Medicare

Medicare is a federal health insurance program for US citizens and permanent legal residents. Medicare is available to people 65 years of age and older but those with qualifying disabilities can also receive Medicare benefits.

Parts of Medicare

Original Medicare

Original Medicare includes Part A and Part B.

You can join a separate Medicare drug plan (Part D).

You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.

Part A (Hospital Insurance): Helps cover:

Inpatient care in hospitals
Skilled nursing facility care
Hospice care
Home health care.

Part B (Medical Insurance): Helps cover:

Services from doctors and other health care providers
Outpatient care
Home health care
Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Medicare Advantage (also known as Part C)

Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and can include Part D coverage.

In most cases, you’ll need to use doctors who are in the plan’s network.

Plans may have lower out-of-pocket costs than Original Medicare.

Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Contact us today to set up an appointment. Phone: 909-530-0816

* CMS 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 Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

You can use our Medicare Plan Finder to browse plans and enroll (for residents living in California and Arizona)

Medicare Plan Finder

Medicare Enrollment Periods

Annual Election Period (AEP) (Oct 15 to Dec 7)

Medicare Members can make new plan choices. MA to MA. MA to Med supp/ PDP. Med Supp/ PDP to MAPD. The effective date of new changes is Jan 01.

Medicare Open Enrollment (OEP) (Jan 1 to Mar 31)

During this time any MA plan members have the opportunity to change their MA plans or disenroll from an MA plan and go back to Original Medicare with or w/o stand-alone RX plan (Part d). Members cannot go from Original Medicare to an MA plan during this time. Plan change takes effect on the first day of the following month after the current plan processes the change.

Special Election Period (SEP)

Qualifying Members can make changes outside of AEP in accordance with applicable requirements. In some instances, there are exceptions to the timeframe for LIS and Dual Special Needs Plans Members.

Initial Enrollment Period (IEP)

Qualifying members have a seven (7) month window in which to enroll into an MA, MAPD, Med Supp, or PDP plan or stay with Original Medicare (part A and B). This seven-month period is broken up as follows: 3 months prior to and 3 months after Medicare eligibility or the month a person turns 65 years of age.

Frequently Asked Questions

Please reach us at if you cannot find an answer to your question.

What is the difference between and HMO and a PPO?

HMOs have smaller provider networks and lower costs, while PPOs have larger provider networks and more flexibility.

HMOs don’t cover out-of-network care unless it’s an emergency. PPOs allow out-of-network care but at a higher cost.

HMOs require the use of a primary care physician (PCP). All specialist referrals must be requested by the PCP. PPOs do not require a referral from a PCP

HMOs usually have the lower premiums and out-of-pocket costs, while PPOs tend to cost more out of pocket.

Do you need Medicare part B if you have Tricare for Life?

Tricare for Life is a benefit for retired U.S. military members. To be eligible, you must have Medicare Part A and B. There are no enrollment fees for Tricare for Life, but you must continue to pay the Part B premiums. Tricare for Life and Medicare do work together.

Do you need Part B of Medicare if you have Veterans Health benefits?

VA health care is not creditable coverage under Medicare Part B. Medicare-eligible veterans with only VA coverage are subject to a late enrollment penalty for not enrolling into Part B at time of eligibility. However, VA coverage is considered credible for Part D.

What is credible coverage?

Creditable coverage refers to health insurance coverage that is at least as good as the standard Medicare Part B and Part D plans. This coverage can help you delay enrolling in Medicare Part B and Part D without having to pay a penalty when you do enroll. Examples of creditable coverage include large employer group plans, union-sponsored health plans, and Federal Employee Health Benefits . If you are approaching Medicare eligibility and wish to delay Medicare Part B without penalty, you must have creditable coverage. If you are eligible for Medicare Part D but delay enrollment, you accrue a penalty for each month you are eligible but do not enroll. This penalty will start when you enroll in the future and you will need to pay it, in addition to your premium, each month you have Medicare Part D. Evidence of credible coverage can be furnished by you present insurance carrier of human resources department (if employed at the time of Medicare eligibility).