NEW TO MEDICARE
Medicare is a health insurance program for:
- people age 65 or older,
- people under age 65 with certain disabilities, and
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare has:
Part A Hospital Insurance- Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Medicare Advantage Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a preferred provider organization (PPO) or a health maintenance organization (HMO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2026, the standard Part B premium amount is $202.90 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.
Will I have to Pay A Late Enrollment Penalty?
The Medicare late enrollment penalty is a financial penalty imposed on individuals who delay enrolling in certain parts of Medicare when they are first eligible. For Medicare Part B (medical insurance) and Part D (prescription drug coverage), there is a penalty if someone doesn't enroll during their initial enrollment period and doesn't have creditable coverage from another source, such as employer-sponsored insurance. The late enrollment penalty is a percentage of the standard premium and is added to the individual's premium for each full 12-month period they were eligible for but did not enroll. This penalty remains for as long as the individual has Medicare Part B or Part D coverage. It's important to note that the penalty is avoidable by enrolling in Medicare during the initial enrollment period or during special enrollment periods triggered by qualifying events. Individuals who may be subject to a late enrollment penalty should carefully consider their enrollment timing and understand the potential long-term financial consequences of delaying enrollment in Medicare.
Different Types of Medicare Advantage Plans
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage Plans include the following:
Preferred Provider Organization (PPO)
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.
Health Maintenance Organization (HMO)
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan's list except in an emergency. You may also need to get a referral from your primary care doctor to see other doctors or specialists.
Private Fee-for-Service (PFFS)
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Chronic Special Needs (CSNP)
Medicare SNPs are a type of Medicare Advantage Plan (like an PPO or HMO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
NEW TO MEDICARE
Medicare is a health insurance program for:
- people age 65 or older,
- people under age 65 with certain disabilities, and
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare has:
Part A Hospital Insurance- Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Medicare Advantage Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a preferred provider organization (PPO) or a health maintenance organization (HMO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2026, the standard Part B premium amount is $202.90 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.
Will I have to Pay A Late Enrollment Penalty?
The Medicare late enrollment penalty is a financial penalty imposed on individuals who delay enrolling in certain parts of Medicare when they are first eligible. For Medicare Part B (medical insurance) and Part D (prescription drug coverage), there is a penalty if someone doesn't enroll during their initial enrollment period and doesn't have creditable coverage from another source, such as employer-sponsored insurance. The late enrollment penalty is a percentage of the standard premium and is added to the individual's premium for each full 12-month period they were eligible for but did not enroll. This penalty remains for as long as the individual has Medicare Part B or Part D coverage. It's important to note that the penalty is avoidable by enrolling in Medicare during the initial enrollment period or during special enrollment periods triggered by qualifying events. Individuals who may be subject to a late enrollment penalty should carefully consider their enrollment timing and understand the potential long-term financial consequences of delaying enrollment in Medicare.
Different Types of Medicare Advantage Plans
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage Plans include the following:
Preferred Provider Organization (PPO)
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.
Health Maintenance Organization (HMO)
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan's list except in an emergency. You may also need to get a referral from your primary care doctor to see other doctors or specialists.
Private Fee-for-Service (PFFS)
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Chronic Special Needs (CSNP)
Medicare SNPs are a type of Medicare Advantage Plan (like an PPO or HMO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
We are staffed by proven insurance and investment professionals committed to providing our clients with highly personalized service.
Other Links
Address
By Appointment Only
(405) 229-9544 - Sarah
