Frequently Asked Questions About Medicare
Navigating Medicare can be overwhelming, but we’re here to help! Below are some of the most common questions seniors have about Medicare, along with clear answers to help you make informed decisions.
1. When can I enroll in Medicare?
Most people first become eligible for Medicare when they turn 65. Your Initial Enrollment Period (IEP) starts three months before your 65th birthday and lasts for three months after your birthday month—a total of seven months.
If you miss your IEP, you may still enroll during the General Enrollment Period (January 1 – March 31), but you may face late penalties unless you qualify for a Special Enrollment Period (SEP).
Find out more about Turning 65 and enrolling in Medicare for the first time.
2. What is the difference between Original Medicare and Medicare Advantage?
Original Medicare (Parts A & B) is a government program that covers hospital stays (Part A) and medical services (Part B). You can add a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs and a Part D plan for prescription drugs.
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies. These plans often include prescription drug coverage and extra benefits like dental, vision, and hearing.
3. Do I need Medicare if I’m still working?
If you have health insurance through your employer or your spouse’s employer, you may be able to delay Medicare enrollment. However, if the employer has fewer than 20 employees, Medicare may become your primary coverage, so it’s important to check with your employer’s benefits administrator.
4. How much does Medicare cost?
Medicare Part A: Most people get it for free if they’ve worked at least 10 years and paid Medicare taxes.
Medicare Part B: Has a monthly premium (set annually) and may vary based on income.
Medicare Advantage (Part C) & Prescription Drug Plans (Part D): Costs vary depending on the plan and provider.
5. Can I change my Medicare plan?
Yes! You can make changes during designated enrollment periods:
Annual Enrollment Period (AEP): October 15 – December 7 (change any Medicare plan)
Medicare Advantage Open Enrollment Period: January 1 – March 31 (switch or drop a Medicare Advantage plan)
Special Enrollment Periods (SEPs): If you experience certain life events, such as moving or losing employer coverage, you may qualify for a special window to change plans.
6. Does Medicare cover prescription drugs?
Medicare does not automatically include prescription drug coverage. You’ll need to enroll in either:
A Medicare Part D standalone drug plan (if you have Original Medicare)
A Medicare Advantage plan that includes drug coverage
7. Does Medicare cover dental, vision, or hearing?
Original Medicare does not cover routine dental, vision, or hearing services. However, some Medicare Advantage plans offer these additional benefits.
8. What happens if I don’t sign up for Medicare on time?
If you don’t enroll when first eligible and don’t have other qualifying coverage, you may face lifetime late enrollment penalties for Part B and Part D.
9. How do I find the right Medicare plan for me?
Choosing the right Medicare plan depends on your health needs, budget, and preferred doctors. We can help you compare options and find a plan that works for you.
Guidance is also available through Medicare.gov and by calling 1-800-MEDICARE. Your state’s Insurance Commissioner also offers support at no cost to you.
Have Questions? We Can Help!
At Plan Insight, we’re here to guide you through your Medicare journey with personalized support.