Medicare Navigator

Medicare Parts A, B, D, and Medicare Advantage each have different rules and enrollment windows. Bill Advantage explains how the pieces fit together and what missing a window can cost.

What you get

Plain-English overview of each part and how they work together
Enrollment timing and penalty concepts explained clearly
Guidance tailored to the details you provide about your situation
Notes on what to verify at medicare.gov or with a trusted counselor

Who this is for

People approaching 65, retiring, or losing employer coverage who need to navigate Medicare for the first time.

Common situations this tool handles

You are turning 65 in four months and are still covered by your employer's plan. You are not sure whether you need to enroll in Medicare now or later.
You have Original Medicare and are considering switching to Medicare Advantage during open enrollment.
You are already on Medicare Part A and B and your doctor just prescribed a medication that is not covered. You have no Part D plan.

What your analysis looks like

Sample analysis for illustration. Your output will reflect your specific document and situation.

MEDICARE SITUATION REVIEW

Scenario: Approaching 65 with active employer coverage Employer size: More than 20 employees

PART A ENROLLMENT

You can enroll in Part A at 65 without penalty even if you keep employer coverage, because Part A is premium-free for most people. Enrolling in Part A now creates a creditable coverage record and costs you nothing.

PART B TIMING

If your employer has 20 or more employees, your employer plan is primary and Medicare is secondary. You do not need to enroll in Part B right now to avoid a penalty, as long as you enroll within 8 months of losing employer coverage or stopping work. This is the Special Enrollment Period.

CRITICAL WARNING

If your employer has fewer than 20 employees, Medicare becomes primary at 65 regardless of other coverage. In that situation, not enrolling in Part B at 65 will result in a permanent late enrollment penalty of 10% per 12-month period you delayed.

PART D TIMING

Same rule applies as Part B. If you have creditable prescription drug coverage through your employer, you can delay Part D without penalty.

MEDICARE ADVANTAGE CONSIDERATION

If you are considering Medicare Advantage instead of Original Medicare, verify that your current doctors accept the specific plan, not just Medicare generally. Network restrictions are the most common source of dissatisfaction with Medicare Advantage plans.

[Full enrollment timeline and questions for your employer's benefits administrator follows...]

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Questions about this tool

What is the Part B late enrollment penalty and how long does it last?

The penalty is 10% of the standard Part B premium for every 12-month period you were eligible but did not enroll and lacked qualifying coverage. It is permanent -- it applies for as long as you have Part B.

What is the difference between Medicare Advantage and Original Medicare?

Original Medicare is a federal program with a broad national network. Medicare Advantage is private insurance that contracts with Medicare, often with narrower networks, additional benefits, and different cost structures. You cannot have both simultaneously.

Can I switch from Medicare Advantage back to Original Medicare?

Yes, during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). If you switch back to Original Medicare, you may have limited ability to enroll in a Medigap plan depending on your state.

What is new in 2026

Medicare Changes for 2026

Medicare Part D out-of-pocket costs are capped at $2,000 for 2026 under the Inflation Reduction Act, a significant change for enrollees with high drug costs. Medicare Advantage plans have also adjusted networks and formularies for 2026. Verify your plan's current drug formulary and provider network before assuming your 2025 coverage continues unchanged.

These are general updates only. Your specific analysis always uses the latest rules for your document.

How it works

Upload your document. Photo or PDF of your medical bill, EOB, denial letter, or COBRA notice. No account needed to start.
We review it. Bill Advantage reviews your document against healthcare billing rules, insurance regulations, and common error patterns, reflecting the knowledge of healthcare billing professionals, encoded into a system that works in minutes, not days.
You get answers. Receive a plain-English explanation of exactly what happened and why. For most tools, a ready-to-send dispute or appeal letter is included. Save results to your Healthcare Finance Tracker, set reminders for follow-up deadlines, and build a complete record of your healthcare finances over time.

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