1What is Medicare?
Medicare is federal health insurance for people 65 or older (and some younger people with disabilities). It's run by the government, but private insurance companies offer many of the plans.
The short version:
- When your parent turns 65, they become eligible for Medicare
- They have choices: stick with "Original Medicare" or join a private plan
- The right choice depends on their doctors, medications, and budget
2The 4 parts of Medicare
Hospital Insurance
Covers hospital stays, skilled nursing, hospice. Most people get it free (paid through payroll taxes).
Medical Insurance
Covers doctor visits, outpatient care, preventive services. The standard premium is $202.90 a month in 2026; higher incomes pay more.
Medicare Advantage
Private plans that bundle A, B, and usually D. Often include extras like dental, vision, hearing. This is the alternative to Original Medicare.
Drug Coverage
Prescription drug coverage. Either standalone (with Original Medicare) or included in Medicare Advantage.
What about Medigap?
Medigap (Medicare Supplement) plans help pay the gaps in Original Medicare — like deductibles and coinsurance. They only work with Original Medicare, not Medicare Advantage.
3Original Medicare vs Medicare Advantage
This is the big decision. Here's the trade-off:
Original Medicare + Medigap
- See any doctor who accepts Medicare
- No referrals needed for specialists
- Predictable costs with Medigap
- Higher monthly premiums
- No dental/vision included
Medicare Advantage
Most Popular- Often $0 premium plans available
- Dental, vision, hearing usually included
- Drug coverage bundled in
- Must use network doctors
- May need referrals (HMO plans)
Which is right for your parent?
Medicare Advantage if: They're healthy, their doctors are in-network, they want low premiums and extra benefits.
Original Medicare + Medigap if: They have complex health needs, want maximum flexibility, travel frequently, or have favorite doctors not in any network.
4When can they enroll?
Initial Enrollment Period (IEP)
7 months around their 65th birthday: 3 months before, the birthday month, and 3 months after.
This is the most important window — don't miss it!
Annual Enrollment Period (AEP)
October 15 – December 7 each year. They can switch Medicare Advantage plans or change drug coverage.
Open Enrollment Period (OEP)
January 1 – March 31 each year. One chance to switch MA plans or drop to Original Medicare.
Late enrollment penalties
If they don't sign up during their IEP (and don't have other coverage), they may face permanent penalties on their premiums. Part B penalty: 10% of the standard premium for every full 12 months late, for life. Part D penalty: 1% of the national base premium for every month without creditable drug coverage.
5How to choose the right plan
Here's the process we recommend:
List their doctors
Primary care, specialists, hospitals they prefer. These need to be in-network for MA plans.
List their medications
Drug costs vary wildly between plans. Check that their meds are covered and what tier.
Set a budget
How much can they spend monthly? Are they okay with higher out-of-pocket if they get sick?
Compare 3-5 plans
Look at total cost (premium + drugs + expected medical), not just premium.
Check star ratings
CMS rates plans 1-5 stars. Aim for 4+ stars — they have better outcomes.
Let the check do this
The coverage check ranks every county plan by likely yearly cost, checks doctors and medicines against each one, and screens for savings programs. Nothing is saved.
Check coverage now6Common mistakes to avoid
❌ Missing the enrollment deadline
Late penalties are permanent and add up. Mark the calendar.
❌ Choosing based on premium alone
A $0 premium plan can cost more if drug copays are high. Look at total cost.
❌ Not checking if doctors are in-network
Networks change yearly. Verify before enrolling.
❌ Assuming Medicare covers everything
No dental, vision, or hearing in Original Medicare. Long-term care isn't covered either.
❌ Trusting aggressive phone marketers
If someone calls pushing a "free" plan, be skeptical. Do your own research.
7Helping a parent, often from a distance
Most adult children have twenty minutes between work and pickup, live in another city, and have a parent who already got a call from someone pushing a plan. You do not need to sit in an enrollment meeting to do the homework. Everything below runs in your browser, saves nothing, and works with facts you can gather over the phone.
1. Gather four things
Their ZIP code, their doctors, their medicines with strengths, and whether they have Medi-Cal or get a Social Security check. A photo of the Medicare card fills in which parts they have and since when.
2. Run the coverage check
It ranks every county plan by what the year would likely cost for the care they expect, shows which plans list their doctors and cover their medicines, and lists the county programs that may help with cost, food, and care at home.
Start the coverage check3. Check the doctors first
A carrier directory that lists the doctor is evidence. A doctor missing from it is unknown, never “out of network”; directories are partial and change monthly, so call the office before deciding.
Look up a doctor4. Watch the Medigap window
For six months after Part B starts, insurers must sell a Medicare Supplement without health questions. Outside that window most carriers ask them. The check shows the window dates and which conditions each carrier asks about.
See Medigap quotes5. Do not let anyone rush them
Nothing here enrolls anyone. Enrollment happens with the plan, Medicare, or a licensed agent, and the Evidence of Coverage is the final word on any benefit.
8Already on Medicare? Help you may not have heard of
Being enrolled is not the end of it. Several programs lower what you pay, and Medicare pays for care coordination most people never ask about.
Extra Help with drug costs
The Part D low-income subsidy caps copays at a few dollars a fill and pays most or all of the drug-plan premium. Income and savings limits are higher than many people assume.
Medicare Savings Programs
QMB, SLMB, and QI pay the Part B premium, more than $2,400 a year, and QMB also covers Medicare deductibles and copays.
Medi-Cal alongside Medicare
People with both get their cost sharing covered and may qualify for Enhanced Care Management and in-home support through the County.
A yearly chance to switch
From October 15 to December 7 anyone can change plans for the coming year. Networks and drug lists change every year; check yours against the new plan before it is too late to move.
Ask your doctor about these
- Chronic Care Management: monthly check-ins when you have two or more chronic conditions
- Transitional Care Management: help in the month after a hospital stay
- Care navigation after a serious diagnosis
- Diabetes prevention classes, often at no cost to you
- Enhanced Care Management if you have both Medicare and Medi-Cal
The coverage check screens for every one of these with the same answers it uses to compare plans. Check what you may qualify for.