Medicare Frequently Asked Questions
Medicare can feel overwhelming, but getting clear answers doesn’t have to be. Our Frequently Asked Questions cover the basics; enrollment, costs, coverage, prescriptions, and more—so you can make confident decisions about your health care.
Enrollment & Eligibility
When can I enroll in Medicare?
You can first enroll during your Initial Enrollment Period, which lasts seven months: three months before, the month of, and three months after your 65th birthday. Other opportunities include the General Enrollment Period (Jan. 1 – Mar. 31) and Special Enrollment Periods for qualifying life events such as within 63 days of loss of employer creditable coverage (voluntary or involuntary).
Do I have to enroll in Medicare at 65?
Not always. If you have creditable employer coverage, you may be able to delay without penalty. If not, delaying enrollment can result in late fees.
What happens if I miss my Initial Enrollment Period?
You may pay lifelong late penalties and be restricted to enrolling during the General Enrollment Period (Jan. 1–Mar. 31), with coverage beginning the first of the next month.
Can I enroll in Medicare if I’m still working?
Yes. The rules depend on your employer’s size. For companies with fewer than 20 employees, Medicare usually becomes primary at 65. With larger employers, you may be able to stay on their plan and delay Medicare without penalty. Check with your HR or Benefits department to learn if your employer health insurance plan is considered Creditable Coverage.
Do I qualify for Medicare before age 65?
Yes, if you’ve been receiving Social Security Disability benefits for 24 months or have certain conditions like End-Stage Renal Disease (ESRD) or ALS.
Coverage Basics
What does Medicare Part A cover?
Part A covers hospital stays, skilled nursing care (short-term) full time rehab, hospice care, and some home health care.
What does Medicare Part B cover?
Part B covers doctor visits, outpatient services, preventive care, lab work, and medical equipment.
What is Medicare Part C (Medicare Advantage)?
Medicare Advantage plans are private insurance options that include Part A and Part B coverage, often with added benefits like dental, vision, hearing, and prescription drugs (Part D).
What is Medicare Part D?
Part D provides prescription drug coverage through private plans. You must enroll in Part D, unless you have other creditable coverage, otherwise you will be subject to Late Enrollment Penalties (LEP).
Does Medicare cover dental, vision, or hearing?
Original Medicare does not cover routine dental, vision, or hearing. Some Medicare Advantage plans offer these as extras either as part of the plan or for additional premiums.
Does Medicare cover long-term care?
No. Medicare does not pay for custodial care in nursing homes or assisted living. It only covers short-term skilled nursing or rehab after a hospital stay. Long-Term Care (LTC) is separate insurance that requires underwriting.
Costs & Penalties
How much does Medicare cost?
Part A is usually premium-free if you’ve worked 10 years (40 quarters). Part B has a standard monthly premium, with higher rates for individuals with higher incomes (IRMAA). Medicare Advantage, Medicare Supplement/Medigap and Part D plans have varying premiums, deductibles, and copays.
What is IRMAA?
The Income-Related Monthly Adjustment Amount is an added cost for Part B and Part D premiums based on your income. It is based on the household income and for those with higher incomes.
What happens if I don’t sign up for Part B on time?
You may face a 10% penalty for each 12-month period you delayed, and this penalty lasts for life.
Is COBRA considered creditable coverage for Medicare?
No. Once you’re eligible for Medicare, COBRA is not creditable. Relying on COBRA instead of Medicare can cause gaps in coverage and late penalties.
Plan Choices
What’s the difference between Original Medicare and Medicare Advantage?
- Original Medicare: Government-managed, lets you see any provider nationwide who accepts Medicare. Does not include prescription drug coverage unless you add Part D. Most people will add a Supplement or Medigap plan to offset costs and limit risk.
- Medicare Advantage: Private plans that bundle Part A and B, often Part D, and may include extras like dental and vision. Usually requires using a provider network.
What is Medigap (Medicare Supplement)?
Medigap plans help pay for costs that Original Medicare doesn’t cover, like deductibles and coinsurance. They work only with Original Medicare, not Medicare Advantage.
Can I have both Medicare Advantage and Medigap?
No. You must choose one or the other.
When can I change my Medicare plan?
The Annual Enrollment Period (Oct. 15–Dec. 7) allows you to switch plans. You may also qualify for Special Enrollment Periods in certain situations, like moving or losing other coverage.
Prescriptions
Do I need Medicare Part D if I don’t take medications?
Yes, unless you have other creditable drug coverage. If you skip Part D now and add it later, you may face permanent late penalties.
What does “formulary” mean?
A formulary is the list of drugs a Part D or Medicare Advantage plan covers, often grouped into tiers with different costs.
Are all prescriptions included in all Part D plans?
No. Each plan has a formulary of covered prescriptions and are required to have two prescriptions per ailment. It is important to check every year to make sure your prescriptions are still being covered by your insurance company.
Are all prescription tiers the same for Part D plans?
No. Each insurance company can determine which tier they want to place a prescription. It’s important to never assume because one insurance company has a prescription on a low costing tier that a different insurance company will do the same.
Are all pharmacies in-network for Part D plans?
No. Each plan has a network of preferred pharmacies. Using an out-of-network pharmacy can increase costs or may not be covered.
Other Common Questions
Does Medicare cover overseas travel?
Original Medicare does not cover care outside the U.S. Some Medigap and Medicare Advantage plans include limited emergency coverage abroad. However, no other county recognizes our health insurance plans. Be prepared to either have a credit card ready to pay the bill and then submit to your insurance company when you return or have travel medical insurance. Please note, your health insurance company will not pay for emergency travel back home; this is additional travel insurance.
Does Medicare cover telehealth visits?
Yes. Medicare covers many telehealth services, although rules and coverage may vary by plan.
Can I get help with my Medicare costs?
Yes. Programs like Extra Help, Medicaid, or Medicare Savings Programs may assist with premiums, deductibles, and prescriptions.
