EIG Senior CareEveryone is golden (725) 677-3868No cost to you · Updated for 2024–2025
A plain-English guide to understanding Medicare — the parts, the dates, and the mistakes to avoid. Brought to you by your local licensed advisors in Las Vegas.
Turning 65 or new to Medicare? This guide answers the questions people search for most: what Medicare Part A, Part B, Part C and Part D cover, how Medicare Advantage compares with a Medicare Supplement (Medigap) plan, when your Initial Enrollment Period starts, and how to avoid late-enrollment penalties.
Section 1
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.
Simple definition: 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.
Section 2
Medicare is broken into four "parts." Think of them as four building blocks that can be combined based on your needs.
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).
Enrollment: usually automatic at 65 if you're already receiving Social Security benefits.
Covers: doctor visits, outpatient care, preventive services (annual wellness visit, vaccines, screenings), lab tests, mental health services, and durable medical equipment.
Premium: $174.70/month in 2024 for most people (higher at higher incomes).
Deductible: $240/year in 2024 — then Medicare covers 80% of approved costs, and you pay the remaining 20%.
The 20% gap: with Original Medicare there's no out-of-pocket maximum. A serious illness could mean very large 20% bills — which is exactly why many people add a Medigap supplement (next section).
An alternative to Original Medicare: a private insurance company runs your coverage, and it must cover everything Parts A & B cover — often more.
Extra benefits often included:
Trade-off: Advantage plans typically require you to use in-network doctors and may require referrals to see specialists.
Offered through private insurance companies, Part D covers a list of approved medications called a formulary.
The "donut hole" (coverage gap), explained simply:
| Part | Covers | 2024 premium | Run by |
|---|---|---|---|
| Part A | Inpatient stays, skilled nursing, hospice | $0 for most people | Federal government |
| Part B | Doctor visits, outpatient, preventive care | ~$175/month | Federal government |
| Part C | A + B + often dental, vision, hearing, extras | Varies ($0–$100+/month) | Private insurer |
| Part D | Prescription drugs | Varies (~$55/month avg) | Private insurer |
Premium and deductible figures are 2024 amounts and change each year.
Higher income? Medicare adds an extra monthly charge (IRMAA) on Part B and Part D above certain income levels. See the Medicare costs & IRMAA table
Section 3
Original Medicare 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 private plans pay the costs Original Medicare doesn't cover — like deductibles, copays, and coinsurance.
Key rule: Medigap works with Original Medicare — it does not replace it. You must have Parts A & B first. Medigap pays after Medicare pays its share.
| Feature | Plan G | Plan N |
|---|---|---|
| Part A deductible | ||
| Part B deductible | ||
| Part B coinsurance (20%) | Covered (copays may apply) | |
| Excess charges | ||
| Foreign travel emergency | 80% | 80% |
| Typical premium | Higher | Lower |
| Best for | Maximum coverage, predictable costs | Lower premiums, healthy seniors |
You choose ONE path — not both. You cannot have Medigap AND Medicare Advantage at the same time. That's exactly why speaking with a licensed advisor makes sense — we'll help you pick the right one.
Section 4
Timing matters more in Medicare than almost anywhere else. Miss a window and you could face lifetime penalties or coverage gaps.
When you turn 65
A 7-month window — 3 months before your 65th birthday month, your birthday month, and 3 months after. Your first chance to sign up for Parts A, B, C, and D.
Every year: Oct 15 – Dec 7
The main window for changing coverage — switch Advantage plans, change Part D drug plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.
Every year: Jan 1 – Mar 31
Already in an Advantage plan? Switch to a different one or return to Original Medicare. Changes take effect the first of the following month.
Life events
Triggered by qualifying events like losing employer coverage, moving, qualifying for Medicaid, or your plan leaving the market.
Jan 1 – Mar 31
If you missed your Initial Enrollment Period without a qualifying reason, you can sign up here — but late penalties may apply.
Still working at 65? With employer coverage through a company of 20+ employees, you may be able to delay Medicare without penalty. Confirm with HR — and call us. We'll verify your situation at no cost to you.
Section 5
There's no single "best" Medicare plan — the right plan depends on your doctors, medications, budget, and lifestyle. Start with these questions:
Section 6
Late enrollment in Part B or Part D results in lifetime premium penalties. Mark your 65th birthday and sign up during your 7-month IEP window.
Plans change every year — premiums, drug formularies, networks. Review every AEP (Oct 15 – Dec 7) or you could be overpaying.
A $0 Advantage plan in one county can be very different from one in another. Benefits and networks vary by plan and location.
Before enrolling, verify your primary care doctor AND any specialists 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 check your specific drugs.
Medicare does NOT cover routine dental, routine vision, hearing aids, or long-term custodial care. Plan for these separately or choose a plan that includes some.
Section 7
Medicare comes with its own language. Here are the most important terms, in plain English.
Section 8
No. Most people pay $0 for Part A, but Part B has a monthly premium ($174.70 in 2024 for most), and Part C and Part D premiums vary by plan.
With Original Medicare, yes — any doctor who accepts Medicare. With Medicare Advantage, it depends on the plan's network, so always check your doctors before enrolling.
No — you choose one path or the other, never both. Medigap works alongside Original Medicare; Medicare Advantage replaces it.
With employer coverage from a company of 20+ employees, you may delay Medicare without penalty and enroll later through a Special Enrollment Period. Confirm with HR — and call us to verify at no cost to you.
Yes. You can switch plans during the Annual Enrollment Period (Oct 15 – Dec 7), and Advantage members get another chance Jan 1 – Mar 31. Certain life events open Special Enrollment Periods.
Original Medicare doesn't cover routine dental, vision, or hearing aids. Many Medicare Advantage plans include some of these benefits.
It's the Part D coverage gap. After total drug costs reach about $5,030/year, you pay 25% of drug costs until you reach the catastrophic threshold — then costs drop sharply.
If you're already receiving Social Security, you're usually enrolled automatically at 65. Otherwise, apply through Social Security during your 7-month Initial Enrollment Period. We'll walk you through it at no cost to you.
It's a type of Medicare Advantage plan designed for specific groups — people with certain chronic conditions, people with both Medicare and Medicaid, or people living in institutions.
Yes. If you qualify for both, Medicaid may help pay your Medicare premiums and cost-sharing, and you may qualify for a Special Needs Plan with extra benefits.
Generally no, except rare situations (like on a ship within U.S. waters). Some Medigap plans cover 80% of foreign travel emergency care.
A broker (like us) is a licensed advisor who compares plans from multiple insurers for you. Our help is no cost to you — we're compensated by the insurance companies, never by you.
Medicare is complicated — but choosing the right plan doesn't have to be. Our licensed advisors will review your situation, compare every plan available in Las Vegas, and help you enroll. No cost to you. No pressure.