Medicare

Understanding Medicare Doesn't Have to Be Complicated

Medicare can be difficult to understand, especially when you are approaching age 65 or trying to decide whether to stay with Original Medicare or consider Medicare Advantage.

At A&G Professional Group LLC, we believe the first step is understanding your options.

Our goal is to provide clear, educational information so you can make informed decisions about your Medicare coverage.

Need help understanding your options?
We're available to answer your questions and help you review the Medicare coverage options available in your area.

What Is Medicare?

Medicare is a federal health insurance program primarily for people age 65 and older. Some people may qualify for Medicare before age 65 because of certain disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).

Medicare coverage and enrollment rules can depend on your age, work history, disability status, Social Security benefits, and other circumstances.

Because everyone's situation is different, understanding when and how to enroll is an important first step.

📋 Next Medicare Annual Election Period starts Oct 15, 0 days away. Get free guidance now.

What Are the Parts of Medicare?

Medicare has several parts that work together in different ways.

There are 2 main ways to get your Medicare coverage: Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). There is also Medicare Part D.

  • Medicare Part A covers: hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.

  • Medicare Part B covers, including doctor and other health care providers' services and outpatient care. Part B also covers durable medical equipment, home health care, and some preventive services.

  • Medicare Part C, If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C”.

  • Medicare Part D only covers prescription drugs.

Part A - Inpatient Hospital Insurance Coverage

Any inpatient hospital care falls under Part A coverage. That includes:

Whether you pay a Part A premium can depend on your work history and other eligibility factors.

Part B - Outpatient Medical Coverage

Part B covers 2 types of services: 1) Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. 2) Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

  • Doctors' and other health care providers' services

  • Outpatient care

  • Preventive services

  • Durable medical equipment

  • Certain mental health services

  • Certain ambulance services

  • Other Medicare-covered medical services

Part B generally requires a monthly premium.

Part C - Medicare Advantage Plans

Medicare Advantage, also known as Medicare Part C, is offered by Medicare-approved private insurance companies.

Medicare Advantage plans provide your Medicare Part A and Part B coverage through the plan.

Many Medicare Advantage plans also include prescription drug coverage (Part D).

Depending on the plan and your location, Medicare Advantage plans may also include additional benefits.

Plan premiums, cost-sharing, provider networks, prescription drug coverage, and additional benefits vary by plan and service area.

Part D - Drug Coverage

Medicare Part D helps cover the cost of prescription medications.

You can generally obtain Part D coverage through:

  • A standalone Medicare Prescription Drug Plan (PDP), or

  • A Medicare Advantage plan that includes prescription drug coverage (MA-PD)

Drug formularies, premiums, deductibles, cost-sharing, pharmacies, and covered medications can vary by plan.

Your Medicare Coverage Choices

One of the most important decisions you may face is how you receive your Medicare coverage.

  • Part A + Part B

    You may also choose to add:

    • A Medicare Part D prescription drug plan

    • Medicare Supplement Insurance (Medigap)

    With Original Medicare, you can generally see any doctor or other provider that accepts Medicare, subject to Medicare's rules.

    Original Medicare does not have an annual out-of-pocket maximum for covered Part A and Part B services. Medicare Supplement Insurance may help pay certain costs that Original Medicare does not cover.

  • Medicare Advantage is an alternative way to receive your Medicare Part A and Part B benefits through a Medicare-approved private insurance company.

    Many Medicare Advantage plans include:

    • Part A coverage

    • Part B coverage

    • Prescription drug coverage

    • Provider networks

    • Plan-specific cost-sharing

    • Additional benefits that may vary by plan

    Medicare Advantage plans have an annual maximum out-of-pocket limit for covered Part A and Part B services.

    Plan availability, costs, provider networks, drug coverage, and benefits vary by county and plan.

Medicare - Eligibility

Most people are eligible for Medicare Part A and Part B when they turn 65. The rules can be confusing so we invite you to make a consultation with us. The criteria are usually essentially your age and your working status. It will also depend on whether you receive social security benefits.

And if I am not 65 years old, can I qualify for Medicare?

You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

When Can You Enroll in Medicare?

Your enrollment opportunities depend on your individual circumstances.

Initial Enrollment Period

For most people who are first becoming eligible because they are turning 65, the Initial Enrollment Period generally lasts 7 months:

  • 3 months before your 65th birthday month

  • Your birthday mont

  • 3 months after your birthday month

Your exact enrollment situation may depend on when you enroll and whether you are already receiving certain Social Security or Railroad Retirement benefits.

Annual Enrollment Period

The Medicare Annual Enrollment Period (AEP) generally runs from:

October 15 through December 7

During this period, people with Medicare can make certain changes to their Medicare coverage for the following year.

Changes made during AEP generally take effect January 1 of the following year.

Review your Medicare plan options by clicking

Medicare Advantage Open Enrollment Period

Generally runs from:

January 1 through March 31

This period is for people who are already enrolled in a Medicare Advantage plan.

During the MA OEP, eligible individuals may generally:

  • Switch to another Medicare Advantage plan, or

  • Leave Medicare Advantage and return to Original Medicare, with an opportunity to enroll in a Part D plan.

Special Enrollment Periods

Certain life events may provide an opportunity to enroll in or change Medicare coverage outside the standard enrollment periods.

Examples may include:

  • Losing employer or union coverage

  • Moving to a new service area

  • Changes in Medicaid eligibility

  • Qualifying for certain assistance programs

  • Moving into or out of certain institutions

  • Other circumstances recognized by Medicare

Special Enrollment Period rules vary depending on the specific situation.

If you believe you may qualify for a Special Enrollment Period, we can help you understand what information you may need to review your options.

What does Medicare cost?

Medicare costs can include premiums, deductibles, copayments, and coinsurance. Your actual costs depend on several factors, including:

  • The type of Medicare coverage you have

  • Your income

  • The services you receive

  • The plan you choose

  • Whether you qualify for financial assistance

  • Your eligibility for other Medicare programs

For example, under Original Medicare, Part B generally requires a monthly premium and beneficiaries generally pay a portion of Medicare-approved costs for covered services.

Medicare Advantage and Part D plans have their own premiums, deductibles, copayments, coinsurance, provider networks, and other cost-sharing requirements.

Plan costs and benefits can change from year to year.

For this reason, it is important to review your coverage during applicable enrollment periods.

There is no single Medicare option that is right for everyone.

When evaluating your choices, you may want to consider:

Doctors and Specialists

Are your preferred doctors and specialists available under the coverage you are considering?

Hospitals

Are the hospitals and facilities you use included?

Prescription Drugs

Are your medications covered, and what will you pay for them?

Monthly Premiums

What premiums will you pay for Medicare and your additional coverage?

Out-of-Pocket Costs

What deductibles, copayments, coinsurance, and maximum out-of-pocket amounts apply?

Travel

Does your coverage work for the way you travel or live during the year?

Additional Benefits

If considering Medicare Advantage, what additional benefits are included, and are they relevant to you?

Understanding these factors can help you make a more informed decision.

Talk to your licensed insurance agent to figure out which option makes the most sense for you.

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Talk to your licensed insurance agent to figure out which option makes the most sense for you. 〰️

How A&G Professional Group Can Help

Medicare decisions are personal.

Rather than focusing only on premiums or individual benefits, we encourage you to consider your overall healthcare needs, providers, prescriptions, budget, and eligibility.

A&G Professional Group LLC is an independent insurance agency. We can help you understand Medicare coverage options available in your area and explain how different types of coverage work.

We do not make the decision for you. Our role is to help you understand your options so you can make an informed choice.

Have questions about Medicare?

Contact us to discuss your situation.