What Nobody Tells You About Medicare — Until Now

Everyone has an opinion about Medicare — your neighbor, your coworker, your brother-in-law. But opinions aren't answers. These are.

Q1: What is Medicare and how does it work?

Medicare is a federal health insurance program. There are only two ways to qualify: turn 65, or be on Social Security Disability for two years.Medicare is divided into four parts:

Part What It Covers
Part A Hospital
Part B Medical
Part C Medicare Advantage
Part D Prescription Drugs

The problem: Most people don't understand how these four parts work together — or which ones they actually need.How we help: We sit down with you, explain how Medicare works, show you all your options, and talk about the good, the bad, and the ugly of each one. No spin. No sales pitch. Just the truth.

Q2: When should I enroll in Medicare?

Medicare always starts on the first day of your birth month — unless your birthday is on the 1st, in which case it starts the month before.You have a seven-month window called your Initial Enrollment Period:

Window Timing
3 months before Your 65th birthday month
Your birth month The month you turn 65
3 months after Your 65th birthday month

Missing your enrollment window can result in lifetime penalties and coverage delays.Pro tip: If you're still working and have employer coverage, your timeline may be different. This is where professional guidance becomes critical — the rules aren't the same for everyone, and one wrong move can cost you.

Q3: Do I still need Medicare if I have employer insurance?

It depends on the size of your employer.

Employer Size What Happens
20 or fewer employees Medicare becomes your primary insurance — you need to enroll on time
More than 20 employees Your employer coverage is primary — but you still have options

Common mistake: Most people assume they should just stay on their work coverage because it's good. But "good" doesn't mean "best." You should always compare your work coverage to Medicare — apples to apples — because 90% of people have better and/or cheaper coverage on Medicare.Don't guess. Compare.

Q4: What's the difference between Medicare Supplement and Medicare Advantage?

Which is better? Both are excellent coverage, and there is not a right or wrong reason for picking either one. It depends entirely on your personal situation.

Medicare Supplement (Medigap) Medicare Advantage
How it works Works with Original Medicare Replaces Original Medicare
Out-of-pocket costs Lower out-of-pocket costs Often lower monthly premiums — most companies we use have a zero monthly premium
Network No network restrictions — see any doctor who accepts Medicare Network-based — doctors and hospitals must be in-network
Flexibility Greater flexibility More structured, but often includes extra benefits (dental, vision, hearing, gym)

The truth: Neither one is "better" across the board. One is better for you — and the only way to know which one is to sit down, look at your doctors, your medications, your health needs, and your budget, and compare them side by side. That's exactly what we do.We don't care which way you go — Medicare Supplement or Medicare Advantage. We want to make sure it's the right option for you, and that you understand both ways so you can make the right decision.

Have questions about YOUR Medicare situation? We never charge for helping you plan your Medicare.

Q5: How much does Medicare cost in 2026?

Your red, white, and blue Medicare card covers Part A and Part B. Here's what those cost:

Part 2026 Cost
Part A (Hospital) $0 premium for most people
Part B (Medical) Standard monthly premium: $202.90
Part B (Higher income) Income-based — higher earners pay more. Next level: $281.30 (additional levels beyond that)

But Medicare doesn't pay for everything. It leaves 20% for you to cover — plus deductibles. That's where your next decision comes in.There are two options to supplement what Medicare doesn't pay:Option 1: Medicare Supplement (Medigap)You pay a monthly premium to the insurance company, with an annual deductible of $288 in 2026. Plus a separate drug plan (Part D), which can range from $0 to $123/month.Option 2: Medicare AdvantageMost plans have a $0 monthly premium and include a built-in drug plan. But they come with drug deductibles, copayments, and coinsurance when you use your coverage.What we do: We analyze your total expected healthcare spending — not just premiums — so you can see the real cost of each option before you decide.

Q6: What are Medicare penalties and how can I avoid them?

There are two major penalties — and both are lifetime penalties, meaning they don't go away.1. Part B Late Enrollment PenaltyIf you don't enroll in Part B when you're first eligible — or you go without creditable coverage (i.e., work coverage) — you'll pay a penalty added to your Part B premium for the rest of your life.2. Part D Late Enrollment PenaltyIf you go fully on Medicare with a Medicare plan and you don't pick up a Part D drug plan at that time, you'll get a lifetime penalty. For every month you went without Part D coverage, you'll pay a penalty added to your premium when you finally do need one later in life.The important thing: Don't get too caught up worrying about penalties. Come to us at the right time, and we'll make sure you don't get any.(Unless you come to us with them first.)

Q7: Can I change my Medicare plan later?

Yes — but only during specific enrollment periods.Annual Enrollment Period (October 15 – December 7)This is for anyone on a Medicare Advantage plan or a standalone Part D drug plan. During this window, you can switch plans for the following year. Plans change every year — premiums, drug formularies, doctor networks — so the plan that was right for you last year might not be right for you next year.Medicare Advantage Open Enrollment Period (January 1 – March 31)Already on a Medicare Advantage plan and something isn't right? This is your window to make one more change before the lock-in period starts April 1st. This is when people come to us because they picked a plan they shouldn't have — their doctor came out of network, their drugs cost more than they expected, or they signed up with a company they probably shouldn't have to begin with.Special Enrollment Period (SEP)Certain life events — like moving, losing coverage, or other qualifying changes — trigger a Special Enrollment Period. For example, if you move to another county and you're on Medicare Advantage, you have a window to switch to a plan available in your new county.What we do: We stay in touch with our clients every year to review their coverage. And we will never switch your plan unless it's better for you — and we'll make sure you understand exactly why it's better before you sign anything.

Q8: Do I have to pay my Medicare Part B premium?

Yes. When you go on Medicare Part A and Part B, everybody has to pay the Part B premium. That premium goes to the Social Security Administration — they're in charge of collecting and managing the Medicare Part B premium.Never cancel your Medicare Part B. You will throw a wrench into your entire healthcare system, and it will be a pain to get it back.

Ready to sit down and get real answers? We never charge for helping you plan your Medicare.

Q9: How do I choose the best Medicare plan?

Choosing the right plan depends on your Medicare puzzle. Every person's situation is different, and the right plan for your neighbor is probably not the right plan for you.Your puzzle pieces include:


  • Your doctors
  • Your medications
  • Your health needs
  • Your budget
  • Your preferred hospitals
  • Whether you travel or are a snowbird•Whether you get infusions•Whether you get pain shots or injections
  • Do you have upcoming surgeries or procedures
  • Not just what your health looks like now — what it's going to look like in five years


That's where we specialize.

And that's why picking a plan off a website or calling an 800 number doesn't work.For the full answer, see: Why Work With Medicare Planning of Dayton?

Q10: Why work with Medicare Planning of Dayton?

Because this is all we do. Every day. Medicare is the only thing we think about, study, and plan for.Face to Face — Every TimeYou sit down with a certified Medicare advisor — Chris, Jody, or Tanner — in our office. Not a phone call. Not a chatbot.


Every Option, Side by SideWe show you everything that's available and compare them so you can see the differences for yourself.


The Good, the Bad, and the UglyWe don't sugarcoat anything. You'll hear the honest truth about every option — including the ones we don't recommend. We don't care which way you go — Medicare Supplement or Medicare Advantage. We want to make sure it's the right option for you, and that you understand both ways so you can make the right decision.


Lifetime Service and SupportWe review your plan every year. If something changes — your doctors, your medications, your costs — we're on it.


Open Five Days a WeekWalk into our office or pick up the phone. If a Medicare question comes up — next week, next year, five years from now — we're here.


No Fees. Ever.We never charge for helping you plan your Medicare. Insurance companies pay us — you don't.

Q11: Do I automatically get Medicare at age 65?

If you're already receiving Social Security benefits six months before you turn 65, you will get your red, white, and blue Medicare card automatically.If you're not collecting Social Security, you must sign up for your red, white, and blue Medicare card yourself.

Q12: Can I have both Medicare Part A & B and employer insurance?

Yes. You can have your red, white, and blue Medicare card (Part A and Part B) and employer insurance at the same time. How they coordinate depends on the size of your employer.

Q13: Can I have both a Medicare plan and employer insurance?

No. You cannot have a Medicare Supplement and work insurance, or a Medicare Advantage plan and work insurance. They will not coordinate benefits together — it's against the rules. If you're going on a Medicare plan, your employer coverage has to end first.

Q14: Do I have to stop contributing to my HSA when I turn 65?

Yes. You are not allowed to contribute to an HSA after age 65 — not you, and not your employer.If you're going on Medicare after age 65, you must stop contributing to your HSA six months before you go on Medicare. If you don't, there may be a tax penalty — talk to your tax professional about your specific situation.This catches a lot of people off guard. It's one of the most common mistakes we see.

Have Questions? That's What We're Here For.

We never charge for helping you plan your Medicare. Sit down with us and get the answers you actually need.