New to Medicare in Carmel, CA

Navigating Medicare for the first time can be daunting, especially with all the different parts, plans, and enrollment periods to consider. If you’re in Carmel, CA, and new to Medicare, this guide is here to help you understand your options and make informed decisions about your healthcare coverage.

Understanding Medicare

Medicare is a federal health insurance program primarily for people aged 65 and older, but it also covers some younger people with disabilities or specific conditions. Before diving into the specifics, let’s break down the different parts of Medicare.

The Different Parts of Medicare

Medicare is divided into several parts, each covering different services:

• Part A: Hospital Insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Part B: Medical Insurance. It covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
• Part C: Medicare Advantage. These are private plans that offer additional benefits and are an alternative to Original Medicare (Parts A and B).
• Part D: Prescription Drug Coverage. It helps cover the cost of prescription drugs.

Enrolling in Medicare

When Should You Enroll in Medicare?

Most people should enroll in Medicare three months before their 65th birthday, during what’s called the Initial Enrollment Period. This period lasts seven months, starting three months before the month you turn 65 and ending three months after.

How Do You Enroll in Medicare?

Enrolling in Medicare can be done through the Social Security Administration. You can apply online, by phone, or in person at your local Social Security office.

What If I Don’t Enroll in Medicare Part D?

If you don’t enroll in a Medicare Prescription Drug Plan (Part D) when you’re first eligible and you don’t have other creditable drug coverage, you may face a late enrollment penalty if you decide to join later.

Costs Associated with Medicare

Is There a Cost for Medicare Parts A and B in 2025?

Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working. Part B, however, does require a monthly premium, which can vary based on your income.

What Are the Medicare Deductibles for 2025?

Deductibles for Medicare can change annually. As of 2025, Medicare Part A has a deductible that applies to each benefit period, while Part B has an annual deductible.

Medicare and Additional Coverage Options

Medicare Advantage or Medicare Supplement?

Medicare Advantage plans (Part C) are offered by private companies and include all benefits and services covered under Part A and Part B. Some plans offer extra coverage, like vision, hearing, and dental. Medicare Supplement (or Medigap) policies, on the other hand, help pay some of the healthcare costs that Original Medicare doesn’t cover.

Medicare with a Disability

If you’re under 65 and have a disability, you may qualify for Medicare after receiving Social Security Disability Insurance (SSDI) for 24 months.

Working with an Agent

Working with a Knowledgeable Agent

A knowledgeable agent can help you navigate the complexities of Medicare, comparing different plans, and ensuring you’re enrolled in the best option for your needs.

Difference Between a Captive Agent and a Broker

A captive agent works for one insurance company and can only offer that company’s products. A broker, however, can offer plans from multiple companies, providing more options for you to choose from.

What’s the Best Way to Check an Agent’s Online Reviews?

When selecting an agent, it’s crucial to check their online reviews. Look for reviews on independent websites, such as Google, Yelp or the Better Business Bureau. and forums to get an unbiased perspective on their service quality.

Medicare Enrollment Periods

Medicare Annual Open Enrollment Period

The Annual Open Enrollment Period runs from October 15 to December 7 each year. During this time, you can change your Medicare health or prescription drug coverage for the following year.

Who Can Enroll in Medicare?

Generally, anyone age 65 or older, younger people with disabilities, and individuals with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant) can enroll in Medicare.

Potential Penalties and Adjustments

What Are Medicare Penalties?

If you don’t sign up for Medicare when you’re first eligible, you may incur a late enrollment penalty. This can apply to Part A, Part B, and Part D.

What Is the Medicare Income-Related Monthly Adjustment?

The Income-Related Monthly Adjustment Amount (IRMAA) is an additional charge to your Part B and Part D premiums if your income is above a certain level.

Legislative Impacts on Medicare

Medicare and the Inflation Reduction Act 2022

The Inflation Reduction Act of 2022 introduced measures to control drug prices and potentially lower out-of-pocket costs for Medicare beneficiaries.

Conclusion

Navigating Medicare can seem complex, but understanding its parts, knowing when and how to enroll, and being aware of potential costs and penalties can help you make informed decisions. Whether you decide on Original Medicare, Medicare Advantage, or a Supplement plan, ensure that you choose what’s best for your health and financial situation. If in doubt, working with a knowledgeable agent can provide guidance tailored to your specific needs. Welcome to Medicare in Carmel, CA!