Demystifying Medicare — What You Need to Know Before 65 (and After)

Approaching Medicare eligibility (usually at age 65) can feel overwhelming. There are multiple parts, deadlines, costs, and choices — and making a misstep can mean penalties or less coverage. Joanne Giardini-Russell, founder of Giardini Medicare, breaks down the system clearly so you can make informed choices. Here’s what you should know.

What is Medicare? The Basics

• Part A covers hospital stays, inpatient care.
• Part B handles outpatient services, doctor visits, preventive services.
• Part D is prescription drug coverage (not automatic; must enroll or pick a plan).

• Part C (Medicare Advantage) bundles A, B, and often additional benefits (vision, dental, etc.); may have networks, extra restrictions.
• Medigap (Supplement Plans) help cover costs not covered by Original Medicare (coinsurance, copays, etc.).

Key Decision Points & Timing

• When to enroll: The Initial Enrollment Period (IEP) around your 65th birthday is critical. Delaying may result in penalties unless you qualify for a Special Enrollment Period (if still working with employer coverage, etc.)
• Working past 65: If you have employment-based coverage, you might be able to delay some parts, but it depends on your employer size and whether that coverage is “creditable.”
• Annual review: Even after you enroll, things change (premium increases, plan changes, drug coverage changes), so reviewing your plan every year during the Annual Election Period is vital.

Comparing Your Options: Advantage vs Original + Supplement

Source: Planning Alternatives

Cost Considerations

• Premiums: For Parts B & D, plus Medigap or Advantage plan fees.
• Income-related surcharges (IRMAA): If your income is above certain thresholds, you pay more.
• Out-of-pocket costs: Deductibles, copays, coinsurance, etc. These vary widely depending on plan and your health care usage.
• Prescription drugs: Good drug plans can save money; mis-matching a drug plan can lead to high costs.

Avoiding Common Pitfalls

• Assume advertising is complete: always read the fine print. “Zero premium” Advantage plans often have trade-offs.
• Missing deadlines: Late enrollment penalties can apply for Part B or Part D.
• Not reading plan changes: Plans change yearly — drug formularies (which drugs are covered), co-pays, network, etc. A plan that was good one year may not be next.
• Not considering long-term needs and travel/out-of-network care: Your preferences matter.Action Steps:

What Should You Do Now?

• Start planning about 6 months before you turn 65 — understand what your current coverage provides, What options will be available.
• Gather your health & financial info — what medications you take, how often you use medical services, your income, etc.
• Consult reliable sources — e.g. independent brokers, state health insurance programs, or nonprofits; avoid high-pressure sales.
• Use “what if” scenarios — model what your costs would be under different plans given your expected usage.
• Review yearly during open enrollment — your needs or plan offerings may change.

Conclusion

Medicare doesn’t have to be a mystery. By understanding the pieces, asking the right questions, and planning ahead, you can make choices that protect your health and your wallet. As Joanne Giardini-Russell emphasizes, the objective is to find the coverage that fits you, not what works for someone else.

Watch the webinar and live Q&A with Joanne Giardini-Russell of Giardini Medicare, hosted by Planning Alternatives, from September 10, 2025.