Medicare

WHAT IS MEDICARE?  

Medicare insurance is designed for individuals aged 65 and older, as well as those under 65 with specific disabilities. Additionally, Medicare extends its coverage to individuals with End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig's disease.

Original Medicare: Doctor and Hospital Choice  

With Original Medicare, you can choose any doctor or hospital that accepts Medicare, anywhere in the U.S.

Original Medicare: Cost  

It’s important to note that Medicare does not cover all healthcare expenses!  

For services covered under Part B, you typically pay 20% of the Medicare-approved amount after meeting your deductible, which is referred to as coinsurance.  

For 2026, the deductible for Part A is $1,736 for each benefit period, while the Part B deductible stands at $283.00.  

You will also have a monthly premium for Part B, and if you opt for a Medicare drug plan, you'll pay a separate premium for your Medicare Part D coverage.  

There is no annual limit on your out-of-pocket expenses unless you have supplemental insurance, commonly known as Medigap.  

Choosing Medigap can help cover your remaining out-of-pocket costs, such as your 20% coinsurance. Alternatively, you may have coverage from a former employer or union, or through Medicaid.

When! When do you sign up for Medicare?  

A crucial question many have about Medicare is, "When do I sign up?" Other important questions include, "What if I move?" and "If I am on SSDI (Social Security Disability Income) and currently enrolled in Original Medicare, what are my next steps?"  

Click here to learn more about when you can sign up for Medicare and how different plans, including Medicare Advantage, could impact your coverage.

PARTS OF MEDICARE

The ABC's and D of Medicare

Part A: Hospital Insurance, Premium-free for most people, and helps cover:

Inpatient hospital stays, including rehabilitation hospital and psychiatric hospital care. Skilled nursing facilities. Hospice. Home Health Care (in some cases).

Part B: Medical Insurance

The standard Part B premium for 2026 is $202.90 (or higher depending on your income) and helps cover: Most medically necessary doctors' services. Preventive Physician care. Outpatient hospital care and surgery, home health care, durable medical equipment. Mental Health Care.

Part B coverage is optional, though you may be charged a penalty fee if you are without coverage and later want to enroll in Part B.

Part C: Also Known as "Medicare Advantage"

Medicare Advantage is another way to get your Medicare benefits, combining Medicare Part A, Part B, and often Medicare Part D. These plans are run by private approved insurers and provide benefits through Medicare Advantage instead of Original Medicare (Parts A and B).

Part D: Prescription Drug Coverage

Medicare Part D helps cover prescription drug costs and is run by private approved insurers. It may help lower prescription drug costs.

Part D coverage is optional, though you may be charged a penalty fee if you are without prescription drug coverage and later want to enroll in a Part D plan.

Medicare Supplement (Medigap)

Medigap plans are supplemental insurance plans sold by private insurance companies to fill "gaps" in Original Medicare coverage. You can choose from a range of standardized plans, each offering different coverage. These plans are designed to supplement your Original Medicare plan and can help pay Part A and B co-payments, Part A and B coinsurance, and Part A and B deductible.

SSDI: DID YOU KNOW?

According to the law, your SSDI (Social Security Disability Insurance) payments cannot begin until you have been disabled for at least five full months. Typically, your payments will start in the sixth month of your disability. Additionally, if you are approved for SSDI, you need to wait a full two years after that period passes before your Medicare coverage begins—totaling 24 months.

What Medicare coverage is available to people with disabilities?

In simple terms, Medicare coverage is accessible to individuals who qualify due to their disability, just as it is for those who qualify based on age. All individuals eligible for Medicare can receive a comprehensive range of benefits. Importantly, the health care services covered do not need to be related to your disability. This coverage includes certain hospitals, nursing homes, home health services, your doctors, and community-based services.

Can I sign up for a Medigap (Supplemental) Plan or a Medicare Advantage Plan?

Some insurance companies might choose to offer Medigap (Supplemental) policies to individuals under age 65, even in states where this is not mandated. 

If you lack prescription drug coverage from another source that is comparable to Medicare, you should consider enrolling in a Medicare Part D (PDP) Plan.

Alternatively, you could explore receiving your Medicare-covered benefits, including prescription drugs, through a Medicare Advantage Plan available from private insurance companies, such as an HMO or PPO. However, keep in mind that access to providers may be more limited with these plans.

It is important to note that Medicare Advantage Plans cannot deny coverage to people with Medicare based on their health status or pre-existing conditions.

Confused?

Call us. The consultation is completely free of charge!