A Baby Boomer’s
Guide to Mastering
Medicare Basics and
Beyond
Helping You Understand Medicare
The ABC's & More
The Modern Medicare Agency is not connected with or endorsed
by the United States government or the federal Medicare program.
Medicare is
Complicated
With so many different plan choices, the constant stream of mail and
TV ads, and even incorrect information, it’s no wonder Medicare cane
be so overwhelming.
This guide was design to help you learn save time & money.
Learn the different parts of Medicare A B C D
Understand what is and isn’t covered
Know all your options-Medicare Advantage (MA), Medicare Supplement, and
Medicare Part D Prescription Drug (MA-PD) plans
Get a rough idea of costs under different plans
Get an idea if Medicare is right for you, even if you are going to continue working
If Medicare is right for you, use the checklists to help you gather everything you
need to enroll.
Let’s start with the basics.
03
What is Medicare?
Medicare is our government-run health insurance program for people:
Medicare is a federal health insurance program available only to eligible citizens
and legal residents of the United States and is run by the Centers for Medicare &
Medicaid Services (CMS).
Who is Eligible?
Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier
if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring
dialysis or a transplant), or ALS (also called Lou Gehrig’s disease).
Your Medicare Coverage Can Consist of Several Parts
Original Medicare
Part A: Hospital Insurance Part B: Medical Insurance
Subsidized Private Insurance
Part C: Medicare Advantage Part D: Prescription Coverage
Private Insurance
Medicare Supplement
04
What Does Each Part Cover?
PART A: Hospital Insurance
Original Medicare
PART B: Medical Insurance
Inpatient hospital services (such as Medically necessary outpatient
lab tests and surgeries) and supplies doctor visits
(such as wheelchairs and walkers)
Outpatient surgery
considered medically necessary to
treat a disease or condition.
Physical therapy
Includes inpatient hospital room Durable medical equipment (such as
and board, skilled nursing care, hos- crutches and home oxygen supplies)
pice and some home healthcare
costs. Ambulance services
Preventive services (such as flu shots
and screenings for diabetes and
cancers).
PART C: Medicare Advantage
Original Medicare
PART D: Prescription Coverage
A type of Medicare health plan offered Provides outpatient prescription drug
by a private insurance company that coverage. Plans can be purchased on a
contracts with Medicare to provide standalone basis or included in a Medi-
care Advantage plan. Plans vary in
you with all your Part A and Part B ben-
price, copayments and the drugs
efits. Medicare Advantage plans must
included on their formulary (prescrip-
cover all of the services that Original tion drug list). While you may not cur-
Medicare covers — except hospice rently be on any prescription medica-
care — and may also offer extra cover- tion, the chances of you having to take
age. (Original Medicare covers hos- at least one, if not more, in your lifetime
pice care even if you’re in a Medicare increase as you age.
Advantage plan.) In all types of Medi-
care Advantage plans, you’re always
covered for emergency and urgently
needed care.
05
Medicare Supplement Plans (also known as Medigap Plans)
Help pay some of the healthcare costs that Original Medicare doesn’t cover. These
gaps include items like copayments, coinsurance and deductibles. Medicare Sup-
plement plans are provided by private insurance companies. If you have Original
Medicare and you buy a Medicare Supplement policy, Medicare will pay its share
of the Medicare-approved amount for covered healthcare costs. Then your Medi-
care Supplement policy pays its share.
What Does Medicare Cost?
Costs for Medicare vary from year to year
Most people don’t pay a monthly pre-
mium for Part A, because they have
paid into the system during their
working years. Generally, you will
need to pay a Part A deductible, a
Part B deductible, and a monthly Part
B premium. If you enroll in a Part D Pre-
scription Drug plan, you also may pay
a monthly premium. Use this page to
get a rough idea of Medicare costs
in 2024
06
2023 Costs at a Glance
Premium Deductible
Original Medicare
Part A Most people don’t pay a Hospital inpatient deductible:
monthly premium because $1,640 for each benefit period
they already have paid Medi-
Days 1-60: $0 coinsurance for
care taxes while working;
each benefit period
however, if you do have to pay
a premium, it will be $506 each Days 61-90: $408 coinsurance
month or less, depending on per day of each benefit
how many quarters you period
worked in your lifetime.
Days 91 and beyond: $816
coinsurance per each “life-
time reserve day” after day 90
for each benefit period (up to
60 days over your lifetime)
Beyond lifetime reserve days:
all costs.
Part B The standard monthly $240 per year. After your
premium is $174.90. However, deductible is met, you typically
pay 20% of the Medicareap-
some bene-ficiaries pay less
proved amount for most
due to some-thing called the
doctor services (including
hold harmless provision, and most doctor services while
some pay higher because of you’re a hospital inpatient),
their income. If you have outpatient therapy, and dura-
additional questions ble medical equipment.
regarding what your
premium would be, please
contact Medicare directly.
Part C Most Part C (Medicare Advan- Deductibles, copays and coin-
tage) plans have low or zero surance vary by plan.
premiums. Premiums vary by
plan type and geography, and
often include prescription drug
coverage at no extra cost, but
you are still responsible for your
Part B premium.
07
Premium Deductible
Original Medicare
Part D Varies by plan (higher earners Deductibles, copays coinsurance
may pay more). vary by plan
Medigap Medicare Supplement (Medigap) plans also have monthly premi-
ums. These costs also vary
For estimated charges, visit medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
Medicare Doesn’t Cover Everything!
You could be responsible for paying for certain items and services.
Here are some expenses not covered by Parts A and B, and generally not covered by
Medicare Supplement plans:
Long-term care Cosmetic surgery
Most dental care Hearing aids and exams for fitting them
Dentures Acupuncture
Eye examinations related to Routine foot care
prescribing glasses
About 80% of older adults have at least one chronic condition, and 68% have at least two,
according to the National Council on Aging.
Original Medicare covered 63% of the cost of healthcare services for Medicare beneficiaries
ages 65 and older in 2019, the most recent year available.*
*Savings Medicare Beneficiaries Need for Health Expenses in 2022 Some Couples Could Need
as Much as $315,000 after tax, Fidelity View points 8/29/2022
08
How Do You Pay for the Rest?
Call The Modern Medicare Agency to speak with a Licensed Insurance Agent.
(631) 358-5793
We’ll help find Medicare coverage that fits your needs and budget.
www.paulbinsurance.com
What’s the Difference?
Medicare Advantage vs. Medicare Supplement Plan
Medicare Advantage (Part C)
plans are an alternative to
Original Medicare. With
Medicare Supplement Plans
(Medigap), you are still
enrolled in Original Medicare,
but these plans fill the gaps in
Parts A and B. Enrollment is
optional, but if you do choose
to enroll in one, you cannot be
enrolled in the other.
09
Medicare Advantage Plan Medicare Supplement Plan
(Part C) (Medigap)
Original Medicare
Must provide the same level of Helps Cover the co-payments,
coverage as Original Medicare coinsurance and deductibles
Coverage with the exception of hospice that Original Medicare doesn’t
pay.
care.
Prescription
Often includes Medicare Part No Rx coverage — can be
D Prescription Drug coverage. paired with Medicare Part D
Drugs Prescription Drug coverage.
Coverage is from a private Typically accepted by any
Type of health insurance plan, usually provider that accepts Medicare.
Plan network-based, like an HMO or All policies offer Standardized
benefits
PPO. Benefits vary by company.
Out-of- Out-of-pocket costs are Out-of-pocket costs are not
capped.
pocket Costs capped
Limited to an Initial Enrollment Enrollment is year-round.
Period, Annual Election Period,
Enrollment General Enrollment Period, as
well as special circumstances
throughout the year called
Special Enrollment Periods.
Can be as low as $0 per month, Typically range from $85 to $365
but you are still responsible for per month, but vary by plan and
Premiums the Part B premium. Premiums geography. Premiums can also
be affected by age and sex.
are not impacted by age or sex,
Must Pay part B premium.
but do vary by county.
Guaranteed acceptance. During the member's 6-month
Medigap Open Enrollment
Eligibility Period any Medigap policy sold
in the member's state can be
purchased, even if the member
has health problems
10
How Do I Decide? Call the Modern Medicare Agency at (631) 358-5793 to speak with a Licensed
Insurance Agent. We can clearly explain the differences between Medicare Advantage and
Medicare Supplement and help you find a plan that works for you.
How Do I Compare Medigap Policies?
The chart below shows basic information about the different benefits that Medigap
policies cover. If a percentage appears, the Medigap plan covers that percentage of
the benefit, and you’re responsible for the rest.
Medicare Supplement Insurance (Medigap) Plans
Benefits A B C1 D F1,2 G2 K L M N
Medicare Part A
100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
coinsurance and
hospital costs (up
to an additional
365 days after
Medicare benefits
are used)
Medicare Part B
100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
coinsurance or
copayment
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice
100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
care coinsurance
or copayment
Skilled nursing
100% 100% 100% 100% 50% 75% 100% 100%
facility care
coinsurance
Part A deductible 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part B deductible 100% 100%
11
Medicare Supplement Insurance (Medigap) Plans
Benefits A B C1 D F1,2 G2 K L M N
Part B excess
100% 100%
charges
Foreign travel
80% 80% 80% 80% 80% 80%
emergency (up to
plan limits)
2024 Out-of-
pocket limit
$7,060 $3,530
1. Plans C and F are only available for Medicare beneficiaries who became eligible for Medicare prior to Jan. 1, 2020.
2. Plans F and G have a high deductible option that is available in some states. If you choose this option, you must pay for
Medicare-covered costs (coinsurance, copayments and deductibles) up to the deductible amount of $2,800 in 2024
before your policy pays anything.
3. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50
copayment for emergency room visits that don’t result in an inpatient admission.
Can I Qualify for Extra Help?
People with limited income and resources may qualify for Extra Help programs that
pay the Part B Original Medicare premium and/or lower the costs of Medicare pre-
scription drug coverage. You can get more information about assistance by going to
a Social Security office, calling (800) 772-1213, visiting ssa.gov or talking with your
Licensed Insurance Agent.
03
What If I Still Have Employer Coverage Available?
If you are 65 or over, eligible for Medicare, and have insurance through your or your
spouse’s current job, in most cases you should at least take Part A (hospital insur-
ance). (For most people, Part A is free.) If you or your employer contributes to an HSA,
once you have either your Part A or B, you or your employer can no longer contribute
to your HSA account.
To decide whether to take Part B (medical insurance), for which everyone pays a
monthly premium, you should ask your benefits manager or human resources
department how your employer insurance works with Medicare and confirm this
information with the Social Security Administration (SSA) and Medicare. Be aware
that when you qualify for Medicare, your employer insurance may start to work
differently for you. You will need to figure out whether paying for both types of cover-
age will be useful in offsetting your healthcare costs.
How Do I Decide? Call the Modern Medicare Agency (631) 358-5793 to speak with a Licensed
Insurance Agent. We can walk you through the decision-making process so you are comfort-
able with the plan you ultimately pick.
13
Know These Dates!
October 15 – December 7
Open Enrollment (Also known as Annual Election Period)
During this election period, open to anyone in the Medicare program, you can:
Change from Original Medicare to a Medicare Advantage (MA) or Medicare
Advantage plus Part D (MA-PD) plan
Change from an MA or MA-PD plan to Original Medicare
Change one MA plan or MA-PD plan to another MA or MA-PD plan
Enroll in a Part D plan
Change from one Part D plan to another.
January 1 – March 31
Medicare Advantage Open General Enrollment Period
Enrollment Period
This enrollment period is available only to If you miss your Initial Enrollment Period for
existing Medicare Advantage and/or MA-PD Medicare Part A and/or Part B, you get anoth-
members. If you’re currently in a Medicare er chance to enroll during this time. However,
Advantage plan, you can switch from one you may have to pay a late enrollment pen-
Medicare Advantage plan to another, or you alty. Your monthly premium increases 10% for
can disenroll from Medicare Advantage and each 12- month period you were eligible for,
go back to Original Medicare with the option but did not enroll in, Medicare Part B.
of adding a stand-alone Part D plan. You can
make one change during this enrollment
period.
January 1 – December 31
Medicare Supplement plans can be Do You Qualify for a Special
purchased year-round but may require Enrollment Period?
health questions to be answered to Certain special circumstances, or life
determine eligibility. events, may qualify you for what’s called
a Special Enrollment Period.
14
Turning 65?
Find your Birth Month to Find your Initial Enrollment Period
If, like most people, you become eligible for Medicare at age 65, you have a sev-
en-month window to enroll, starting three months before you turn age 65 and ending
three months after your birthday month.
This one-time enrollment period is your first opportunity to sign up for Medicare Part
A and/or Part B. This is also your first chance to enroll in a Medicare Advantage plan
(Part C) or Part D Prescription Drug plan.
Your Enrollment Window
If Your Enrollment 65th Enrollment
Birthday Opens Birthday Closes
Is In
January October April
February November May
March December June
April January July
May February August
June March September
July April October
August May November
September June December
July January
October
November August February
December September March
15
If you do not enroll during your initial enrollment period or do not provide
proof of insurance under another eligible plan, you will pay a substantial
penalty each month.
Turning 65 Checklist
What You Need to Know and Do to Sign Up for Medicare and Health Insurance
About 9 Months Before Your 65th Birthday
Determine whether you’re entitled to Medicare
WHY? If you start receiving Social Security before you turn 65, you will be automatically enrolled for Part A
and/or Part B (and if so, to expect your Medicare card in the mail) or you’ll need to sign up. It also will estimate
your premium amounts and provide information so you can decide whether you want Part B and whether you
want to supplement Original Medicare or go with a Medicare Advantage plan.
How? Choose one of three ways:
1. Call Social Security at (800) 772-1213. If you are deaf or hard of hearing, call (800) 325-0778. (Medicare is
managed by the Centers for Medicare and Medicaid Services. Social Security works with CMS by enrolling
people in Medicare.) –OR–
2. Visit your local Social Security office. Use the Social Security Office locator at secure.ssa.gov/ or call (800)
772-1213 –OR–
3. Go online to Medicare’s Eligibility & Premium Calculator: medicare.gov/
Review your current health insurance plan
WHY? Depending on the number of employees your employer has will be important for you to know. If your
employer has fewer than 20 employees, Medicare will be primary and you will need to take your Part A and B.
If your employer has 20 or more employers, if you take Medicare it will be secondary to your employer plan. In
both of these situations you could benefit by taking a Medicare plan and should review those options. You
should also confirm with your employer whether drug coverage is creditable coverage. If it is not, you may
need to take Part D, which is a standalone prescription drug program where you will need your Part A or your
Part B.
16
Explore your options for purchasing health insurance
WHY? Medicare doesn’t cover everything. You may want to consider enrolling in a Medicare Advantage
plan; or supplementing Original Medicare (Parts A and B) with a Medicare Supplement plan; and you may
need Medicare Part D Prescription Drug coverage.
How? Gather your current medical coverage information (plan, cost, prescriptions, preferred doctors and
hospitals, etc.) and then call the Modern Medicare Agency at (631) 358-5793 to speak with a Licensed Insur-
ance Agent. We can explain your options, answer your questions and help you to enroll.
IMPORTANT! Avoid long-term penalties! If you don’t sign up for Part B when you’re first eligible, your monthly
premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t
sign up for it.
Turning 65 Checklist
About 6 Months Before Your 65th Birthday
Contact your doctors to see if they accept Medicare
WHY? Finding out whether your doctors accept Medicare or participate in Medicare Advantage networks
can help you decide whether you want to enroll in Medicare Supplement or Medicare Advantage.
How? Call your doctors directly, or see if they’re listed on the Medicare.gov directory: https://www.medi-
care.gov/care-compare/
Consider and/or decide whether to purchase Medicare Supplement or Medicare
Advantage health insurance
WHY? If you choose, you may enroll in a Medicare Supplement plan up to six months prior to your 65th birth-
day. You cannot, however, enroll in Original Medicare or Medicare Advantage until three months before your
65th birthday month. age.
How? Call the Modern Medicare Agency at (631) 358-5793 to speak with a Licensed Insurance Agent.
We can explain your options, give you a price quote, answer your questions and help you enroll.
17
About 3 Months Before Your 65th Birthday
Sign up for Medicare, if you have not received your automatic enrollment information in the mail, and
if you’re not already getting retirement or disability benefits. (Medicare can be an option for you even
if you continue to work.)
How? Pick one of three ways:
1. Call Social Security at (800) 772-1213. If you are deaf or hard of hearing, call (800) 325-0778. (Medicare is
managed by the Centers for Medicare and Medicaid Services. Social Security works with CMS by enrolling
people in Medicare.) –OR–
2. Visit your local Social Security office. Use the Social Security Office locator at secure.ssa.gov/ICON/main.-
jsp or call (800) 772-1213. –OR–
3. Fill out a form online (if applying for Medicare only and not Social Security benefits) at secure.ssa.gov/i-
Claim/rib. Before you start, gather information on this checklist: ssa.gov/hlp/isba/10/isba-checklist.pdf.
Research and enroll in a Medicare Part D Prescription Drug plan, a Medicare
AdvantagePart D plan or a Medicare Supplement plan.
How? Call the Modern Medicare Agency at (631) 358-5793 to speak with a Licensed Insurance Agent. We can
explain your options, give you a price quote, answer your questions and help you enroll. Be sure to have your
current medical coverage information available when you call. For more information, visit us at www.paulbin-
surance.com
IMPORTANT! Avoid a late enrollment penalty! If you decide not to join a Medicare Prescription Drug plan
when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get
extra help, you’ll likely pay a late enrollment penalty.
18
Already 65 But Did Not Enroll in Medicare Yet
If you did not enroll into Medicare when you first turned 65 because your employer had 20 or
more employees and your group prescription drug coverage was creditable, you do have a
Special Enrollment Period when you lose your employer coverage, whether voluntary or involun-
tary. Once you are enrolled in Medicare, you do not need to sign up each year, but you can
make changes on an annual basis to your Medicare Advantage or Medicare Prescription Drug
coverage for the following year. You also may want to review your Medicare Supplement health
insurance plan each year, because premiums can change from year to year. While you can
switch Medicare Supplement plans at any time throughout the year, you may be subject to
underwriting. Even though you don’t have to review your Medicare Supplement plan along with
your prescription drug plan, it may be convenient to do so at that time.
You’d like to pay less for your prescriptions and healthcare services
Your medications changed in the past year
You were diagnosed in the past year with a new medical condition.
Medicare Open Enrollment Period Also known as Annual Election Period
October 15 – December 7
Medicare Advantage Open Enrollment Period for Medicare Advantage or Medicare
Advantage Prescription Drug
January 1 – March 31
19
Your Medicare Part A and Part B effective dates: Part A ______________ Part B ______________
Current Medicare Plan Information: Carrier: ______________________
Monthly Premium: ______________ Deductible: ___________________
Current Prescriptions Where Filled (check one)
Local
Name of Prescription Frequency Dosage Mail Order
Pharmacy
Compare your existing Medicare Advantage and Medicare Supplement health
insurance plan with other plans to see if you can find a better plan or lower rate.
How? Call the Modern Medicare Agency (631) 358-5793 to speak with a Licensed Insurance Agent. We can
compare your current plan to other plans, give you price quotes, answer questions, and help you switch plans
if you decide to. It helps to have your current medical coverage information available when you call. For more
information, visit us at www.paulbinsurance.com
How the Modern Medicare Agency Works
Our agents can help you navigate the Medicare maze to find a plan that is right for you. Our
team is highly experienced and understands their is no one best plan for all. we take and edu-
cational and consultive approach to help consumers understand all their options so they are
comfortable choosing the right plan to fit their needs and budget.
20
Here is how our process works and what you can expect.
1. You call the Modern Medicare agency at (631) 358-5793 to speak to a Licensed Insurance
Agent.
Before you call, gather your current medical coverage information (plan, cost, prescrip-
tions, preferred doctors and hospitals, etc.).
2. You discuss with our Medicare Specialist:
Your existing insurance coverage
The four parts of Original Medicare and how it works
Types of coverage including Medigap, Medicare Advantage and prescription drug coverage
Which of those plans might work the best for you, whether or not you are going to continue
working.
3. Our Agents :
Helps you enroll immediately –OR–
Emails the policy materials for you to review and you enroll at a later date.
4. You receive your new insurance policy ID card in the mail.
We understand that deciding on a Medicare health
plan is one of the most important decisions you’ll
make in retirement. We’re here to help. To speak with
a Licensed Insurance Agent, call (631-358-5793)
21
We strive to take the stress and confusion out of your
Medicare World. We operate as independent Medicare
agents which means we do not work for the insurance
carriers and this allows us to keep the consumers best
interest at heat.
DISCLAIMER: 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 Medi-
care.gov or 1-800-MEDICARE to get information on all of
your options.”
