Frequently Asked Questions
Find answers to common questions about Medicare coverage, enrollment, costs, and our services.
What is Medicare?
Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It has four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
Is there a cost to use this service?
No, our service is completely free to use. There is no obligation to enroll in any plan when you receive a quote. We connect you with Medicare specialists who can help you compare plans at no cost to you.
When can I enroll in Medicare?
You can enroll during your Initial Enrollment Period (3 months before your 65th birthday, the month of your birthday, and 3 months after), during the Annual Enrollment Period (October 15 - December 7), or during a Special Enrollment Period if you qualify.
What is the difference between Medicare Advantage and Medicare Supplement?
Medicare Advantage (Part C) is an alternative to Original Medicare that bundles Part A, B, and usually Part D into one plan from a private insurer. Medicare Supplement (Medigap) works alongside Original Medicare to help pay for costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.
How do I know which Medicare plan is right for me?
The right plan depends on your individual needs, budget, health conditions, and preferred doctors. Our Medicare specialists can help you compare plans available in your area and find the right fit. Call us Monday – Friday, 8 AM – 8 PM local time for a free consultation.
Can I change my Medicare plan?
Yes, you can change your plan during the Annual Enrollment Period (October 15 - December 7) or during a Special Enrollment Period if you qualify. Medicare Advantage enrollees can also switch plans during the Open Enrollment Period (January 1 - March 31).
What does Medicare cost?
Most people pay no premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. The standard Part B premium is set annually by CMS and is deducted from your Social Security check. Part D premiums vary by plan. You will also have deductibles, copays, and coinsurance depending on the services you receive and the plan you choose.
Does Medicare cover prescription drugs?
Original Medicare (Parts A and B) does not include prescription drug coverage. You can add a standalone Part D plan for drug coverage, or choose a Medicare Advantage plan that includes prescription drug benefits. Part D plans cover both generic and brand-name medications, though each plan has its own formulary (list of covered drugs).
Does Medicare cover dental, vision, and hearing?
Original Medicare provides very limited coverage for dental, vision, and hearing services. It does not cover routine dental cleanings, eye exams for glasses, or hearing aids. However, many Medicare Advantage plans include dental, vision, and hearing benefits as part of their coverage package.
What is the Medicare donut hole?
The donut hole (or coverage gap) is a phase of Medicare Part D prescription drug coverage. After you and your plan have spent a certain amount on covered drugs, you enter the donut hole where you may pay a higher share of drug costs. Once your out-of-pocket spending reaches a set threshold, you move into catastrophic coverage where your costs drop significantly.
What happens if I miss my enrollment period?
If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you may have to wait until the General Enrollment Period (January 1 - March 31) to sign up for Part B, with coverage starting July 1. You may also face a late enrollment penalty — a permanent increase of 10% on your Part B premium for each 12-month period you were eligible but did not enroll.
Can I have Medicare and employer insurance at the same time?
Yes, you can have both Medicare and employer-sponsored insurance. Which one pays first depends on the size of your employer. If your employer has 20 or more employees, your employer plan is the primary payer. If fewer than 20, Medicare pays first. Coordinating both coverages can help reduce your out-of-pocket costs.
What is IRMAA?
IRMAA (Income-Related Monthly Adjustment Amount) is an additional premium surcharge that higher-income Medicare beneficiaries pay for Part B and Part D coverage. It is based on your modified adjusted gross income from two years prior. If your income exceeds certain thresholds, you will pay more than the standard premium. You can appeal IRMAA if you have experienced a life-changing event such as retirement or divorce.
How do I appeal a Medicare coverage decision?
If Medicare denies coverage for a service or item, you have the right to appeal. The appeals process has five levels: redetermination by the plan or Medicare contractor, reconsideration by an independent review organization, hearing before an administrative law judge, review by the Medicare Appeals Council, and judicial review in federal court. You must file your initial appeal within 120 days of receiving the denial notice.
Still Have Questions?
Our licensed Medicare specialists are available 8 AM – 8 PM local time, Monday – Friday to help you understand your options and find the right plan.