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Medicare FAQ

In most cases, you are eleigible for Medicare if you are 65 and have been a U.S. resident for at least 5 years. If you have any questions on if you’re elgibile for Medicare, you can always reach out to licensed agent or learn more in our Medicare 101 modules.

Medicare works differently depending on what Medicare path you take.

If you go the route of Original Medicare, once you are enrolled, you will get your Red White and Blue Medicare card. Once you have that you can decide if you want to enroll in any supplemental insurance like Medigap or Part D- prescription drug coverage.

Or, you could decide to enroll in a Medicare Advantage Plan which will take over for Original Medicare A, B, and D and will be your primary insurance moving forward.

If you have alternate coverage through an employer, you may be able to delay Medicare Part B enrollment.

If you are enrolled in an Under 65 Individual or Family Plan, you will have to move onto Medicare as you will not longer be eligible.

When you get close to your 65th birthday, it’s best to compare your situation along with your options to determine if Medicare is the right move for you.

Once you sign up for any part of Medicare, you are no longer eligible to contribute to an Health Savings Account (HSA) however, you can use any remaining funds that you have.
Medicare Open Enrollment which is also known as Medicare’s Annual Election Period (AEP) starts on October 15th and goes through December 7th.

To apply for Medicare, you can enroll online through the Social Security Administration website at SSA.gov, call Social Security at 1-800-772-1213, or visit your local Social Security office.

If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B starting the first day of the month you turn 65. If not, you should apply during your Initial Enrollment Period, which starts three months before the month you turn 65 and ends three months after.

You can enroll in Medicare either online, in person at a local Social Security office, or over the phone. The easiest way is to enroll online. However, you will need to have an online Social Security account.

For online enrollments, you will need to go to the Social Security Administration’s website at SSA.gov to create an account by providing basic information like your name, address, and phone number. You’ll also need your social security number to complete the application as well as information that can help identify you; typically your place of birth.

On occasion, individuals may be asked further information, like original birth certificates.

Typically, you can only make changes to your Medicare coverage during the Medicare Open Enrollment Period (AEP). If you experience a qualifying life event – change in residence, change in eligibility, loss of coverage from employment – you may qualify for a Special Enrollment Period which would allow you to make changes outside of the AEP Window.

For more information about Special Enrollment Periods, See Medicare’s SEP Page.

Medicare costs can vary depending on what parts of Medicare you elect into. You’ll need Part A which is premium free, and part B, which has a premium based on your income.

Supplemental plans including Prescription Drug Coverage, vary by carrier as well as Medicare Advantage plans. You can use the MED65 Find a Plan tool to compare the cost of available plans.

For those who have Original Medicare as their primary insurance, you can search for providers at Medicare.gov. You can also ask your provider if they accept Medicare.

If you have a Medicare Advantage plan, you need to check your insurance carrier’s provider directory – usually located online via their website.

Original Medicare does not cover dental, vision or hearing. Those benefits will have to be obtained in an alternate way (such as standalone coverage). With some Medicare Advantage plans, dental, vision, and hearing are covered but not always and benefits will vary by plan.

Original Medicare is government-run and includes Part A (hospital) and Part B (medical), letting you see any doctor that accepts Medicare, usually without referrals, but it doesn’t cover prescription drugs unless you add Part D or help with out-of-pocket costs. If you want Original Medicare to be your primary insurance, you can purchase a Medigap plan to help “fill the gaps” Original Medicare does not cover.

If you choose to enroll in a Medicare Advantage (Part C) instead, the insurance carrier becomes the primary insurance and Original Medicare sits in the background. Medicare Advantage plans combine Parts A and B, usually includes drug coverage, and may offer extra benefits like dental or vision – but it often requires you to use a network of providers and get referrals for specialists.

See the chart below for a side-by-side breakdown.

Medicare Original

  • Coverage Includes: Part A (Hospital) and Part B (Medical)
  • Provider Choice: Any provider that accepts Medicare
  • Referral Needed for Specialist? No
  • Prescription Drug Coverage: Not included – must add a separate Part D plan
  • Extra Benefits: (Dental, Vision, etc.) Not included
  • Out-of-Pocket Limits: No annual limit (but Medigap can help)
  • Medigap Eligibility: Can add a Medigap plan for extra coverage
  • Monthly Costs: Part B premium + optional Medigap/Part D
  • Administered By: Federal Government

Medicare Advantage

  • Coverage Includes: Part A and B, often includes Part D (Rx)
  • Provider Choice: In-network providers (HMO or PPO plans)
  • Referral Needed for Specialist? Often yes (depends on plan type)
  • Prescription Drug Coverage: Usually included
  • Extra Benefits: (Dental, Vision, etc.) Usually included
  • Out-of-Pocket Limits: Yes – annual out-of-pocket maximum
  • Medigap Eligibility: Cannot combine with Medigap
  • Monthly Costs: Part B premium + possible plan premium
  • Administered By: Private insurance companies approved by Medicare