Medicare
Original Medicare, Advantage, or Medigap — Chosen Deliberately
Original Medicare doesn't cover everything — deductibles, 20% coinsurance with no cap, prescription drugs, dental, vision, hearing, and long-term custodial care are all gaps. Choices like Medicare Advantage vs. Medigap, drug plan selection, enrollment timing, and IRMAA surcharges all affect your real out-of-pocket costs. Planning ahead keeps healthcare predictable.
Original Medicare vs. Medicare Advantage
Original Medicare (Part A hospital coverage plus Part B medical coverage) pairs naturally with a Medigap supplement and a standalone Part D drug plan, giving you broad access to any provider who accepts Medicare — at the cost of a separate supplement premium. Medicare Advantage (Part C) bundles hospital, medical, and often drug coverage into one plan, typically with a lower or $0 premium, but usually restricts you to a network and requires referrals or prior authorization for some care. Neither option is universally better — the right fit depends on your health, providers, budget, and how much you value flexibility versus predictable costs.
Enrollment Timing and Penalties
Your Initial Enrollment Period runs seven months around your 65th birthday, and missing it can trigger permanent late-enrollment penalties added to your Part B and Part D premiums for life. If you're still working past 65 with employer coverage, whether you need to enroll on time depends on your employer's size — a detail that trips up more people than almost any other Medicare rule. Alvin walks through your specific timeline so a deadline never costs you money unnecessarily.
Coordinating Medicare with Your Broader Plan
Higher income triggers IRMAA surcharges on Part B and Part D premiums — based on your tax return from two years earlier, so a large Roth conversion or capital gain today can raise your Medicare costs down the road. And Medicare itself covers very little custodial long-term care, which is exactly why a Medicare strategy and a long-term care strategy need to be built together, not in isolation.
Not connected with or endorsed by the United States government or the federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program.
Key Considerations
- Medicare does not cover custodial long-term care — a separate LTC plan is essential.
- IRMAA is based on your tax return from two years prior, so a large income event today can raise premiums in the future.
- Missing your Initial Enrollment Period can trigger permanent late-enrollment penalties for Part B and Part D.
- Switching between Medicare Advantage and Medigap later isn't always guaranteed — timing and underwriting rules apply.
- Review your Part D drug plan annually; formularies and costs change every year even if your medications don't.