Medicare – The Only Game in Town

Marshall Rathmell |

Medicare – The Only Game in Town

Every American that lives long enough eventually faces the moment they qualify for Medicare health insurance.  It’s quite a change from medical insurance coverage before age 65 in the US, where about 50% of Americans receive their health insurance coverage from employer-sponsored group health plans where family coverage for one premium is common.

THE DETAILS, OR you can skip down to THE ANSWER!

When you turn 65, you have a 7-month window to enroll in Medicare.  Every year after your initial enrollment, there’s a period where you can change your Medicare service provider.

As we approach Annual Enrollment Period, AEP in Medicare lingo, that begins October 15th and ends December 7th, mailboxes and social media fill up with Medicare materials to “help make the decision easier” for those who qualify! 

Here is some basic information for the newbies.  All Medicare policies are individual plans, which means each spouse has their own policy and each pays their own premium.  Medicare has 4 basic areas of coverage:

                Part A – Hospital Insurance

                Part B – Medical Insurance that pays for doctor’s services and outpatient care

                Part C – Medicare Advantage, which is an alternative to traditional Medicare

                Part D – Outpatient prescription drug coverage

Who pays for Medicare?  Medicare Part A is free for most enrollees and funded by payroll tax of 1.45% each from employer and employee.  Enrollees pay premiums for the other 3 parts.  Part B premiums range from $135.50 to $460.50, and the premium is based on the enrollee’s previous year’s income.  Enrollment in Part C and Part D is optional, and premiums vary by the selected plan.

Is Medicare mandatory? Medicare isn’t actually mandatory, but it’s complicated to decline.  Late enrollment comes with penalties.  Medicare Part A and Part B are the foundation of Medicare and to decline these comes with consequences.  If you are still employed after age 65 and have employer provided medical insurance, you can delay Part B until you retire.  You must be enrolled in Part A and Part B to enroll in a Medigap plan or Medicare Advantage plan.

Medicare Part A and Part B alone won’t provide the coverage or peace of mind most people want to have for their health insurance.  Here’s where it gets complicated.  There are more than 3,000 Medicare Advantage plans and most of them have several levels of premiums and with distinct coverage for pages and pages of medical treatments.


When faced with this array of choices, many people seek out a Medicare consultant for advice.  A Medicare consultant is a specialist in helping people understand Medicare by being knowledgeable of the many plans and combinations of plans to match each person’s unique needs.  These consultants guide you through the process evaluating the positives and negatives of the plans for you.

Some Medicare consultants work at non-profits (like and some do it on their own.  Either way, the service is free to you.  The consultants (or their employer) are paid by the insurance companies if they help you enroll and you pay the same premium you would if you enrolled by yourself. 

In today’s environment, you can set up a meeting in person, face to face (schedule this early as they fill up fast) in their office or your office or home.  They also consult over the phone or by zoom.

RECOMMENDATION - Use the same thought process you would when seeking medical treatment; find the best specialist to help you solve your problem. 

Wishing you good health for the future.

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