Medicare Resource Hub
Your comprehensive guide to Medicare coverage, enrollment, costs, and Social Security benefits
Everything you need to know when you're first exploring Medicare - eligibility, all parts explained, Medigap options, when to enroll, and how to avoid penalties.
Who is Eligible for Medicare?
Primary Eligibility Requirements
- Age 65+: Most people become eligible at age 65
- Citizenship: Must be a U.S. citizen OR a legal permanent resident who has lived in the U.S. for at least 5 consecutive years
Under 65? You May Still Qualify
You can qualify before age 65 if you have:
- Received Social Security Disability Insurance (SSDI) for 24 months
- End-Stage Renal Disease (ESRD) requiring dialysis or transplant
- ALS (Lou Gehrig's disease) - immediate eligibility
The Four Parts of Medicare
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Premium-Free for Most
If you or your spouse have 40 work credits, you qualify for premium-free Part A
What Part A Covers:
- Hospital stays: Inpatient care, semi-private rooms, meals
- Skilled nursing: Up to 100 days after 3-day hospital stay (days 1-20 covered in full; days 21-100 require copayment)
- Hospice care: End-of-life care services
- Home health: Part-time skilled nursing care
Part B covers medically necessary services like doctors' visits, outpatient care, preventive services, and durable medical equipment.
What Part B Covers:
- Doctor visits: Primary care, specialists, outpatient
- Preventive services: Screenings, vaccines, wellness visits
- Medical equipment: Wheelchairs, walkers, oxygen
- Lab tests & X-rays: Diagnostic services
Medicare Advantage plans (Part C) are offered by private companies approved by Medicare. They include all Part A and Part B coverage. Most plans also include Part D prescription drug coverage, but verify this when comparing plans.
Additional Benefits Often Include:
- Dental coverage: Cleanings, exams, sometimes major work
- Vision coverage: Eye exams, glasses
- Hearing benefits: Exams, hearing aids
- Out-of-pocket maximum: The most you'll pay in a year for covered in-network services (excludes premiums and non-covered services). Once you hit this limit, the plan pays 100% for covered in-network care.
Part D provides prescription drug coverage through private insurance companies. Each plan has its own formulary (list of covered drugs) and pharmacy network.
Late Enrollment Penalty
If you go 63 or more consecutive days without creditable coverage after your Initial Enrollment Period, you may face a permanent penalty added to your premium. Exceptions exist for those with creditable coverage.
How to Choose:
- • Check which plans cover YOUR specific drugs
- • Compare total costs (premium + copays)
- • Verify your pharmacy is in-network
- • Review drug tier placements
Original Medicare does not cover:
- • Deductibles
- • Copays/Coinsurance
- • Outpatient Prescription Drugs
- • Healthcare outside the U.S.
- • Hearing Aides, Exams, Screenings
- • Routine Eye Exams and Most Glasses
When to Sign Up for Medicare
Initial Enrollment Period (IEP)
Your 7-month enrollment window:
October 15 - December 7
Switch between Medicare Advantage and Original Medicare, or change your Part D plan. Changes effective January 1.
January 1 - March 31
Already in Medicare Advantage? Switch to a different MA plan or return to Original Medicare.
Medicare Supplement (Medigap) Plans
Most Popular for New Enrollees
Covers nearly everything except the Part B annual deductible ($283 in 2026)
Most Comprehensive Available
Grandfathered Plan
Covers everything including Part B deductible
Only available if you became eligible for Medicare before January 1, 2020
Medicare Supplement Enrollment Period
A six-month window that begins on your Part B effective date or 65th birthday, whichever is later.
No medical underwriting.
Can choose from any Medicare Supplement Plan options.
Medicare Supplement Guaranteed Issue (GI) Situations
There are several other GI situations to enroll into a Medicare Supplement plan with no underwriting. For example:
- • Loss of coverage
- • Moving to a new area, and many more
All plan options may not be available.
If you do not qualify for a GI situation, you may need to undergo medical underwriting.
Missing Enrollment - Penalties
⚠️ Consequences of Missing Enrollment
Part B Late Enrollment Penalty
Monthly cost may go up 10% for each full 12-month period that you could have had Part B but did not enroll.
Exception: You do not have to pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
Part D Late Enrollment Penalty
Monthly cost will have a penalty of 1% of the national base premium multiplied by the full, uncovered months you were eligible.
National Base Premium: $38.99 (2026)
Important: This information is for educational purposes only and is not a substitute for professional advice. Medicare rules, costs, and coverage can change. Always verify current information at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).