FAQs

This FAQ provides essential information for individuals turning 65 or becoming eligible for Medicare, covering enrollment, coverage options, costs, and more. For personalized guidance, we offer consultations to help you navigate the Medicare application process and choose the best plan for your needs. Contact us at 833-585-2450 to schedule a consultation.

1. What is Medicare, and who is eligible?

Medicare is a federal health insurance program primarily for individuals aged 65 or older. It also covers people under 65 with disabilities (after 24 months of Social Security Disability Insurance), End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). You must be a U.S. citizen or a legal resident for at least five continuous years. Our consultations can clarify your eligibility.

2. When should I enroll in Medicare?

Most commonly you should enroll during your Initial Enrollment Period (IEP), a seven-month window starting three months before your 65th birthday month, including the birthday month, and ending three months after. Alternatively, if you are covered by your employer, and the coverage is considered “creditable,” you may delay enrollment into Medicare. Missing these periods may result in penalties. We can guide you through timely enrollment during a consultation.

3. How do I enroll in Medicare?

If you’re receiving Social Security benefits 4 months before you turn 65, you’re automatically enrolled in Parts A and B. Otherwise, enroll through the Social Security Administration, online at their website – SSA.gov, by calling 1-800-772-1213 (TTY 1-800-325-0778), or visiting a local office. Our consultations can streamline this process.

4. What are the different parts of Medicare?

Medicare consists of four parts:

• Part A: Hospital insurance
• Part B: Medical insurance
• Part C: Medicare Advantage (private plans combining A, B, often D)
• Part D: Prescription drug coverage

5. What does each part of Medicare cover?

• Part A: Inpatient hospital stays, skilled nursing facility care, hospice, and some home
  health care.
• Part B: Doctor visits, outpatient care, preventive services, and some medical equipment.
• Part C: All benefits of Parts A and B, often with extras like dental or vision, through
  private plans.
• Part D: Prescription drug coverage through private plans.

6. How much does Medicare cost?

• Part A: Premium-free for most who worked 10 years (40 quarters); otherwise, up to $518/month in 2025.
• Part B: Standard premium is $185.00/month in 2025, higher for high-income earners.
• Part C and Part D: Costs vary by plan. Our consultations can help you compare costs.
• Medigap: Costs vary by plan and eligibility. Our consultations can help you compare costs.

7. What is the difference between Original Medicare and Medicare Advantage?

Original Medicare (Parts A and B) offers flexibility to see any provider accepting Medicare. Medicare Advantage (Part C) is offered by private insurers, often includes additional benefits, but may limit you to a provider network. We can help you decide during a consultation.

8. Should I choose Original Medicare or Medicare Advantage?

It depends on your needs. Original Medicare offers provider flexibility but higher out-of-pocket costs. Medicare Advantage may have lower costs and extra benefits but restricts provider choices. Our consultations can help you evaluate your options.

9. What is Medigap, and do I need it?

Medigap (Medicare Supplement Insurance) covers out-of-pocket costs in Original Medicare, like copays and deductibles. It’s not compatible with Medicare Advantage. If you choose Original Medicare, Medigap may reduce costs. We can assess your need for Medigap in a consultation. 

10. How do I choose a Medicare Part D plan?

Give us a call – we will compare Part D plans based on your medications, preferred pharmacies, premiums, and formulary. You can also use the Medicare Plan Finder to evaluate options. Our consultations can simplify this process.

11. What happens if I miss my Initial Enrollment Period?

Our consultations can help you avoid penalties by determining you eligibility for special enrollment periods. Also, you can enroll during the General Enrollment Period (January 1–March 31), but coverage starts July 1, and you may face a Part B late enrollment penalty (10% premium increase per year delayed).

12. Can I change my Medicare plan later?

Yes, during the Annual Enrollment Period (October 15–December 7), you can switch between Original Medicare and Medicare Advantage or change Part D plans. Changes take effect January 1. We can guide you through plan changes.

13. What if I’m still working at 65 with employer insurance?

If your employer has 20 or more employees, their plan is primary, and you can delay Part B without penalty. Enroll in Part A (usually premium-free) only if you ARE NOT using a HAS (health savings account). After retiring, use a Special Enrollment Period for Part B. Our consultations can clarify your options.

14. How does Medicare work with other insurance?

If you have employer coverage, it may be primary or secondary depending on employer size and your work status. For example, if working with 20+ employees, employer coverage is primary. We can explain coordination during a consultation.

15. What are Medicare Savings Programs?

Medicare Savings Programs help low-income individuals pay for premiums, deductibles, and copays. Eligibility varies by state; contact your state’s Medicaid office for details. Our consultations can assist with eligibility questions.

16. Are there programs to help with prescription drug costs?

The Extra Help program assists low-income individuals with Part D premiums and copays. Some states offer pharmaceutical assistance programs. We can help you explore these options in a consultation.

17. How do I find a doctor who accepts Medicare?

Use the Physician Compare tool on Medicare’s website to find providers accepting Medicare. Our consultations can help locate providers in your area.

18. What preventive services does Medicare cover?

Medicare covers annual wellness visits, cancer screenings, diabetes tests, flu shots, and more, often at no cost. We can review covered services during a consultation.

19. How do I appeal a Medicare decision?

If you disagree with a coverage or payment decision, file an appeal. Instructions are on your Medicare Summary Notice or Explanation of Benefits. The process varies by plan type. Our consultations can guide you through appeals.

20. Where can I get more information or help with Medicare?

Visit Medicare.gov, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), or contact your State Health Insurance Assistance Program (SHIP) for free counseling. Our consultations
offer personalized support.

Medicare Costs Table (2025)

Additional Resources

For state-specific programs, contact your local SHIP or Medicaid office. Our consultations provide tailored guidance to ensure you select the right Medicare plan and avoid enrollment
pitfalls. Contact us at 833-585-2450 to schedule a consultation.

Key Citations:

• 2025 Medicare Parts A & B Premiums and Deductibles
• Medicare Official Website
• Social Security Administration Medicare Enrollment
• Medicare Plan Finder