Medicare questions, answered

Medicare is not free for most people. Part A is usually premium-free if you or your spouse paid Medicare taxes long enough (generally 10 years). Part B has a monthly premium. Some Medicare Advantage plans have a $0 plan premium, but you generally still pay the Part B premium and may have deductibles, copays, or coinsurance. Part D premiums and other costs vary by plan.

No. Medicare is federal health insurance based mainly on age, while Medicaid is a joint federal-state program. Medicaid eligibility categories, income and resource rules, and covered services vary by state. Some people qualify for both; contact your state Medicaid agency to confirm eligibility.

Most people choose Original Medicare (Part A and Part B), sometimes with a separate Part D drug plan and Medigap, or Medicare Advantage (Part C), which provides Part A and Part B through a private plan and may include Part D. Costs, provider rules, and benefits vary, so compare the specific options available to you.

Part D covers prescription drugs. You can get Part D through a separate drug plan with Original Medicare or through many Medicare Advantage plans; covered drugs, pharmacies, premiums, and other costs vary by plan.

Yes. If you have Medicare and Medicaid, you may qualify for a D-SNP if you meet the plan's eligibility rules and live in its service area. Costs and any extra benefits vary by plan and Medicaid category; confirm details with the plan and your state Medicaid agency.

Not always. Group health coverage based on your or your spouse's current employment may qualify you to delay Part B and use a Special Enrollment Period. Confirm payment order with your benefits administrator. Creditable drug coverage is a separate Part D rule; it does not by itself let you delay Part B.

Generally, it lasts 7 months: the 3 months before the month you turn 65, your birthday month, and the 3 months after. If your birthday is on the first of a month, the period starts 4 months before and ends 2 months after that month; Medicare coverage may also start a month earlier. Check your dates with Social Security or Medicare.

October 15 to December 7 each year. Changes you make take effect January 1. Review your Annual Notice of Change and compare available options with your current needs. We can help review plans we represent; we do not offer every plan available in your area.

From January 1 through March 31, people already enrolled in a Medicare Advantage plan can make one change: switch to another Medicare Advantage plan or return to Original Medicare. If you return to Original Medicare, you can also join a standalone Part D plan. This period does not let someone in Original Medicare newly join Medicare Advantage. Confirm plan availability and effective dates with Medicare.

Apply for Parts A and B through Social Security. You can compare and enroll in Medicare Advantage or Part D plans through Medicare.gov or an insurer. A licensed agent can help with plans they represent and are licensed to offer; ask which plans are included and how the agent is compensated.

The 2027 defined standard benefit has a $700 deductible and a $2,400 annual out-of-pocket threshold. Actual plan designs can vary. After qualifying costs reach the threshold, covered Part D drugs have no cost-sharing for the remainder of the year.

VA health benefits and Medicare cover care in different settings. Whether to enroll in Part B depends on your circumstances and other coverage; delaying Part B may lead to a penalty unless an exception applies. VA prescription coverage is generally considered creditable for Part D, but confirm your current status with VA. Ask Social Security or Medicare about your Part B enrollment window before deciding.

Not by itself. VA coverage is not the current-employment group health coverage that qualifies for the usual Part B Special Enrollment Period. Other exceptions may apply, so check your exact situation and deadline with Social Security or Medicare before delaying Part B.

IRMAA is an income-related adjustment to Part B and Part D premiums. Social Security determines whether it applies, generally using tax information from two years earlier when available. Check your notice or contact Social Security for your individual amount.

No. A $0 plan premium means no additional plan premium. You generally continue to owe the Part B premium, although some plans may help pay part or all of it. You may also have copays, coinsurance, or a deductible. Each plan sets its own costs and yearly limit for covered Part A and Part B services; Part D drug costs are generally tracked separately.

It depends on the plan. HMOs generally use provider networks for non-emergency care; HMO-POS plans may cover some out-of-network care. PPOs generally cover out-of-network care at a higher cost. Rules vary, so confirm each provider and facility with the specific plan before enrolling.

Original Medicare is federal Part A and Part B coverage; it generally lets you use any provider that accepts Medicare, and it has no yearly limit on your Part A and Part B out-of-pocket costs. Medicare Advantage plans are offered by private insurers and set plan-specific costs and provider rules; many use networks, and some include Part D or extra benefits.

Often. During the Annual Enrollment Period (October 15–December 7), you can join, switch, or drop a Medicare Advantage plan for coverage starting January 1. If you are already enrolled in Medicare Advantage, you may also have one change during the Medicare Advantage Open Enrollment Period (January 1–March 31). Special Enrollment Periods may apply in certain situations. We can help check which window applies.

Many Medicare Advantage plans include Part D drug coverage (MAPD plans), but not all. If a plan does not include drug coverage, you generally cannot add a separate Part D plan while staying in that Medicare Advantage plan; limited plan-type exceptions apply. Check the specific plan rules before enrolling. We can review its drug coverage and formulary.

Medicare Advantage plans have a yearly limit on what you pay for covered Part A and Part B services. The limit is set by each plan and may differ for in-network and out-of-network services. After you reach the applicable limit, the plan pays 100% of covered services for the rest of the calendar year. Premiums, Part D drug costs, and services the plan does not cover generally do not count toward this limit.

If you're 65 or older and have Medicare Part B, your one-time 6-month Medigap Open Enrollment Period starts the first day of the month you're enrolled in Part B. During this period, insurers generally can't deny you a policy or charge more because of a pre-existing condition. Outside it, federal and state guaranteed-issue rights and insurer rules vary; underwriting may apply. Confirm your rights with your State Insurance Department or Medicare.

No. Medigap doesn't include prescription drug coverage. If you want Medicare drug coverage, you can enroll in a standalone Part D plan, subject to eligibility and enrollment rules.

Plan G covers most Medicare-approved Part A and Part B cost-sharing, except the Part B deductible. Plan N has different benefits and cost-sharing. Compare current plan benefits and premiums available to you; the right fit depends on your needs and budget.

Most Medigap policies do not have provider networks. With Original Medicare, you can generally use doctors and hospitals that accept Medicare for covered services, subject to Medicare's coverage rules. Medicare SELECT policies may require designated hospitals and, in some cases, doctors for full benefits. Emergency-care rules and other policy terms apply, so check the policy and confirm provider participation before care.

Each person must purchase their own individual Medigap policy; premiums are not shared. Pricing depends on the insurer, plan, pricing method, location, discounts, and other factors allowed by state law. Ask how a specific policy is priced and how its premium may change over time.

Medigap premiums vary by insurer, plan, and pricing method (community-rated, issue-age-rated, or attained-age-rated). Location, discounts, and other state-permitted factors may also affect rates. Ask about the pricing method and how premiums may change over time. We can help compare options we represent and are licensed to offer in your area.

After your Initial Enrollment Period ends, you may owe a Part D late enrollment penalty if you go 63 or more days in a row without Part D or other creditable prescription drug coverage. The penalty is generally 1% of the national base beneficiary premium for each full uncovered month and is added to your Part D premium for as long as you have drug coverage. You don't pay the penalty while receiving Extra Help. Keep coverage notices and confirm whether other coverage is creditable.

Yes. During the Annual Enrollment Period (Oct 15–Dec 7), you can make certain plan changes for the next year. Review your Annual Notice of Change and compare available options against your current medications and needs; we can help review plans we represent.

After you reach the 2027 out-of-pocket threshold, you won’t pay out-of-pocket for covered Part D drugs for the rest of the calendar year. Plan premiums remain due, and plan designs can vary.

Most Medicare Advantage plans include Part D drug coverage, but not all. Whether you can add a separate Part D plan depends on the type of Medicare health plan; joining one may end Medicare Advantage coverage for some plan types. Check with the plan before enrolling. We can help review formulary information for plans we represent; confirm current coverage with the plan.