Medicare Basics
Insurance Eligibility
You automatically qualify for insurance coverage when you meet the eligibility criteria, such as turning 65 and receiving Social Security or Railroad Retirement benefits. Enrollment in Social Security automatically enrolls you in the corresponding insurance coverage. These programs are linked—when you start receiving Social Security, you are also enrolled in the insurance plan.
Even if you don’t plan to retire at age 65, you can still sign up for coverage during your Initial Enrollment Period (IEP) and opt for additional plans when you retire.
Am I Eligible for Medicare Insurance Coverage?
Many people assume that Medicare is exclusively for those aged 65 and older, but you may qualify for Medicare enrollment before reaching 65. There are several situations in which individuals under 65 can become eligible for Medicare. Explore the scenarios below to see if you qualify
Under 65, you are eligible if:
Over 65, you are eligible if:
Choosing the Right Plan for You
We offer different coverage plans, each designed to meet specific needs.
You have the option of staying with Original Medicare (Part A & Part B) or electing to add a Medicare Supplement plan, Medicare Advantage plan, or stand alone Prescription Drug Coverage (Part D).
Part A will also cover medically necessary private and at-home health services. “Medically necessary” refers to any service deemed essential by a doctor to help someone recover or improve their health. Medically necessary at-home services can include:
Additional Care Covered by Part A:
Part B provides medical insurance coverage, helping with necessary supplies and services to treat health issues and conditions. Some of the services covered include:
In some cases, Part B also covers part-time rehabilitation and home health services.
Each Advantage plan will have varying out-of-pocket costs and coverage rules. For example, some plans may require a referral to see a specialist. Most Advantage plans also include prescription drug coverage (Part D).
*Note: The additional services offered through Advantage plans vary by plan and location. Not all plans may offer all extra benefits.
Although Part D plans are often viewed as an “add-on” to your insurance, prescription drug coverage is essential and should not be overlooked. For many, managing prescription costs is one of the most important and complex parts of healthcare coverage. With various plan options, ratings, and drug tiers, it’s important to carefully consider your choices. You have two options for Part D coverage:
You are eligible for a stand-alone prescription drug plan if you meet the following conditions:
When choosing a Part D plan, the cheapest option may not be the best. Compare coverage for your current medications, as low-cost plans might not cover your prescriptions, leading to higher out-of-pocket expenses.
New Part D regulations will take effect in 2026. Stay updated to make the best decision for your prescription needs.
Coverage Costs
Each fall, the Centers for Medicare and Medicaid Services (CMS) announces updates to premiums and deductibles for the Medicare program. Since the Cost of Living Adjustment can vary yearly, it’s important to stay updated on these changes to ensure your coverage remains suitable for your needs.
While costs for Medicare Supplement and Medicare Advantage plans may differ, all beneficiaries should be aware of potential changes to premiums, deductibles, and co-pays for Part B and Part D. Although there is a premium for Part A, most beneficiaries will not need to pay it due to common eligibility factors.
