Medicare FAQs

Your Question
What is Medicare?
Is Medicare free?
Who is eligible for Medicare?
Will I automatically be enrolled in Medicare when I turn 65?
I didn't enroll in Medicare Part B when I turned 65 because I was still working. Can I enroll now?
I originally refused Medicare Part B when I turned 65. Can I enroll now?
What is the Initial Enrollment Period (IEP)
What is the General Enrollment Period (GEP)
What is the Special Enrollment Period (SEP)
What is Late Enrollment Penalty?
Does Medicare pay 100% of my healthcare cost?
What does Medicare Part A cover?
What does Medicare Part B cover?
Does Medicare have deductibles and coinsurance?
Does Medicare pay for prescription drugs?
What is Part C Medicare Advantage?
What does Medicare Advantage cover?
Does Medicare Advantage cover prescription drugs?
Can I skip playing for Part B premium if I have a Medicare Advantage?
When can I enroll or disenroll from Medicare Advantage?
What is the Annual Enrollment Period (AEP)
What is the Medicare Advantage Open Enrollment Period (MAOEP)?
What is Part D Prescription Drug Plan (PDP)?
When can I enroll or disenroll from Medicare Prescription Drug Plan?
What is Medicare Supplement Plan?
What is the most popular Medicare Supplement plan and why?
What is the best time to enroll in Medicare Supplement?
What is the best time to enroll in Medicare Supplement?
What are the differences between Original Medicare and Medicare Advantage
What are differences between Medicare Supplement and Medicare Advantage?
What are differences between Medicare Supplement and Medicare Advantage?

What is Medicare?

Medicare is a Federal health insurance program for people 65 years or older, people with certain disabilities, and those people with permanent kidney failure treated with dialysis or a transplant. Original Medicare has two parts - Part A which is often called hospital insurance, and Part B which is called medical insurance.

Is Medicare free?

No! Medicare is not Free. If you paid Medicare taxes for 40 quarters (or 10 years), Medicare Part A will have no monthly premium. However, Medicare Part B has a monthly premium. For 2025, the monthly premium for Part B is $185.00 and it tends to change every year. Most people pay the Medicare Part B monthly premium of $185.00, however, a small percentage of people with higher income may pay additional Income-Related Monthly Adjustment Amount (IRMAA).

Who is eligible for Medicare?

To qualify for Medicare, you must be:

65 or older; or
Disabled and receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months; or
Have permanent kidney failure treated with dialysis or a transplant

Contact the Social Security Administration to file an application. There are several ways to apply for Medicare including filing your application online, via phone, or in person by visiting your local Social Security Administration Office. You can also apply for Social Security Income (SSI) benefits at the same time.

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Will I automatically be enrolled in Medicare when I turn 65?

If you are receiving Social Security Income (SSI) or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday, you will receive your Medicare ID card (RED, WHITE, AND BLUE card) in the mail. Also, people who have been receiving disability income for 24 months, will be automatically enrolled in Medicare Part A and Part B and will be receiving their Medicare ID in the mail. If you want to refuse Part B coverage, you must inform Social Security Administration that you want to opt out of Part B. You will later receive new Medicare ID Card showing that you are only enrolled in Medicare Part A.

I didn't enroll in Medicare Part B when I turned 65 because I was still working. Can I enroll now?

Yes, you can. You may qualify to enroll in Medicare during a Special Enrollment Period (SEP) if you delayed enrolling in Part B. If you were working and had group health insurance through your employer or your spouse's employer, you will not have to pay the Part B premium Late Enrollment Penalty.

I refused Medicare Part B when I turned 65. Can I enroll now?

Yes, people who refused, terminated, or withdrawn from Medicare Part A and/or Medicare Part B can enroll again. You can use the General Enrollment Period (GEP) during the months of January, February, and March to enroll in Medicare Part A and Part B. Your Medicare coverage will begin on July 1st. Your Medicare coverage will not begin until July 1st.

What is the Initial Enrollment Period (IEP)

Initial Enrollment Period (IEP) is one in a lifetime enrollment period. IEP is a 7 month window that begins 3 months from your 65th birthday month, your 65th birthday and 3 months after your birthday month. This enrollment is triggered when you become eligible for Medicare at 65 or 24 months after being on disability benefits.

During this enrollment period, you can do the following:

Enroll in Medicare Part A and Part B when you turn 65
Enroll in Part C Medicare Advantage Plan, or
Enroll in a Medicare Supplement (Also see Medicare Supplement Open Enrollment Period (MSOEP), and
Enroll in Part D Prescription Drug Plan (PDP)

What is the General Enrollment Period (GEP)

General Enrollment Period (GEP) is a yearly occurring enrollment period to allow those who missed to enroll in Medicare Parts A and B during their Initial Enrollment Period (IEP). General Enrollment Period (GEP) runs from January 1st thru March 31st of every colander year. When you elect to enroll in Medicare Part A and/or Part B during GEP, your Medicare coverage will begin on July 1st of the same year.

One problem with enrolling for Medicare during GEP is that you cannot enroll in either Part C Medicare Advantage or Part D Prescription Drug plan until the upcoming Annual Enrollment Period (AEP). What that means, you will not have any supplemental and prescription coverage until January 1st of the following year.

What is the Special Enrollment Period (SEP)

Generally, Medicare Special Enrollment Period (SEP) is period of 2 months that is triggered by certain circumstances allowing you the chance to make changes to your plans. Circumstances that trigger an SEP are:

Move to New Service Area (different state or county)
Involuntarily Gained or Lost Employer or Union Coverage
Released from Imprisonment
Change in Medicaid Eligibility or Medicare Savings Program
Change in Low Income Subsidy Eligibility
Moved In or Moved Out of Nursing Home or Long-Term Care Facility
Became Part of State Pharmacetical Assistance Program
Have Chronically Ill or have disability and Receiving Social Security
Enrolled in Dual Special Needs Plan (DSNP)
Enrolling in a 5 Star Plan available in your area

In addition, Special Enrollment Period (SEP) can also be triggered when you lose a group health insurance from your employer or your spouse's employer. In this circumstances, you will have 8 months from the time you lose your benefits. During those 8 months you can apply for Medicare Part A and Part B without being liable to pay Late Enrollment Penalty.

What is Late Enrollment Penalty?

Medicare Part A has a late enrollment penalty that apply for those who missed to enroll when they first become eligible. If you were eligible for Part A for 2 years but didn't sign up, you'll have to pay the higher premium for 4 years. Medicare Part B, has a penalty is equal to 10% per year for every year (12 full months) that you waited to enroll. This penalty gets applied against the standard Part B premium that you supposed to pay every month.

Does Medicare pay 100% of my healthcare cost?

No. Medical services are covered by Medicare just like Group Health Insurance, you may have deductibles, copays and coinsurance that you have to pay when you use medical services.

What does Medicare Part A cover?

Part A covers inpatient hospital services like hospital stays, medications given when hospitalized, basic hospital meals, in-hospital lab services, home healthcare, skilled nursing home, and hospice care.

What does Medicare Part B cover?

Medicare Part B covers outpatient medical services like doctor's visits, emergency and urgent care visits, medications given at doctor's office, lab services, durable medical equipment, outpatient surgical procedures, ambulance services, diagnostic radiology, radiation and chemotherapy, some immunizations, and diagnostic procedure. Part B also covers preventive care including flu shots, colonoscopies, mammograms and more.

Does Medicare have deductibles and coinsurance?

A deductible is the amount you must pay each year before Medicare starts paying its portion of your medical cost. Both Medicare Part A (Hospital Insurance) and Part B (doctor services) have deductibles. Medicare Part A has a deductible of $1,676 for 2025 for each benefit period and Medicare Part B has a deductible of $257 for 2025.

Coinsurance is a percentage of your medical bill that you have to pay after you meet your deductible. For Medicare Part B, Medicare pays 80% of the bill and leaves you with 20% for you to pay. You will continue to pay your 20% share until the end of the year and there is no cap on how much you pay.

Does Medicare pay for prescription drugs?

Original Medicare does not cover prescription drugs. However, Medicare may cover some drugs if they are given inpatient like hospital or outpatient like doctor's office. Medicare may cover some drugs like immunosuppressive drugs (for transplant patients) and oral anti-cancer drugs.

What is Part C Medicare Advantage?

Medicare Advantage (MA) is a type of Medicare health plan that are approved my Medicare but they are offered by private health insurance companies. Medicare Advantage plans are pretty similar to employer's group health plan. MA plans are considered an alternative to Original Medicare.

What does Medicare Advantage cover?

At minimum, Medicare Part C Medicare Advantage must covers all services under Original Medicare Part A (Hospital Insurance) and and B (Medical Insurance). In addition, Medicare Advantage plans often include Prescription Drugs coverage embedded in the plan. It may also cover other extra benefits like dental, hearing, vision, and over-the-counter (OTC) benefits.

Does Medicare Advantage cover prescription drugs?

Most Medicare Advantage plans include prescription drug coverage. However, there few Medicare Advantage plans that do not cover prescription drugs. Those plans are suited for Medicare beneficiaries who have prescription coverage from the Veterans Affairs (VA) or for those beneficiaries who might have to pay a high amount of Part D Late Enrollment Penalty.

Can I skip playing for Part B premium if I have a Medicare Advantage?

NO. You must be enrolled in both Medicare Part A and Part B to be eligible to enroll in Medicare Advantage. If you stop paying your Medicare Part B premium, you will be disenrolled from Medicare Part B and Medicare Part C as well.

When can I enroll or disenroll from Medicare Advantage?

You can first enroll into Part C Medicare Advantage plan at the same time you enroll into Original Medicare during your Initial Enrollment Period (IEP). Another time you can enroll in Medicare Advantage during the Annual Enrollment Period (AEP) which runs from October 15 thru December 7. Your plan will start on January 1.

What is the Annual Enrollment Period (AEP)

Annual Enrollment Period (IEP) is a yearly occurring enrollment period that runs from October 15th through December 7th. When you elect to make changes during the Annual Enrollment Period (AEP), you newly elected plan will start on January 1st of the following year. It is very important to realize that insurance carriers change their plan's health and drugs coverage every year and this AEP period allow Medicare beneficiaries to make transitions from one plan to other plans. During the Annual Enrollment Period (AEP), you can make the following transitions:

If you only have Original Medicare Part A and Part B, you can elect to enroll in Part C Medicare Advantage plan to gain more benefits and prescription drug coverage. Or, you can also add stand-alone Part D Prescription Drugs Plan (PDP) to cover your drug cost.
You can drop your current Part C Medicare Advantage Plan and enroll in a different Part C Medicare Advantage.
You can drop your current Part D Prescription Drugs Plan (PDP) and enroll in a stand-alone Part C Medicare Advantage Plan.
You can drop your current Part C Medicare Advantage Plan and enroll in a stand-alone Part D Prescription Drugs Plan (PDP).

Millions of Medicare beneficiaries utilize the Annual Enrollment Period (AEP) to transition from one plan to another. Our highly experiences Medicare Advisors are here to help you and make this transition process easy and transparent.

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

Medicare Advantage Open Enrollment Period (MAOEP) is yearly enrollment period that runs from January 1st through March 31st. Only Medicare beneficiaries who are current enrollees in a Medicare Advantage plan can utilize MAOEP to make certain transitions. During the Medicare Advantage Open Enrollment Period, Medicare beneficiaries to make one time change. When you utilize MAOEP to make changes during the any of the three months, your changes will become effective on the 1st of the following month as shown in the table below. Medicare Advantage enrollees can elect to do one of the following transition:

You can disenroll from your Medicare Advantage plan and enroll in a new Medicare Advantage plan.
you can disenroll from Medicare Advantage plan and go back to Original Medicare. You may then elector to enroll in Part D Prescription Drug Plan (PDP) and add a Medicare Supplement (Medigap).

What is Part D Prescription Drug Plan (PDP)?

Medicare Part D Prescription Drug Plans, also known as PDP are standalone plans that are approved by Medicare but are offered by private health insurance companies. Prescription Drug Plans (PDP) provide coverage for prescription drugs and medications purchased from retail or mail-order pharmacies. Some vaccines may also be covered by PDP plans.

When can I enroll or disenroll from Medicare Prescription Drug Plan?

You can first enroll into Part D Prescription Drug Plan (PDP) at the same time you enroll into Original Medicare during your Initial Enrollment Period (IEP). Another time you can enroll in PDP during the Annual Enrollment Period (AEP) which runs from October 15 thru December 7. Your plan will start on January 1. Finally, you can enroll in PDP during the Medicare Advantage Open Enrollment Plan (MAOEP) only if you are disenrolling from a Part C Medicare Advantage plan. MAOEP occurs from January 1 thru March 31.

What is Medicare Supplement Plan?

Medicare supplement (Medigap) plan serves to fill the gap that Medicare leaves behind. If you only have Original Medicare, both Parts A and B have cost-sharing like deductibles, copays and coinsurance that you are responsible to pay when you use the services. For example, Part A has a deductible of $1,5576 for 2022 that you must pay when you stay in the hospital. Another example of cost-sharing, Part B has a deductible of $233 for 2022 and then you continue to pay 20% of your medical expenses all the way too the end of the calendar year. You can envision those out-of-pocket costs as holes or gaps in your coverage and the Medicare Supplement plan is the filler to close those holes. When you purchase a Medicare Supplement policy, Medicare will pay its share first of your medical expenses, then your Medicare Supplement policy pay what Medicare has left to you.

There are 10 Medicare Supplement (Medigap) plans out there in the marketplace and those plans differ from one another in the level of coverage, cost, and cost-sharing. Medicare Supplement plans have an alphabet letter designation attached to them to differentiate from one to another like plans A, B, C, D, F, G, K, L, M, N, High Deductible Plan F, and High-Deductible Plan G

What is the most popular Medicare Supplement plan and why?

The 2 most popular Medicare Supplement plans are Plan G and Plan N. Those 2 plans offer very rich coverage at a very affordable monthly premium.

What is the best time to enroll in Medicare Supplement?

The best time to enroll in Medicare Supplement is during your Medicare Supplement Open Enrollment Period (MSOEP) because you don't have to go through underwritting. You will have guaranteed issue right and insurance companies cannot turn you down. MSOEP starts from the month your Medicare Part B start and to extends for 6 months.

What are the differences between Original Medicare and Medicare Advantage

Original Medicare only includes Part A and Part B. Unlike Medicare Advantage, Original Medicare does not have an Maximum-Out-Of-Pocket (MOOP) . Medicare Advantage plans have limitations on where you can go to get healthcare while with Original Medicare, you can use any healthcare provider to obtain healthcare.

The chart below reveals the major differences between Original Medicare and Medicare Advantage Plans. These differences can affect your healthcare cost, healthcare access restrictions, extra benefits and more.

What are differences between Medicare Supplement and Medicare Advantage?

The chart below reveals the major differences between Medicare Supplement and Medicare Advantage Plans. These differences can affect your healthcare cost, healthcare access restrictions, extra benefits and more.

Medicare FAQs Index