Enroll in Medicare in Florida, Maine, Massachusetts, New Hampshire, North Carolina, South Carolina, and Virginia.
What Exactly is Medicare?
Many people have heard of Medicare, but not everyone fully understands how it works or how to maximize its benefits. Before diving into the different “parts” of Medicare, let’s start with a few key facts and a brief look at its history.
DID YOU KNOW: When Medicare launched in 1966, it played a historic role in ending segregation by requiring hospitals and doctors to integrate to receive Medicare funding. Thousands of waiting rooms, hospital floors, and medical practices opened their doors to all patients, shaping a more equitable health care system.
Medicare was officially launched in 1966 under the Social Security Administration as a national health insurance program for older Americans. But the name “Medicare” has roots that go back even further. Originally, it referred to a 1956 program that provided health care to military families under the Dependents’ Medical Care Act.
In 1961, President Dwight D. Eisenhower hosted the first White House Conference on Aging, where he proposed creating a health care program for Social Security beneficiaries. After years of debate and policy development, President Lyndon B. Johnson signed Medicare into law in July 1965, under Title XVIII of the Social Security Act.
The first Medicare cards were issued in 1966—and the very first recipients were President Harry Truman and his wife, Bess Truman, symbolizing the program’s promise to protect the health of older Americans.
Medicare Part A
Medicare Part A, often called hospital insurance, helps cover qualifying medical expenses associated with inpatient care. This includes hospital stays, skilled nursing facility care, hospice services, and certain types of home health care. Most people become eligible at age 65 if they or their spouse have worked and paid Medicare taxes for at least 40 quarters, which is about 10 years, and are a U.S. citizen or legal permanent resident. The benefit is the same regardless of income, as long as the minimum work requirement is met. Some individuals may qualify for Medicare Part A before turning 65 if they have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). One of the main advantages of Part A is that it generally does not require a monthly premium. This is often referred to as “premium-free Part A,” since the cost was already collected during your working years through payroll tax contributions.
With that said, Medicare Part A offers valuable coverage but it does come with several gaps you should be aware of. For example, beneficiaries are responsible for an inpatient hospital deductible, along with daily coinsurance costs that begin after 60 days of a hospital stay, and even higher costs after 90 days when lifetime reserve days are used. In addition, there are limits and deductibles that apply to skilled nursing facility stays, restrictions on coverage for blood transfusions, and certain services such as durable medical equipment that are covered only under Part B rather than Part A. Because these costs can add up quickly, it’s important to understand where Medicare leaves off and how supplemental coverage can help fill the gaps. To get a clear picture of your options and maximize your benefits, we encourage you to connect with one of our licensed Medicare brokers in Florida, Maine, Massachusetts, New Hampshire, North Carolina, South Carolina, or Virginia, or simply give us a call to discuss your coverage needs.
Medicare Part B
If you’re looking to learn more about Medicare Part B, get comfortable—there’s quite a bit to cover. Part B is the portion of Medicare that helps pay for everyday healthcare needs such as doctor visits, outpatient care, lab tests, x-rays, and many routine medical services. It essentially covers most “outpatient” care as well as some inpatient services that Part A doesn’t handle. Medicare organizes Part B benefits into two main categories: medically necessary services, which are treatments or supplies needed to diagnose or treat a medical condition, and preventive services, which include screenings, vaccines, and checkups designed to keep you healthy and catch potential issues early.
Unlike Part A, Medicare Part B comes with premiums and costs. In 2025, most people will pay a standard premium of $185/month for Part B. If your income is above certain thresholds, you may be required to pay an additional amount known as the Income-Related Monthly Adjustment Amount (IRMAA). The annual deductible for Part B in 2025 is $257, after which Medicare generally covers 80% of approved Part B services—you are responsible for the remaining 20%. Unlike some health plans, there is no annual or lifetime cap on that 20% coinsurance, meaning that if your qualifying medical expenses climb high (for example, $100,000), your share could be $20,000 (or more).
Did you know? If you don’t sign up for Medicare Part B when you first become eligible, you could face a late enrollment penalty. For each full 12-month period that you were eligible but didn’t enroll, your Part B premium may increase by 10%—permanently. The good news is that you have a 7-month Initial Enrollment Period (IEP): it starts 3 months before your 65th birthday, includes your birthday month, and continues for 3 months afterward. While there are some exceptions, it’s important to understand your options so you don’t end up paying more than you should.
Medicare Part B provides essential coverage, but it doesn’t cover everything and can leave you with significant out-of-pocket costs. That’s where we come in. Our licensed Medicare specialists can walk you through the enrollment process, explain how penalties work, and help you choose coverage that reduces your expenses and gives you peace of mind about your healthcare future.
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Medicare Part C
Medicare Part C, also known as Medicare Advantage, can feel a little complex, but here’s what you need to know. These plans combine the benefits of Part A (hospital insurance), Part B (medical insurance), and often Part D (prescription drug coverage) into a single plan offered by a private insurance company. Instead of paying your premiums directly to Medicare, you pay them to the insurer that manages your plan.
By law, Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, but they may structure benefits differently and even include extras such as vision, dental, hearing, wellness programs, or transportation services. Most Medicare Advantage options are offered through local HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) networks, which help insurers manage costs while giving you access to coordinated care and added benefits.
So, what does this mean for you? Simply put, Medicare Advantage (Part C) can sometimes give you more value for your money. Unlike Original Medicare, which doesn’t include extras like dental, vision, or fitness benefits, many Medicare Advantage plans do. They may also offer additional perks such as lower or no deductibles and an annual out-of-pocket maximum to help protect you from high healthcare costs.
However, there are trade-offs. To provide these added benefits, Medicare Advantage plans use provider networks. This means your costs are generally lower if you see doctors, hospitals, or specialists who are in-network, but you may pay more or have limited coverage if you go out-of-network.
Medicare Part D – Prescription Drug Plans
Unfortunately, Original Medicare (Parts A and B) does not include prescription drug coverage. That’s why, if you choose to stay with Original Medicare, you’ll also need to enroll in a Part D plan, which is Medicare’s prescription drug coverage. These plans are regulated and approved by Medicare but are offered through private insurance companies and cooperative organizations.
Every Part D plan must provide at least a standard level of coverage as set by Medicare, but each plan has its own list of covered medications called a formulary and groups drugs into cost “tiers.” This means the prescriptions you take and the plan you choose can significantly affect your costs.
Part D coverage is structured into four phases:
Deductible Phase – you pay 100% of drug costs until your deductible is met.
Initial Coverage Phase – after the deductible, the plan pays most of the cost and you pay a copay or coinsurance.
Coverage Gap (the “Donut Hole”) – once your total drug spending reaches a certain limit, you pay a higher share of costs.
Catastrophic Coverage – after you spend enough out-of-pocket, your costs drop dramatically for the rest of the year.
Did You Know? Medicare Part D wasn’t added until 2003!
Medicare Part D helps cover the cost of prescription drugs, but unlike Parts A and B, it’s provided through private insurance companies approved by Medicare. With Part D, you’ll typically pay a monthly premium to your insurance carrier, along with copays or coinsurance for your prescriptions depending on your plan’s formulary.
It’s important to know that there are specific rules about when you can enroll or disenroll from a Part D plan. To avoid a late enrollment penalty, you should sign up for Part D as soon as you’re first eligible for Medicare unless you already have creditable prescription drug coverage. Creditable coverage is insurance that is expected to pay, on average, at least as much as Medicare’s standard drug coverage. Each year, your employer or current plan should notify you whether your coverage meets this standard.
Need help finding the right plan? We’ll review your medications, preferred pharmacies, and healthcare needs to match you with a Part D option that works best for you.
HOW TO SIGN UP FOR MEDICARE
Medicare Enrollment Period
Initial Enrollment Period (IEP)
7-Month “Turning 65 Election Period
Annual Enrollment Period (AEP)
October 15 – December 7
Open Enrollment Period (OEP)
January 1 to March 31
Special Enrollment Periods (SEP)
Individuals who drop their employer group health plan, qualify for the Extra Help (Low-Income Subsidy (LIS)) program, or eligible for both Medicare and Medicaid benefits (Dual-eligibility).
Knowledgeable Licensed Insurance Agents
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“Not affiliated with the U.S. government or federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact MEDICARE.GOV OR 1-800-MEDICARE to get information on all your options.”