Medicare is a federal health insurance program for people age 65 or older and for certain individuals under 65 with qualifying disabilities or medical condition

• Part A: Hospital insurance (inpatient care, skilled nursing, hospice)

• Part B: Medical insurance (doctor visits, outpatient care, preventive services)

• Part C: Medicare Advantage – combines Parts A & B and often Part D

• Part D: Prescription drug coverage

• Medigap: Medicare Supplement plans to help pay your out-of-pocket costs with Original Medicare

• You’re automatically enrolled if you’re already receiving Social Security. Otherwise, you’ll apply through the Social Security Administration at ssa.gov/medicare or by calling 1-800-772-1213.

• Yes, if you have creditable employer coverage. It’s important to verify this with your employer to avoid penalties later.

• No. You are responsible for 20% of your medical costs unless you have a Medigap plan or enroll in a Medicare Advantage plan with built-in cost protection.

• These plans are offered by private insurance companies and may include medical, hospital, prescription, dental, vision, hearing, transportation, and more. They usually have lower monthly premiums but may come with copays and network restrictions.

• A Medigap plan works with Original Medicare to pay for deductibles, coinsurance, and other out-of-pocket costs. You can use any doctor nationwide that accepts Medicare.

• If you miss your 6-month Medigap Open Enrollment Period (which starts when you're both 65+ and have Part B), you may have to answer health questions to get coverage. Some companies can deny you or charge more based on your health..

• Yes. After your initial enrollment window, Medigap plans typically require medical underwriting. If you’ve had a major illness or surgery, you might not qualify or may face higher premiums.

• No, you’re not required to get a Medicare Supplement plan—but it’s important to understand the consequences of skipping it.

  Original Medicare (Parts A and B) doesn’t cover everything. Without a supplement plan, you’re responsible for 20% of your medical costs with no out-of-pocket limit. That means if you face a major illness or hospitalization, those bills can add up fast.

  If you choose not to enroll in a Medigap plan during your Medicare Supplement Open Enrollment Period (which starts when you're 65 or older and enrolled in Part B), you may be subject to underwriting later—meaning insurance companies can deny you coverage or charge higher premiums due to your health history.

  So while it’s optional, skipping a supplement can leave you financially exposed, especially as you age or if unexpected health issues arise. If you're unsure, let’s schedule a Medicare planning session to discuss the best fit for your needs.

• No. You cannot have both at the same time. You must choose one or the other.

• Many Medicare Advantage plans have networks, prior authorizations, and limited coverage for out-of-state emergencies, long-term care, and some expensive treatments like certain cancer drugs.

• Yes. A separate cancer or critical illness policy can help pay lump-sum cash benefits if you’re diagnosed with a serious condition. This helps cover things Medicare or Advantage plans may not, like travel for treatment or lost income.

• These are not covered by Original Medicare but may be included in Medicare Advantage plans or purchased separately as standalone policies.

• No, Medicare doesn’t cover custodial care like assisted living or nursing home stays beyond short-term rehab. A long-term care insurance policy or hybrid life policy can help cover these costs.

• Final expense (or burial insurance) is a simple way to ensure loved ones aren’t left with the burden of funeral costs and small debts. These policies are usually affordable and don’t require medical exams.

• Part D is optional coverage for prescription drugs. You can get it through a standalone plan or as part of a Medicare Advantage plan. Each plan has its own list of covered drugs (formulary) and cost tiers.

• If you don’t have other creditable drug coverage (like from an employer or the VA), then yes—getting Medicare Part D is highly recommended. Without it, you could face:

  • A lifetime penalty added to your premium if you delay enrollment

  • High out-of-pocket costs for medications

  • Limited access to affordable prescriptions when you need them most

  Even if you don’t take medications now, a basic plan can protect you from future expenses and penalties.

  Tip: If you’re unsure, I can help you review your current situation and make sure you’re covered.

• A formulary is a list of medications a plan covers, sorted into cost tiers:

  • Tier 1: Preferred generics – lowest cost

  • Tier 2: Generic drugs – low cost

  • Tier 3: Preferred brand-name – moderate cost

  • Tier 4: Non-preferred brand – higher cost

  • Tier 5: Specialty drugs – highest cost

• Yes! One plan may list a drug in Tier 2, while another places it in Tier 3. This can significantly affect your cost—so it’s important to compare.

• Extra Help (Low-Income Subsidy) helps pay for your Medicare Part D premiums, deductibles, and copays if you meet certain income and resource requirements.

• Apply online at ssa.gov/extrahelp or call Social Security at 1-800-772-1213. We can also assist with your application.

• You may qualify automatically if you’re on Medicaid or receiving Supplemental Security Income (SSI), but it’s best to check your status.

• Qualified Medicare Beneficiary (QMB):
  This program helps pay for your Medicare Part A and Part B premiums, as well as deductibles, coinsurance, and copayments. If you're eligible, you won’t have to pay anything out of pocket for covered services under Medicare.

• Specified Low-Income Medicare Beneficiary (SLMB):
  This program helps cover your Medicare Part B premium only. It's designed for people with limited income and resources who don't qualify for full Medicaid.

• Qualifying Individual (QI):
  Like SLMB, the QI program helps pay for your Medicare Part B premium, but it allows for slightly higher income limits. You must reapply every year, and funds are granted on a first-come, first-served basis.

• Qualified Disabled and Working Individual (QDWI):
  This program helps certain disabled individuals who are working and lost their premium-free Part A due to returning to work. It helps pay the Medicare Part A premium

• Your IEP is a 7-month window: 3 months before your 65th birthday, your birthday month, and 3 months after.

• Yes. If you delay enrolling in Part B or Part D without creditable coverage, you may face lifetime penalties added to your monthly premiums.

• If you delayed enrollment and don’t qualify for a Special Enrollment Period, you may have to wait until the next General Enrollment Period and could face penalties. Medical underwriting may also apply for Medicare Supplement plans.

• Enroll during your IEP

• Confirm employer coverage is creditable

• Contact us if you’re unsure—we can help you avoid costly mistakes

• • Annual Enrollment Period (AEP): Oct 15–Dec 7

  • Open Enrollment Period (OEP): Jan 1–Mar 31 (for Medicare Advantage changes)

  • Special Enrollment Period (SEP): For qualifying life events like retirement or loss of employer coverage

• CHIP: Children's Health Insurance Program (for dependent grandchildren if applicable)

• SHIP: State Health Insurance Assistance Program—provides free, unbiased Medicare counseling

• What it is: Offers free, local, unbiased counseling and assistance to Medicare-eligible individuals and their families.

• Phone Number: 1-877-839-2675

• Website: https://www.shiphelp.org

• Medicare fraud includes false billing, misusing your Medicare number, and offering services you didn’t request.

• • Keep your Medicare card secure

  • Review your Medicare statements regularly

  • Don’t respond to unsolicited calls or home visits

  • Only give your Medicare number to trusted providers

  How do I report suspected fraud?
  Call 1-800-MEDICARE (1-800-633-4227)
  Visit: www.Medicare.gov
  Contact your local Senior Medicare Patrol: www.smpresource.org

We recommend beginning your planning at least 6 months before your 65th birthday or retirement date.

1. Watch the Medicare 101 Webinar

2. Apply for Medicare through SSA.gov

3. Schedule your Medicare Planning Session with us

4. Review options for Part D, Advantage, and Supplements

5. Consider applying for Extra Help or Medicaid if eligible

6. Complete enrollment and track plan start dates

7. Stay informed annually—plans and benefits change!

If you miss your IEP and don’t qualify for a Special Enrollment Period, you may have to wait until the General Enrollment Period (Jan 1–Mar 31) and pay a late enrollment penalty.

Yes, you can make changes during Open Enrollment (Oct 15–Dec 7), or if you qualify for a Special Enrollment Period due to life events (like moving or losing employer coverage).

It’s a temporary coverage gap in Medicare prescription drug plans. After you and your plan spend a certain amount, you pay a higher share of drug costs until you reach catastrophic coverage.

It depends on your plan. Original Medicare does not require referrals. Medicare Advantage plans (especially HMOs) may require them.

No. You can continue Medicare while working. If you get employer coverage, you may delay or coordinate Part B depending on the size of the company.

Each Part D plan has a formulary (drug list). It’s important to compare plans each year to see if your medications are covered and what tier they’re in.

You may need to find an in-network provider or switch to a different plan. Medicare Advantage plans often have limited networks.

Call 1-800-MEDICARE (1-800-633-4227) or your local SHIP office. Always check your statements and report anything suspicious.