Medicare

Upon turning 65 years old, you'll be eligible for Medicare coverage, as a way to supplement or completely replace your existing health insurance coverage. Through the use of your Medicare card, the government provides Original Medicare at this time, also known as Medicare Part A and Medicare Part B. For those who remain on employer-sponsored health insurance and have paid into Medicare for 40 work quarters (or have a spouse who has), you should only select Medicare Part A. For those losing employer-sponsored health insurance or any other health insurance, you sign up with social security for Medicare Part A and Part B. Part B eligibility is always contingent on losing formerly credible health insurance coverage from another source. For 2025, the standard Part B premium is $185 per month. Depending on your income, you may pay more or less but if you have a premium, you must continue to pay it. 

If you have Medicare Part A and Part B, you have two options to further enhance your Medicare coverage. 

1) Medicare Part C or Medicare Advantage- Health Insurance plans provided by private insurance companies that offer at least the same level of benefits as Original Medicare but can also include extra perks such as dental, vision and hearing services. With this arrangement, you forfeit Original Medicare and agree to accept the terms and conditions of the insurance company's provider network. Essentially, the insurance company is the boss! Some Medicare Advantage plans include Original Medicare's network with out of network benefits. Most Medicare Advantage plans include credible drug coverage, otherwise known as Part D coverage. 

2) Medicare Supplement Insurance or Medigap- Administered by various private insurance companies, different coverage levels will help pay for additional out-of-pocket costs(deductibles, copays, coinsurance) not covered by Original Medicare Part A and Part B. Typically, the more expensive the Medigap plan is in premium( denoted by letters such as Plan G or Plan K), the more of Original Medicare out-of-pocket costs it covers. With Medigap, despite the insurance company you choose, your network is still Original Medicare. We say "you are the boss" in this arrangement. Prior authorizations, referrals, network limitations, etc don't get in the way like it does with Medicare Advantage.  

Part D or Medicare Prescription Drug Benefit- With Medigap, you will probably have to buy Part D coverage separately. Part D coverage or alternative credible prescription coverage is required at all times for anyone who qualifies for Medicare. Medicare Advantage plans usually cover prescriptions as well, signified as an MAPD(Medicare Advantage Prescription Drug) plan. Without it, a penalty is assessed by the government.