Question 1

What is the difference between Part A and Part B?

Accepted Answer

Part A is hospital insurance — it covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, some home health, and hospice. Most people do not pay a Part A premium if they or a spouse paid Medicare taxes for ten or more years. Part B is medical insurance — it covers doctor visits, outpatient care, preventive screenings, lab tests, imaging, durable medical equipment, and some home health. Part B has a monthly premium that most enrollees pay, and the standard amount is set each year by CMS. Original Medicare is the combination of Part A and Part B; it does not include Part D prescription drug coverage, dental, vision, or hearing.

Question 2

When can I enroll, and what happens if I miss the window?

Accepted Answer

If you are newly eligible at 65, your Initial Enrollment Period (IEP) runs seven months — the three months before your 65th birthday month, the month itself, and the three months after. Existing Medicare enrollees use the Annual Election Period (AEP) from October 15 through December 7 to switch Medicare Advantage or Part D plans for the coming year. The Medicare Advantage Open Enrollment Period (January 1 through March 31) lets you change Advantage plans once or move back to Original Medicare. Outside those windows you generally need a Special Enrollment Period (SEP) triggered by a life event — moving, losing other coverage, or a plan change — to make changes. Missing a window can mean delaying coverage for a full year or facing late-enrollment penalties that follow you for life, so we set the calendar with you before we sign anything.

Question 3

What are the late-enrollment penalties and how do I avoid them?

Accepted Answer

Part B has a late-enrollment penalty that adds 10 percent of the standard premium for each full 12 months you could have had Part B but did not, and the penalty follows you for as long as you have Part B. Part D has a separate late-enrollment penalty that is calculated from the national base premium and stacks continuously. Both penalties can be avoided — the most common path is to keep creditable employer group coverage past 65 (from an employer with 20 or more employees) or to enroll during your Initial Enrollment Period. COBRA does not count as creditable employer coverage for the Part B penalty rule — that is the single most common surprise we help clients unwind. We check the date math with you before anything is signed so the penalties never apply.

Question 4

How do network rules differ between Original Medicare and Medicare Advantage?

Accepted Answer

Original Medicare has no network — any provider in the country that accepts Medicare is in-network, and most do. Medicare Supplement (Medigap) plans sit on top of Original Medicare and follow the same no-network rule, which is why Medigap enrollees can travel and still be covered. Medicare Advantage plans use a defined local network — typically an HMO (referrals required, out-of-network not covered except emergencies) or a PPO (out-of-network allowed at a higher cost). PPO and HMO networks are local to a county or service area, so a doctor you have seen for 20 years may be in one Advantage plan and out of another, and the difference is invisible on a glossy brochure. We confirm every doctor on your list is in-network before recommending an Advantage plan, and we explain when a Supplement’s nationwide flexibility is worth the additional premium.

Medicare plans,
explained side by side

Medicare Advantage vs Medicare Supplement vs Original Medicare

Who is eligible for Medicare?

You are 65 or older

You have a qualifying disability

You have End-Stage Renal Disease (ESRD)

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Medicare plans, explained side by side