Question 1

What is Medicare and who qualifies?

Accepted Answer

Medicare is the federal health insurance program primarily for people 65 and older. You may also qualify if you're under 65 with certain disabilities or end-stage renal disease. Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes for at least 10 years.

Question 2

What are the different parts of Medicare?

Accepted Answer

Medicare has four main parts: Part A covers hospital stays, skilled nursing, and hospice care. Part B covers doctor visits, outpatient care, and preventive services. Part C (Medicare Advantage) bundles Parts A and B through a private insurer, often with extras. Part D covers prescription drugs.

Question 3

Is Medicare free?

Accepted Answer

Part A is usually premium-free if you've worked and paid Medicare taxes for 10+ years. Part B has a standard monthly premium (around $174.70 in 2025, though this changes annually). Medicare Advantage and Part D plans have their own premiums, which vary widely — some are $0 per month.

Question 4

What does Medicare NOT cover?

Accepted Answer

Original Medicare does not cover most dental, vision, hearing, or long-term care. It also doesn't cover care outside the U.S. in most cases. Medicare Advantage plans often add dental, vision, and hearing benefits to fill some of these gaps.

Question 5

When should I sign up for Medicare?

Accepted Answer

Your Initial Enrollment Period (IEP) is a 7-month window — 3 months before your 65th birthday month, your birthday month itself, and 3 months after. Enrolling during the first 3 months means your coverage starts on the 1st of your birthday month. Waiting can delay coverage and trigger late penalties.

Question 6

What happens if I miss my Initial Enrollment Period?

Accepted Answer

If you miss your IEP without a qualifying reason, you may face a permanent late-enrollment penalty added to your Part B premium (10% for each 12-month period you were eligible but didn't enroll). Part D also has a late penalty. The General Enrollment Period (January 1 – March 31 each year) lets you sign up, but coverage won't start until July 1.

Question 7

I'm still working at 65 — do I need to enroll in Medicare?

Accepted Answer

It depends on your employer's size. If your employer has 20 or more employees, your group plan is primary and you can delay Medicare without penalty. If your employer has fewer than 20 employees, Medicare becomes primary and you should enroll to avoid gaps. Always check with your HR department and a Medicare advisor before deciding.

Question 8

What is the Annual Enrollment Period?

Accepted Answer

The Annual Enrollment Period (AEP) runs October 15 through December 7 each year. During this window you can switch Medicare Advantage plans, switch from Original Medicare to Medicare Advantage (or vice versa), and join, switch, or drop a Part D drug plan. Changes take effect January 1 of the following year.

Question 9

Can I change my plan outside of the Annual Enrollment Period?

Accepted Answer

Yes, in certain situations. A Special Enrollment Period (SEP) is triggered by qualifying life events such as losing employer coverage, moving out of your plan's service area, or qualifying for Extra Help. Medicare Advantage members also have a Medicare Advantage Open Enrollment Period from January 1 to March 31 to make one plan change.

Question 10

What's the difference between Medicare Advantage and Medicare Supplement?

Accepted Answer

Medicare Advantage (Part C) replaces Original Medicare through a private insurer, often with lower premiums but network restrictions and copays. Medicare Supplement (Medigap) works alongside Original Medicare to cover its out-of-pocket costs, giving you freedom to see any Medicare-accepting provider nationwide. The right choice depends on your health needs, budget, and how much you value flexibility.

Question 11

How do I know if my doctors accept my plan?

Accepted Answer

For Medicare Advantage (HMO or PPO), you'll need to check the plan's provider directory each year — networks can change. For Medicare Supplement plans, any doctor who accepts Original Medicare will accept your coverage, giving you nationwide flexibility with no network restrictions.

Question 12

How do I make sure my prescriptions are covered?

Accepted Answer

Each Part D and Medicare Advantage plan has a formulary — a list of covered drugs organized into tiers that determine your cost. Before enrolling, compare plans using Medicare's Plan Finder tool at medicare.gov, or let us run a free comparison for you based on your specific medications and preferred pharmacy.

Question 13

Can I use my Medicare plan if I travel or live in two states?

Accepted Answer

Medicare Supplement plans are ideal for travelers — they're accepted by any Medicare provider nationwide. Medicare Advantage plans are typically network-based and may only cover emergency or urgent care outside their service area. If you split time between states or travel frequently, a Medigap plan is usually the better fit.

Question 14

What is a deductible, copay, and coinsurance?

Accepted Answer

A deductible is the amount you pay before your insurance kicks in. A copay is a fixed dollar amount you pay for a service (e.g., $20 per doctor visit). Coinsurance is a percentage you pay after meeting your deductible (e.g., 20% of the Medicare-approved amount). Original Medicare has a 20% coinsurance with no out-of-pocket maximum — a Medigap plan can eliminate or cap this exposure.

Question 15

Is there help paying for Medicare if I have limited income?

Accepted Answer

Yes. Extra Help (also called the Low Income Subsidy) assists with Part D drug costs. Medicare Savings Programs can help pay Part A and B premiums, deductibles, and copays. Eligibility is based on income and assets. We can help you determine if you qualify and walk you through the application process.

Question 16

How much does a Medicare Supplement plan cost?

Accepted Answer

Medigap premiums vary by plan type, your age, gender, tobacco use, and the insurance company. In Orange County, Plan G premiums typically range from around $100 to $200+ per month for a 65-year-old. The best time to enroll is during your Medigap Open Enrollment Period (the 6 months starting when you're 65 and enrolled in Part B) — insurers cannot deny you or charge more based on health during this window.

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