Medicare Basics: What You Need to Know
Welcome to our comprehensive guide to Medicare! Jeremy Patterson has been helping Medicare beneficiaries over 19 years. He is an Independant Senior Insurance Advisor who helps his clients avoid costly mistakes when choosing the right Medicare Plan and Retirement Solutions.
Today, we'll explore the different parts of Medicare, eligibility requirements, enrollment periods, and how to choose the best coverage for your unique healthcare needs. By 2025, Medicare will serve over 65 million beneficiaries, making it one of America's most important health insurance programs.

by Jeremy Patterson

Who Is Eligible for Medicare?
Age-Based Eligibility
You qualify for Medicare when you turn 65, regardless of your retirement status. This is the most common eligibility path and applies to U.S. citizens and legal residents who have lived in the country for at least 5 years.
Disability-Based Eligibility
If you're under 65, you may qualify after receiving Social Security Disability Insurance (SSDI) benefits for 24 months. People with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) can qualify immediately without the waiting period.
Citizenship Requirements
To be eligible for Medicare, you must be a U.S. citizen or a legal resident who has lived in the United States for at least 5 consecutive years before applying for Medicare benefits.
Original Medicare: Parts A & B
Part A: Hospital Insurance
Covers inpatient hospital care, skilled nursing facility care (up to 100 days), hospice care, and some home health services. Most people don't pay a premium if they or their spouse paid Medicare taxes while working.
Part B: Medical Insurance
Covers doctor visits, outpatient care, preventive services, and medical supplies. The standard monthly premium in 2025 is based on your income, with most people paying around $170 per month.
Cost-Sharing
With Original Medicare, you'll pay a deductible for both Parts A and B, plus 20% coinsurance for most services. There's no annual out-of-pocket maximum, which can leave you exposed to potentially high costs.
Part C: Medicare Advantage Plans
All-in-One Coverage
Medicare Advantage plans combine Part A, Part B, and usually Part D prescription drug coverage in a single plan, often with additional benefits not covered by Original Medicare.
Extra Benefits
Many plans offer dental, vision, hearing, fitness memberships, and transportation to medical appointments—services not covered by Original Medicare.
Provider Networks
Most Medicare Advantage plans use provider networks (HMO or PPO). This means you may need to use doctors and hospitals within the plan's network to get the lowest costs.
Cost Structure
Plans typically have lower premiums but use copayments and coinsurance. Unlike Original Medicare, Advantage plans have an annual out-of-pocket maximum for covered services.
Part D: Prescription Drug Coverage
Plan Selection
Choose from 14+ prescription drug plans in most areas, each with different premiums, formularies (covered drugs), and pharmacy networks. Plans are offered by private insurance companies that contract with Medicare.
Cost Structure
Part D plans typically have a monthly premium, annual deductible, and copayments or coinsurance for each prescription. Costs vary based on the drugs you take and which plan you choose.
Out-of-Pocket Cap
Starting in 2025, Medicare beneficiaries will have their annual out-of-pocket prescription drug costs capped at $2,000, providing significant financial protection for those with high medication expenses.
Medigap: Extra Coverage Options
10
Plan Options
Standardized Medigap plans lettered A through N
100%
Coverage
After $257 Part B deductible when covered by Plan G
$0
Hospital Costs
When covered by Plan G
Medigap policies (Medicare Supplement Insurance) are sold by private companies to help pay costs that Original Medicare doesn't cover. These policies can significantly reduce your out-of-pocket expenses, including deductibles, copayments, and coinsurance. Remember that Medigap policies work only with Original Medicare, not Medicare Advantage, and don't include prescription drug coverage.
Enrollment: When and How to Sign Up
Initial Enrollment Period (IEP)
Your 7-month IEP includes the 3 months before your 65th birthday month, your birthday month, and the 3 months after. For those qualifying through disability, enrollment begins after 24 months of receiving SSDI benefits.
How to Enroll
Sign up through the Social Security Administration online at SSA.gov, by calling 1-800-772-1213, or by visiting your local Social Security office. Medicare enrollment is not automatic for most people.
Special Working Situations
If you're still working and covered by employer insurance when you turn 65, you may qualify for a Special Enrollment Period later, allowing you to delay Medicare enrollment without penalty.
Late Enrollment Penalties
If you miss your enrollment window without qualifying for an exception, you may face lifetime premium penalties—10% for each 12-month period you could have had Part B, and 1% per month for Part D.
Key Takeaways & Resources

Review All Options
Compare Original Medicare, Medicare Advantage, Part D, and Medigap
Meet Deadlines
Know your enrollment periods to avoid lifetime penalties
Get Assistance
Schedule a consultation at askmhc.com for free, unbiased guidance
Explore Financial Help
Extra Help and Medicare Savings Programs available
Medicare can seem complex, but understanding your options is essential for making the best healthcare decisions.
Next Steps: Preparing for Your Medicare Journey
Gather Your Information
Collect your Social Security number, birth certificate, current health insurance details, and list of medications and healthcare providers before starting the enrollment process.
Research Your Options
Use the Medicare Plan Finder at askmhc.com to compare plans available in your area. Consider your health needs, budget, preferred doctors, and prescription medications.
Schedule a Consultation
Contact Jeremy at 318-470-2537 for a personalized review of your Medicare options. We can help you understand the pros and cons of each choice based on your specific situation.
Mark Your Enrollment Dates
Put your Initial Enrollment Period dates on your calendar to ensure you don't miss this important window. Remember, delaying can result in gaps in coverage and lifetime penalties.