We Decode the ABCs (and Ds) of Medicare So You Can Get Back to the Good Stuff
Medicare
Insurance Plans
Trying to understand Medicare can feel like learning a foreign language.
You turn 65 and bam — you’re expected to be an expert in insurance. But with every acronym, form, and phone call, you become even more confused than when you began.
You can try reading all the articles. You can ask your neighbor. But talking to someone who actually knows the system — and takes the time to walk you through it — makes a world of difference.
If you’re ready for clear, pressure-free Medicare guidance, talk to one of our local advisors.
New To Medicare?
What is Medicare?
Medicare is a federal health insurance program for:
- People 65 or older
- Younger individuals with disabilities (such as End-Stage Renal Disease or ALS)
What is the enrollment timeline?
Initial Enrollment Period starts 3 months before your 65th birthday and ends 3 months after.
Pro Tip: Missing it can result in late penalties or coverage gaps.
What’s not covered?
- Long-term care
- Dental
- Vision
- Hearing aids
- Most routine foot care
That’s why many people choose supplemental coverage (like a Medigap or Medicare Advantage plan) to fill in the gaps.
Ready to start exploring your Medicare options? Schedule a free consultation with an agent today!
Switching Plans
Timing Matters
Unfortunately, you can’t switch your Medicare plan whenever you want. Here are the specific windows:
Medicare Annual Enrollment Period (AEP): Oct 15 – Dec 7
You can switch Medicare Advantage or Part D plans.
Medicare Advantage Open Enrollment: Jan 1 – Mar 31
You can switch Medicare Advantage plans or go back to Original Medicare.
Coverage Is Subject to Change Year to Year
Keep in mind that even if you like your current plan this year, it might not be the best fit next year. Here’s what may change year to year:
- Premiums
- Copays
- Prescription drug formularies
- Network providers
- Extra benefits (like dental, vision, hearing)
Check Your Medications and Doctors
Not all plans cover the same drugs or work with the same providers. So before you switch, it’s important to ask yourself:
- Is my doctor in-network?
- Are my prescriptions covered, and how much will they cost?
Consider Total Cost, Not Just Premiums
Some plans look cheap upfront, but higher copays and deductibles can cost more in the long term. Before switching, make sure you consider:
- Premiums
- Out-of-pocket max
- Specialist visits
- Hospital stays
- Drug costs
You Don’t Have to Navigate It Alone
While researching on your own — or even asking friends — can be helpful, nothing compares to working with our licensed experts who’re trained to guide you through the Medicare maze with clarity and confidence.
Here’s how a CVIG agent can help:
Review current coverage
Compare new plan options
Identify savings or better benefits
Prevent coverage gaps or late penalties
Let’s explore your plan options together.
Helping a Loved One
with Medicare
Medicare Is Not One-Size-Fits-All
There are different types of Medicare plans, and not all cover the same things. The main options include:
Pro Tip: Your loved one may need extra coverage depending on their health, income, and lifestyle.
Medicare Doesn’t Cover Long-Term Care
This surprises many caregivers. Medicare does NOT cover:
Pro Tip: Families must plan ahead and explore options like long-term care insurance, Medicaid, or veterans’ benefits.
- Assisted living
- Nursing homes (except short rehab stays)
- 24/7 home care
Enrollment Windows Are Crucial
Know your loved one’s Initial Enrollment Period (around their 65th birthday) and Annual Enrollment Period (Oct 15–Dec 7). Missing a deadline can result in:
- Coverage delays
- Gaps in care
- Permanent late penalties
Their Doctors & Medications Might Not Be Covered
Not all plans cover all doctors, hospitals, or prescriptions. Before switching or enrolling in a plan, confirm:
- Are their current doctors in-network?
- Are their medications covered?
- What will they pay out of pocket?
You May Be Able to Act on Their Behalf
To speak to Medicare or their insurance carrier directly, your loved one must fill out an authorization form (like a HIPAA release or Medicare’s “Authorization to Disclose Personal Health Information”). If your loved one has diminished capacity, power of attorney (POA) or legal guardianship may be required to manage decisions. We recommend calling us when you’re with your loved one, even if you’re authorized to speak on their behalf.
Medigap vs. Medicare Advantage: Choosing Your Path
Once you have your red, white, and blue Original Medicare card, you come to a fork in the road. There are two main ways to round out your coverage and protect your savings.
This is a big decision, but it becomes much clearer when you see how each option works for your personal health and budget. It’s about what’s right for you.
Read More
These two paths offer very different approaches to your healthcare. One acts as a partner to your Original Medicare, picking up costs it leaves behind. The other takes over completely, offering an all-in-one package.
A Closer Look at Medicare Advantage Plans (Part C)
Medicare Advantage plans are an alternative way to get your Medicare benefits. Private insurance companies offer these plans, which bundle everything together. They include all the benefits of Part A (hospital) and Part B (medical), and usually roll in Part D (prescription drugs) too.
Many of these medicare insurance plans go a step further, offering benefits that Original Medicare doesn’t cover at all. These can include:
- Routine dental, vision, and hearing care
- Gym memberships and fitness programs
- Allowances for over-the-counter health items
- Transportation to doctor appointments
The trade-off is that most Medicare Advantage plans operate with a network of doctors and hospitals, like an HMO or PPO. This helps keep costs down, but it means you’ll want to check that your preferred doctors are in the network.
How Medicare Supplemental Insurance (Medigap) Works
This path is different. You keep your Original Medicare, and you add a separate plan to fill in the cost gaps.
A Medicare Supplemental Insurance plan helps pay for things like your deductibles, copayments, and coinsurance. It’s designed to protect you from unpredictable out-of-pocket costs.
With a Medigap plan, you have the freedom to see any doctor or visit any hospital in the country that accepts Medicare. There are no networks to worry about.
What Are Special Enrollment Periods?
Life doesn’t always stick to a calendar, and your health insurance needs can change when you least expect them. While most people sign up for Medicare plans during their initial window or the fall open enrollment period, certain life events can trigger a Special Enrollment Period. This gives you a special window to make changes to your coverage outside of the usual times.
You might qualify for one of these special medicare enrollment periods if you experience a situation like:
- You moved to a new address that isn’t in your current plan’s service area.
- You lost your health coverage from an employer (yours or your spouse’s).
- You have the chance to get other coverage from an employer.
- Your current plan is changing its contract with Medicare.
Still on the Job at 65?
More and more people are continuing to work past age 65, and it’s a wonderful thing. If you’re in this boat, you have some important decisions to make about your health coverage. You may be able to delay enrolling in some parts of Medicare without facing a penalty, but it has to be done correctly.
The key is the group health plan you have through your job (or your spouse’s job). If that plan is considered “creditable coverage” by Medicare, you might choose to hold off on signing up for Part B. This can save you from paying the Part B premium while you’re still covered at work.
However, this is an area where you need to be very cautious. If you leave your job and don’t sign up for Part B within your special enrollment period, you could face a lifelong late enrollment penalty. We can help you look at your employer plan and your Medicare options to see what makes the most sense for your situation right now.
Let’s Find Your Peace of Mind, Together
Plans, periods, penalties — it all can feel overwhelming. It can feel like one more complicated thing to deal with in a world that already asks so much of you. You’ve worked your whole life, and you deserve to feel secure and cared for in this next chapter.
That’s why we’re here. We’re a family-owned group, and we believe in talking to people like people.
So let’s explore your plan options together.
Your Questions, Answered With Care
What does Medicare NOT cover?
Original Medicare was designed to cover a lot, but it doesn’t cover everything. Some of the most common items not included are long-term care (such as nursing home stays), most dental care, eye exams for prescription glasses, dentures, and cosmetic surgery.
Can I use Medicare when I travel?
Generally, Original Medicare only covers you within the United States. It doesn’t provide coverage in foreign countries except in very rare, specific situations. Some Medicare Advantage plans offer benefits for emergency care when you’re traveling abroad, which is something to consider if you love to travel.
Do I need Part D if I don’t take meds now?
This is a great question. While you might not take prescriptions now, it’s a good idea to consider getting a low-cost Part D plan. If you wait to sign up until you need it, you could face a permanent monthly penalty added to your premium. Think of it as low-cost insurance for your future health needs.
Can my spouse be on my Medicare plan?
A straightforward no. Medicare is an individual insurance program. Even if you’ve been on the same family health plan for 40 years, you and your spouse will each enroll in your own Medicare plan based on your own eligibility. You can both choose the same plan, but they will be two separate policies.
