Facebook-f Instagram Youtube
Main Menu
Contact US
Main Menu
Contact US

Understanding Medicare

Stop the Confusion. Let's Simplify Medicare.

Medicare can feel complicated. Part A, Part B, deductibles, copays, enrollment periods, Medicare Advantage, Medicare Supplements, Part D — it’s a lot to take in.

We believe there is a much simpler way to understand Medicare.

Before choosing a Medicare plan, we start by answering three basic questions:

  • When and how do I enroll in Medicare?
  • What does Original Medicare cover — and what will I be responsible for paying?
  • How do I protect myself from the costs Medicare doesn't cover?
Once you understand those three things, choosing your Medicare coverage becomes much easier.

Step 1: Enrolling in Medicare

When Do I Enroll?

For most people, Medicare eligibility begins at age 65.
Your Initial Enrollment Period is a seven-month window that includes:
  • The three months before the month you turn 65
  • The month you turn 65
  • The three months after the month you turn 65
But turning 65 doesn’t always mean you need to enroll in every part of Medicare immediately.
If you or your spouse are still working and you have employer-sponsored health coverage, you may be able to delay certain parts of Medicare without a penalty.
This is why one of the first things we determine is when you actually need to enroll.

Already Receiving Social Security?

If you’re already receiving Social Security benefits when you become eligible for Medicare, you will generally be automatically enrolled in Medicare Parts A and B.
If you’re not receiving Social Security yet, you’ll generally need to enroll yourself.

Step 2: What does Medicare cover?

Original Medicare is made up primarily of Part A and Part B.

Medicare Part A — Hospital Coverage

Part A primarily helps cover:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Certain home health services
  • Hospice care
Most people qualify for premium-free Part A based on their work history or their spouse’s work history.

Medicare Part B — Medical Coverage

Part B primarily helps cover:
  • Doctor visits
  • Outpatient care
  • Preventive services
  • Diagnostic testing
  • Medical equipment
  • Many other medically necessary services
Part B has a monthly premium, and higher-income beneficiaries may pay an additional amount based on income.
Understanding what Medicare costs each month is important — but that’s only part of the picture.

The bigger question is:

What could Medicare leave you responsible for?

Step 3: How much does Medicare cover?

This is where we believe Medicare starts becoming much easier to understand.

Instead of immediately talking about insurance plans, we first look at Original Medicare itself.
Think of Medicare as the foundation of your health coverage.
Medicare pays a significant portion of your healthcare expenses — but Original Medicare does not pay 100% of everything.
Depending on the services you receive, you can be responsible for:
  • Deductibles
  • Coinsurance
  • Certain hospital costs
  • Skilled nursing facility cost-sharing
  • Services Medicare doesn't cover
For many Part B services, after you meet the annual deductible, Medicare generally pays 80% of the Medicare-approved amount and you are responsible for the remaining 20%.

And here’s an important point:

Original Medicare does not have an annual maximum out-of-pocket limit.

That means there is no simple dollar amount where Original Medicare says, “You’ve spent enough this year — we’ll pay 100% from here.”
That’s what we call your financial exposure.

Step 4: Understand Your Financial Exposure

Before you choose additional coverage, you should understand the risk you’re trying to protect yourself from.

We walk our clients through questions such as:

  • What happens if I'm hospitalized?
  • What happens if I need surgery or expensive outpatient treatment?
  • What happens if I have ongoing doctor visits or medical treatments?
  • What am I responsible for after Medicare pays its share?
Once you understand what Medicare covers and what it leaves behind, you can make a much more informed decision about your coverage.

You are no longer simply asking:

“Which Medicare plan should I buy?”

Instead, you’re asking:

“How much of this financial risk am I comfortable keeping, and how much do I want my insurance to cover?”

That’s a much better place to start.

Step 5: Decide How You Want to Protect Yourself

Once we understand your potential financial exposure, we can start discussing the different ways to manage that risk.

For most Medicare beneficiaries, that means considering two primary approaches:

Original Medicare + Medicare Supplement

You keep Original Medicare as your primary coverage and purchase a Medicare Supplement policy to help cover some or most of the costs Medicare leaves behind.

Prescription drug coverage can generally be added separately through a Medicare Part D plan.

Medicare Advantage

Instead of receiving your Medicare benefits directly through Original Medicare, you enroll in a private Medicare Advantage plan that provides your Part A and Part B benefits.

These plans have their own premiums, copays, networks, rules and annual maximum out-of-pocket limits.

Neither approach is automatically right for everyone.

The goal is to understand the differences and determine which approach fits your healthcare needs, budget, lifestyle and comfort with financial risk.

Our Approach: Education Before Enrollment

At Health Coverage Solutions, we don’t believe your Medicare conversation should start with an insurance company or a specific plan.
It should start with understanding Medicare.
First, we help you determine when and how to enroll.
Then, we explain what Medicare covers.
Next, we show you what Medicare doesn’t cover and what your potential financial exposure may be.
Only then do we start discussing the different coverage options available to help reduce that risk.

That's how we simplify Medicare.

Understand Medicare. Understand Your Risk. Then Choose Your Coverage.

Ready to Get Started?

Whether you’re turning 65, retiring, leaving employer coverage or simply trying to understand your Medicare options, we’re here to help.
Schedule a Medicare Consultation
Scroll to Top