Beyond 65_ Your Roadmap to Smarter Health Care Choices

BEYOND 65:
Your Roadmap To
Smarter Healthcare Choices
By Hope Suhr “Hope The Medicare Lady”

Medicare Explained
Are you turning 65 and feeling overwhelmed
about getting started with Medicare? This
book is for you! With step-by-step guidance,
helpful resources, and a clear understanding
of the basics of Medicare, you’ll be equipped
to make informed decisions about your
healthcare coverage. Don’t let confusion and
uncertainty hold you back from accessing the
benefits you’re entitled to. This book is
designed to guide you through making
decisions about your Medicare and senior
benefits plans. You can choose to work with
an agent at no cost to you, as we are paid by
the insurance company to help you navigate
the system and make it easier for you. With
our expertise and guidance, you can
confidently choose the right plan to fit your
needs.
By Hope Suhr

Disclaimers:
TPMO (Third-Party Marketing Organization): “We do not offer every plan available in
your area. Currently, we represent 9 organizations which offer 40 products 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.
Affiliation:
“Elpis Insurance is not connected to the Federal Medicare Program. This is a solicitation for insurance.”
Educational:
“This is only for educational purposes, and no plan-specific benefits or details will be shared.”

© Hope Suhr
If you’re ready to explore your options for
Medicare and get started on the path to
coverage, I’m here to help. Whether you
prefer to attend a Medicare Master Class
online or read this book and navigate the
system on your own, I’m available to provide
guidance and support every step of the way.
I’m dedicated to helping you make informed
decisions about your healthcare coverage
and ensuring you have the resources to
access the benefits you’re entitled to. So,
welcome to Medicare! Let’s work together to
set you up for success. Contact me today to
learn more about how we can get started.
Hope Suhr
34024 Winterberry Lane
Lake Elsinore CA 92532
www.ElpisInsurance.com

Checklist - Pre-Enrollment:
8-12 Months before you turn 65: Start
exploring what is available in your zip code.
You can check your options by visiting
www.elpisinsurance.com or using an online
tool to compare plans in your area.
6 Months before you turn 65: Go to a
workshop or start a relationship with your
broker or agent.
3 Months before you turn 65: Enroll in
Original Medicare to get your Part A and Part
B activated.
Your birthday month: Begin your Medicare
coverage (given your Part A and Part B are
activated)
3 Months after you turned 65: If you haven’t
started on a plan, let’s talk. We can work to
get your plan in place!

This 7-chapter book is your guide to obtaining
Medicare when you turn 65, retire, or if you
are eligible due to a disability, End-Stage
Renal Disease (ESRD), or Amyotrophic
Lateral Sclerosis (ALS). It provides a step-bystep
process and is designed for individuals
who prefer a do-it-yourself approach.
1. Introduction: Understanding the Basics
of Medicare
2. Step 1: Enrolling in Medicare Part A and
Part B
3. Step 2: Choosing Between Original
Medicare and Medicare Advantage
4. Step 3: Adding Prescription Drug
Coverage with Medicare Part D
5. Step 4: Understanding Medicare
Supplement Insurance (Medigap)
6. Conclusion: Making the Most of Your
Medicare Coverage
7. Empowering Your Retirement

Introduction: Understanding the
Basics of Medicare
As you approach the age of 65 or prepare to
retire, it's important to understand Medicare
and how it fits into your healthcare planning.
Medicare is a federal health insurance
program designed to provide coverage to
individuals who are 65 or older, those with
certain disabilities, those with end stage renal
disease or ALS (also called Lou Gehrig’s
disease).
In this chapter, we will cover the basics of
Medicare, including the different parts of
Medicare and what they cover, eligibility
requirements and the costs associated with
the program.
We regularly update the list of companies we
work with, as the available providers may
change each year. While the providers listed
below are among the most current, it's
important to note that these can vary from
year to year. For the most up-to-date list of
providers and plans, please visit our website
or contact us directly.

Please note that current providers
available to you may include (subject to
change), based on your zip code:
Aetna Medicare
Alignment Health Plan
Align Senior Care
Anthem Blue Cross
Anthem Blue Cross Partnership
Plan
Astiva Health
Blue Shield of California
Central Health Medicare Plan
Clever Care Health Plan
Humana
Imperial Health Plan of
California, Inc.
Kaiser Permanente
Providence Medicare Advantage
Molina Healthcare of California
SCAN Health Plan
UnitedHealthcare
Wellcare
Wellcare by Health Net

Section 1: What is Medicare?
Medicare is a federal health insurance
program that was established in 1965. It is
administered by the Centers for Medicare
and Medicaid Services (CMS), which is a
division of the U.S. Department of Health and
Human Services (HHS).
Medicare is a vital resource, but it can also
be complex and confusing to navigate. There
are several parts to the program, each with
its own set of rules, regulations, and
coverage options. It’s essential to have a
basic understanding of Medicare and the
options available to you, so you can make
informed decisions about your healthcare
coverage.
Section 2: Parts of Medicare
Medicare is divided into several parts, each
of which covers different types of healthcare
services. The four parts of Medicare are:
●
Medicare Part A: This part of Medicare
provides coverage for inpatient hospital

●
●
●
stays, skilled nursing facility care,
hospice care, and home health care.
Medicare Part B: This part of Medicare
provides coverage for outpatient
services, such as doctor visits, lab tests,
preventive care, and medical equipment.
Medicare Part C : ( Also known as
Medicare Advantage ) This part of
Medicare allows beneficiaries to receive
their healthcare coverage through private
insurance companies that are approved
by Medicare. Medicare Advantage plans
must provide at least the same level of
coverage as Original Medicare ( Parts A
and B ).
Medicare Part D: This part of Medicare
provides coverage for prescription drugs.
These plans are run by private insurance
companies that are approved by
Medicare and must follow rules set by
Medicare.
Section 3: Eligibility Requirements
To qualify for Medicare, you must meet
one of the following conditions:
●
You are 65 years or older

● You are under 65 and have received
Social Security Disability Insurance
(SSDI) for at least 24 months
● You have been diagnosed with End -
Stage Renal Disease (ESRD) or
Amyotrophic Lateral Sclerosis (ALS)
Additionally, you must be a U.S. citizen or a
legal resident who has lived in the United
States for at least five consecutive years
before applying.
If you are already receiving Social Security or
Railroad Retirement benefits, you will
typically be automatically enrolled in
Medicare Part A and Part B. However, if you
are not yet receiving these benefits when you
turn 65, you will need to enroll manually. You
can apply for Medicare online before your
65th birthday. After 65, in most cases, you
may need to visit a local Social Security
Administration (SSA) office to complete
enrollment.
Section 4: Costs of Medicare
There are several costs associated with
Medicare, including premiums, deductibles,
coinsurance, and copayments. The amount

you will pay depends on the type of coverage
you have, your income, and other factors.
Below is an overview of the premiums for
each part of Medicare:
Medicare Part A (Hospital Insurance)
● Premium : Most people don’t pay a
premium for Part A if they or their
spouse paid Medicare taxes for at
least 40 quarters (10 years). If you
don’t meet this requirement, you may
have to pay a premium for Part A,
which can vary depending on how
many quarters you worked.
● Deductibles and Coinsurance : Part
A has deductibles for inpatient stays,
and you may also have coinsurance
for extended hospital stays or skilled
nursing facility care.
Medicare Part B (Medical Insurance)
● Premium : Part B requires a monthly
premium, which is based on your
income. In 2025, the standard
premium is $174.70 per month.
However, higher-income individuals
may pay more due to IRMAA
(Income-Related Monthly

●
●
Adjustment Amount). IRMAA is an
additional charge for individuals with
higher incomes, based on income from
two years prior (e.g., 2023 income for
2025 premiums).
Deductibles and Coinsurance: Part B
also has an annual deductible, and
after that, you will typically pay 20% of
the cost for most services, such as
doctor visits and outpatient care.
Late Enrollment Penalty (LEP): If you
don’t sign up for Part B when you’re
first eligible and don’t qualify for a
Special Enrollment Period, you may
face a Late Enrollment Penalty
(LEP). This penalty is 10% of your
premium for each 12-month period you
delay enrollment.
Medicare Advantage (Part C)
●
Premium: Medicare Advantage plans
are offered by private insurers and can
have an additional monthly premium
on top of the Part B premium. The cost
of the premium will depend on the
specific plan you choose.
● Costs : Medicare Advantage plans
often include additional benefits, such

as dental or vision coverage, and may
have varying deductibles, coinsurance,
a n d o u t - o f - p o c k e t m a x i m u m s
depending on the plan.
Medicare Part D (Prescription Drug Coverage)
● Premium : Part D plans are offered
through private insurance companies,
and the premiums vary depending on
the plan you choose. The national
average monthly premium in 2025 is
around $33.19, but it can be higher or
lower depending on the plan. Higherincome
individuals will also be subject
to IRMAA, which applies to Part D
premiums as well.
● Late Enrollment Penalty (LEP) : If
you don’t enroll in Part D when you’re
first eligible and don’t have other
creditable prescription drug coverage,
you may be charged a Late
● Enrollment Penalty (LEP). This
penalty is 1% of the national base
beneficiary premium for each month
you delay enrollment.

Step 1: Enrolling in Medicare
Part A and Part B
Enrolling in Medicare Part A and Part B is the
first step in getting started with Medicare. In
this chapter, we will walk you through the
enrollment process, including the different
enrollment periods, the information you will
need to provide, and the ways you can enroll.
We will also provide useful websites and
phone numbers to help you navigate the
enrollment process.
Section 1: Enrollment Periods
There are several enrollment periods for
Medicare, each with its own rules and
deadlines. These enrollment periods include:
●
Initial Enrollment Period (IEP): This is the
seven-month period that begins three
months before the month of your 65 th
birthday and ends three months after the
month of your 65 th birthday. If you are
eligible for Medicare because of a
disability, your IEP will begin three

months before your 25 th month of
receiving disability benefits and end three
months after your 25 th month of receiving
disability benefits.
●
●
General Enrollment Period (GEP): If you
missed your IEP, you can enroll in
Medicare Part A and/or Part B during the
GEP, which runs from January 1 to March
31 each year. However, you may have to
pay a late enrollment penalty. This is also
known as Open Enrollment Period
(OEP).
Special Enrollment Period (SEP): If you
have certain life events, such as losing
your employer-sponsored health
coverage or moving to a new area, you
may qualify for a SEP that allows you to
enroll in Medicare outside of the standard
enrollment periods.
Note: Moving to a new area only qualifies for
a SEP if you're enrolling in a Medicare
Advantage Plan (MAPD) or Part D
Prescription Drug Plan (PDP). It does not
apply to Part A or Part B enrollment.

For additional information on SEPs for Part A
and Part B, you can refer to Medicare.gov
SEP page.
Section 2: Information Needed to Enroll
To enroll in Medicare, you will need to provide
some basic information about yourself,
including your name, Social Security number,
date of birth, and information about your
current healthcare coverage. If you are
enrolling in Medicare Part B, you may also
need to provide information about your
employment or union coverage, if applicable.
Section 3: Ways to Enroll
There are several ways to enroll in Medicare,
including:
●
Online: You can enroll in Medicare Part A
and/or Part B online at the Social
Security Administration (SSA) website.
(www.ssa.gov/medicare). If you are
already receiving Social Security or
Railroad Retirement benefits, you will be
automatically enrolled in Medicare Part A

and Part B, and you will receive your
Medicare card in the mail.
●
●
By phone: You can call the SSA at
1-800-772-1213 (TTY: 1-800-325-0778)
to enroll in Medicare Part A and/or Part B.
Representatives are available Monday
through Friday from 7 a.m. to 7 p.m. local
time, based on your time zone.
In person: You can visit your local Social
Security office to enroll in Medicare Part
A and/or Medicare Part B. To find your
nearest office, visit www.ssa.gov/locator.
SCAN HERE
appointment.
to connect or set up an

Enrolling in Medicare Part A and/or Part B is
an important first step in getting started with
Medicare. In this chapter, we walked you
through the enrollment process, including the
different enrollment periods, the information
you will need to provide, and the ways you
can enroll. We also provided useful websites
and phone numbers to help you navigate the
enrollment process.
Step 2: Choosing Between
Original Medicare and Medicare
Advantage
Medicare Coverage Options
Medicare provides multiple coverage options,
and choosing the right one depends on your
healthcare needs, budget, and preferences.
Below, we will outline the key components of
Medicare and the three primary ways to
receive coverage.
Understanding Medicare Parts and Coverage
Options
● Medicare Part A (Hospital Insurance) :
Covers inpatient hospital stays, skilled

nursing facility care, hospice, and
some home health care.
● Medicare Part B (Medical Insurance)
: Covers outpatient care, doctor visits,
preventive services, and medical
equipment.
● Medicare Part D (Prescription Drug
Plan - PDP) : Provides prescription
drug coverage, which can be added to
Original Medicare or a Medigap plan.
● Medicare Advantage (Part C -
MAPD) : A private insurance plan that
includes Part A, Part B, and often Part
D coverage, along with additional
benefits.
● Medicare Supplement (Medigap) :
Private insurance that helps cover
costs not paid by Original Medicare,
such as copayments, coinsurance,
and deductibles.
Choosing Your Medicare Coverage
There are three main ways to structure your
Medicare coverage:
Option 1: Original Medicare (Part A & Part B) +
PDP

●
●
●
Coverage: Basic hospital and medical
i n s u r a n c e , p l u s o p t i o n a l d r u g
coverage.
Costs:
○ Part A: Usually no premium if
○
you’ve worked 40 quarters.
Part B: Monthly premium (varies
by income).
○ Part D: Additional monthly
premium and potential copays/
deductibles.
Considerations:
○ No cap on out-of-pocket costs.
○ You can see any doctor that
accepts Medicare.
○ May have high out-of-pocket
costs without supplemental
insurance.
Option 2: Original Medicare (Part A & Part B) +
Medigap + PDP
●
●
Coverage : Basic hospital and medical
i n s u r a n c e , p l u s s u p p l e m e n t a l
coverage to reduce out-of-pocket
costs and an optional drug plan.
Costs:
○ Part A & B premiums.

●
○ Medigap policy premium (varies
by plan and provider).
○ Part D premium and drug costs.
Considerations:
○ Greater predictability in costs.
○ No network restrictions; can see
any provider that accepts
Medicare.
○ Higher monthly premiums but
lower out-of-pocket expenses.
Option 3: Medicare Advantage (MAPD)
● Coverage: Combines Part A, Part B,
and usually Part D into a single plan
managed by a private insurer. Often
includes extra benefits like vision,
dental, and wellness programs.
● Costs:
○ Must continue paying Part B
premium.
○ Additional monthly premium
(varies by plan).
○ Copayments and coinsurance for
services.
● Considerations:

○
○
○
Generally lower premiums than
Medigap but higher out-ofpocket
costs.
Requires using network doctors
and hospitals.
May include additional benefits
beyond Original Medicare.
How to Decide Which Coverage Option
is Best for You
Your choice should be based on the following
factors:
●
●
●
Doctor and Hospital Preferences: Do
you want the freedom to see any
provider, or are you comfortable with a
network?
Prescription Drug Needs: Are your
medications covered by your plan’s
formulary?
Budget: Can you afford higher monthly
premiums for lower out-of-pocket
costs, or do you prefer lower
premiums with potential higher costs
when you use services?

●
Travel: Do you travel frequently and
need nationwide or international
coverage?
By understanding these options and
evaluating your healthcare priorities, you can
choose the Medicare plan that best suits your
needs.
Section 1: Medicare Part A (Hospital
Insurance)
Medicare Part A helps cover inpatient hospital
stays, skilled nursing care, hospice care, and
some home health services. Here are some
details to consider:
●
●
Premium: Most people do not pay a
monthly premium for Part A if they or
their spouse have paid Medicare taxes
for at least 40 quarters (10 years). If
you do not meet this requirement, you
may pay a premium.
Deductibles and Coinsurance: Part A
has deductibles for inpatient hospital
stays, and you may also need to pay
coinsurance for extended stays in a
hospital or skilled nursing facility.

Section 2: Medicare Part B (Medical
Insurance)
Medicare Part B covers outpatient services,
such as doctor visits, preventive care, and
medical equipment. Here's what you need to
know:
● Premium: Part B has a standard
premium that is based on your income.
For 2025, the standard premium is
$185 per month, but high-income
individuals may pay more due to
IRMAA (Income-Related Monthly
Adjustment Amount). This part B
changes every year.
● Deductibles and Coinsurance: Part B
has an annual deductible, and after
meeting the deductible, you typically
pay 20% of the cost for most services,
such as doctor visits and outpatient
care.
Section 3: Medicare Advantage (Part C)
Medicare Advantage plans are offered by
private insurance companies approved by
Medicare. These plans provide all the
benefits of Original Medicare (Parts A and B),

and may also offer additional coverage, such
as prescription drugs (Part D), vision, and
dental care.
● Premium: Medicare Advantage plans
may have an additional monthly
premium on top of the Part B premium.
The cost of the premium depends on
the plan you choose.
● Costs: Medicare Advantage plans
have varying deductibles, coinsurance,
and out-of-pocket limits, which can
differ depending on the plan.
Section 4: Medicare Part D (Prescription
Drug Coverage)
Medicare Part D helps cover the cost of
prescription drugs. It is offered through
private insurance companies, and the
premiums vary depending on the plan you
choose.
● Premium: The average national
premium for Part D in 2025 is about
$33.19 per month, but premiums can
vary by plan and income.

● Late Enrollment Penalty (LEP): If
you don’t enroll in Part D when you are
first eligible and do not have creditable
prescription drug coverage, you may
have to pay a Late Enrollment Penalty
(LEP).
M e d i c a r e S u p p l e m e n t I n s u r a n c e
(Medigap)
Medigap plans are additional policies you can
purchase to help pay for some of the costs
not covered by Original Medicare, such as
copayments, coinsurance, and deductibles.
These plans are sold by private insurance
companies.
● Premium: Medigap plans have their
own monthly premium, in addition to
the Part B premium.
● Benefits: Medigap plans help cover
the out-of-pocket costs associated with
Original Medicare and may provide
additional benefits, such
as travel emergency
coverage.

Section 2: What is Medicare Advantage
(Part C)?
Medicare Advantage, also known as
Medicare Part C, is an alternative to Original
Medicare offered by private insurance
companies. These plans must offer at least
the same benefits as Original Medicare but
may also offer additional benefits, such as
prescription drug coverage, vision, dental and
hearing benefits.
Section 3: How to Choose Between
Original Medicare and Medicare
Advantage
Choosing between Original Medicare and
Medicare Advantage can be a challenging
decision. Here are some key factors to
consider:
●
Cost: Medicare Advantage plans often
have lower premiums than Original
Medicare, but you may pay more outof-pocket
costs when you use
healthcare services. Original Medicare
typically has higher monthly premiums,

but your out-of-pocket costs may be
lower for routine services.
○ Medicare Advantage (MAPD)
Plans generally include Part A,
Part B, and sometimes Part D
coverage, all bundled into one
p l a n . W h i l e t h e m o n t h l y
premium may be lower, these
plans often have higher costsharing
requirements (such as
copayments, coinsurance, and
deductibles). However,
Medicare Advantage plans
come with an annual
maximum out-of-pocket limit
(MOOP), which caps the
amount you will have to pay for
covered services in a given
year. Once you reach that cap,
the plan covers 100% of the
costs for covered services.
○ Original Medicare (Part A and
Part B) does not have a MOOP.
You will have to pay 20% of the
Medicare-approved amount for
most Part B services after
meeting your deductible, and
there is no cap on how much

●
●
you will pay out-of-pocket for
those services. For Medicare
Part A, there are deductibles
and coinsurance for inpatient
stays, but no annual out-ofpocket
limit either.
Out-of-Pocket Costs: With Original
Medicare, you are responsible for a
portion of the cost of services (such as
the 20% coinsurance for Part B
services) and you may need to
purchase a Medigap plan to help
cover these costs. On the other hand,
Medicare Advantage plans often offer
more predictable out-of-pocket costs
with copayments or coinsurance for
various services. These plans also
tend to have lower or zero premiums,
but higher costs for certain services
depending on the plan structure.
Additional Benefits:
○
Medicare Advantage (MAPD)
often includes benefits not
covered by Original Medicare,
s u c h a s dental, vision,
hearing care, wellness
programs, and sometimes

●
●
prescription drug coverage
(Part D).
○ Original Medicare does not
cover these benefits, so you
would need to purchase a
separate Part D plan and
possibly a Medigap policy.
Travel: If you travel frequently within
the continental U.S., Original Medicare
may be a better choice, as it allows
you to see any healthcare provider
who accepts Medicare. Medicare
Advantage plans may limit your
coverage outside of your service area.
Chronic conditions: If you have a
chronic condition, such as diabetes or
heart disease, you may benefit from a
Medicare Advantage plan that offers
additional care management and
coordination of care services.
Section 4: Useful Websites and Phone
Numbers
Here are some useful websites and phone
numbers to help you choose between
Original Medicare and Medicare Advantage:

● Medicare: www.medicare.gov; 1-800-
MEDICARE (1-800-6334227) (TTY:
1-877-486-2048)
● State Health Insurance Assistance
Program (SHIP): www.shiptacenter.org;
1-800-633-4227
● Medicare Rights Center:
www.medicarerights.org; 1-800-333-4114
● National Council on Aging: www.ncoa.org;
1-800-677-1116
Choosing between Original Medicare and
Medicare Advantage can be a difficult
decision, but understanding these factors to
consider can help you make an informed
choice. By using the resources provided in
this chapter, you can compare the costs and
benefits of each option and choose the plan
that best meets your healthcare needs and
budget.

Step 3: Adding Prescription
Drug Coverage with Medicare Part D
Section 1: What is Medicare Part D?
Medicare drug coverage (also known as
Medicare Part D) helps pay for the brandname
and generic drugs you need. It's
optional and offered to everyone with
Medicare by insurance companies and other
private companies approved by Medicare.
Even if you don’t take prescription drugs now,
consider getting Medicare drug coverage to
avoid paying a late enrollment penalty if you
join a plan later
Section 2: Understanding Medicare Part D
Coverage and Costs
Medicare Part D plans vary in terms of the
prescription drugs they cover, the costs of
those drugs, and the monthly premiums and
deductibles you must pay. When comparing
plans, consider the following:
●
Formulary: A list of drugs covered by the
plan. Check to see if the drugs you take

are covered and if there are any
restrictions or limitations
● Premium: The monthly cost of the plan.
Plans with lower premiums may have
higher out-of-pocket costs, such as
copayments or coinsurance.
● Deductible: The amount you must pay
out-of-pocket before the plan begins
covering your prescription drugs. Some
plans have no deductible, while others
may have deductibles of up to $445.
● Copayment or coinsurance: The amount
you pay for each prescription drug.
Copayments are a fixed dollar amount,
while coinsurance is a percentage of the
drug’s cost. Some plans may offer $0
copayments for certain drugs.
● Catastrophic coverage: Once you reach a
certain out-of-pocket limit, you will pay
only a small copayment or coinsurance
for the remainder of the year.
Enrolling in Medicare Part D can help you
save money on your prescription drug costs.
By using the resources provided in this
chapter, you can compare the costs and
coverage of different plans and choose one
that best meets your healthcare needs and

budget. Don’t forget to enroll during your
Initial Enrollment Period (IEP) or Annual
Enrollment Period (AEP), and seek help from
a Medicare-approved insurance agent or
representative if you need it.
Understanding Your Prescription Drug
Coverage Stages
Prescription drug plans have different stages
that affect how much you pay for your
medications. Here’s a simple breakdown:
1. Deductible Stage
○ At the start of the year, you may
have to pay the full cost of your
medications until you reach
your plan’s deductible amount.
Some plans cover certain drugs
right away, even before you
meet the deductible. Reaching
the $2000 Max out of pocket.
2. Initial Coverage Stage
○ Once you meet your deductible,
your insurance helps pay for
your prescriptions. You will pay
a set amount (copayment) or a
percentage of the cost

(coinsurance) until your total
drug costs reach a certain limit.
3. Catastrophic Coverage Stage
○
If your out-of-pocket drug costs
reach a high amount, you enter
this stage. You will then pay
only a small amount for your
medications for the rest of the
year.
Section 3: How to Enroll in Medicare
Part D
You can enroll in Medicare Part D during your
Initial Enrollment Period (IEP) when you first
become eligible for Medicare, or during the
Annual Enrollment Period (AEP) from
October 15 to December 7 each year. You
can also enroll during a Special Enrollment
Period (SEP) if you have a qualifying event,
such as losing your current prescription drug
coverage.
To Enroll in Medicare Part D, you can:
●
Visit the Medicare website at
www.medicare.gov and use the Plan

Finder tool to compare plans in your
area.
● Call 1-800-MEDICARE (1-800-633-5227)
to speak with a representative who can
help you enroll over the phone.
● Contact a Medicare-approved insurance
agent or broker in your area who can
help you enroll.
S
tep 4: Understanding
Medicare Supplement Insurance
(Medigap)
Section 1: W h a t i s M e d i c a r e
SupplementInsurance (Medigap)?
Medicare Supplement Insurance, also known
as Medigap, is a type of private insurance
that helps cover out-of-pocket costs that
Original Medicare does not, such as
deductibles, copayments, and coinsurance.
Medigap policies work with Original
Medicare, meaning Medicare pays first, and
then your Medigap policy pays second to
help cover remaining costs.

Section 2: When to Buy a Medigap Policy
The best time to buy a Medigap policy is
during your Medigap Open Enrollment Period
(OEP). This is a six-month period that begins
on the first day of the month you are both 65
or older and enrolled in Medicare Part B.
During this time, you have Guaranteed Issue
(GI) rights, meaning:
● Insurance companies cannot deny you
coverage.
● You cannot be charged higher
premiums due to your health status or
pre-existing conditions.
If you miss your Medigap Open Enrollment
Period:
●
●
You can still apply for a Medigap policy
at any time.
However, insurance companies may
require medical underwriting, meaning
they can review your health history,
charge you higher premiums, or deny
coverage based on pre-existing
conditions.

Since Guaranteed Issue rights only apply
during this six-month window, it’s important to
enroll early to secure the most options and
the lowest possible premiums.
Section 3: Understanding Medigap
Coverage and Costs
Medigap policies are standardized by the
federal government, meaning each plan
offers the same benefits, regardless of the
insurance company selling it. There are 10
standardized Medigap plans, labeled Plan A
through Plan N, each offering different levels
of coverage.
However, three states—Massachusetts,
Minnesota, and Wisconsin—have different
Medigap plan structures, so coverage options
may vary if you live in one of these states.
When comparing Medigap plans, consider:
● Monthly Premium: The amount you
pay each month for the policy.
● Deductible: The amount you must
pay out of pocket before the policy
begins covering costs.

● Copayment or Coinsurance: The
portion you pay for each medical
service or treatment.
● Foreign Travel Emergency Coverage:
Some Medigap plans offer coverage
for medical emergencies outside the
U.S.
By understanding your Medigap options and
enrolling at the right time, you can avoid
higher costs and ensure comprehensive
coverage alongside your Medicare benefits.
Section 4: Useful Websites and Phone
Numbers
Here are some useful websites and phone
numbers to help you understand Medigap
coverage and costs:
● State Health Insurance Assistance
Program (SHIP): www.shiptacenter.org;
1-800-633-4227
● National Association of Insurance
Commissioners: www.naic.org;
1-816-783-8300

Section 5: Understanding the Difference
Between Medigap and Medicare
Advantage
Medigap and Medicare Advantage are two
different types of insurance that help cover
healthcare costs, but they work in very
different ways.
● Medigap (Medicare Supplement)
policies work with Original Medicare.
They help cover out-of-pocket costs
like copayments, coinsurance, and
deductibles. You must have both
Medicare Part A and Part B to buy a
Medigap plan, and you’ll continue
paying your Part B premium.
● Medicare Advantage (MAPD) plans are
an alternative to Original Medicare and
are offered by private insurance
companies. These plans replace
Original Medicare and often include
additional benefits like vision, dental,
and prescription drug coverage. If you
enroll in an MAPD plan, you must
keep both Medicare Parts A and B and
continue paying your Part B premium.

When deciding between Medigap and
Medicare Advantage, consider the following:
● Cost: Medigap policies generally have
higher monthly premiums but lower outof-pocket
costs, while Medicare
Advantage plans may have lower
monthly premiums but higher out-ofpocket
costs.
● Flexibility. Medigap policies allow you to
see any healthcare provider that accepts
Medicare, while Medicare Advantage
plans often require you to use a network
of providers.
● Prescription drug coverage: Medigap
policies do not include prescription drug
coverage, while Medicare Advantage
plans may include prescription drug
coverage.
Medigap can be a valuable insurance policy
for those who want to reduce their out-ofpocket
costs and maintain flexibility in
choosing their healthcare providers. By using
the resources provided in this chapter, you
can compare plan options and costs to find
the best coverage for your needs.

Conclusion: Making the Most of Your
Medicare Coverage
Section 1: Understanding Medicare
Coverage
Understanding the basics of Medicare
coverage is essential to maximizing the
benefits you receive. Medicare is divided into
several parts, including Part A, Part B, Part C
(Medicare Advantage) and Part D. Each part
covers different healthcare services and
costs.
● Part A: Covers hospital stays, skilled
nursing care, hospice care, and home
health care.
● Part B: Covers doctor visits, outpatient
care, preventive services, and medical
equipment.
● Part C: Also known as Medicare
Advantage, is an alternative to Original
Medicare and includes Parts A and B,
and sometimes Part D, with additional
benefits.
● Part D: Covers prescription drugs.

It is important to understand what is covered
under each part of Medicare to ensure that
you are taking advantage of all available
benefits.
Section 2: Understanding Your Costs
Understanding your healthcare costs under
Medicare is essential to budgeting and
planning for medical expenses. In addition to
monthly premiums for Medicare Part B and
Part D, you may also have copayments,
coinsurance, and deductibles.
To understand your costs, it is important to
review your Medicare Summary Notice
(MSN) regularly and keep track of your outof-pocket
expenses. You can also use
Medicare’s online cost estimator tool to
estimate your healthcare costs for the
upcoming year.

Section 3: Useful Websites and Phone
Numbers
Here are some useful websites and phone
numbers to help you make the most of your
Medicare coverage.
● Medicare: www.medicare.gov; 1-800-
MEDICARE (1-800-6334227) (TTY:
1-877-486-2048)
●
State Health Insurance Assistance
Program (SHIP): www.shiptacenter.org;
1-800-633-4227
● Social Security Administration (SSA) :
www.ssa.gov/medicare; 1-800-772-1213
(TTY: 1-800-325-0778)
Making the most of your Medicare coverage
requires understanding the available benefits
and taking advantage of preventive services,
m a n a g i n g y o u r p r e s c r i p t i o n s , a n d
understanding your costs. By using the
resources provided in this chapter, you can
make informed decisions and ensure that you
are receiving the healthcare you
need at a reasonable cost.
Let’s Get Started!

NOW FOLLOW THESE EASY STEPS or
SCAN the barcode and have us help you get
started on the process. We are here for you.
Steps to Enroll in Medicare
Step 1: Sign Up for Medicare
You have a 7-month window to sign up for
Medicare:
●
●
●
3 months before your 65th birthday
The month of your 65th birthday
Up to 3 months after your 65th birthday
To enroll, visit ssa.gov and click on "Sign up
for Medicare." Be sure to write down your
login details for future reference, and store
them in a safe and secure place to protect
your personal information.
Username: ______________________
Email: __________________________
Code: __________________________
Password: ______________________

Step 2: Get Your Medicare Number & Card
Once you’ve signed up, you will receive your
Medicare Beneficiary Identifier (MBI) number
and Medicare card in the mail, usually within
3 weeks. Watch for a letter from the
Department of Health and Human Services,
and keep your Medicare card in a safe place
to prevent loss or identity theft.
Step 3: Explore Coverage Options
Now that you’re enrolled in Medicare, decide
whether Original Medicare (Parts A & B) is
enough for your needs or if you want
additional coverage. Consider:
● Medicare Advantage (Part C) – An
alternative to Original Medicare that
often includes extra benefits.
● Medigap (Medicare Supplement) –
Helps cover out-of-pocket costs in
Original Medicare.
● Prescription Drug Plans (Part D) – If
you stay with Original Medicare, you
may need a separate Part D plan for
medications.
Step 4: Choose & Enroll in a Plan

If you decide to add a Medicare Advantage,
Medigap, or Part D plan, compare your
options and enroll during your initial
enrollment period. You can research and sign
up through Medicare.gov or directly with an
insurance provider.
Let’s discuss group insurance and credible
coverage when starting with Medicare.
When you first become eligible for Medicare,
you may already have health insurance
through a group plan from your employer or
your spouse’s employer. This is known as
group insurance or group health coverage.
If you have group insurance, you may have
what’s called “creditable coverage.” This
means that your current insurance is
expected to pay, on average, as much as the
standard Medicare prescription drug
coverage. If you have creditable coverage,
you can delay enrolling in Medicare Part D
without facing a late enrollment penalty if you
enroll in Part D later.
It’s important to note that if you don’t have
creditable coverage and you don’t enroll in

Medicare Part D when you’re first eligible,
you may face a penalty if you enroll later. So,
it’s essential to understand your current
coverage and whether it’s creditable before
making any decisions about enrolling in
Medicare.
Empowering Your Retirement
In this final chapter, we want to
emphasize the crucial role we play in
empowering you for your retirement years.
With our comprehensive knowledge and
expertise in Medicare Advantage, Medigap,
and Part D plans, we are here to guide and
support you every step of the way. As your
trusted advisors and advocates, we prioritize
your peace of mind and strive to ensure that
you have the best possible coverage for your
healthcare needs.
We understand that retirement can be a
complex and overwhelming time, especially
when it comes to navigating healthcare
options. That’s why we are committed to
building strong relationships with our clients
by providing accessibility, education, and
personalized support. Our goal is to make

you feel heard, understood, and empowered
throughout your Medicare journey.
By choosing us as your trusted advisors, you
can rest assured that we will keep you
informed about any changes or new plans
during the Annual Enrollment Period (AEP).
We conduct proactive plan reviews in late
September, allowing you to make wellinformed
decisions without feeling rushed.
Our focus is on maximizing the benefits
available to you and helping you make
choices that align with your unique healthcare
needs.
Retirement is a time for relaxation and
enjoyment, and we want to ensure your
healthcare needs are met so you can focus
on what matters most. Retirement is a time
for relaxation and enjoyment, and we want to
ensure your healthcare needs are met so you
can focus on what matters most. With our
guidance, advocacy, and commitment to
exceptional service, we aim to empower you
for a fulfilling, worry-free retirement. Trust us
to be your dedicated partners as we work.
together to create a brighter future for your
well-being.

About the Author
Our commitment to your health
Introducing Hope Suhr, CEO of Elpis
Insurance Services and your go-to resource
for insurance expertise. Hope is a secondgeneration
insurance agent.
With a passion for helping families and
businesses, Hope is known as “Hope the
Medicare Lady” and has built a reputation for

understanding the ins-and-outs of insurance
solutions.
From a young age, Hope was inspired by her
entrepreneurial family and their unwavering
work ethic. Now a second generation
licensed agent, she continues their legacy in
providing custom-tailored policies that ensure
the highest level of protection for you and
your loved ones.
With her extensive knowledge and access to
a wide range of insurance carriers, Hope is
equipped to guide you through the maze of
health insurance, Medicare, and other
insurance options.
But she doesn’t stop there! Hope’s
commitment extends beyond insurance. As
an owner of additional small businesses, she
has been recognized by the Small Business
Administration (SBA) as the Women in
Business Champion of the Year. Her
dedication to empowering others also led her
to establish a nonprofit organization
supporting local women entrepreneurs.
Hope’s dedication to empowering others led
her to establish the Women’s Business

R e s o u r c e s C o n n e c t i o n , a n o n p r o fi t
organization supporting local women
entrepreneurs.
Whether you need assistance with insurance,
financial planning, or navigating the
complexities of business solutions, Hope is
your trusted advisor.
Discover the peace of mind that comes from
working with a knowledgeable and caring
professional. Contact Hope at (714)
797-9996 for a NO-COST consultation, and
let’s protect your business, family, and assets
together!
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