Medicare 101
Plain-English answers to what Medicare is, how it works, and what you need to do. No jargon.
What Is Medicare?
Medicare is the federal health insurance program for people 65 and older, plus certain younger people with disabilities. It's made up of different "parts" — each covering different types of care. Understanding the basics helps you make smart choices and avoid costly mistakes.
Questions? Call Bryan at 281-254-0139 — explaining this is what we do every day.
Step 1 — The Foundation Everyone Starts With
Parts A and B are the core of Medicare. Almost everyone enrolls in both.
Part A
Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.
Cost: Most people pay $0 premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
Part B
Medical Insurance
Covers doctor visits, outpatient care, preventive services, lab tests, X-rays, durable medical equipment, and some home health services.
Cost: The standard 2026 Part B premium is $185/month. Higher-income individuals may pay more (IRMAA surcharge).
Step 2 — Choose One Coverage Path
Parts A and B alone don't cover everything. After enrolling, you pick one of the two options below — not both.
Medicare Advantage
Part C
A private plan that replaces Original Medicare and bundles your Part A and B coverage — often adding Part D, dental, vision, and hearing too.
Cost: Many plans have $0 additional premium. You pay copays when you use care. Doctor networks apply.
Drug coverage: Usually included in the plan.
🏙️ Tip: Pair your Advantage plan with a Hospital Indemnity plan to cover daily hospital copays your MAPD doesn't pay.
Medicare Supplement
Medigap
A private policy that works alongside your Original Medicare — covering the copays, deductibles, and coinsurance that Parts A and B leave behind.
Cost: Higher monthly premium ($100–$300+), but very predictable out-of-pocket costs. See any Medicare-accepting provider, nationwide.
Drug coverage: Add a standalone Part D plan (below).
Not sure which path is right for you? Call Bryan free at 281-254-0139 — he'll walk through both options with your doctors and budget in mind.
Enrollment Windows — When to Sign Up
Timing is critical. Missing your window can mean permanent penalties. Here's what you need to know.
Initial Enrollment Period (IEP) — When You Turn 65
A 7-month window: 3 months before your 65th birthday month, the month you turn 65, and 3 months after. This is your first chance to enroll in Parts A, B, and a drug/supplement plan. Don't miss it.
Special Enrollment Period (SEP) — If You're Still Working
If you have employer coverage when you turn 65, you can delay Medicare without penalty. Once you retire or lose that coverage, you get an 8-month SEP to enroll in Part B penalty-free. Important: employer must have 20+ employees for this to apply.
General Enrollment Period — If You Missed Your Window
January 1 – March 31 each year. Coverage begins July 1. Late enrollment penalties apply permanently — 10% per year for Part B, 1% per month for Part D. Call us before this happens so we can minimize the impact.
Annual Open Enrollment — For Plan Changes
October 15 – December 7 each year. Switch from Original Medicare to Advantage (or vice versa), change Advantage plans, or add/change a Part D drug plan. Changes take effect January 1. We contact all clients every fall to review.
What Medicare Doesn't Cover
Knowing the gaps helps you plan. These are the most common surprises.
Routine Dental
Original Medicare doesn't cover cleanings, fillings, extractions, or dentures. Many Medicare Advantage plans include basic dental — standalone plans are also available year-round.
Routine Vision
Eye exams for glasses/contacts and eyewear are not covered. Some Advantage plans include vision benefits. Standalone vision plans are available.
Hearing Aids
Original Medicare doesn't cover hearing aids or most exams to fit them. Some Advantage plans offer hearing benefits. Standalone options exist.
Long-Term Care
Medicare covers short-term skilled nursing after a hospital stay, but not custodial care (help with daily living). Long-term care insurance is a separate product.
Still Have Questions?
That's what we're here for. Every person's Medicare situation is different, and a 15-minute call with Bryan can save you hundreds — or thousands — of dollars and a lot of confusion.
Free, no obligation, no pressure.