FREQUENTLY ASKED QUESTIONS
Your Health Insurance Questions, Answered
What is the difference between Original Medicare & Private Plans?
Original Medicare provides basic hospital and medical coverage through Parts A and B, with the flexibility to see any doctor or hospital that accepts Medicare, but it does not include prescription drug coverage and can have higher out-of-pocket costs. In contrast, private Medicare plans, such as Medicare Advantage (Part C) and Medicare Part D, offer additional benefits like prescription drug coverage, dental, and vision care, often with lower premiums and a cap on out-of-pocket expenses. However, Medicare Advantage plans typically require you to use a network of providers, which can limit your choice of healthcare providers.
How do I enroll in Medicare?
You can enroll in Medicare during your Initial Enrollment Period, which starts three months before you turn 65 and lasts for seven months. If you miss this period, you can enroll during the General Enrollment Period from January 1 to March 31, with coverage starting July 1. Each year, you can also make changes to your Medicare plan during the Open Enrollment Period from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31 if you’re already enrolled in a Medicare Advantage plan. Special Enrollment Periods are available for qualifying life events.
What happens if I need to make a change in my coverage?
If you need to make changes to your Medicare coverage, you can do so during specific enrollment periods. During the Open Enrollment Period (October 15 to December 7), you can switch between Medicare plans or adjust your coverage. If you’re already in a Medicare Advantage plan, you can make changes during the Medicare Advantage Open Enrollment Period (January 1 to March 31). For changes due to specific life events, such as moving or losing other coverage, you may qualify for a Special Enrollment Period. Making changes outside these periods may result in delays or penalties.
What if I already have Medicare?
If you already have Medicare, I can review your current coverage and ensure you are on the best plan.
Will I automatically be enrolled in Medicare when I turn 65?
You will automatically be enrolled in Medicare at age 65 if you are receiving Social Security benefits or railroad retirement board benefits at least four months before you enroll in Medicare.
If you are not collecting Social Security or RailRoad retirement income, you may apply for both Part A and Part B online at www.ssa.gov. Once you complete the application and provide the required documentation, you will begin receiving benefits on the first day of your 65th birth month. Please reach out, and I would be happy to send you step-by-step instructions.
Do I need to enroll in Medicare if I work past 65?
While it is not mandatory, I recommend you enroll in Medicare Part A coverage as soon as you become eligible if you qualify for premium-free Part A coverage, and you are not contributing to an HSA (Health Savings Account).
If your employer offers creditable health coverage, you do not need to enroll in Medicare Part B if you are working past age 65. Creditable coverage is healthcare coverage that provides at least equal benefits to Original Medicare.
Suppose you do not have creditable coverage and do not enroll in Medicare Part B when you first become eligible. In that case, you may have to pay the Medicare Part B late enrollment penalty as long as you have Medicare Part B.
How much does Medicare cost?
For most, the Medicare Part A premium is $0 per month. To qualify for zero premium, you must have worked at least 40 quarters or ten years paying Medicare taxes. If you did not meet this qualification, you would be required to pay the Medicare Part A premium.
The standard Medicare Part B premium in 2025 is $185.00. This can increase based on income. This difference in premium reflects your Income Related Monthly Adjustment Amount (IRMAA).
Do I need to enroll in Medicare every year?
Original Medicare coverage is automatically renewed each year you are eligible. Thus, you do not need to renew your Medicare parts annually.
Medicare Supplement plans work the same way; once you are accepted, the plan is automatically renewed as long as you continue to pay the monthly premium.
Medicare Advantage plans are contracted on an annual basis. Most Medicare Advantage plans renew automatically. If your plan is not renewing automatically, you will receive a special notice in the mail. If you choose to evaluate a change, you can do so during the Annual Enrollment Period.
What happens to my Medicare if I move?
If you move to a new city or state, you will need to change your address with Social Security. If you have a private plan such as a Medicare Supplement, Medicare Advantage or Part D plan, you maybe required to change your plan based on the new location.
What is the Medicare deductible?
Medicare Part A and Medicare Part B have deductibles and costs that change annually.
In 2025, the Medicare Part A per-benefit-period deductible is $1,676, and the Medicare Part B annual deductible is $257.
Does Medicare cover my prescriptions?
Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription Medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, most Medicare Advantage plans provide full Part D coverage.
If you do not enroll in Medicare Part D, you may be subject to the Medicare Part D late enrollment penalty. This penalty is for those who delay Part D benefits without creditable coverage. You will be required to pay the additional cost as long as you have Medicare Part D.
What is the difference between HMO & PPO?
Medicare Advantage Plans use both HMO and PPO networks.
HMO plans are in-network only and typically require referrals to see a specialist. PPO plans also have a network of doctors and hospitals, but allow for out-of-network coverage, usually at a higher cost. PPO plans typically give you a larger network to work with.
Will Medicare cover my medical expenses?
Original Medicare does not cover 100% of your medical costs once you enroll in coverage. Medicare Part A requires you to pay a per-benefit-period deductible and copayments. Then, Medicare Part B requires an annual deductible and a coinsurance of 20% with no maximum out-of-pocket.
Does Medicare change every year?
Original Medicare benefits do not change each year. However, the premiums, deductibles, and covered services may change annually.
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