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Medicare FAQs

Medicare Frequently Asked Questions.

Straight Answers to Common Medicare Questions

Medicare can be confusing, especially when you are turning 65, retiring, comparing Medicare Supplement and Medicare Advantage, or trying to understand prescription drug coverage.
At Health Coverage Solutions, our goal is to make Medicare easier to understand.
Below are answers to some of the questions we hear most often from our clients.

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    Medicare Basics

    Medicare is the federal health insurance program primarily for people age 65 and older, as well as certain younger people who qualify because of disability or specific medical conditions.
    Medicare is divided into different parts:
    Part A primarily covers inpatient hospital services.
    Part B primarily covers doctors, outpatient services, diagnostic testing, durable medical equipment and other medical services.
    Part C, also called Medicare Advantage, is a private alternative for receiving your Medicare Part A and Part B benefits.
    Part D provides outpatient prescription drug coverage.
    Original Medicare consists of:
    Medicare Part A + Medicare Part B
    Original Medicare is administered by the federal government.
    You can generally receive Medicare-covered care from any doctor or hospital in the United States that accepts Medicare.
    Original Medicare does not cover all of your medical expenses, and it does not have an annual out-of-pocket maximum by itself.
    Many people therefore add Medicare Supplement insurance and Part D prescription coverage.
    No.
    Original Medicare includes deductibles, coinsurance and other potential out-of-pocket expenses.
    For many Medicare Part B services, for example, you are generally responsible for 20% of the Medicare-approved amount after satisfying the applicable Part B deductible.
    Because Original Medicare does not have an annual out-of-pocket maximum by itself, many beneficiaries choose either:
    Original Medicare + Medicare Supplement
    or
    Medicare Advantage
    to better manage their potential medical expenses.
    No.
    Many people receive Medicare Part A without paying a monthly premium because they or their spouse paid Medicare taxes while working.
    Most people pay a monthly premium for Medicare Part B.
    Depending on your coverage, you may also have premiums for:
    • Medicare Supplement insurance
    • Medicare Part D
    • Medicare Advantage
    • Other health or prescription coverage
    Higher-income beneficiaries may also pay additional Part B and Part D amounts through IRMAA.

    Turning 65 and Enrolling in Medicare

    We recommend beginning the process approximately three to six months before you turn 65.
    This gives you time to understand:
    • Whether you need to enroll
    • When your Medicare will begin
    • Whether you should remain on employer coverage
    • Medicare Supplement vs. Medicare Advantage
    • Prescription drug coverage
    • Your doctors
    • Your medications
    • Your expected costs
    You don’t need to wait until the month you turn 65 to start planning.
    For most people, the Medicare Initial Enrollment Period lasts seven months.
    It generally includes:
    3 months before your 65th birthday month
    Your birthday month
    3 months after your birthday month
    Special timing rules apply if your birthday is on the first day of the month.
    No.
    Enrollment in Medicare Part A and Medicare Part B is generally handled through Social Security.
    An independent Medicare agency like HCS can help you understand when you should enroll and what insurance options you may want once your Medicare effective dates are established.
    Some people are automatically enrolled, while others need to apply.
    Whether you are automatically enrolled can depend on whether you are already receiving Social Security or certain Railroad Retirement Board benefits.
    If you are approaching 65, don’t assume enrollment will happen automatically. Confirm your Medicare status in advance.

    Working Past Age 65

    Not necessarily.
    If you or your spouse are actively working and you have qualifying employer group health coverage, you may be able to delay Medicare Part B without a late enrollment penalty.
    However, the answer depends on your specific employer coverage and circumstances.
    Before delaying Medicare, verify how your employer insurance coordinates with Medicare.
    There isn’t one answer for everyone.
    We recommend comparing:
    • Employer premium
    • Family premium
    • Deductible
    • Maximum out-of-pocket
    • Prescription coverage
    • Doctor network
    • Medicare premiums
    • Medicare Supplement or Medicare Advantage costs
    • Spouse and dependent coverage
    • HSA considerations
    Sometimes Medicare provides better coverage or a lower overall cost.
    Sometimes staying with the employer is the better decision.
    We compare the two rather than automatically recommending one.
    If you delayed Part B because you had qualifying employer coverage based on current employment, you generally have an 8-month Special Enrollment Period after the employment or qualifying coverage ends, whichever happens first.
    However, that does not mean you should wait eight months.
    If you want Medicare to begin immediately after your employer insurance ends, start the enrollment process before retirement.
    This can be a serious mistake.
    COBRA generally does not extend the Medicare Part B Special Enrollment Period based on current employment.
    Your 8-month Part B Special Enrollment Period generally begins when your employment or qualifying active employer coverage ends, even if you elect COBRA.
    Once you are enrolled in Medicare, you generally can no longer contribute to a Health Savings Account.
    People working past age 65 should carefully coordinate Medicare enrollment with HSA contributions because Medicare Part A can sometimes be retroactive when enrolling after 65.
    Speak with your employer, tax professional and Medicare advisor before making the transition.

    Medicare Supplement / Medigap

    Medicare Supplement insurance is also called Medigap.
    It is private insurance designed to work alongside Original Medicare.
    Original Medicare pays first, and your Medicare Supplement policy pays according to the standardized benefits of the plan you selected.
    Medigap can help reduce the deductibles, coinsurance and other Medicare-approved expenses that Original Medicare leaves you responsible for.
    No.
    They are two completely different ways of structuring Medicare coverage.
    A Medicare Supplement works with Original Medicare.
    Medicare Advantage is a private plan that becomes the way you receive your Medicare Part A and Part B benefits.
    You generally choose one approach or the other.
    No.
    Medicare Supplement insurance is designed to supplement Original Medicare.
    It cannot be used to pay Medicare Advantage copayments or deductibles.
    Plan G and Plan N are both standardized Medicare Supplement plans.
    Plan G
    Generally provides more comprehensive coverage and includes Medicare Part B excess charges.
    Plan N
    May offer a lower monthly premium but can include certain office visit and emergency room copayments and does not cover Part B excess charges.
    The decision often comes down to whether the premium savings with Plan N are large enough to justify accepting the additional potential cost-sharing.
    Neither is automatically better.
    Plan G may appeal to someone who values maximum predictability.
    Plan N may appeal to someone who is comfortable accepting some additional cost-sharing in exchange for a lower monthly premium.
    At HCS, we compare the actual premium difference and help clients decide whether the savings justify the trade-off.
    High-Deductible Plan G is another Medicare Supplement option.
    It can have a significantly lower monthly premium than traditional Plan G.
    In exchange, you are responsible for Medicare-covered expenses until the annual high deductible is reached.
    After the deductible is satisfied, the policy provides its applicable Plan G benefits for the remainder of the year.
    For the right person, it can provide a combination of:
    Low monthly premium + Original Medicare provider access + protection against very large Medicare-covered expenses.
    Your federal Medicare Supplement Open Enrollment Period generally lasts six months and begins the first month you are:
    Age 65 or older
    and
    Enrolled in Medicare Part B.
    During this period, you generally can purchase any Medigap policy available to you without being denied because of your health. It is a one-time enrollment period and does not repeat every year.
    No.
    This is one of the most common Medicare misconceptions.
    The October 15 through December 7 Medicare Open Enrollment Period primarily allows changes involving Medicare Advantage and Part D coverage.
    It is not an annual Medigap Open Enrollment Period.
    You can apply for a Medicare Supplement at other times during the year, but medical underwriting may apply if you are outside a protected enrollment period.
    You can apply to change Medicare Supplement companies throughout the year.
    However, outside your Medigap Open Enrollment Period or another guaranteed issue situation, the new insurance company may be permitted to use medical underwriting.
    Do not cancel your existing Medicare Supplement until your replacement coverage has been approved and the effective date has been confirmed.
    Medical underwriting is the process an insurance company may use to evaluate your health when deciding whether to approve a Medicare Supplement application.
    It may include:
    • Health questions
    • Medical conditions
    • Recent treatments
    • Prescription medications
    • Pending procedures
    • Other health information
    Underwriting usually does not apply during your federal Medigap Open Enrollment Period or when you have certain guaranteed issue rights.
    Guaranteed issue refers to certain situations in which you have a protected right to purchase specified Medicare Supplement coverage without being declined because of your health.
    Situations can include certain losses of coverage, Medicare Advantage plan terminations, moves outside a plan’s service area and other qualifying circumstances.
    Specific plans and deadlines apply.

    Medicare Advantage

    Medicare Advantage is also called Medicare Part C.
    It is a private Medicare-approved alternative to receiving your Medicare Part A and Part B benefits directly through Original Medicare.
    Medicare Advantage plans may include:
    • HMO plans
    • PPO plans
    • Prescription drug coverage
    • Dental benefits
    • Vision benefits
    • Hearing benefits
    • Other supplemental benefits
    Benefits, networks and costs vary by plan.
    Yes.
    You remain in the Medicare program and must generally continue paying your Medicare Part B premium.
    The Medicare Advantage plan becomes the way you receive your Medicare Part A and Part B benefits.
    No.
    Some Medicare Advantage plans have a $0 additional monthly plan premium, while others have a monthly premium.
    A $0 plan premium also does not mean your health care costs nothing.
    You may still have:
    • Doctor copayments
    • Specialist copayments
    • Hospital costs
    • Coinsurance
    • Prescription costs
    • Other out-of-pocket expenses
    And you generally continue paying your Medicare Part B premium.
    Most do.
    Depending on the plan, you may be enrolled in an HMO or PPO network.
    Before enrolling, we recommend checking:
    • Doctors
    • Specialists
    • Hospitals
    • Medical groups
    • Pharmacies
    • Other important providers
    A doctor accepting Medicare does not automatically mean the doctor participates in every Medicare Advantage plan.
    HMO
    An HMO generally requires you to receive routine care from participating network providers, except in certain circumstances such as emergencies.
    Some plans also require referrals.
    PPO
    A PPO generally provides more flexibility and may cover eligible services outside the preferred network.
    However, out-of-network care generally costs more and providers must meet the plan’s requirements.
    Prior authorization means a Medicare Advantage or prescription drug plan may require approval before it will cover certain services or medications.
    Depending on the plan, this can apply to:
    • Diagnostic testing
    • Rehabilitation
    • Skilled nursing
    • Medical equipment
    • Procedures
    • Prescription drugs
    • Other services
    Medicare Advantage plans have a maximum amount you can be required to pay for applicable covered Part A and Part B medical services during a calendar year.
    This is commonly called the MOOP — Maximum Out-of-Pocket.
    You do not automatically pay the MOOP.
    You accumulate the plan’s applicable copayments and coinsurance as you receive medical services.

    Medicare Part D

    Medicare Part D provides outpatient prescription drug coverage.
    If you have Original Medicare, you can generally enroll in a separate Part D prescription drug plan.
    Many Medicare Advantage plans include Part D coverage within the Medicare Advantage plan.
    We recommend comparing Part D plans using your actual:
    • Medications
    • Dosages
    • Frequency
    • Pharmacy
    Don’t choose a Part D plan based only on premium.
    The best plan for one person can be completely different from the best plan for someone taking different medications.
    A formulary is the list of prescription drugs covered by a Part D plan.
    Plans can place medications into different tiers and may have different coverage requirements.
    Formularies can also change from year to year.
    You should still consider prescription drug coverage.
    Going too long without Medicare Part D or other creditable drug coverage can result in a Part D late enrollment penalty when you enroll later.
    Your decision shouldn’t be based only on the medications you take today.
    Yes.
    That does not mean everyone should change plans every year.
    It means you should review:
    • Your medications
    • Your pharmacy
    • Premium
    • Formulary
    • Drug tiers
    • Deductible
    • Estimated annual cost
    Sometimes the review confirms that there is no reason to make a change.

    Enrollment Periods

    Medicare’s yearly Open Enrollment Period runs from:

    October 15 through December 7

    During this period, you can make certain changes involving Medicare Advantage and Part D coverage.
    Changes generally become effective January 1.
    If you are already enrolled in Medicare Advantage, the Medicare Advantage Open Enrollment Period generally runs from:

    January 1 through March 31

    During this period, you can generally make one change:
    • Switch to another Medicare Advantage plan, or
    • Leave Medicare Advantage and return to Original Medicare
    If you return to Original Medicare, you can generally enroll in a stand-alone Part D plan.
    A Special Enrollment Period, or SEP, allows someone to enroll in or change certain Medicare coverage outside the normal enrollment periods after a qualifying event.
    Examples can include:
    • Retiring and losing qualifying employer coverage
    • Moving
    • Moving outside a Medicare Advantage plan's service area
    • A plan terminating
    • Losing certain coverage
    • Becoming eligible for certain assistance programs
    Each SEP has its own rules and deadlines.

    Changing Medicare Coverage

    Yes, when you have an enrollment period that allows the change.
    Common opportunities include:
    October 15–December 7 Medicare Open Enrollment
    and, for people already enrolled in Medicare Advantage:
    January 1–March 31 Medicare Advantage Open Enrollment.
    Certain Special Enrollment Periods may also allow the change.
    Not necessarily.
    This is extremely important.
    Your right to leave Medicare Advantage and your right to purchase a Medicare Supplement are separate issues.
    Outside your Medigap Open Enrollment Period, you may need to qualify medically unless you have a guaranteed issue right, trial right or another applicable protection.
    We recommend determining your Medicare Supplement eligibility before completing the Medicare Advantage disenrollment.
    You are not losing Medicare.
    You may have options to:
    • Select another Medicare Advantage plan
    • Return to Original Medicare
    • Enroll in Part D
    • Potentially obtain certain Medicare Supplement coverage under guaranteed issue protections
    Keep the non-renewal notice you receive from the insurance company.
    Before automatically choosing another Medicare Advantage plan, understand all of your options.

    Moving and Medicare

    Original Medicare is a federal program, so your Part A and Part B coverage does not become a different version of Medicare simply because you move to Florida.
    However, Medicare Advantage and Part D plans operate within specific service areas.
    A permanent move may therefore require you to select new coverage and may create a Special Enrollment Period.
    In many cases, yes.
    Traditional Medicare Supplement coverage generally moves with you as long as you remain enrolled in Original Medicare and continue paying the premium.
    However, your rate may change based on the new residence, and you may want to compare Florida Medicare Supplement options.
    Changing from your existing Medigap policy to another policy may require medical underwriting unless you have another protected enrollment right.
    If you permanently move outside your Medicare Advantage plan’s service area, you will generally have a Special Enrollment Period to select new coverage.
    Depending on your circumstances, you may be able to choose:
    A Florida Medicare Advantage plan
    or
    Original Medicare + Medicare Supplement + Part D
    A move outside your plan’s service area can also create important Medigap guaranteed issue rights in certain circumstances.
    Review these rights before automatically enrolling in another Medicare Advantage plan.

    Health Coverage Solutions

    Health Coverage Solutions is an independent insurance agency specializing in Medicare education and coverage.
    We help clients understand and compare options including:
    • Original Medicare
    • Medicare Supplement
    • Medicare Advantage
    • Medicare Part D
    • Turning 65
    • Working past 65
    • Employer-to-Medicare transitions
    • Guaranteed issue situations
    • Medicare plan reviews
    Our focus is Independent Guidance and Education.
    Yes.
    Being independent allows us to evaluate Medicare insurance options from the companies we represent rather than approaching every client with one predetermined solution.
    Our job is to help you understand the trade-offs and make an informed decision.
    You generally do not pay HCS a separate consulting fee for helping you enroll in the Medicare insurance products we represent.
    Insurance agents are generally compensated by the insurance company when an eligible enrollment is completed.
    Your plan premium is not increased simply because you used HCS as your agent.
    We will help you understand the differences and determine which approach better fits your priorities.
    We look at factors such as:
    • Doctors
    • Hospitals
    • Prescriptions
    • Budget
    • Budget
    • Travel
    • Provider access
    • Potential out-of-pocket exposure
    • Comfort with networks
    • Prior authorization
    • Future coverage options
    There isn’t one answer that’s right for everyone.
    Yes.
    We work with people who are:
    • Turning 65
    • Retiring after 65
    • Already on Medicare Supplement
    • Already enrolled in Medicare Advantage
    • Reviewing Part D
    • Moving to Florida
    • Losing a Medicare Advantage plan
    • Evaluating a change in coverage
    No.
    In many cases, the best recommendation is:

    Make no change.

    Annual reviews are intended to determine whether your current coverage still works well for you.
    A review does not mean a change is necessary.
    We recommend having:
    • Medicare card
    • Current insurance information
    • Doctor and specialist list
    • Prescription medication list
    • Dosages
    • Preferred pharmacy
    • Preferred hospitals
    • Upcoming medical needs when known
    • Questions or concerns about your current coverage
    Accurate information allows us to provide a much more useful review.
    Yes.
    Health Coverage Solutions provides educational opportunities for people who want to better understand Medicare, including Turning 65 educational seminars and events at our office.
    Our goal is to explain Medicare in an easy-to-understand environment and give attendees an opportunity to ask questions.
    Visit our Seminars & Events page for upcoming opportunities.

    Still Have a Medicare Question?

    Medicare doesn’t have to be overwhelming.
    Whether you’re turning 65, retiring, reviewing existing coverage, moving to Florida or simply trying to understand your options, the Health Coverage Solutions team is here to help.
    Schedule a Consultation

    Schedule a Medicare Consultation

    Health Coverage Solutions
    6810 N State Road 7 Coconut Creek, FL 33073

    Important Information

    This information is intended for educational purposes and provides general information about Medicare.
    Medicare rules, insurance plan benefits, premiums, networks, formularies, underwriting requirements and enrollment rights can vary by individual circumstances and may change.
    Health Coverage Solutions is not connected with or endorsed by the U.S. government or the federal Medicare program.
    For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE.
    Developer/Compliance Note: Add any current CMS-required TPMO or marketing disclaimer applicable to Health Coverage Solutions before publication.
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