Medicare 101

Medicare is a federal health insurance program primarily for people who are 65 or older. It also covers certain younger people with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare is divided into different parts, each covering specific services. Understanding these parts is the first step to making the most of your Medicare benefits.

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working.

Medicare Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Part B requires a monthly premium, which is based on your income.

Medicare Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers, and most include prescription drug coverage and extra benefits like dental, vision, and hearing.

Medicare Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Your Initial Enrollment Period (IEP) begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after — a 7-month window. Enrolling during this period helps you avoid late enrollment penalties.

If you miss your IEP, you can enroll during the General Enrollment Period (January 1 – March 31 each year), but you may pay a late enrollment penalty. Coverage begins July 1 of that year.

The Annual Enrollment Period (October 15 – December 7) allows current Medicare beneficiaries to switch plans, add or drop drug coverage, or move between Original Medicare and Medicare Advantage.

Original Medicare (Parts A and B) is the traditional fee-for-service program managed directly by the federal government. You can see any doctor or hospital that accepts Medicare, and you typically pay 20% of covered services after your deductible.

Medicare Advantage plans are offered by private insurers and often include additional benefits not covered by Original Medicare — such as dental, vision, hearing, fitness memberships, and over-the-counter allowances. Many plans have $0 premiums.

The right choice depends on your health needs, preferred doctors, prescription drugs, and budget. A licensed Medicare advisor can help you compare your specific options at no cost to you.

Navigating Medicare can feel overwhelming, but you don't have to do it alone. At Sunset Insurance Enterprises, we specialize in helping seniors understand their Medicare options and find the plan that best fits their needs and budget.

Our services are completely free to you — we're compensated by the insurance carriers, not by you. There's no pressure and no obligation. We simply help you make an informed decision.