The Medicare Dude

Turning 65 and Medicare: Why One Wrong Decision Can Affect You for Life Turning 65 isn’t just another birthday. For millions of Americans, it marks the beginning of Medicare eligibility—and the choices you make at this moment can follow you for the rest of your life. Many people assume Medicare is simple. It’s not. Many believe they can “change plans later.” Sometimes they can’t. And many don’t realize that one mistake at 65 can permanently limit their options. If you’re approaching age 65, or helping a parent or spouse, this is information you must understand. Why Turning 65 Is a Critical Medicare Milestone When you turn 65, you enter a unique window of opportunity that you may never get again. This is the one time in your life when you can often: Enroll in a Medicare Supplement (Medigap) plan Avoid medical underwriting Secure lifetime access to comprehensive coverage Once that window closes, the rules change—and not in your favor. The Lifetime Impact of Choosing the Wrong Medicare Plan Many people are steered into Medicare Advantage plans at 65 because: $0 premiums sound attractive Benefits look generous on paper The plan is easy to enroll in What they aren’t told is this: Medicare Advantage is not permanent protection. It is an annual contract that can change every year. Benefits can be reduced. Doctor networks can shrink. Out-of-pocket costs can increase. Prescription coverage can change. And when your health declines—as it often does with age—you may discover you can’t leave. Medicare Supplement vs Medicare Advantage: The Risk Most People Don’t See Medicare Supplements (Medigap) Nationwide access to doctors No networks Predictable costs Designed to protect you when you’re sick Medicare Advantage Plans Network restrictions Prior authorizations Copays and coinsurance Plans change every single year The biggest difference? If you try to switch from Medicare Advantage to a Medicare Supplement later, you may have to pass medical underwriting. And that’s where many people hit a wall. Medical Underwriting: Why Your Future Health Matters Today Medical underwriting means insurance companies can: Ask health questions Review medications Decline your application If you are denied a Medicare Supplement, you may never be able to get one. This is why planning ahead at 65 is so important—even if you’re healthy today. Top 50 Health Conditions That Can Cause Medicare Supplement Denials Insurance companies differ, but these are some of the most common reasons people are declined for Medicare Supplement coverage later in life: Diabetes (especially insulin-dependent) Obesity (high BMI) Rheumatoid arthritis COPD Congestive heart failure Atrial fibrillation Stroke or TIA history Cancer (recent or ongoing) Multiple sclerosis Parkinson’s disease Alzheimer’s or dementia Chronic kidney disease End-stage renal disease Heart attack history Coronary artery disease Peripheral vascular disease Lupus Crohn’s disease Ulcerative colitis Pulmonary hypertension Chronic liver disease Cirrhosis Hepatitis (chronic) Organ transplant history Severe asthma Sleep apnea (untreated) Insulin resistance with complications Diabetic neuropathy Diabetic retinopathy Autoimmune disorders Fibromyalgia Chronic pain conditions requiring opioids HIV/AIDS ALS Bipolar disorder Schizophrenia Major depressive disorder (severe/recent) History of substance abuse Recent major surgery Wheelchair dependency Oxygen use Amputation Uncontrolled hypertension Recurrent falls History of blood clots Pulmonary embolism Severe osteoporosis Frequent hospitalizations Memory impairment Any condition requiring ongoing specialist care Many of these conditions develop after age 65—which is why locking in coverage early matters. The Unstable Nature of the Medicare Advantage Landscape Medicare Advantage plans are approved one year at a time. That means: Your doctor may not be in-network next year Your hospital may no longer be covered Your copays may increase Your maximum out-of-pocket may rise Your medications may move tiers When you’re healthy, these changes are inconvenient. When you’re sick, they can be devastating. The Question You Should Be Asking at 65 Instead of asking: “What’s the cheapest plan?” Ask: “What plan protects me when I’m older, sicker, and need care the most?” Because Medicare planning isn’t about today—it’s about your future self. Why Working With a Medicare Expert Matters Medicare is not one-size-fits-all. It’s not set-and-forget. And it’s not forgiving when mistakes are made. The right guidance at 65 can: Preserve your future options Protect your finances Prevent permanent coverage limitations About the Author William Gray, also known as “The Medicare Dude,” has spent years helping individuals and families navigate Medicare with clarity and confidence. He works with many of the nation’s leading carriers and focuses on education first—pressure never.

Medicare Part A: “Admitted” Is the Key Word Here’s something every Medicare beneficiary needs to know: 👉 You must be formally admitted to the hospital for Medicare Part A to apply. Simply being in the hospital is not enough. What Counts as Medicare Part A? Medicare Part A applies only when: A doctor admits you as an inpatient, and That order is officially in your medical record When this happens: All hospital charges fall under the Part A deductible The 80/20 coinsurance does NOT apply Current Medicare Part A Costs Part A deductible: $1,736 per benefit period Hospital days 1–60: $0 coinsurance after the deductible Days 61–90: Daily coinsurance applies (These amounts only apply if you are admitted.) What Does Not Count as Part A? These situations fall under Medicare Part B: Observation status Outpatient hospital stays Less than 24 hours without formal admission Even overnight stays can be billed as Part B — and that’s when the 80/20 coinsurance applies. One Question That Can Save You Money Ask this every time: 👉 “Am I being admitted as an inpatient, or am I under observation?” Bottom Line Admitted inpatient → Medicare Part A (deductible-based, no 80/20) Observation/outpatient → Medicare Part B (80/20 applies) About Me I’m William Gray, also known as The Medicare Dude. I’m licensed in 11 states and have helped people with Medicare for over 29 years. 📞 Have questions or want more information? Reach out — I’m happy to help. — William Gray, The Medicare Dude

Getting Medicare as a green card holder is entirely possible, but the rules are stricter than they are for U.S. citizens. To avoid lifelong penalties and gaps in coverage, you need to understand the "5-year rule" and your specific enrollment windows. 1. Are You Eligible? As a green card holder (Lawful Permanent Resident), your eligibility for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) depends on two main factors: The 5-Year Residency Rule: You must have lived in the U.S. continuously for at least five years immediately before the month you apply for Medicare.   The Age or Disability Requirement: You must be 65 or older, OR have a qualifying disability (like ESRD or ALS) that has qualified you for Social Security Disability Insurance (SSDI) for at least 24 months.   2. When Should You Enroll? Timing is everything. If you miss your window, you may face a permanent 10% increase in your monthly premiums for Part B.   If You Are Turning 65 Your Initial Enrollment Period (IEP) is a 7-month window:   3 months before the month you turn 65.   The month you turn 65. 3 months after the month you turn 65.   If You Reach 5 Years of Residency After Age 65 If you are already 65 but haven't hit your 5-year residency mark yet, your IEP begins the month you hit that 5-year anniversary. You have 3 months before and 3 months after that anniversary to sign up. If You Miss Your Window If you miss the IEP, you must wait for the General Enrollment Period, which runs from January 1 to March 31 each year. Your coverage will typically start the month after you sign up.   3. Understanding the Costs While citizens and green card holders pay the same for Part B (the standard premium is $185/month in 2025/2026), the cost of Part A depends on your work history in the U.S.   Premium-Free Part A: You get this if you (or your spouse) worked in the U.S. and paid Medicare taxes for at least 10 years (40 quarters).   Paid Part A: If you don’t have 10 years of work history, you can "buy into" Part A. As of 2025, the premium is roughly $278 or $505 per month, depending on how many work credits you do have.   Note: If you have to pay for Part A, you must also enroll in Part B. However, you are allowed to enroll in Part B without buying Part A if you prefer.   4. How to Enroll The enrollment process is handled by the Social Security Administration (SSA), not the Medicare office.   Gather Documents: You will need your Green Card (I-551), proof of U.S. residency (like utility bills or tax records for the last 5 years), and your birth certificate.   Apply Online: The fastest way is via the Social Security website. Apply by Phone or In-Person: You can call 1-800-772-1213 or visit your local Social Security office.   Important Checklist [ ] Check your arrival date: Have you been here for 5 continuous years? [ ] Check your work credits: Do you have 40 quarters (10 years) of U.S. work history? If not, be prepared for Part A premiums. [ ] Check the calendar: Is your 65th birthday or 5-year anniversary approaching?

Hi, I'm William Gray, founder of The Medicare Dude. Many people are paying different prices for the exact same coverage. Because Medigap plans are standardized, a Plan G with one carrier has the same benefits as Plan G with another—the only difference is the price. I represent 40 organizations and can help you find the best value for your budget with a Free Medicare Supplement Review. ✅ No fees for my services. ✅ Independent, unbiased advice. ✅ Personalized year-round support. Call to Action: 📞 Call me at 386-871-3858 or visit TheMedicareDude.com today!

Medicare (Original Parts A & B) covers essential hospital stays, doctor visits, outpatient care, and preventive services, but generally doesn't cover routine dental, vision (exams/glasses/contacts), hearing aids, most long-term care, or prescription drugs (unless administered in a hospital/clinic). You can fill gaps with Medicare Advantage (Part C) (often adds dental/vision/drugs) or Medigap (supplements costs). What Original Medicare (Parts A & B) Covers: Part A (Hospital Insurance): Inpatient hospital care, skilled nursing facility stays, hospice, and some home health care. Part B (Medical Insurance): Doctor visits, outpatient care, medical supplies, preventive services (like flu shots, screenings), lab tests, durable medical equipment, and mental health care. What Original Medicare (Parts A & B) Doesn't Cover: Prescription Drugs: Requires separate Part D or Advantage plan. Dental: Routine exams, cleanings, dentures, most dental care. Vision: Routine eye exams, eyeglasses, contact lenses (except after cataract surgery). Hearing: Hearing aids, exams for hearing aids, or most related services. Long-Term Care: Custodial care (help with daily living like bathing, dressing). Cosmetic Surgery . Most care outside the U.S.: (with exceptions). How to Get More Coverage: Medicare Advantage (Part C): Bundles benefits, often includes drug coverage (Part D) and extras like dental/vision, but uses private plans with specific networks. Medicare Part D: Stand-alone prescription drug plans. Medigap (Medicare Supplement): Works with Original Medicare to pay your out-of-pocket costs (deductibles, copays).

You should generally enroll in Medicare when you first become eligible (around age 65) during your Initial Enrollment Period (IEP) to avoid lifetime penalties, but you can delay enrollment without penalty if you have current, credible employer group health coverage (from a large employer, 20+ people), using a Special Enrollment Period (SEP) once that coverage ends. Delaying without qualifying coverage means a permanent 10% Part B penalty for each year you waited. When to Enroll (Most People) Initial Enrollment Period (IEP): A 7-month window around your 65th birthday (3 months before, your birthday month, and 3 months after). Sign up during this time to get Part A (hospital) and Part B (medical) without late fees. When You Can Delay (Without Penalty) If you have Employer Coverage: You can delay Part B enrollment if you or your spouse are still working and have health insurance from that job, provided it's a large group plan (20+ employees). Special Enrollment Period (SEP): Once you stop working or lose that job-based coverage, you get an 8-month SEP to sign up for Medicare Part B without a penalty. When You Should NOT Delay (or Risk Penalties) Small Employer Plans: If your employer has fewer than 20 employees, you likely need to enroll in Medicare at 65 to avoid penalties, as your employer plan may not be considered "credible coverage". COBRA/Retiree Plans: Coverage from COBRA or retiree plans generally doesn't qualify for a penalty-free delay; you'll need to enroll when first eligible. Key Takeaway Enroll at 65 (IEP): Best practice to avoid penalties, unless you have a qualifying job plan. Delay with Job: Only delay Part B if you have group health coverage from a large employer; use the SEP when it ends. Avoid Penalties: Missing the IEP or SEP without a valid reason results in a permanent late enrollment penalty for Part B.

A Medicare Supplement (Medigap) plan fills gaps in Original Medicare (Part A & B) by paying your out-of-pocket costs like copays, coinsurance, and deductibles, offering predictable spending in exchange for higher monthly premiums, with standardized plans (like G, N) covering different levels of costs but not prescription drugs. You need it if you have Original Medicare and want help with costs not covered, but not if you have Medicare Advantage (Part C). It works by paying your share after Medicare pays first, letting you see any doctor or hospital accepting Medicare. How Medigap Works You need Original Medicare: You must be enrolled in Medicare Part A (Hospital) and Part B (Medical). Private insurers sell plans: Companies like Blue Cross, AARP, etc., sell these standardized policies. Pay premiums: You pay a monthly premium to the private insurer, plus your Part B premium. Medicare pays first: When you get care, Original Medicare pays its share of the approved amount. Medigap pays the rest: Your Medigap plan then pays your remaining portion (copay, coinsurance, deductible). No networks: You can use any doctor or hospital nationwide that accepts Medicare. Do You Need It? (Yes, if...) You want predictable, lower out-of-pocket costs. You want to avoid the network restrictions of Medicare Advantage plans. You want coverage for things like foreign travel emergencies (in some plans). Do You Not Need It? (If...) You have a Medicare Advantage (Part C) plan; you cannot have both. You are comfortable with the cost-sharing and potential gaps in Original Medicare alone. Common Plans & Key Differences Standardized: Plans with the same letter (e.g., Plan G) offer the same basic benefits, regardless of the insurer. Most Popular: Plan G (high coverage, few gaps) and Plan N (lower premium, small copays for doctor visits) are common choices. No Part B Deductible Plans for New Enrollees: If you first became eligible for Medicare after Jan 1, 2020, you can't buy Plans C or F, which covered the Part B deductible.

In 2026, most people will pay a standard $202.90 monthly premium for Medicare Part B, with a $283 annual deductible before paying 20% coinsurance for most services, plus costs for Part A (often premium-free), Part D (drugs), or Medicare Advantage (Part C) plans, which vary but average around $14-$34/month. Your specific costs depend on income (IRMAA), late enrollment penalties, and chosen plan (Part C/D). Medicare Part A (Hospital Insurance) Premium: Most people pay $0 if they worked 10+ years. Deductible: $1,736 per benefit period (covers first 60 days). Coinsurance: $434/day (days 61-90), $868/day (lifetime reserve). Medicare Part B (Medical Insurance) Standard Premium: $202.90/month (for incomes up to $109k single, $218k joint). Higher Premiums (IRMAA): Income-related surcharges apply for higher earners. Deductible: $283/year. Coinsurance: You pay 20% of Medicare-approved amounts after the deductible. Medicare Advantage (Part C) & Part D (Drugs) Part C: Average premiums around $14-$34/month, but $0 plans exist; requires Part B enrollment. Part D: Monthly premiums vary by plan; out-of-pocket drug costs capped at $2,100 annually in 2026. Key Factors Affecting Your Cost Income: Higher income means higher Part B and D premiums (IRMAA). Late Enrollment: Penalties add to your Part B premium for each year you delayed signing up. Plan Choice: Part C & D costs differ significantly by insurer and chosen benefits.

Medicare has four parts: A (Hospital) for inpatient care, B (Medical) for doctor visits/outpatient services, C (Medicare Advantage) as an all-in-one private plan bundling A, B, & usually D with extras, and D (Prescription Drugs) for medications, often through private plans. Original Medicare (A & B) covers essential care, while Part C offers a different way to get benefits, and Part D fills prescription gaps. Medicare Part A (Hospital Insurance) Covers: Inpatient hospital care (semi-private room, meals, nursing), skilled nursing facility (SNF) care, hospice care, and some home health care. Medicare Part B (Medical Insurance) Covers: Doctor visits, outpatient care, durable medical equipment, mental health services, lab tests, X-rays, ambulance services, and many preventive services like flu shots. Medicare Part C (Medicare Advantage) Covers: All services in Part A & B, plus often includes dental, vision, hearing, and fitness benefits. How it works: Provided by private insurance companies approved by Medicare; often bundles A, B, and D; may require using provider networks and referrals. Medicare Part D (Prescription Drug Coverage) Covers: Prescription medications. How it works: Offered by private companies, with different costs (premiums, deductibles, copays) and drug lists (formularies).

Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease). William Gray www.themedicaredude.com