Turning 65? Here's What Medicare Actually Covers — And What It Doesn't.
Medicare enrollment is one of the most consequential financial decisions you'll make — and the deadlines are not forgiving. Miss your window and you could pay higher premiums for life. Arnold Rabinowitz has helped Boynton Beach and SE Florida seniors navigate Medicare since 1995.
What Happens When You Get Medicare Wrong
Most people don't realize they made the wrong choice until a doctor visit, a hospital stay, or a pharmacy receipt reveals the gap.
Miss your initial enrollment window for Part B or Part D and you pay a surcharge on your premium for the rest of your life. It's 10% for Part B for every 12 months you waited, and 1% per month for Part D. These penalties never go away.
10% / year Part B penalty — permanentlyMedicare Advantage plans have provider networks. If your doctor or specialist isn't in-network, you pay out-of-pocket — or change doctors. Choosing the wrong plan type for your health situation can mean thousands in unexpected bills annually.
Thousands in avoidable out-of-pocket costsNot all Part D plans cover all medications. Choosing a plan without checking your specific drug formulary means you could pay full retail price for medications you take every month. Arnold compares Part D plans against your actual prescription list.
$0 coverage for excluded medicationsThese mistakes are avoidable — with the right advisor before you enroll.
A free consultation with Arnold takes 30 minutes. The penalties you're avoiding could cost thousands per year.
Get Your Free Medicare ReviewMedicare Enrollment Periods — Explained Clearly
Each window has different rules. Missing the wrong one triggers penalties. Here's what you need to know.
Your first opportunity to enroll in Medicare Parts A and B. Enrolling during this 7-month window avoids late enrollment penalties entirely. If you're still working and covered by a qualifying employer plan, you may have a Special Enrollment Period after you retire.
✓ Best window — zero penalty riskPart B: 10% added to your monthly premium for every 12-month period you were eligible but didn't enroll. Part D: 1% of the national base beneficiary premium multiplied by the number of months you went without coverage. Both penalties are permanent.
⚠ Penalty is lifetime — never goes awayThe main window each fall to switch Medicare Advantage plans, change Part D drug plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1. Arnold reviews your current plan against available options each AEP to ensure you're not overpaying.
Review your plan each October — costs change year to yearIf you're already enrolled in a Medicare Advantage plan, you can switch to a different Advantage plan or return to Original Medicare (and enroll in a standalone Part D plan) during this window. This is your second chance if the AEP plan choice isn't working.
Only for existing Medicare Advantage enrolleesQualifying life events — losing employer coverage, moving out of a plan's service area, losing Medicaid eligibility — trigger a Special Enrollment Period. SEPs are time-sensitive, usually 2 months from the triggering event. Arnold helps clients act quickly when an SEP is triggered.
Act within 2 months of qualifying eventMedicare Supplement vs. Medicare Advantage — Which Is Right for You?
These two paths cover your Medicare gaps very differently. Arnold walks every client through both before recommending either.
Arnold's approach: Neither plan type is universally better. The right choice depends on your health, your doctors, your prescriptions, your budget, and how often you travel. Arnold walks you through both — and names the specific Florida carriers worth considering for each — before you decide anything.
Confused About Medicare? That's Normal. Call Arnold.
One free conversation will give you more clarity than hours of reading government websites. Arnold has been explaining Medicare to Boynton Beach seniors since 1995. No forms before the call. No pressure after it.
Medigap Plan G, Plan N, and Plan A — Compared
For people enrolling in Medicare after January 1, 2020, Plans G and N are the most popular Medigap options in Florida. Here's how they differ.
Plan premiums vary significantly by Florida carrier, your age, your county, and your health history. Arnold compares actual carrier rates for your specific situation — not national averages. Schedule a free comparison →
Medicare Supplement Insurance in Boynton Beach — Specialist Since 1995
As a Certified Senior Advisor (CSA), Arnold's training goes beyond insurance licensing. The CSA designation requires specialized education in the health, financial, psychological, and social issues facing older adults — the exact population navigating Medicare.
His approach: explain your options honestly, compare actual Florida carrier rates for your situation, and make sure you're enrolled on time. He doesn't push Advantage over Supplement or vice versa — he finds what fits your life.
"Medicare decisions affect the rest of your life — and the penalties for getting them wrong affect the rest of your life too. My job is to make sure that never happens to a client."
Medicare Part D — How Arnold Finds the Right Drug Plan for You
Not all Part D plans cover the same medications at the same cost. The plan with the lowest premium isn't always the lowest total cost. Arnold runs your actual prescription list against available plans before recommending one.
Name of each medication, dosage, and how often you take it. Arnold uses this to check formulary coverage across every available Part D plan in your county.
Each plan has a drug formulary — its list of covered medications and their tier (cost level). Arnold identifies which plans cover all your medications and at what out-of-pocket cost, not just which have the lowest premium.
Sometimes the plan with the $0 premium costs you $200 more per year on your medications than a plan with a $35 premium. Arnold shows you the math — total annual cost, not just the monthly premium line.
The Part D Coverage Phases
In 2025, Medicare Part D restructured significantly. Here's how the coverage phases now work.
Pay full drug costs until you meet the plan's deductible (up to $590 in 2025)
Pay your plan's copay or coinsurance for covered drugs. Plan pays the rest.
New in 2025: $2,000 out-of-pocket cap. After that, $0 for covered drugs for the rest of the year.
New 2025 option: spread your Part D drug costs into monthly payments throughout the year
2025 change worth knowing: The new $2,000 out-of-pocket cap is a significant improvement for people on high-cost medications. If you're currently on a specialty drug, Arnold can show you how this change affects your annual cost.
What Medicare Peace of Mind Actually Looks Like
This is what clients who work with Arnold before enrolling tell him they gained.
No lifetime penalty surcharges. Arnold tracks your enrollment window and makes sure you know exactly when to act — and helps you do it.
Arnold checks that your existing doctors accept your new plan before you enroll. No surprise out-of-network bills from specialists you've seen for years.
Your Part D plan was selected against your actual drug list. Every medication you take is on the formulary — at the tier you expected.
Whether you chose Supplement or Advantage, you understand what you'll pay monthly, what you'll pay at appointments, and what the worst-case scenario looks like. No surprises.
When Medicare sends a confusing letter, a claim gets denied, or you're not sure if a service is covered — Arnold's direct number is in your phone and he answers it.
Arnold contacts you each October before AEP closes. Plan costs change every year. He makes sure you're not paying more than you should be.
Frequently Asked Medicare Questions
These are the questions Arnold hears most from Boynton Beach seniors. Plain answers, no jargon.
What is the best supplemental insurance for Medicare in Florida?
For people enrolling in 2025, Plan G is the most comprehensive Medigap option and covers nearly everything except the Part B deductible ($257 in 2025). Plan N offers lower premiums with small copays for some visits and is a strong option for people in generally good health.
The "best" plan depends on your health, your doctors, your prescriptions, and your budget. Arnold compares actual carrier rates in Boynton Beach, Boca Raton, Delray Beach, and all of SE Florida to find the right match. Schedule a free comparison →
What's the difference between Medicare Supplement and Medicare Advantage?
Medicare Supplement (Medigap) works alongside Original Medicare — you keep your full Medicare coverage, and the supplement plan pays the gaps (copays, coinsurance, deductibles). You can see any doctor who accepts Medicare, anywhere in the country.
Medicare Advantage (Part C) replaces Original Medicare with a private plan — often at low or $0 premium, often including dental and vision, but with network restrictions, prior authorization requirements, and cost-sharing that can make total expenses harder to predict.
Neither is universally better. Arnold spends time walking clients through both before recommending either.
When do I need to sign up for Medicare?
Your Initial Enrollment Period is the 7-month window that starts 3 months before your 65th birthday and ends 3 months after. Enrolling during this window avoids late enrollment penalties.
If you're still working at 65 and covered by a qualifying employer plan (20+ employees), you may be able to delay Medicare enrollment without penalty. However, this must be documented correctly. Arnold helps clients in this situation make sure their delay is penalty-free. Talk to Arnold about your specific situation →
What does Medicare NOT cover?
Original Medicare (Parts A and B) does not cover: dental, vision, hearing aids, long-term care, or most prescription drugs(Part D is separate). It also doesn't cover care outside the US for most situations.
This is why Medicare Supplement, Medicare Advantage, standalone Part D, and dental insurance exist — to fill these gaps. Arnold's job is to make sure your total coverage package actually addresses all of them, not just the Parts A and B gaps.
Can I be denied a Medigap plan because of my health?
During your Medigap Open Enrollment Period(6 months starting when you're 65+ and enrolled in Part B), insurers cannot deny you coverage or charge you more based on pre-existing conditions. You have guaranteed issue rights.
Outside of this window, insurers can use medical underwriting in Florida — meaning they can decline your application or charge more based on health history. This is one of the most important reasons to get Medigap coverage at the right time rather than waiting. Arnold walks every client through the timing before they make a decision.
Is it too late to get Medicare if I'm already 67?
No — you can enroll in Medicare Part A and Part B during the General Enrollment Period(January 1 – March 31 each year) if you missed your Initial Enrollment Period. However, you will likely face late enrollment penalties on your Part B premium.
If you delayed enrollment because you had qualifying employer coverage, you may be able to enroll penalty-free through a Special Enrollment Period. Arnold helps clients determine which situation applies and what the penalty exposure looks like. Call Arnold to review your specific situation →
What is a Medicare insurance agent near me — and do I need one?
A licensed Medicare insurance agent near you (like Arnold) can compare Medigap, Medicare Advantage, and Part D options from multiple carriers and help you enroll — at no cost to you. Agents are compensated by the carriers, not by the client.
You don't need an agent — Medicare.gov lets you research plans independently. But Medicare is complex, enrollment windows are unforgiving, and an experienced local advisor who knows the SE Florida carrier market can help you avoid mistakes that cost you for years. Arnold has been that advisor for 1,500+ Florida clients since 1995.
Don't Let Medicare Catch You Off Guard.
Arnold Rabinowitz is a Certified Senior Advisor and independent insurance advisor who has been helping Boynton Beach and SE Florida seniors navigate Medicare since 1995. One free consultation — by phone or in person. No pressure to enroll in anything on the call.
Free consultation. No obligation. Arnold will give you honest information whether you work with him or not.