Carrier-neutral Medicare guidance
Advantage, Supplement, Part D. Four letters, ten plan names and one deadline that does not move. We will sit on the other side of the table and go through it at the speed you want to go through it.
Give us a birthday and we will show you the exact seven-month window Medicare gives you. Nothing is sent anywhere.
Your Initial Enrollment Period is seven months long: the three months before the month you turn 65, that month, and the three months after. If you were born on the first of a month, the whole window shifts one month earlier.
Every enrollment windowThe four things you are choosing between
Every Medicare decision is one of four shapes. Drag the box, use the arrow keys, or simply keep scrolling — each face is the whole of one choice, not a teaser for it.
The foundation
Part A and Part B, run by the federal government.
Part C
One private plan in place of A and B, usually with drugs included.
Medigap
A standardised policy that pays what Original Medicare leaves behind.
Part D
The coverage that decides what you actually pay at the counter.
Original Medicare, in four letters
The inpatient half of Original Medicare.
Doctors, outpatient care, equipment, prevention.
A private plan that replaces how you receive A and B.
Either a standalone plan or built into Advantage.
Part A
The inpatient half of Original Medicare.
Most people pay no premium for Part A because they or a spouse paid Medicare taxes for at least 40 quarters — ten years of work. There is a deductible for each benefit period rather than once a year, so a second hospital stay later in the year can mean a second deductible.
Worth knowing
A benefit period is not a calendar year. It starts the day you are admitted and ends once you have been out of a hospital or skilled nursing facility for 60 days in a row.
Part B
Doctors, outpatient care, equipment, prevention.
Part B has a monthly premium that CMS sets each year, usually taken out of a Social Security payment. Higher earners pay an income-related adjustment on top, called IRMAA, which is based on the tax return from two years earlier. After the annual deductible you generally pay 20% of the Medicare-approved amount.
Worth knowing
That 20% has no ceiling. Original Medicare on its own has no annual out-of-pocket maximum, which is the single reason most people add a Supplement or choose an Advantage plan.
Part C
A private plan that replaces how you receive A and B.
You keep paying the Part B premium. Many Advantage plans add no premium of their own. You pay copays as you use care, and every plan has an annual maximum out-of-pocket — a MOOP — that caps what in-network Part A and B care can cost you in a year. CMS sets the highest MOOP a plan may use; plans can and do set lower ones.
Worth knowing
Advantage plans use networks and prior authorization. Check that your doctors, your hospital and your drugs are all in the plan before you enrol, and re-check every autumn, because networks and formularies change on 1 January.
Part D
Either a standalone plan or built into Advantage.
A monthly premium set by the plan, a deductible that cannot exceed the CMS limit, then copays or coinsurance by tier. Higher earners pay a Part D IRMAA as well. Once your out-of-pocket spending on covered drugs reaches the annual cap you pay nothing more for them that year.
Worth knowing
If you go 63 days or more without creditable drug coverage after your Initial Enrollment Period, Medicare adds a late enrollment penalty of 1% of the national base beneficiary premium for every full month you went without — and it stays on your premium for as long as you have Part D.
Side by side
There is no best plan, only a best fit. These are the seven questions that decide it, answered honestly for all three routes — including where each one is weaker.
Original Medicare
Any provider in the United States that accepts Medicare. No referrals.
Medicare Advantage
The plan’s network, in the plan’s service area. HMOs usually need referrals.
Original + Supplement
Any provider that accepts Medicare, same as Original — the policy follows Medicare.
Original Medicare
No. There is no annual out-of-pocket maximum on Parts A and B.
Medicare Advantage
Yes. Every plan has a MOOP for in-network Part A and B care. CMS sets the ceiling.
Original + Supplement
Plans G and N have no stated cap but leave very little uncovered. Plans K and L have a real annual limit.
Original Medicare
Not included. You add a standalone Part D plan.
Medicare Advantage
Usually built in. A plan without drugs is an MA-only plan and it is worth checking which you are looking at.
Original + Supplement
Not included, and it cannot be. You add a standalone Part D plan.
Original Medicare
No.
Medicare Advantage
No. Advantage plans cannot use medical underwriting.
Original + Supplement
Yes, outside your guaranteed-issue windows. This is the single most important thing to understand about Medigap.
Original Medicare
The Part B premium, plus IRMAA if your income is above the threshold.
Medicare Advantage
The Part B premium, plus the plan premium — often $0 — plus copays as you use care.
Original + Supplement
The Part B premium, plus the Medigap premium, plus a Part D premium. Higher fixed cost, lower variable cost.
Original Medicare
Covered anywhere in the US. Almost nothing outside it.
Medicare Advantage
Emergency care travels. Routine care usually does not leave the service area.
Original + Supplement
Same US coverage as Original, and G and N add 80% foreign travel emergency up to a $50,000 lifetime maximum.
Original Medicare
Review the Part D plan every autumn.
Medicare Advantage
Every autumn without exception. Networks, formularies, copays and Star Ratings all reset on 1 January.
Original + Supplement
The policy itself is standardised and stable. Review the Part D plan every autumn.
The dates that do not move
Medicare runs on a calendar, and the calendar does not negotiate. Here is every window, what it lets you do, and when what you decide takes effect.
Enrolment departures
Everyone approaching 65 who is not already on Medicare through disability.
When it takes effectSign up in the three months before your birthday month and coverage starts on the first day of that month. Sign up during or after it and coverage starts the first of the month after you sign up.
Anyone who missed their Initial Enrollment Period and has no Special Enrollment Period.
When it takes effectCoverage begins the first of the month after you sign up. You may owe a Part B late enrollment penalty of 10% for each full 12-month period you could have had Part B and did not — and it lasts for as long as you have Part B.
Everyone already on Medicare. This is the once-a-year window for changing plans.
When it takes effectEvery change made in this window takes effect on 1 January.
People who are already in a Medicare Advantage plan on 1 January.
When it takes effectChanges take effect the first of the following month. You cannot use this window to move from Original Medicare into an Advantage plan — it only runs one way.
Anyone whose circumstances change in a way Medicare recognises.
When it takes effectEach Special Enrollment Period has its own length and its own start date. If you think one applies to you, it is worth confirming the exact dates rather than assuming.
Five conversations
It is always “what happens to me”. These five are composites written to show the shape of a real conversation — the facts and the rules are exact, the people are not.
Margit was still teaching three days a week at 65, on a school district plan that covered more than 20 employees. Her question was whether she had to do anything at all. The answer was that she could delay Part B without penalty for as long as that employer coverage lasted, but she should take premium-free Part A, and she needed to understand that the eight-month Special Enrollment Period for Part B would start the month after the job ended — not the month after COBRA ran out. She retired eighteen months later, enrolled inside that window, and picked up a Plan G with a standalone Part D. The whole thing took one conversation and a diary note.
The mistake would not have been picking the wrong plan. It would have been assuming COBRA counted.
Illustrative composite. Not a real customer, not a testimonial, and not a promise of any particular outcome.
Tomás grows most of what he eats and sees a doctor roughly twice a year. He had been sold on the idea that Plan G was the only respectable choice. When we walked through what he actually uses, Plan N came out ahead: the copay on an office visit was money he would spend two or three times a year, and New Mexico doctors who bill Part B excess charges are rare enough that the exposure was small. We also checked that his two prescriptions sat on the preferred tier of the Part D plan he was considering. He chose N with his eyes open, which is the only reason it was the right answer.
Plan N is not a lesser Plan G. It is a different bet, and it only works if you know what you are betting.
Illustrative composite. Not a real customer, not a testimonial, and not a promise of any particular outcome.
Delphine had been happy with her Advantage plan for four years. Then her rheumatologist left the network on 1 January and the nearest in-network replacement was ninety minutes away. She had missed the Annual Enrollment Period because nothing had been wrong in October. What she had was the Medicare Advantage Open Enrollment Period, January to March, which let her move to a different Advantage plan that held her specialist — once. We checked the new plan’s formulary against her infusion drug before she moved, not after.
The plan she had was not a bad plan. It just stopped being her plan on the first of January.
Illustrative composite. Not a real customer, not a testimonial, and not a promise of any particular outcome.
Hideo moved from Illinois to Washington to be near his daughter. His Advantage plan did not operate in the new county, which triggered a Special Enrollment Period — but the clock started when he told the plan he had moved, and there was a version of the timing where it would have started earlier and given him less room. We worked out the actual dates, established that a Supplement was available to him in Washington under the state’s rules, and moved him to Original Medicare with a Plan G and a Part D plan chosen around his blood pressure medication.
A move is one of the few events that reopens almost every door. It also closes them again on a schedule.
Illustrative composite. Not a real customer, not a testimonial, and not a promise of any particular outcome.
Rosaura took no medication at all and could not see why she should pay a premium for a drug plan. The arithmetic she had not been shown was the late enrollment penalty: 1% of the national base beneficiary premium for every full month without creditable coverage, added permanently once she does need a plan. We found her the least expensive Part D plan in her county that still covered the two drugs she was most likely to need, and treated it as what it is — insurance against a future she cannot see from here.
The penalty is not a fine you pay once. It is a line on your premium for the rest of your life.
Illustrative composite. Not a real customer, not a testimonial, and not a promise of any particular outcome.
How we work
Licensed advisors are paid a commission by the carrier, and CMS sets that commission at the same amount for every comparable plan. There is no plan we make more money on. That single fact is what makes carrier-neutral advice possible, and it is why we will tell you plainly when the right answer for you is a plan we do not offer.
We are appointed with 31 carriers and licensed in 38 states, which is a lot and is still not all of them. Where our shelf ends, we say so and point you at Medicare.
Book a call, or just ring us. There is no script, no quota and no cost to you — advisor commissions are set by CMS and are the same whichever plan you choose.
Type, the business name, the phone number and the logo are studio
controls rather than visitor controls — a customer looking at a
demonstration wants to see it in their colours, not to be handed a
font picker. They live at ?studio=1.
Open that address anywhere and the site arrives already wearing this brand — on the first frame, not after a flash of ours.