Medicare questions, answered

Part A is usually premium-free if you or your spouse paid Medicare taxes 10+ years. Part B has a monthly premium. Advantage and Part D plans vary — some are $0 premium.

No. Medicare is federal health insurance based mainly on age. Medicaid is a state/federal program based on income. Some people qualify for both (dual-eligible).

Yes — that's called being dual-eligible, and it usually unlocks lower costs and extra benefits through a D-SNP plan.

Not always. If you have creditable employer coverage you may delay Part B penalty-free. Without creditable coverage, delaying causes lifelong penalties. We check your situation.

October 15 to December 7 each year. Changes you make take effect January 1. We review your plan every fall to make sure it's still your best fit.

Parts A and B are through Social Security (online, phone, or local office). For your plan choice, a local agent like us compares your options and enrolls you — free.

The coverage-gap 'donut hole' is effectively gone, replaced by a ~$2,100 annual out-of-pocket cap. After you hit it, covered drugs cost $0 the rest of the year.

Often yes — Part B protects access to non-VA care and avoids penalties. VA and Medicare cover different settings, so together they give you the most flexibility.

IRMAA is an income-related surcharge added to your Part B and Part D premiums if your income is above set thresholds. We can estimate whether it applies to you.

No. A $0 plan premium means no extra monthly premium beyond your Part B premium, but you still have copays, a possible drug deductible, and a max out-of-pocket. Two $0 plans can differ by thousands in real cost.

It depends on the plan's network. HMO plans require in-network providers; PPO plans offer out-of-network flexibility at higher cost. We verify your specific doctors and hospital against every plan before you enroll.

Original Medicare (Parts A and B) is federal coverage with no network restrictions and no out-of-pocket maximum. Medicare Advantage is an all-in-one private plan that adds an annual spending cap and usually drug coverage and extras, but requires using a provider network.

Yes. During the Annual Enrollment Period (October 15 – December 7) you can switch, drop, or join a Medicare Advantage plan. Changes take effect January 1. We review your plan each fall.

Most Medicare Advantage plans include Part D drug coverage (MAPD plans). If your plan does not include drug coverage, you would need a standalone Part D plan. We confirm drug coverage and formulary before you enroll.

Every Medicare Advantage plan is required to have an annual out-of-pocket maximum — the most you pay in a year for covered services. For 2026 the federal cap is set by CMS. Once you reach your plan's limit, covered services cost you $0 for the rest of the year.

You get a 6-month Medigap Open Enrollment Period when you first enroll in Part B at 65, with guaranteed acceptance. After that, switching may require health underwriting — insurers can decline or charge more based on health history. We'll tell you your window and options.

No. Medigap doesn't include drug coverage — you add a standalone Medicare Part D plan. We set both up together to make sure you have complete coverage.

Plan G is the most comprehensive widely-available plan — you pay only the annual Part B deductible. Plan N has a lower monthly premium but charges small copays (up to $20 for office visits and $50 for emergency room). The right plan depends on how often you use care.

No — that is one of the main advantages. Medigap works with Original Medicare, so you can see any doctor or hospital in the U.S. that accepts Medicare, with no referrals required.

Each person must purchase their own individual Medigap policy. Premiums are set by the carrier based on age, gender, and sometimes tobacco use — they are not shared.

Premiums vary by plan letter, carrier, age, and location. We compare every carrier and plan in your area to find the best combination of coverage and cost for your situation.

If you go without creditable drug coverage after you're first eligible for Medicare, a permanent late enrollment penalty is added to your monthly premium. The penalty is 1% of the national base premium for every month you went without coverage. Enrolling on time — or keeping creditable employer drug coverage — avoids it.

Yes. During the Annual Enrollment Period (Oct 15–Dec 7) you can switch Part D plans for the next year. We review your plan each fall to make sure your medications are covered at the best cost.

For 2026, the Medicare Part D out-of-pocket cap is approximately $2,100. Once you reach this threshold, covered drugs cost you $0 for the rest of the year — a major change from the previous 'donut hole' system.

Most Medicare Advantage plans (called MAPD plans) include Part D drug coverage. If your plan does not include drug coverage, you would need a standalone Part D plan. We verify formulary coverage for your specific medications before enrollment.

A formulary is the list of drugs a Part D plan covers, organized into tiers that determine your cost. If your medication is not on the formulary, you may pay full price. We check your full prescription list against every plan's formulary to find the lowest total cost — not just the lowest premium.

Except for emergencies and urgent care, out-of-network care usually isn't covered on an HMO — you'd pay full cost. That's why network checks matter.

Often slightly, in premium or copays, in exchange for out-of-network flexibility. The right trade-off depends on how you use care.

You qualify if you have both Medicare and Medicaid (or your state's Medicare Savings Program). We can verify your status and enroll you in a SNP if you're eligible.

Original Medicare generally doesn't. Some Advantage plans and standalone dental policies help — coverage and limits vary widely, so compare carefully.