Medicare, explained one part at a time.

The four parts of Medicare

Parts A and B make up "Original Medicare," run directly by the federal government. Parts C and D are delivered through private insurance companies that Medicare approves and regulates.

Medigap: filling in what Original Medicare leaves behind

Medicare Supplement Insurance is sold by private companies to help pay the deductibles, copays, and coinsurance that Original Medicare doesn't cover.

When you can enroll or make changes

Missing a window can mean waiting months to make a change — or a permanent late-enrollment penalty. These are the windows that come up most.

Special Enrollment Periods, in depth

Outside AEP (Oct 15–Dec 7) and MA OEP (Jan 1–Mar 31), a client can only enroll or switch if a valid SEP applies. A wrong or unsupported SEP is the fastest way to get an application rejected, a client retro-disenrolled, and a complaint on an agent's record. This is a training aid, not legal advice — the carrier's enrollment platform, the carrier's rules, and CMS's Medicare Advantage and Part D Enrollment Guidance always override it. Codes shown are common agent shorthand; enrollment platforms may label them differently.

Where SEPs fit among the election periods

Five rules that apply to every SEP

1. The event date starts the clock, not the call date. Put the date the move, coverage loss, or discharge actually happened on the application.
2. Count full calendar months. "2 full months after the month you move" means a move on March 10 gives through May 31.
3. Effective date is usually the 1st of the month after the plan receives the application. Some SEPs allow a client-chosen date within the window.
4. One-time vs. ongoing. Most SEPs are one election, then they close. A few (institutional, dual/LIS, integrated care, 5-star) can be used repeatedly within their own limits.
5. The SEP limits the destination. Loss of creditable drug coverage lets a client add drug coverage — it does not open any change they want. Match the plan type to what the SEP permits.

Moves and location

Only a permanent change of residence counts — a snowbird's winter stay or a hospital stay isn't a move. A move inside the same service area qualifies only if new plans are available at the new address; run both ZIP codes to prove it. If the client moved out of their plan's area and doesn't choose a new plan, they'll be disenrolled to Original Medicare — say this on the call.

Losing coverage

LEC and LCC are different SEPs — LEC lets the client join any MA or PDP; LCC only opens plans with drug coverage. Ask for the last day of coverage, not the last day worked; COBRA ending counts as leaving employer coverage. Clients leaving employer coverage often also need Part B through SSA's 8-month Part B SEP — the MA window is still only 2 full months after coverage ends.

Ongoing status SEPs

Plan or government changes

First-year and Part B timing

A client in their first 12 months of their first-ever MA plan, who either dropped a Medigap to join or joined MA at 65, can return to Original Medicare with guaranteed-issue Medigap rights. Help them apply for the Medigap and a PDP together so there's no coverage gap.

Compliance checklist — before submitting any off-AEP application

• Event identified from the client's own words, not suggested by the agent
• Exact event date on the application (not today's date)
• Today is inside the SEP window, counted in full calendar months
• Plan type is a permitted destination for that SEP
• SEP statement read aloud and a clear "yes" recorded (not "yeah," "uh-huh," or silence)
• Proof noted (letter, lease, termination date, facility name)
• Effective date explained, and what happens to current coverage

Worked examples

Mistakes that get applications rejected or clients disenrolled

2026 costs at a glance

Costs are set annually by CMS. These are the standard 2026 figures — actual amounts can vary by income (Part B/D) and by plan (Part C/D).

What's changing for 2027

CMS finalized the Contract Year 2027 Medicare Advantage & Part D rule on April 2, 2026 — the biggest annual update to Star Ratings, Part D, and marketing rules since the Inflation Reduction Act. Here's what's locked in, what's still a projection, and what actually changes for people on Medicare.

Medicaid, Extra Help, and Special Needs Plans

A whole layer of programs sits underneath Medicare for people with limited income, a qualifying chronic condition, or a long-term care need. Getting the category right changes what a client is eligible for, what they'll actually pay, and what an agent is allowed to say.

Glossary: terms every agent should know cold

The shorthand you'll hear on every call, training, and compliance document — defined once, in plain language.

AEP Annual Enrollment Period

October 15 – December 7. Switch MA plans, PDP plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.

IEP Initial Enrollment Period

The 7-month window around a person's 65th birthday when they first sign up for Parts A and B.

MA OEP MA Open Enrollment Period

January 1 – March 31. Lets someone already in a Medicare Advantage plan switch plans or return to Original Medicare — once.

GEP General Enrollment Period

January 1 – March 31. For people who missed their IEP and have no Special Enrollment Period; coverage starts the next month.

SEP Special Enrollment Period

An enrollment window opened by a qualifying life event — losing employer coverage, moving, gaining or losing Medicaid/Extra Help, and others.

Medigap OEP Medigap Open Enrollment

The 6-month guaranteed-issue window starting the month someone is 65+ and enrolled in Part B — no medical underwriting allowed.

TPMO Third-Party Marketing Organization

Any organization — including agencies and agents — that markets Medicare plans on a carrier's behalf. Subject to specific disclosure and recording rules.

SOA Scope of Appointment

The documented agreement on which product categories a beneficiary wants to discuss, required before a personal marketing appointment.

PTC Permission to Contact

Documented proof a beneficiary agreed to be contacted — required before any outbound marketing call.

PECL Pre-Enrollment Checklist

The CMS-required checklist reviewed with a beneficiary before completing enrollment in an MA or Part D plan.

MOOP Maximum Out-of-Pocket

The most a person pays out-of-pocket in a plan year before the plan covers 100% of covered services. Required on every MA plan.

IRMAA Income-Related Monthly Adjustment Amount

A surcharge added to Part B and Part D premiums for higher-income beneficiaries, based on tax return data from two years prior.

Formulary Drug list

The list of drugs a plan covers, organized into cost tiers. Varies by plan even within the same carrier.

Star Ratings CMS quality score

CMS's 1–5 star rating of MA and Part D plan quality and performance — also determines a plan's bonus payments.

Benefit Period Part A measurement

How Part A hospital/SNF coverage is measured — starts on inpatient admission, ends after 60 consecutive days with no inpatient care.

Creditable Coverage Drug coverage standard

Drug coverage that's at least as good as standard Part D. Having it avoids the Part D late-enrollment penalty when someone eventually enrolls.

Guaranteed Issue No medical underwriting

A right to buy a policy — usually Medigap — without health questions or a higher price for pre-existing conditions.

Dual Eligible Medicare + Medicaid

Anyone enrolled in both Medicare and Medicaid, whether full-benefit or through an MSP only.

FBDE Full-Benefit Dual Eligible

A dual-eligible person who receives full Medicaid benefits, not just help with Medicare premiums or cost-sharing.

QMB / SLMB / QI / QDWI Medicare Savings Programs

The four state-run programs that pay some or all of a person's Medicare premiums and cost-sharing. See the Medicaid & SNPs section for details.

LIS / Extra Help Part D subsidy

The federal subsidy that reduces or eliminates Part D premiums, deductibles, and copays for people with limited income and resources.

D-SNP / C-SNP / I-SNP Special Needs Plans

MA plans restricted to dual-eligible beneficiaries, people with a qualifying chronic condition, or long-term facility residents, respectively.

FIDE / HIDE SNP D-SNP integration levels

How tightly a D-SNP's Medicare and Medicaid benefits are integrated — FIDE is fully integrated under one entity; HIDE shares a parent company across both.

MSP ⚠ two meanings

Watch for context: "Medicare Savings Program" (state help paying Medicare costs) and "Medicare Secondary Payer" (the rules for who pays first when other coverage exists) share the same acronym.

AOR Agent of Record

The licensed agent officially attached to a beneficiary's policy for servicing and commission purposes.

MAPD MA Prescription Drug plan

A Medicare Advantage plan that bundles Part C and Part D coverage together.

PDP Prescription Drug Plan

A standalone Part D plan, paired with Original Medicare rather than bundled into an MA plan.

Ready-to-Sell (RTS) Carrier certification status

The status confirming an agent is currently certified and authorized to sell a specific carrier's plans — required before every sale.

AHIP Annual agent certification

America's Health Insurance Plans' standard annual training and testing that most carriers require before certifying an agent for the plan year.

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Official Medicare resources

Every figure on this page is publicly available from the federal government. Here's where to verify anything, or get help directly.

Agent platform & CRM

Where quoting, e-App enrollment, and client records actually live day to day — separate from the consumer resources above.