Straight answers to common Medicare questions

Medicare is federal health insurance, mainly for people 65 and older. Some younger people qualify because of certain disabilities or conditions such as ALS or end-stage renal disease.

Part A covers hospital stays, limited skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and preventive services. Part C, called Medicare Advantage, is a private plan that bundles A and B and usually adds drug coverage and extras. Part D covers prescription drugs.

Your Initial Enrollment Period is seven months: the three months before your 65th birthday month, the birthday month itself, and the three months after. Signing up early in that window generally helps your coverage start on time.

If you're already receiving Social Security or Railroad Retirement benefits when you turn 65, you're typically enrolled in Parts A and B automatically. Otherwise, you need to sign up yourself.

It depends. If you're covered through your own or your spouse's current employer, you may be able to delay Part B without a penalty, but the rules depend on the employer's size. If you contribute to a Health Savings Account, you generally must stop before enrolling in Medicare. Talk with me before your birthday so you don't miss a deadline.

Original Medicare (Parts A and B) lets you see any provider in the country who accepts Medicare, but it has no annual out-of-pocket limit on its own, so many people add a supplement and a drug plan. Medicare Advantage plans use provider networks, have copays and an annual out-of-pocket maximum, often include drug coverage and extras, and may require referrals or prior approval. Neither is better for everyone.

Medigap is private insurance that helps pay costs Original Medicare leaves behind, like deductibles and coinsurance. Plans are standardized and labeled by letter. They work only with Original Medicare, not with Medicare Advantage.

If you have Original Medicare, you need a Part D plan or other creditable drug coverage to avoid a late penalty. Many Medicare Advantage plans already include drug coverage.

Original Medicare generally doesn't cover routine dental, vision, or hearing care, long-term custodial care, or most care outside the U.S. Some Medicare Advantage plans offer limited dental, vision, and hearing benefits.

Original Medicare is accepted by providers across the U.S. who take Medicare. Medicare Advantage depends on the plan's network and service area, and moving out of your plan's area opens a special enrollment period.

If you go without qualifying coverage, you may pay a lifelong Part B penalty of 10% for each full 12 months you could have had it, and a Part D penalty that grows each month without creditable drug coverage. You also have a limited window to buy any Medigap plan without health questions, so timing matters.

Programs such as Extra Help for drug costs and Medicare Savings Programs for premiums are available based on income and resources. I can help you find out whether you might qualify.

You can make changes during Annual Enrollment (October 15 – December 7). If you're in a Medicare Advantage plan, you also have an open enrollment period from January 1 to March 31 to switch plans or return to Original Medicare. Certain life events, like moving or losing other coverage, open a special enrollment period.

In most cases, no. Plan prices are set by the insurance companies and are generally the same whether you enroll directly or through an agent, and agents are typically paid by the carriers. I'll help you compare options, though I don't offer every plan available in your area.