Plan review — eligibility, timing and what fits

Step 1 of 7

When does Medicare open for you?

Your Initial Enrollment Period is fixed by your birthday, and the rules on either side of it are different. Everything else follows from getting this right.

Your date of birth

Month

Day

Year

If you were born on the first of a month, Medicare treats you as turning 65 in the month before. We apply that automatically.

Where are you with Medicare today?

Not on Medicare yet Approaching 65, or past it and never enrolled. Part A only Usually because employer coverage is still in place. Part A and Part B Original Medicare, with nothing added yet. On a Medicare Advantage plan A Part C plan from a private carrier. On a Medicare Supplement A Medigap letter plan, usually with a Part D plan alongside.

Do you or a spouse still have coverage through a job?

Yes — 20 or more employees This is the coverage that lets you delay Part B without a penalty. Yes — fewer than 20 employees Medicare usually pays first here, so delaying Part B is risky. COBRA COBRA is not active employer coverage for Part B purposes. Retiree or union coverage Also not active employer coverage for Part B purposes. No employer coverage

How do you qualify for Medicare?

By turning 65 Through disability End-stage renal disease

Step 2 of 7

Which county do you live in?

Medicare Advantage and Part D plans are sold county by county, not state by state. Two people a mile apart can have entirely different shelves to choose from.

ZIP code

Step 3 of 7

Who are we talking to?

Your name and an email are needed for the consent form. Everything below the rule is optional — skip any of it and the conversation still works.

First name required

Last name required

Email required

Phone

I have a spouse or partner whose coverage should be considered too

Optional from here. Every one of these changes the advice, and none of them is required.

How much do you travel or move about?

Rarely — my care is all close to home Often — I am away several times a year I live in two states, or I am away for months at a time

This is one of the few answers that genuinely decides the Advantage-versus-Supplement question rather than nudging it.

Doctors or hospitals you want to keep Free text. We do not check networks from this page, and we will not pretend to — an advisor verifies each one against the plan before anything is signed.

Anything ongoing we should factor in?

Anything else worth knowing

Step 4 of 7

What do you take?

The same drug can sit on tier 2 in one Part D plan and tier 4 in another, and that gap is usually larger than any premium difference. This is the part of the review that saves money.

Start typing a drug name Matched against the US National Library of Medicine's RxTerms index. Use the up and down arrows, then Enter. If your drug is not offered, add what you typed.

Nothing added yet.

I take no prescription medication at all

Step 5 of 7

The decision, not a price

Here is what your answers point at, and what argues against it. Nothing below is a premium: there is no public Medicare plan-premium API, so a number here would be one we made up.

The trade-offs, both directions

If it is a Supplement: the plan letters

Medigap benefits are standardised by federal law. Every Plan G pays exactly what every other Plan G pays, whoever sells it — so this comparison needs no API and cannot go out of date on benefits. Plan F and Plan C are closed to anyone newly eligible for Medicare on or after 1 January 2020. What differs between carriers is the premium and how it is rated.

Scroll the table sideways to see Plans G, N, K and L.

What Medigap Plans G, N, K and L each pay towards the gaps Original Medicare leaves.
Benefit	G Plan G	N Plan N	K Plan K	L Plan L
Part A hospital coinsurance Plus 365 extra hospital days after Medicare benefits are used up.	100% Covered in full	100% Covered in full	100% Covered in full	100% Covered in full
Part A deductible Charged once per benefit period, not once per year.	100% Covered in full	100% Covered in full	50% Partly covered	75% Partly covered
Part B coinsurance or copayment The 20% Original Medicare leaves you with on most outpatient care.	100% Covered in full	100% less copays Conditional	50% Partly covered	75% Partly covered
Part B deductible No plan sold to people newly eligible since 2020 may cover this.	Not covered Not covered	Not covered Not covered	Not covered Not covered	Not covered Not covered
Part B excess charges What a non-participating doctor may bill above the Medicare rate.	100% Covered in full	Not covered Not covered	Not covered Not covered	Not covered Not covered
Skilled nursing facility coinsurance Days 21 to 100 of a qualifying skilled nursing stay.	100% Covered in full	100% Covered in full	50% Partly covered	75% Partly covered
First three pints of blood The three pints a year Original Medicare does not pay for.	100% Covered in full	100% Covered in full	50% Partly covered	75% Partly covered
Part A hospice coinsurance Respite care and outpatient drugs under the hospice benefit.	100% Covered in full	100% Covered in full	50% Partly covered	75% Partly covered
Foreign travel emergency Care in the first 60 days of a trip, up to a $50,000 lifetime maximum.	80% Partly covered	80% Partly covered	Not covered Not covered	Not covered Not covered
Annual out-of-pocket limit Only K and L have one. CMS resets the amount every year.	None Not covered	None Not covered	Yes — higher Conditional	Yes — lower Conditional

Medigap policies are standardised by federal law, so a Plan G is a Plan G whoever sells it — only the price, the service and the rate history differ. Massachusetts, Minnesota and Wisconsin standardise their policies differently. Plans F and C are closed to anyone newly eligible for Medicare on or after 1 January 2020. The annual out-of-pocket limits on Plans K and L are reset by CMS each year.

Which direction should an advisor work in?

Medicare Advantage One private plan in place of A and B, usually with drugs included, a network, and a cap on a bad year. Original Medicare, a Supplement and a Part D plan Any doctor in the country that takes Medicare, no referrals, higher fixed cost, very little left to pay. Still deciding — walk me through both A real answer. Most people who choose well spend a conversation here first.

Step 6 of 7

Before a licensed agent can act for you, you have to say so in writing. This is the CMS model consent, prefilled from your answers. Read it, then sign it.

The agent and agency

Name of Primary Writing Agent: Edward Gudas
Agent National Producer Number: 16974880
Phone Number: 1-847-754-4628
Email Address: [email protected]
Name of Agency: Gradepoint Insurance Group, LLC
Agency National Producer Number: 21297322
Owner of Agency: Edward Gudas
Phone Number: 1-847-754-4628
Email Address: [email protected]

Consent for agent or broker assistance

The CMS model consent language, prefilled from your answers. Read it, then sign it below.

I, [First Name] [Last Name], give my permission to Edward Gudas to serve as the health insurance agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by telephone only for the purposes of one or more of the following:

Searching for an existing Marketplace application;
Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums;
Providing ongoing account maintenance and enrollment assistance, as necessary; or
Responding to inquiries from the Marketplace regarding my Marketplace application.

I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII is kept private and safe when collecting, storing, and using my PII for the stated purposes above.

I confirm that the information I provide for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge. I understand that I do not have to share additional personal information about myself or my health with my Agent beyond what is required on the application for eligibility and enrollment purposes. I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by e-mailing Edward at [email protected].

CMS publishes this model language for Marketplace enrolment. A real Medicare sales appointment is additionally governed by a Scope of Appointment (CMS form 10675), which records which product types you agreed to discuss and is normally taken before the meeting. This demonstration reproduces the model consent exactly as published rather than paraphrasing it.

Your signature

Your full legal name

I have read the consent above and I agree to it.

What is recorded with this signature

Recorded by the server, from the connection itself

Your IP address and the country Cloudflare resolves it to
Approximate network location: country, region, city, postal code and time zone
Your network operator: autonomous system number and organisation name
The Cloudflare data centre that answered, the HTTP version and the TLS version
Your full browser user-agent string, Accept-Language and referring page
The UTC time the submission arrived, and a generated reference ID

Reported by this page, and sent with the submission

Your local time, time zone name and UTC offset
Your browser languages, platform, and the brand and version it reports
Screen size, window size and device pixel ratio
Whether you have reduced motion or a dark colour scheme turned on
The page you landed on, the page you are on now, and the referrer
How long you spent on each step, and in total
The SHA-256 hash, version and length of each consent document exactly as it was shown to you
Whether each signature was drawn or typed, and how much ink it carries

Never collected

Canvas, WebGL, audio or font fingerprints, or any other covert device signal
Your Social Security number, your Medicare number, or any bank detail
The signature images themselves — they stay in this browser tab and are never uploaded

Step 7 of 7

Check it, then sign it

Everything you told us, in one place. Change anything that is wrong — you come straight back here — then attest that it is true.

Review and attestation

Everything you entered, in one place. Correct anything that is wrong before you sign, then attest that it is true.

I, [First Name] [Last Name], have reviewed the eligibility, timing, location, health context, prescriptions and coverage direction shown on this page. I attest that the information is true and complete to the best of my knowledge.

I understand that nothing on this page is an enrolment. No application has been transmitted to the Centers for Medicare and Medicaid Services, to Medicare, or to any insurance carrier, and no plan has been selected on my behalf. Enrolment in Medicare Part A and Part B is done through the Social Security Administration; enrolment in a Medicare Advantage, Medicare Supplement or Part D plan is done through the plan or through Medicare.

I understand that the coverage direction shown to me compares how the parts of Medicare work — networks, referrals, out-of-pocket maximums, medical underwriting and travel — and does not quote a premium for any plan. Premiums, deductibles, formularies and provider networks are set by each plan, vary by county, and change on 1 January each year.

I understand that Medicare Supplement policies are medically underwritten outside my guaranteed-issue windows, that Plan F and Plan C are closed to anyone newly eligible for Medicare on or after 1 January 2020, and that going without creditable prescription drug coverage for 63 days or more can add a permanent Part D late enrollment penalty.

I understand that a record of this session is assembled when I submit, that it includes the network and device details disclosed to me on this page, and that it includes a cryptographic hash of each consent document exactly as it was shown to me.

Your second signature

This one is a separate record from the consent. Two documents, two signatures, two hashes.

Your full legal name

I attest that everything above is true and complete to the best of my knowledge.

Finished

Nothing was sent anywhere

The record below was assembled by a Cloudflare Pages Function, returned to this browser once, and forgotten. It was not written to a database, not logged, and not transmitted to CMS, Medicare, the Social Security Administration or any carrier.

Reference

Speak to an advisor Download the record

The record, in full

Everything the server saw, everything this page reported, and the SHA-256 of each consent document as it was shown to you — recomputed on the server from the text it received, so the match is checked rather than claimed.

Seven questions, then a conversation

There is something to fix before you go on

When does Medicare open for you?

Which county do you live in?

Who are we talking to?

What do you take?

The decision, not a price

The trade-offs, both directions

If it is a Supplement: the plan letters

The agent and agency

Consent for agent or broker assistance

Your signature

Recorded by the server, from the connection itself

Reported by this page, and sent with the submission

Never collected

Check it, then sign it

Review and attestation

Your second signature

Nothing was sent anywhere

The record, in full

Put your name on it.

Seven questions, then a conversation

There is something to fix before you go on

When does Medicare open for you?

Which county do you live in?

Who are we talking to?

What do you take?

The decision, not a price

The trade-offs, both directions

If it is a Supplement: the plan letters

Consent for an agent to help you

The agent and agency

Consent for agent or broker assistance

Your signature

Recorded by the server, from the connection itself

Reported by this page, and sent with the submission

Never collected

Check it, then sign it

Review and attestation

Your second signature

Nothing was sent anywhere

The record, in full

Put your name on it.