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Medicare

Medicare doesn't have to be overwhelming.

There are a handful of moving parts and a great deal of jargon. Let’s take them one at a time, in words that actually mean something.

Most people come to me having read three websites and felt worse after each one. That is normal. Medicare is not complicated because you are missing something — it is complicated because it is several different things wearing the same name.

So here is the whole thing, laid out slowly. Read as much or as little as you want, then ask me about the part that matters to you.

What is it?

Medicare is the federal health insurance program, mostly for people 65 and over, and for some younger people with certain disabilities.

The part that trips everyone up is this: “Medicare” is not one plan you sign up for. It is a set of pieces. Some pieces come from the federal government. Other pieces come from private insurance companies. You end up choosing how to put them together — and the combination you choose is what determines what you pay and which doctors you can see.

That choice is the whole ballgame, and it is why it’s worth slowing down.

Who might it be for?

You are probably in the right place if any of these sound like you:

  • You are approaching 65 and starting to get mail about it — a lot of mail.
  • You are already 65 or older and still working, and wondering what to do about it.
  • You are leaving a job, retiring, or losing employer coverage.
  • You are helping a parent or spouse work out their coverage.
  • You already have a Medicare plan and you are not sure it is still the right one.
  • You are under 65 and on Medicare because of a disability.

If none of those fit but you are still confused, that also counts. Ask anyway.

What options are available?

Here are the pieces, one at a time.

  • Original Medicare

    The federal program itself: Part A and Part B together. You can see any doctor or hospital in the country that accepts Medicare, with no network to worry about. Original Medicare does not cover everything, and it does not have a cap on what you could pay out of pocket in a bad year — which is why most people add something to it.

  • Part A — hospital insurance

    Covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health care.

    Worth knowing: Most people do not pay a monthly premium for Part A, because they or their spouse paid Medicare taxes long enough while working. There are still deductibles and coinsurance amounts, and those change from year to year.

  • Part B — medical insurance

    Covers doctor visits, outpatient care, preventive services, lab work, and durable medical equipment such as walkers and oxygen.

    Worth knowing: Part B has a monthly premium, and higher earners pay more. There is also a deductible and, after that, you typically pay a share of the cost. Signing up late can mean a penalty that stays with you, so timing matters.

  • Part C — Medicare Advantage

    A different way of getting your Medicare. These are plans from private insurance companies, approved by Medicare, that bundle your Part A and Part B together — and usually your prescription coverage too. Many include extra benefits Original Medicare does not, and plans differ enormously from one to the next.

    Worth knowing: Medicare Advantage plans generally use networks, so which doctors and hospitals are in the plan matters a great deal. They also have their own rules about referrals and prior approval, and their own yearly limit on what you pay out of pocket. This is the option where reading the specific plan really counts.

  • Medicare Supplement — also called Medigap

    A private policy that sits alongside Original Medicare and helps pay some of what Original Medicare leaves you to pay, such as deductibles and coinsurance. The plans are standardized and identified by letter, so a Plan G from one company covers the same things as a Plan G from another — though the price and the company’s service can differ.

    Worth knowing: A Supplement works with Original Medicare, not with Medicare Advantage — you choose one path or the other. Supplements do not include prescription coverage, so people on this path usually add a Part D plan. When you first become eligible you generally have a window where health questions are not asked; outside that window, medical underwriting may apply.

  • Part D — prescription drug coverage

    Prescription coverage sold by private insurance companies. Every plan has its own list of covered drugs — its formulary — its own pharmacy network, and its own pricing tiers.

    Worth knowing: Two plans with similar premiums can treat your specific prescriptions completely differently. This is why I always want your actual medication list before saying anything useful about Part D. Going without drug coverage when you are eligible can also mean a lasting penalty.

The one decision underneath all of it

Nearly everyone ends up choosing between two paths: Original Medicare with a Supplement and a Part D plan, or a Medicare Advantage plan. Neither one is the right answer for everybody. The right answer depends on your doctors, your prescriptions, how much you travel, and how you feel about trading a predictable monthly cost for a lower one with more variables.

When people usually call me

Three moments come up again and again.

  • Turning 65

    There is a window around your 65th birthday when you first sign up — it opens before your birthday month and stays open for a few months after. Missing it can cost you, both in penalties and in waiting.

    If you are still working and covered by an employer plan, the picture changes, and the right move depends on the size of the employer and how the coverage works. This is worth a conversation rather than a guess.

  • Losing employer coverage

    Retiring, changing jobs, or coming off a spouse’s plan usually opens a special window to move onto Medicare without a penalty. These windows have deadlines attached.

    Bring me the date your current coverage ends and we can work backwards from there.

  • Reviewing coverage you already have

    Plans change every year — what they cover, what they cost, which doctors are in network, and which drugs are on the list. The plan that was right for you two years ago may not be right now.

    A review costs you nothing. Sometimes we find something better. Sometimes I tell you that you are already in good shape, and you get to stop worrying about it.

What should I know or consider?

Before you decide anything, these are the questions worth answering honestly:

Which doctors do you want to keep?
Networks are the single most common source of regret. Write the names down before you look at plans.
What do you actually take?
Your exact prescriptions, doses included. Drug coverage varies wildly between plans.
How much do you travel?
Time spent out of state, or seasonally elsewhere, changes which path makes sense.
Predictable or lower?
Would you rather pay a steadier amount each month, or a smaller one with more variation when you use care?
What are the deadlines?
Enrollment windows are real and missing them can carry a penalty that does not go away.
Who else is affected?
Spouses are enrolled individually. Two people in one house can end up on different plans, and that is often correct.
To be confirmed by Tessa

Medicare compliance and disclosure wording

The Medicare and CMS-required disclaimers for this page — including the statement that Three16 Benefits is not connected with or endorsed by the U.S. government or the federal Medicare program, and the statement of how many organizations and plans Tessa represents — must be supplied by Tessa and her carriers in their exact approved wording.

Nothing has been written here on her behalf, because this language is regulated and getting it wrong matters. It needs to be added and approved before the site goes live.

Take a moment

Where are you with Medicare?

Five questions, nothing scored. They tell me what to explain first, and they will probably tell you which bit you have been putting off.

  1. 1 of 5 Where are you in the timeline?
  2. 2 of 5 Which part is least clear to you?
  3. 3 of 5 When you compare options, what matters most to you?
  4. 4 of 5 Is there a deadline you are worried about missing?
  5. 5 of 5 What would make this easier for you?

Medicare is a small number of decisions that each have real consequences. Knowing which ones you are unsure about is most of the work.

Book a time — and I will have your answers in front of me

Leave your name and email and your answers come with the booking, so we do not spend the first ten minutes covering ground you have already covered. Contact details only — please keep health details out of this, we will go through those properly when we talk.

Would rather not? Book without sending your answers.

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Other things I can help with

Let's go through it together.

Bring me your doctors, your prescriptions, and your questions. I'll explain the options in plain language and you can decide from there — there is never any obligation, and a conversation costs you nothing.

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