Frequently Asked Questions

Medicare is federal health insurance for people 65 or older, some younger people with qualifying disabilities, and people with End-Stage Renal Disease.  There are four parts to Medicare, and each help cover specific services.  The four parts are: 

• Medicare Part A (Original Medicare - Hospital Insurance) 
  Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. 
• Medicare Part B (Original Medicare - Medical Insurance)
  Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. 
• Medicare Part C (Medicare Advantage Plans)
  Part C is private-sector health insurance that covers everything included in Part A and B and often includes coverage for additional services that are not included in Part A or Part B.  Depending on the plan you choose, you can get dental insurance, prescription coverage, fitness benefits, and much more. 
• Medicare Part D (Prescription Drug Coverage) 
  Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). 

Medicare Supplement Insurance is private health insurance that covers gaps in Original Medicare (Parts A & B). Medicare Supplement Plans help pay some of the health care costs that the Original Medicare Plan doesn't cover. Medicare Supplement Plans are not the same as Medicare Advantage Plans (Part C) and can only be combined with Original Medicare. You may choose to also enroll in a stand-alone prescription drug plan, or a dental and vision plan. 

A Special Needs Plan (SNP) is a type of Medicare Advantage plan that covers more specific health care needs for those who qualify. All SNPs include prescription drug coverage, but availability of plans will depend on where you live. You can find these plans using our Enrollment Tool when you select “Add all Special Needs Plans (SNP)” at the top of your search results.

SNPs are broken into four categories, which include: 

• Dual Special Needs Plans (D-SNPs)  
  These are for people who have both Medicare and Medicaid (called “dual eligible”) 
• Chronic Special Needs Plans (C-SNPs)  
  These are for people living with certain severe or disabling chronic conditions 
• Institutional Special Needs Plans (I-SNPs)  
  These are for eligible people who live in a skilled nursing facility 
• Institutional-Equivalent Special Needs Plans (IE-SNPs)  
  These are for eligible people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility 

While Part A pays the majority of Medicare-approved hospital costs, you will be responsible for paying things like deductibles and coinsurance. In addition, Medicare only pays approximately 80% of your Medicare-approved doctor visits, procedures and tests and you’re responsible for the other 20%. A Medicare Advantage plan (Part C) may help keep your healthcare costs more affordable and many Part C plans can include Part D prescription drug coverage. 

Whether you need a Prescription Drug Plan is completely up to you. Most Medicare Advantage plans include Prescription Drug Coverage (Part D).  These types of coverage help protect you against high out-of-pocket drug costs, and if you decide not to get one when you’re first eligible, you may pay a late enrollment penalty later. Even if you don’t take many prescriptions now, you should consider enrolling in a Prescription Drug Plan when you’re first eligible.   

Your Medicare Card will show whether you have Medicare Part A, Part B or both. You will need the Medicare Card number when you enroll in Part C.  If you do enroll for Medicare Advantage (Part C), you will receive an additional card once your enrollment is complete. Be sure to carry all cards with you and show them to your doctor, hospital, or other health care provider if you need medical care. 

Except for those who qualify by disability, Medicare eligibility generally begins at age 65 and signing up on time can help you avoid premium surcharges. But if you’re working past age 65, you may qualify for a Medicare Special Enrollment Period (SEP) that allows you to delay enrollment without incurring penalties, as long as you have confirmation of creditable coverage from you or your spouse’s employer. This means you can wait to sign up until you or your spouse stop working or you lose your health insurance, whichever comes first.  However, before you postpone enrollment, it’s good to consult with the benefits administrator at your or your spouse’s workplace to see how the group policy will cover you at age 65 and beyond.   

Anyone turning 65—or anyone under 65 with a disability or other special situation—may enroll.  Some people are enrolled into Part A and B automatically, while others must sign up.

If you currently receive Social Security or Railroad Retirement Board benefits, you may be automatically enrolled. You'll receive your Medicare Card in the mail before your 65th birthday. You'll still have an Initial Enrollment Period (IEP), during which you may make Medicare coverage decisions. 

If you are not currently receiving Social Security or Railroad Retirement Board benefits when you turn 65, you'll have to sign up for Medicare yourself. You can enroll online at the Social Security website (https://secure.ssa.gov/iClaim/rib) or by calling or visiting your local Social Security office.  Medicare may not notify you about your eligibility, so be sure to mark your IEP dates on your calendar. 

Yes.  You must have Medicare Part A and Part B to join a Medicare Advantage Plan (Part C).  You will be asked to enter the number on your Medicare Card while you are filling out your enrollment forms with our Enrollment Tool. 

If you’re eligible for Original Medicare (Parts A & B) you can usually only enroll, switch plans, or drop a plan at certain times of the year.  These times are called enrollment periods.  The enrollment periods for Original Medicare are as follows: 

• Initial Enrollment Period (IEP) 
  This period varies for each person.  If you qualify by age, it starts 3 months before you turn 65, includes your birthday month, and ends 3 months later.  If you qualify by disability, it starts three months before the 25th month of disability benefits from Social Security or the Railroad Retirement Board, includes the 25th month of disability benefits, and ends 3 months later. 
• General Enrollment Period (GEP) 
  General Enrollment lasts from January 1 to March 31 and is open for people who miss their IEP.  During this period, you can sign up for Part A and/or Part B, but your coverage won’t start until July 1. You may also have to pay a late-enrollment penalty for Medicare Part B if you didn’t sign up when you were first eligible. And if you aren’t eligible for premium-free Part A, you may have to pay a late-enrollment penalty for this as well.  
• Special Enrollment Period (SEP) 
  The timing of SEP varies depending on your qualifying situation; however, once you are eligible for special enrollment, it generally lasts for eight months.  Qualifying situations can include moving, losing coverage, financial eligibility, getting married, or chronic illness.  

Once you’re enrolled in Original Medicare, you usually have the option to enroll in a Medicare Advantage plan during certain times of the year.  These times are called enrollment periods.  The enrollment periods for Medicare Advantage are as follows:  

• Initial Coverage Election Period (ICEP) 
  For most people, this period takes place at the same time as their Initial Enrollment Period for Original Medicare, described above. If you delay Medicare Part B enrollment, your ICEP starts three months before you have both Medicare Part A and Part B and ends the last day of the month before your Medicare Part B coverage starts. 

• Open Enrollment Period (OEP) 
  Open Enrollment lasts from January 1 to March 31.  During this time the only changes you can make are to switch between different Medicare Advantage plans or drop your Medicare Advantage plan and go back to Original Medicare. If you do revert to Original Medicare, you can sign up for a stand-alone Medicare prescription drug plan during this period as well.   

• Annual Enrollment Period (AEP) 
  Annual Enrollment lasts from October 15 to December 7.  If you are already enrolled in Medicare, this is the time you have to make the most changes to your current plan or switch to a different Medicare plan entirely. Whatever changes you make will begin on January 1 of the following year. 

• Special Enrollment Period (SEP) 
  The timing of SEP varies depending on your qualifying situation.  Qualifying situations can include moving, losing coverage, financial eligibility, getting married, or chronic illness.  

You can enroll online right here!  Simply click “Get My Quotes and Enroll Online” to start the process.  You will be asked a few initial questions before you are directed to the Enrollment Tool.  Once the tool launches, just enter your zip code to see all the available plans in your area and choose the plan that’s right for you.  When you find the plan you want, click “Add to Cart”.  The exact forms you need will appear for you to fill out, review, and submit, and just like that, you’ve enrolled.   

There are a few things you may want to consider before you delay enrollment in Medicare Part A.

• Does the Employer Have 20 or More Employees? 
  If your or your spouse's employer has 20 or more employees and a group health plan, you don't have to sign up for Medicare at 65 if it doesn't make financial sense. (However, Part A is free for most people.) 

• Does the Employer Have Fewer than 20 Employees?
  If your or your spouse's employer has fewer than 20 employees and the health coverage is not part of a multiemployer group plan, at age 65 you must enroll in Medicare Part A, which will be your primary insurance. “Primary” means that Medicare pays first, and then the employer insurance kicks in to pay whatever might be covered under that policy but was not covered by Part A. 

• Do You Have a Health Savings Account? 
  If you're saving to a Health Savings Account and wish to keep doing so, you must delay enrollment in Medicare Part A (or Medicare Part B), because Medicare enrollees can't contribute to an HSA. In fact, to avoid a tax penalty, you should plan to stop making HSA contributions at least six months prior to signing up for Medicare.

• Potential Penalties: 
  If you don’t enroll in Medicare Part A at age 65 and neglect to sign up within eight months of stopping work or losing employer coverage (whichever comes first), you may have to pay a penalty. In any case, you should sign up for Part A before your employer coverage ends to avoid a gap in your health coverage. 

It is recommended that you confirm your Medicare options with your employer or a licensed sales agent.

There are a few things you may want to consider before you delay enrollment in Medicare Part B: 

• Does the Employer Have 20 or More Employees? 
  If your or your spouse's employer has 20 or more employees and a group health plan, you don't have to sign up for Medicare at 65 if it doesn't make financial sense. (There is a premium for Part B, so you may want to delay enrollment to avoid this monthly charge.) 

• Does the Employer Have Fewer than 20 Employees? 
  If your or your spouse's employer has fewer than 20 employees and the health coverage is not part of a multiemployer group plan, at age 65 you must enroll in Medicare Part B, which will be your primary insurance. 

• Do You Have a Health Savings Account? 
  If you have an HSA and want to continue making contributions to it, you must delay signing up for Medicare Part B. Stop making contributions to your HSA at least six months before you sign up for Part B. And you’ll want to sign up for Medicare at least a month before you stop work or lose employer coverage. 

• Potential Penalties:  
  You must sign up for Medicare Part B within eight months from the time you stop work or lose employer coverage. Failing this, your premiums may include a penalty — for the rest of your life. In addition, you may have to wait to enroll in Medicare, resulting in a risky gap in health care coverage. 

You can make changes to Medicare Advantage during the Annual Enrollment Period (October 15-December 7). Some people are eligible for a Special Enrollment Period (SEP), which can happen if you move or lose other insurance coverage. There are different rules about when you can make changes and the type of changes you can make depending upon your SEP. 

If you are 65 years or older, there are still a few requirements you need to meet before you can enroll in Medicare.  First, you must be a United States citizen or a permanent resident who has lived in the U.S. for at least five years. Then you must meet one of the following criteria: 

1. You or your spouse has worked at least 10 years and are eligible for either Social Security or Railroad Retirement benefits. 
2. You or your spouse is a government employee or retiree who has paid Medicare payroll taxes while working. 

You do not have to be on Social Security before you can enroll in Medicare.  But keep in mind that if you are not on Social Security, you will have to enroll for Medicare on your own. It’s important to apply for Medicare during your initial enrollment period. This is a seven-month period including your 65th birth month plus the three months before and after it.  If you do not enroll in Medicare during this initial time frame, you may have to pay a permanent surcharge on your Medicare Part B and Part D premiums. 

There are a few requirements you must meet in order to qualify for premium-free Medicare Part A.  You must be 65 or older, and you, or your spouse, need to have paid Medicare taxes for at least 10 years of your life. These do not have to be consecutive years. 

You may also qualify for premium-free Medicare Part A if you are 65 or older and meet one of three requirements: 

1. You are receiving Social Security or Railroad Retirement benefits. 
2. You are eligible to receive Social Security or Railroad Retirement benefits but have not yet applied for them. 
3. You or your spouse was employed in a government job that was Medicare-covered. 

You may be dual eligible to enroll in Medicare and Medicaid if you meet certain financial eligibility requirements. Your eligibility for Medicaid depends on your income and financial resources. 

Even if you don’t qualify for Medicaid while enrolled in Medicare, you may still qualify for one of the federally funded Medicare Savings Programs to help people with limited income and resources. Check with your state’s Medicaid office to determine if you qualify. 

You must first be enrolled in Original Medicare (Parts A & B) before you are eligible for a Medicare Supplement Insurance (Medigap) plan. You are eligible to buy Medigap coverage during your six-month Medigap Open Enrollment Period.  This period automatically starts the first month you have Medicare Part B and you’re 65 or older.  

If you wait until the open enrollment period passes, it may cost more to buy a Medicare Supplement Insurance plan in the future, or you could be denied based on current or past health issues. You are not able to purchase both a Medigap and a Medicare Advantage (Part C) plan.

Under Original Medicare, you can go to any doctor, hospital or other health care provider that accepts Medicare.  Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.  And Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. 

Medicare Advantage plans must provide all the coverage you would get from Original Medicare.  They usually provide additional coverage not included in Parts A and B such as vision, dental, hearing and prescription drug coverage.  Medicare Advantage plans usually have a predetermined network of providers, and you may need to pay out-of-pocket if you use healthcare services that are outside of the network. 

Part D is offered through private companies, either as a stand-alone plan to go with Original Medicare, or it’s included with your Medicare Advantage Plan.  This means coverage can vary depending on the plan you choose.  All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS.  

Each plan should have a list of the specific drugs it covers, which is called a “formulary”. If your drug is not on the formulary, you may have to request an exception, pay out of pocket, or file an appeal.  Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. 

Original Medicare does not include dental insurance, but some Medicare Advantage plans can have dental coverage built in. If you choose a plan without dental coverage built in, you can also look for a stand-alone dental plan. 

Original Medicare does not cover routine vision exams or glasses, but Part B (medical insurance) helps cover certain vision-related services if you have eye disease or injury.  However, you can enroll in certain Medicare Advantage plans that provide the same coverage as Part B and then some.  There are quite a few Medicare Advantage plans that cover routine eye exams and corrective lenses. 

Medicare does not usually cover medical care you receive when traveling outside the U.S. and its territories. Some Medicare Advantage Plans may cover emergency care abroad, or you can look for a Medigap policy that offers this type of coverage instead. If you plan to travel often, it’s a good idea to check the specific coverage rules of the policy you choose. 

Medicare does not usually cover nursing home care or custodial care, which includes helping you with daily activities such as bathing, dressing, eating, or using the bathroom.  Occasionally, Medicare Part A can cover skilled nursing facility care, but it must be certified and deemed medically necessary.  Original Medicare may also provide some home health care coverage, including physical therapy or speech-language pathology services, depending on the circumstances.  

Most people pay no premium for Medicare Part A, but in 2023, the standard premium for Medicare Part B starts at $164.90, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022. Premiums for Medicare Advantage plans and Part D prescription drug plans vary based on the plan.

Yes, there are plans that you can enroll in that have no monthly premium, but keep in mind that you will still need to pay a premium if you are enrolled in Medicare Part B.  Zero-premium plans available in your area might have a higher deductible, copay, or total out-of-pocket exposure than plans that have premiums, so make sure you carefully compare the details of each plan to get the coverage that is right for you. 

Medicare Part D prescription drug plan premiums vary depending on the plan. In addition, Medicare requires higher-income individuals and married couples to pay an extra fee based on their income. You should compare prices to find the best price for your needs. 

You are no longer allowed to contribute money to your health savings account (HSA) once you enroll in Medicare, but you can continue using money already in your HSA to pay out-of-pocket Medicare costs, such as Part A, B, C or D premiums, medical copays/coinsurance, or dental copays. An HSA cannot be used for dental or Medicare supplement premiums. 

Several programs are available to help people pay out-of-pocket expenses and premiums for Medicare.  You can find more information about who qualifies and how to apply at Medicare.gov.  Some of the programs include:  

• Medicaid, including dual eligibility in Medicare and Medicaid 
• Medicare Extra Help program 
• Medicare Savings Programs (MSP); there are four of these based on your financial need and situation 
• PACE (Program of All-inclusive Care for the Elderly) 
• State Health Insurance Assistance Program (SHIP) 
• Supplemental Security Income (SSI), administered through the Social Security Administration