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MEDICARE BASICS TRAINING
Updated: 15 hours ago
Michel T. Braden September 13, 2026 WHAT IS MEDICARE
MEDICARE BASICS TRAINING
Welcome to our article on Medicare Basics Training. Some people call this Medicare Basics or Medicare 101; for this article, I chose Medicare Basics Training because I think it best captures the goal. After reading this article on Medicare Basics Training, you will have a much clearer understanding of Medicare. Not just what Medicare is, but what it covers, the options you have, and the time to enroll.
I've been an independent Medicare Broker for the past 11 years; my wife just began Medicare in July, and I will be enrolling in Medicare next July. I wanted to share that background because I know from firsthand experience and from working with nearly 1000 clients what the process is and how daunting and confusing it can be.
I like to say that way back in Home Economics class, they taught us how to write a check, but the school never put any money in my account. And for Medicare, we pay taxes, but we get absolutely no training or information until we turn 64 1/2 years old; then the floodgates open, and we're inundated with information, postcards, brochures, and flyers from just about anyone associated with Medicare. No one knows what to do, what to keep, what to throw away, or who to call. That's why I'm writing this article, and I hope it helps you feel balanced and empowered to take on the Medicare enrollment process with confidence and security.
The learning curve is steep because many Medicare concepts, lingo, and nomenclature are foreign to most of us. Understanding Medicare is easier said than done. I have seen too many people go down the rabbit hole, get completely lost, and get turned around before they even start, so I hope this article gives you a gentle push in the right direction. Frankly, Medicare can feel a little scary when it’s entirely new to us. Most of us spend our lives working for an employer who selects our insurance for us. We go to an annual benefits meeting and sign up for the plan they’ve chosen.
My first piece of advice is to stay calm; you have time to get everything sorted out. Your first task should be looking for a licensed independent Medicare Broker in your area. Medicare agents typically work for only one or two insurance companies. Brokers contract with many different companies, giving you access to more plans and more options.
Do a Google Search for Medicare Brokers Near Me. Then, look at their website, see if they are a BBB member, and based on what you see, choose the three best options, call them one at a time, and explain your situation. Then listen to how they answer your questions and decide whether you feel comfortable with them and their responses. Are they friendly and polite? Ask them about their business and clients, then ask how the Medicare process works. Once you have found a broker that you feel comfortable with, pat yourself on the back, because you just made a huge decision that will pay dividends for you for many years to come. Your Broker will do most of the heavy lifting, but they will never tell you which plan to get; that decision is only for you and your family.
A few things that set the good brokers apart from others:
Their email address should match their website.
Their website should have great information, and not simply be a landing page.
The more experience a broker has, the better they are at working for and with their clients.
A broker will never charge you a penny for their time, their help, or for any service they provide you.
Agents/Brokers are paid a commission for any policy they write; this is their compensation.
Once you have found a broker, you can ignore all of the information that is being sent to you from various insurance companies, but be sure to keep a file for any letters or communication that comes from the Social Security Administration and Medicare (CMS).
If you want to go to a seminar, great, you can get some good information, but be careful not to give your name, number, or email to anyone. Part of the plan is to get your information so they can call, text, email, and otherwise pester or rush you into a decision. My second piece of advice is to protect yourself and your privacy by setting up a temporary email you can give out during the Medicare Fact Finding Mission. It should be simple, like jerryisturning65@gmail.com.
EVERYONE FEELS OVERWHELMED BY MEDICARE
Some people retire at or before 65. And unless you have been given Medicare Coverage earlier from the Social Security Administration, you will want to know what your Initial Enrollment Period is for Medicare. You can review it using the Medicare IEP chart below.
A Few Quick Medicare Enrollment Guidelines:
If you have Health insurance from your employer, and your employer has more than 20 employees, you do not have to enroll in Medicare at 65. You can wait until you retire, but for many people, it costs less to enroll sooner rather than later.
If you work for an employer with fewer than 20 employees, you must enroll in Medicare at age 65.
You do not need to take Social Security to enroll in Medicare.
If you are already taking Social Security, you will automatically be enrolled in Medicare Part A and Medicare Part B when you turn 65.
Medicare Part A is free for most Americans based on our work history. So it makes sense to sign up for Part A when you turn 65. Your Employer Group insurance will be your primary insurance, but you will have extra coverage and benefits under Medicare Part A.
Now let's start with the basics of Medicare.
DO YOU QUALIFY FOR MEDICARE
Once you’ve confirmed you qualify for Medicare, we recommend starting with the basics. People get confused when they jump right into Medigap and Medicare Advantage plans before they even understand how Original Medicare benefits work.
GETTING FAMILIAR WITH THE MEDICARE ALPHABET
MEDICARE COVERAGE OPTIONS
Original Medicare means having both Medicare Part A and Medicare Part B. Medicare is a straightforward 80/20 health plan: Medicare pays 80% of your covered services after you meet the calendar-year deductible of $283 for 2026. You then pay the remaining 20%. This is why most people add a Medicare Supplement/Medigap plan to cover their 20% share.
Medicare Supplement Plans and Medigap Plans mean the same thing. People can choose from 11 standardized Medicare Supplement plans. The most popular plans are Plan G, Plan N, and HDG (High-Deductible Plan G). A standardized plan means each lettered Medicare Supplement/Medigap plan has the same coverage and the same benefits in all 50 states; the only difference is the premium each carrier charges in a particular state. Using the chart below, you can easily compare every Medicare Supplement/Medigap plan side-by-side.
Medicare Advantage is the common Term for enrolling in Medicare Part C. Originally, Part C was called Medicare Choice when President Clinton signed it into law. Medicare Advantage offers health insurance options from for-profit insurance carriers. In essence, it combines Medicare Part A, Medicare Part B, and, in Many cases, Medicare Part D, so many refer to these plan options as All-In-One plans.
Every Medicare Advantage plan has co-pays and coinsurance, and many offer additional benefits that sound great. Still, in the long run, they don't cover as much as you think, such as routine dental, vision, and hearing. They also include Memberships to Health Clubs like Silver Sneakers, Silver and Fit, Renew Active, and Active and Fit.
Medicare Advantage HMO plans often require you to choose a PCP (Primary Care Provider) and get a referral before you can see a specialist. They also typically only cover you in the service area you live in, which is most likely the county where you live. And you are only covered if A) you go to a provider that is in the plan's network. B) they often require a PA (Prior Authorization) for certain tests and procedures. They can also require as many 2nd and 3rd opinions as they want.
Medicare Advantage PPO plans offer more coverage flexibility, but that usually comes with a trade-off: higher Doctor Visit co-pays. Most PPO plans allow members to see providers in other states, so they are much more favorable if you plan to travel. There are co-pays for Hospital Stays that run around $395 per night, co-pays for MRI’s and CT Scans that can often cost $400 or more, and the highest-ticket item is that every Medicare Advantage Plan requires you to pay 20% Coinsurance for all Cancer Treatments.
Other types of Medicare Advantage Plans are called Special Needs Plans (SNP) and C-SNP (Chronic Special Needs Plans). These plans are built around a Care Team and its networks, and benefits are streamlined to support beneficiaries.
Most Medicare Advantage Plans may have $0 monthly premiums, but the key point is that they all have a MOOP, or Maximum Out-of-Pocket amount, which you must reach before the plan pays for all your healthcare costs. The national average in 2026 is $5,900! You will need to do your homework to determine whether a Medicare Advantage Plan (MA or MAPD) is the best plan for you.
If you have ever wondered why there are so many Medicare Advantage plan commercials on the radio and on television, they can do this because the Government (CMS-Medicare) pays the plan 1K per month for taking on your risk! This pays for the lion's share of their advertising and marketing, which is why they can offer “Extra” that Medicare cannot.
One last distinction: your Medicare Advantage plan is only good for a Calendar Year. So, every year you will need to choose a new Medicare Advantage plan for the new year on January 1. If your plan is still available, you can keep it, or you can switch to another plan. But be warned: once you choose a plan, you cannot switch plans during the year unless you are granted a Special Enrollment Period (SEP).
Everyone has just three options for Medicare Coverage:
1. Enroll in Original Medicare alone, without a Medicare Supplement/Medigap plan.
2. Enroll in Original Medicare with a Medicare Supplement/Medigap plan.
3. Enroll in a Medicare Advantage Plan (Medicare Part C).
MEDICARE PART A
Medicare Part A is your Hospital Coverage. This coverage pays for your room and board in a hospital or skilled nursing facility.
MEDICARE PART B
Medicare Part B covers outpatient services. This includes pretty much everything else: doctor visits, lab work, surgeries, durable medical equipment, diagnostic tests, and more.
MEDICARE PART C
Medicare Part C refers to Medicare Advantage Plans.
MEDICARE PART D
Medicare Part D covers prescription medications. CMS (Centers for Medicare and Medicaid Services), also known as Medicare, will assess a penalty for anyone who has not signed up for or enrolled in a Medicare Part D Prescription Drug plan within 63 days of their Medicare Part B effective date.
HOW MUCH DOES MEDICARE COST?
Alright, so we know you're eligible for Medicare once you turn 65; you qualify for Part A, Part B, Part D, and Part C (Medicare Advantage is optional).
Now you’ll need to know what you can expect to pay for each of these parts. This is especially important if you decide whether to stay working past age 65 for an employer that offers health benefits or retire and have Medicare as your primary insurance.
COST FOR MEDICARE PART A
Medicare Part A is free for most people, as long as you or a spouse has worked for at least 10 years in the United States and paid Medicare taxes.
COSTS FOR MEDICARE PART B
Medicare Part B depends on your income. People new to Medicare in 2026 have a base cost of $202.90 per month. However, people in higher-income brackets pay an “Income Adjustment.” This is called an IRMAA adjustment. IRMAA is simply a term of endearment that the government places on high-wage earners so that they pay for Medicare more than everyone else.
Social Security bases income adjustments on the income you reported on your tax returns. They usually look at your income tax return from two years ago.
If your income has decreased since then, you can file an appeal request. You’ll present proof of your lower income and ask Social Security to lower your Part B premium. They will reconsider your premium and notify you if it can be lowered.
Once Social Security has determined what you’ll pay based on your income, it will deduct your Part B premiums from your monthly Social Security benefits. If you delayed enrolling in your Social Security income benefits, they will invoice you directly for Part B each quarter.
Then, when you file to start receiving your SSI benefits, they’ll switch over to the monthly deduction from your monthly Social Security check.
DO YOU REALLY NEED MEDICARE PART B
Medicare is the National Health Insurance plan for all Americans 65 and older; therefore, having Medicare Part B is a must-have if Medicare will be your primary insurance at age 65. What many people new to Medicare do not realize is that you have to be enrolled in Medicare Part B once you turn 65 to participate in Original Medicare, Medicare Part C (Medicare Advantage), VA Benefits, Tricare, and Champ VA.
COST FOR MEDICARE PART D
Understanding Medicare Part D costs can be tricky because plans have varying premiums. Beneficiaries may also pay more due to their income, as mentioned above in the Part B cost section.
Most states have more than 10 different Part D plans to choose from. The national average Part D premium is currently around $38.99/month in 2026. That’s a good ballpark figure to use if you are just running some estimates today. However, the Trump administration is pulling a stabilization subsidy for Stand-Alone Medicare Part D plans beginning in 2027. This will result in higher premiums for most Prescription Drug Plans. Some Medicare Part D plans will also have a $0.00 Monthly Premium. 2027 is definitely the year to take a close look at your current plan and switch during the Fall Annual Enrollment period (AEP) so you are set up for success next year.
Part D plans have different drug formularies, so you’ll choose one that offers your medications at reasonable prices. The Medicare website has a handy plan finder tool to help you choose one that fits you.
You pay Part D premiums directly to the insurance carrier. However, you can request that Social Security deduct that monthly premium from your Social Security income check. If you owe an income adjustment for having a high income, this surcharge will be added to the monthly premium of your chosen Part D drug plan.
WHAT THINGS ARE NOT COVERED BY MEDICARE
Original Medicare does not offer any coverage for routine dental care, routine vision care (Services you receive from an Optometrist), or routine hearing care. Medicare does cover most procedures at an ophthalmologist's office. Medicare covers most of your healthcare costs, but you are still responsible for your share. This includes things like deductibles, coinsurance, and co-pays.
Overall, Medicare works much like the employer coverage you’ve had during your working career. Most everyone paid their share of the monthly premium through payroll deductions, and you picked a new plan each year. Then, when you went to the doctor, you often had copays and coinsurance with your employer's group health plan. Lastly, the average deductible for employer group health plans is now between $4,000 and $6,000 per year.
WHAT MEDICARE COVERS
Medicare Part A pays for your first 60 days in the hospital. Your share of that cost is a hospital deductible, which will be $1,736 in 2026. After 60 consecutive days in the hospital, Medicare pays a diminishing share of your benefits. You begin paying a larger share as a daily hospital co-pay. This can be hundreds of dollars per day, so you need supplemental coverage to protect you from those Part A expenses.
Medicare Part B pays for your outpatient care. This includes services such as doctor visits, lab work, imaging tests, surgeries, durable medical equipment, and even things like chemotherapy, radiation, and dialysis. After you meet a small deductible you pay once per year ($283 in 2026), Part B covers 80% of these services.
Medicare Part D helps to pay for retail prescription medications. By that, we mean medications that you either receive from the pharmacy or prescriptions you might receive from a mail-order pharmacy.
Most Medicare Part D Plans have a monthly premium that is in addition to your Medicare Part B monthly premium. These plans also come with deductibles. No supplemental plans are available or required for Medicare Part D Prescription Drug plans. These plans have a MOOP of $2,200 annually for 2026. The projected MOOP for Part D in 2027 is $2,400. Most Brokers will help you compare which Prescription Drug Plans are best for you after taking into consideration your specific prescribed medications, and you can change plans every year. To compare plans and see medication costs, use the Medicare Plan Finder Tool on the Medicare website at www.medicare.gov.
WRAPPING THINGS UP
Congratulations, you made it through, and thank you for being attentive and for taking control of your Medicare. I know we covered a lot of ground in a short time, and you all get 5 Stars from me for processing all the information we provided in this article. I know you are more confident and empowered about understanding the premise and concepts of Medicare. As you work with your Medicare Broker, you will continue to expand your knowledge and confidence knowing what Medicare is, what Medicare provides, and what your Medicare options are.
I would love to make this article one or two pages long, but it is impossible to whittle it down as a stenographer would in a courtroom. If anything is unclear, or if you still want/need more information on what Medicare is, what Medicare Covers, or any of the Four Parts of Medicare, please let me know. I am happy to send you whatever you need to make your journey into Medicare as smooth as possible.
You will find a lot of interesting and additional information on our website at www.bradenmedicare.com. While you are on the website, you can complete the Contact Us page or, if you prefer, email me directly at mike@bradenmedicare.com or call me at (480) 225-1393.
You can also call Medicare directly with questions at 1-800-MEDICARE (1-800-633-4227) or visit the Medicare.gov website to start a live chat. TTY users should call 1-877-486-2048.
