Frequently Asked Questions

Medicare has several parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). 

You can enroll in Medicare, as early as three months before the month of your 65th birthday. This marks the beginning of what is called your Initial Enrollment Period. This period lasts seven months in total and includes the three months before the month you turn 65, the month in which you turn 65, and the three months after.

If you are receiving Social Security or Railroad Retirement Board benefits when you first become eligible for Medicare, then you’ll be automatically enrolled in Part A and Part B and will get your Medicare card in the mail.

If you aren’t receiving Social Security benefits when you become eligible for Medicare, and you want to go on Medicare, you can enroll online or by calling/visiting your local Social Security office.

It’s a good idea to start learning about Medicare in the months leading up to your Initial Enrollment Period so you are ready to make your coverage choices. Your coverage will begin on the first of your birthday month if you enroll during the three months before. If you enroll later, then your coverage start date will be later, too.

If you retire or lose employer coverage before age 65, you’ll need other health coverage until you reach Medicare eligibility age and have your seven-month Initial Enrollment Period.

If you are 65 or older when you retire or lose employer coverage, you may qualify for what is called a Special Enrollment Period (SEP). During this time, you have up to eight months to enroll in Part B without incurring a late enrollment penalty.

In addition, there are two things to note:

First, during this same period you only have two months to enroll in a Medicare Advantage (Part C) or Medicare Part D prescription drug plan. If you miss it, you could end up paying a late enrollment penalty that’s added to your monthly premium for as long as you have Part D. That can really add up, so pay attention to this timing. You can get drug coverage through a Medicare Advantage plan or by adding a standalone Part D plan to Original Medicare.

Second, it’s important to talk with your employer plan benefits administrator before you make Medicare decisions. You’ll need a written notice of “creditable coverage” from the plan to qualify for a SEP and avoid late penalties. The notice certifies that the plan provides coverage at least as good as Medicare.

When you’re over 65 and retiring soon, getting Part B can be simple. If you qualify for a Special Enrollment Period (see question 2 above), you’ll have up to eight months to enroll in Part B without penalty. If you don’t qualify for an SEP, you will have a Part B late penalty. To get Part B, you will enroll directly with Social Security, which you can do online, in person or on the phone.

If you have additional coverage under an employer retirement plan, you’ll want to understand how that plan works with Medicare. Talk with your employer benefits administrator before making any Medicare decisions.

First you need to know if you can delay Medicare without penalty. If your company has less than 20 employees you are required to take original Medicare, Parts A and B at age 65. If your company has 20 or more employees, and the coverage you have is considered creditable, you can delay without penalty. Note that some employers may have internal requirements regarding Medicare enrollment as well. An example might be that if you keep working but have health insurance through your spouse’s employer, your spouse’s employer may require you to get Medicare at 65 if you want to stay on their plan.  

Talk with the employer plan benefits administrator to understand how Medicare might work with your current coverage and to find out if you can delay.

Your choice of doctor depends on what Medicare coverage you have. You can see any doctor that accepts Medicare if you have Original Medicare (Parts A & B) as your primary insurance. On the other hand, most Medicare Advantage plans have provider networks, and some plans may require referrals and/or preauthorizations to see certain specialists. Both Original Medicare and Medicare Advantage plans cover most emergency care when and where it’s needed.

Original Medicare (Parts A and B) does not cover routine dental care or most dental procedures, or vision care other than medically necessary eye exams. Medicare Advantage plans may offer additional vision and dental benefits, but coverage varies. 

A Medicare Supplement plan, also known as Medigap, is private insurance that helps cover the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t pay for—such as copayments, coinsurance, and deductibles. These plans are designed to “fill the gaps” in your Medicare coverage, giving you more predictable healthcare expenses and peace of mind. One of the biggest advantages of a Medigap plan is flexibility: you can see any doctor or specialist nationwide who accepts Medicare, with no referrals or network restrictions. It’s important to note that Medicare Supplement plans do not include prescription drug coverage, so you’ll need a separate Part D plan for medications. They also don’t cover routine dental, vision, or hearing services. Medigap plans are standardized by the federal government, meaning Plan G from one insurance company offers the same basic benefits as Plan G from another. The ideal time to enroll is during your six-month Medigap Open Enrollment Period, which begins when you’re both 65 and enrolled in Medicare Part B—during this time, you can’t be denied coverage or charged more due to pre-existing conditions.

Watch this YouTube video for more information.

A Medicare Advantage Plan, also known as Medicare Part C, is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans combine your Medicare Part A (hospital) and Part B (medical) coverage into one plan, and most also include prescription drug coverage (Part D). In addition to covering everything Original Medicare does, Medicare Advantage plans often offer extra benefits like dental, vision, hearing, fitness memberships, and even over-the-counter allowances.

Unlike Medigap, Medicare Advantage plans use a network of doctors and hospitals. Most plans are either HMOs or PPOs, which means you may need to choose doctors in-network and get referrals to see specialists, depending on the plan type. Costs also work differently—rather than paying deductibles and coinsurance like with Original Medicare, you’ll typically have copays for services, and each plan has an annual out-of-pocket maximum for covered services, which Original Medicare does not.

Medicare Advantage plans can have low or even $0 monthly premiums, but it’s important to look closely at each plan’s network, drug coverage, and out-of-pocket costs to make sure it fits your needs and budget.

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Medicare Supplement (Medigap) works with Original Medicare. You keep Medicare Part A and Part B, and the supplement plan helps pay the out-of-pocket costs that Medicare doesn’t cover, like copays, coinsurance, and deductibles. You can see any doctor or specialist nationwide who accepts Medicare—no networks, no referrals required. You’ll need to add a separate Part D plan for prescription drugs. Monthly premiums are typically higher, but your medical costs are more predictable and consistent.

Medicare Advantage, on the other hand, replaces Original Medicare. These are all-in-one plans offered by private insurance companies that include your Part A and B coverage—and usually Part D prescription coverage too. They often offer extra benefits like dental, vision, hearing, and fitness programs. However, they use networks (HMO or PPO), and you may need referrals or have higher costs for out-of-network care. Monthly premiums can be lower—even $0—but you pay copays as you go, and your out-of-pocket costs can vary.

Watch this video for more information