Medicare is divided into Parts A, B, C, D, and Medigap. Each addresses a different need, and most beneficiaries use a combination. We walk you through the basics in plain language so you can make confident choices.
Who this is for
- Adults turning 65 in the next 12 months
- Anyone receiving SSDI for 24 months
- People with ESRD or ALS
- Family members helping a loved one enroll
What you get
Part A - Hospital Coverage
Inpatient care, skilled nursing, hospice, some home health. Usually has no monthly premium.
Part B - Medical Coverage
Doctor visits, outpatient care, preventive services, durable medical equipment.
Part C - Medicare Advantage
Bundled alternative offered by private carriers; often includes dental, vision, hearing.
Part D - Prescription Drugs
Standalone or bundled prescription coverage with a phased benefit design.
Medigap - Supplemental
Fills cost-sharing gaps in Original Medicare. Standardized Plans A through N.
What Do the Parts of Medicare Actually Cover?
Medicare is not a single plan. It is a set of parts, and you build your coverage out of them. Most people in Orange County end up using two or three pieces together. Once you see what each part does, every later choice gets easier.
The parts of Medicare, in plain language
Part A, hospital coverage
Inpatient hospital stays, skilled nursing after a hospital stay, hospice, and some home health care. Most people pay no monthly premium for Part A. You earned it by paying Medicare taxes while you worked.
Part B, medical coverage
Doctor visits, outpatient care, lab work, preventive screenings, and equipment such as a walker. Part B has a monthly premium set by the government, and that amount changes each year.
Part C, Medicare Advantage
A private plan that takes over how you receive your Part A and Part B benefits. Most bundle drug coverage and add dental, vision, and hearing. You keep paying your Part B premium.
Part D, prescription drugs
Drug coverage sold by private insurers. You can buy it on its own, or get it built into a Medicare Advantage plan.
Medigap, also called Medicare Supplement
A private policy that pays much of what Original Medicare leaves to you. It only works next to Original Medicare. You cannot pair it with an Advantage plan.
Two roads, and you pick one
Road one is Original Medicare, usually with a Medigap policy and a Part D drug plan.
Road two is a single Medicare Advantage plan that bundles most of it together. Nearly every Medicare decision flows from this one fork.
When Can You Sign Up, and What If You Wait?
Timing shapes your Medicare as much as the plan you pick. Each window opens a different door. Some of those doors do not reopen, so learning the names now saves money later.
Enrollment windows worth putting on the calendar
Initial Enrollment Period (IEP)
Seven months long. It starts three months before the month you turn 65 and ends three months after. This is when most people first sign up.
Special Enrollment Period (SEP)
Opens when life changes. Retiring, losing job-based coverage, or moving out of a plan's service area can each trigger one.
General Enrollment Period (GEP)
A yearly catch-up window early in the year. It exists for people who missed their first chance, and a late penalty often comes with it.
Annual Enrollment Period (AEP)
October 15 through December 7. You may join, switch, or drop an Advantage or Part D plan. New coverage starts January 1.
Medicare Advantage Open Enrollment (OEP)
January 1 through March 31. If you already have an Advantage plan, you get one change. You may switch plans or go back to Original Medicare.
Late penalties do not go away
Sign up for Part B late without other qualifying coverage, and a penalty is added to your premium. It stays there for as long as you have Part B.
Part D works the same way, and the charge follows you from plan to plan. Both are easy to avoid when you check the rules before a deadline passes.
Original Medicare or Medicare Advantage?
This is the fork that decides how you get care. Neither road is better for everyone. The right answer depends on your doctors, your travel, your health, and how much surprise you can tolerate.
Two ways to receive your Medicare benefits
Original Medicare, plus Medigap and Part D
Pay more each month. Pay less at the point of care.
- Doctor choice
- Any provider in the country who accepts Medicare. No referrals.
- Monthly cost
- Your Part B premium, plus a Medigap premium, plus a drug plan premium.
- Cost when you use care
- Very steady. The supplement absorbs most of the cost sharing.
- Travel
- Strong. Your coverage moves with you anywhere in the country.
- Extra benefits
- Dental, vision, and hearing are bought separately.
- Health questions
- A supplement can ask about your health outside protected windows.
Medicare Advantage (Part C)
Pay less each month. Share more of the cost when you use care.
- Doctor choice
- A network. HMO plans usually need referrals, PPO plans allow more choice.
- Monthly cost
- Your Part B premium, plus the plan premium, which is often low or zero.
- Cost when you use care
- Copays and coinsurance until you reach the plan's yearly cap.
- Travel
- Usually limited to the service area, except for emergencies.
- Extra benefits
- Dental, vision, hearing, and fitness are often built in.
- Health questions
- None. You may join if you live in the service area.
One trap catches people every year. They pick a plan on premium alone, then learn their cardiologist is out of network. Another trap is assuming you can move between these two roads at any age. Advantage plans are open to you each fall, but a supplement may ask health questions later.
What Does Medicare Cost?
There is no single Medicare price. Your total depends on which parts you use and how you combine them. Think in yearly totals, not monthly premiums.
- Part A premium. Most people pay nothing, because they or a spouse paid Medicare taxes long enough.
- Part B premium. Everyone with Part B pays it. The standard Part B premium is set by the government and changes each year.
- Deductibles and coinsurance. Original Medicare has its own hospital and medical deductibles. Those reset on a schedule set each year.
- Plan premiums. A supplement, a drug plan, or an Advantage plan may each add a monthly premium.
- Costs at the point of care. Copays for visits, tests, and prescriptions add up differently on each road.
What is IRMAA?
IRMAA is short for income-related monthly adjustment amount. If your income is above a set level, Social Security adds a surcharge to your Part B and Part D premiums. It is based on your tax return from two years earlier. If your income dropped since then, you can ask Social Security to look again.
Premiums and deductibles change every year, so we never quote them from memory. We pull the current figures for your situation. Then we show the yearly total for each option, side by side, in writing.
Still Working at 65? Here Is How That Changes Things
Plenty of Orange County residents are still working at 65. Others are covered by a spouse's plan, or a retiree plan from a school district or city job. Employer coverage changes your timing, and the size of the employer matters most.
- Larger employers. If the group plan comes from a large employer, you may be able to delay Part B without a penalty. A Special Enrollment Period opens when that coverage ends.
- Smaller employers. With a small group, Medicare usually pays first. Delaying Part B can leave you with big gaps and a penalty later.
- COBRA and retiree plans. These usually do not protect you from a Part B penalty. Many people learn that the hard way.
- Health savings accounts. Once Medicare starts, you can no longer add money to an HSA. Plan the stop date before you enroll.
Here is a common example. A teacher in Orange plans to retire in the spring. She keeps her district plan and delays Part B, which is allowed. We map her last day of coverage, file for Part B under a Special Enrollment Period, and start a drug plan the same day. No gap, no penalty, no scramble.
Bring paperwork, not guesswork
Ask your benefits office for written proof of your group coverage. Social Security asks for that form when you enroll later. Getting it early can prevent weeks of delay.
How Do You Actually Choose?
Our order of operations
- 01
Start with your doctors
List the providers you will not give up. Everything else bends around that list.
- 02
Add your prescriptions
Exact names, doses, and pharmacy. Drug costs swing more than premiums do.
- 03
Pick your road
Original Medicare with a supplement, or an Advantage plan. We compare full-year totals for both.
- 04
Check the details that bite
Referral rules, prior authorization, travel coverage, and the yearly cap on your costs.
- 05
Enroll, then set a reminder
We handle the application. Then we review your plan each fall, before the December deadline.
Bring these to your review
A ten minute prep list
- Your Medicare card, or your Social Security account login.
- A list of every doctor and specialist you see.
- Your prescriptions with doses, plus the pharmacy you use.
- Any employer or retiree coverage documents.
- A rough sense of your yearly household income, for IRMAA.
We are an independent agency in Orange, so we compare carriers instead of selling one. Meet us in person, by video, or by phone, in English or Spanish. Korean, Mandarin, and Vietnamese help is available. See how we work, read the turning 65 guide, or contact us to start.
What it costs
What you pay under Medicare depends on which parts you use and how you combine them. Part A usually carries no premium if you or a spouse paid Medicare taxes long enough, while Part B carries a monthly premium that rises at higher income levels. Add-ons like a supplement or drug plan bring their own premiums, and Advantage plans may lower premiums while shifting costs to copays. The clearest way to know your real yearly total is to compare full scenarios rather than single line items. A licensed agent can confirm current premium and deductible figures for your situation.
How it works
- 01
Confirm eligibility window (IEP, AEP, SEP).
- 02
Compare Original Medicare vs. Medicare Advantage.
- 03
Identify must-have benefits (doctors, prescriptions, travel).
- 04
Enroll and onboard with carrier support.
- 05
Annual review during AEP (Oct 15 - Dec 7).