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Get Your Free Simply 65 Medicare Guide
Medicare made easy. We’ve gathered everything you need for a smooth start into one simple, friendly guide. Just the clear answers you deserve.
Your Simple T65 Medicare Checklist
Use this quick, at-a-glance list to stay on track as you approach your 65th birthday. We're here to make every step clear and stress-free.
Your Medicare Enrollment Checklist for those living in the United States
If you are already receiving Social Security or Railroad Retirement Board:
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Automatic Enrollment: If you are receiving your SS or RRB at least 4 months before your 65th birthday, then you will be automatically enrolled in Medicare Parts A and B.
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Watch Your Mail: Your Medicare card should arrive at least three months before your 65th birthday.
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Check Status: If your card hasn't arrived by then, call 1-800-MEDICARE (1-800-633-4227) to ensure your enrollment is on track.
If you are NOT yet receiving Social Security or Railroad Retirement Board:
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Take Action: You must manually enroll in Medicare.
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Timeline: Your Initial Enrollment Period (IEP) begins. Contact Social Security or call 1-800-MEDICARE (1-800-633-4227) at least three months before your 65th birthday to start the process.
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Avoid Penalties: Starting early ensures your coverage begins on time and helps you avoid late-enrollment fees.
Not sure where to start? We're here to help.
The Original Medicare Master Chart (2026)
Use this quick chart to understand what Original Medicare Parts A & B do – and where the biggest gaps are.
Medicare Part A (Hospital)
Primary Role: Inpatient coverage (room & board)
Monthly Premium: $0 per month for most people
Annual Deductible: Around $1,736 per benefit period
What is Covered:
- Inpatient hospital stays
- Skilled nursing (after a 3-day hospital stay)
- Hospice care
- Home health services
What You Pay After Deductible:
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Hospital stays
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Days 1–60: $0 copayment after deductible is met.
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Days 61–90: $434 per day coinsurance.
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Days 91–150: $868 per day (lifetime reserve days).
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Skilled Nursing (Days 21–100): $217 per day.
Annual Risk: Resets every new ‘benefit period’. A benefit period starts when you are admitted to a hospital or skilled nursing facility and ends when you have gone 60 consecutive days without needing inpatient care. If you are readmitted within 60 days, you do not pay a new deductible.
Medicare Part B (Medical)
Primary Role: Outpatient coverage (doctors & tests)
Monthly Premium: $202.90 per month in 2026
Annual Deductible: $283.00 per year
What is Covered:
- Doctor and specialist visits
- Outpatient surgery and ER
- Preventive care (flu shots, screenings, etc.)
- Durable medical equipment (like wheelchairs)
What You Pay After Deductible: You pay 20% coinsurance; Medicare pays 80%
Annual Risk: UNCAPPED – there is no maximum limit on what you could spend in a year
Critical Gaps: What Original Medicare Does NOT Cover
Financial Gaps
Service Gaps
- 20% coinsurance under Part B – if you have a $100,000 surgery, you owe $20,000.
- No maximum out-of-pocket (MOOP). Your financial risk is technically unlimited.
- Prescription drugs – almost no coverage for retail medications (you need a separate Part D plan).
- Dental, vision, hearing – no routine coverage for exams, glasses, dentures, or hearing aids.
- Long-term care – no coverage for custodial care in nursing homes or assisted living.
- Foreign travel – Medicare coverage generally stops at the U.S. border.
How People Close These Gaps
Most people do not stay on Original Medicare alone because of the uncapped financial risk. They usually choose one of these two paths:
Medigap (Path 2): You pay a separate monthly premium to a private company (for plans like Plan G or Plan N). These plans help cover the 20% coinsurance, so your medical bills become more predictable.
Medicare Advantage (Path 3): You move into a private HMO or PPO plan that replaces your Original Medicare. These plans usually include Part D (drug coverage), often add extras like dental and vision, and include an annual maximum out-of-pocket limit (MOOP) to cap your costs.
2026 Medicare Journey: Costs & Coverage Comparison
Monthly Part B Premium
Annual Part B Deductible
Annual Part A Deductible
Copays/Coinsurance
MOOP (Max Out-of-Pocket)
Drug Coverage (Part D)
Dental, Vision, Hearing
Path 1: Original Medicare
~$1,736 (Per Benefit Period)
20% Coinsurance (No Limit)
NONE (Must Buy Part D)
$202.90
$283.00 (Paid by you)
UNCAPPED (Unlimited Risk)
NOT COVERED
Path 2: Original + Medigap
$202.90 + Medigap Prem.
$283.00 (Paid by you)
MEDIGAP COVERS 100%
MEDIGAP COVERS 20%
Medigap provides protection
Must Buy Standalone Plan
NOT COVERED
Path 3: Medicare Advantage
$202.90 + Plan Prem. ($0+)
REQUIRED CAP (~$9k or less)
Varies (Often $0)
Varies (Often Included)
Fixed Copays ($10 – $40)
USUALLY INCLUDED
OFTEN INCLUDED
Path 1
Path 1
Path 1
Path 1
Path 1
Path 1
Path 1
Path 2
Path 2
Path 2
Path 2
Path 2
Path 2
Path 2
Path 3
Path 3
Path 3
Path 3
Path 3
Path 3
Path 3
*Costs based on 2026 projections. MOOP = Maximum Out-of-Pocket limit.
Choosing Your Path: Medigap vs. Advantage
Understanding the fundamental differences in how you access doctors, pharmacies, and specialists is the key to a stress-free Medicare journey.
Medigap
Best for flexibility
- Doctors: See any provider in the U.S. that accepts Medicare. No networks.
- Flexibility: No referrals needed to see specialists.
- Costs: Higher monthly premiums, but virtually no out-of-pocket costs for medical services.
- Prescriptions: Requires a separate Part D plan.
Advantage
Best for all-in-one
- Doctors: Limited to local HMO or PPO networks. Specific doctors and hospitals only.
- Convenience: Hospital, medical, and drug coverage all on one card.
- Costs: Often $0 monthly premiums, but you pay copays as you use services.
- Extras: Often includes dental, vision, hearing, and gym memberships.
The Medicare Enrollment Process Made Simple
01
Initial Enrollment Window
Sign up during your Initial Enrollment Period—the 7-month window around your 65th birthday—to avoid lifelong late fees and secure your coverage on time.
02
Healthcare Audit
List your current doctors, specialists, and essential prescriptions. We’ll use this 'healthcare audit' to ensure your new plan includes your preferred providers and pharmacies.
03
Compare Your Choices
Decide between Original Medicare with a Medigap supplement or a Medicare Advantage plan. We break down the costs and network structures of each for total clarity.
04
Finalize with Confidence
Submit your application securely with our guidance. Once enrolled, we will confirm your coverage and stay with you to help you understand your benefits card.
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