What is Medicare?
Medicare is health insurance provided by the federal government — not a private company. It helps pay for hospital stays, doctor visits, prescriptions, and much more.
Most people don't pay anything for Part A (hospital coverage) because they or their spouse paid Medicare taxes while working. Other parts do have monthly premiums, and we'll walk through all of it below.
"Medicare is the federal government's health insurance program for people 65 and older, and for certain younger people with disabilities or specific medical conditions."
Who Qualifies for Medicare?
- Age 65 or older — U.S. citizens or permanent residents who've lived here at least 5 years
- Under 65 with a disability — if you've received Social Security Disability Insurance (SSDI) for 24 months
- End-Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a transplant
- ALS (Lou Gehrig's Disease) — automatic enrollment upon receiving disability benefits
You'll hear both terms a lot. "Original Medicare" is Parts A + B managed by the government. "Medicare Advantage" (Part C) is a private-insurance alternative. More on both below.
The 4 Parts of Medicare
Medicare is broken into four "parts." Think of them as four building blocks that can be combined based on your needs.
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Covers doctor visits, outpatient care, preventive services, lab tests, and durable medical equipment.
All-in-one plans from private insurers that include Parts A & B plus often dental, vision, hearing, and more.
Covers prescription medications through private plans that work alongside Original Medicare.
🏥 Part A — Hospital Insurance
What it covers: Inpatient hospital care, skilled nursing facility stays (after a 3-day hospital stay), hospice care, and some home health services.
Cost: Most people pay $0 in premiums for Part A if they've worked and paid Medicare taxes for at least 10 years (40 quarters). If not, the premium can be up to $505/month in 2024.
Deductible: $1,632 per benefit period in 2024 (not per year).
Enrollment: Usually automatic at 65 if you're already receiving Social Security benefits.
🩺 Part B — Medical Insurance
What it covers: Doctor visits, outpatient hospital care, preventive care (annual wellness visit, vaccines, screenings), lab tests, mental health services, durable medical equipment (walkers, wheelchairs).
Premium: $174.70/month in 2024 for most people (higher if your income exceeds $103,000/year as an individual).
Deductible: $240/year in 2024, then Medicare covers 80% of approved costs — you pay the remaining 20%.
With Original Medicare, there's no out-of-pocket maximum. A serious illness could mean very large 20% bills. This is exactly why many people add a Medigap supplement plan (see Section 3).
⭐ Part C — Medicare Advantage
Medicare Advantage is an alternative to Original Medicare. Instead of the government running your coverage, a private insurance company does — and they're required to cover everything Parts A & B cover, often more.
Extra benefits often included:
- 🦷 Dental — cleanings, X-rays, sometimes dentures
- 👓 Vision — eye exams, eyeglasses or contacts allowance
- 👂 Hearing — hearing exams and hearing aids
- 🛒 OTC Allowance — monthly credit for over-the-counter items at approved stores
- 🥑 Grocery/Food Allowance — some plans offer monthly credits for healthy foods
- 🚗 Transportation — rides to medical appointments
- 💪 Fitness — gym memberships through programs like SilverSneakers
Trade-off: Advantage plans typically require you to use in-network doctors and may require referrals to see specialists.
💊 Part D — Prescription Drugs
Part D is the Medicare prescription drug program. It's offered through private insurance companies and covers a list of approved medications called a formulary.
The Donut Hole (Coverage Gap) — explained simply:
- Initial Coverage: You pay your copays normally until total drug costs hit ~$5,030/year
- Coverage Gap ("Donut Hole"): You pay 25% of drug costs until you reach the out-of-pocket threshold
- Catastrophic Coverage: After ~$8,000 out of pocket in 2024, your costs drop dramatically
See how all 4 parts compare at a glance:
| Part | Nickname | Covers | 2024 Premium | Who Manages It |
|---|---|---|---|---|
| Part A | Hospital | Inpatient stays, skilled nursing, hospice | $0 for most people | Federal Government |
| Part B | Medical | Doctor visits, outpatient, preventive care | ~$175/month | Federal Government |
| Part C | Medicare Advantage | A+B+often dental, vision, hearing, extras | Varies ($0–$100+/month) | Private Insurer |
| Part D | Prescriptions | Prescription drugs | Varies (~$55/month avg) | Private Insurer |
Medicare Supplement (Medigap) Plans
Original Medicare (Parts A & B) pays about 80% of covered costs — leaving you responsible for the other 20%, with no cap. A serious illness or surgery could mean tens of thousands in out-of-pocket bills.
Medigap fills those gaps. These are private insurance plans that pay the costs Original Medicare doesn't cover — like deductibles, copays, and coinsurance.
Medigap works with Original Medicare — it does NOT replace it. You must have Parts A & B enrolled first. Medigap pays after Medicare pays its share.
The Most Popular Plans: Plan G & Plan N
| Feature | Plan G | Plan N |
|---|---|---|
| Part A Deductible | ✅ Covered | ✅ Covered |
| Part B Deductible | ❌ Not covered | ❌ Not covered |
| Part B Coinsurance (20%) | ✅ Covered | ✅ Covered (copays may apply) |
| Excess Charges | ✅ Covered | ❌ Not covered |
| Foreign Travel Emergency | ✅ 80% | ✅ 80% |
| Typical Monthly Premium | Higher | Lower |
| Best for | Maximum coverage, predictable costs | Lower premiums, healthy seniors |
Medigap vs. Medicare Advantage — Two Separate Paths
Original Medicare + Medigap + Part D
You keep Original Medicare and add a Medigap supplement to cover the gaps, plus a standalone drug plan.
- See any doctor who accepts Medicare nationwide
- No referrals needed for specialists
- Predictable, capped out-of-pocket costs
- Best for frequent travelers or snowbirds
Medicare Advantage (Part C)
Replace Original Medicare with an all-in-one private plan that often bundles drug coverage plus extra benefits.
- Often $0 or low monthly premiums
- Extra benefits: dental, vision, hearing, OTC
- Built-in out-of-pocket maximum
- Good if you stay local and use in-network doctors
You cannot have Medigap AND Medicare Advantage at the same time. Each path serves a different type of person. That's exactly why speaking with a licensed advisor makes sense — we'll help you pick the right one.
When to Enroll — Key Dates & Deadlines
Timing matters more in Medicare than almost anywhere else. Miss a window and you could face lifetime penalties or coverage gaps. Here's every period you need to know.
A 7-month window — 3 months before your 65th birthday month, your birthday month, and 3 months after. This is your first chance to sign up for Medicare Parts A, B, C, and D.
The main window for changing your Medicare coverage. You can switch Advantage plans, change Part D drug plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.
If you're already in a Medicare Advantage plan, you can switch to a different Advantage plan or return to Original Medicare. Changes take effect the first of the following month.
Triggered by qualifying events like losing employer coverage, moving to a new area, qualifying for Medicaid, or your plan leaving the market. SEPs let you enroll or change plans outside normal windows.
If you missed your Initial Enrollment Period without a qualifying reason, you can sign up here — but late penalties may apply.
⚠️ Late Enrollment Penalties — Don't Miss Your Window
Part B Penalty: If you don't sign up for Part B when you're first eligible (and don't have qualifying employer coverage), your monthly premium goes up 10% for each 12-month period you delayed — and that penalty is permanent for as long as you have Part B.
Part D Penalty: If you go without drug coverage for 63+ continuous days after your IEP, you'll pay a 1% penalty per month delayed, added to your premium indefinitely.
Part A Penalty (if applicable): If you have to buy Part A (didn't work 40 quarters), delaying beyond your IEP adds a 10% premium surcharge for twice the number of years delayed.
If you have employer coverage through a company with 20+ employees, you may delay Medicare without penalty. When you retire, you'll qualify for a Special Enrollment Period. Always confirm this with your HR department — and call us. We'll verify your situation for free.
How to Choose the Right Plan
There's no single "best" Medicare plan — the right plan depends entirely on you: your doctors, your medications, your budget, and your lifestyle. Start by answering these questions:
Answering those questions alone is the hard part. EIG Senior Care's licensed advisors do this every day. We'll review your doctors, medications, and budget — then show you every plan available in Las Vegas that fits your situation. At no cost to you.
General Rules of Thumb
- Want the freedom to see any doctor? Original Medicare + Medigap is usually the better fit.
- Want extra benefits and lower premiums? Medicare Advantage often delivers more value per dollar.
- Travel a lot? Medigap is typically better since Advantage plans are network-based.
- Tight monthly budget? Some $0-premium Advantage plans are excellent — but review the out-of-pocket maximum carefully.
- Multiple prescriptions? Always run your drug list through a plan's formulary before choosing a Part D plan.
Common Medicare Mistakes to Avoid
These are the mistakes we see most often — many of which are costly and some of which are permanent.
Late enrollment in Part B or Part D results in lifetime premium penalties. Mark your 65th birthday on the calendar and sign up during your 7-month IEP window.
Plans change every year — premiums, drug formularies, provider networks. Review your plan every Annual Enrollment Period (Oct 15 – Dec 7) or you could be overpaying.
A $0 Advantage plan in one county can be very different from one in another. Network, benefits, and drug coverage vary significantly by plan and location.
Medicare Advantage plans have networks. Before enrolling, verify your primary care doctor AND any specialists you see regularly are in-network — or expect to pay out-of-pocket.
Your prescriptions may not be covered — or could cost much more — under certain Part D plans. Always look up your specific drugs on Medicare.gov's Plan Finder before choosing.
Medicare does NOT cover routine dental, routine vision, hearing aids, or long-term custodial care. Plan for these separately or choose an Advantage plan that includes some of them.
Medicare Glossary
Medicare comes with its own language. Here are the most important terms, explained in plain English.
The monthly amount you pay for coverage — whether or not you use any medical services that month. Like a membership fee.
The amount you pay out-of-pocket for health services before your insurance starts sharing the cost. Example: $240 Part B deductible in 2024.
A fixed dollar amount you pay for a specific service — like $20 for a doctor visit. After you pay, insurance covers the rest.
Your percentage share of a medical bill after your deductible. Original Medicare's Part B coinsurance is 20% — meaning if a service costs $1,000, you pay $200.
The most you'll pay in a given year before insurance covers 100% of costs. Original Medicare has NO cap — which is why many people add Medigap or choose Advantage plans with a built-in limit.
The doctors, hospitals, and facilities that have agreements with your insurance plan. In Medicare Advantage, using out-of-network providers typically costs significantly more.
The list of prescription drugs covered by a Part D plan. Each formulary organizes drugs into "tiers" — higher tiers usually cost you more.
A requirement that your doctor get approval from your insurance plan before you receive certain services or medications. Without it, the service may not be covered.
Private supplemental insurance that fills the "gaps" in Original Medicare — covering deductibles, copays, and coinsurance that Medicare doesn't pay.
A Medicare-approved plan from a private company that provides all Part A and Part B benefits, often bundled with drug coverage and extra benefits.
For Part A, a benefit period starts when you're admitted to a hospital and ends when you haven't received inpatient care for 60 consecutive days. Each new benefit period comes with a new deductible.
A type of Medicare Advantage plan designed for specific groups — people with certain chronic conditions, people who qualify for both Medicare & Medicaid, or people who live in institutions.
Income-Related Monthly Adjustment Amount. Higher-income beneficiaries pay more for Part B and Part D. If your income exceeds $103,000/year (individual), expect a surcharge.
Health or drug coverage from an employer or union that's "as good as" Medicare. If you have this, you can delay Medicare without penalty.
Frequently Asked Questions
Not entirely. Part A is usually free — if you (or your spouse) worked and paid Medicare taxes for at least 10 years (40 quarters), your Part A premium is $0.
Part B has a monthly premium — $174.70/month for most people in 2024. If your income is higher, you'll pay more (see IRMAA).
Part C and Part D plans have their own premiums set by the private insurance companies offering them.
With Original Medicare (Parts A & B), you can see any doctor or specialist in the country who accepts Medicare. That's the vast majority of doctors.
With Medicare Advantage (Part C), you typically need to use in-network providers — though some plans offer out-of-network coverage at higher cost. Always verify your doctor is in-network before enrolling.
No — you choose one OR the other. You cannot legally hold a Medigap policy and a Medicare Advantage plan at the same time.
Medigap works alongside Original Medicare. Medicare Advantage replaces Original Medicare. They are two different coverage pathways. Pick the one that fits your needs.
If you work for a company with 20 or more employees and have employer group health coverage, you may be able to delay Medicare enrollment without penalty. When you leave that job or lose that coverage, you'll receive an 8-month Special Enrollment Period to sign up for Medicare.
Important: If your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65 and you should enroll on time. Always verify with your HR department — and call us to confirm.
Yes — every year during the Annual Enrollment Period (Oct 15 – Dec 7), you can switch plans. Changes take effect January 1.
If you're in a Medicare Advantage plan, you can also switch during the Open Enrollment Period (Jan 1 – Mar 31) — changes take effect the following month.
Switching FROM Medicare Advantage back to Original Medicare + Medigap can be harder because Medigap insurers may require medical underwriting outside of specific enrollment periods in most states.
Original Medicare does NOT cover routine dental cleanings, eyeglasses, contact lenses, or hearing aids. These are significant gaps many seniors are surprised by.
Many Medicare Advantage plans DO include dental, vision, and hearing benefits as extra coverage. The scope of coverage varies significantly by plan — some cover only basic care, others are quite comprehensive.
The "donut hole" is a coverage gap in Part D prescription drug plans. Once your total drug costs reach a certain threshold (~$5,030 in 2024), you enter the gap and pay 25% of drug costs until you hit the catastrophic coverage threshold (~$8,000 out of pocket in 2024).
After reaching the catastrophic level, your costs drop dramatically for the rest of the year. The Inflation Reduction Act has been gradually reducing the donut hole — it will be fully eliminated for most drugs in 2025.
You can enroll in Medicare through the Social Security Administration — online at SSA.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.
If you're already receiving Social Security benefits when you turn 65, you'll typically be enrolled in Parts A & B automatically. Otherwise, you need to actively sign up.
For Medicare Advantage and Part D plans, enrollment is done directly through the private insurance plan or a licensed Medicare broker. Call us — we'll walk you through the entire enrollment process at no charge.
A Special Needs Plan (SNP) is a type of Medicare Advantage plan designed for people with specific needs. There are three types:
D-SNP (Dual-eligible): For people who qualify for both Medicare and Medicaid. Often $0 premium with extensive extra benefits.
C-SNP (Chronic condition): For people with specific chronic conditions like diabetes, heart failure, or COPD. Tailored benefits for that condition.
I-SNP (Institutional): For people who live long-term in a nursing facility or care home.
Yes — this is called being "dual eligible." If you qualify for both Medicare and Medicaid, Medicaid can help pay your Medicare premiums, deductibles, and copays. Special Dual-Eligible SNP plans (D-SNPs) are often the best coverage option for this group.
Dual-eligible beneficiaries have year-round Special Enrollment Periods and often receive extensive benefits at little to no cost. Call us — if you might qualify, this is a conversation worth having.
Generally, no. Original Medicare does not cover care received outside the United States (with a few narrow exceptions along the U.S.-Canada border).
Some Medigap plans (like Plan G and Plan N) cover 80% of emergency care costs abroad, up to a lifetime limit. If you travel internationally, this is an important factor in your plan selection.
A Medicare broker (or agent) is a licensed professional who helps you compare and select Medicare plans. Working with a broker costs you nothing — brokers are compensated by the insurance companies, not by you.
A good broker is independent and represents multiple carriers, so they can show you plans across different companies and help you find the best fit. EIG Senior Care's advisors are licensed Medicare brokers serving Las Vegas and Nevada.
Still Confused? That's Normal.
We're Here to Help.
Medicare is complicated — but choosing the right plan doesn't have to be. EIG Senior Care's licensed advisors will review your situation, compare every plan available in Las Vegas, and help you enroll. Free. No pressure.
We're EIG Senior Care — your local Medicare advocates in Las Vegas, Nevada. Licensed, independent, and on your side.