Understanding Medicare Starts Here

Turning 65 is a milestone — and for many people, figuring out Medicare is one of the most important and confusing decisions that comes with it. With different parts, plan options, enrollment deadlines, and coverage choices, it’s easy to feel overwhelmed before you even get started.

Since 1982, Professional Insurance Programs has helped individuals and families across Wisconsin navigate life’s important decisions with confidence. Our team is here to explain your Medicare options clearly, answer your questions honestly, and help you find coverage that fits your healthcare needs and budget — without the pressure.

Medicare Basics

Medicare is a federal health insurance program for:

  • Individuals age 65 and older
  • Certain individuals under age 65 with qualifying disabilities
  • Individuals with End-Stage Renal Disease (ESRD)

If you are turning 65, your Initial Enrollment Period begins three months before your birthday month, includes your birthday month, and continues for three months after. Missing this window can result in late enrollment penalties, so it’s important to start planning ahead.

Questions We Can Help You Understand

Choosing Medicare coverage is one of the most important healthcare decisions you’ll make. We help you work through questions like:

  • What is the difference between Medicare Supplement and Medicare Advantage plans?
  • Which type of coverage may fit my healthcare needs and budget?
  • Can I keep my current doctors and providers?
  • Will my prescriptions be covered?
  • Do I need a prescription drug plan if I don’t currently take medications?
  • What happens if I delay enrollment?

There are no silly questions when it comes to Medicare. Our team is here to make sure you feel informed and confident — not rushed or confused.

Understanding Your Medicare Coverage Options

Medicare Part A – Hospital Insurance
Helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.
Medicare Part B – Medical Insurance

Helps cover doctor visits, outpatient services, preventive care, and certain medical supplies and services. Part B requires a monthly premium based on your income.

Medicare Part C – Medicare Advantage

Private insurance plans approved by Medicare that combine Parts A and B and often include prescription drug coverage and additional benefits such as dental, vision, and hearing.

Medicare Part D – Prescription Drug Coverage
Helps cover prescription medication costs through plans offered by private insurance companies. Costs and covered medications vary by plan, so it’s important to compare options carefully.
Medicare Supplement Insurance (Medigap)

Helps cover certain out-of-pocket costs not paid by Original Medicare, including deductibles, copayments, and coinsurance. Medigap plans work alongside Original Medicare — not as a replacement.

Medicare Enrollment Information

Some individuals are automatically enrolled in Medicare Parts A and B if they are already receiving Social Security benefits. Others must enroll during their Initial Enrollment Period.

You can apply for Medicare by:

  • Visiting Social Security Online
  • Contacting your local Social Security office
  • Calling Social Security at 1-800-772-1213

Not sure where to start? Our team can walk you through the process and help you understand what to expect at each step.

Helpful Medicare Resources

  • Medicare.gov
  • Social Security Administration
  • Medicare & You Handbook
  • Apply for Medicare Online

Why Work With Us

  • Four Decades of Wisconsin Experience Since 1982, Professional Insurance Programs has helped Wisconsin individuals and families navigate important insurance decisions at every stage of life. Medicare is one of the most significant — and we treat it that way.

  • Clear, Honest Guidance We explain your options in plain language, without jargon or pressure. Our goal is to make sure you understand what you’re choosing and why it fits your situation.

  • Personalized Support Medicare isn’t one-size-fits-all. We take the time to understand your healthcare needs, your providers, your prescriptions, and your budget before making any recommendations.

  • Here for the Long Term Medicare coverage isn’t a set-it-and-forget-it decision. As your health needs change, we’re here to help you review your options at each annual enrollment period and make adjustments when needed.

Frequently Asked Questions

Medicare Supplement plans work alongside Original Medicare and help cover certain out-of-pocket costs like deductibles and copayments. Medicare Advantage plans are offered by private insurance companies and provide Medicare benefits through a managed plan structure, often with additional benefits. The right choice depends on your healthcare needs, preferred providers, and budget.
It depends on the type of Medicare coverage you choose. Original Medicare and most Medigap plans offer broad provider access. Medicare Advantage plans typically have network restrictions, so it’s important to verify that your preferred providers participate before enrolling.
Many people in good health still choose to enroll in Part D coverage when first eligible. Delaying enrollment without other qualifying drug coverage can result in a late enrollment penalty that stays with you permanently — even if you later decide you need coverage.
Most people should begin reviewing their options several months before turning 65. Your Initial Enrollment Period is a seven-month window — starting three months before your birthday month and ending three months after. Starting early gives you time to compare plans and make a confident decision.

No. Costs, provider networks, prescription coverage, and additional benefits can vary significantly from plan to plan and year to year. That’s why comparing options carefully — and reviewing your coverage annually — is so important.

Missing your Initial Enrollment Period without qualifying coverage in place can result in late enrollment penalties for Part B and Part D that increase your premiums permanently. There are Special Enrollment Periods available in certain situations, such as losing employer coverage, but it’s important not to assume you qualify. Our team can help you understand your options if you’ve missed a window.

Medigap — also called Medicare Supplement insurance — helps cover out-of-pocket costs that Original Medicare doesn’t pay. The best time to enroll is during your Medigap Open Enrollment Period, which begins the month you turn 65 and are enrolled in Part B. During this window, insurers cannot deny coverage or charge more based on your health history.

We’re Here to Help You Understand Your Options

For over 40 years, Wisconsin individuals and families have trusted Professional Insurance Programs to help them make informed decisions at life’s most important moments. Whether you’re approaching Medicare eligibility for the first time or reviewing your current coverage, we’re here to make the process clearer, simpler, and less stressful. Call 800-637-4676 or email info@mypip.org to learn more or request additional information.

Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.