Medicare basics explained

{{whyLabel}}: Knowing if and when you qualify prevents late enrollment penalties and ensures you have coverage when needed.

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• Confirm you are 65 or older, or qualify via disability/specific conditions (e.g., ALS or ESRD).
• Check if you or your spouse have worked at least 10 years (40 quarters) to qualify for premium-free Part A.
• Use the 'Eligibility & Premium Calculator' on the official Medicare website.

{{doneWhenLabel}}: You have confirmed your eligibility status and expected Part A premium cost.

{{whyLabel}}: Part A covers major expenses like hospital stays, which can be financially devastating without coverage.

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• Note that Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health.
• Be aware of the 2025 deductible ($1,676) and the 2026 deductible ($1,736) per benefit period.
• Understand that most people pay $0 monthly for Part A if they paid Medicare taxes while working.

{{doneWhenLabel}}: You can list the primary services covered by Part A and its current deductible amounts.

{{whyLabel}}: Part B covers essential outpatient services like doctor visits and preventive care, forming the second half of 'Original Medicare'.

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• Note that Part B covers doctor services, outpatient care, medical supplies, and preventive services.
• Record the standard monthly premium: $185.00 for 2025 and $202.90 for 2026.
• Factor in the annual deductible ($257 in 2025; $283 in 2026) and the 20% coinsurance you typically pay after the deductible.

{{doneWhenLabel}}: You understand the monthly premium, annual deductible, and the 20% coinsurance rule for Part B.

{{whyLabel}}: Choosing the right path affects your choice of doctors, out-of-pocket costs, and geographic flexibility.

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• Original Medicare (Parts A & B): Use any provider that accepts Medicare; usually paired with a Medigap plan.
• Medicare Advantage (Part C): Private plans that bundle A, B, and usually D; often have network restrictions (HMO/PPO) but may offer extra benefits like dental/vision.
• Compare the 2025/2026 out-of-pocket maximums: Original Medicare has no limit, while Advantage plans must have a cap (e.g., $9,350 in 2025 for in-network).

{{doneWhenLabel}}: You have decided which Medicare path (Original or Advantage) best fits your health needs and budget.

{{whyLabel}}: Prescription costs can be high; Part D provides essential coverage and prevents permanent late-enrollment penalties.

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• Note the major 2025/2026 reform: A $2,000 (2025) or $2,100 (2026) annual out-of-pocket cap on covered drugs.
• Check the maximum annual deductible ($590 in 2025; $615 in 2026).
• Understand that you can get Part D through a standalone plan (with Original Medicare) or bundled in an Advantage plan.

{{doneWhenLabel}}: You know the out-of-pocket cap and how to obtain drug coverage.

{{whyLabel}}: If choosing Original Medicare, Medigap helps pay the 20% coinsurance and deductibles that Medicare doesn't cover.

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• Identify standardized plans (labeled A through N); Plan G and Plan N are currently among the most popular.
• Note that you cannot have both Medigap and Medicare Advantage simultaneously.
• Check for the 'Medigap Open Enrollment Period' (6 months starting when you are 65+ and enrolled in Part B) for guaranteed issue rights.

{{doneWhenLabel}}: You understand how Medigap supplements Original Medicare and have identified a plan type that interests you.

{{whyLabel}}: This official tool provides personalized cost estimates based on your specific medications and preferred pharmacies.

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• Visit the official Medicare.gov website and select 'Find Plans'.
• Enter your zip code and current prescription drugs to see total estimated annual costs for different plans.
• Compare star ratings (quality scores) for Medicare Advantage and Part D plans in your area.

{{doneWhenLabel}}: You have a shortlist of 2-3 specific plans with estimated annual costs.

{{whyLabel}}: Missing this 7-month window can lead to lifetime premium penalties and delayed coverage.

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• Calculate your window: 3 months before your 65th birthday month, the month of, and 3 months after.
• If you are still working and have 'creditable' employer coverage, research the Special Enrollment Period (SEP) rules to delay Part B without penalty.
• Mark these dates clearly in your calendar.

{{doneWhenLabel}}: You have identified the exact start and end dates of your 7-month enrollment window.

{{whyLabel}}: Most Medicare enrollments are processed through the Social Security Administration (SSA) website.

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• Go to SSA.gov and select 'Create an Account'.
• Complete the identity verification process (requires SSN and US mailing address).
• Use this account to apply for Medicare or check your benefit status.

{{doneWhenLabel}}: You have a functional login for the SSA.gov portal.

{{whyLabel}}: This is the formal step to activate your primary health insurance.

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• Log into your SSA account during your IEP.
• Complete the online application for Medicare (usually takes 10-20 minutes).
• If you are already receiving Social Security benefits, you will likely be enrolled automatically; check for your 'Welcome to Medicare' packet in the mail.

{{doneWhenLabel}}: Your application is submitted and you have a confirmation number.

{{whyLabel}}: Parts A and B do not cover most prescriptions or have out-of-pocket limits; these private plans fill those gaps.

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• Use the Medicare Plan Finder or call 1-800-MEDICARE to enroll in your selected plan.
• Provide your Medicare Number (found on your red, white, and blue card).
• Confirm the start date of your coverage (usually the 1st of the month you turn 65).

{{doneWhenLabel}}: You have received enrollment confirmation from your private insurance provider.

{{whyLabel}}: This portal allows you to track claims, view your preventive service calendar, and manage your drug list.

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• Once you have your Medicare Number, register at MyMedicare.gov.
• Set up your 'Blue Button' to easily download and share your health data with doctors.
• Opt-in for electronic versions of the 'Medicare & You' handbook.

{{doneWhenLabel}}: You can log in and see your active Medicare coverage details.

{{whyLabel}}: This one-time introductory visit is covered at 100% and establishes a baseline for your future care.

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• Call your primary care doctor within the first 12 months of having Part B.
• Specifically request the 'Welcome to Medicare' preventive visit.
• Prepare a list of current medications and medical history to discuss.

{{doneWhenLabel}}: Your appointment is scheduled or completed.

{{whyLabel}}: Plans change their costs and drug formularies every year; the ANOC tells you exactly what will change for the next year.

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• Look for this document in your mail or email every September.
• Compare your current plan's new premium, deductible, and drug coverage for the upcoming year (e.g., 2026).
• Decide if you need to switch plans during Open Enrollment.

{{doneWhenLabel}}: You have reviewed your plan's changes and decided whether to keep or change your coverage.

{{whyLabel}}: This is your annual window to switch plans if your current one becomes too expensive or drops your doctors/drugs.

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• Note the dates: October 15 to December 7 every year.
• Use this time to re-run your drugs through the Plan Finder to see if a better deal exists for the next calendar year.
• Changes made during this time take effect on January 1.

{{doneWhenLabel}}: The AEP dates are permanently marked in your annual planning calendar.