Julia Alves, Medicare Insurance Broker

Answer: If you didn’t enroll in Medicare when you turned 65 and are now retiring, you’ll need to act before your employer coverage ends to avoid gaps in coverage and potential penalties.

1. Understand your coverage status

If you had creditable employer group health coverage (e.g., from a company with 20+ employees) when you turned 65, you can delay Medicare Part B enrollment until you lose that coverage.

*In most cases, you should have already enrolled in Medicare Part A, as for the majority of people, it is a $0 premium.

2. Apply for Medicare Part B during your Special Enrollment Period (SEP)

You have an 8‑month SEP after you stop working (or lose your employer health insurance, whichever comes first) to sign up for Medicare Part B without penalty.

If you miss the SEP, you’ll face a life‑long 10% penalty on your Part B premium for each year you could have enrolled but didn’t.

Complete the required forms:

Form CMS‑40B: Your application for Medicare Part B.

Form CMS‑L564: Employer‑completed form explaining you had creditable coverage and are now retiring

Submit both to Social Security, preferably sooner rather than later, within your SEP.

4. Plan coverage timing

You can choose to start Medicare Part B the day after your employer coverage ends if you submit the application before you lose coverage.

After enrolling in Part B, you have a 63‑day Special Enrollment Period to add Medigap, Medicare Advantage, or Part D drug coverage.

Answer: This is a simple yet very important detail. Turning 65 opens up your Initial Enrollment Period (IEP). However, this period starts 3 months before your 65th birthday month and stays open until 3 months after. In total, you have 7 months of an enrollment period. It is important to start as soon as your IEP opens up, as enrolling in Medicare and receiving your Medicare ID card, also known as your red, white, and blue card, can take up to a few weeks.

Example: your 65th birthday is May 18. You can start enrolling (and should) as soon as February 1st! Your IEP will be open until August 31st.

Answer: Original Medicare (highly recommended with a Medicare Supplement Plan as well) with a Part D plan is better, as these plans are flexible, you can use any doctor that accepts Medicare in the nation. There are no networks or referrals needed.

Answer: Usually, an individual will qualify for Medicare Coverage before 65 IF they have certain medical conditions. This includes ALS, End Stage Renal Disease (ESRD), or if an individual is on Social Security Benefits or Railroad Retirement Benefits on the basis of disability for more than 24 months.

For ALS, the individual is qualified for Medicare as soon as the first month of receiving Social Security Benefits.

For ESRD, there are a couple of additional eligibility requirements necessary.

Answer: Yes, you are responsible for an IRMAA surcharge if your income from two years ago exceeds certain thresholds. In 2026, if your MAGI is above $109,000 as an individual filer or if you and your spouse file jointly above $218,000 you would fall into the first IRMAA tier, which is 35% more of the total Part B premium cost. You will be notified by mail if this is the case!

Answer: In many ways, the IRA will affect seniors. As of 2026, there's a yearly cap of $2,100 on what you pay out-of-pocket for covered Part D drugs, so since 2025, there are no more unlimited costs if you need expensive meds. Insulin stays capped at $35 per month, many vaccines are free, and drug companies face penalties if they raise prices too fast.

Plus, starting this year, Medicare negotiated lower prices for 10 common high-cost drugs, cutting costs. This is expected to save seniors about $1.5 billion in total out-of-pocket spending annually. So, these changes make important medicines more affordable, so many older adults can afford their treatments without breaking the bank.

Answer: Short Answer: Yes, Medicare Advantage plans can offer extra benefits.

Long Answer: Depending on the plan, this could mean additional coverage for things like transportation to appointments, care coordination, nutritional support, or wellness programs. However, the added benefits vary by plan.

If you would like to be proactive, it’s a good idea to review your plan’s Summary of Benefits or speak with a broker. Benefits can differ a lot from one plan to another.

Answer: Medicare does pay for telehealth specialist visits, not just primary care, but coverage depends on the type of visit and current Medicare rules (as starting Feb. 1st, 2026 you must live in a rural area and go to an office or medical facility that’s also in a rural area for most telehealth services) for Original Medicare. However, many Medicare Advantage plans make telehealth easier and more flexible.

Answer: An HMO (Health Maintenance Organization) can be a good fit for some people, but there are a few downsides to be aware of:

Limited provider network – You generally must use doctors and hospitals in the plan’s network, except in emergencies.

Referrals are usually required – You might need to see your primary care doctor first to get a referral for specialists.

Less flexibility – If you like choosing your own specialists or seeing providers outside the network, an HMO can feel restrictive.

Out-of-network care is typically not covered – Non-emergency care outside the network is usually paid fully out of pocket.

HMOs often have lower premiums and predictable costs, but the trade-off is less freedom when choosing providers.

Answer: Yes! Medicare covers hip, knee, and shoulder replacement surgery when it’s medically necessary and ordered by a doctor.

Part A covers the hospital stay IF the surgery is inpatient.

Part B covers the surgeon, outpatient surgery, physical therapy, and equipment like walkers.

Most joint replacements are now done outpatient, which means Part B usually applies. After meeting the Part B deductible, Medicare typically covers 80%, and the remaining 20% depends on whether you have a Medigap.

Medicare Advantage plans also cover joint replacement surgery, but may have different costs, networks, or authorization requirements.

Answer: Original Medicare (Parts A & B) unfortunately does not include routine dental, vision, or hearing coverage. These benefits usually come through Medicare Advantage (Part C) plans, or through standalone dental/vision/hearing plans if you prefer to stay with Original Medicare + a Medigap.

Now, would adding these benefits to Original Medicare make it more expensive for everyone? Possibly, it would require changes in how Medicare is funded, but dental, vision, and hearing care actually help prevent bigger, more expensive health issues down the road, so including them could reduce LONG TERM healthcare costs. But anytime benefits are expanded, there has to be a plan for how that cost is shared. For now, the best way to get these benefits is through a Medicare Advantage plan or by adding a standalone dental, vision, and hearing plan if you stay with Original Medicare and a supplement.

Answer: If you have creditable health coverage through your (or your spouse’s) active employer, meaning it’s as good as or better than Medicare, you can delay enrolling without facing any penalties.

But if you don’t have that type of coverage and skip enrolling when you first become eligible, you could end up paying late enrollment penalties that last a lifetime:

Part A: Most people get this premium-free, so there’s usually no need to worry, but if you do have to pay for Part A and you delay, there’s a 10% penalty that lasts twice as long as the time you waited to sign up.

Part B: 10% extra added to your monthly premium for every 12 months you delay.

Part D (prescription drug plan): 1% added for each month you go without creditable drug coverage.

So, the short version... if you’re turning 65 soon, make sure you know whether your current insurance counts as creditable coverage before you delay. It can save you a lot of money later!

Answer: Here are a few quick ways to check:

Look at the official plan documents. The Summary of Benefits and Evidence of Coverage will spell out what’s included (and what’s not). If it’s not written there, it’s not guaranteed.

Check Medicare.gov. This is one of the most reliable sources since it comes straight from Medicare.

Watch for red flags. If a flyer or call only talks about “free” stuff without details, or if it sounds too good to be true, be cautious. Real plans always include disclaimers, limitations, and/or exclusions.

Ask a licensed broker. An independent broker (like me!) can confirm what’s accurate and help you see if those benefits actually make sense for your needs. Confirm they are contracted with multiple carriers and not directly working for only one carrier!

It's best to always double-check before you enroll.

Answer: This is part of the exact email I send to my current clients transitioning into Medicare, approaching their 65th birthday:

"We are 3 months before your 65th birthday, which means the process to enroll & apply for Medicare starts now! The very first step to enrolling in Medicare is applying for Medicare Part A & B. There are a few different ways you can do this

You can visit your nearest Social Security office in person.

You can call Social Security office.

Lastly, you can apply online at https://www.ssa.gov/

I want to remind you that this process can take a few weeks, so it is best to do this as soon as possible!"

There is additional info in the email, but that is the very first step! Once you apply or if you are automatically enrolled (this would be the case if you were already getting social security benefits), then I would recommend finding a broker to help you compare routes like Original Medicare with a Supplement vs Medicare Advantage and compare plan options.

Remember, your Initial Enrollment Period starts 3 months before your birth month and ends only 3 months after your birth month, so it is a 7 month enrollment period.

Answer: Original Medicare (Parts A & B) does not cover hearing aids or routine hearing exams, which means most people would pay out of pocket if they only have Original Medicare. However, many Medicare Advantage (Part C) plans do include hearing benefits, like coverage for hearing exams, fittings, and even an allowance toward hearing aids. Some Medicare Supplement Plans may even have a noninsurance benefit that includes discounted rates to hearing aids. The details vary by plan, so it’s important to review your options each year!

Answer: Unfortunately, a sudden change in your health by itself does not qualify you for a Special Enrollment Period (SEP) with Medicare.

That being said, if your health takes a turn and, for example, your situation now qualifies you for Medicaid or a Special Needs Plan, that could open the door to an SEP. Otherwise, you’d need to make changes during the regular enrollment periods.

Answer: One tip for the best way to balance affordability with personalization is to first focus on what you truly need, like making sure your doctors are in-network and your prescriptions are covered. From there, we can compare a few options side by side to find a plan that checks those boxes without you paying for things you don’t really need and/or use. That way, you can feel confident you’re getting the right coverage at the best value for you.

Answer: Yes, if you’re enrolled in Medicare, you still have to pay your monthly Part B (and Part D, if you have it) premiums, even if you’re living outside the U.S. and not using the benefits. Medicare generally doesn’t cover care outside the country, but keeping your coverage active prevents late-enrollment penalties and gaps in coverage if you move back or need care in the U.S. later.

Answer: As more baby boomers age into Medicare, the system is under pressure, especially the Hospital Insurance (Part A) trust fund.

Experts do project that this part of Medicare could face funding shortfalls in the coming years, possibly as soon as the 2030s. That doesn’t mean Medicare is going away, but it does mean changes may be needed to keep the program strong for future generations.

It is important to note that if you’re already on Medicare or close to enrolling, your benefits are not in immediate danger. The Medical & Drug Insurance (Part B and Part D), which covers doctor visits and prescriptions, is funded differently and isn’t at risk of running out of money in the same way. Lawmakers are consistently exploring solutions.

Bottom line: it is not a crisis, it just might be an adaptation and change in the future years.

Answer: Getting married doesn’t change the basics of how Medicare works, but it can affect your costs, your eligibility for certain programs, and when or how you enroll.

For example, if you didn’t work enough to qualify for premium-free Part A (hospital insurance) on your own, you may now qualify through your spouse, as long as they’ve worked at least 10 years and you’ve been married for at least one year. Also, if your spouse is still working and you’re on their employer group plan, marriage could trigger a Special Enrollment Period, which means you can delay enrolling in Part B and avoid the late penalty when you do sign up. Some Medicare Advantage and drug plans even offer household discounts or allow spouses to join the same plan, depending on your area.

One thing to keep in mind is how marriage may affect your costs. Medicare looks at your household income, so if your new spouse has a higher income, you could be bumped into a higher premium bracket... this is called IRMAA. It can also affect whether you qualify for programs like Medicaid, Extra Help, or a Medicare Savings Program. Bottom line: it’s a good time to review your Medicare coverage and make sure everything still fits your needs and your budget.

Answer: If I had to pick a mistake I see seniors make when it comes to Medicare, it’s this: not fully understanding their options or waiting too long to enroll.

I totally get it. Medicare can be confusing, and there’s a lot of noise out there. But making the wrong choice early on (or missing your enrollment window) can lead to costly penalties and limited coverage.

Some common oopsies I see:

1. Signing up too late and getting hit with lifetime penalties

2. Choosing a plan based only on the premium (without looking at coverage, networks, or drug costs)

3. Assuming Medicare covers everything (spoiler: it doesn’t... dental, vision, and prescriptions aren’t included in Original Medicare)

4. Skipping annual reviews!! Plans change every year!

5. Not working with a broker! (It's free.. why wouldn't you!)

Answer: If you're on Medicare and still stressed about affording your prescriptions in 2025, you're not alone, but there are programs that can help. Extra Help (the Low-Income Subsidy) can lower or wipe out your Part D premium, deductible, and drop your copays to just a few bucks if you qualify. There’s also the new Prescription Payment Plan, which lets you spread out your drug costs month by month instead of paying a bunch up front (recommended for individuals with high up-front medication costs). And starting in 2025, there's a $2,000 annual cap on what you’ll spend out-of-pocket for prescriptions, a huge win for everyone with Part D.

On top of that, some people qualify for a Medicare Savings Program or their state’s SPAP for extra help with drug costs. Nonprofits like PAN Foundation and HealthWell also offer copay assistance, especially if you take expensive or brand-name meds.

A few next steps may be:

-Apply or reapply for Extra Help anytime through Social Security or Medicare.gov.

-Look into your state’s SPAP (State Pharmaceutical Assistance Program), if available.

-Check for manufacturer or nonprofit assistance programs (PAPs) for the specific medications you take.

-See if you qualify for a Medicare Savings Program (MSP)

Answer: Not really! There’s no one-size-fits-all solution when it comes to Medicare. Every situation is different, but if you’re looking at your monthly premium and starting to wonder if it’s still worth it, you’re definitely not alone.

Medigap is a solid choice… for some people! These plans let you see any doctor that takes Medicare, nationwide, with almost no out-of-pocket costs (depending on the plan). That’s a huge perk if you’re traveling often or just want the freedom to go where you want without dealing with networks or referrals. Many also offer limited coverage for emergencies abroad.

If you value convenience or travel often, and it fits your budget, I don’t think Medigap is a mistake. And even if your travel or budget has changed, it still wasn’t a mistake—your priorities just shifted. The good news? In most cases, your coverage can shift with you. If you’re no longer traveling much or the premium just isn’t working for you anymore, it may be worth looking at other options.

Answer: Original Medicare generally doesn’t cover you outside the U.S., but the good news is, you do have options! Some Medicare Supplement (Medigap) plans, like Plan G or Plan N, include limited foreign travel emergency coverage. That can help with emergency care while abroad, up to a lifetime limit. Also (this varies by plan but) some Medicare Advantage Plans MAY also cover some limited foreign travel emergency coverage. Another route is to look into travel insurance specifically designed for medical coverage. Especially if it's a longer trip or if you travel frequently, it can give you peace of mind.

Answer: Yes, some Medicare seminars can be genuinely helpful — especially when they’re hosted by independent brokers who focus on educating you, not selling to you. These types of events walk you through all your options and don’t pressure you to enroll in anything on the spot.

That said, a lot of seminars out there do feel like timeshare pitches. They're often run by agents tied to just one insurance company, so the information is limited and sales-heavy. That doesn’t mean all events are bad — the key is finding one that puts education first.

What to look for:

Hosted by an independent broker, no heavy branding from a specific insurance carrier, focuses on Medicare in general (not just one plan), & no pressure to enroll — just helpful info to get you informed.

If it checks those boxes, it’s probably worth your time!

Answer: This answer isn’t one-size-fits-all!

If you're turning 65 soon but planning to delay Social Security until age 70, just know that Medicare doesn't automatically start and delaying Social Security doesn't always mean you can delay Medicare.

If you’re still working and have employer coverage, you might be able to delay Part B (and Part D) without a penalty, but it really depends on your specific situation. If you don’t have other qualifying coverage, you’ll need to enroll yourself during your Initial Enrollment Period (IEP), which is a 7-month window that starts three months before your birthday month and ends three months after. It’s important to enroll on time to avoid late penalties and make sure you have the coverage you need.

Answer: If you’ve been told you have prediabetes, Medicare covers some preventive services you may be able to take advantage of to help you avoid developing type 2 diabetes. One of them is the Medicare Diabetes Prevention Program (MDPP). This free, year-long program includes group classes on healthy eating, exercise, and lifestyle changes, with support for up to two years if you qualify. Medicare also covers free diabetes screenings, nutrition counseling, and weight loss support if you meet certain criteria.

Answer: In most cases.. yes!

If you have Original Medicare with a Medicare Supplement Plan + a Standalone Part D Plan:

- You will most likely want to update your address with Social Security and Medicare

- Standalone Part D Plans are region specific, with your move you will be eligible for a Special Enrollment Period (SEP), usually about 60 days, to search for and enroll in a new plan available in your new region.

If you have a Medicare Advantage Plan (MAPD):

- Again, these are region specific, with your move you will be eligible for a Special Enrollment Period, usually about 60 days, to search for and enroll in a new plan available in your new region.

In summary

1. Submit address change to Social Security and Medicare

2. It is necessary to review your plan options if you have a MAPD or a Standalone Part D Plan

3. You will have a 60-day SEP to enroll in a new plan available to you in your new region

*TIP: Work with a Licensed Medicare broker like me to help you through all of this :)

Answer: The answer to this, like in a lot of questions about Medicare, is: it depends!

Here are 2 questions to ask yourself:

1. Are you receiving Social Security Disability Insurance (SSDI)? (Key Word --> Social Security!)

2. If so, has it been 24 months since you started receiving SSDI?

If yes to both, the answer is YES, you do qualify for Medicare Insurance and should usually be automatically enrolled starting that 25th month.