Frequently Asked Questions

Medicare is a federal health insurance program primarily for people aged 65 and older, but also for some younger individuals with disabilities or specific diseases.

People aged 65 and older, those under 65 with certain disabilities, and individuals with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) are eligible.

- Part A: Hospital Insurance
- Part B: Medical Insurance
- Part C: Medicare Advantage (an alternative to Original Medicare, offered by private companies)
- Part D: Prescription Drug Coverage
An agent can explain the differences and help you decide which parts you need.

- Initial Enrollment Period: 7 months around your 65th birthday (3 months before, the month of, and 3 months after).
- General Enrollment Period: January 1 to March 31 each year (if you missed the initial period).
- Special Enrollment Period: For certain life events, such as losing other insurance.
An agent can help educate so you do not incur penalties.

- Part A: Usually free if you or your spouse paid Medicare taxes for at least 10 years.
- Part B: Standard premium (income-based), plus any deductibles or co-insurance.
- Part C & D: Varies by plan, with additional premiums, deductibles, and co-pays.

Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Doctor visits, outpatient care, preventive services, lab tests, mental health care, and some home health care.

A bundled plan offered by private insurers that includes Part A, Part B, and often Part D coverage, along with extra benefits like vision, dental, or hearing.

Prescription drugs, though each plan has its own formulary (list of covered drugs).

If you have employer-based insurance, you may delay enrolling in Part B without penalty, depending on the size of your employer.

- Premium: The amount you pay monthly for coverage.
- Deductible: The amount you pay out-of-pocket before Medicare starts to pay.
- Coinsurance: The percentage of costs you pay after the deductible is met.

Original Medicare (Parts A & B) does not cover routine dental, vision, or hearing services. Some Medicare Advantage plans may offer these benefits.

Medigap, or Medicare Supplement Insurance, is a private insurance policy that helps cover some of the out-of-pocket costs not covered by Original Medicare, such as deductibles, co-pays, and coinsurance.

- Consider your healthcare needs, budget, preferred doctors, and medications.
An agent has the tools, knowledge and experience to help you make this decision.

Medicare coordinates with other insurance, such as employer coverage, retiree insurance, or Medicaid. How they work together depends on the specific situation.

The AEP runs from October 15 to December 7 each year, during which you can join, switch, or drop a Medicare plan.

You may be subject to late enrollment penalties for Part B and Part D if you don’t sign up when first eligible and don’t have other credible coverage.

You can change your plan during the AEP or a Special Enrollment Period (SEP) if you qualify due to certain life events.

Protect your Medicare number, review statements for errors, and report suspicious activities to Medicare or the Senior Medicare Patrol.

- Contact Medicare directly, use the online Medicare Plan Finder, or seek assistance from the State Health Insurance Assistance Program (SHIP).
- Local agents in your area can help guide you and partner with you for all of this process.