Getting to Know Medicare
Medicare is a federal health insurance program designed to support:
Individuals 65 and older
People under 65 with certain disabilities
People of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
The Four Parts of Medicare
🛏 Part A – Hospital Insurance
Part A helps cover inpatient hospital care, skilled nursing facility care (short-term), hospice services, and some home health care.
Most people don’t pay a premium for Part A because they paid into Medicare taxes during their working years.
🩺 Part B – Medical Insurance
Part B covers doctor visits, outpatient care, preventive services, and some home health services not covered by Part A.
A monthly premium is typically required for Part B.
💊 Prescription Drug Coverage (Part D)
Part D helps lower the cost of prescription medications and protects against future increases.
Plans are offered by private insurance companies approved by Medicare, and most require a monthly premium.
Important: If you delay enrollment, you may have to pay a late enrollment penalty.
This Medicare overview is based on official guidance from www.cms.gov.
By calling the phone number on this website, you will be connected to a licensed insurance agent.
Who Qualifies for Medicare?
You may be eligible for Medicare if:
You’re 65 or older, and
You or your spouse worked at least 10 years in a Medicare-covered job, and
You’re a U.S. citizen or a permanent legal resident
But that’s not the only way to qualify.
You may also qualify under age 65 if:
You’ve received Social Security Disability benefits for at least 24 months
You have End-Stage Renal Disease (ESRD) and require regular dialysis or a kidney transplant
Premium-Free Part A — When Do You Qualify?
You can receive Part A (Hospital Insurance) without paying a premium if:
You're already receiving Social Security or Railroad Retirement Board benefits
You're eligible for those benefits but haven’t started receiving them yet
You or your spouse had Medicare-covered government employment
If you qualify based on disability or ESRD, you can also receive premium-free Part A before age 65.
What About Part B?
Most people must pay a monthly premium for Part B (Medical Insurance).
This premium is usually deducted from your:
Social Security check
Railroad Retirement benefits
Civil Service Retirement check
If you're not receiving any of those, Medicare will send you a bill every three months.
Have questions? Let us help you navigate your Medicare options.
Give us a call—we’re here to guide you every step of the way.
By contacting the phone number on this website, you will be connected with a licensed insurance agent.
Important Medicare Enrollment Dates & Guidelines
Navigating Medicare enrollment doesn't have to be overwhelming. Here's a quick guide to help you stay on track and make informed decisions.
📅 September – October: Time to Review
Start preparing for the upcoming year by reviewing your current plan.
Look out for notices from your Medicare plan about changes in coverage, costs, or benefits.
Download the official Medicare & You 2025 handbook for up-to-date information.
Use Medicare’s comparison tools to explore your options and make informed choices.
📆 October 15 – December 7: Annual Enrollment Period (AEP)
This is the only time of year when all Medicare beneficiaries can make the following changes:
Switch from Original Medicare to a Medicare Advantage Plan
Go back to Original Medicare from a Medicare Advantage Plan
Switch between different Medicare Advantage Plans
Join or drop a Medicare Prescription Drug Plan (Part D)
Make changes to Medicare Advantage Plans with or without drug coverage
Any changes made during this time take effect on January 1 of the following year.
🗓 January 1: New Coverage Starts
If you made changes during AEP, your new plan begins on this date.
If you kept your current plan, any updates to coverage or costs take effect now.
📆 January 1 – March 31: Medicare Advantage Open Enrollment
If you're enrolled in a Medicare Advantage Plan, you can:
Switch to a different Medicare Advantage Plan
Return to Original Medicare and enroll in a standalone Part D plan
You can only make one change during this period. Changes go into effect the first of the month after your request is received.
🛡 When to Buy a Medicare Supplement (Medigap) Policy
The best time to purchase a Medigap plan is during your Medigap Open Enrollment Period:
Begins the month you turn 65 or older and enroll in Part B
Lasts for six months
You have guaranteed access to any Medigap policy in your area during this time—no health underwriting required
💡 Note: If you delayed Part B due to group coverage, your Medigap enrollment window begins once you enroll in Part B.
Need Help Navigating Enrollment?
We’re here to make it simple. Give us a call and let’s walk through your Medicare options together.
📞 By calling the number on this site, you’ll be connected with a licensed insurance agent.
Choosing or Changing Medicare? Here’s What We’ll Look At Together
As your health needs or budget change, it’s important to review your Medicare coverage each year. Here are key questions to help you decide if your current plan still fits—or if it’s time to explore new options:
✅ 1. Coverage & Costs
What are your monthly premiums, deductibles, and copays?
How much do you pay for doctor visits, hospital stays, or specialist care?
Is there a maximum yearly out-of-pocket limit for your plan?
Are there coverage rules (like referrals or prior authorizations) that could affect access or costs?
✅ 2. Other Health Coverage
Do you have employer coverage, VA benefits, or coverage through Indian Health/Tribal Health Services?
How does your current non-Medicare coverage work alongside Medicare?
Will changing plans affect your retiree or union benefits?
💬 Tip: Check with your benefits administrator or give us a call before making changes.
✅ 3. Doctor & Hospital Access
Do your preferred doctors and specialists accept the plan?
Are they accepting new patients?
Are your providers in-network, or will you pay more to see them?
Do you need a referral to see a specialist?
✅ 4. Prescription Drug Coverage
Are your medications covered under the plan’s formulary?
What are your drug copays or coinsurance amounts?
Do you qualify for Extra Help or Medication Therapy Management (MTM)?
Will you pay a late enrollment penalty if you delay drug coverage?
What’s the plan’s star rating for drug services?
✅ 5. Quality of Care
Are you satisfied with the care you’re receiving?
How do Medicare star ratings and reviews from other enrollees compare across plans?
Have you had issues with delays, access, or communication?
✅ 6. Convenience
Are doctor’s offices and pharmacies near your home?
Do the providers offer electronic health records (EHRs) or e-prescriptions?
Can you receive prescriptions by mail?
Does your pharmacy offer preferred cost sharing (lower drug prices)?
✅ 7. Travel Coverage
Will your plan cover you if you travel to another state or out of the country?
Original Medicare doesn’t typically cover care outside the U.S.—do you need travel medical coverage or Medigap?
Still Have Questions? Let’s Talk.
Choosing the right Medicare coverage can feel overwhelming—but you don’t have to do it alone.
📞 Give us a call and let us help you find a plan that truly fits your needs.
Information sourced from www.medicare.gov
By calling the number on this website, you’ll be connected to a licensed insurance agent.
Let’s Make Your First Year with Medicare a Smooth One
Starting Medicare is a big step—and we’re here to help you make the most of it from day one. Here are the key actions to take during your first year:
📝 1. Authorize Someone to Help You (If You’d Like)
If you want a family member, friend, or caregiver to talk to Medicare on your behalf, you’ll need to fill out a Medicare Authorization Form.
Without it, Medicare can’t share your personal health information—even with your spouse.
👉 Get the form at Medicare.gov
🩺 2. Schedule Your “Welcome to Medicare” Preventive Visit
Within your first 12 months of having Medicare Part B, you’re eligible for a free, one-time preventive visit.
This is a great chance to:
Review your medical history
Talk about preventive screenings
Create a personalized care plan with your doctor
📅 Don’t wait—this benefit is only available during your first year!
💻 3. Set Up Your MyMedicare.gov Account
This secure, online portal gives you access to your personal Medicare info 24/7. You can:
Track health care claims
View your Medicare Summary Notices (MSNs)
Check your deductible status
Manage preventive care reminders
Review your plan details or shop for new ones
🔐 Sign up at MyMedicare.gov
📚 4. Learn What Medicare Covers
Medicare covers a wide range of services—but it’s important to understand what’s included and what might require extra coverage.
Use the Medicare coverage tool to search for tests, services, or items
Talk with your doctor about coverage for anything not listed
Ask questions—don’t assume something is or isn’t covered!
📞 5. Still Have Questions? Let’s Chat.
We’re just a phone call away. Whether you need help with coverage, plan changes, or general questions—we’re here to make your first year with Medicare as smooth as possible.
This information was sourced from www.medicare.gov
By calling the number on this website, you'll be connected with a licensed insurance agent.
Coordinated Medicare & Medicaid Benefits
If you qualify for both Medicare and Medicaid, you may be eligible for a special plan that brings both programs together under one coordinated plan—making it easier to manage your care and benefits.
✅ Am I Eligible?
You may qualify for a Medicare-Medicaid Coordinated Plan if:
You’re 21 or older, and
You’re eligible for both Medicare and Medicaid (often called dual-eligible), and
You may have ongoing health conditions or financial needs that require extra support
🧩 What Is a Medicare-Medicaid Coordinated Plan?
Also known as a dual-eligible special needs plan (D-SNP) in some states, this type of plan helps combine your Medicare and Medicaid benefits in one place. It often includes:
Medical coverage from Medicare
Cost-sharing and long-term care support from Medicaid
Access to extra services like care coordination, transportation, personal in-home support, and dental or vision care
Medicare remains the primary payer, while Medicaid helps cover things Medicare doesn’t—like deductibles, copays, or long-term services and supports.
🤝 Why Coordinated Care?
With a coordinated plan:
You’ll work with one team to manage both Medicare and Medicaid services
Your benefits are designed to work together seamlessly
Care is tailored to your unique health goals and needs
This approach helps reduce confusion, simplify billing, and improve your overall care experience.
💬 Let’s See if You Qualify
Have questions or think you might be eligible for dual coverage? Give us a call—we’re happy to help you explore your options and find out if a Coordinated Medicare-Medicaid Plan is right for you.
This information was sourced from www.medicare.gov
💡 Don’t Miss Out: A Quick Guide to Navigating Medicare Enrollment
Turning 65? That’s more than just a milestone—it marks your eligibility for Medicare, the federal health insurance program for older adults and certain individuals with disabilities. Enrolling on time helps ensure uninterrupted access to care and protection from late penalties.
But with so many timelines, parts, and plan options, getting started can feel like a lot. That’s where this short guide comes in.
⏰ Your Initial Enrollment Period (IEP)
Your Initial Enrollment Period (IEP) is your golden window to sign up.
Starts: 3 months before your 65th birthday month
Includes: Your birthday month
Ends: 3 months after your birthday month
That gives you 7 months total to enroll in Medicare Part A and Part B without facing late enrollment penalties or coverage delays.
🔔 Special Note: If your birthday falls on the first day of the month, your IEP is bumped up—coverage can start the month before your birth month.
Example: If your birthday is December 1, coverage can begin November 1.
⚠️ Missed the Window? Here's What That Means
Delaying your Medicare enrollment past your IEP can cost you—literally.
If you don’t sign up for Part B during your IEP and don’t qualify for a Special Enrollment Period, you could face a 10% penalty for every 12-month period you go without coverage. This penalty is added to your monthly premium for life.
💡 Example: John turns 65 in July but forgets to enroll until November. Because he missed his IEP, John may face late penalties and a delay in his coverage start date—potentially putting both his wallet and health at risk.
✅ What You Can Do Now
Avoid the stress—and the penalties—with a few simple steps:
📅 Set Reminders: Mark your IEP on your calendar so you don’t miss a beat.
📚 Do Your Research: Visit medicare.gov and ssa.gov to explore your options.
🤝 Talk to a Medicare Specialist: You don’t have to figure this out alone. We can walk you through the process and help you select the right plan for your needs and budget.
🎯 Take Control of Your Coverage
Enrolling on time ensures a smooth transition into Medicare and sets the stage for confident, stress-free healthcare planning. A little prep now can save you time, money, and headaches later.
This information is based on official guidance from medicare.gov and cms.gov.
How we can help:
The more you understand Medicare, the more confident you'll feel in making the right choices for your health coverage. That’s why we’ve put together this dedicated Medicare Resource Center—to simplify the process and guide you every step of the way.
Here, you’ll find helpful tools and information designed to support you in choosing a plan that fits your unique needs and lifestyle.
If you have questions or need personal guidance, don’t hesitate to reach out. We're always here to help. Call or text 910-631-5392 or email [email protected].
By calling the number on this site, you’ll be connected with a licensed insurance agent.
Information:
Get a Consultation & Medicare Supplement Quote at No Cost
Are you on Medicare?
If you are new to Medicare and need a little more information, click below.
North Carolina: We do not offer every plan available in your area. Currently we represent 23 organizations which offer 121 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
South Carolina: We do not offer every plan available in your area. Currently we represent 21 organizations which offer 107 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Georgia: We do not offer every plan available in your area. Currently we represent 20 organizations which offer 103 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Tennessee: We do not offer every plan available in your area. Currently we represent 18 organizations which offer 98 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Florida: We do not offer every plan available in your area. Currently we represent 25 organizations which offer 152 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Virginia: We do not offer every plan available in your area. Currently we represent 19 organizations which offer 105 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Maryland: We do not offer every plan available in your area. Currently we represent 17 organizations which offer 89 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Kansas: We do not offer every plan available in your area. Currently we represent 12 organizations which offer 67 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Texas: We do not offer every plan available in your area. Currently we represent 28 organizations which offer 164 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Ohio: We do not offer every plan available in your area. Currently we represent 23 organizations which offer 133 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Michigan: We do not offer every plan available in your area. Currently we represent 15 organizations which offer 92 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
California: We do not offer every plan available in your area. Currently we represent 33 organizations which offer 178 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
A non-government site hosted by Price Services Group, L.L.C., a health insurance agency
Price Services Group (L.L.C.) is NOT Endorsed by or Affiliated with Medicare or ANY Government Program.
Price Services Group, L.L.C. Copyright 2025 -- All Rights Reserved
Phone: (866) 648-1578 Email: [email protected]
