When you approach your 65th birthday, one major topic starts coming up more frequently: Medicare. If you’ve ever tried researching it on your own, you probably found yourself buried in complex terminology, confusing deadlines, and plan comparisons that feel like a maze. You might even hear conflicting advice from friends, family, or the internet.

That’s why we’ve put together this detailed and easy-to-understand blog that busts myths, answers frequently asked questions, and empowers you to make informed Medicare decisions.

Let’s start by clearing the air.

What Is Medicare—and Who Needs It?

Medicare is the United States’ federal health insurance program primarily designed for:

• People aged 65 and older

• Certain younger individuals with qualifying disabilities

• Individuals with End-Stage Renal Disease (ESRD) or ALS

Unlike employer-provided or private insurance, Medicare has multiple parts, each with a specific role in your coverage. Understanding how these parts interact—and which ones you need—is essential for good healthcare planning.

Breaking Down the Parts of Medicare

Let’s look at the four major parts of Medicare and what each one does:

Part A – Hospital Insurance

Covers:

• Inpatient hospital stays

• Skilled nursing facility care

• Hospice

• Limited home health services

Usually free if you or your spouse paid Medicare taxes for 10+ years. Still, you’re responsible for deductibles and coinsurance.

Part B – Medical Insurance

Covers:

• Doctor visits

• Outpatient care

• Preventive services (e.g., screenings, vaccines)

• Durable medical equipment

Requires a monthly premium. In 2025, the standard rate is about $174.70, with higher earners paying more.

Part C – Medicare Advantage

An alternative to Original Medicare, offered by private insurers. Combines Parts A and B, and usually includes Part D (drug coverage), plus extras like:

• Dental

• Vision

• Hearing

• Fitness memberships

May offer lower costs, but networks can be more restrictive.

Part D – Prescription Drug Plans

Helps cover prescription drug costs. Plans differ in drug lists, costs, and pharmacy networks. Available as standalone plans (if you have Original Medicare) or included in many Medicare Advantage plans.

Medicare Supplement Plans (Medigap)

Even with Medicare, you still have out-of-pocket costs. That’s where Medigap comes in. These are private plans that help pay:

• Copayments

• Coinsurance

• Deductibles

You must have Original Medicare to qualify for Medigap, and you cannot have Medigap and Medicare Advantage at the same time.

Plans are standardized (Plans A through N), but prices vary by provider, location, and age.

Common Medicare Myths—Debunked

Let’s address some of the most common misconceptions about Medicare.

❌ Myth 1: “Medicare is completely free.”

✅ Fact: While some parts (like Part A) may be premium-free, most people pay premiums, deductibles, and coinsurance.

❌ Myth 2: “I’m automatically enrolled.”

✅ Fact: You’re only auto-enrolled if you’re already receiving Social Security. Everyone else must enroll manually—especially important during the Initial Enrollment Period.

❌ Myth 3: “Medicare covers everything.”

✅ Fact: Original Medicare doesn’t cover dental, vision, hearing aids, or long-term care. You may need additional plans for full protection.

❌ Myth 4: “I can enroll whenever I want.”

✅ Fact: Timing matters. If you miss your Initial Enrollment Period or Annual Enrollment Period, you may face late penalties or coverage gaps.

Key Medicare Enrollment Periods to Know

Initial Enrollment Period (IEP)

• Starts 3 months before your 65th birthday

• Ends 3 months after

• Best time to enroll to avoid penalties

General Enrollment Period (GEP)

• Jan 1 – Mar 31

• For those who missed IEP

• Coverage starts July 1 (penalties may apply)

Annual Enrollment Period (AEP)

• Oct 15 – Dec 7

• Change from Original Medicare to Advantage (or vice versa)

• Switch or join a Part D plan

Medicare Advantage Open Enrollment

• Jan 1 – Mar 31

• Switch from one Advantage plan to another or revert to Original Medicare

Missing these deadlines can be costly. It pays to plan ahead.

What Medicare Doesn’t Cover

While Medicare offers broad coverage, here’s what’s not included unless you have additional insurance:

• Routine dental care (cleanings, fillings, dentures)

• Vision exams and eyeglasses

• Hearing aids and hearing exams

• Long-term custodial care

• Overseas medical coverage

You can fill these gaps with a Medigap policy or a Medicare Advantage plan with extended benefits.

How to Choose the Right Medicare Plan

Every person’s needs are different, so don’t just follow what worked for a friend or relative. Consider:

• Your current doctors and hospitals – Are they in-network?

• Your prescriptions – Are they covered by your Part D or Advantage plan?

• Your travel habits – Will you need coverage outside your home state or country?

• Your budget – What can you afford in premiums vs. out-of-pocket costs?

Use tools like the Medicare Plan Finder on Medicare.gov—or better yet, speak with a licensed Medicare advisor who can compare plans based on your situation.

Why Work With a Medicare Advisor?

Navigating Medicare can feel like trying to solve a puzzle blindfolded. A licensed Medicare advisor helps you:

• Compare plans in your area

• Avoid penalties and coverage gaps

• Understand the pros and cons of Original Medicare vs. Advantage

• Make informed decisions without high-pressure sales tactics

This kind of help is especially useful during the Annual Enrollment Period, when dozens of new plans flood the market.

Talk to a Trusted Medicare Specialist

Don’t let confusion or misinformation guide your Medicare decisions. Whether you’re new to Medicare or considering switching plans, W. Michael Jarman is here to help.

W. Michael Jarman
📞 Phone: +1 (503) 828-2328
📧 Email: wmichaeljarman@gmail.com