Medicare FAQ: Your Top Questions, Answered
Medicare Made simple: Your top questions answered
1. What are the different parts of Medicare?
Medicare includes four main components:
- Part A: Covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services.
- Part B: Covers outpatient services like doctor visits, preventative care, and durable medical equipment.
- Part C (Medicare Advantage): A bundled plan offered by private insurers that typically includes Parts A, B, and often D. This also may offer extras such as dental vision, and fitness.
- Part D: Provides prescription drug coverage.
Some individuals choose Medigap (Medicare Supplement) plans to help with deductibles, copays, and coinsurance not covered by Original Medicare (CMS, 2024; KFF, 2023).
2. When should I enroll in Medicare?
Your Initial Enrollment Period (IEP) spans seven months:
- Three months before you turn 65
- The month you turn 65
- Three months after you turn 65
Enrolling within this window helps you avoid late enrollment penalties and ensures timely coverage activation (CMS, 2024).
3. Do I have to enroll if I’m still working?
If you, or your spouse, are still working and have employer-sponsored coverage, you may be able to delay Part B and/or Part D enrollment without penalty. Whether this applies depends on your employer’s size and plan type. Consulting with one of our licensed Medicare experts can help clarify your situation (CMS,2024).
4. What happens if I miss my Initial Enrollment Period?
If you miss your IEP and don’t qualify for a Special Enrollment Period, you’ll need to wait until the General Enrollment Period (January 1-March 31). Coverage typically begins July 1 and you may face a permanent late enrollment penalty for Part B or Part D (CMS, 2024).
5. What’s the difference between Original Medicare and Medicare Advantage?
- Original Medicare: Includes Parts A and B. You can visit any healthcare provider who accepts Medicare. Prescriptions coverage must be added via Part D and you can combine with Medigap insurance.
- Medicare Advantage (Part C): Offered by private insurers, these plans often include Part D and additional benefits (like dental or vision). However, there may be provider networks or coverage limitations (KFF, 2023).
6. Do I need a Part D plan if I don’t take medications?
Yes. If you don’t enroll in Part D during your IEP and don’t have other creditable coverage, you may face a late enrollment penalty–even if you currently don’t take prescriptions (CMS,2024).
7. What does Medicare not cover?
Original Medicare does not typically cover:
- Dental, Vision, and Hearing Services
- Long-term custodial care
- Routine care abroad
8. How much does Medicare cost?
- Part A: Usually has no premium if you or your spouse paid Medicare taxes for at least 10 years (40 quarters); otherwise you may owe a premium.
- Part B: Monthly premium varies by income.
- Part C and D: Costs depend on the specific plan; some Medicare Advantage plans charge very low premiums but may include copays or networks restrictions.
- Medigap: Has its own separate premium alongside Original Medicare.
Out-of-pocket expenses vary across plans, including deductibles, copays, and coinsurance (CMS, 2024; Kiplinger, 2024).
9. Can I keep my doctor?
- With Original Medicare, you may see any provider that accepts Medicare.
- With Medicare Advantage, plans usually work within provider networks. We suggest confirming your preferred doctors are in-network inf you’re considering these plans (KFF, 2023).
10. Can I change my plan later?
Yes.
- During the Annual Enrollment Period (October 15-December 7)
- During a Special Enrollment Period if you experience a qualifying life event, such as moving.
- For a complete list of Special Enrollment exceptions, please visit CMS.gov.
References:
Administration for Community Living. (2025). *State Health Insurance Assistance Program*. https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship
Centers for Medicare & Medicaid Services. (2024). *Medicare & You 2024*. U.S. Department of Health and Human Services. https://www.medicare.gov/publications
Kaiser Family Foundation. (2023). *An overview of Medicare*. https://www.kff.org/medicare/
Kiplinger. (2024). *Medicare basics: 12 things you need to know*. https://www.kiplinger.com/retirement/medicare/medicare-basics-things-you-need-to-know
Medicare Rights Center. (2025). *Medicare snapshot: Stories from the Helpline*. https://www.medicarerights.org/media-center/medicare-rights-center-releases-new-medicare-snapshot
National Council on Aging. (2024). *What Is a State Health Insurance Assistance Program (SHIP) and How Can It Help Me?* https://www.ncoa.org/article/what-is-a-state-health-insurance-assistance-program-and-how-can-it-help-me
Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
