Answers to Frequently Asked Questions About Medicare and Health Insurance

As you approach 65 or explore options for yourself or a loved one, understanding Medicare’s various parts, plans, and costs can feel complex. This page provides clear, concise answers to the most frequently asked questions about Original Medicare, Medicare Advantage, Part D drug coverage, Medigap policies, enrollment periods, eligibility, and more – helping you make informed decisions about your healthcare coverage.

If you have additional questions, contact My Medicare Solution!

You are eligible for Medicare if you meet both of these requirements:

• You are 65 and older, or under 65 with qualifying disabilities, or any age with end-stage renal disease.
• You are a citizen or legal resident of the United States, and have spent at least 5 consecutive years in the country.

Your initial enrollment is a 7-month window, including the three months prior to your birthday, the month of your birthday, and three months after your birthday. We recommend a consultation well in advance of your 65th birthday to make sure that you can transition seamlessly and without paying for months when you don’t yet need Medicare coverage. (Example. If your birthday is in June, your eligibility starts on March 1st and ends on September 30th, unless your birthday is on the first day of the month, then everything shifts a month earlier.)

My Medicare Solution will work with you through the process:

1. Choose the appropriate time to transition to Medicare.
2. Apply for your “Original Medicare”, Part A and Part B.
3. Select additional coverage, whether “Medicare Supplement” or “Medicare Advantage”.
4. Once A and B are active, apply for additional coverage. (Steps 1-4 are done in one or two consultations.)
5. After that, if there are any changes in your life (moving, serious illness, divorce) or you want to change your plan during Annual Enrollment, we’ll have a new consultation and update your coverage as necessary.

Online at SSA.gov or through a scheduled phone appointment with Social Security. You do not have to sign up for your Social Security benefits at the same time as Medicare, but you can. We also can assist you with the application process. Please contact us for more information.

It depends. If you have alternative “creditable coverage” like employer or union coverage, you do not have to enroll during your initial enrollment window and can enroll any time while you continue work, prior to retirement. If you do not have other creditable coverage, you may not be able to enroll in Medicare right away, which means a gap in coverage. In addition, you will face penalties once you do enroll that will stay with you for the rest of your life. To avoid complications, a consultation is recommended during your initial enrollment.

As long as your employer or union coverage is considered “creditable”, you can enroll in Medicare at any time of the year and you should consider starting the Medicare enrollment process 2 months prior to your retirement to avoid any gaps in coverage.

Medicare Part “A” is one of the two parts of Original Medicare, provided by the government. It covers in-patient care like hospitalization, skilled nursing facilities or rehab and hospice. The cost of Medicare Part A depends on work history – if you or your spouse has worked for 10 years or accumulated 40 credit hours, Part A is $0. If you have worked for fewer years, you may have an additional cost. Part A and Part B do not cover all your costs and it is a good idea to get additional coverage to cover those gaps.

Medicare Part “B” is one of the two parts of Original Medicare, provided by the government. It covers out-patient care like doctors’ visits, labs and tests, emergency room, outpatient surgery, chemotherapy, dialysis. It also covers Durable Medical Equipment. The cost of Part B depends on income and may go up yearly for inflation. Part A and Part B do not cover all your costs and it is a good idea to get additional coverage to cover those gaps.

While you are required to have Medicare Part A and Part B (“Original Medicare”) once you are over age 65 and retired, it is almost always not enough coverage. There are large gaps in Original Medicare and no additional benefits like prescription, dental, vision, or hearing coverage. To make sure that those large (and potentially expensive or dangerous) gaps are filled or made manageable, and to add needed additional benefits and avoid prescription plan penalties, it’s a good idea to have additional coverage. Some additional coverage options have no additional premiums and still provide great coverage for the gaps in Original Medicare. We recommend a free consultation so we can discuss these gaps and provide options for your consideration.

Medicare Part “C” plans are also called Medicare Advantage Plans. These plans are provided by private insurance companies and may include additional benefits like dental, vision, hearing, prescription and others while providing greater protection from medical and hospital expenses than Original Medicare.

Part “D” is Prescription Drug coverage. Because Original Medicare doesn’t cover prescription medications, this benefit is only available through private insurance companies and can either be a stand-alone plan or included in Medicare Advantage/Part “C” plans.

Original Medicare Part A and Part B don’t provide dental care except in extremely limited circumstances, but you can find dental options included in Medicare Advantage plans.

Medicare Supplement plans, also known as “Medigap” plans, are plans provided by private insurance companies to lessen or close the medical “gaps” in Original Medicare. They are secondary to Original Medicare and generally do not provide additional benefits like dental vision and hearing. They also do not provide prescription coverage, so if you have a Medicare Supplement plan and need coverage for your medications, you will need to get a stand-alone Part D plan. Medigap plans are standardized by the Federal Government by the letter name of the plan, so if someone mentions “Plan G” “Plan F” “Plan N”, they are likely talking about a Medigap plan.

No. You cannot hold both at the same time. In fact, it is not legal in most cases for someone to sell you a Medicare Supplement Plan when you have a Medicare Advantage Plan unless your Medicare Advantage Plan ends the month prior to the start of the Medicare Supplement plan.

You usually can keep your current doctors. Medicare brokers and agents are required to review your doctors and prescriptions when assisting you with selecting coverage, so you don’t have to be on your own when you’re making the transition.

It depends on whether your employer coverage is creditable and also how it compares to Medicare. We recommend a free, no-obligation consultation, where we’ll help you compare your coverage to Medicare and make sure you have the best options for your needs and situation.

Yes. Once your employer or union benefits transition to ‘retiree’ benefits (insurance that you can keep after you no longer work with the company and you are 65 or over), your coverage becomes secondary to Medicare. If you do not have both Medicare Part A and Part B, your insurance may not pay for your medical bills as there is no active primary insurance. We also recommend comparing your retiree benefits to other options in Medicare to make sure you are getting the coverage that works best for you, we can help with that.

It depends on your situation. If the employer group has 20 employees or more, and you’re going to continue to work, then yes, but there are many things to consider. Whether you continue to work or not, we recommend a consultation when you first become eligible for Medicare.

If you are a Veteran who uses the Veterans Administration for your medical care, it’s a good idea to have Medicare as a backup and in case of an emergency. There are Medicare plans specifically made for Veterans to provide additional benefits and, in some cases, even reductions in Medicare premiums. TRICARE requires members to have Medicare A and B after age 65, but it’s still a good idea to have a consultation, as there are plans with additional benefits made just for TRICARE members.

This is alternative coverage such as employer or union coverage that is considered “at least as good as Medicare”. If your coverage is not considered “creditable”, you may face the same penalties as if you had no insurance coverage at all. The HR department or Benefits Coordinator of your employer or union has to provide a yearly Notice of Creditable Coverage, so if you aren’t sure, please contact that department. Please note that if your employer group is under 20 employees, your coverage is likely not creditable and you should consult an insurance broker.

It depends on the situation. If you are in a nursing home or skilled nursing home for recovery purposes then yes, the first 100 days are covered, as long as you continue recovering. If you are in a facility for “custodial care”, meaning ‘non-medical care for daily living activities”, Medicare will not cover the cost of your care, but there are other options. Let us know if you’d like more information.

Medicare is medical insurance for those that are 65+, or under 65 and have qualifying disabilities. Medicaid is financial assistance from the state for qualifying low-income individuals. If you qualify for both Medicare and Medicaid, there are special plans for Dual Medicare/Medicaid recipients that add great additional benefits (like dental, vision, hearing and grocery allowance) at no extra cost. We recommend a consultation to discuss your options.

Yes, we can definitely help. We work with individual medical coverage for those who are not eligible for Medicare and can compare those options to your COBRAConsolidated Omnibus Budget Reconciliation Act, a federal law that allows continuation of health insurance coverage after certain qualifying events. options and chart a trajectory of coverage to bridge the gap between your retirement and your spouse becoming eligible for Medicare.  Medicare is individual coverage, with no spousal options (except where it counts for Medicare Part A eligibility). You can choose the same plan when your spouse turns 65, but you will still have individual plans. We are here to make sure that both spouses have the coverage that works right for them.

If you have additional questions, contact My Medicare Solutions for a free, no-obligation consultation!