Medicare 101: Your Free Guide to Understanding Medicare

Navigating Medicare can feel overwhelming, but this guide breaks it down into simple, easy-to-understand steps. Whether you're new to Medicare or helping a loved one, this guide will help you understand the basics.

What is Medicare?

Medicare is a federal health insurance program for:

• People aged 65 and older.
• Younger individuals with certain disabilities.
• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease).

The Parts of Medicare

Medicare is divided into four main parts, each covering different services:

Part A Hospital insurance (inpatient care, skilled nursing, hospice, some home health)- Usually premium-free if you or your spouse paid Medicare taxes while working.Part B Medical insurance (doctor visits, outpatient care, preventive services, medical supplies)- Requires a monthly premium (based on income).Part C Medicare Advantage (an alternative to Original Medicare, often includes Part D)- Offered by private insurers approved by Medicare. Part D Prescription drug coverage- Offered by private insurers; helps lower the cost of medications.

Enrollment Periods

Understanding when to enroll is crucial to avoid penalties and gaps in coverage. Here are the key enrollment periods:

1. Initial Enrollment Period (IEP)
   
   • When: 7 months (3 months before, during, and 3 months after your 65th birthday).
   • What: Sign up for Part A, Part B, Part C, or Part D.

1. General Enrollment Period (GEP)
   
   • When: January 1 – March 31 each year.
   • What: Enroll in Part A and/or Part B if you missed your IEP.

1. Annual Enrollment Period (AEP) When: October 15 – December 7 each year
2. What: Switch, join, or drop Medicare Advantage or Part D plans.
3. Special Enrollment Period (SEP)
   
• When: Varies (e.g., losing employer coverage, moving, qualifying for Medicaid).
• What: Enroll or make changes outside standard periods.

Medicare Costs

Costs vary depending on the parts and plans you choose. Here’s a quick breakdown:

• Part A: Premium: $0 for most people (if you’ve worked 10+ years).
  • Deductible: $1,676 per benefit period (2025).
• Part B:Premium: $185.00/month (2025; higher incomes pay more).
  • Deductible: $257 year (2025).
• Part C (Medicare Advantage): Premiums vary by plan (some are $0).
• May include additional benefits.

Part D:
Premiums vary by plan (average ~$34/month in 2024). Deductibles and copays  may apply.

Medicare vs. Medicaid

• Medicare: Federal program for seniors and certain disabled individuals.
• Medicaid: State and federal program for low-income individuals of all ages.
• Some people qualify for both ("Dual Eligible") and get extra benefits.

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Tips for Choosing a Plan

Assess Your Needs:

• Do you need prescription drug coverage?

• Do you prefer Original Medicare or a Medicare Advantage plan?

1. Compare Plans:
   Use the Medicare Plan Finder tool at Medicare.gov. or contact a licensed agent at Lonsinsurance.com 
2. Check Networks:
   Ensure your doctors and hospitals are in-network for Medicare Advantage plans.
3. Review Costs:
   Compare premiums, deductibles, copays, and out-of-pocket maximums.

Common Medicare Mistakes to Avoid

• Missing Enrollment Deadlines: Late enrollment can lead to lifelong penalties.
• Not Reviewing Plans Annually: Plans and your needs can change.
• Assuming You’re Automatically Enrolled: You must sign up unless you’re already receiving Social Security benefits.

 

Don't miss out on the opportunity to ensure you're getting the most from your Medicare healthcare coverage. At Lons Insurance, we specialize in helping individuals like you maximize their benefits and explore additional options you may qualify for. Our team is dedicated to providing personalized, expert advice to meet your unique healthcare needs.

Take the first step towards better coverage and peace of mind. Call Lons Insurance  at 954-598-5109 today to schedule a review of your current Medicare plan. Let us help you make informed decisions about your healthcare future. Your health and well-being are our top priorities—reach out now and see how we can make a difference for you!