The Medicare Dude

Medicare (Original Parts A & B) covers essential hospital stays, doctor visits, outpatient care, and preventive services, but generally doesn't cover routine dental, vision (exams/glasses/contacts), hearing aids, most long-term care, or prescription drugs (unless administered in a hospital/clinic). You can fill gaps with Medicare Advantage (Part C) (often adds dental/vision/drugs) or Medigap (supplements costs). What Original Medicare (Parts A & B) Covers: Part A (Hospital Insurance): Inpatient hospital care, skilled nursing facility stays, hospice, and some home health care. Part B (Medical Insurance): Doctor visits, outpatient care, medical supplies, preventive services (like flu shots, screenings), lab tests, durable medical equipment, and mental health care. What Original Medicare (Parts A & B) Doesn't Cover: Prescription Drugs: Requires separate Part D or Advantage plan. Dental: Routine exams, cleanings, dentures, most dental care. Vision: Routine eye exams, eyeglasses, contact lenses (except after cataract surgery). Hearing: Hearing aids, exams for hearing aids, or most related services. Long-Term Care: Custodial care (help with daily living like bathing, dressing). Cosmetic Surgery . Most care outside the U.S.: (with exceptions). How to Get More Coverage: Medicare Advantage (Part C): Bundles benefits, often includes drug coverage (Part D) and extras like dental/vision, but uses private plans with specific networks. Medicare Part D: Stand-alone prescription drug plans. Medigap (Medicare Supplement): Works with Original Medicare to pay your out-of-pocket costs (deductibles, copays).

You should generally enroll in Medicare when you first become eligible (around age 65) during your Initial Enrollment Period (IEP) to avoid lifetime penalties, but you can delay enrollment without penalty if you have current, credible employer group health coverage (from a large employer, 20+ people), using a Special Enrollment Period (SEP) once that coverage ends. Delaying without qualifying coverage means a permanent 10% Part B penalty for each year you waited. When to Enroll (Most People) Initial Enrollment Period (IEP): A 7-month window around your 65th birthday (3 months before, your birthday month, and 3 months after). Sign up during this time to get Part A (hospital) and Part B (medical) without late fees. When You Can Delay (Without Penalty) If you have Employer Coverage: You can delay Part B enrollment if you or your spouse are still working and have health insurance from that job, provided it's a large group plan (20+ employees). Special Enrollment Period (SEP): Once you stop working or lose that job-based coverage, you get an 8-month SEP to sign up for Medicare Part B without a penalty. When You Should NOT Delay (or Risk Penalties) Small Employer Plans: If your employer has fewer than 20 employees, you likely need to enroll in Medicare at 65 to avoid penalties, as your employer plan may not be considered "credible coverage". COBRA/Retiree Plans: Coverage from COBRA or retiree plans generally doesn't qualify for a penalty-free delay; you'll need to enroll when first eligible. Key Takeaway Enroll at 65 (IEP): Best practice to avoid penalties, unless you have a qualifying job plan. Delay with Job: Only delay Part B if you have group health coverage from a large employer; use the SEP when it ends. Avoid Penalties: Missing the IEP or SEP without a valid reason results in a permanent late enrollment penalty for Part B.

A Medicare Supplement (Medigap) plan fills gaps in Original Medicare (Part A & B) by paying your out-of-pocket costs like copays, coinsurance, and deductibles, offering predictable spending in exchange for higher monthly premiums, with standardized plans (like G, N) covering different levels of costs but not prescription drugs. You need it if you have Original Medicare and want help with costs not covered, but not if you have Medicare Advantage (Part C). It works by paying your share after Medicare pays first, letting you see any doctor or hospital accepting Medicare. How Medigap Works You need Original Medicare: You must be enrolled in Medicare Part A (Hospital) and Part B (Medical). Private insurers sell plans: Companies like Blue Cross, AARP, etc., sell these standardized policies. Pay premiums: You pay a monthly premium to the private insurer, plus your Part B premium. Medicare pays first: When you get care, Original Medicare pays its share of the approved amount. Medigap pays the rest: Your Medigap plan then pays your remaining portion (copay, coinsurance, deductible). No networks: You can use any doctor or hospital nationwide that accepts Medicare. Do You Need It? (Yes, if...) You want predictable, lower out-of-pocket costs. You want to avoid the network restrictions of Medicare Advantage plans. You want coverage for things like foreign travel emergencies (in some plans). Do You Not Need It? (If...) You have a Medicare Advantage (Part C) plan; you cannot have both. You are comfortable with the cost-sharing and potential gaps in Original Medicare alone. Common Plans & Key Differences Standardized: Plans with the same letter (e.g., Plan G) offer the same basic benefits, regardless of the insurer. Most Popular: Plan G (high coverage, few gaps) and Plan N (lower premium, small copays for doctor visits) are common choices. No Part B Deductible Plans for New Enrollees: If you first became eligible for Medicare after Jan 1, 2020, you can't buy Plans C or F, which covered the Part B deductible.

In 2026, most people will pay a standard $202.90 monthly premium for Medicare Part B, with a $283 annual deductible before paying 20% coinsurance for most services, plus costs for Part A (often premium-free), Part D (drugs), or Medicare Advantage (Part C) plans, which vary but average around $14-$34/month. Your specific costs depend on income (IRMAA), late enrollment penalties, and chosen plan (Part C/D). Medicare Part A (Hospital Insurance) Premium: Most people pay $0 if they worked 10+ years. Deductible: $1,736 per benefit period (covers first 60 days). Coinsurance: $434/day (days 61-90), $868/day (lifetime reserve). Medicare Part B (Medical Insurance) Standard Premium: $202.90/month (for incomes up to $109k single, $218k joint). Higher Premiums (IRMAA): Income-related surcharges apply for higher earners. Deductible: $283/year. Coinsurance: You pay 20% of Medicare-approved amounts after the deductible. Medicare Advantage (Part C) & Part D (Drugs) Part C: Average premiums around $14-$34/month, but $0 plans exist; requires Part B enrollment. Part D: Monthly premiums vary by plan; out-of-pocket drug costs capped at $2,100 annually in 2026. Key Factors Affecting Your Cost Income: Higher income means higher Part B and D premiums (IRMAA). Late Enrollment: Penalties add to your Part B premium for each year you delayed signing up. Plan Choice: Part C & D costs differ significantly by insurer and chosen benefits.

Medicare has four parts: A (Hospital) for inpatient care, B (Medical) for doctor visits/outpatient services, C (Medicare Advantage) as an all-in-one private plan bundling A, B, & usually D with extras, and D (Prescription Drugs) for medications, often through private plans. Original Medicare (A & B) covers essential care, while Part C offers a different way to get benefits, and Part D fills prescription gaps. Medicare Part A (Hospital Insurance) Covers: Inpatient hospital care (semi-private room, meals, nursing), skilled nursing facility (SNF) care, hospice care, and some home health care. Medicare Part B (Medical Insurance) Covers: Doctor visits, outpatient care, durable medical equipment, mental health services, lab tests, X-rays, ambulance services, and many preventive services like flu shots. Medicare Part C (Medicare Advantage) Covers: All services in Part A & B, plus often includes dental, vision, hearing, and fitness benefits. How it works: Provided by private insurance companies approved by Medicare; often bundles A, B, and D; may require using provider networks and referrals. Medicare Part D (Prescription Drug Coverage) Covers: Prescription medications. How it works: Offered by private companies, with different costs (premiums, deductibles, copays) and drug lists (formularies).

Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease). William Gray www.themedicaredude.com

Yes. Each year, I review your plan to make sure you're still getting the best coverage and lowest costs. I stay with you long after enrollment — you’re never on your own.

Most clients get a response from me within minutes. You can call or text me directly at 904-460-8120 for fast answers.

Absolutely. I specialize in helping FEHB, FEP Blue, and federal retirees compare Medicare options and coordinate benefits to reduce premiums and out-of-pocket costs.

Ideally, 6–12 months before turning 65. But I can help at any time — whether you’re new to Medicare, preparing to retire, losing employer coverage, or considering switching plans during AEP.