How Do I Apply for Medicare?

by | Oct 9, 2025 | Medicare Advantage, Medicare Supplement, Original Medicare, Prescription Drug Coverage, Rules & Enrollment

Understanding the Medicare Application Process

Enrolling in Medicare is a major milestone in your healthcare journey, but it doesn’t have to be confusing. Whether you’re approaching age 65 or qualifying earlier due to disability, knowing when and how to apply ensures you avoid gaps in coverage or penalties. Here’s a step-by-step guide to applying for Medicare with confidence.

Eligibility: Who Can Apply for Medicare

You are generally eligible for Medicare if:

  • You’re 65 or older, and either a U.S. citizen or a permanent resident who’s lived in the U.S. for at least five years.

  • You’re under 65, but have received Social Security Disability Insurance (SSDI) for 24 months.

  • You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease).

If you’re already receiving Social Security benefits, you’ll be enrolled automatically in Medicare Parts A and B. Otherwise, you’ll need to apply manually through the Social Security Administration.

How to Apply for Medicare Parts A & B (Original Medicare)

You can apply for Original Medicare in one of three ways:

Online: Visit SSA.gov/Medicare

By Phone: Call Social Security at 1-800-772-1213.

In Person: Visit your local Social Security office.

  • Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing, and hospice care.

  • Part B (Medical Insurance) covers doctor visits, preventive care, outpatient services, and durable medical equipment.

If you’re still working and covered under employer insurance, you may choose to delay Part B to avoid paying unnecessary premiums—but it’s important to confirm this with your HR department or a licensed Medicare advisor before making that decision.

Applying for Medicare Advantage (MAPD) Plans

After enrolling in Parts A and B, you may decide to choose a Medicare Advantage Plan (Part C) instead of using Original Medicare as your primary insurance. These plans are offered by private insurance companies and often include additional benefits such as:

  • Bundled Prescription drug coverage

  • Additional dental, vision, and/or hearing benefits

  • Wellness programs and gym memberships

Enrollment in a Medicare Advantage Plan is handled through the private insurer offering the plan, not through Medicare directly. The benefit of using a brokerage (like Emerald Medicare) to enroll in a MAPD plan is they will usually handle the enrollment & application process on your behalf, acting as the middleman between you and your insurance provider.

Medigap (Medicare Supplement) Plans

If you prefer to stay with Original Medicare, you can add a Medigap policy to help pay for costs that Parts A and B don’t cover—such as deductibles, coinsurance, and copayments.

  • You must have both Parts A and B to buy a Medigap plan.

  • Depending on your home state, you may or may not have to go through medical underwriting and wait for approval.

Just like with a Medicare Advantage (MAPD) Plan, the best & easiest way to enroll in a Medigap plan is to reach out to your Medicare broker, who will advise you on the coverage options available in your zip code. Otherwise, you can reach out to the carriers directly to get prices and/or compare options, and even enroll directly with the carrier by reaching out to their customer service and/or new enrollment department. 

Prescription Drug Plans (PDP – Part D)

If you choose Original Medicare (if you do NOT choose an MAPD plan) you’ll likely also need a standalone Part D prescription drug plan.

  • These plans are also available through private insurance companies.

  • Enrollment is typically completed via Medicare.gov or directly through the plan’s website.

  • Make sure to review each plan’s formulary (drug list) to ensure your prescriptions are covered affordably.

With Emerald Medicare, once you enroll in Original Medicare (Parts A/B), we walk you through all your coverage options and thoroughly explain how these options differ. We also handle your enrollment application(s) along with reviewing your list of Medications & Doctors to make sure there are no gaps in your coverage. 

Get Guidance from the Medicare Experts

Applying for Medicare doesn’t have to be stressful. At Emerald Medicare, our licensed experts can walk you through every step—from choosing Parts A and B to comparing Supplement, Advantage, and Part D options personalized to your needs.

Start your Medicare journey confidently—contact Emerald Medicare today!

(888) 683-6372 or (845) 358-1220

info@emeraldmedicare.com

Medicare HMOs vs. PPOs

by | Oct 2, 2025 | Medicare Advantage

Which Plan is Right for You?

Choosing between a Medicare HMO (Health Maintenance Organization) and a Medicare PPO (Preferred Provider Organization) has always been about balancing cost with flexibility. But in today’s Medicare Advantage marketplace, the differences are becoming even more important. With Medicare plan changes in 2025 and shifting carrier strategies, it’s crucial to understand not only how these plans work but also how the landscape is evolving.

As your trusted Medicare resource, Emerald Medicare is here to break down what these plans really mean for you and why reviewing your options carefully each year matters more than ever.

The Basics: Medicare Provider Networks Explained

A provider network is simply the list of doctors, hospitals, and other healthcare providers that contract with a Medicare Advantage (MAPD) plan. These providers agree to accept the plan’s payment terms, which helps the plan effectively manage their costs. That’s why staying in-network almost always results in lower out-of-pocket expenses.

  • Medicare HMO Plans: Require you to use in-network providers for coverage (except emergencies). You typically need to choose a primary care provider (PCP) who coordinates your care and provides referrals for specialists. Costs are often lower, and some Medicare Advantage HMOs even offer $0 premiums.
  • Medicare PPO Plans: Allow you to see both in-network and out-of-network providers. You don’t need referrals for specialists, but premiums and deductibles are generally higher. Out-of-network visits can mean significantly higher costs.

Why Medicare PPOs Are Declining and HMOs Are Expanding

In recent years, many carriers have started phasing out or scaling back Medicare Advantage PPO options. The reason is simple: PPOs are more expensive for insurance companies to maintain, and those costs are increasingly difficult to manage. By contrast, Medicare HMOs allow insurers to better control costs because care is funneled through networks and coordinated by primary care providers. This model has become more profitable and more sustainable for insurers — and as a result, HMOs are growing in availability.

For beneficiaries, this means you’ll likely see more HMO Medicare Advantage plans in 2025, while PPOs may become less common or come with higher premiums to reflect the added flexibility.

The Impact of the Inflation Reduction Act on Medicare Plans

Starting in 2025, the Inflation Reduction Act introduces a $2,000 annual cap on out-of-pocket prescription drug costs. This change applies across Medicare Advantage plans, including both HMOs and PPOs. It’s a huge win for consumers, helping protect retirees from unpredictable, sky-high pharmacy bills.

The law also allows Medicare to negotiate prices for certain high-cost drugs, which may help reduce overall costs in the system. This could benefit enrollees across both HMO and PPO plan types, though the exact impact will vary by medication and carrier.

Hidden Medicare Plan Changes to Watch For

Beyond these big themes, there are subtle changes that consumers often overlook. Carriers aren’t just restructuring plans; some are also reducing broker compensation or shifting benefits in ways that may not be obvious.

For example, one Medicare Advantage plan in 2025 may advertise new perks like food cards or fitness memberships, while at the same time quietly reducing dental, vision, or over-the-counter allowances. These trade-offs don’t always get highlighted in marketing materials, which is why reviewing the Annual Notice of Change every fall is so important.

Choosing the Right Medicare Advantage Plan for 2026 & Beyond

When deciding between a Medicare HMO vs. PPO, ask yourself:

  • Do I want to keep my current doctors and specialists? Are they in-network on an HMO?
  • Am I comfortable coordinating my care through a primary care provider and getting referrals?
  • Would I rather pay a little more each month for the freedom to see providers outside the network?
  • How much do I rely on extra benefits like dental, vision, or over-the-counter allowances?

There’s no one-size-fits-all answer. The right plan is the one that best aligns with your health needs, financial priorities, and comfort level with provider restrictions.

Stay Ahead of Medicare Plan Changes With Emerald Medicare

At Emerald Medicare, our role is to help you see past the fine print, understand how these changes affect you personally, and ensure you’re in the plan that delivers the best value. Don’t assume your plan will look the same just because it has in the past. Even plans with the same name can change dramatically from year to year.

Click below to schedule an appointment with one of our Medicare Experts.

Or, Contact Us
📞 (888) 683-6372 or (845) 358-1220
📧 office@emeraldmedicare.com

Mark Brownstein, CSA® | Calendly

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Medicare Advantage Benefits: Vision and Hearing Coverage in 2025 and Beyond

by | Feb 19, 2025 | Medicare Advantage, Medicare Benefits

Vision and hearing care are vital for maintaining independence, social confidence, and overall health as we age. While these benefits are often taken for granted during working years with employer-provided coverage, transitioning to Medicare requires careful evaluation of available plans to ensure your needs are met. We’re here to help you navigate the changing landscape of Medicare Advantage benefits, and today we’ll turn our attention to vision and hearing care.

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Medigap vs. Medicare Advantage: What You Need to Know

Original Medicare doesn’t provide coverage for routine vision exams or hearing aids, though it does cover certain specialist visits, including audiology, optometry, and ophthalmology.

In contrast, Medicare Advantage (Part C) plans have increasingly expanded their vision and hearing benefits to address these gaps. 

As Medicare Advantage plans continue to evolve, they are enhancing their offerings in vision and hearing care, providing more comprehensive coverage for beneficiaries. Let’s take a closer look at what’s changing for 2025 and how you can make the most of your benefits.

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Expanding Vision and Hearing Coverage in 2025

In 2025, Medicare Advantage plans will further standardize and improve their vision and hearing benefits. These updates aim to enhance access to care while potentially lowering out-of-pocket costs for beneficiaries.

  • Vision Care Enhancements: Plans are expanding allowances for prescription glasses and contact lenses, as well as covering a broader range of vision services.
  • Hearing Aid Benefits: New standalone hearing aid benefits will introduce increasing annual allowances, ensuring beneficiaries can access financial support as their needs evolve:
    • Year 1: $500
    • Year 2: $1,000
    • Year 3: $1,500

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Vision Coverage: What’s Included?

Medicare Advantage plans are designed to address the vision care needs of beneficiaries, offering benefits that often include:

  • Routine Eye Exams: Most plans cover annual eye exams, essential for monitoring eye health and updating prescriptions, at no additional cost when using in-network providers.
  • Prescription Glasses and Contacts: Many plans offer allowances for eyeglasses or contact lenses, making vision correction more affordable.
  • Corrective Eye Surgeries: Some plans provide partial coverage for procedures like cataract surgery or LASIK, helping beneficiaries manage costs for these often-expensive treatments.
  • Specialized Vision Devices: Coverage may also include adaptive devices, such as magnifiers, for those with specific vision needs.

Hearing Coverage: What’s Included?

Hearing care is another critical area of focus for Medicare Advantage plans. Here’s what beneficiaries can expect:

  • Annual Hearing Exams: Covered by most plans to help identify hearing issues early and provide timely support.
  • Hearing Aids and Fittings: Many plans cover the cost of hearing aids, including fittings and adjustments, ensuring the right fit and optimal assistance.
  • Standalone Hearing Aid Benefits: As mentioned, these new benefits offer increasing allowances, helping beneficiaries afford hearing aids over time.
  • Lower Out-of-Pocket Costs: By reducing copayments and coinsurance for hearing aids and related services, plans to make these essential devices more accessible.

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Maximizing Your Vision & Hearing Benefits

To make the most of your Medicare Advantage vision and hearing benefits, consider these tips:

  1. Schedule Preventive Exams Early: Ensure you use the fully covered annual eye and hearing exams provided by your plan.
  2. Check Allowances for Glasses and Hearing Aids: Understand your plan’s annual allowances and plan your purchases accordingly.
  3. Use In-Network Providers: Save on costs by staying within your plan’s provider network.
  4. Evaluate Your Plan During AEP: Use the Medicare Annual Enrollment Period to compare plans and switch to one that better fits your vision and hearing needs if necessary.

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Look Ahead to 2025 with Emerald Medicare

Medicare Advantage plans are continually enhancing their vision and hearing benefits, making them an attractive option for beneficiaries seeking comprehensive healthcare coverage. At Emerald Medicare, we’re here to guide you through these changes and ensure you find the best plan for your needs.

If you’re ready to explore your Medicare Advantage options, our team of expert advisors is here to help. Click below to schedule an appointment with one of our brokers through Calendly, or contact us directly at the number or email below.

Contact Us:

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

An Essential Guide for Medicare Advantage Plans

by | Feb 5, 2025 | Medicare Advantage, Rules & Enrollment

As your trusted Medicare experts, Emerald Medicare is committed to helping you navigate your healthcare options with ease. Medicare Advantage (Part C) plans are a popular choice among beneficiaries, offering comprehensive coverage with additional benefits not included in Original Medicare. If you’re considering Medicare Advantage, this guide will walk you through how these plans work, their benefits, and how to choose the best plan for your needs.

What is Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A & B) offered by private insurance companies approved by Medicare. These plans bundle hospital (Part A), medical (Part B), and prescription drug coverage (Part D) into one all-inclusive plan. Many also offer extra benefits like dental, vision, hearing, and even wellness programs—making them an attractive option for those seeking added value beyond traditional Medicare.

With Medicare Advantage, all healthcare services are managed through your plan’s network of doctors, hospitals, and pharmacies. While this structure helps control costs, it’s important to understand how provider networks function before enrolling, and how this may limit your options for medical care.

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What Do Medicare Advantage Plans Cover?

Unlike Original Medicare, which requires separate coverage for prescriptions (Part D) and supplemental benefits (Medigap), Medicare Advantage plans integrate multiple types of coverage into a single, bundled plan. Here’s what’s typically included:

Hospital Coverage (Part A) – Inpatient stays, skilled nursing facility care, and some home healthcare services.
Medical Coverage (Part B) – Doctor visits, outpatient services, diagnostic tests, preventive care, and durable medical equipment.
Prescription Drug Coverage (Part D) – Most Medicare Advantage plans include built-in drug coverage, covering a range of prescription medications.

 

Additional Benefits – Many Medicare Advantage plans also offer:

  • Dental Coverage (routine cleanings, fillings, dentures, etc.)
  • Vision Coverage (eye exams, glasses, and contacts)
  • Hearing Coverage (hearing exams and hearing aids)
  • Fitness Benefits (gym memberships, virtual exercise programs)
  • Transportation (rides to medical appointments)
  • Over-the-Counter (OTC) Allowances (stipends for medical supplies and everyday wellness products)

Because benefits vary by plan, it’s essential to compare options carefully or consult a Medicare expert to find the best fit for your healthcare needs.

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Why Should I Choose a Medicare Advantage Plan?

Medicare Advantage plans combine coverage, convenience, and cost savings into a single plan, making them a great option for many beneficiaries. Here’s why they appeal to millions of Medicare enrollees:

1. Comprehensive Coverage

Unlike Original Medicare, which requires additional plans for prescriptions and supplemental coverage, Medicare Advantage offers all-in-one protection with extra benefits.

2. Lower Out-of-Pocket Costs

Many Medicare Advantage plans have low or $0 monthly premiums, and they cap out-of-pocket expenses, protecting beneficiaries from excessive costs. In contrast, Original Medicare has no limit on annual medical expenses unless paired with a Medigap policy.

3. Extra Benefits Beyond Original Medicare

With dental, vision, hearing, and wellness perks, Medicare Advantage covers services not included in traditional Medicare, making healthcare more affordable and accessible.

4. Preventive Care & Care Coordination

Many Medicare Advantage plans focus on preventive care and managed healthcare, offering case management services, wellness incentives, and telehealth options for added convenience.

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Medicare Advantage vs. Medigap: Key Differences

Understanding the distinction between Medicare Advantage and Medigap (Medicare Supplement Insurance) is crucial when choosing a plan.

Feature Medicare Advantage (Part C) Medigap (Supplement)
Coverage Type Combines hospital, medical, and drug coverage Supplements Original Medicare, filling cost gaps
Network Limited to plan’s provider network (HMO/PPO) No network restrictions—see any provider nationwide who accepts Medicare
Premium Costs Often lower premiums, but may have higher copays/coinsurance Higher premiums but lower out-of-pocket costs
Out-of-Pocket Maximum Yes (protects against high medical bills) No limit on costs under Original Medicare
Extra Benefits Includes dental, vision, hearing, fitness, etc. No additional benefits beyond medical cost coverage
Prescription Drug Coverage Usually included (Part D) Requires separate Part D enrollment
Travel Coverage Limited outside your service area Nationwide and some foreign travel coverage

Medicare Advantage is best for those who prefer bundled coverage and lower upfront costs, while Medigap is ideal for those who want broad provider access and more predictable expenses.

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How to Choose the Right Medicare Advantage Plan

When selecting a Medicare Advantage plan, consider the following:

🔹 Provider Network: Does your preferred doctor, hospital, or pharmacy accept the plan? HMOs require referrals and network providers, while PPOs offer more flexibility.
🔹 Prescription Drug Coverage: Check the plan’s formulary (covered drug list) to ensure your medications are included.
🔹 Extra Benefits: Need dental or vision care? Want access to telehealth or home fitness programs? Compare added perks to find a plan that suits your lifestyle.
🔹 Out-of-Pocket Costs: Compare premiums, deductibles, copays, and maximum out-of-pocket (MOOP) limits to determine your total expected expenses for the year.
🔹 Star Ratings: Medicare.gov rates plans on a 5-star scale based on customer satisfaction and quality of care. A higher-rated plan often means better coverage and service review from real beneficiaries.

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How to Enroll in a Medicare Advantage Plan

You can enroll in a Medicare Advantage plan during specific enrollment periods:

📌 Initial Enrollment Period (IEP) 
Starts 3 months before you turn 65 and continues 3 months after your birthday month.
📌 Annual Enrollment Period (AEP) 
October 15th – December 7th each year. You can switch, join, or drop a Medicare Advantage plan.
📌 Medicare Advantage Open Enrollment Period
January 1st – March 31st each year. If you’re already enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare during this time.

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Explore Medicare Advantage with Emerald Medicare

Choosing a Medicare Advantage plan is an important decision that requires careful consideration of your healthcare needs, provider preferences, and financial situation. At Emerald Medicare, we’re dedicated to helping you find the best-fit plan with zero-cost expert guidance.

If you’re considering a Medicare Advantage plan or need help comparing options, we’re here for you! Click below to schedule an appointment with one of our expert brokers through Calendly or contact us directly:

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

 

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

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