General Basics
Q: What is Medicare and who qualifies for it?
A: Medicare is a federal health insurance program for people 65 and older, and for younger people with
certain disabilities or end-stage renal disease (ESRD).
Q: What’s the difference between Original Medicare and Medicare Advantage?
A: Original Medicare = Part A (hospital) + Part B (medical). Medicare Advantage (Part C) = Private plan
that combines A & B, usually with drug coverage and extra benefits.
Q: When can I sign up for Medicare?
A: Your Initial Enrollment Period (IEP) is the 7 months around your 65th birthday (3 before, the month
of, and 3 after).
Q: Do I need to enroll if I’m still working and have employer insurance?
A: If you have large employer coverage (20+ employees), you can delay Part B without penalty. If not,
you should enroll.
Q: What’s the difference between Medicare and Medicaid?
A: Medicare = Federal program, based on age or disability. Medicaid = State & federal program, based
on income.
Costs
Q: How much does Medicare cost?
A: Part A: Usually free (if you paid Medicare taxes 10+ years). Part B: $174.70/month in 2024 for most.
Part C & D: Vary by plan.
Q: What is the Medicare Part B premium and how is it determined?
A: $174.70/month in 2024, higher if your income is above certain levels (IRMAA).
Q: What are deductibles, copays, and coinsurance?A: Deductible = What you pay first. Copay = Fixed amount per service. Coinsurance = Percentage you
pay after deductible.
Q: Does Medicare cover everything?
A: No. You’ll pay for deductibles, copays, coinsurance, drugs, dental, vision, hearing, and long-term
care unless you have extra coverage.
Q: Will I be penalized if I don’t sign up when eligible?
A: Yes. Late penalties apply for Part B and Part D if you don’t have other creditable coverage.
Coverage
Q: What does Original Medicare cover?
A: Part A = Hospital, skilled nursing, hospice, home health. Part B = Doctor visits, preventive care,
outpatient services, durable equipment.
Q: Does Medicare cover prescriptions?
A: Not under Original Medicare. You need Part D or a Medicare Advantage plan with drug coverage.
Q: Does Medicare cover dental, vision, or hearing?
A: Generally no. Some Medicare Advantage plans include these benefits.
Q: Will Medicare cover me outside the U.S.?
A: Usually no, except in very limited cases. Medigap Plan G, N, and others may include emergency
foreign travel coverage.
Q: Does Medicare cover long-term care or nursing homes?
A: No. Medicare only covers short-term skilled nursing or rehab—not custodial care.
Enrollment & Deadlines
Q: What is the Initial Enrollment Period (IEP)?
A: A 7-month window around your 65th birthday.
Q: What if I miss my enrollment period?
A: You may have to wait until the General Enrollment Period (Jan–Mar) and may face late penalties.
Q: When is the Annual Enrollment Period (AEP)?
A: Every year from Oct 15–Dec 7. You can change Medicare Advantage or Part D plans.
Q: What is the Medicare Advantage Open Enrollment Period?
A: Jan 1–Mar 31. You can switch to another Advantage plan or back to Original Medicare.
Q: How do I switch from one plan to another?
A: Apply for the new plan during an enrollment period; the new coverage automatically replaces the old.
Supplemental Insurance (Medigap)
Q: What is Medigap and how does it work?
A: Medigap (Medicare Supplement) fills the cost gaps in Original Medicare—deductibles, coinsurance,
copays.
Q: What’s the difference between Plan G, Plan N, etc.?A: Each lettered plan covers different sets of gaps. Plan G is most popular (covers almost everything
except Part B deductible).
Q: Can I have both a Medigap plan and Medicare Advantage?
A: No. You must choose one or the other.
Q: When can I buy a Medigap policy without medical underwriting?
A: During your Medigap Open Enrollment Period (6 months starting when you’re 65 and enrolled in Part
B).
Q: Will Medigap cover services Medicare doesn’t?
A: No. It only covers Medicare’s cost gaps, not extras like dental or vision.
Prescription Drug Coverage (Part D)
Q: Do I need Part D if I don’t take medications?
A: It’s wise to enroll—otherwise you may face a late penalty if you need it later.
Q: What happens if I don’t enroll in Part D on time?
A: You’ll pay a lifetime penalty added to your monthly premium.
Q: How do drug formularies work?
A: Each plan has a list of covered drugs (formulary), organized in tiers with different costs.
Q: What’s the coverage gap (“donut hole”)?
A: A temporary limit on what the plan pays for drugs after a spending threshold, though discounts now
reduce the burden.
Q: How do I apply for Extra Help with drug costs?
A: Through Social Security or your state Medicaid office.
Other Common Concerns
Q: Can my spouse and I share the same Medicare plan?
A: No. Medicare is individual coverage. Each person must enroll separately.
Q: Does Medicare cover home health care?
A: Yes, but only part-time skilled nursing or therapy—not full-time custodial care.
Q: How do I know if my doctor accepts Medicare?
A: Ask your doctor directly, or check the Medicare.gov Physician Finder.
Q: How do Medicare Advantage HMO and PPO plans differ?
A: HMO: Must use in-network providers (except emergencies). PPO: More flexibility, higher cost for
out-of-network.
Q: Will Medicare cover vaccines and preventive services?
A: Yes. Many vaccines (flu, COVID-19, shingles, pneumonia) and screenings (mammograms,
colonoscopies, diabetes checks) are covered.
