What are the basic Medicare eligibility requirements?

To be eligible for Medicare, you must be at least 65 years old and a U.S. citizen or a permanent legal resident who has lived in the United States for at least five continuous years.

How does my work history affect my Medicare eligibility?

If you have paid Medicare taxes for about 10 years, you typically qualify for premium-free Part A hospital insurance. Those with shorter work histories may still qualify by paying monthly premiums.

Can individuals under 65 qualify for Medicare?

Yes. Individuals under 65 can qualify if they have received Social Security Disability Insurance (SSDI) benefits for 24 months or have specific medical conditions such as End-Stage Renal Disease (ESRD) or ALS.

What is the Initial Enrollment Period for Medicare?

The Initial Enrollment Period begins three months before your 65th birthday and ends three months after it—a seven-month window that allows you to enroll without late-enrollment penalties.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket (MOOP) limit. In 2025 it can be up to $8,850 for in-network care, after which the plan pays 100% of covered services.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket limit. In 2025 it can be up to 8850 dollars for in-network care, after which the plan pays 100 percent of covered services.

What are the key parts of family health insurance?

Premiums, deductibles, copays, and out-of-pocket maximums determine how much a family spends on health insurance each year.

How do I find affordable ACA coverage?

Visit GenerationHealth.me/aca-marketplace-quotes to compare ACA plans and see if you qualify for subsidies that lower your monthly premium.

Do family health plans include dental and vision?

Most standard health plans do not include dental and vision. Families should add standalone coverage to complete their protection.

What is the main difference between Medicare Plan G and Medicare Advantage?

Medicare Plan G works with Original Medicare to cover most out-of-pocket costs after the Part B deductible. Medicare Advantage replaces Original Medicare with a private plan that includes copays, networks, and often drug and extra benefits.

Is Medicare Plan G better than Medicare Advantage?

Plan G is better if you want predictable costs and doctor freedom. Medicare Advantage can be better if you want lower premiums and built-in extras like dental and vision.

What are the four main parts of Medicare?

Medicare consists of four primary parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Each part covers different aspects of healthcare needs.

How do I enroll in Medicare, and what are the important enrollment periods?

You can enroll in Medicare during your Initial Enrollment Period, which begins three months before your 65th birthday and lasts for seven months. There are also General Enrollment Periods from January 1 to March 31 each year and Special Enrollment Periods for unique circumstances like continued employment or qualifying life events.

What are the costs associated with each Medicare part?

Part A is often premium-free for most beneficiaries but includes a $1,676 deductible per benefit period. Part B has a standard $185 monthly premium and a $257 annual deductible in 2025. Costs for Part C (Medicare Advantage) and Part D (drug coverage) vary by plan and include potential copays and premiums.

What are the penalties for missing Medicare enrollment deadlines?

Missing Medicare enrollment deadlines can result in permanent financial penalties. For Part D, the penalty adds 1% of the national base beneficiary premium for each month without coverage, applied permanently. Late enrollment in Part B also triggers ongoing higher monthly premiums.

Compare Medicare Advantage Plans with Help from a Licensed Agent -

Compare Medicare Advantage Plans with Help

Choosing the right Medicare Advantage plan is one of the most important decisions for your health and finances. With dozens of plans available in most areas, finding one that covers your doctors, medications, and preferred hospitals can be confusing. That’s where professional guidance makes all the difference.

Why Comparing Plans Matters

Not all Medicare Advantage (Part C) plans are the same. Each plan offers different:

Monthly premiums and copays
Doctor and hospital networks
Prescription drug coverage
Extra benefits like dental, vision, and hearing

Reviewing these details side-by-side helps avoid costly mistakes and ensures you receive the coverage you need.

How a Licensed Agent Can Help

At Generation Health, our licensed agents do the heavy lifting for you. We:

Review your current coverage and medications
Compare local plans from trusted carriers
Check your doctors’ participation in each network
Explain costs in simple terms
Help you enroll safely and confidently

You’ll get personalized guidance — not a one-size-fits-all approach.

Get Help Today

Whether you’re new to Medicare or reviewing your options for the upcoming year, you don’t have to do it alone. Contact Generation Health for expert, no-cost help comparing Medicare Advantage plans that fit your needs and budget.

📞 Call Rob Simm, Licensed Agent
👉 Visit GenerationHealth.me to start your comparison today.

🧱 FAQ

Q1: What’s the best way to compare Medicare Advantage plans?
A: Work with a licensed agent who can review your prescriptions, preferred doctors, and coverage needs to match you with the right plan options in your area.

Q2: Is there a fee to get help comparing Medicare plans?
A: No. Licensed Generation Health agents provide Medicare help at no cost or obligation to you.

Q3: Can I change my Medicare Advantage plan each year?
A: Yes. You can review and switch plans during the Annual Enrollment Period (October 15 – December 7) or during special enrollment periods.

📊 Comparison Table:

Feature	Plan A	Plan B
Monthly Premium	$0	$25
Doctor Network	Local HMO	Nationwide PPO
Prescription Coverage	Included	Included
Dental, Vision, Hearing	Basic	Comprehensive
Fitness & OTC Benefits	Limited	Included
Out-of-Pocket Max	$8,300	$6,700

About the Author: Rob Simm

Rob Simm is a licensed health insurance broker and founder of Generation Health, specializing in Medicare Advantage, Medicare Supplement, and Marketplace coverage across the United States. With years of experience helping seniors and families navigate complex insurance choices, Rob’s mission is simple — to make health coverage easier to understand and more affordable for everyone.

When he’s not meeting with clients or building new digital tools to simplify plan comparisons, Rob enjoys community outreach events across North Carolina and Virginia, helping educate residents about their Medicare options.

📞 Contact Rob directly at GenerationHealth.me for trusted, one-on-one guidance.