Medicare

Most people become eligible for Medicare at age 65. You may also qualify earlier if you have certain disabilities or medical conditions such as End-Stage Renal Disease (ESRD) or ALS. Eligibility is based on your age or health status, not your income or employment.

Example: If your 65th birthday is on June 15th, you can start Medicare coverage as early as June 1st. Your Initial Enrollment Period (IEP) lasts 7 months total:

• It begins 3 months before the month you turn 65.

• It includes your birthday month.

• It continues for 3 months after your birthday month.

If you have credible group coverage through an employer (yours or your spouse’s), you can delay Medicare without penalty. When that coverage ends, you qualify for a Special Enrollment Period (SEP) that lasts 8 months.

Example: If you retire at age 67 and lose your group health insurance, you can sign up for Medicare Part B and Part D at that time without late enrollment penalties. Wilson Insurance helps Cincinnati-area employees transition smoothly from group coverage to Medicare.

Medicare has four main parts that cover different types of care.

• Part A – Covers hospital stays

• Part B – Covers doctor visits and outpatient care

• Part C (Medicare Advantage) – Private plans that bundle A and B (and often Part D)

• Part D – Covers prescription drugs

Example: Someone might enroll in Original Medicare (Parts A and B) and add Part D for prescriptions, while another person may choose a Medicare Advantage plan (Part C) that combines all three in one.

Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes long enough. Part B and Part D usually have monthly premiums, which can change based on your income and plan choice.

Example: In 2025, the standard Part B premium is $185.00 per month, but higher-income individuals may pay more. Prescription drug coverage (Part D) could add another $10–$110 per month, depending on the plan.

Medicare covers many essential services but leaves out others. It generally does not cover routine dental care, vision exams or glasses, hearing aids or long-term custodial care.

Example: If you need new eyeglasses or dental work, Medicare won’t pay for it, but you can add a Medicare Advantage plan or separate dental/vision coverage through Wilson Insurance to help with those costs.

Original Medicare (Parts A and B) covers many costs, but it doesn’t pay for everything. Medicare Supplement Insurance, also called Medigap, helps cover the “gaps” such as deductibles, copayments, and coinsurance. These plans are offered by private insurance companies and work alongside your Medicare coverage.

Example: If you have a hospital stay with Medicare Part A, you’re responsible for a deductible of over $1,600 in 2025. With a Medicare Supplement plan, that deductible could be paid for you, greatly reducing your out-of-pocket costs.

At Wilson Insurance, we help people in Cincinnati compare Medigap and Medicare Advantage options to decide which fits best for their health needs and budget.

Medicare Advantage (Part C) plans are offered by private insurance companies and combine Parts A and B into one plan. Many Advantage plans also include Part D prescription drug coverage and may add extra benefits like dental, vision, hearing, fitness programs, and more. You must still pay your Part B premium, but Advantage plans often have lower monthly costs than Medicare Supplement (Medigap) plans.

Example: A Medicare Advantage plan in Cincinnati might include hospital, doctor, and prescription drug coverage plus dental and vision benefits — all in one card — with a low or even $0 monthly premium.

At Wilson Insurance, we help people compare Medicare Advantage vs. Medigap to determine which option works best for their health needs, budget, and preferred doctors.

You can enroll in Medicare through Social Security online, by phone or at your local office. Enrollment typically begins three months before your 65th birthday and lasts for seven months. At Wilson Insurance, we’ve helped thousands of people in Cincinnati and across the U.S. navigate this process and avoid costly mistakes.

Example: If your 65th birthday is in October, your Initial Enrollment Period runs from July through January. Wilson Insurance can help you compare plans and make sure you’re set up for coverage starting October 1st.