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MediWhat.Info • Medicare education

New to Medicare? Start Here

If you’re new to Medicare, you may be wondering:

“Where do I even start?”

You’re not alone. Medicare introduces a lot of unfamiliar terms — Part A, Part B, Part D, Medicare Advantage, Medigap, enrollment periods, provider networks and more.

The good news is that you don’t have to understand everything at once.

This guide walks you through Medicare in a logical order so you can figure out what you need to do first, what decisions come next and which questions actually matter for your situation.

Step 1: Find Out Whether You Need to Sign Up for Medicare

One of the first things to determine is whether Medicare will enroll you automatically or whether you need to sign up yourself.

Some people are automatically enrolled in Medicare Part A and Part B when they become eligible because they’re already receiving certain Social Security or Railroad Retirement Board benefits.

Other people — including many who delay Social Security retirement benefits — need to actively enroll.

Don’t assume that turning 65 automatically takes care of everything.

Check how to sign up for Medicare at Medicare.gov

Step 2: Know When You Should Enroll

For most people who become eligible for Medicare at 65, the first opportunity to enroll is the Initial Enrollment Period.

It generally lasts seven months:

But that doesn’t necessarily mean everyone should enroll in every part of Medicare immediately at age 65.

Your situation may be different if you or your spouse are still working and you have health insurance through a current employer.

Learn more about turning 65 and Medicare →

Step 3: If You’re Still Working at 65, Stop Here Before Making Changes

This is one of the most important Medicare questions we encounter.

Turning 65 does not automatically mean you should drop your employer health insurance.

If you or your spouse are still working and you’re covered by an employer health plan, Medicare may work differently depending on the type of coverage you have.

Before making changes, find out:

These details can affect when you should enroll and whether delaying certain parts of Medicare could result in penalties later.

Don’t cancel good employer coverage simply because you’re turning 65. Compare the two situations first.

Read our Medicare and turning 65 information →

Step 4: Understand Medicare Part A and Part B

Before comparing Medicare plans, it helps to understand the foundation.

Medicare Part A — Hospital Insurance

Part A primarily helps cover inpatient hospital care and certain other services, including qualifying skilled nursing facility care, hospice care and some home health care.

Medicare Part B — Medical Insurance

Part B helps cover medically necessary services such as doctor visits, outpatient care, preventive services, durable medical equipment and many other medical services.

Together, Part A and Part B are known as Original Medicare.

Learn more about Original Medicare →

Step 5: Understand What Original Medicare Doesn’t Do

Getting Part A and Part B doesn’t necessarily finish your Medicare decisions.

Original Medicare has deductibles and cost sharing, and it generally doesn’t include routine outpatient prescription drug coverage.

That’s why people entering Medicare usually have another major decision to make.

Step 6: Choose How You Want to Receive Your Medicare Coverage

There are two main paths.

Path 1: Original Medicare

You keep Medicare Part A and Part B as your primary health coverage.

You may also choose:

Learn about Medicare Supplement insurance →

Learn about Medicare Part D →

Path 2: Medicare Advantage

A Medicare Advantage plan — also called Part C — is another way to receive your Medicare-covered benefits through a private insurance company approved by Medicare.

You still have Medicare, but the Medicare Advantage plan administers your Medicare-covered services.

Many Medicare Advantage plans also include prescription drug coverage and may offer additional benefits.

Provider networks, copays, maximum out-of-pocket limits, prescription coverage and other plan details can vary.

Learn more about Medicare Advantage →

Step 7: Don’t Choose Based Only on the Monthly Premium

A Medicare plan with a low or even $0 additional monthly premium isn’t automatically the least expensive or best option for you.

Before choosing coverage, consider:

For people living in rural Texas, provider access and travel distance can be especially important.

Step 8: Check Your Doctors Before Choosing a Medicare Advantage Plan

If you’re considering Medicare Advantage, don’t assume your doctors participate simply because you’ve heard of the insurance company.

Networks can differ between individual plans offered by the same company.

Check the specific plan against the doctors, specialists and hospitals you actually use.

This can be particularly important in rural communities where you may receive routine care locally but travel to Abilene, Brownwood, Stephenville, Mineral Wells or another larger community for specialists or hospital services.

Step 9: Check Your Prescriptions and Pharmacy

Your medications deserve their own comparison.

Medicare prescription plans can differ in:

Don’t assume the plan that works well for your spouse, neighbor or friend will also be the best fit for your prescriptions.

Learn more about Medicare prescription drug coverage →

Step 10: Understand Your Medigap Enrollment Opportunity

If you’re considering Original Medicare with a Medicare Supplement policy, timing can matter.

Your federal Medigap Open Enrollment Period generally lasts for six months beginning when you’re 65 or older and enrolled in Medicare Part B.

During this period, federal protections give you important rights when purchasing a Medigap policy.

Waiting until later can affect your ability to purchase certain coverage depending on your circumstances and applicable rights.

Learn more about Medicare Supplement insurance →

Step 11: Compare the Two Medicare Paths

There isn’t one Medicare choice that’s right for everyone.

For one person, Original Medicare combined with Medigap and Part D may make sense.

For someone else, a Medicare Advantage plan may better fit their healthcare needs, providers and budget.

The important question isn’t:

“Which Medicare plan is best?”

A better question is:

“Which Medicare coverage fits my doctors, prescriptions, healthcare needs, travel patterns and budget?”

Step 12: Get Your Medicare Coverage in Place Before You Need It

Once you know when your Medicare Part A and Part B coverage will begin, work backward from that date.

Give yourself time to:

  1. Confirm your Medicare enrollment
  2. Understand your coverage choices
  3. Check doctors and hospitals
  4. Review prescriptions and pharmacies
  5. Compare expected costs
  6. Choose your additional coverage

You don’t need to wait until the last minute.

A Simple Medicare Checklist

If all of this still feels like a lot, start with these questions:

If you can answer those questions, you’re already well on your way to making an informed Medicare decision.

New to Medicare in Rural Texas?

MediWhat.Info is based in Cisco, Texas, and provides Medicare education and personal assistance throughout our rural Texas service area.

We understand that Medicare decisions can look different in smaller communities. Your nearest specialist may be in another county. Your preferred hospital may be 30 or 60 miles away. Your local pharmacy may be important to you.

Those things belong in the Medicare conversation.

We currently serve residents throughout:

You Don’t Have to Figure Out Medicare Alone

If you’re approaching Medicare and aren’t sure what you’re supposed to do first, that’s a perfectly reasonable place to start.

We can help you work through the process in order:

Enrollment → coverage choices → doctors → prescriptions → costs → decision.

No need to become a Medicare expert before asking for help.

Get Help Getting Started With Medicare

If you’re new to Medicare, turning 65, retiring or helping a family member with Medicare, we’re happy to help you understand the next steps.

Mike & Tracy Wetsel
Licensed Insurance Agents
MediWhat.Info — Cisco, Texas
Phone: 254-413-3309

Contact MediWhat.Info →

Plan availability varies by county, ZIP code and year. Medicare rules and plan details can change. Medicare.gov and the Social Security Administration are the official government sources for Medicare eligibility and enrollment information.