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).
Below are the aspects of Medicare which are a “Choose Your Own Adventure” and why it’s important to speak with an expert about the differences and pros and cons of each:
- 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
| Insurance Type & Feature |
Medicare Advantage (Part C) |
Original Medicare + Medigap + Part D |
| Network restrictions |
Often yes |
Usually more flexibility |
| Additional benefits (vision/dental) |
Often included |
Buy separately or out of pocket |
| Out-of-pocket max limits |
Usually present |
Can be higher, more unpredictable |
| Premium costs vs extras |
Sometimes lower premium but trade-offs |
More predictable costs but may cost more overall |
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.