Medicare 101

Medicare 101

Our mission is to make Medicare easier to understand and help every client feel informed, supported, and confident in their healthcare coverage decisions. Whether you are turning 65, retiring, helping a loved one, or reviewing your current plan, Almond Insurance is here to guide you through the process.

Our mission is to make Medicare easier to understand and help every client feel informed, supported, and confident in their healthcare coverage decisions. Whether you are turning 65, retiring, helping a loved one, or reviewing your current plan, Almond Insurance is here to guide you through the process.

Step One

Are you eligible?

Three quick questions. Real answer at the end — not a sales pitch.

A 30-second eligibility check
1
Are you 65 or older — or turning 65 in the next 12 months?
2
Under 65 with a qualifying disability or condition?
3
U.S. citizen, or legal resident for 5+ consecutive years?
The Building Blocks

The four parts

A and B are Original Medicare, run by the federal government. C and D are private plans you can add. Click any card.

A
Hospital Insurance
Original Medicare
Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people pay $0 premium for Part A if they or a spouse paid Medicare taxes for 10+ years.
B
Medical Insurance
Original Medicare
Doctor visits, outpatient care, preventive screenings, and durable medical equipment. The standard 2026 premium is set by Medicare and adjusted yearly.
C
Medicare Advantage
Bundled alternative
Private plans that bundle A and B (and usually D) into one package. Often include dental, vision, hearing, and fitness benefits Original Medicare doesn't cover.
D
Prescription Drugs
Add-on coverage
Stand-alone drug plan that pairs with Original Medicare. Drugs sit in tiers — generic, preferred brand, specialty — that determine your copay.
When To Enroll

The windows that matter

Miss an enrollment window and you could face penalties added to your premium for the rest of your life. Here are the dates.

Time it right. We track every deadline for our clients and reach out before each window opens. It's the unglamorous work that saves people thousands.

A typical Medicare year

Two key windows repeat every year:

Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
AEP · Oct 15 – Dec 7
OEP · Jan 1 – Mar 31
IEP

Initial Enrollment Period

7 months around your 65th birthday

Starts 3 months before your birth month, includes your birth month, and continues 3 months after. This is your most important window — do not miss it.

AEP

Annual Enrollment Period

Oct 15 – Dec 7 every year

Anyone on Medicare can add, drop, or switch coverage. Changes take effect January 1.

OEP

Open Enrollment Period

Jan 1 – Mar 31 every year

If you're on a Medicare Advantage plan, you can switch plans or return to Original Medicare. One change only.

SEP

Special Enrollment Period

Triggered by qualifying life events

Moving, losing employer coverage, or qualifying for Extra Help. Usually a 2-month window.

MEDIGAP OEP

Medicare Supplement OEP

6 months from your Part B start date

Your one-time guaranteed-issue window. Insurance companies cannot deny you or charge more for pre-existing conditions.

PART B SEP

After Employer Coverage

8 months after employer coverage ends

If you delayed Part B because you had qualifying employer coverage, this is your penalty-free window to sign up.

Don't Leave Money On The Table

Late penalties are permanent.

Miss an enrollment window without qualifying coverage and Medicare adds a penalty to your premium for life. Here's how it works.

Part B Late Penalty

10% per 12-month period, added permanently

If you don't sign up for Part B when first eligible — and you don't have qualifying employer coverage — your monthly premium goes up by 10% for each full 12-month period you delayed.

Example: Delay enrollment by 2 years → your Part B premium is 20% higher for life.

Part D Late Penalty

1% per month, added permanently

Go 63 or more consecutive days without Part D or other creditable drug coverage and Medicare adds a penalty for every month you went without.

Example: A 12-month gap adds roughly $4.10/month to your Part D premium in 2026 — every month, forever.

How to avoid all of it

Enroll on time. Or have us track it.

The simplest path: enroll during your IEP, the 7-month window around your 65th birthday. If you have employer coverage past 65, sign up within 8 months of losing it.

Our promise: Almond clients get deadline reminders before every window — it's the boring work that pays off.
The Gaps

What Original Medicare doesn't cover.

Parts A and B leave real gaps. The good news: most of these can be addressed by adding Part C, Part D, or a Medicare Supplement.

Most prescription drugs
Routine dental
Eye exams & glasses
Hearing aids
Gym & wellness
Long-term care
Care outside U.S.
Daily living help
Extended stays

READY TO GET STARTED?

Let’s Simplify Medicare Together.

Whether you are turning 65, reviewing your current coverage, comparing prescription drug options, or helping a loved one understand Medicare, Almond Insurance is here to provide clear answers and no-pressure guidance.

Personalized Medicare guidance you can trust. Call today to schedule your free consultation.

6870 Rote Rd # 103, Rockford, IL 61107

6870 Rote Rd #103, Rockford, IL 61107, USA

Business hours

monday: 8am - 5pm

tuesday: 8am - 5pm

wednesday: 8am - 5pm

thursday: 8am - 5pm

friday: 8am - 5pm

We may not offer every plan available in your area. Currently we represent Medicare Advantage organizations which offer different plan options in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP), to get information on all of your options.

This website is not an official government website. It is operated by Almond Insurance and is not affiliated with the Centers for Medicare and Medicaid Services (CMS). The information on this website is not a substitute for professional medical advice. Please consult with your doctor or other healthcare provider for more information about your specific health needs. This website is a solicitation for insurance. By providing us with your contact information, you agree that an authorized representative or licensed insurance agent or producer may contact you by telephone, email, or mail to answer your questions or provide additional information about Medicare Advantage, Part D, or Medicare Supplement Insurance plans.

Copyright 2026. Almond Insurance. All rights reserved.