Medicare Questions and Answers

Start learning about your options about three months before you turn 65. Your Initial Enrollment Period generally lasts seven months: it starts three months before your birthday month, includes your birthday month, and ends three months after it. If you already have health coverage through work, check with your employer’s benefits administrator before deciding whether to enroll in Medicare Part B.

Some people are automatically enrolled in Medicare Part A and Part B, often because they already receive Social Security or Railroad Retirement Board benefits. Others need to sign up. If you are still working or covered through a spouse’s current employment, find out how that coverage works with Medicare before deciding whether to delay Part B.

Part A generally helps cover inpatient hospital care and certain related services. Part B generally helps cover doctors’ services, outpatient care, and certain preventive services. Together, Part A and Part B are called Original Medicare. They do not cover every health care service or every out-of-pocket cost.

It depends on your employer coverage and circumstances. Whether you can delay Part B without a late enrollment penalty may depend on whether your coverage is based on current employment and other factors. The employer’s size and the type of coverage can also affect which coverage pays first. Ask your benefits administrator how the coverage coordinates with Medicare, then confirm your enrollment timing with Social Security or Medicare.

COBRA may let you continue certain employer coverage after a job or coverage ends, but it generally does not count as coverage based on current employment for the Part B Special Enrollment Period. That period is generally eight months after employment ends or the employer coverage ends, whichever happens first. Don’t assume COBRA gives you extra time to enroll in Part B; confirm your dates before your work coverage ends.

Before your employer coverage ends, confirm the date it ends and ask your benefits administrator how it works with Medicare. If you need to enroll in Part B using a Special Enrollment Period, you may need documents showing that you had qualifying coverage through current employment. You may also want to compare Medicare Advantage, Medicare Supplement, and prescription drug coverage options before your existing coverage ends.

Some employer or union drug coverage is considered “creditable,” meaning it’s expected to pay, on average, at least as much as standard Medicare drug coverage. Ask your employer or plan administrator for written confirmation. If you go 63 days or more without creditable prescription drug coverage after you’re eligible, a Part D late enrollment penalty may apply.

Medicare Advantage, also called Part C, is a way to receive Medicare-covered benefits through a private plan approved by Medicare. Plans may use provider networks and have plan-specific costs and rules.

Medicare Supplement Insurance, also called Medigap, helps pay some out-of-pocket costs under Original Medicare. It works alongside Original Medicare; it is not a substitute for it. Medigap generally does not include prescription drug coverage, so you may need a separate Part D plan if you choose Original Medicare with a supplement.

Yes. “Medicare Supplement Insurance” and “Medigap” are two names for the same type of private insurance. A Medigap policy can help pay certain costs that Original Medicare does not fully pay. Benefits are standardized by plan letter in most states, but premiums can vary by company and location.

Medigap is designed to work with Original Medicare. You can’t use a Medigap policy to pay Medicare Advantage plan premiums, deductibles, copayments, or coinsurance. If you’re considering changing from one type of coverage to another, check enrollment dates and confirm when the new coverage begins before ending existing coverage.

Original Medicare generally does not cover routine dental care, eye exams for glasses, or most outpatient prescription drugs. Coverage may be available through other insurance or a Medicare plan, depending on the plan and your situation. Check the specific service, plan documents, and costs before making a decision.

A move can affect your plan choices, especially if you move outside your current Medicare Advantage plan’s service area. You may qualify for a Special Enrollment Period to choose coverage available at your new address. Contact your plan when you know your moving date and confirm the deadline and choices that apply to you.

In general, you can keep your Medigap policy when you move, as long as you still have Original Medicare. If you want to change policies, your options may depend on federal protections and your state’s rules. Before canceling a policy, check whether you can get another one and whether medical underwriting may apply.

Review your plan’s costs and coverage for the coming year. Check whether your doctors, hospitals, prescriptions, pharmacies, premiums, copayments, and plan rules still fit your needs. Medicare plans can change their costs, covered services, provider networks, and drug formularies from year to year.

The Annual Notice of Change, or ANOC, explains changes to your Medicare plan that take effect the following January. Plans send it each fall. Read it alongside your current needs and prescriptions, and contact your plan if you do not receive it.

The Medicare Open Enrollment Period is October 15 through December 7. During this period, eligible beneficiaries can make certain changes to Medicare Advantage and Part D coverage, generally effective January 1. Other enrollment periods may apply after events such as moving or losing certain coverage. The rules depend on your situation.

Medigap does not have an annual open enrollment period that lets everyone switch plans without restrictions each fall. Outside your Medigap Open Enrollment Period or a qualifying protection, an insurer may be able to consider your health history when you apply, depending on applicable rules. State laws may provide additional rights. Check your options before canceling your current policy.

Your Medicare choices can depend on your enrollment dates, current coverage, prescriptions, preferred doctors, budget, and where you live. Having those details in mind can help you talk through the options that may be available to you.

A licensed insurance agent can explain available plan options and help you compare them. For help with your situation, visit our Contact Us page to connect with a licensed agent.