How Medicare works, in plain words.
I'm Erick Vallarino, an insurance agent serving all of Texas, and I live and work here in the Valley. Medicare has four parts and a lot of mail. Here is how it fits together, the same way I explain it at the kitchen table. My help costs you nothing.
Each part of Medicare has its own job.
You'll see these letters on a lot of mail. Here is what each one is for.
Hospital
Part A helps pay when you are admitted to the hospital. It can also help with some care after a hospital stay, and with hospice.
Doctors and outpatient care
Part B helps pay for doctor visits, preventive care, lab tests and X-rays. Outpatient means the hospital did not admit you, even if you stayed the night.
Medicare Advantage
Part C is another way to get your Medicare, through a private company approved by Medicare. You still get everything Parts A and B cover, and most plans add extra benefits, like some dental, vision and hearing care, and more. Most also include drug coverage. How Medicare Advantage works
Prescription drugs
Part D helps pay for medicines from the pharmacy. You get it inside a Medicare Advantage plan, or as its own plan. Skipping it when you first qualify can mean a penalty later, so ask me first. How drug plans work
Turning 65?
Your window to sign up is 7 months long. I made a page just for you.
The four parts of Medicare
- Part A (Hospital): Helps cover inpatient hospital care.
- Part B (Doctors and outpatient care): Helps cover doctor visits, outpatient care and preventive services.
- Part C (Medicare Advantage): Another way to get your Medicare, through a private company approved by Medicare.
- Part D (Prescription drugs): Helps cover prescription medicines.
Medicare Advantage, or Original Medicare with a Supplement?
You get your Medicare one of two ways: through a Medicare Advantage plan, or through Original Medicare, which many people pair with a Medicare Supplement. Neither one is right for everybody.
| Topic | Medicare AdvantagePart C: one plan from a private company | Original Medicare with a SupplementParts A and B, plus a Medigap policy from a private company |
|---|---|---|
| What it is | Another way to get your Medicare, through a private company approved by Medicare. You still get everything Parts A and B cover, and most of your care goes through one plan, with one card. | Original Medicare, Part A and Part B, pays its share of your covered bills first. A Medicare Supplement (Medigap) is private insurance that helps pay your share of the costs for services Medicare covers, like deductibles, coinsurance and copays. |
| Doctors | Most plans have a network of doctors and hospitals. Some plans cover care outside the network, but it may cost more. You may need a referral to see a specialist, or the plan's OK before some care. | In general, any doctor or hospital in the U.S. that takes Medicare, with no network to learn. In most cases you don't need a referral or the plan's OK first. |
| Drug coverage | Most plans include drug coverage, so your doctors and your medicines are in one plan, with one card. Before you choose, I check your medicines on the plan's drug list. | Supplements sold today don't include drug coverage. You add a separate Part D drug plan, which usually has its own premium. I check your medicines in those plans too. |
| When you can join | You can join when you first get Medicare. Every fall, from October 15 to December 7, you can join, switch or drop a plan for the next year. You can also join at certain other times, like after a move. A plan can't turn you down or charge you more because of your health. | Your best time is your 6-month Medigap Open Enrollment Period, starting the first month you have Part B and are 65 or older. Then a company can't turn you down or charge you more because of your health. Later, it can ask health questions and may say no or charge more, unless you have a special right to buy. This window comes only once. |
| Who it can fit | People who like one plan and one card, want drug coverage and extras like some dental, vision and hearing care in the same plan, would rather keep monthly costs down and pay copays when they get care, and whose doctors are in the network. | People who want any doctor who takes Medicare anywhere in the U.S., spend time away from home, or would rather pay more each month so their share of each bill is smaller and easier to plan for. |
| Extras | Most plans add benefits Original Medicare doesn't cover. For 2027, most Medicare Advantage plans in the Valley include dental, vision and hearing benefits. What's included is different in each plan. | Supplements generally don't cover dental, vision or hearing aids. A separate dental or vision policy can go next to one. |
| What you pay | Usually your Part B premium, a plan premium in some plans, and copays or a share of the cost when you get care. For 2027, most Medicare Advantage plans in the Valley have no monthly plan premium. Each plan has a yearly limit on what you pay for covered Part A and Part B services. Once you reach it, you pay nothing more for those services for the rest of the year. Limits in and out of the network can differ. Premiums, copays and benefits can change each year. | Usually your Part B premium, a monthly Supplement premium, and a premium for your drug plan. How much the Supplement pays depends on the plan letter. After the yearly Part B deductible, standard Plan G pays your share of Medicare-approved costs for services Medicare covers. High-deductible Plan G has its own yearly deductible to meet before it pays. Each letter covers the same things at every company, but premiums can differ a lot, so I compare them for you. Premiums usually go up over time, for example with age. |
| Travel | Emergency and urgent care are covered anywhere in the U.S. Other care away from home depends on the plan's network. For 2027, many Medicare Advantage plans in the Valley cover emergency and urgent care outside the United States, including in Mexico. Some don't, so if you go to Mexico, that is one of the first things I check. This is for emergencies, not routine care, and each plan sets its own limits. You may have to pay first and then ask the plan to pay you back. Not every company offers every one of these benefits. | With most policies, any doctor in the U.S. who takes Medicare, wherever you are. Medicare SELECT policies may require certain hospitals or doctors for full benefits. Several plan letters, like G and N, also help pay for emergency care outside the U.S., within the plan's limits. |
Medicare Advantage plans with these benefits are offered in the Valley by companies I'm contracted with: Aetna Medicare, HealthSpring, Humana, Prominence Health Plan, UnitedHealthcare and Wellcare.
Original Medicare by itself has no yearly limit on what you pay out of pocket, unless you have other coverage, like a Supplement, Medicaid, or coverage from a job, a retirement plan or a union. That's why I go over two choices with you, and I offer both: a Medicare Advantage plan or a Medicare Supplement.
Read more about Medicare Advantage and the Medicare Supplement.
Every year, from October 15 to December 7, you can change your Medicare Advantage or drug plan for the next year. That's when we sit down and go over what changed.
Medicaid is a different program.
The names sound alike, so people mix them up all the time.
What is Medicaid?
Medicaid helps people with limited income and savings pay for health care. Each state runs its own. Medicare is mostly for people 65 and older, and some younger people with disabilities.
Can I have both?
Yes, some people have both, and the two work together. Some Medicare plans are made just for them. In Texas, the state runs Medicaid and decides who qualifies. I don't work for the state. You can apply at YourTexasBenefits.com or by calling 2-1-1. If you have Medicaid, call me, and we'll look at which Medicare plans work with it. I can also help you apply for Extra Help with drug costs. That's a federal program, run by Social Security.
Where do Medicare.gov and 1-800-MEDICARE fit?
They are Medicare's own website and phone line. They can show you every plan in your area, and I don't offer every plan. What I add is a person who sits down with you, and stays after.
The questions that matter.
Before you pick any plan, ask these. I go through every one with you, at your kitchen table or at an office near you.
- Are my doctors and my hospital in the plan?
- Are all my medicines covered?
- Which pharmacy costs me less?
- Do I need a referral to see a specialist?
- What if I get sick while I travel?
- Does it work with my other coverage, like Medicaid or insurance from work?
I'm an independent agent. I don't work for just one insurance company. For Medicare Advantage and drug plans, I'm contracted with Aetna Medicare, HealthSpring, Humana, Prominence Health Plan, UnitedHealthcare and Wellcare. If you're better off staying put, I'll tell you.
Still have questions? That's what I'm here for.
No question is too small. I'll explain it as many times as you need, in English or Spanish. My help costs you nothing.