Getting comfortable with Medicare can feel overwhelming, but knowing what steps to take in your first 90 days can make a significant difference in how well your benefits work for you. Whether you’re just turning 65 or transitioning from employer coverage, this Medicare starter guide breaks down what you should do in the first three months to set yourself up for success.

FAMILIARIZE YOURSELF WITH THE MEDICARE INITIAL ENROLLMENT PERIOD (IEP)

 The first step in your Medicare education is to understand your Initial Enrollment Period. This is the seven-month window that begins three months before your 65th birthday, your birth month, and the three months after. Enrolling during your IEP means you will avoid late enrollment penalties and delays in coverage.

If you’re not sure whether you qualify for automatic enrollment in Medicare or need to sign up manually, it’s essential to check with Social Security or Medicare directly. Some individuals, especially those who continue working past age 65, may delay Part B to avoid paying unnecessary premiums while covered by an employer plan. However, timing is everything. If you miss your IEP and don’t have creditable coverage, you could face a permanent penalty added to your monthly premium. Understanding the IEP not only protects your wallet but also helps ensure a smooth transition into Medicare coverage.

CONFIRM WHEN YOUR MEDICARE COVERAGE STARTS

After enrolling, it’s crucial to confirm your Medicare start date. You’ll receive a red, white, and blue Medicare card in the mail, which indicates when your coverage begins. This date varies depending on when you enroll in the IEP. Keep this card in a safe place, but also consider making a copy for your records. You can check your enrollment status and coverage start date by creating a Medicare.gov account if you haven’t already.

Your coverage start date determines when you can begin using your Medicare benefits. Enrolling during the first three months of your IEP will typically allow your coverage to start on the first day of your birthday month. However, if you wait until your birthday month or the months following, the start date may be delayed. Knowing exactly when your benefits begin ensures you’re covered when you need care, allowing you to schedule doctor visits and obtain prescriptions without interruption.

ENROLLING IN THE BEST PLAN FOR YOU

Once you’re enrolled in Parts A and B, the next step is determining how you want to receive your benefits. You have two primary options: stick with Original Medicare, which allows you to visit any provider and any hospital in the US, or choose Medicare Part C, also known as Medicare Advantage, which bundles hospital, medical, and often drug coverage into one plan.

Your decision should be based on your current and future healthcare needs, your preferred doctors and hospitals, and your financial situation. Original Medicare offers more flexibility and nationwide access to providers, but it lacks out-of-pocket maximums and comprehensive drug coverage. On the other hand, Medicare Advantage plans often include additional benefits, such as dental, vision, and wellness programs, but may require the use of a specific network of providers. Carefully compare plan benefits, premiums, provider access, and additional services to determine which path best aligns with your lifestyle.

ENROLLING IN ADDITIONAL COVERAGE

Original Medicare doesn’t cover everything. To help fill the gaps, many new beneficiaries explore supplemental coverage options, such as Medigap/Medicare Supplement Plans, which cover out-of-pocket costs like deductibles, copayments, and coinsurance. If you choose Original Medicare, you may also want to enroll in a standalone Part D plan for prescription drug coverage.

Your six-month Medigap Open Enrollment Period is a critical window that begins when you’re both 65 and enrolled in Part B. During this time, you have guaranteed issue rights, meaning you can enroll in any Medigap plan available in your state without medical underwriting. After this window closes, you could be denied coverage or charged more based on health conditions. Similarly, enrolling in Part D when first eligible helps avoid lifetime late enrollment penalties and ensures your medications are covered from the start.

Braden Medicare Insurance Initial Enrollment Period Poster For Medicare

UNDERSTANDING WHAT MEDICARE COSTS

One of the most important things to understand is that Medicare is not free of charge.  While Part A is usually premium-free if you’ve paid Medicare taxes for at least 10 years, Part B has a standard monthly premium ($185 in 2025) that can vary based on your income. Medicare Advantage and Part D plans may also have premiums, copays, and deductibles, which differ by plan and carrier. Additionally, Medigap premiums vary depending on the plan and your state of residence.

Beyond premiums, it’s essential to understand your potential out-of-pocket costs, including deductibles, coinsurance, and copayments. Original Medicare doesn’t cap these expenses, which is why most Medicare beneficiaries add a Medicare Supplement (also known as Medigap) plan to bolster Original Medicare.

 Medicare Advantage plans do have a yearly out-of-pocket maximum, but costs can vary significantly depending on whether you stay in-network. Reviewing your income-related premium amounts (IRMAA), if applicable, and budgeting for recurring healthcare costs will help prevent unexpected expenses and ensure your financial health stays on track alongside your physical health.

GETTING COMFORTABLE WITH YOUR NETWORKS

If you choose a Medicare Advantage plan, you’ll likely be required to use a network of doctors, specialists, and hospitals. It’s essential to understand the rules of your plan. HMO plans typically require referrals and have strict network restrictions, while PPO plans offer more flexibility with out-of-network care, albeit at a higher cost. If you stick with Original Medicare, you can visit any provider nationwide that accepts Medicare.

During your first 90 days, review your plan’s provider directory to ensure your current doctors participate in the network. You should also identify nearby specialists and hospitals that accept your coverage. Establishing care with a primary care physician early helps coordinate preventive services, manage chronic conditions, and keep your records up to date. If you need a new doctor, consider scheduling meet-and-greet appointments to ensure the provider is a good fit. This proactive approach helps you feel confident and supported in your healthcare decisions from the beginning.

Understanding your MOOP is vital.  MOOP is an acronym used to describe your Maximum Out-of-Pocket Expense with Medicare Advantage.  Each Plan will have an MOOP, meaning that you are responsible for all Co-Pays and Co-Insurance until you reach your plan’s designated MOOP.  After that, your plan will cover all remaining costs for the remainder of the calendar year. MOOP values vary by plan, but the nationwide average is over  $5,700.

HOW TO COMPARE MEDICARE PLANS

Cost is essential to everyone, especially when we retire, and the cost of healthcare is not for the faint of heart.  But how can you compare Original Medicare and Medicare Advantage Plans since they are entirely different?

First, let’s examine Original Medicare with either a Medicare Supplement/Medigap Plan N or Plan G. I am using these two plans as examples because they are far and away the two most popular plans available and are used by over 95% of Medicare recipients.

 Braden Medicare Insurance Highway Sign Poster Showing The Option To Choose To Enroll In Original Medicare Or Enroll In A Medicare Advantage Plan

Beneficiaries choose one of these two Medicare options:

Medicare Supplement premiums vary from state to state.  Arizona’s Medigap premiums are among the lower third of rates nationwide.  Also, men will always pay $10-$20 more than women for coverage. And, discounts matter, so if you are living at the same address with anyone who is 60 or older, you will receive a Roommate Discount of 6-20%.

As an example, let’s say a 65-year-old man chooses Original Medicare, and he adds on a Medigap/Medicare Supplement Plan G (Plan G typically runs $30 more per month than Plan N).  His premium will be approximately $150 per month, totaling $1,800 per year. His Medicare Part B Annual Deductible is $257. So, his total costs for the year will be $1,800, plus the Part B Deductible $257 for a total of $2,057. Now, Original Medicare does not include routine Dental or Vision coverage, so I would budget an additional $600 for both, bringing our total to $2,657 for the year. Additionally, Part A (Hospitalization is typically free, and his Medigap/Medicare Supplement Plan pays the $1,776 Medicare Part A Deductible.

Physical and Occupational Therapy are included under Original Medicare; they are not included with Medicare Advantage plans.  And most Medicare Advantage plans limit the number of visits to 10.

Medicare Advantage HMO Plans offer the lowest-cost plans (Most plans have a $0 Monthly Premium), but they have the most restrictive networks.  Most HMO plans nationwide are known as All-In-One plans because they typically include Prescription Drug Coverage, Dental, Vision, and hearing benefits, as well as a Gym Membership. But the nationwide average MOOP of $5,700 means that you will pay out of pocket $5,700 before the plan pays everything. That is over $3,000 more than Original Medicare with a Medicare Supplement (Medigap) plan.

A few other things to consider when considering Medicare Advantage plans.  Typically, you need to stay within your network.  Your plan is generally only sound in the county where you live, but you are covered for Emergency care out of network.  Cancer Treatments have a 20% Co-Insurance with every Medicare Advantage plan. If you are hospitalized, the average inpatient cost per day is $300 for the first 7 days.

Medicare Advantage Plans: The majority of plans offer some coverage for routine Dental, Vision, and Hearing Care.  These benefits have been shrinking over the last three years, and even though insurance companies advertise $1,000 in Dental Coverage, they do not disclose that it is actually broken down into just $250 per quarter.

Regarding vision care, services provided at an Ophthalmologist’s office are typically covered by Medicare, but not at an Optometrist’s office.

In Arizona, the Mayo Clinic, Mayo Hospital, and Barrow’s Neurological Center accept Original Medicare, but they do not accept any Medicare Advantage plans.

Lastly, this really is important; Medicare typically covers anything that a Doctor who accepts Medicare’s Assignment deems is a “Medically Necessary Procedure”.  While Medicare Advantage plans can require you to get two, three, or more second opinions, they are not obligated to approve anything.

PRESCRIPTION DRUG PLANS

99% of all Medicare Advantage plans provide coverage for Prescription Medications; However, you are still responsible for the costs of your prescriptions.  And there are many Stand-Alone Medicare Part D Prescription Drug Plans for those who prefer Original Medicare.  These plans can range from a monthly premium of $0 to $89.  Everyone is different, and sometimes more expensive plans can save you the most money overall.  We always conduct a comprehensive comparison to find you the lowest combined costs of premiums and the cost of your medications each year.

The maximum OOP (Out-Of-Pocket) costs anyone will pay for their total prescriptions for the year is $2,000 ($2,100 in 2026).

PREVENTATIVE SCREENINGS

Medicare emphasizes preventive care and offers a range of services at no cost to you. Within the first year of having Part B, you’re entitled to a “Welcome to Medicare” visit—a one-time preventive appointment to establish a health baseline. You should also schedule additional covered services, such as annual wellness visits (starting in year two), screenings for cancer, diabetes, and heart conditions, as well as immunizations for flu, pneumonia, and COVID-19.

Taking advantage of preventive services not only keeps you healthier but also saves money in the long run by detecting issues early. Make a checklist of what you’re eligible for and work with your primary care provider to complete necessary tests or vaccinations. Many preventive services have specific timeframes and eligibility guidelines, so staying on top of your Medicare calendar ensures you don’t miss valuable benefits. Use this time to establish a routine of care that supports long-term wellness.

SETTING UP AN ACCOUNT ON THE MEDICARE WEBSITE

Setting up your account on Medicare.gov is a crucial step in managing your benefits effectively. With your account, you can view your claims and coverage, track preventive services, print a new Medicare card, and update your contact information. This portal simplifies your Medicare experience and puts essential tools at your fingertips.

A Medicare.gov account also allows you to compare plans, manage prescription drug costs, and keep track of your plan’s network and formulary updates. If you ever change coverage, this account becomes an indispensable tool for ensuring a seamless transition. During your first 90 days, take the time to become familiar with your portal’s features.

Whether you’re managing your own care or assisting a spouse, being digitally connected to your benefits helps you stay informed and proactive about your health coverage.

WRAPPING THINGS UP

The first 90 days after enrolling in Medicare are critical for making smart decisions about your healthcare. By understanding your enrollment window, confirming your start date, choosing the right plan, and setting up your Medicare.gov account, you’ll ensure a strong start.

Please don’t hesitate to contact us if you have any questions. We are here to help, and our services are provided at no charge, including our time and expertise.  This includes during the enrollment process and for the next twenty years.

Braden Medicare Insurance Business Card For Michael Braden