Haven Guide to Your Medicare Options

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Our passionate and dedicated team brings together a diverse range of skills and expertise to deliver exceptional results. From creative visionaries to meticulous strategists, we work seamlessly together to meet and exceed our clients’ expectations.

Nadia Ponce Simbron

Partner

Licensed Insurance Agent
LIC# 4431312

Calvin Vo

Partner

Licensed Insurance Agent | Tax Agent
LIC# 4438235

Haven Guide to Your Medicare Options

Turning 65 or retiring soon?

At Haven, we break down your choices to ensure your health coverage and financial planning work together seamlessly. Explore the four pillars of Medicare below.

The basics

What is Medicare?

The primary health insurance program in the United States for people aged 65 or older, as well as younger individuals with certain disabilities or end-stage renal disease.
Medicare is not a single plan, but a collection of “Parts” (A, B, C, and D) that cover specific services like hospital stays, doctor visits, and prescriptions.

Part A (Required)

The first half of Original Medicare

Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part A is usually free to enroll for most people who have worked in the US for 10+ years.

To use Part A, it has require payments for deductibles and copays.

Part B (Required)

The second half of Original Medicare

Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Part B has a monthly enrollment cost that often increase year to year and is dependent on your income.
You may face a permanent monthly penalty if you do not sign up for Part B when you first become eligible at age 65.

To use Part B, it requires a monthly premium, an annual deductible, and coinsurance payments.

Part D (Add-On)

Stand-alone plans that add critical prescription drug coverage

Original Medicare (Parts A and B) generally does not cover outpatient prescription drugs. Because of this, Part D is a necessary addition to your coverage to avoid paying the full retail price for medications.
You may owe a permanent late enrollment penalty if you go 63 days or more without creditable drug coverage after turning 65.

To use Part D, it requires a monthly premium, an annual deductible, and copayments or coinsurance for your medications.

Part C (Alternative)

An all-in-one alternative to Original Medicare

Combines Part A, Part B, and usually Part D (MAPD) into one comprehensive plan.
Often includes extra benefits like routine dental, vision, hearing, and fitness memberships.
Usually have lower annual out-of-pocket maximum at the cost of staying in network.

Supplement (Add-On)

Medigap plans are private insurance policies that pay for the “gaps” in Original Medicare

You pay a monthly fee to a private insurance company. Prices vary by plan type (e.g., Plan G, Plan N) and provider.
Different plans cover different costs of using Medicare, such as your hospital deductibles, the coinsurance for medical services, and foreign travel emergency care.
While there isn’t a government-mandated “tax” penalty like Part B or D, there is a significant risk: if you wait past your initial 6-month window at age 65 to join, insurance companies can charge you much higher premiums or deny you coverage entirely based on your health.

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The cost of using medicare

What does Original Medicare (A + B) actually cost you?

While Original Medicare is a government program, it isn’t free. You will generally pay a monthly premium just to keep your coverage, along with additional costs whenever you visit a doctor or stay in the hospital. Since the government updates these rates every year, your costs might change slightly each January.

Most people use their retirement savings to cover these expenses, or use relies on available programs for helps. However, since many people don’t qualify for that extra help, it’s important to plan for these bills as part of your personal budget.

What does this look like in real life?
To give you a better idea of what you might pay out of your own pocket when using Medicare, let’s look at a quick example:

Out of pocket cost

Imagine you need a necessary procedure that requires you to stay in the hospital for one week, followed by several follow-up doctor visits during your recovery.

Part A: Deductible

$1,736 (Once every hospital stay for the year)

Part B: deductible

Part B: Co-Insurance for procedure

20% of total cost

Part B: Co-insurance for Doctor visits

20% of total cost

Learn More from CMS

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The Bottom Line

In this scenario, you would be looking at an initial out-of-pocket cost of at least $2,019 (your hospital and medical deductibles combined for 2026), plus 20% of the bill for your procedure and any doctor visits.

It is also important to remember that Original Medicare (Parts A and B) does not cover prescription drugs. To get drug coverage, you usually have to buy a separate plan (Part D), which comes with its own monthly premium and costs.

How Can Medicare Costs Be Manage?

For most people, there are two ways to avoid facing a large unexpected bill

Frequently Asked Questions

We’re here to help: Navigating the dozens of available plans can be overwhelming. We can help you compare options to find the one that fits your specific prescriptions and budget; contact us today for free assistance.

How can Haven help me?

As a family-owned agency, Haven treats every client like a neighbor rather than a policy number. Calvin and Nadia serve as your personal guides, taking the time to understand your health needs and budget so you don’t have to navigate the complex world of Medicare alone.

We act as your professional resource to simplify the enrollment process. From comparing plan networks to checking prescription costs, we provide the clear information you need to make a confident decision. Our goal is to ensure you feel supported, informed, and valued as a member of our community.

I am turning 65, what do I have to do first?

If you are already receiving Social Security benefits, you don’t need to do anything. The government will automatically enroll you in Medicare Part A and Part B. You should receive your red, white, and blue Medicare card in the mail about three months before your 65th birthday.

If you are not yet receiving Social Security, you must sign up manually. You can do this online through the Social Security website during your seven-month Initial Enrollment Period. This window starts three months before the month you turn 65 and ends three months after. If you miss this window without having other creditable coverage, you may have to pay a permanent late enrollment penalty.

Warning: If you don’t sign up for a Part D prescription plan manually when you are first eligible, you may face a permanent lifetime late-enrollment penalty if you decide to join one later.

What if I don’t do anything else after getting medicare A and B?

If you only have Medicare Part A and Part B, you have what is called Original Medicare. This provides solid coverage for hospital stays and doctor visits, but it has two major gaps: it does not include most prescription drug coverage, and there is no limit on your out-of-pocket spending.

Without additional coverage, you will be responsible for a coinsurance for almost every medical service you receive. Because there is no out-of-pocket maximum, a serious illness could result in very high bills. Most people choose to add a private Part D drug plan and either a Medigap policy or a Medicare Advantage plan to cap these costs.

How do I get prescription drug coverage?

To get prescription drug coverage, you must join a private insurance plan. You can do this by enrolling in a standalone Medicare Part D plan to go along with Original Medicare, or by choosing a Medicare Advantage plan that includes drug coverage as part of its package.

You are generally eligible to sign up during your seven-month Initial Enrollment Period when you first turn 65. If you wait to join later and don’t have creditable coverage from another source (like an employer), you may have to pay a permanent late-enrollment penalty added to your monthly premium.

How do I get Medicare Supplement for Original Medicare?

To get a Medicare Supplement (Medigap) policy, you must first be enrolled in Medicare Part A and Part B. You then buy a policy from a private insurance company, as the government does not sell these plans directly.

The best time to buy is during your Medigap Open Enrollment Period, which starts the month you are 65 or older and enrolled in Part B. During this six-month window, insurance companies cannot deny you coverage or charge you more for pre-existing health conditions. If you wait until after this window, you may be required to answer medical questions, and companies can refuse to sell you a policy.

How do I get Medicare Advantage?

To get a Medicare Advantage plan (Part C), you must first be enrolled in both Medicare Part A and Part B. Once your Original Medicare coverage is active, you can join a plan through a private insurance company that has been approved by Medicare.

The easiest time to join is during your Initial Enrollment Period when you first turn 65. If you miss that, you can sign up during the Open Enrollment Period (October 15 – December 7) each year. Your new coverage will then begin on January 1 of the following year.

We’re here to help: You might also qualify for a Special Enrollment Period if you’ve recently moved, lost employer coverage, or had other life changes. We can help you check your eligibility and find the plan that fits your needs—contact us today for free assistance.

Still have a question?

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Haven Tax & Insurance Agency is a licensed insurance agency that works with Medicare enrollee to explain Medicare Advantage, Medicare Supplement, and Prescription Drug Plan options. Plans are available to anyone who has both Medicaid from the State and Medicare. Premiums, co-pays, co-insurance, and deductible may vary based on your Medicaid eligibility category and/or the level of “Extra Help” you receive. Please contact the plan for further details. Haven Tax & Insurance Agency is a licensed and certified representative of Medicare Advantage [ HMO, HMO SNP, PPO, PPO SNP and PFFS] organizations [ and stand-alone PDP prescription drug plans] that have Medicare contract. Haven Tax & Insurance Agency and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Currently we represent [0-22] organizations which offer [0-685] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. We offer plans from a number of insurance companies.