Whether you’re new to Medicare or have been enrolled for years, questions are bound to come up. Medicare can be complex, and understanding the basics (and the not-so-basics) can make a big difference when it comes to your healthcare.
To help you feel more confident and informed, we’ve compiled some of the top Medicare FAQs we hear from beneficiaries—along with clear, straightforward answers.
1. When Can I Enroll in Medicare?
If you’re turning 65, your Initial Enrollment Period (IEP) starts three months before your 65th birthday, includes your birth month, and continues for three months after.
If you’re already receiving Social Security benefits, you may be automatically enrolled in Parts A and B. If not, you’ll need to sign up through the Social Security Administration.
There are also Special Enrollment Periods (SEPs) and an Annual Enrollment Period (AEP) each year from October 15 to December 7, when current beneficiaries can review and change plans.
2. What’s the Difference Between Medicare Parts A, B, C, and D?
Here’s a quick breakdown:
- Part A: Covers inpatient hospital care, skilled nursing, and some home health services.
- Part B: Covers outpatient care like doctor visits, lab work, preventive services, and medical equipment.
- Part C (Medicare Advantage): An alternative to Original Medicare. These plans are offered by private insurance companies and usually include Part A, Part B, and often Part D.
- Part D: Prescription drug coverage, offered separately or as part of a Medicare Advantage plan.
3. What Does Medicare Not Cover?
Medicare covers many services, but there are things it generally does not include, such as:
- Long-term care or custodial care
- Routine dental, vision, and hearing services (unless part of a Medicare Advantage plan)
- Overseas emergency care (except in limited cases)
- Personal care or assistance with daily living
- Most cosmetic or elective procedures
If you’re wondering “what Medicare doesn’t cover,” it’s always wise to review your options or speak with a licensed agent to fill potential gaps in coverage.
4. Do I Need a Prescription Drug Plan?
If you have Original Medicare (Parts A and B), you’ll need to enroll in a standalone Part D plan to receive drug coverage. If you enroll in a Medicare Advantage plan, drug coverage is often included.
Important: Delaying enrollment in Part D without having other creditable coverage could result in a late enrollment penalty.
5. What’s the Difference Between Medicare Advantage and Medicare Supplement Plans?
This is one of the most frequently asked Medicare questions answered::
- Medicare Advantage (Part C)replaces your Original Medicare and is offered through private companies. These plans often include medical, hospital, and drug coverage in one plan and may have provider networks.
- Medicare Supplement (Medigap)plans work with Original Medicare to help pay some out-of-pocket costs, like deductibles and coinsurance. These plans do not include drug coverage—you’d need a separate Part D plan.
Your choice depends on your healthcare preferences, budget, and whether you want access to a wider network of providers.
6. What’s the Difference Between Medicare Advantage and Medicare Supplement Plans?
Yes—during certain periods. Most changes happen during the Annual Enrollment Period (AEP) from October 15 to December 7. There’s also the Medicare Advantage Open Enrollment Period from January 1 to March 31, which allows people enrolled in a Medicare Advantage plan to make a one-time change.
Some beneficiaries also qualify for Special Enrollment Periods due to life events like moving, losing coverage, or qualifying for Medicaid.
7. Is There a Penalty If I Don’t Enroll on Time?
There can be, yes. Here are a few examples:
- Part B: If you delay enrollment without other creditable coverage, you may pay a monthly penalty for as long as you have Medicare.
- Part D: A penalty may apply if you go 63 or more days without drug coverage after you’re first eligible.
- Medigap: If you don’t enroll during your Medigap Open Enrollment Period, you may face medical underwriting later, depending on your state.
8. Can I Work with a Licensed Medicare Agent?
Yes! Whether you’re new to Medicare or looking to review your options, a licensed Medicare agent can help you:
- Understand your enrollment timelines
- Compare plan types and availability in your ZIP code
- Answer questions based on your personal healthcare needs
There’s no cost to work with a licensed agent—insurance companies pay them, not you.
Still Have Questions? Let’s Talk.
We know Medicare isn’t one-size-fits-all. If you didn’t see your question answered here—or you want to go deeper into a specific topic—we’re here to help. Check out our Medicare FAQs for more insights and clarity on your Medicare options.
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