Medicare Basics

The annual Medicare enrollment period runs from October to December, so we think it is important to review both the basics and a few lesser-known rules surrounding this benefit. This post will cover how and when to get into Medicare, a quick review of what exactly Medicare covers, and how much you can expect to pay for Medicare insurance.


If you are age 65 and a US citizen or permanent legal resident, you are eligible for Medicare. Your initial enrollment period starts 3 months before the month you turn 65 and runs 7 months, ending the third month after you turn 65. As   an example, if your birthdate is 11/10/1957, your enrollment starts 8/10/2022 (3 months before you turn 65), and runs to 2/10/2023 (3 months after you turn 65).

The annual enrollment period gives you an opportunity once a year to change your coverage or provider. This is not the only time you can sign up for Medicare if you have never been enrolled before.

If you or your spouse continue to work beyond age 65, you have existing health insurance coverage through your (or your spouse's) employer, and your company has 20 or more employees, you can stay with your current health insurance. If this is true for you, once you retire, you will have an 8 month window to get enrolled into Medicare.

Many people will physically (well, digitally) sign up for Medicare. However, it is possible to be automatically enrolled if you meet certain criteria.

  • If you receive Social Security benefits or Railroad Retirement benefits for at least 4 months prior to your 65th birthday, you will be automatically enrolled in Original Medicare.
  • If you have ALS (Lou Gehrig's Disease) or End Stage Renal Disease, you will be enrolled in Medicare when you receive Social Security Disability benefits.
  • Anyone else who is eligible to receive Social Security Disability is automatically enrolled in Medicare after 24 months of disability  
  • When you begin receiving Social Security benefits at any point after age 65, you will be automatically enrolled in Medicare Parts A and B. However, you have the ability to opt out of Part B.


Original Medicare is run by the federal government and premiums are paid directly to the government (specifically, the Centers for Medicare and Medicaid, part of the Department of Health and Human Services) which in turn makes payment to health care facilities and professionals. Similar to private insurance companies' "networks," you can use any doctor or hospital that accepts Medicare, anywhere in the United States.

Medicare is structured in Parts.

These are the two primary parts of Medicare that you must enroll in. Like every other health insurance plan in America, there are limitations and restrictions regarding scope and time when it comes to what Parts A and B cover. There are also deductibles and co-insurance amounts.

In addition, there are some options to Medicare that fill in the gaps Original Medicare does not cover.

  • Plan C. Better known as Medicare Advantage, Plan C is Medicare-approved plan offered by private insurance companies that bundles Parts A and B with other types of coverage such as vision, dental, hearing, and more. Most Medicare Advantage plans also include Medicare's prescription drug coverage, known as Part D. Medicare Advantage is no longer available for new enrollments as of 2020.
  • Part D. Medicare Part D is drug coverage. This helps cover the cost of prescription drugs, shots, and vaccines. Part D can be purchased separately or bundled with other Medicare plans.
  • Plan E. We don't talk about Plan E. (Not really - Plans E, H, I, and J have not been available for sale since 2010. Plan F is no longer available for sale as of 2020.)
  • Plans G, K, L, M, and N. These are more commonly referred to as Medigap Plans or Supplement Plans. These plans are run by private insurance companies, have separate premium payments, and can cover services Medicare does not cover, Part A/B deductibles, foreign travel, and more. You cannot buy (and do not need) Medigap plans if you are covered by a Medicare Advantage (Part C) plan.


If you have had a health insurance policy at any point in the last few decades, you'll be familiar with the varying ways in which you will pay for health care. At a basic level, your out-of-pocket costs are broken down into three buckets: premiums, deductibles, and copay and co-insurance. This one-minute video from health insurance company Aetna does a good job of explaining those terms. To keep this blog somewhat shorter, we'll only discuss the monthly premiums and related items.

Each part of Medicare has its own cost structure. For Part A, the hospital insurance, most people have a $0 monthly premium because they (or their spouse) paid Medicare taxes for at least 10 years while working. This is the same 10 years, or 40 quarters, needed to receive Social Security benefits. If you (or your spouse) have earned between 30 and 39 Social Security quarters, your Part A premium will be $274/month. If you (or your spouse) have earned fewer than 30 Social Security quarters, your Part A premium will be $499/month.

For Part B, the standard premium is about $170/month, though this amount can be adjusted upwards significantly due to "late enrollment penalties" and income-based adjustments. Both of those topics will be discussed in a separate blog post.

Part D monthly premiums depend entirely on which plan you sign up for. As mentioned earlier, Part D drug coverage can be purchased as a standalone policy or bundled with other coverage. A recent plan comparison search for standalone plans in North Texas showed monthly premiums ranging from $6 to $108 for 2023.


We will have a separate blog available in the next few weeks covering some special Medicare situations, including what happens if you’re still working but have Medicare, why it’s a good idea to apply for Medicare “on time,” and how your annual income can affect your monthly Medicare premiums. Stay tuned; all this and more in our next exciting episode blog! 

The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. All performance referenced is historical and is no guarantee of future results. All indices are unmanaged and may not be invested into directly.


Get the latest posts from BentOak Capital

Keep updated on how the latest financial trends impact you!

More about the author: BentOak Capital Team

Please remember to contact BentOak Capital ("BentOak"), in writing, if there are any changes in your personal/financial situation or investment objectives for the purpose of reviewing/evaluating/revising our previous recommendations and/or services, or if you want to impose, add, to modify any reasonable restrictions to our investment advisory services, or if you wish to direct that BentOak to effect any specific transactions for your account. A copy of our current written disclosure Brochure discussing our advisory services and fees continues to remain available upon request or at

BentOak Capital is a registered investment adviser with offices located in Weatherford, Fort Worth, and Lubbock Texas. BentOak Capital may only transact business in those states in which it is registered or qualifies for an exemption or exclusion from registration requirements. BentOak Capital’s website is limited to the dissemination of general information pertaining to its advisory services, together with access to additional investment-related information, publications, and links. Accordingly, the publication of BentOak Capitals’ website on the Internet should not be construed by any consumer and/or prospective client as BentOak Capitals’ solicitation to effect or attempt to effect transactions in securities, or the rendering of personalized investment advice for compensation, over the Internet. Any subsequent, direct communication by BentOak Capital with a prospective client shall be conducted by a representative that is either registered or qualifies for an exemption or exclusion from registration in the state where the prospective client resides. For information pertaining to the registration status of BentOak Capital, please contact the state securities regulators for those states in which BentOak Capital maintains a registration filing. A copy of BentOak Capital’s current written disclosure statement discussing BentOak Capital’s business operations, services, and fees is available at the SEC’s investment adviser public information website – or from BentOak Capital upon written request. BentOak Capital does not make any representations or warranties as to the accuracy, timeliness, suitability, completeness, or relevance of any information prepared by any unaffiliated third party, whether linked to BentOak Capital’s website or incorporated herein and takes no responsibility therefor. All such information is provided solely for convenience purposes only and all users thereof should be guided accordingly.

This website and information are provided for guidance and information purposes only. The content is developed from sources believed to be providing accurate information. Investments involve risk and unless otherwise stated, are not guaranteed. Be sure to first consult with a qualified financial adviser and/or tax professional before implementing any strategy regarding your individual situation. This website and information are not intended to provide investment, tax, or legal advice.

Insurance products and services are offered and sold by individually licensed and appointed insurance agents.

Securities offered through LPL Financial, Member FINRA / SIPC. Investment advice offered through BentOak Capital, a registered investment advisor, and separate entity from LPL Financial. The LPL Financial representatives associated with the website may discuss and/or transact securities business only with residents of states in which they are properly licensed. No offers may be made or accepted from any resident outside of the following states: AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, KS, KY, LA, ME, MO, NC, NJ, NM, OH, OK, PA, TN, TX, VA, WA.