Medicare 101

Frequently Asked Questions

Medicare is a health insurance program for people age 65 or older. Some younger people are eligible for Medicare including people with disabilities, permanent kidney failure and amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS). Medicare helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.

Original Medicare included:

Part A—Hospital insurance helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay), and some home health care and hospice care.
Part B—Medical insurance helps pay for doctors’ services and many other medical services and supplies that the hospital insurance does not cover.

Other parts of Medicare are:

Part C—Medicare Advantage plans are offered by private companies and approved by Medicare. These plans generally help you pay the medical costs not covered by Original Medicare.
Part D—Prescription drug coverage helps pay for prescribed medications.

When should I sign up for Medicare?

Will my Medicare premiums be higher because of my higher income?

What information does an agent or broker need to help me enroll in Medicare?

An agent or broker can help you with the process of selecting a plan and completing the enrollment. In order to best assist you, they will need to know the names and dosages of any medications you take, as well as your preferred pharmacies, so that they can narrow down the options based on how your medications will be covered. (Out-of-pocket costs for specific medications will vary considerably from one plan to another and from one pharmacy to another).

And if you’re considering Medicare Advantage plans, the agent will also need to know the names of your doctors, in order to find plans that have those doctors in their provider networks.

Is the coverage provided by Medicare as good as my employer-sponsored health insurance?

If you enrolled only in Original Medicare, you would almost certainly notice gaps in coverage that you didn’t have under your employer-sponsored insurance (ESI) plan. But most Medicare enrollees don’t go with the barebones coverage. Of Original Medicare beneficiaries, 81% have some sort of supplemental coverage (generally Medigap, employer-sponsored insurance, or Medicaid), according to a Kaiser Family Foundation analysis. And nearly half of all beneficiaries select Medicare Advantage plans, which incorporate various supplemental coverage in addition to basic Medicare benefits.

Medicare beneficiaries who have supplemental Medicare coverage will generally find that their resulting coverage is quite comprehensive. And depending on the cost of the employer-sponsored plan (including premiums and out-of-pocket costs), some people also end up with lower overall healthcare costs once they switch to Medicare.

What are my coverage options under Medicare?

Original Medicare coverage is the same in every state, including eligibility, benefits, and premiums. A Medicare beneficiary pays the same price for Medicare Part B, regardless of where the beneficiary lives (although premiums for Part B do vary based on income).

A significant portion of Medicare’s coverage is provided through private plans. The private plan options under Medicare – including Medicare Part D (prescription coverage), Medigap (supplemental coverage), and Medicare Advantage – vary significantly from one area to another in terms of which insurers offer coverage, the specific plan designs they offer, and the pricing. Most of the general regulations that apply to those plans are the same in every state. However, state regulations for Medigap plans do vary considerably.

Federal rules do not require Medigap insurers to offer coverage to disabled enrollees under age 65 but the majority of the states have implemented their own rules to ensure at least some access to Medigap plans for these enrollees.

What is Medicare Open enrollment?

Medicare Open Enrollment – also known as Annual Enrollment Period (AEP) refers to an enrollment period that takes place each fall, during which Medicare plan enrollees can reevaluate their existing Medicare coverage- whether it is Original Medicare with supplemental drug coverage, or Medicare Advantage- and make changes if they wish to do so.

If you are interested in learning about other Special enrollment opportunities, we are here to assist you.

When Is Medicare Open enrollment?

What plan changes can be made during Medicare Open Enrollment?

If you are already enrolled in Medicare coverage, you can:

Switch from Original Medicare to Medicare Advantage (as long as you are enrolled in both Medicare Part A and Medicare Part B and live in the Medicare Advantage Plan’s service area).
Switch from Medicare Advantage to Original Medicare (plus a Part D prescription drug plan {PDP}, and possibly a Medigap plan depending on the state and the persons circumstances) with requirements for medical underwriting.
Switch from one Medicare Advantage plan to another.
Switch from one Medicare Part D Prescription Drug Plan (PDP) to another.
Enroll in a Medicare Part D Prescription Drug Plan if you didn’t enroll when you were first eligible for Medicare during your Initial Enrollment period. (If you haven’t maintained other creditable coverage, a late enrollment penalty may apply).

If I change my coverage at the start of Open Enrollment, can I change my mind before the December 7 deadline?

If I make a mistake when I change my coverage during Open Enrollment, can I fix it after January 1st?

It the Open Enrollment period has ended and you’ve enrolled in a Medicare Advantage plan but believe that you should have picked a different plan, you can use the Medicare Advantage Open Enrollment Period (MAOEP) to pick a different Medicare Advantage plan.

The Medicare Advantage Open Enrollment Period (MAOEP) window is January 1st – March 31st. You can only make one change during MAOEP and it is specific to Medicare Advantage Plans only.

What is the difference between Medicare and Medicaid?

Can I have Medicare and Medicaid at the same time?

As of 2019, 12.3 million people were covered under both Medicare and Medicaid (amounting to about 20% of Medicare beneficiaries). This happens when a person has Medicare because they are 65 and over or disabled and also qualifies for Medicaid due to their financial situation. Dual eligibles are low income and often have chronic medical conditions (60% of dual eligibles had multiple chronic conditions in 2018). To improve their access to health care, the ACA created the Medicare-Medicaid coordination office (MMCO) to help align coverage under the two programs. The law also allowed insurance companies to offer specialized plans that include both Medicare and Medicaid benefits.

Despite efforts to align coverage, the most popular type of managed care plan for dual eligibles is a type of Medicare Advantage Plan called a Dual Eligible Special Needs Plan (DSNP). As of 2021, about 3 million people were enrolled in DSNP plans operating in 43 states. All DSNP’s must have contracts with state Medicaid agencies requiring the DSNP’s to pay for these things themselves and be reimbursed by the state, reducing the likelihood of dual eligibles from being improperly billed. As of 2021, DSNP’s are required to integrate care with Medicaid programs.

We are not connected to the Federal Medicare Program or affiliated with any United States Government or State agency. This is a solicitation for insurance.

We do not offer every plan in your area. Any information we provide is limited to those plans we do offer in your service area. Please contact medicare.gov, 1.800.MEDICARE or your local State Health Insurance Program (SHIP) to get information on all of your options.