Understanding Medicare Insurance
Medicare is federal health insurance for people 65 and older, plus certain younger people with disabilities or specific conditions. While Medicare provides essential coverage, understanding your options and making the right choices requires navigating enrollment periods, comparing plan types, and avoiding costly penalties.
That's where we come in. With over 20 years of Medicare experience, Larry Fisackerly helps Texas seniors understand their options, compare plans from all major carriers, and enroll with confidence.
The Parts of Medicare
Medicare has different "parts" that cover different services. Understanding what each part covers helps you make informed decisions:
Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Cost:
Premium-free for most people (if you or your spouse worked 10+ years)
Medical Insurance
Covers doctor visits, outpatient care, preventive services, medical equipment, and some home health.
Cost:
$174.70/month (2024) for most people
Higher earners pay more
Medicare Advantage
Private insurance that replaces Original Medicare. Often includes prescription drugs, dental, vision, and hearing.
Cost:
Varies by plan (some $0 premium)
Still pay Part B premium
Prescription Drugs
Covers prescription medications. Required if you're on Original Medicare and not in a Medicare Advantage plan with drug coverage.
Cost:
Varies by plan (avg $30-70/month)
Avoid late enrollment penalties
Your Medicare Coverage Options
Once you have Original Medicare (Parts A & B), you have two main paths to enhance your coverage:
Option 1: Medicare Advantage (Part C)
Medicare Advantage plans are offered by private insurance companies and replace Original Medicare. These "all-in-one" plans typically include:
- ✓ Hospital coverage (Part A)
- ✓ Medical coverage (Part B)
- ✓ Usually prescription drugs (Part D)
- ✓ Often dental, vision, hearing
- ✓ Fitness benefits (gym memberships)
- ✓ Over-the-counter allowances
- ✓ Transportation to appointments
- ✓ Out-of-pocket maximum protection
Option 2: Original Medicare + Supplement + Part D
Keep Original Medicare and add a Medicare Supplement (Medigap) policy to cover gaps, plus a separate Part D plan for prescriptions:
- ✓ See any Medicare-accepting doctor
- ✓ No networks or referrals needed
- ✓ Nationwide coverage
- ✓ Predictable costs
- ✓ Supplement covers copays/deductibles
- ✓ Part D covers prescriptions
- ✓ Plans standardized (same coverage)
- ✓ No prior authorization needed
Medicare Enrollment Periods
Understanding when you can enroll in or change Medicare coverage is crucial to avoiding penalties and gaps in coverage:
Initial Enrollment Period (IEP)
Your first chance to enroll in Medicare. This 7-month window includes:
Annual Enrollment Period (AEP)
October 15 - December 7 every year
Change Medicare Advantage plans, switch from Advantage to Original Medicare (or vice versa), join/change/drop Part D plans. Changes take effect January 1.
Special Enrollment Periods (SEP)
Qualify for enrollment outside normal periods due to:
- • Moving to a new area
- • Losing employer coverage
- • Moving into a nursing home
- • Qualifying for Medicaid
- • Plan leaving your area
How to Choose Your Medicare Coverage
Deciding between Medicare Advantage and Original Medicare + Supplement can be overwhelming. Here's what to consider:
| Factor | Medicare Advantage | Original Medicare + Supplement |
|---|---|---|
| Monthly Costs | Often $0-50/month (+ Part B) | $150-250/month typical (+ Part B + Part D) |
| Doctor Choice | Must use network | Any Medicare doctor nationwide |
| Referrals | Often required for specialists | No referrals needed |
| Out-of-Pocket Max | Yes ($8,000-9,000 typical) | Varies, but supplement covers most costs |
| Extra Benefits | Dental, vision, hearing, gym, OTC | Not usually included |
| Travel Coverage | Limited outside service area | Nationwide + some foreign travel |
| Prescription Drugs | Usually included | Separate Part D plan needed |
Need Help Deciding?
We'll review your doctors, medications, budget, and health needs to recommend the best option for YOUR situation. Every person is different—there's no one-size-fits-all answer.
Understanding Medicare Costs
Medicare costs include premiums, deductibles, copays, and coinsurance. Here's what to expect:
- • Part A: $0 premium for most, $1,632 deductible per benefit period
- • Part B: $174.70/month premium, $240 annual deductible, 20% coinsurance
- • No out-of-pocket maximum - costs can add up without supplemental coverage
- • Premium: $0-100/month (still pay Part B premium)
- • Deductible: $0-500 typical
- • Copays: $10-50 per doctor visit, higher for specialists
- • Out-of-pocket max: Protection from catastrophic costs
- • Premium: $150-250/month average (varies by plan letter and age)
- • Coverage: Pays most or all of Original Medicare deductibles and coinsurance
- • Predictable costs: Know your monthly budget with few surprise bills
- • Part D separate: Add $30-70/month for prescription coverage
Avoiding Late Enrollment Penalties
Missing enrollment deadlines can result in permanent penalties that increase your costs for life:
Part B Late Enrollment Penalty
10% increase in premium for each 12-month period you were eligible but didn't enroll. This penalty lasts as long as you have Part B.
Part D Late Enrollment Penalty
1% of the national base premium for each month you were without creditable drug coverage. This penalty is permanent.
Get Expert Medicare Help
Choosing Medicare coverage is one of the most important health decisions you'll make. With over 20 years of experience, I can help you:
- Understand your enrollment window and avoid penalties
- Compare Medicare Advantage plans from all carriers
- Review Medicare Supplement options and pricing
- Check if your doctors are in-network
- Verify your prescriptions are covered
- Enroll in your chosen plan
- Answer questions year-round
Get Your Free Medicare Consultation
Turning 65 or need to change plans? Let's discuss your options. With 30+ years of Medicare experience, I'll help you make the right choice with confidence.