General Medicare FAQ

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  • Medicare is a federal health insurance program primarily for people age 65 and older, as well as certain younger individuals with disabilities or qualifying medical conditions.

  • Medicare is divided into different parts:

    • Part A – Hospital coverage

    • Part B – Medical coverage

    • Part C (Medicare Advantage) – Alternative to Original Medicare offered by private insurance companies

    • Part D – Prescription drug coverage

  • Most people become eligible for Medicare at age 65. Your Initial Enrollment Period begins three months before your 65th birthday month, includes your birthday month, and continues for three months after.

  • It depends. If you are still working and have credible employer coverage, you may be able to delay certain parts of Medicare without penalties.

  • You may face late-enrollment penalties or delays in coverage, especially for Medicare Part B and Part D.

  • Original Medicare includes:

    • Medicare Part A (hospital)

    • Medicare Part B (medical)

    Original Medicare is managed by the federal government.

  • Medicare Advantage (Part C) plans are offered by private insurance companies and combine Medicare Part A and Part B coverage. Many plans also include prescription drug coverage and extra benefits like dental, vision, hearing, and fitness programs.

  • A Medicare Supplement (Medigap) plan helps cover some of the out-of-pocket costs that Original Medicare does not pay, such as deductibles, copayments, and coinsurance.

  • No. You cannot have both at the same time.

  • Original Medicare does not fully cover most prescription medications. Prescription drug coverage is available through Medicare Part D plans.

  • Medicare Part D provides prescription drug coverage through private insurance companies approved by Medicare.

  • Original Medicare generally does not cover routine dental, vision, or hearing services. Some Medicare Advantage plans may include these benefits.

  • With Original Medicare and most Medicare Supplement plans, you can generally see any doctor who accepts Medicare. Medicare Advantage plans may use provider networks.

  • Yes. Coverage, costs, provider networks, and drug formularies can change annually, so it’s important to review your plan each year.

  • The Annual Enrollment Period runs from October 15th through December 7th each year. During this time, you can:

    • Change Medicare Advantage plans

    • Change Part D drug plans

    • Return to Original Medicare

  • IRMAA stands for Income-Related Monthly Adjustment Amount. Higher-income beneficiaries may pay additional premiums for Medicare Part B and Part D.

  • Generally, Medicare does not cover long-term custodial care such as assisted living or nursing home care.

  • Deductibles vary by Medicare part and may change each year. These are the amounts you pay before coverage begins.

  • Yes. Depending on the type of plan and time of year, you may have opportunities to change coverage.

  • The right plan depends on:

    • Your healthcare needs

    • Budget

    • Prescription medications

    • Preferred doctors

    • Travel habits

    • Desired benefits

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