When to enroll
Your Initial Enrollment Period is a 7-month window: the three months before the month you turn 65, your birthday month, and the three months after. Enrolling on time helps you avoid late-enrollment penalties and gaps in coverage. If you’re still working and covered by an employer plan, the rules can differ — that’s exactly the kind of thing I’ll help you sort out.
The parts of Medicare
Original Medicare has two parts: Part A (hospital) and Part B (medical). Part D covers prescription drugs. Original Medicare doesn’t cap your out-of-pocket costs and doesn’t include drug coverage on its own, which is why most people add coverage on top — and that’s where the two main paths come in.
Path 1: Medicare Advantage
A Medicare Advantage (Part C) plan bundles your coverage — often including drug coverage and extras — through a private carrier, usually with a network and an annual out-of-pocket maximum.
Learn about Medicare AdvantagePath 2: Medicare Supplement (Medigap)
A Medigap policy works alongside Original Medicare to help cover costs like deductibles and coinsurance, giving you broad provider choice. You typically pair it with a standalone Part D drug plan.
Learn about MedigapHow I help you choose
There’s no single “best” plan — the right choice depends on your doctors, your prescriptions, your budget, and how you like to get care. I’ll compare the options available in your area, check that your doctors and medications are covered, and explain the trade-offs so you can decide with confidence. My help costs you nothing; carriers pay licensed agents whether you use one or not.
Medigap vs. Medicare Advantage: an honest comparison
Most people round out Original Medicare in one of two ways. Neither is "better" in the abstract — the right one depends on how you like to get care, your prescriptions, your budget, and whether you travel. Here's a fair side-by-side:
| Original Medicare + Medigap + Part D | Medicare Advantage (Part C) | |
|---|---|---|
| Provider choice | Any provider in the U.S. who accepts Medicare — no networks. | Usually a network (HMO or PPO); care outside it may cost more or not be covered. |
| Monthly cost | A Medigap premium plus a Part D premium, in exchange for very predictable costs. | Often a low or $0 plan premium, with copays as you use care. |
| Out-of-pocket predictability | Very high — a good Medigap plan covers most gaps. | Costs vary with use, but every plan has an annual out-of-pocket cap. |
| Extra benefits | Not included; you'd add dental, vision, or hearing separately. | Often bundles extras like dental, vision, hearing, or fitness. |
| Drug coverage | Added through a standalone Part D plan you choose. | Usually built into the plan. |
| Switching later | Changing Medigap after your one-time open enrollment can involve health questions. | You can change plans each year during Annual Enrollment. |
We don't earn more by steering you toward one path — our job is to lay out the trade-offs clearly and help you pick the one that fits.
The parts of Medicare, explained in plain language
Medicare is built from parts that each do a different job. Understanding what each one does — and what it leaves out — is the first step to choosing coverage that actually fits your life.
| Part | What it covers | Good to know |
|---|---|---|
| Part A — Hospital | Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. | Most people pay no monthly premium for Part A because they or a spouse paid Medicare taxes long enough while working. |
| Part B — Medical | Doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. | Part B has a monthly premium and an annual deductible, and it typically pays 80% of approved costs, leaving you the other 20% with no cap. |
| Part C — Medicare Advantage | A private-plan alternative that bundles Part A and Part B, and usually Part D, into one plan. | Plans use networks and set an annual out-of-pocket maximum. Extras like dental, vision, or hearing are sometimes included. |
| Part D — Drugs | Prescription-drug coverage, offered as a standalone plan or built into a Medicare Advantage plan. | Each plan has its own list of covered drugs (a formulary). Going without creditable drug coverage can trigger a lifelong penalty. |
| Medigap — Supplement | Private coverage that pays much of what Original Medicare leaves you to pay, like deductibles and coinsurance. | Medigap works only with Original Medicare — not with Medicare Advantage — and does not include drug coverage. |
Medicare enrollment periods and deadlines
Timing is one of the most important parts of Medicare. Enrolling in the right window protects you from penalties and gaps — and some windows only come around once. Here are the periods that matter most:
| Window | When | What it's for |
|---|---|---|
| Initial Enrollment Period (IEP) | The 7 months around your 65th birthday — the 3 months before your birthday month, the month itself, and the 3 months after. | Your first chance to sign up for Parts A, B, and D and to buy a Medigap policy with the strongest protections. |
| Medigap Open Enrollment | A one-time 6-month window that starts the month you're 65 and enrolled in Part B. | You can buy any Medigap plan sold in your state with no health questions — a guaranteed right that usually doesn't return. |
| Annual Enrollment Period (AEP) | October 15 – December 7 every year. | Switch Medicare Advantage or Part D plans for the coming year; changes take effect January 1. |
| Medicare Advantage Open Enrollment | January 1 – March 31 every year. | If you're already in a Medicare Advantage plan, make a one-time change or return to Original Medicare. |
| General Enrollment Period | January 1 – March 31 every year. | A fallback to enroll in Part B if you missed your IEP (a late penalty may apply). |
| Special Enrollment Periods (SEPs) | Triggered by life events — losing employer coverage, moving, and more. | Let you make changes outside the standard windows when something qualifying happens. |
What Original Medicare doesn't cover
Original Medicare is strong, but it has real gaps. Knowing them up front helps you decide what extra coverage — if any — is worth it for you. Original Medicare generally does not cover:
- Routine dental care, dentures, most vision and eyeglasses, or hearing aids
- Prescription drugs you take at home (that's Part D's job)
- Long-term custodial care, such as an extended nursing-home stay
- Most care outside the United States
- An annual cap on your out-of-pocket spending under Parts A and B
A Medigap policy, a Medicare Advantage plan, or standalone add-ons can each fill different gaps. We help you weigh which gaps are worth covering for your health and budget — without pushing you toward anything you don't need.
Help paying for Medicare
Several programs can lower what you pay for Medicare, and many people who qualify never apply. If money is tight, it's worth checking — we can point you in the right direction at no cost:
- Extra Help (Low-Income Subsidy). Federal help that lowers Part D drug costs, including premiums, deductibles, and copays, for people with limited income and resources.
- Medicare Savings Programs. State programs (such as QMB, SLMB, and QI) that can help pay Part B premiums and, in some cases, other costs.
- Free counseling. Your State Health Insurance Assistance Program offers free, unbiased Medicare help — SHIBA in Washington and SHINE in Florida.
Questions worth asking before you choose a plan
Whether you work with us or shop on your own, these questions cut through the noise and keep the decision focused on what matters to you:
- Are my doctors and preferred hospital in the plan's network?
- Are all of my prescriptions on the plan's drug list, and at what tier?
- What will I actually pay in a normal year — and in a bad one?
- Do I travel or split time between states, and will my coverage travel with me?
- How much provider freedom do I want versus a lower premium?
- If my health changes later, can I switch — and would I face health questions?
A quick Medicare glossary
| Term | What it means |
|---|---|
| Premium | The amount you pay each month to keep a plan, whether or not you use care. |
| Deductible | What you pay out of pocket before your coverage starts paying. |
| Coinsurance / copay | Your share of a cost after the deductible — a percentage (coinsurance) or a flat amount (copay). |
| Formulary | The list of prescription drugs a Part D or Advantage plan covers, organized in tiers. |
| Network | The doctors, hospitals, and pharmacies a plan has contracted with. |
| Out-of-pocket maximum | The most you'll pay in a year under a Medicare Advantage plan before it covers 100%. |
| Guaranteed issue | Your right to buy certain coverage without answering health questions. |
Licensed independent insurance agent (NPN 22261820) · WA & FL
Written and reviewed by Vadim Marusin, a licensed independent insurance agent. Maru Insurance is an independent agency (WA License WAOIC #1365574, FL License #G363233) representing multiple A-rated carriers across Washington and Florida.