Medicare Open Enrollment
October 15, 2026 through December 7, 2026
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We can help you understand Medicare. (252) 232-4400
Understanding Medicare: Coverage and Plan Options Explained
If Medicare feels confusing, you are not alone. Understanding Medicare coverage and plan options starts with learning how Original Medicare, Medicare Advantage, Part D Prescription Coverage, and Medicare Supplement insurance work.
Silver Linings Insurance specializes in Medicare.
We help people in Virginia, North Carolina, and Tennessee compare coverage based on their doctors, prescriptions, budget, and healthcare needs.
As your 65th birthday approaches, the emails, texts, calls, commercials, and direct mail can become overwhelming. Most messages promote a specific insurance company. However, few explain how the pieces fit together or what you should consider.
At Silver Linings Insurance, we take a quieter, more personal approach.
As an independent insurance brokerage, we work with multiple carriers rather than one specific company. We start with your needs, explain your choices clearly, and give you time to ask questions.
When you call, you will work directly with our owner, Scott Dashiell. You will not have to start over with a different call-center representative each time. Scott specializes in Medicare and remains available when you need help.
You do not have to choose a plan during your first conversation. We can simply start with your questions.
Compare Your Medicare Options
This chart provides a simple overview of the two main ways to receive your Medicare benefits. We explain both options in more detail below the chart, and Scott can review them with you personally.
Steps to Understanding Medicare
We know there is a lot of information to learn and understand, and Silver Linings Insurance is here to help you.
You do not need to learn everything at once. These steps explain the main choices, how the parts work, what to compare, and when to enroll.
Click on these links to go to a specific section and quickly find the information you need:
- First Step: Understanding Medicare Coverage Options > Click
- Second Step: Understanding Medicare Parts A, B, C, and D > Click
- Third Step: Compare the Coverage Options That Matter to You > Click
- Fourth Step: Review Your Prescription Drug Coverage > Click
- Fifth Step: Understanding Medicare Enrollment > Click
- How Silver Linings Insurance Makes Understanding Medicare Easier > Click
- Common Medicare Questions & Answers > Click
First Step: Understanding Medicare Coverage Options
As outlined in the chart above, you can receive your benefits through Original Medicare or a Medicare Advantage plan. Before comparing individual plans, it helps to know how these two coverage options differ.
The right option depends on your doctors, prescriptions, travel, budget, health needs, and preferred way of receiving care.
Consider talking with us after your 64th birthday. Starting early gives you time to learn, ask questions, and make a comfortable decision.
What Is the Difference Between Original Medicare and Medicare Advantage?
Original Medicare provides Part A and Part B coverage directly through the federal government and offers broader provider access. Medicare Advantage provides those benefits through a Medicare-approved private insurance company, often use networks, and may include prescription coverage and additional benefits.
Option 1: Original Medicare
Original Medicare provides Part A and Part B coverage directly through the federal government and offers broader provider access. You can add a separate Part D prescription drug plan. You may also purchase Medicare Supplement insurance, also called Medigap, to help with certain out-of-pocket costs.
Option 2: Medicare Advantage
With Medicare Advantage, a Medicare-approved private insurer provides your Part A and Part B benefits through one plan, often using networks. Most plans include Part D. Some offer dental, vision, hearing, fitness, or transportation benefits. However, details and limits vary.
Second Step: Understanding Medicare Parts A, B, C, and D
Medicare has four parts. Part A covers hospital care, Part B covers medical and outpatient care, Part C is another name for Medicare Advantage, and Part D covers prescription drugs. Understanding what each part covers makes it easier to compare your coverage options.
Part A Covers Hospital Care
Part A provides hospital insurance. It helps cover inpatient hospital stays, qualifying skilled nursing facility care, hospice care, and certain home healthcare services.
However, receiving care in a hospital does not always mean the hospital considers you an inpatient. The hospital may classify some services as outpatient care, which generally falls under Part B.
Part B Covers Medical Care
Part B provides medical insurance. It helps cover doctor visits, outpatient services, preventive care, medical equipment, tests, and other medically necessary services.
Together, Parts A and B make up Original Medicare.
Part C is Medicare Advantage
Part C is another name for Medicare Advantage. Approved private insurers offer these plans as another way for you to receive Part A and Part B benefits.
Most plans include Part D prescription drug coverage. Some provide additional benefits, such as dental, vision, hearing, fitness, transportation, or over-the-counter allowances.
Part D Covers Prescription Drugs
Part D helps cover outpatient prescriptions. You can add a stand-alone plan to Original Medicare or receive drug coverage through a Medicare Advantage plan that includes Part D. *See the Fourth Step for information about Part D coverage and penalties.
Is Medigap Another Part of Medicare?
No. Medicare Supplement insurance, also called Medigap, is not a fifth part. It only works with Original Medicare and helps pay certain costs that Parts A and B leave for you to pay.
Third Step: Compare the Coverage Options That Matter to You
Next, compare how each option fits your doctors, prescriptions, travel, budget, and preferred way of receiving care.
Fourth Step: Review Your Prescription Drug Coverage
Review your prescriptions needs separately because every Part D plan has its own covered medications, pharmacy network, drug tiers, and rules. It is important to know your enrollment period and penalties that may apply if you have a gap in prescription coverage.
Prescription Drug Plans have a formulary, which is the plan’s list of covered medications. Because they differ, a plan that works well for one person may not work well for another.
When we compare your prescription coverage, we consider:
- Your current prescriptions
- Medication dosages and frequency
- Brand-name and generic options
- The plan’s formulary and drug tiers
- Preferred and standard pharmacies
- Mail-order options
- Special coverage rules for your medications
Can Your Part D Coverage Change?
Yes. Plans may change their formularies, pharmacy networks, drug tiers, and rules each year. Your prescriptions can change too.
Therefore, review your drug coverage during the Annual Enrollment Period. Silver Linings Insurance can help you evaluate your options and check your medications again.
Medicare Part D Enrollment and Penalties
You can enroll in a stand-alone Part D plan if you have Medicare Part A, Part B, or both and live within the plan’s service area. When you first become eligible, you should enroll in Part D or maintain creditable prescription drug coverage.* You want to avoid a gap in coverage. If your Initial Enrollment Period has ended and you go 63 consecutive days or more without either type of drug coverage, Medicare may add a late enrollment penalty when you enroll. You will generally pay permanent financial surcharge for as long as you have Medicare drug coverage. Therefore, if your enrollment period or creditable coverage ends, make sure your new Part D or other creditable drug coverage begins before your uncovered period reaches 63 days.
*Creditable prescription drug coverage is expected to pay, on average, at least as much as standard Part D coverage.
Extra Help: People who qualify for Extra Help do not pay a Part D late enrollment penalty while receiving that assistance. Learn more about Extra Help through Medicare.
Do You Need Part D if You Do Not Take Prescriptions?
Part D is optional, but you should still consider enrolling even if you do not currently take prescription medication. The late enrollment rules apply based on how long you go without qualifying drug coverage, not whether you use prescriptions. Additionally, your medication needs can change unexpectedly. Enrolling when you first become eligible, or maintaining creditable coverage, can help you avoid a future penalty and a possible gap in drug coverage.
Fifth Step: Understanding Medicare Enrollment
Enrollment timing depends on your age, current insurance, employment, and life changes. Understanding these dates can help prevent coverage gaps and late penalties.
When Can You First Sign Up?
Most people become eligible at age 65. Your Initial Enrollment Period lasts seven months. It includes the three months before your birthday month, your birthday month, and the three months after it.
Your coverage start date can depend on when you enroll. Therefore, starting early can help you avoid a gap.
Social Security automatically enrolls some eligible beneficiaries. Others must actively enroll.
If you have questions about your timing, call Silver Linings Insurance. Call (252) 232-4400
What Is Medicare Open Enrollment?
Annually from October 15th through December 7th
“Medicare Open Enrollment” often refers to the Annual Enrollment Period from October 15th through December 7th. During this time, enrolled beneficiaries can change coverage for the following year.
- Depending on your situation, you may be able to:
- Move from Original Medicare to Medicare Advantage
- Move from Medicare Advantage to Original Medicare
- Change Medicare Advantage plans
- Join, change, or drop a Part D plan
When Is Medicare Advantage Open Enrollment?
Annually January 1st through March 31st
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. It only applies to people who already have a Medicare Advantage plan.
During this period, you can make one permitted change. You may switch to another Medicare Advantage plan or return to Original Medicare and join a separate Part D plan.
What Is a Special Enrollment Period?
A Special Enrollment Period lets you make certain changes after a qualifying event. For example, you may qualify after losing employer coverage or moving outside your current plan’s service area.
Do You Need to Enroll at Age 65 if You Are Still Working?
It depends. If you or your spouse still works and you have qualifying employer group coverage, you may be able to delay part of Medicare.
However, the rules depend on your employer’s size and coverage. COBRA, retiree coverage, Marketplace insurance, and some employer plans follow different rules.
Each spouse may also face a different decision. We can help you identify the right questions to ask your benefits administrator and discuss your specific situation.
How Silver Linings Insurance Makes Understanding Medicare Easier
Silver Linings Insurance is here to help you from the months before your 65th birthday through enrollment and future life changes. Our brokerage brings more than 35 years of insurance experience. We listen, explain your choices, and identify plans we represent that fit your needs.
1. We Get to Know You
Before comparing coverage, we ask about your:
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- Doctors, specialists, and hospitals
- Prescriptions and preferred pharmacies
- Healthcare needs
- Travel and living arrangements
- Budget and comfort with out-of-pocket expenses
- Current insurance
- Retirement plans and upcoming life changes
This helps us narrow your options and reduce surprises.
2. We Compare Your Options
We compare the plans we represent based on your doctors, prescriptions, needs, and preferences. We also explain each option’s strengths and limitations, so you do not feel rushed.
3. We Explain Everything and Welcome Questions
Insurance includes unfamiliar terms. Therefore, we explain deductibles, copayments, networks, formularies, and enrollment periods in plain language.
We also welcome questions. If something does not make sense the first time, we will explain it another way.
4. We Stay with You
Our relationship does not end when you enroll. Contact us with coverage questions or when you receive a confusing notice, move, retire, change medications, or experience a life change.
Additionally, we remain available during the Annual Enrollment Period to review whether your coverage still fits.
Medicare Help in Virginia, North Carolina, and Tennessee
Understanding Medicare coverage where you live is important because Medicare Advantage and Part D options differ by county and ZIP code, so local details matter.
Silver Linings Insurance helps people understand coverage in VA, NC, and TN. Your care may cross state or county lines. For example, people in Norfolk, VA may travel to North Carolina to see a specialist. Others travel or move closer to family.
Therefore, we consider where you live and receive care when comparing the plans we represent. You receive individual attention and answers from someone who takes the time to explain, compare, and answer your questions throughout the year.
Common Medicare Questions
What Is the Difference Between Medicare and Medicaid?
Medicare primarily provides federal health insurance for people age 65 and older and certain younger people who qualify. Medicaid helps eligible people based on income and other requirements. Some people qualify for both programs.
Can You Qualify Before Age 65?
Yes. Certain people qualify before age 65 because of a disability, End-Stage Renal Disease, or ALS. Eligibility and enrollment timing depend on the qualifying condition.
Do Married Couples Need the Same Plan?
No. Coverage is individual. You and your spouse can choose different plans based on your doctors, prescriptions, health needs, and preferences.
Does Medicare Cover You When You Travel?
Original Medicare generally covers eligible services throughout the United States when you use a provider that accepts it. Medicare Advantage travel coverage depends on the plan, network, and type of care you need.
Can You Change Your Coverage?
Yes, but enrollment periods and eligibility rules determine when and how.
If you want to leave Medicare Advantage and return to Original Medicare, first confirm whether you can obtain the Medigap coverage you want. An insurance company may review your health history in some situations.
We can explain the available periods and your options before you change coverage.
Should You Review Your Coverage Every Year?
Yes. Medicare Advantage and Part D plans can change their provider networks, formularies, benefits, and coverage rules. Additionally, your prescriptions and healthcare needs may change.
We can provide an annual review to confirm that your coverage still fits.
What Should You Bring to a Plan Review?
Bring your Medicare card, prescription list, preferred pharmacy, doctors, specialists, hospitals, current insurance information, and plan notices.
Also share any upcoming retirement, move, medication change, or life event. This helps us compare accurately.
You are Not Alone in Understanding Medicare
Choosing coverage is an important decision, but it should not feel stressful, confusing, or like a sales pitch. Your coverage should reflect your doctors, prescriptions, health needs, budget, and lifestyle, not which insurer reaches you first.
Silver Linings Insurance specializes in Medicare and starts with your needs. We will walk you through the steps, explain the plans we represent, and help you identify coverage that fits your life.
Then we stay available when you have questions, experience a change, or need help during an enrollment period. Call Silver Linings Insurance at (252) 232-4400 to talk directly with Scott about your Medicare questions.
