Medicare - Questions & Answers
Getting Started with Medicare
Congrats on the beginning of your Medicare journey!
Turning 65 has it’s perks! Including being eligible for a Medicare Health Plan!
We're sure you’re aware that Medicare is COMPLICATED. Nobody teaches you what to do, and there aren’t very many resources out there that you know you can trust!
That’s where we come into play! If you’re just looking for some basic information, feel free to look around our website here.
If you’re turning 65 within the next 3 months give us a call! Medicare is very personalized, we want to talk to you and find out your specific wants & needs to help you find the plan that’s right for YOU.
How do I enroll/apply for Medicare?
That depends!
Are you already pulling from Social Security?
If so, you don’t actually need to apply for Original Medicare (that’s Medicare A and B).
You will automatically be enrolled, and will receive a Medicare card 3 months before your birthday.
Your Medicare will always be effective the first day of the month you turn 65. For instance, if your birthday is on June 23rd, your Medicare will be effective June 1st.
However, if your birthday is on the 1st of the month, your Medicare will begin the 1st of the previous month. For example, if your birthday is on June 1st, your Medicare will be effective May 1st.
​
Not pulling from Social Security yet?
You can enroll in Medicare 3 months before you turn 65, the month of, and 3 months after.
​
However, if you want your Medicare to be effective on the first of your birth month, you’ll need to enroll within the 3 months prior to your birth month.
For example, if you turn 65 November 14th, you’re eligible for Medicare on November 1st.
You can enroll in Medicare beginning September 1st. If you enroll in Medicare from September 1st- October 31st, your Medicare will be effective on November 1st. If you enroll in Medicare from November 1st- December 31st, your coverage will be effective the first of the following month when you apply, (If you enroll on November 15th, your Medicare will be effective on December 1st).
You want to make sure you don’t have a gap in coverage, so the earlier the better! Applying right away (3 months before your 65th birthday), gives you time to apply for Medicare, receive a card in the mail, then enroll in a Medicare Health Plan (either a Supplement/Medigap plan and a Part D drug plan, or a Medicare Advantage Plan/Part C), with time to spare, making sure you won’t go without health insurance.
Afraid of trying to submit a Medicare application on your own?
One of our local lisenced agents can help you apply for Medicare, AND a Health Plan! We represent ALL the major insurance carriers in your area, and do it all for FREE! Give us a call or fill out a contact form, and let’s get the ball rolling!
Am I Eligible for Medicare?
If you are 65 or older and you (or another qualifying person, like your current or former spouse) paid Medicare taxes while working for a certain amount of time (usually at least 10 years), you are eligible for Medicare!
You may also be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease).
Still not sure if you qualify? Give us a call or fill out a contact form!
Medicare Coverage Options
Once you have Original Medicare (A and B), there are a few different paths you can take!
Finding out which is best for you, is best done either in person or over the phone so that we can chat and ask questions to help guide you down the right path!
Medicare Options
Option 1 - Original Medicare
Although this option isn’t necessarily recommended, and can hurt your wallet, it IS technically an option! Original Medicare is comprised of Part A: Hospital Insurance, and Part B: Medical Insurance.
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
About 99% of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment, and Part B has a premium of $185/mo for 2025. Part B can cost more, depending on your income.
​
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,676 in 2025. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.
In 2025, beneficiaries must pay a coinsurance amount of $419 per day for the 61st through 90th day of a hospitalization in a benefit period and $838 per day for lifetime reserve days.
For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $209.50 in 2025.
For most other services covered under Part A and B, Medicare pays 80% coinsurance, and you pay 20% coinsurance.
Seem like a lot of money? IT IS! That’s why there’s other options.
Option 2 - Medicare Supplement/Medigap & a Part D Drug Plan
Supplements (Plan G for example), are designed to pick up the 20% coinsurance that Original Medicare doesn’t pay. There are many different supplements that vary in cost and coverage, and some aren’t available to you if you’re just turning 65.
Although premiums vary depending on plan and Insurance Carrier, a Plan G is a Plan G no matter which Insurance Carrier you go with. The only thing that differs is the premium. Supplements having monthly premiums on top of your Part B premium (unless you qualify for an income-based assistance program, you have to continue to pay your Part B premium no matter which option you choose).
The average cost of a Medicare supplement for someone just turning 65 is about $150/mo. When you are just starting out on Medicare and in your Intial Enrollment Period (IEP), you have guaranteed issue on a Supplement.
This means that there is no medical underwriting, and they cannot deny you based on pre-existing conditions. If you don’t chose to go with a supplement during your IEP and want a supplement later on down the road, there will be medical underwriting which means the plan doesn’t have to approve your application.
If you chose to go with a supplement, it is also recommended that you also enroll in a Part D Prescription Drug Plan. Even if you aren’t currently taking any medications you will want to enroll in a drug plan.
If you go 63 days or more without drug coverage, you may encur a late enrollment penalty later on. The late enrollment penalty is an amount that can be added to your Medicare drug coverage (Part D) premium.
You’ll generally have to pay the penalty for as long as you have Medicare drug coverage. Side note: If you’re still working and are staying with employer insurance, you typically do not have to enroll in Part B or D, as long as your work insurance is considered creditable coverage.
Option 3 - Medicare Advantage Plan (Part C)
​
Medicare Advantage Plans are Medicare-approved plans from private companies that offer an alternative to Original Medicare for your health coverage.
These “bundled” plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn’t.
There are two main types of Medicare Advantage Plans, HMO’s and PPO’s.
HMO’s are Health Maintenance Organizations, and PPO’s are Prefered Provider Organizations.
PPO’s offer more flexibility than HMOs, allowing you to see providers outside of the network, and usually without a referral to a specialist. If you enroll in a Medicare Advantage Plan that is an HMO, you must see providers within the plan’s Network.
​
Most Part C plans include prescription drug coverage however their drug formularies vary. We can help you find a plan that has your providers in their network, and covers your medications.
If you enroll in a Medicare Advantage plan, that is your primary insurance. If you go see a doctor, you will only show them your Part C plan card, (and your Medicaid card if you have Medicaid through your state). You will still HAVE Original Medicare, you just won’t be using the card while on an Advantage Plan (still keep the card though, it can be important later on!).
Monthly premiums vary from one Advantage Plan to another, but they are typically less expensive than a Medicare Supplement. The average cost of an Advantage Plan is around $17/mo, and there are usually $0 options depending on your zip code.
Employment and Medicare
If you aren’t already receiving Social Security benefits at age 65, you won’t be signed up automatically, so you’ll have to decide when you want to enroll.
But if you continue to work and have health benefits through your job, depending on the size of your employer, you can delay enrolling in Medicare. The same goes for your health insurance if it’s through your spouse’s job.
But you need to consider some rules about enrollment, and it’s always wise to compare the cost and coverage of your employer insurance to your own Medicare plan! (We can help you do this for FREE!)
​
If you delay enrolling in Medicare during your Initial Enrollment Period (when you first become eligible for Medicare), you’re entitled to a special enrollment period (SEP) to sign up for Medicare before or within eight months of losing that job-based coverage to avoid a late enrollment penalty.
Large employers with at least 20 employees must offer you and your spouse the same benefits they offer younger employees and their spouses. In this situation, you have a few options! You can accept the employer health plan and delay Medicare enrollment, decline employer coverage and enroll in your own Medicare plan, or have employer coverage and Medicare at the same time.
​
Many people enroll in Medicare Part A at 65, even with employer coverage because it’s premium-free as long as you or your spouse have paid at least 40 quarters of Medicare taxes. However you’ll want to wait if you want to continue contributing pretax dollars to a health savings account (HSA). You can’t make new HSA contributions after you enroll in Medicare.
​
Those who have access to employer-based health insurance can delay signing up for Medicare Part B while they’re still working, if they chose to keep their employer insurance instead. That way, they don’t have to pay premiums for both Medicare and the employer coverage. Part B premiums are $185/mo in 2025.
If I choose to have both employer insurance and Medicare, who pays what?
If you choose to enroll in both an employer group plan and Medicare Part B, the employer insurance is always primary.
That means it pays your medical bills first. Medicare will pay only for services it covers that the company plan doesn’t.
So unless your employer insurance doesn’t cover much, you could be paying monthly Medicare premiums for no real good reason. This is different for small employers!
Veterans and Medicare
If you’re a veteran, or recieve veteran’s benefits (thank you for your service!), you may think you don’t need Medicare. However, the VA actually encourages you to utilize both!
Enrolling in a Medicare Advantage plan can give you some extra coverage & provide you with benefits that you may not currently have. There are actually some Advantage Plans that are designed specifically for veterans!
If you qualify for veterans’ healthcare benefits and you choose to enroll in Medicare, you can opt to get treatment under either program.
But you’ll need to decide which benefits program you want to use before receiving care.
Caregiver Resources
If you’re caring for someone on Medicare, or trying to help them navigate their Medicare insurance, you don’t need the additional stress of trying to learn all about health insurance! We are more than happy with have a discussion with you, and explain the things you need to know.
In order to help someone with their Medicare plan, and make changes to their insurance, you will need to get consent to discuss health care information or become their Power of Attorney, depending on what it is you’re trying to accomplish, and the health of the person you are trying to help. You may need to fill out an Authorization to Release Information form and or a Medicare Appointment of Representative form.
​
It’s helpful for you to have copies of their plan information so you have a good idea of what they currently have for insurance, and what is covered. It is also helpful to have a list of all their current medications, and know the names of any doctors that they see.
​
If you have questions about what forms you need, or how you can help someone on Medicare, give us a call or fill out a contact form!