No jargon, no alphabet soup — just clear answers about what Medicare is, who qualifies, when to enroll, and how to make the most of it.
Medicare is a federal health insurance program primarily for people 65 and older. It also covers certain younger people with disabilities or specific health conditions. It's made up of four parts — each covering different types of care.
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.
Covers outpatient care, doctor visits, preventive services, and medical equipment and supplies.
An all-in-one alternative to Original Medicare offered by private insurers. Often includes Parts A, B, and D — plus extras like dental, vision, and hearing.
Helps cover the cost of prescription medications. Available through private insurers as a stand-alone plan or bundled with Medicare Advantage.
Medigap (Medicare Supplement Insurance) is a separate private policy that helps cover out-of-pocket costs — like copayments, coinsurance, and deductibles — that Original Medicare doesn't pay.
Most people become eligible at 65, but there are other qualifying conditions too.
U.S. citizens or permanent residents who have lived in the country for at least 5 consecutive years are generally eligible when they turn 65.
Under 65? If you've received disability benefits from Social Security or the Railroad Retirement Board for 24 consecutive months, you qualify.
End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant) qualifies you for Medicare at any age.
Amyotrophic Lateral Sclerosis (Lou Gehrig's disease) qualifies you for Medicare from the first month you receive disability benefits.
Timing matters. Missing the right window can mean penalties or gaps in coverage.
A 7-month window: the 3 months before your 65th birthday month, your birthday month itself, and the 3 months after. This is the ideal time to enroll in Parts A and B.
October 15 – December 7 every year. During this window you can switch, join, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
Available in specific situations — like losing employer coverage, moving out of your plan's service area, or qualifying for a low-income subsidy. Call us if you think you may qualify.
January 1 – March 31 each year. If you're already enrolled in a Medicare Advantage plan, you can switch to another MA plan or return to Original Medicare once during this period.
Medicare is not free — but for many people, Part A costs nothing. Here's a general breakdown:
| Part | Typical Premium | Notes |
|---|---|---|
| Part A | Often $0 | Premium-free if you or your spouse paid Medicare taxes for at least 10 years. Otherwise a premium applies. |
| Part B | Starts ~$185/mo | Monthly premium required. Amount may vary based on income (IRMAA surcharge for higher earners). |
| Part C (MA) | Varies by plan | Many plans have $0 premium. May include extra benefits not in Original Medicare. |
| Part D | Varies by plan | Stand-alone drug coverage has monthly premiums. Extra Help (LIS) can reduce costs significantly. |
| Medigap | Varies widely | Supplement insurance to cover gaps. Premiums depend on plan type, location, and age. |
Cost looks different for everyone. Our agents can show you exactly what you'd pay — and find every savings program you're eligible for, including Medicaid and Extra Help (LIS).
There's a lot of confusion about Medicare. Here are the most common myths — and the truth.
Medicare is free. You don't have to pay anything once you turn 65.
Part A is often premium-free, but Part B, Part C, and Part D have monthly premiums, plus deductibles and copayments. Many people qualify for assistance programs that reduce those costs significantly.
Medicare covers everything. Dental, vision, and hearing are all included.
Original Medicare does not cover most dental care, routine vision exams, or hearing aids. Many Medicare Advantage (Part C) plans do include these benefits — which is one reason they're popular.
Medicare Advantage and Medigap are the same thing.
They're very different. Medicare Advantage (Part C) replaces Original Medicare. Medigap (Medicare Supplement) works alongside Original Medicare to help cover its out-of-pocket costs. You can't have both at the same time.
You can enroll anytime after 65 without penalty.
If you miss your Initial Enrollment Period and don't have qualifying other coverage, you could face late enrollment penalties for Part B and Part D that last for as long as you have Medicare.
Drug coverage is automatic. I don't need to sign up for Part D separately.
Prescription drug coverage (Part D) is optional and must be added separately. If you don't enroll when first eligible and go without creditable drug coverage, you may pay a late enrollment penalty later.
Medicare doesn't have to be complicated. An SBHIS agent will sit with you, review your situation, and recommend the plan that truly fits — at no cost to you.
No pressure. No sales pitch. Just a knowledgeable agent who will take the time to explain your options clearly, in your language.
1-888-816-9881