Who Is Eligible for Medicare?

You qualify for Medicare if:

• You are 65 or older
• You are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months
• You have ALS (Lou Gehrig’s disease) or End-Stage Renal Disease
• You are a U.S. citizen or lawful permanent resident living in the U.S. for at least 5 consecutive years

Understanding the 4 Parts of Medicare

Part A: Hospital Insurance

Covers:

• Inpatient hospital stays
• Skilled nursing facilities
• Hospice care
• Some home health services

2025 Part A Costs:

Deductible (2025): $1,632 per benefit period

💡 Most people do not pay a premium for Part A.

Part B: Medical Insurance

Covers:

• Doctor visits
• Outpatient care
• Preventive services (e.g., screenings, vaccines)
• Durable medical equipment

2025 Part B Costs:

• Standard Premium: $185/month
• Deductible: $240/year
• Coinsurance: 20% of Medicare-approved amount after deductible

Late Enrollment Penalty:
If you delay enrollment without credible coverage, your premium may increase by 10% for every 12-month period you were eligible but not enrolled.

📝 Learn how to avoid Medicare penalties

Part C: Medicare Advantage

Medicare Advantage Plans are offered by private insurance companies approved by Medicare. They must provide at least the same level of coverage as Original Medicare (Parts A & B).

Includes:

• Vision, hearing, dental
• Prescription drug coverage (usually)
• Wellness programs

Out-of-Pocket Maximum: These plans limit how much you’ll pay annually in out-of-pocket costs, unlike Original Medicare.

🧐 Review Medicare Advantage vs. Original Medicare

Part D: Prescription Drug Coverage

Available as:

• A standalone Part D plan
• Integrated into many Medicare Advantage plans

Covers:

• Medications prescribed by your doctor
• Formulary drugs listed by your plan

2025 Part D Costs:

• National base premium: $36.78/month (varies by plan)
• Late Enrollment Penalty: 1% of the base premium × number of uncovered months

💊 Get help choosing a Part D plan

Medicare Enrollment Periods

Initial Enrollment Period (IEP)

• Starts 3 months before you turn 65
• Includes your birth month
• Ends 3 months after your birth month

General Enrollment Period (GEP)

• January 1 – March 31
• Coverage begins July 1

Annual Enrollment Period (AEP)

• October 15 – December 7
• Make changes to your Medicare plan

Medicare Advantage Open Enrollment

• January 1 – March 31
• Switch Medicare Advantage plans or return to Original Medicare

📅 See full Medicare enrollment timeline

What Does Medicare Cover?

✅ View a full list of covered services

What Medicare Doesn’t Cover

• Long-term custodial care
• Most dental, vision, and hearing
• Routine foot care
• Cosmetic surgery
• Overseas emergency care (Original Medicare)

You may want to consider a Medicare Advantage or Medigap plan to get additional protection.

Medicare Advantage (Part C)

Benefits:

• All-in-one coverage
• Often includes prescription drugs
• May include extra benefits like fitness programs
• Simplified billing through one provider

Drawbacks:

• Network restrictions (HMO or PPO)
• Referrals may be required
• Varies greatly by county

📍 See plans available in your ZIP code

Prescription Drug Coverage (Part D)

Make sure you enroll when first eligible to avoid penalties (enrollment can be deferred with existing creditable coverage). 

Plan Features:

• Varying formularies
• Preferred pharmacy networks
• Mail-order discounts

💡 Tip: Even If you don’t take medication now, enroll in a low-cost plan to avoid penalties later if you don’t have creditable coverage. Please check with your benefit plan administrator to confirm if your coverage is considered creditable.

Medigap (Medicare Supplement Insurance)

Medigap plans help fill coverage “gaps” in Original Medicare, including:

• Copayments
• Coinsurance
• Deductibles

Important Notes:

• Cannot be used with Medicare Advantage
• Best time to enroll is during your Medigap Open Enrollment (starts when you turn 65 and enroll in Part B), which  allows to enroll without submitting to underwriting. 

🛡️ Explore Medigap Plans & Benefits

Comparing Coverage Options

🤔 Still unsure? Talk to a licensed agent

learn more about some of the most frequently asked Medicare questions. 

Learn More

Speak With a Medicare Specialist

Confused by your options? Tim, a licensed insurance broker in Florida, can help you:

• Review your eligibility
• Compare Medicare plans in your area
• Enroll in a plan that suits your health and budget

📞 Call us at 813-501-5011

💬 Or Schedule Your No Cost Consultation