Jane Ahrens, Medicare Insurance Broker

Answer: No, you do not, but turning 65 gives you a special enrollment period (qualification) to switch to a different Medicare plan if you want to.

Answer: When you're on a Part C, it does not follow the Medicare Part A deductible at all. You signed a contract with that Medicare Advantage plan to pay the co-pays outlined in the Summary of Benefits and Evidence of Coverage for your plan. In this example, you would pay a maximum of $2,450 for your hospital stay if you stayed for 7 days. Take the $350/day and multiply that by the number of days. The average hospital stay length is two days, in which case you'd only pay $700. If you had a two day stay on original government Medicare, you'd pay the $1,676 for that two day stay. So you make out better with your plan for a shorter stay.

Answer: Ambulance rides to the hospital fall under Part B of Medicare. In 2025 there is an annual deductible of $257 which must be paid first (if it hasn't been already) and then you'd be responsible for 20% of the bill. The ambulance company would have to agree to Medicare assignment in the first place. Most do.

Answer: You didn't specify which premium you meant. Your Part B premium (based on 2023 income) is income-based if you are an individual with higher income (above $106K for a single filer). If you are under $106K, your Part B is $185/month.

If you are talking about a Medicare Supplement premium, it's possible that you were receiving a household discount on the monthly premium which would be gone now.

It's impossible to say without knowing what premiums you mean.

Answer: There are several types of Medicare Advantage plans including HMOs, PPOs, PFFSs and MSA plans. There are plans called MA only (those without a Part D) and those called MAPD (which include Part D). There are also plans tailored to specific populations and these are referred to as Special Needs Plans (SNPs). They include such plans as CSNP (for those with chronic conditions), DSNP (for those who have both Medicare and Medicaid), and ISNP (for institutionalized individuals). A good agent can help you choose the plan that is best suited for your needs.

Answer: Seniors on original Medicare are entitled to receive all the CDC-approved vaccines at no cost including Flu, Shingles, Pneumonia, and Covid, + some others when given at a pharmacy. There may be a cost for a doctor's office visit if given at a doctor's office and getting a vaccine is the sole purpose for the visit.

Answer: If you were disabled for 24 months or longer (SSDI) you would have been given Medicare at that point. If not, yes, you will receive a Medicare card automatically during the 4th month before your birthday month, and it will be effective on the first day of your 65th birthday month. You get the opportunity to choose a Medicare supplement or Medicare Advantage plan, too. Even if you had Medicare because of your disability, when you turn 65, you get to make another Medicare plan selection due to turning 65.

Answer: You will automatically be enrolled in Parts A and B and receive your Medicare card during the fourth month preceding your birthday month. It will still be effective on the first day of month of your birthday month unless you were born on the 1st of a month. In that case, your coverage begins on the 1st day of the previous month.

Answer: Medicare does not provide long term care. The only care provided by Medicare in a Skilled Nursing Facility is for rehab ordered by a doctor after a surgery. That coverage ends at 100 days and often ends sooner if the patient stops progressing. For traditional nursing home custodial coverage, a long-term-care policy would need to be purchased.

Answer: In general, with an HMO you are restricted to seeing doctors in that plan's network. If you go outside of the network, except in an emergency, you will not be covered. With a PPO, there is both in-network and out-of-network coverage, although you usually pay more for out-of-network services.

Answer: What is the difference between a Medicare Supplement (Medigap) policy and a Medicare Advantage Plan? Will I always be able to purchase either?