Medicare Explained:
Parts A, B, C & D
A complete guide to how Medicare works — from enrollment timing and Original Medicare to plan options and prescription coverage.
Written by licensed Medicare broker Steve Germain. Serving South Florida families since 2009.
Step 1 of 4
Medicare Enrollment Timing
Know your enrollment window — missing it carries a permanent penalty.
Initial Enrollment Period (IEP)
You have a 7-month window to sign up for Medicare — starting 3 months before your 65th birthday month, including the month you turn 65, and ending 3 months after. Missing this window without a qualifying reason results in a permanent late-enrollment penalty.
Still working? You may be able to wait.
If you or your spouse have qualifying employer coverage from an active job, you may delay Medicare enrollment penalty-free. This is one of the most frequently misunderstood rules in Medicare — and the details matter. Always verify before making this decision.
Start planning 6 months early.
We recommend beginning your Medicare research at least 6 months before your 65th birthday. The earlier you start, the more plan options are available to you and the less stressful the transition.
Your 7-Month Initial Enrollment Period
Missing this window without a qualifying reason results in a permanent late-enrollment penalty added to your monthly premium — for as long as you have Medicare. Find your enrollment dates →
Already 65 and missed your window? See our Medicare FAQ — or call us directly at (954) 281-5622. Special Enrollment Periods exist, and you may have more options than you think.
The Bottom Line: Missing your enrollment window can cost you for life. Plan early — and call us before you decide to delay.
Step 2 of 4
Original Medicare: Parts A & B
Where every Medicare journey begins — and the gap most people don't see coming.
Part A — Hospital Coverage
Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people pay $0 in Part A premiums if they or their spouse paid Medicare taxes for at least 10 years. However, Part A carries a per-benefit-period deductible that can catch people off guard.
Part B — Medical Coverage
Part B covers doctor visits, outpatient services, preventive care, and durable medical equipment. Part B charges a standard monthly premium set by the government each year. It covers 80% of approved medical costs after your annual deductible — which means you are responsible for the remaining 20%.
The 20% gap — with no cap
Here's what surprises most people: Original Medicare leaves you personally responsible for 20% of every approved medical cost — with no out-of-pocket maximum. That gap is exactly why supplemental coverage is so important.
What Original Medicare Actually Covers
There is no out-of-pocket maximum. A $200,000 hospital stay means you personally owe $40,000 — with nothing to stop the bill from growing. That gap is exactly why supplemental coverage exists.
Higher-income beneficiaries may also pay an additional surcharge called IRMAA on top of their Part B and Part D premiums. Use our free calculator to see if it applies to you.
The Bottom Line: Original Medicare is a strong foundation — but it was never designed to stand alone.
Not sure which option is right for you?
Every Medicare situation is different. Schedule a free, no-pressure review — we'll compare your specific options using your doctors, medications, and budget.
Schedule a Free Medicare ConsultationStep 3 of 4
Medicare Supplement vs. Medicare Advantage
Two paths to closing the coverage gap. Here's how they compare.
Once you understand the 20% gap, the next question is: how do you close it? There are two primary paths. Here's an honest comparison:
| Feature | Medicare Supplement | Medicare Advantage |
|---|---|---|
| Monthly Premium | Higher (varies by plan) | Often $0 |
| Out-of-Pocket Costs | Very low — most gaps covered | Deductibles & copays apply |
| Doctor Choice | Any Medicare-accepting doctor in the U.S. | Network-based (HMO or PPO) |
| Referrals Required | No | Often yes (HMO plans) |
| Rx Coverage | Separate Part D plan required | Usually built in |
| Extra Benefits | Medical coverage only | May include dental, vision, gym |
| Best For | People who want to see any doctor and have predictable, low out-of-pocket costs | People who prefer lower monthly premiums and don't mind a provider network |
The right path depends on your doctors, health history, prescriptions, travel habits, and budget. There is no universal answer — and that's exactly why working with an independent broker who represents over 25 carriers makes all the difference. Talk with a licensed advisor →
The Bottom Line: We'll compare your real options side by side — including your doctors, prescriptions, and budget — so you can choose with confidence.
Step 4 of 4
Medicare Part D: Prescription Drug Coverage
Don't overlook the prescription piece — the late-enrollment penalty is permanent.
What Part D covers
Part D plans cover prescription drugs. If you choose Original Medicare with a Supplement plan, you'll need a standalone Part D plan. Most Medicare Advantage plans include prescription drug coverage built in.
The late-enrollment penalty
If you go 63 or more days without creditable drug coverage and didn't enroll in Part D when first eligible, you'll pay a permanent penalty — 1% of the national base beneficiary premium per month without coverage. This is added to your Part D premium for as long as you have Medicare.
Annual plan reviews protect your wallet
Part D formularies — the list of covered drugs and their cost tiers — change every single year. A plan that covered your medications affordably this year may not next year. We review your coverage every fall at no cost to make sure your prescriptions are covered at the best available price.
Not sure if you'll owe a penalty? Use our free Part D penalty calculator →
The Bottom Line: The right drug plan can save you hundreds of dollars a year. We review yours every year — at no cost to you.
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