United States
Hong KongMedicare: four parts, one enrollment window that matters
Part A covers hospital care, Part B outpatient, Part C is Medicare Advantage as an alternative to A and B, and Part D is prescription drugs. Eligibility begins at 65, with late enrollment penalties and income-related surcharges.
Every planner gets Medicare questions from clients, and the exam reflects that.
The four parts
| Part | Covers | Premium |
|---|---|---|
| A | Inpatient hospital, skilled nursing after a qualifying stay, hospice | Usually none, with sufficient work history |
| B | Physician services, outpatient, preventive care, durable equipment | Monthly, income related |
| C | Medicare Advantage - a private plan replacing A and B, often bundling D | Varies |
| D | Prescription drugs, through private plans | Varies, income related |
Original Medicare is A and B, usually with a Medigap supplement and a separate Part D plan. Medicare Advantage is the alternative route, and a client cannot hold both Medigap and Advantage.
Enrollment
The initial enrollment period runs seven months: the three months before the month you turn 65, that month, and the three months after.
Missing it without qualifying coverage triggers late enrollment penalties that are permanent - added to the Part B premium for life, and to Part D on a per-month basis.
Permanent is the word questions test.
A client with qualifying employer coverage can generally delay Part B without penalty through a special enrollment period. But enrolling in Part A ends HSA contributions, and the enrollment can be backdated. Advise before, not after.
IRMAA
The income-related monthly adjustment amount. Higher-income beneficiaries pay surcharges on Part B and Part D premiums.
It is based on modified adjusted gross income from two years earlier, which is the planning point: a large Roth conversion or capital gain at 63 raises Medicare premiums at 65. That two-year look-back is examinable and genuinely useful.
What Medicare does not cover
- Custodial long-term care - the largest gap by far.
- Most dental, vision and hearing under original Medicare.
- Care outside the United States, in most circumstances.
- Cosmetic procedures.
The first is the one that connects to long-term care planning, and the misconception clients most reliably hold.
Medigap
Standardized supplemental plans, lettered, sold by private insurers and covering the gaps in original Medicare. The open enrollment period for Medigap is six months from Part B enrollment at 65, during which you cannot be turned down for health reasons.
Missing that window means underwriting, which is a real consequence and a good exam question.
Dollar limits here are indexed annually and several were changed by recent legislation. Confirm the current figure before relying on it, and expect the exam to test the rule rather than the number.
Common questions
What are the four parts of Medicare?
Part A is inpatient hospital care, Part B is outpatient and physician services, Part C is Medicare Advantage as an alternative to A and B, and Part D is prescription drugs.
When do you enroll in Medicare?
During the seven-month initial enrollment period - the three months before the month you turn 65, that month, and the three months after. Missing it without qualifying coverage triggers permanent penalties.
What is IRMAA?
An income-related surcharge on Part B and Part D premiums for higher-income beneficiaries, based on modified adjusted gross income from two years earlier.
Can you delay Medicare if still working?
Part B can generally be delayed with qualifying employer coverage through a special enrollment period. But enrolling in Part A ends HSA contributions and can be backdated, so advise before rather than after.
What is the Medigap open enrollment period?
Six months from Part B enrollment at 65, during which you cannot be declined for health reasons. Missing it means underwriting.