Question 1

What is Medicare?

Accepted Answer

Medicare is a federal health insurance program primarily for people age 65 and older, and for some people under 65 with certain qualifying conditions. Medicare is made up of Parts A, B, C, and D.

Question 2

What are the parts of Medicare (A, B, C, and D)?

Accepted Answer

Part A generally relates to inpatient hospital care. Part B generally relates to outpatient and physician services. Part C (Medicare Advantage) is an alternative way to receive Medicare benefits through private plans approved by Medicare. Part D helps cover prescription drugs through private plans approved by Medicare.

Question 3

Is Original Medicare the same as Medicare Advantage?

Accepted Answer

No. Original Medicare refers to Part A and Part B administered by the federal government. Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare and may have different rules such as provider networks and copays.

Question 4

Do I have to choose Medicare Advantage or a Medicare Supplement?

Accepted Answer

Many people choose either (1) Original Medicare plus a Medicare Supplement (Medigap) and a Part D drug plan, or (2) a Medicare Advantage plan. The best fit depends on your doctors, prescriptions, budget, and preferences. Options vary by ZIP code and eligibility.

Question 5

Does Medicare cover dental, vision, and hearing?

Accepted Answer

Original Medicare typically does not cover most routine dental, vision, or hearing services. Some Medicare Advantage plans may include additional benefits, but coverage and limits vary by plan and service area.

Question 6

When should I enroll if I'm turning 65?

Accepted Answer

Most people have a 7-month Initial Enrollment Period that begins 3 months before their birthday month, includes their birthday month, and ends 3 months after. Enrolling at the right time can help avoid gaps or delays.

Question 7

Do I need Part B at 65 if I'm still working?

Accepted Answer

It depends on your employer coverage and employer size. Some people can delay Part B without penalty if they have qualifying employer coverage. It's important to confirm your situation before delaying.

Question 8

What happens if I delay Medicare Part B?

Accepted Answer

If you delay Part B without qualifying coverage, you may face a late enrollment penalty and delayed enrollment timing. If you have qualifying employer coverage, you may be able to enroll later during a Special Enrollment Period.

Question 9

When does Medicare coverage start?

Accepted Answer

Start dates depend on when you enroll and your eligibility. Some enrollments start the first day of your birthday month, but timing can vary - especially if you enroll late or delay certain parts.

Question 10

Can I keep my current employer plan and Medicare?

Accepted Answer

Some people keep employer coverage and enroll in Medicare later. Coordination depends on employer size and plan rules. It's important to confirm who pays first and whether delaying Part B is appropriate.

Question 11

Can I get Medicare under 65?

Accepted Answer

Some individuals qualify for Medicare under 65 due to disability or certain qualifying conditions. Eligibility and timing depend on the specific circumstance.

Question 12

Are my Medicare options different under 65?

Accepted Answer

They can be. Plan availability, Medigap access, and enrollment rules may differ by state, ZIP code, and eligibility. Reviewing options specific to your area is important.

Question 13

Can I buy a Medicare Supplement (Medigap) under 65?

Accepted Answer

Medigap rules for under-65 Medicare beneficiaries vary by state and may depend on eligibility and timing. Availability and pricing can be different than age-65 enrollment.

Question 14

Does Medicare cover me the same way if I'm under 65?

Accepted Answer

Core Medicare benefits are generally consistent, but plan availability, networks, and additional benefits vary by plan and service area. Your best next step is to review what is available where you live.

Question 15

Is Medicare free?

Accepted Answer

Some people qualify for premium-free Part A, but Part B typically has a monthly premium. Other costs may include deductibles, coinsurance, copays, and prescription costs depending on coverage choices.

Question 16

Does Original Medicare have a maximum out-of-pocket limit?

Accepted Answer

Original Medicare generally does not have a standard annual maximum out-of-pocket limit. Some people add supplemental coverage to help manage out-of-pocket exposure.

Question 17

What is IRMAA?

Accepted Answer

IRMAA is an income-related adjustment that can increase Part B and Part D premiums for some beneficiaries based on reported income. The rules and thresholds can change by year.

Question 18

Why did my costs change this year?

Accepted Answer

Plans can update benefits, formularies, networks, copays, and premiums annually. Even if you keep the same plan, details may change year to year.

Question 19

What is coinsurance vs a copay?

Accepted Answer

A copay is a set dollar amount for a service. Coinsurance is typically a percentage of the cost of a service. Your plan documents explain which applies and when.

Question 20

Does Medicare cover ambulance rides?

Accepted Answer

Medicare may cover medically necessary ambulance transportation under certain conditions. Coverage details and cost-sharing depend on your coverage and circumstances.

Question 21

Does Medicare cover physical therapy?

Accepted Answer

Medicare may cover physical therapy when medically necessary. Coverage details and cost-sharing vary based on setting and coverage type.

Question 22

What is Medicare Advantage (Part C)?

Accepted Answer

Medicare Advantage is an alternative way to receive Medicare benefits through private insurance companies approved by Medicare. Plans may include different rules such as provider networks, copays, and coverage structure.

Question 23

What's the difference between HMO and PPO in Medicare Advantage?

Accepted Answer

HMO plans generally require using in-network providers and may require referrals. PPO plans may allow more flexibility, including some out-of-network coverage, but rules vary by plan.

Question 24

What is prior authorization?

Accepted Answer

Prior authorization means the plan may require approval before certain services are covered. Requirements vary by plan and service type.

Question 25

Can I use my Medicare Advantage plan when traveling?

Accepted Answer

Coverage when traveling depends on plan rules and what care is needed. Emergency and urgent care are typically handled differently than routine services. Always review plan details before relying on coverage while traveling.

Question 26

Do Medicare Advantage plans have a maximum out-of-pocket?

Accepted Answer

Many Medicare Advantage plans include an annual maximum out-of-pocket limit for covered medical services. Limits and what counts toward them vary by plan.

Question 27

Can I see a specialist without a referral?

Accepted Answer

Referral rules vary by plan type (HMO vs PPO) and plan design. Always confirm specialist access rules in your plan documents.

Question 28

What is a Medicare Supplement (Medigap)?

Accepted Answer

Medigap policies help cover certain out-of-pocket costs left by Original Medicare. Medigap policies are offered by private insurers and work alongside Parts A and B.

Question 29

Do Medigap plans include prescription coverage?

Accepted Answer

Medigap policies generally do not include prescription drug coverage. Many people add a standalone Part D plan for prescriptions.

Question 30

What is Medigap Open Enrollment?

Accepted Answer

This is a time period (often when you're both 65+ and enrolled in Part B) when you may have guaranteed-issue rights to buy certain Medigap policies without medical underwriting. Rules can vary by situation and state.

Question 31

What's the difference between Plan G and Plan N?

Accepted Answer

Plan letters represent standardized benefit structures. Differences can include cost-sharing for certain services. Availability and pricing vary by carrier and location; review plan details before choosing.

Question 32

Can I be denied a Medigap policy?

Accepted Answer

Outside certain guaranteed-issue periods, medical underwriting may apply depending on the state and situation. Eligibility and pricing can vary.

Question 33

What is Medicare Part D?

Accepted Answer

Part D helps cover outpatient prescription drugs through private plans approved by Medicare. Costs and coverage depend on the plan's formulary, tiers, and pharmacy network.

Question 34

What is a formulary?

Accepted Answer

A formulary is the plan's list of covered drugs. Plans can change formularies and tiers, and coverage can vary by dosage, form, or brand/generic status.

Question 35

What are drug tiers?

Accepted Answer

Tiers are categories that may affect what you pay for medications. Tier placement can change, and different plans may place the same drug in different tiers.

Question 36

Can I change my Part D plan?

Accepted Answer

You may be able to change during certain enrollment periods such as AEP, or during a qualifying SEP. Rules depend on your situation.

Question 37

What is the Part D late enrollment penalty?

Accepted Answer

If you go without creditable prescription coverage for a certain period, you may pay a late enrollment penalty. Whether it applies depends on your coverage history.

Question 38

What is AEP (Annual Enrollment Period)?

Accepted Answer

AEP runs from October 15 to December 7 each year. During this time, many beneficiaries can review and change coverage options for the next year.

Question 39

What is the Medicare Advantage Open Enrollment Period (OEP)?

Accepted Answer

OEP generally runs from January 1 through March 31 for people already enrolled in a Medicare Advantage plan. Options and rules apply based on your situation.

Question 40

What is an SEP (Special Enrollment Period)?

Accepted Answer

An SEP is a time outside standard enrollment periods when you may be able to make changes due to a qualifying event such as moving or losing certain coverage. Eligibility rules apply.

Question 41

If I move, can I change my Medicare plan?

Accepted Answer

Moving may trigger an SEP depending on circumstances. Timing and eligibility rules apply, and plan availability differs by county and ZIP code.

Question 42

If I lose employer coverage, can I enroll in Medicare?

Accepted Answer

Losing qualifying employer coverage may allow a Special Enrollment Period for Part B and/or plan changes. It's important to review timing to avoid gaps or penalties.

Question 43

Can I switch from Medicare Advantage to Original Medicare?

Accepted Answer

Switching may be possible during certain enrollment periods. If you want a Medigap policy, underwriting rules may apply depending on timing and state-specific protections.

Question 44

Why should I review my Medicare plan each year?

Accepted Answer

Plans can change benefits, networks, formularies, and costs each year. An annual review helps confirm your plan still aligns with your doctors, prescriptions, and budget.

Question 45

If my plan still fits, do I have to change it?

Accepted Answer

No. If your plan still fits your needs, you can keep it. A review is about confirming alignment - not forcing a change.

Question 46

What should I have ready for a Medicare review?

Accepted Answer

A list of your doctors, your prescriptions (name/dosage), preferred pharmacies, and any concerns about costs or access. We compare available options based on your ZIP code and eligibility.

Question 47

Can my prescriptions affect which plan is best for me?

Accepted Answer

Yes. Drug coverage varies by plan. Formularies, tiers, and preferred pharmacies can change, so verifying coverage based on your exact medications is important.

Frequently Asked Questions

Getting Started

Turning 65

Under 65 Medicare

Costs & Coverage

Medicare Advantage

Medigap

Part D

Enrollment Periods

Annual Reviews

Still Have Questions?