Getting the Medicare Coverage You Need
is as Simple as 1, 2, 3…
Enroll in Medicare Parts A&B
When can I first enroll?
Medicare Advantage + Part D
- The three months before your 65th birthday, the month of, and the three months after
- Enrollment in Part A is automatic if you are already receiving Social Security Benefits
- Your state may have a six-month guaranteed window that starts when you turn 65 and enroll in Part B
What if I’m late?
Medicare Advantage + Part D
- For Part A, usually no penalties (unless you didn’t pay enough into Social Security)
- For Part B, premiums will be higher after the Initial Enrollment Period (unless you qualify for an exception)
- What if I work past age 65?
- You can apply later but may be charged a higher premium due to existing health problems, or rejected depending on your health history
- Wait until the Open Enrollment Period (OEP), Oct. 15 – Dec. 7
- You may qualify for Special Election Period (SEP)
Once enrolled in Original Medicare, determine the additional coverage that is right for you.
Medicare Part A
- Most people don't pay a monthly premium
- Inpatient hospital care
- Inpatient mental health care
- Skilled nursing services
- Hospice care
- Some blood transfusions
- $1,632 deductible/admission for a hospital stay of fewer than 60 days
- Stays of more than 60 days require additional daily copays
- Multiple stays may mean multiple deductibles
- Visit any qualified hospital in the U.S. that accepts new Medicare patients
- Hospital care outside the U.S. isn't usually covered
Medicare Part B
Doctor & Outpatient Visits
- $174.70 monthly premium (may be higher based on income)
- Physician services
- Outpatient hospital services
- Outpatient mental health
- Laboratory services
- Durable medical equipment (wheelchairs, oxygen, etc.)
- Outpatient physical, occupational therapy
- Some preventive care
- You can get care throughout the U.S., but generally not outside the country
- Participating physicians who accept Medicare patients
- $240 annual deductible for 2024
- Medicare pays 80%, you pay 20% of Medicare-approved cost
- No Maximum-Out-of-Pocket (MOOP)
- No RX Coverage
Medicare Supplement (Medigap)
- Designed to cover what Medicare Parts A & B doesn't – such as deductibles, co-payments, and co-insurance.
- Plans are named A, B, C, D, F, G, K, L, M, N and HDF (except WI, MN, MA).
- Pay-Upfront Type of Plan
- If plan is put together correctly you will have little to no out-of-pocket costs for medical care.
- Goes with you anywhere in the U.S.
- No networks.
- Guaranteed renewable as long as you pay your premium on time and not made any material misrepresentation on your application for insurance.
- Premium at age 65 starts at $160+ per month. The more comprehensive coverage, the higher the premium.
- In most cases, premiums are based on gender, ZIP code and age.
- Average increase: 6-7%/year.
- Premiums nearly double every 10 years.
- No RX Coverages included
Medicare PDP (Part D)
- Helps with cost of outpatient prescription drugs
- Only offered through private insurance companies
- Most states have 25-30 plans
- Each plan has a list of drugs it covers (formulary)
- Make sure your drugs are covered before you enroll in the plan. The list of
drugs changes yearly.
- Coverage is not automatic.
- Penalties may apply if you enroll late (1% per month accumulating).
- Average cost for Part D is $35-45 per month
Option 2: Medicare Advantage (Part C)
- Combines Part A and Part B and, in most cases, includes Part D into one plan
- Offered by private insurance companies (HMO PPO, PFFS, SNP, MSA-No RX)
- Pay-As-You-go Type of Plan
- Plan premiums start as low as $0 per month
- Eliminate all deductibles associated with Medicare Part A and Part B
- Pay a small copay for all Medicare-covered services
- All plans have a max-out-of-pocket
- Some plans offer additional benefits not covered by Medicare like dental and vision preventive care and gym memberships
- Most plans use networks of doctors and hospitals.
- Coverage may be limited outside the networks unless emergency room (ER) or urgent care.
- Possible to spend more if you reach out-of-pocket (OOP) maximum.
$1,200 - 2,500/year
$0 - 500/year
Let us handle the application process for you. It’s FREE!
- Verify your Medicare enrollment period is valid
- Choose the right supplemental option for your situation
- Option 1 or Option 2
- Choose the carrier and plan that fits your needs
- Yearly plan review
PCF-SB.com web site is operated by PCF Senior Benefits LLC, a licensed health insurance agency. We are in no way affiliated or endorsed by the Federal Medicare program. We offer Medicare Advantage plans, Medicare supplemental insurance policies (Medigap plans), and Medicare Part D prescription drug plans (PDP). PCF Senior Benefits LLC represents most of the national Medicare insurance carriers as well as several regional companies. The availability of Medicare Advantage plans and Medicare supplements varies from state-to-state, county-to-county. Our licensed independent insurance agents who specialize in Medicare Health plans are also standing by to provide a free consultation and answer questions about your Medicare options. Neither PCF Senior Benefits LLC nor its agents is connected with the 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 of your options.