Medicare is a federally funded health insurance program designed to help cover health care costs for individuals in the United States. Most people qualify for Medicare at age 65, provided they meet citizenship and work history requirements.

In some cases, non-working spouses may be eligible based on their partner's Medicare-covered work history. Younger individuals may also qualify for Medicare if they have certain eligible conditions.

Understanding Medicare Parts and Coverage

Original Medicare

Original Medicare includes two main parts:

1. Part A: Hospital Insurance - Covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services. Most people don't pay a premium for Part A.
2. Part B: Medical Insurance - Covers doctor visits, outpatient care, preventive services, medical equipment, and some home health care. Part B comes with a monthly premium, an annual deductible, and typically a 20% coinsurance.

Original Medicare allows you to see any doctor or provider who accepts Medicare, anywhere in the U.S.

To reduce out-of-pocket expenses, many people add a Medigap (Supplemental Insurance) policy, which helps cover deductibles, copays, and coninsurance. Keep in mind, Medigap does not include coverage for dental, vision, hearing, or prescription drugs.

Medicare Advantage (Part C)

Medicare Advantage is offered through private insurers and bundles Parts A and B — often with added benefits like:

• Prescription drug coverage
• Dental, vision, and hearing
• Wellness programs

These plans often have lower premiums but more limited provider networks. If you travel often or live in multiple states, be sure to check that your providers and locations are covered.

Part D: Prescription Drug Coverage

Medicare Part D is an optional benefit offered by private insurance companies that helps cover the cost of prescription medications.

These plans differ in price and the drugs they cover but typically include a broad selection of both generic and brand-name prescriptions as well as vaccines.

Individuals with Original Medicare often enroll in Part D to reduce their out-of-pocket expenses for medications.

Enrollment Periods

You'll enter Medicare either automatically or manually, depending on whether you're receiving Social Security benefits. If you're already receiving Social Security at age 65, you'll be automatically enrolled in Parts A and B.

If not, you'll need to sign up manually during your Initial Enrollment Period (IEP) — a seven-month window that includes the three months before your 65th birthday, your birthday month, and the three months after.

Other important Medicare enrollment windows include:

Medicare Open Enrollment Period (October 15-December 7)

• Primary window each year to make changes to existing Medicare coverage. This includes switching between Original Medicare and Medicare Advantage plans and changing Medicare Advantage plans. Additionally, you can enroll in or change Part D prescription drug plans.

General Enrollment Period (GEP) (January 1-March 31)

• For those who missed their Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period (SEP), they can enroll in Part A and/or Part B during the GEP. Coverage begins July 1 of that year, and late enrollment penalties may apply. 

Special Enrollment Periods (SEPs)

• SEPs allow you to make changes to your Medicare coverage outside of the standard enrollment windows due to specific life events, such as losing employer or other health coverage, moving out of your plan’s service area, or gaining eligibility for other coverage (like Medicaid). The timing and duration of SEPs depend on the qualifying event.

Medicare Advantage Open Enrollment Period (January 1-March 31)

• For individuals already enrolled in a Medicare Advantage plan, this period allows you to switch to a different Medicare Advantage plan. Additionally, you can drop your Medicare Advantage plan and return to Original Medicare (Parts A and B), with the option to add a Part D plan. 

Enrollment Methods and Resources

You can enroll in Medicare or get assistance through the following resources:

Enrollment options

1. Online: Social Security Administration Medicare Sign-Up 
2. Phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) 
3. In Person: Visit your local Social Security Office – Office Locator 

Helpful resources

1. Medicare Official Website: medicare.gov  
2. State Health Insurance Assistance Program (SHIP): Offers free Medicare counseling and support. 

The Impact of Income on Medicare Premiums

Your Medicare premiums can be affected if your income exceeds certain annual thresholds. Determined by your modified adjusted gross income (MAGI) from two years prior, the Income-Related Monthly Adjustment Amount (IRMAA) surcharge may be paid in addition to standard premiums for Part B and D.

Reviewed annually, IRMAA is calculated on a sliding scale and may be appealed if you've experienced a significant income reducing event.

Working Past 65

If you plan to work past 65 or are covered by a spouse's employer plan, it's a good idea to talk with the employer's benefits administrator at least six months before your 65th birthday.

Even if you continue working, you'll still have a seven-month Initial Enrollment Period (IEP) when you turn 65.

Reaching out ahead of time will help you understand whether you need to enroll in Medicare right away or if you can delay coverage without penalties.

Be sure to ask how Medicare would work alongside your current coverage, whether retiree coverage is an option, and how your spouse or other dependents may be impacted.

Frequently Asked Questions

Can I have Medicare and employer coverage at the same time? Yes. One plan becomes primary, the other secondary. Talk to your HR or advisor to coordinate coverage.

How do Medicare and COBRA work together? The interaction depends on which coverage you get first.

• COBRA before Medicare: You must enroll in Medicare when eligible. If your COBRA includes creditable drug coverage, you may delay Part D. Without it, you have 63 days to enroll in Part D after COBRA ends to avoid a penalty.
• Medicare (Parts A and B) before COBRA: Medicare becomes your primary coverage, and COBRA is secondary. COBRA may help cover costs Medicare doesn't.
• Medicare Part A only before COBRA: You must enroll in Part B within eight months of leaving your job to avoid late enrollment penalties.

Can I have both Medigap and Medicare Advantage plans at the same time? No, you cannot have both Medigap andMedicare Advantage coverage at the same time.

Can I still contribute to a Health Savings Account (HSA) after enrolling in Medicare? No. You can no longer contribute once enrolled in any part of Medicare. But you can still spend your HSA funds on eligible medical expenses, including premiums, copays, and more.

Resonant Capital Advisors, LLC (“Resonant”) is an SEC registered investment adviser headquartered in Madison, Wisconsin. This communication is limited to the dissemination of general information for educational purposes only and, accordingly, should not be construed, in any manner whatsoever, as a substitute for personalized individual advice from Resonant. Although all information provided in this communication is gathered from sources deemed to be reliable, Resonant cannot guarantee the completeness or accuracy of such information and the information should not be regarded as a complete analysis of any subject discussed. This communication is based on information available as of the date of this communication. There is no guarantee that the information will remain current or complete in the future. Resonant and its employees are not legal or tax advice experts. The information presented in this communication does not constitute legal, tax or accounting advice. Always consult an attorney or tax professional regarding your specific legal or tax situation. 

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