pay for your Medicare coverage, regardless of whether you use medical services.
Deductible
The amount you pay out-of-pocket before Medicare starts paying its share.
Copayment
A fixed dollar amount you pay for a covered service (e.g., $20 per doctor visit).
Coinsurance
Your share of costs after meeting your deductible, expressed as a percentage (e.g., 20% of the Medicare-approved amount).
Formulary
The list of prescription drugs covered by a Part D or Medicare Advantage plan.
IRMAA
Income-Related Monthly Adjustment Amount — higher-income beneficiaries pay more for Parts B and D.
Medigap
Supplemental insurance sold by private companies to help cover costs Original Medicare doesn't pay (also called Medicare Supplement).
Creditable Coverage
Drug coverage that is at least as good as Medicare Part D. Having this lets you delay Part D without penalty.
Ready to Talk Through Your Options?
Ana-Cristina is here to answer your questions — in English or Spanish — with no pressure and no obligation.