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Reaching the Medicare Milestone

After Mark lost his job two years ago at age 63, he decided to collect Social Security benefits. By doing so, Mark automatically enrolled in Medicare Part A and Part B starting the first day of the month he turns 65. Along the way, he researched several Medicare Advantage Plans before settling on one in August, three months prior to his 65th birthday in November when it takes effect.

Had he not received early Social Security benefits, Mark would’ve signed up for Original Medicare in August, three months prior to his November birthdate, by contacting Social Security at 1-800-772-1213 or online at

The initial Medicare enrollment period is October 15 to December 7. This is typically the time to review your options. However, you can first sign up for Part A and Part B during the 7-month period that begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

About Medicare Advantage Plans

Mark took his time to research 5-Star Rated Medicare Advantage Plans offered by various private insurance companies contracted with Medicare. The Centers for Medicare & Medicaid Services (CMS) created the Star Rating system below to help beneficiaries and their families compare plan performance and quality for Medicare Advantage Plans, Medicare Prescription Drug Plans and Medicare Cost plans.

5-star rating: Excellent

4-star rating: Above Average

3-star rating: Average

2-star rating: Below Average

1-star rating: Poor

“MA Plans” or “Medicare Part C Plans,” as they are often called, work like traditional HMOs and PPOs to offer money-saving coverage for things that aren’t covered by Original Medicare. These include health-related services, wellness programs (like gym memberships), transportation to doctor visits, routine vision care, over-the-counter drugs, adult day care services, hearing aids, routine dental care and prescription drug coverage offered through Medicare-approved private companies who must follow rules set by Medicare. (Source: Medicare & You Handbook)

Know your plan

Remember, you still have Medicare but most of your Part A and Part B coverage comes from your MA Plan and not original Medicare. When you go to your doctor’s office, you present your Medicare Advantage card, not your Medicare card.

Mark’s MA Plan pays his 2019 Part B premium of $135.50. In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. In fact, you’ll have to pay this penalty for as long as you have Part B.

Mark’s cost sharing is less under Medicare Advantage too. For example, if he visits a primary care physician, he may pay a copayment of $10. However, if he visits a primary care physician under Original Medicare, he may have a coinsurance of 20%, which could be more than $10. Many MA plans like his have no copayment and no monthly premium.

The different types of Medicare Advantage Plans include: HMO, PPO, Private-Fee-For-Service (PFFS), Special Needs Plans (SNPs), HMO Point-of-Service (HMOPOS) plans and high-deductible Medical Savings Account (MSA) Plans. To compare costs in specific MA Plans, visit

Part A is hospital insurance

Covers inpatient hospital care as well as inpatient skilled nursing facility care. It does not cover custodial or long-term care. It also covers hospice, home health care and inpatient care in a religious nonmedical health care institution.

Part B is medical insurance

Covers medically necessary doctors’ services, outpatient care, home health care, durable medical equipment, mental health care, preventative services and other medical services. Other covered services for Part A and Part B, too numerous to mention in this short space, can be found at

Not covered in Original Medicare Part A and Part B

  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Massage therapy
  • Routine physical exams
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Long-term care
  • Concierge care

You don’t need to sign up for Medicare each year. However, you should review your Medicare health and prescription drug coverage. Always review the materials your MA Plan sends you as well. No matter how you get your Medicare, you have certain rights and protections. Read and know your Handbook. Personalized help is available at 1-800-MEDICARE. (Source: Medicare & You Handbook)

DISCLAIMER: Past performance does not predict future results. This report is based on data obtained from sources we believe to be reliable. Hefren-Tillotson does not, nor any other party, guarantee the accuracy or completeness of this report or make any warranties regarding results obtained from its usage. All opinions and estimates included in this report constitute the firms judgment as of the date of this report and are subject to change without notice. This report is for informational purposes only and is not intended as an offer or solicitation to buy or sell the securities herein mentioned.

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