Medicare Questions & Answers: Eligibility
Eligibility Q&A
Showing 81 questions
I'm retiring next year - do I need to do anything with my Medicare?
1. Determine Your EligibilityMost people become eligible for Medicare at age 65. If you are retiring and will turn 65 next year, you should begin the enrollment process as early as three months before your 65th birthday. If you are already 65 or older, you may need to evaluate how your retirement affects your current Medicare enrollment.
2. Understand How Retirement Affects Coverage
If you’re retiring and currently have health insurance through your employer, that coverage will likely end when you stop working. You’ll need to ensure that you have Medicare Parts A (hospital insurance) and B (medical insurance) to avoid gaps in coverage. Even if you’re already enrolled in Part A, you’ll still need to sign up for Part B if it hasn't been done yet.
3. Enroll During the Special Enrollment Period (SEP)
For individuals retiring after age 65, retirement triggers a Special Enrollment Period (SEP), during which you can sign up for Medicare Part B without incurring late penalties. The SEP begins the month your employer coverage ends and lasts for eight months.
4. Consider Additional Coverage Options
Beyond Parts A and B, you may want to explore:
• Medicare Part D: Prescription drug coverage to help lower medication costs.
• Medigap: Supplemental insurance to cover costs not paid by Original Medicare, such as copayments and deductibles.
• Medicare Advantage Plans (Part C): An alternative to Original Medicare that combines Parts A and B, and often Part D, into a single plan.
5. Know Key Deadlines
Avoid gaps in coverage or penalties by knowing when to enroll:
• Initial Enrollment Period (if turning 65): Starts three months before your 65th birthday and ends three months after.
• Special Enrollment Period: Applies if you had employer-provided coverage and are retiring after age 65.
6. Contact Medicare or a Licensed Insurance Agent
Reach out to Medicare (1-800-MEDICARE) or your local Insurance Agent for personalized guidance on your specific situation.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
Maybe. How long did you have a Medicare Advantage plan?If you are still in your first year of Medicare Advantage coverage and you previously had a Medicare Supplement plan that you dropped to join the Medicare Advantage plan, you may exercise your 'Trial Right' Special Enrollment Period to return to your Medicare Supplement plan with no medical questions. If that plan is no longer available, you may choose another Medicare Supplement insurance company and enroll without Medical Underwriting, within certain guidelines.
If you enrolled directly into a Medicare Advantage plan during your Initial Enrollment Period and are leaving that plan within the first 12-months of coverage, you may also choose to return to Original Medicare and enroll with a Medicare Supplement plan without Medical Underwriting, again, subject to certain guidelines.
This process can be a bit tricky because you must first drop the Medicare Advantage plan and return to Original Medicare before you may enroll for a Medicare Supplement plan, and this can take some time. The Annual Enrollment Period is from October 15 - December 7 each year, and it is a very busy time of year for Social Security and Medicare, as most Medicare beneficiaries need to review and make changes to their plans during that time of year. It is possible that you could leave your Medicare Advantage plan and go back to Original Medicare only to have your Special Enrollment denied by the insurance company and find yourself without a Supplement plan while also outside of the Annual Enrollment Period, so also unable to re-enroll in your Medicare Advantage plan. If you want to do this, be prepared to start the process in October to allow enough time for the disenrollment and re-enrollment. You do not want to wait until the end of November or beginning of December to start this process.
Am I eligible for a Special Enrollment Period if I lose employer coverage?
Yes, if you lose employer coverage, you qualify for a Medicare Special Enrollment Period (SEP).• For Original Medicare (Part A and/or Part B), you have 8 months from the date your group health plan ends or you stop working — whichever comes first—to enroll without penalty. This only applies if your coverage was through active employment (not COBRA or retiree coverage).
• For Medicare Advantage (Part C) and Part D (prescription drug coverage), the SEP is shorter: you have 2 months from the date your employer coverage ends to sign up.
Key points:
• The 2-month SEP for Part C and Part D starts when your employer coverage ends — not when employment ends.
• Missing this window may mean waiting until the next Annual Enrollment Period and possibly facing late enrollment penalties.
I'm turning 65 in three months but still working with employer coverage. Do I need to sign up for Medicare right now or can I wait?
The real answer depends on one specific detail: how many employees your company has.If it's 20 or more, your employer coverage is considered primary, and you can generally delay Medicare Part B without any penalty — as long as you sign up within eight months after you eventually leave that job or the coverage ends, using what's called a Special Enrollment Period.
If your employer has fewer than 20 employees, Medicare typically becomes primary at 65 whether you're still working or not, which usually means you do need to enroll on time to avoid a gap in coverage.
One thing almost everyone should still do, regardless of employer size: sign up for Part A, since it's usually premium-free and can run alongside your employer coverage. The one exception is if you're contributing to a Health Savings Account — enrolling in any part of Medicare stops those contributions, so that's worth planning around.
Before you decide anything, check with your HR or benefits department to confirm your employer's size and whether your coverage is considered "creditable" — that one conversation determines whether waiting is actually safe for your situation, or whether it's setting you up for a penalty later.
At the same time, meet with a trusted independent Medicare agent like myself who will give you guidance about the best steps forward.
Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?
Medigap plans are underwritten in most states once you’re outside your initial enrollment window (usually 6 months after you turn 65 and enroll in Part B). That means:• Insurance companies can ask about your health
• They can deny coverage, charge more, or exclude pre-existing conditions
You don’t need to go through underwriting if:
1. You’re in your Medigap Open Enrollment Period (the 6-month window after you enroll in Medicare Part B).
2. You qualify for a guaranteed issue right, such as:
• Your current Medigap plan ends or stops covering your area
• You move out of your plan’s service area (for Medicare SELECT)
• You lose other creditable coverage (like employer or union coverage)
• You’re within 12 months of trying a Medicare Advantage plan and want to switch back to Medigap (the “trial right”)
If you’re switching Medigap plans just because of cost or benefits, and you’re outside of those protected periods, expect to answer health questions — and possibly be declined.
I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?
Medigap plans, also known as Medicare Supplement Insurance, are private insurance policies designed to cover healthcare costs not included in Original Medicare. While Medicare itself is a federal program with standardized benefits, Medigap plans are offered by private insurers, and their rules can vary depending on state laws and circumstances.Medical Underwriting Outside Guaranteed Periods
If you apply for a Medigap plan outside your guaranteed issue period (when you turned 65), insurers are generally allowed to use a process called "medical underwriting." Medical underwriting enables them to evaluate your health history and decide whether to approve your application, decline coverage, or adjust premiums. This practice is permitted under federal law because Medigap plans are private insurance products, and insurers have the right to assess risk when determining eligibility outside federally protected periods.
State Regulations
While federal law sets the baseline for Medigap protections, states may have additional regulations that expand consumer rights. For example, some states prohibit medical underwriting entirely or allow open enrollment periods for Medigap plans beyond the federally mandated timeframe. If you were denied coverage, it may be worth investigating whether your state offers extended protections.
What You Can Do
If you have been denied a Medigap plan due to your health history, here are steps you can take:
• Check whether you were within a guaranteed issue period at the time of your application. If so, you may be able to appeal the denial.
• Consult your state’s Department of Insurance to learn about any state-specific rules that might apply.
• Look for alternative forms of coverage, such as Medicare Advantage plans, which may provide similar benefits without medical underwriting.
• Seek advice from a licensed Medicare counselor or broker who can help you navigate your options.
Who qualifies for Medicare coverage if they are under 65?
Individuals under 65 can qualify for Medicare if they have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months, or if they have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD). Some individuals with ALS may be automatically enrolled in Medicare, while those with ESRD need to actively sign up.Elaboration:
Social Security Disability Insurance (SSDI):
If you are under 65 and have been receiving SSDI benefits for 24 months, you are eligible for Medicare Parts A and B, according to the Centers for Medicare & Medicaid Services (CMS).
Amyotrophic Lateral Sclerosis (ALS):
Individuals with ALS are automatically enrolled in Medicare Parts A and B the month their disability benefits begin, says the CMS.
End-Stage Renal Disease (ESRD):
If you have ESRD, you are eligible for Medicare Parts A and B regardless of age, but you need to actively enroll when you first become eligible, states the Centers for Medicare & Medicaid Services.
Can Medicare drop me for health reasons?
No, Medicare cannot drop you because of your health. If you have Medicare, your coverage continues even if you have health problems or develop a new illness.Original Medicare (Parts A and B) is a government health insurance program, so once you’re enrolled, you’re guaranteed coverage (assuming you remain eligible, such as by age or disability status).
The following are a few details to know:
Original Medicare (Parts A & B): You cannot be denied or dropped based on your health.
Medicare Advantage (Part C): These are private insurance plans, but they must accept anyone who’s eligible for Medicare and who lives in their service area, regardless of health. The only exception is for people with end-stage renal disease (ESRD) — until recently, plans did not have to accept those patients, but this has now changed, and nearly all plans accept ESRD.
Medicare Supplement (Medigap): When you first become eligible (your 6-month Medigap Open Enrollment Period), you’re guaranteed acceptance regardless of health. Outside that window, insurance companies in most states can ask health questions, but once they accept you, they cannot drop you as long as you pay your premiums.
In summary, while your plan options may vary based on when and how you apply, once you have Medicare coverage, the program cannot drop you for health reasons.
If I have been on disabilty due to an accident, do I qualify for Medicare Insurance?
If you're on disability due to an accident, you'll be eligible for Medicare after receiving disability/SSDI payments for 24 months. The clock starts when you begin receiving disability payments, not on the date of the accident.In month 25, you're enrolled in part A and part B automatically, and you'll get your card in the mail a few months before your Medicare start date. And there's a couple of exceptions: If you have ALS (Lou Gherig's Disease), Medicare starts immediately. And if you have end stage renal disease (ESRD) the timing can be sooner, depending on treatment.
Quick example: If your disability/SSDI payments began in June of 2025, your Medicare would begin in June of 2027.
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
Often, yes, but it depends on what type of employer coverage you are losing and whether you have (or are enrolling in) Medicare Part B.If you are losing employer/union coverage that supplements Original Medicare (including many retiree plans or COBRA): You generally have a federal Medigap “guaranteed issue” right. That means you can buy a Medigap policy without medical underwriting, and you typically must apply within 63 days of the coverage ending (or the date you are notified it is ending, depending on timing).
If you are losing active employer coverage and you are enrolling in Part B now: You may not be using “guaranteed issue,” but you typically get a 6‑month Medigap open enrollment period starting when Part B becomes effective, during which you can usually buy any Medigap plan sold in your state without underwriting.
If you are voluntarily dropping employer coverage that you could keep: You often do not get a guaranteed issue right.
Also, Medigap generally requires that you have Original Medicare (Part A and Part B), and guaranteed issue rights and plan availability can vary by state.
I have Medicare Part A and B since 06/01/2006 because of disability. My husband retired on 4/1/2024, and I now have no other coverage except for Medicare Parts A and B because I missed open enrollment for insurance coverage. Note: SS dropped SSI and changed it to straight SS. Please help.
You may be eligible for a special enrollment period (SEP), but you will definitely be able to enroll during Annual Enrollment (AEP) for coverage starting Jan 1, 2027.Are you 65 or older? Or still under 65 on disability? Medigap rules and plan options will differ.
When did SSI end? Was it within the last 3 months? If you lost Medicaid or Extra Help eligibility recently, an SEP may apply.
What is your state and your Medicaid status? SSI often comes with Medicaid or a Medicare Savings Program (MSP) that pays your Part B premium. Is that still active?
What is your household income now? Your husband's retirement income may have pushed you off SSI, and it probably counts toward your eligibility for Extra Help and Medicaid.
Let's confirm your Medicaid/MSP status with your state. Apply for Extra Help (the Low-Income Subsidy) through SSA. If you qualify, Extra Help also waives any Part D late penalty and lets you switch drug plans monthly. Also check your Part B premium. If the state stopped paying it, it's now coming out of your Social Security check.
Medicare Annual Enrollment is Oct 15 – Dec 7 (AEP): You can definitely enroll during AEP. If your are on Medicaid, look at D-SNPs. If not, look at a Medicare Advantage plan with drug coverage, or a standalone drug plan plus Medigap if you are eligible. Compare doctors, prescriptions and out-of-pocket costs on the 2027 plans. Enroll early in AEP. Some 2027 plans have enrollment caps and can close mid-AEP.
Now: Do you qualify for an SEP. One example is the SEP after losing Medicaid, if it was recent. Another is an exceptional-circumstances SEP if you were never told your coverage was ending. That would take effect sooner than Jan 1.
Without an SEP, you have no drug coverage and only Original Medicare until Jan 1. That means 20% coinsurance with no out-of-pocket cap.
Part D late penalty is 1% of the national base premium for each month you went without coverage that counted as creditable; however, Extra Help waives the penalty.
Do I have to apply for Medicare if I am still working past 65?
Not necessarily — but the answer depends entirely on one thing: the size of your employer. This comes up constantly with clients I work with throughout Bedford, NH and the rest of Hillsborough County, since so many people here are working well past 65.
If your employer has 20 or more employees: you can generally delay Medicare Part B without penalty, as long as you're covered by that employer's group health plan. When your employment or coverage eventually ends, you'll get an 8-month Special Enrollment Period to sign up for Medicare — penalty-free.
If your employer has fewer than 20 employees: the rules flip. Medicare typically becomes your primary coverage regardless of your employer plan, which means delaying Medicare in this situation usually isn't the right move — you could end up with significant gaps in what actually gets paid. This is exactly the kind of detail worth confirming for your specific employer, rather than assuming either way.
A few other things worth knowing:
Part A is usually premium-free, so many people enroll in Part A even while delaying Part B — but if you're contributing to a Health Savings Account (HSA), enrolling in Part A stops your HSA contribution eligibility, and Part A can apply retroactively up to 6 months. That timing needs to be planned around, not discovered after the fact.
COBRA and retiree health coverage do not count as active employer coverage for delaying Medicare. If you're relying on either of those past 65, you're likely already past your enrollment window without realizing it.
Bottom line: whether you "have to" apply depends on your employer's size and exactly what kind of coverage you currently have — not just whether you're still working. Getting this wrong in either direction, delaying when you shouldn't, or enrolling when you didn't need to, can be a costly mistake.
I'm a local, independent Medicare agent based in Bedford, New Hampshire, serving Hillsborough County and the surrounding area.
What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?
Guaranteed Issue (GI) for a (Medigap/Medicare Supplement) plan means an insurance company must sell you a policy, cannot deny you coverage, cannot charge you more because of health conditions, and cannot impose waiting periods for pre-existing conditions. Medigap works alongside **Original Medicare** to help cover out-of-pocket costs like deductibles and the 20% Part B coinsurance. The strongest GI protection occurs during your one-time, six-month Medigap Open Enrollment Period, which begins when you are age 65 or older and enrolled in Medicare Part B.You may also qualify for Guaranteed Issue in certain special situations, such as losing employer coverage, your **Medicare Advantage** plan leaving Medicare or your service area, or exercising a 12-month “trial right” after first joining Medicare Advantage. In these cases, you typically have 63 days to apply for certain standardized Medigap plans without medical underwriting. Outside of these protected periods, insurers in most states can require health screening and may deny coverage or charge higher premiums.
What if I missed my window to sign up?
There are a LOT of moving parts to this question. For the sake of simplicity I am assuming you’re saying you missed the 7 month window (3 months before your birth month, your month of birth, and 3 months after) to sign up for Medicare.You can call Social Security anytime to sign up for Part A as long you qualify for premium-free Part A (you’ve worked and paid into the system for at least 40 quarters, or 10 years).
For Part B, there’s a General Enrollment Period (GEP) from January 1st to March 31st each year, with Part B starting July 1st. If you were eligible this year, and signed up in GEP 2027, you will pay a 10% monthly penalty ($20.25 at the 2026 rate) per year you missed. It’s cumulative, so if you didn’t sign up until GEP 2028, you’d pay 20%, etc. It’s also permanent, so you pay that penalty as long as you have Part B coverage.
If you don’t qualify for premium free Part A, the same GEP applies, and the 10% penalty applies, but it only lasts for twice as long as you went without coverage. So the part A penalty is finite, the Part B penalty follows you forever.
However, if you have employer coverage or spousal coverage that can be considered creditable (VA coverage, COBRA, and ACA coverage are not creditable) then you have a different situation.
Your best bet is to talk to agent to review your situation in detail to see if any special election periods apply that can help you.
I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?
No, as a green card holder with only 4 years in the US, you are not yet eligible for Medicare. To qualify for Medicare, you need to have been a lawful permanent resident (green card holder) and lived in the US continuously for 5 years.Here's a more detailed explanation:
Lawful Permanent Resident: You need to hold a green card, which grants you permanent residency in the US.
Continuous US Residence: You must have lived in the US for 5 years continuously, meaning you've maintained your primary residence in the US during that time.
Age: You need to be 65 years old or older.
In your case, you're 4 years into your US residency and haven't met the 5-year requirement. You'll need to wait until you've been a green card holder and lived in the US for 5 continuous years to be eligible for Medicare.
What happens when you're eligible:
You'll need to apply for Medicare, which can be done through the Social Security Administration or online.
You may need to pay a monthly premium for Medicare Part A (hospital insurance) if you haven't worked in the US for the required 40 quarters (10 years).
If you do have the required work history, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance).
You can also enroll in Medicare Part D (prescription drug coverage) if you have Part A and/or Part B.
What happens if I am unable to provide creditable coverage?
If you go without creditable coverage for too long, you could face a late enrollment penalty when you sign up for Medicare Part B or Part D.Part B (Medical Insurance) – If you don’t have creditable coverage and delay enrolling, your premium may go up 10% for every 12 months you were eligible but didn’t sign up. This penalty is permanent.
Part D (Prescription Drug Coverage) – If you go 63 days or more without creditable drug coverage, you may pay an extra monthly penalty for as long as you have Part D.
Creditable coverage means your existing insurance is at least as good as Medicare’s standard coverage. If you’re ever unsure whether your plan is creditable, ask your insurer for a written notice—keep it in your records in case Medicare ever asks for proof.
If I live part of the year abroad, do I still have to pay for Medicare if I don’t use it?
If you plan to live outside the United States for an extended period, you may have the option to disenroll from Medicare Part B and avoid paying the monthly premium while you are abroad. However, this decision should be made carefully. When you return to the U.S., you may need to demonstrate to the Social Security Administration that you had qualifying health coverage or met specific enrollment requirements to avoid a late enrollment penalty. Depending on your circumstances, you could also experience a delay before your Part B coverage becomes effective again.For many individuals who travel or reside overseas part-time, maintaining Medicare Part B coverage may provide greater flexibility and peace of mind. One option is to enroll in a $0 premium Medicare Advantage plan (while continuing to pay the Part B premium) that offers worldwide emergency and urgent care benefits. While Medicare Advantage plans are generally designed for use within the United States, certain plans can help cover emergency medical situations that occur abroad—something Original Medicare typically does not cover.
Before making any changes to your Medicare coverage, it’s important to evaluate how long you expect to be outside the country, whether you maintain a U.S. residence, your access to healthcare overseas, and the potential impact of future enrollment rules and penalties. Consulting with a Medicare specialist can help ensure you make the choice that best fits your travel and healthcare needs.
Note: Individuals living abroad generally do not automatically qualify for a Special Enrollment Period simply because they reside outside the United States. Eligibility to reenroll in Part B without penalty typically depends on meeting specific Medicare enrollment rules, such as having qualifying employer group health coverage. Always verify your situation with the Social Security Administration before dropping Part B.
Do I qualify for SEP if my health dramatically gets worse out of nowhere?
A sudden worsening of health, even with hospitalization, generally does not give you a Medicare Special Enrollment Period (SEP) to change coverage mid-year.What can create a Medicare SEP that sometimes relates to a health change is one of these situations:
- You qualify for a Chronic Condition Special Needs Plan (C‑SNP): If you are diagnosed with a qualifying chronic condition and a C‑SNP is available where you live, you may be able to join that plan using an SEP.
- You enter, live in, or leave an institution: If you are in a skilled nursing facility, nursing home, or similar facility, you may have an SEP to change Medicare Advantage/Part D coverage.
- You gain or lose Extra Help (LIS) or Medicaid: These programs can allow plan changes outside the usual enrollment periods.
- You move or lose other coverage: Moving out of your plan’s service area or losing creditable drug/employer coverage can trigger SEPs.
- Your plan changes materially: Certain plan terminations or other CMS-approved circumstances can trigger an SEP.
If none of those apply, your main options are usually:
- Annual Enrollment Period (AEP): Oct 15–Dec 7 (changes effective Jan 1).
- Medicare Advantage Open Enrollment Period (MA OEP): Jan 1–Mar 31 (only if you are already in a Medicare Advantage plan).
- State Medigap switching rules (where available): If you have a Medigap (supplement) policy, some states give extra opportunities to switch plans without medical underwriting, such as California and Oregon's “birthday rule,” which can allow a switch to a Medigap plan with equal or lesser benefits around your birthday (subject to state timing and requirements).
Should I worry about my income effecting my Medicare eligibility?
No, income does not affect your eligibility for Medicare, however, if your income is above a certain threshold, an IRMAA (Income Related Monthly Adjustment Amount) will be applied to your Part B & Part D monthly premiums. The IRMAA is determined by your tax returns from 2 years ago- 2026 will be determined by your 2024 tax returns. There is an appeal form on the Social Security website ssa.gov. I recommend checking to see if an appeal category applies to your situation.
What happens to my Medicare coverage if I move to a U.S. territory like Guam or the Virgin Islands?
Yes, **Original Medicare generally continues to work if you move to a U.S. territory such as Guam or the U.S. Virgin Islands**. Medicare specifically considers Guam and the U.S. Virgin Islands part of the U.S. for Medicare coverage purposes. ([Medicare][1])### If you have Original Medicare
If you have **Part A and Part B**, you generally don't lose that coverage simply because you move to Guam or the U.S. Virgin Islands. You can use Medicare-participating doctors and hospitals in those territories. ([Medicare][2])
However, you should make sure your new doctors and hospitals **accept Medicare** before receiving care.
### If you have Medicare Advantage
This is where moving can make a big difference.
Medicare Advantage plans have a specific **service area**. If you move outside your plan's service area, your current plan generally cannot continue providing your regular coverage there. You get a **Special Enrollment Period** to choose another Medicare Advantage plan or return to Original Medicare. ([Medicare][3])
Your Special Enrollment Period generally begins when you move and continues for **2 full months after the month you move**. If you notify your plan before moving, it can begin the month before you move. ([Medicare][3])
### What about Part D?
Part D is also plan-specific. If your prescription plan doesn't serve your new location, you'll generally have an opportunity to choose another Part D plan.
One important difference for people with limited income: **Medicare's Extra Help program isn't available in Guam or the U.S. Virgin Islands**, although other assistance programs may be available in those territories. ([Medicare][4])
### ⭐ The simple rule
**Moving to Guam or the U.S. Virgin Islands does not automatically end Original Medicare.**
But if you're enrolled in **Medicare Advantage or a Part D plan**, moving can require you to **change plans or return to Original Medicare** because private plans have service areas.
If you're considering a move to
I’ll be turning 65 in April. I have full VA coverage and good hospital and doctor coverage through Eisenhower here in the desert. The VA doesn’t provide dental care. Do I still need to enroll in Medicare, and if so, which part makes sense for my situation?
Congratulations on approaching your 65th birthday! With VA coverage and additional hospital and doctor coverage through Eisenhower, you have a solid foundation for your healthcare needs. Since the VA doesn't provide dental care, you'll want to consider how Medicare can complement your existing coverage.*Do you need to enroll in Medicare?*
While VA coverage is excellent, Medicare can help fill gaps, including potential out-of-pocket costs and additional benefits. Enrolling in Medicare can provide more comprehensive coverage and financial protection.
*Which part of Medicare makes sense for you?*
Consider the following:
- *Medicare Part A*: Covers hospital stays, which might overlap with your existing VA coverage. However, Part A typically has no premium if you've worked and paid Medicare taxes.
- *Medicare Part B*: Covers doctor services, outpatient care, and some preventive services. This might complement your existing coverage.
- *Medicare Part D*: Covers prescription medication. If you have medication costs not covered by the VA, Part D might be beneficial.
- *Medicare Advantage (Part C)*: Combines Part A and Part B coverage, often with additional benefits like dental, vision, or hearing. Some plans might offer dental coverage, which could be valuable given the VA's limitations.
*Key considerations:*
- *VA coverage and Medicare coordination*: Understand how your VA coverage and Medicare will work together. In some cases, Medicare may be the primary payer, while the VA coverage supplements it.
- *Out-of-pocket costs*: Consider potential costs associated with Medicare, such as premiums, deductibles, and copays.
- *Dental coverage*: If dental care is a priority, explore Medicare Advantage plans that offer dental benefits or consider standalone dental insurance.
*Next steps:*
- *schedule a consultation with me
Does everyone over the age of 65 qualify for Medicare?
To be eligible for Original Medicare Part A and Part B, you must be age 65 or have been entitled to Social Security Disability insurance for 24 months (two exceptions to this: disabled due to end stage renal disease ESRD or ALS).Part A is hospital insurance and comes with a zero dollar premium if you are insured (e.g. paid FICA tax for 10 years) for Social Security benefits. Many people sign up for Part A, even if they are continuing to work since it is a benefit they have earned and does not cost anything extra. It simply provides extra coverage.
Part B is medical insurance and in 2026 comes with a $202.90 monthly premium for most individuals (some high earners pay pay more for their Part B). If you are still working at age 65 and covered by an employer group health plan (EGHP), many people hold off on signing up for Part B, due to the cost of the premium. There is also no penalty for filing after age 65, if you are covered by an EGHP that is creditable. You should ask your Human Resources Department if your EGHP is creditable before deciding not to take Part B at age 65.
If you have not worked and paid into Social Security and are not insured for benefits, you can get Part A and Part B, but you would owe the monthly premiums for both. For Part A, the monthly premiums may range from ~$300 to over $500 monthly. For Part B, the monthly premium will be $202.90.
I also recommend working with a local Medicare expert at least 4-6 months before your 65th birthday. Additionally, if you are on Social Security Disability, reach out 4-6 months before you are eligible for Medicare. Medicare experts will be able to educate you on all your Medicare options (e.g. Original Medicare, Medicare Advantage Plans, Dental, Vision, Hearing etc...), as well as ensure that you avoid costly late enrollment penalties.
I am a resident in another country outside of America, will I still be covered living abroad?
No you will not. Medicare does not generally cover healthcare outside of the United States except in limited medical emergencies in a foreign country that is closer than the nearest U.S. hospital. If you are living abroad you should still consider keeping your Medicare though if you plan to return to the United States to avoid penalties. However it may not be worth the cost if you do not plan to return and plan to live abroad permanently and will not travel very frequently.
Will I lose my Medicare benefits if I get married?
So the question is, will I lose my Medicare benefits if I get married?
Regarding your Medicare benefits, you will not lose your Medicare benefits. Meaning that say if you have Part A, Part B, and a supplemental and drug plan, once you get married your coverage will stay the exact same. When you are married, Medicare coverage is completely separate, so there are no group plans. There's no plans that you can add on to your life. Sometimes plans give a household discount, but everybody is on their own individual plan.
The only thing that you can possibly lose is if you are getting extra assistance through the state, through your state's Medicare Savings Program, as we have here in Connecticut. There are different income thresholds. So for instance, if you are making $2,600 a month from your Social Security and a small pension, and you're single, you would most likely qualify for that Medicare Savings Program in Connecticut. However, if you get married to your spouse and they happen to have a larger income, say if they're making $3,500 a month, you would be over the threshold, which is about $3,600 to $3,800 as a couple to be on that savings program.
So you won't lose Medicare, but you would lose that extra assistance from the state. Hope this helps.
Can eligibility for certain Medicare Advantage plans depend on where I live?
Yes — eligibility for Medicare Advantage plans can absolutely depend on where you live.Here’s why location matters:
Medicare Advantage plans are county-based
Medicare Advantage plans are approved and offered by county, not statewide or nationwide. That means a plan available in one county may not exist in the neighboring one.
Provider networks are local
Most Medicare Advantage plans use local doctor and hospital networks (especially HMOs and PPOs). If you live outside the service area, the plan can’t guarantee access to in-network care, so you wouldn’t be eligible.
Benefits and costs vary by area
Premiums, copays, extra benefits (like dental, vision, transportation, or fitness), and even plan types can change based on your ZIP code or county.
Moving can affect your plan
If you move to a different county or state:
Your current Medicare Advantage plan may no longer be available
You may qualify for a Special Enrollment Period to choose a new plan
Medicare Advantage vs. Original Medicare
Original Medicare works the same nationwide, but Medicare Advantage plans are location-specific, which is a key difference to keep in mind if you travel or relocate often.
Can I be turned down for a Medicare Advantage plan because of my health?
You generally cannot be turned down for a Medicare Advantage plan because of your health, as long as you’re eligible for Medicare Parts A and B and live in the plan’s service area.Enrollment and health conditions
Medicare Advantage plans (Part C) are required to accept you regardless of pre‑existing conditions; they must follow the same “no health underwriting” rule as Original Medicare for eligibility.
Since 2021, people with End‑Stage Renal Disease (ESRD) can also enroll in most Medicare Advantage plans, which used to be a major exception.
Plans also cannot drop you from coverage later just because your health gets worse, as long as you keep paying premiums and meet basic plan rules.
When a plan can say “no”
A Medicare Advantage plan can’t deny you based on health, but it can deny enrollment for non‑medical reasons such as:
You don’t have both Part A and Part B.
You don’t live in the plan’s service area or network county.
You try to enroll outside of an allowed enrollment period (Initial Coverage Election Period, Annual Enrollment Period, or a qualifying Special Enrollment Period).
You are enrolled in certain types of other coverage that are incompatible with that plan (for example, another Medicare Advantage plan at the same time).
Coverage limits vs enrollment denial
Even though you can’t be turned down for health reasons, the plan can have rules about which doctors you can see (network), which drugs are covered (formulary), and when you need prior authorization or step therapy.
A plan must cover all services that Original Medicare covers and cannot refuse medically necessary care, but it may deny particular services if it decides they are not medically necessary under Medicare rules, in which case you have appeal rights.
Medicare Advantage vs Medigap (important distinction)
Medicare Supplement (Medigap) plans are different: outside of your first Medigap open‑enrollment or certain guaranteed‑issue situations, a Medigap insurer can use medical underwr
How to enroll in Part D plan for RX coverage?
You can enroll in a Medicare Part D plan through the Medicare.gov website. You will want to be careful and make sure you verify that all of your medications are covered and compare your out-of-pocket costs between plans as they will vary. Also make sure your preferred Pharmacy is in network as well. Even though the insurance carriers no longer compensate Medicare Health Insurance Agents to enroll Medicare beneficiaries into their Part D Plans, some agents may be willing to offer their time and expertise in finding a plan that fits your needs. This process can be time consuming if you have a lot of prescriptions, so start early and be sure to have an organized list of your prescriptions and the dosages ready to enter when you do your research. Remember, not signing up for Medicare Part D when you are eligible even if you don’t have any prescriptions will result in a late penalty when you sign up later on down the road.
How do I apply for Medicare if I qualify because of a disability?
You cannot apply for Medicare due to a disability directly; you must first be approved for SSDI through the Social Security Administration (SSA). You can submit your application online using the SSA Disability Benefits Portal.To get Medicare due to a disability before age 65, you must first qualify for and receive Social Security Disability Insurance (SSDI) for 24 months. You will then be automatically enrolled in Medicare Parts A and B starting in your 25th month.
Because you are under 65, your Medicare enrollment is usually automatic. You will receive a Welcome Packet and your official Medicare Card in the mail approximately 3 months prior to your 25th month of SSDI benefits.
For more details/guidance, go to: https://www.ssa.gov/benefits/disability/qualify.html
How does divorce affect my Medicare eligibility, premiums, or benefits?
Great Question: Divorce can affect Medicare in a few important ways, but your eligibility for Medicare itself is usually not affected if you're already entitled to it based on your own work history or your former spouse's work history.If you're eligible based on your own work record (typically 40 quarters/10 years of Medicare-covered employment), divorce does not change your Medicare eligibility.
If you're relying on a former spouse's work record to qualify for premium-free Medicare Part A, you may still qualify if:
The marriage lasted at least 10 years.
You are currently unmarried.
You are age 65 or older.
Your former spouse is eligible for Social Security retirement or disability benefits.
After a divorce, if you don't have enough work credits yourself, you may still receive premium-free Part A through your ex-spouse if the 10-year marriage rule is met.
Divorce does not automatically change your Medicare Advantage or Medigap coverage.
However, if you were covered under a spouse's employer health plan before Medicare, losing that coverage due to divorce may trigger a Special Enrollment Period, allowing you to make Medicare coverage changes.
Can You Be Denied a Medicare Advantage Plan?
As long as you apply for a plan during a valid election period and you meet the eligibility requirements, you can't be denied.To qualify for a Medicare Advantage plan, you must have both part A and part B of Medicare. Some plans have additional requirements such as plans designed for people who have a chronic condition such as diabetes or heart conditions. There are also plans designed specifically for people who also have Medicaid and may contain additional requirements that look into the level of Medicaid or state wavers. It's always best to work with an experienced agent to help guide you through the process of choosing and enrolling into a plan.
If I qualify for both Medicare and Medicaid, how does that eligibility work together?
If you qualify for both Medicare and Medicaid, you are considered dual eligible. This means you can receive benefits from both programs, helping reduce your healthcare costs and improve access to care.Medicare is your primary health insurance and generally pays first for covered medical services, including hospital stays, doctor visits, and prescription drug coverage (depending on your plan).
Medicaid works alongside Medicare and may help pay for:
Medicare premiums
Deductibles and copayments
Services Medicare doesn't fully cover, such as certain long-term care services and supports
Many dual-eligible beneficiaries choose a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed specifically for people who qualify for both programs. These plans often provide additional benefits and help coordinate care.
Because Medicaid eligibility and benefits vary by state, it's important to review your options annually to make sure you're receiving all available assistance.
If you think you may qualify for both Medicare and Medicaid, a licensed insurance agent experienced in Medicare can help you understand your choices and determine which coverage best fits your needs.
This information is for educational purposes only and is not a complete description of benefits. Eligibility for Medicare, Medicaid, and D-SNP plans varies. Contact your state Medicaid office for specific eligibility requirements.
Are Medicare Advantage plans guaranteed issue?
Medicare Advantage plans are guaranteed issue, meaning you cannot be denied coverage or pay more for your plan based on preexisting conditions, recent diagnosis or your current health condition. However, you can only enroll in plans within your service area, have Medicare Part A and B, and enroll during valid enrollment periods.If you're concerned about managing costs during a health crisis or illness, here are some things to consider when selecting a Medicare Advantage Plan:
- look for a lower maximum out of pocket amount. This can help reduce costs for medical services that use original Medicare billing such as radiation, chemotherapy, and infusions.
- understand what services you will use or need most frequently and estimate how many visits you may need in a plan year. Then, compare copays from different plans.
- ensure that all of your providers are in network and your prescriptions are on the plan's formulary.
- $0 premium plans might not always be the best option. Plans with a premium may have lower copays for services you use the most, saving you money even with paying a monthly premium.
An experienced broker who knows your area's network of providers and plans can guide you through finding the right plan for you.
If I don't have a primary physician will my new carrier assign me to one?
Yes — in many cases, if you enroll into certain Medicare plans, especially HMO plans, the insurance carrier may automatically assign you a Primary Care Physician (PCP) if you do not select one during enrollment.However, you usually still have the ability to change your assigned doctor afterward if you would prefer someone else who is in-network and accepting new patients. I always recommend reviewing the provider network carefully to make sure the doctor, specialists, hospitals, and medical groups are a good fit for your healthcare needs and location.
I also partner with senior-focused healthcare networks and medical groups that offer strong support for Medicare beneficiaries, including access to quality primary care physicians, quicker new-patient appointments, coordinated specialist care, wellness resources, and senior activities. My goal is not only to help clients select a plan, but also help connect them with healthcare resources and support systems that can improve their overall experience and quality of care.
What is the CMS-L564 form and when do I need it for Medicare enrollment?
The CMS-L564 — “Request for Employment Information” is a Medicare form used primarily when someone delayed Medicare Part B because they had employer-sponsored group health coverage based on current employment. It proves to Social Security that you had qualifying coverage, which can allow you to enroll in Part B during a Special Enrollment Period (SEP) and generally avoid a Part B late-enrollment penalty.
Can you get Medicare if you never worked or didn't pay into the system?
Yes, you can get Medicare if you never worked or didn't pay into the system, but you will likely have to pay a monthly premium for Part A (hospital insurance). To get it for free, you generally need 10 years (40 quarters) of work or qualify for low income Medicaid!
Do I need to enroll in Medicare if I already have VA health benefits?
That's a trick question and relies heavily on what your goals or even your benefit level with the VA is. If you live near a VA location or maybe you have Tricare the answer could be no you dont need to enroll in medicare. However if you receive limited benefits and do not have easy access to a VA location or maybe you want more private access to doctors and specialist versus government employees, you may want to get Medicare parts A and B and potentially even enroll into a Part C or medicare advantage plan. This doesn't remove your ability to go to the VA for care or prescriptions but can actually enhance your healthcare benefits and provide some really important benefits you may not be getting like dental, vision, gym memberships and so on all at no cost in most cases.
What's the difference between Medicare and Medicaid?
One of the most common questions I hear is:“What’s the difference between Medicare and Medicaid?”
While the names sound similar, they are actually two very different programs.
Medicare is primarily health insurance for:
• People age 65 and older
• Certain younger individuals with disabilities
• People with End-Stage Renal Disease (ESRD) or specific qualifying conditions
Medicare is generally based on age or disability status — not income.
Medicaid, on the other hand, is a needs-based program designed to help individuals and families with limited income and resources. Medicaid rules can vary from state to state.
Here’s a simple way to think about it:
• Medicare = Age or disability-based health coverage
• Medicaid = Income and asset-based assistance program
Some people qualify for BOTH Medicare and Medicaid at the same time. These individuals are often referred to as “dual eligible” beneficiaries.
When someone qualifies for both programs, Medicaid may help pay for things like:
• Medicare premiums
• Copays and deductibles
• Additional healthcare services
• Long-term care support in some situations
This is why proper guidance matters so much. Many seniors don’t realize they may qualify for additional assistance programs that could potentially save them thousands of dollars each year.
I spend a lot of time helping seniors and families understand these programs, review their options, and connect them with resources that may help — always at no cost.
Chuck Winslow
US Marine Veteran 🇺🇸
Retirement & Legacy Planner
Contact me.
How to sign up for A & B?
You can sign up for Medicare Part A and Part B online through the Social Security Administration (SSA) website during your 7-month Initial Enrollment Period (3 months before to 3 months after your 65th birthday). The process takes about 10 minutes, and you will need to create a login.gov account.Several ways to Enroll:
- Online, visit SSA.gov and click "Sign up for Medicare".
- Phone: Call Social Security at 1-800-772-1213
- In-Person: Visit your local Social Security office.
What is the cost and value of a supplemental plan, and what plans are available?
This is a big question with a LOT of variables.First, there are two pathways for supplemental medicare coverage: a medigap plan, or a medicare advantage plan. Which option is right for you depends on a lot of factors. But in general:
Cost:
Medigap plans will always have a premium tied to them. What the premium is depends on several factors and on the plan you choose. A high deductible plan G will have a much lower premium than a standard plan G, for example.
Medicare advantage plans are USUALLY (but not always) premium free so there could be no additional cost beyond your part B Premium.
In both cases you must continue to pay your part B premium in addition to any plan premiums to remain eligible.
Value:
The value of a Medigap plan is flexibility. There are no networks, so if a doctor accepts medicare, they accept your medigap plan. What your copayments or coinsurance would be depends on the plan you select. For example, if you choose a standard plan G, you pay the Medicare Part B deductible ($283 in 2026) and the plan pays the rest of your medical expenses. The coverage is simple. You do need to pick up a standalone Medicare Part D plan for prescription drug coverage, and there is no preventive dental, vision or hearing coverage.
A medicare advantage plan will typically include your part D coverage, as well as basic dental, hearing and vision coverage. Often you will get some comprehensive dental, a copay or stipend for hearing aids, and a stipend for eyewear. You will have a medical network (an HMO or PPO) which means you have to work with doctors in that network, and while there’s typically no premium, you will have copays for most services and those will vary by carrier and by plan within a carrier.
What plans are available?
This is going to depend on your location. Most areas have the same medigap plans available, but medicare advantage options differ by county. So, you would need to talk to an agent or go to medicare.gov to see all your options.
Barson Financial / Kellogg Insurance Group / Integrity Insurance Company • Las Vegas, NV
Does life insurance affect my Medicare eligibility or premiums?
The short answer — No.Life insurance has absolutely no effect on your Medicare eligibility or your monthly premiums. The two are completely separate and do not interact with each other in any way.
Here's what actually determines your Medicare premiums:
Part A (Hospital Insurance)
Most people pay $0 for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.
Part B (Medical Insurance)
Your Part B premium is based on your income — specifically your Modified Adjusted Gross Income (MAGI) from two years prior.
For 2026, the standard premium is $202.90/month. Higher earners pay more through what's called IRMAA.
Part C (Medicare Advantage) & Part D (Drug Plans)
Premiums vary by plan, carrier, and your location — not by your life insurance coverage.
Can I cancel or drop Medicare Part B if I move abroad?
How to Drop Medicare Part BTo drop Medicare Part B, follow these steps:
Steps to Terminate Coverage
Submit a Written Request: Send a written request to the Social Security Administration (SSA) to terminate your Part B coverage.
Personal Interview: You may need to schedule a personal interview with the SSA to discuss the risks associated with dropping your coverage.
Return Your Medicare Card: You must return your Medicare card along with your request.
Important Considerations
Coverage End Date: Your Medicare Part B coverage will end at the end of the month following your request.
Potential Risks: Consider the following risks before dropping Part B:
Higher out-of-pocket costs for outpatient services.
Late enrollment penalties if you decide to re-enroll in the future.
When to Drop Part B
You can safely drop Part B if you have other qualifying health insurance, such as through an employer with 20 or more employees. Ensure you re-enroll within 8 months of losing that coverage to avoid penalties.
Condition for Dropping Part B Safe to Drop? Notes
Actively employed (20+ employees) Yes Must re-enroll within 8 months after losing employer coverage.
Small employer (<20 employees) No Medicare is primary; dropping Part B can lead to high costs.
COBRA coverage No COBRA does not qualify for penalty-free delay.
VA benefits only No VA coverage is not considered creditable for Part B.
Make sure to evaluate your current health insurance situation before making a decision to drop Medicare Part B.
What if you have Medicare and SSI or you have both Medicare and Medicaid how do you qualify for LIS or Extra Help?
A person who receives Medicare, and Supplemental Security Income (SSI) automatically qualifies for Extra Help. They should not need to complete a separate Extra Help application. Medicare normally sends a purple notice confirming eligibility. A person who has SSI, or Medicaid but does not yet have Medicare cannot receive Medicare Extra Help yet, because Extra Help only applies to Medicare Part D drug coverage. Once Medicare begins, SSI or full Medicaid should make the person automatically eligible.Applications can be submitted through Social Security online or by calling 1-800-772-1213. Someone who may qualify for QMB, SLMB, or QI should also apply through their state Medicaid office, because qualifying for one of those programs automatically provides Extra Help.
Can I have both Medicare and Medicaid at the same time?
Yes. You can have both Medicare and Medicaid at the same time. Individuals who qualify for both are called dual-eligible beneficiaries.* Medicare is your primary health insurance.
* Medicaid helps pay Medicare costs, such as premiums, deductibles, copays, and coinsurance, and may also cover services like dental, vision, hearing, transportation, and long-term care.
Many dual-eligible individuals enroll in a Dual Eligible Special Needs Plan (D-SNP), which combines Medicare benefits with extra services such as prescription drug coverage, dental, vision, hearing, OTC allowances, transportation, care coordination, and, on some plans, grocery or utility benefits.
To qualify, you must:
1. Be eligible for Medicare, and
2. Meet your state’s Medicaid income and eligibility requirements.
Medicaid assistance may include Full Medicaid or a Medicare Savings Program (QMB, SLMB, QI, or QDWI), depending on your eligibility.
I'm over 65, not enrolled in Part A or B, and leaving active coverage through an employer with 20+ employees for six months of COBRA.
No, once your active employer coverage ends, your 8-month Special Enrollment Period starts immediately, and COBRA doesn't extend or pause it. So even if you elect 6 months of COBRA, you still need to enroll in Part A and B within 8 months of your active coverage ending, not 8 months from when COBRA runs out. Waiting until COBRA ends would put you outside the SEP window and risk a late enrollment penalty plus a potential gap in coverage.
Do I need Medicare Part B if I have VA benefits?
VA benefits and TRICARE are treated very differently when it comes to Medicare Part B.VA benefits are a separate health care system. Medicare gives the veteran more flexibility outside the VA system, but Part B is not technically required just because someone has VA benefits.
TRICARE is different. For most Medicare-eligible TRICARE beneficiaries, Medicare Part B is required in order to keep TRICARE active.
Even with VA benefits, I would still strongly consider enrolling in Medicare Part B in most cases.
The reason is simple. VA benefits and Medicare do not work together the same way employer insurance and Medicare do. If you receive care through the VA, the VA generally covers care provided within the VA system. But if you go outside the VA system, Medicare may be what gives you access to non-VA doctors, hospitals, outpatient services, specialists, and medical equipment.
If you have both Medicare and VA benefits, you can use either program, but they generally do not pay for the same service at the same time. That is why Part B is often an important planning decision, even though it is not technically required for VA benefits.
Unless you are enrolled in TRICARE For Life, you may also want to consider how you would cover the costs that Medicare Part B does not fully pay if you receive care outside the VA system. For some people, that may mean reviewing a Medicare Supplement plan to help cover Original Medicare cost-sharing. For others, it may mean reviewing a Medicare Advantage plan as an alternative way to receive Medicare benefits.
If there is a chance you may need or want care outside the VA system, Medicare Part B should be strongly considered. You may also want to review whether a Medicare Advantage plan or Medicare Supplement plan makes sense to help cover the Medicare Part B cost-sharing that VA benefits may not cover outside the VA system.
Can my employer force me to take Medicare when I turn 65?
It depends on your individual situation, which feels like a bit of a cop-out. If your employer is considered a small employer (less than 20 employees) they can force you to enroll in Medicare. Smaller employers do not have to operate by the same federal rules as larger companies. Medicare Part A & B will become your primary coverage.If your employer is over 20 people, the employer cannot legally force you to enroll into Medicare. People with larger employers have three choices for their insurance. First, just stay on your employers plan. You can delay Medicare without penalty but make sure to notify Social Security of your intent to delay. The second option is to enroll in Medicare Part A, defer Part B, and stay on your employer coverage. Last, you could drop the employer plan and enroll in Medicare Part A&B.
Make sure and review your options with your employer's HR department to verify you are taking are taking a correct action. They may even be able refer you to a Medicare agent that can review Advantage and Supplement Options.
if you defer Medicare you can visit the Social Security website at this link: https://www.ssa.gov/medicare/sign-up/part-b-only. If you don't like doing things online, you can call SSA directly for assistance at 1-800-772-1213.
Can Medicare Advantage plans deny coverage for pre-existing conditions?
Short answer: no. Medicare Advantage plans are guaranteed issue. If you have Part A and Part B, live in the plan's service area, and enroll during a valid enrollment period, the plan has to take you — no health questions, no medical underwriting, no rate-ups for your history. That's been true across the board since 2021, when even the old End-Stage Renal Disease exclusion was removed. There is no health condition that can keep you out of a Medicare Advantage plan.I think this question comes up so often because people are remembering how health insurance worked before 65, or they're mixing up two different products. The place pre-existing conditions do matter in Medicare is Medigap (Medicare Supplement). Outside your one-time six-month Medigap Open Enrollment window — and outside a handful of guaranteed-issue situations — Medigap carriers in most states can ask health questions and decline you based on your answers.
That distinction is worth sitting with, because it cuts both ways. Your health history can't keep you out of Medicare Advantage today — but if you join an Advantage plan and later decide you want to switch to Original Medicare with a Medigap policy, that's the move where your health may be underwritten. A lot of people don't learn this until they're trying to make that switch.
One more thing people confuse with a "denial": an Advantage plan can never deny you enrollment for a condition, but it can require prior authorization for specific treatments once you're a member. That's a coverage-management issue, not a pre-existing condition exclusion — and you have appeal rights when it happens.
If you're weighing Advantage vs. Medigap right now and you have health history, the order you make decisions in matters. A local independent agent can walk you through which doors stay open and which ones may close.
Does moving to a new state let me switch from Medicare Advantage to Medigap without health questions?
Moving to a new state opens a Special Enrollment Period (SEP) for your move where you can switch with what's called . The moving process is a bit involved. First, you will need to stop your Advantage Plan and go back to Original Medicare. Once you are back in Original Medicare, you can apply for a Medigap Plan.Keep in mind that moving from Medicare Advantage to Medigap does not cover prescriptions. You will need to add a separate Prescription Drug Plan (Part D) with your Medigap Policy. Don't forget to check and see if your medications are covered.
You’ll have up to two months to get a Part D prescription plan, and you’ll qualify for a Medigap guaranteed issue period that lasts up to 63 days after your Medicare Advantage coverage ends. During this time, you can purchase most Medigap plans regardless of existing health problems.
Although the Medigap Plans offer the same coverage, premiums are not the same price. Also, different sates have their own rules for Medigap policies. For instance, New York, Connecticut, and Massachusetts offer enrollment at anytime, without the need for a Special Enrollment Period. Check with a licensed Medicare Broker in your new home town to help you with the specific rules in your new hometown.
My spouse is younger than 65 — does my Medicare cover them, and what happens to their health insurance when I enroll?
No. Medicare is individual coverage. When you enroll in Medicare, your spouse does not become covered by your Medicare just because you are married.What happens to your spouse’s insurance depends on where the coverage comes from now.
If you are still working and keeping your employer health plan, your spouse may be able to remain on that employer coverage even after you enroll in Medicare. Confirm that with the employer before making any changes.
If you are retiring and the employer coverage is ending, your younger spouse will need another source of health insurance. Common options include:
Coverage through their own employer
COBRA, if available
An individual plan through the Health Insurance Marketplace
Medicaid or another program if they qualify
Losing employer coverage generally creates a Special Enrollment Period for Marketplace coverage, so your spouse does not necessarily have to wait for the annual enrollment period.
COBRA may also allow a spouse who was covered under your employer plan to temporarily continue that same coverage after retirement or loss of employment.
The important part is to plan both transitions at the same time. Don’t move yourself to Medicare and assume your spouse’s coverage will take care of itself.
Before your employer plan ends, confirm your Medicare effective date and have your spouse’s replacement coverage approved with its start date confirmed. The goal is for neither of you to have a gap in coverage.
Is it mandatory to sign up for Medicare at age 65?
It's not mandatory to sign up for Medicare at 65, but a person will need to plan carefully in order to not miss any deadlines to register. If you happen to miss registration you run a risk of lifelong late penalties and gaps in health coverage unless you qualify for an exception, such as having active health insurance through a job.You can delay signing up for Medicare Part B without facing penalities in the following situations: You are still working, the employer as 20 or more employees, you are covered by group health insurance through your employer or through your spouse's employer. If your employer has under 20 workers, you do not want to delay your enrollment in Medicare. Medicare will become your primary coverage.
Penalties will apply in the following scenarios: The Part B premium will go up by 10% for every 12 month period of delayed enrollment without other qualifying coverage. Part D (Prescription Drug Coverage) will go up by 1% of the national base beneficiary premium for every month you go without Medicare or other creditable drug coverage. (Creditable is defined as coverae as good as a standard Medicare coverage). Part B and Part D penalties are permanent penalties.
There is also a penalty for Part A if you have to pay a premium. Your Part A premium will go up by 10% and you pay the penalty for twice the number of years your Part A enroillment is delayed. Keep in mind that according to Medicare.gov, a Part A penalty applies to 1% of Medicare beneficiaries. As a reminder, there are people who did not have enough working hours between them or a spouse to quaify for a free premium on Part A.
Do you automatically get Medicare if you're on Social Security Disability?
The question is, do you automatically get Medicare if you're on Social Security disability?
The way Social Security disability works is that you will qualify for Medicare A and B two years after you're found to be disabled. This is different for everybody. If you win a favorable decision, you can start collecting Social Security disability income. A lot of times you get your Medicare card sent to you automatically because you were found to be disabled years before. If for some reason they found you to be disabled maybe a year before you get your favorable decision, again, you have to wait to that two year mark to start getting Medicare benefits.
A couple things to think about is that a lot of times if you did win a case for Social Security and then you get your Medicare card automatically, you don't always have to keep the Medicare. More importantly, if you have a spouse that has group coverage. Now the caveat to that is normally for most folks turning 65, you could opt out of Medicare for now if you have an employer with 20 or more employees. However, with Social Security disability under 65 Medicare, that company has to have more than 100 employees.
So if you have a spouse that works for an employer that has more than 100 employees and the insurance is better for you, I always say hold off, don't go on Medicare. However, when that time comes, maybe if your spouse retires or if they lose their job, at that point if you do not have insurance through your spouse's employer, you would have to go on Medicare at that time.
Hope that helps.
I hear about special Medicare Advantage plans for Chronic Conditions. How do I qualify for the plans? What is the benefit of enrolling in a special needs plan?
These plans are called Chronic Condition Special Needs Plans, or C-SNPs. They are Medicare Advantage plans designed for people with certain serious or disabling health conditions.To qualify, you generally need to:
Have Medicare Parts A and B
Live in the plan’s service area
Have one of the chronic conditions that the particular plan is designed to serve
Have the diagnosis verified by your healthcare provider
Qualifying conditions can include things such as diabetes, chronic heart failure, certain cardiovascular or lung conditions, cancer, dementia, stroke, kidney failure requiring dialysis and several others. Not every C-SNP covers every condition. The plan has to specifically serve your diagnosis.
The advantage is that the plan is built around the needs of people with that condition. That can mean a provider network with doctors who commonly treat it, prescription coverage designed around medications those members frequently use, and more care coordination between doctors, specialists and the plan. All Special Needs Plans also include Part D prescription coverage.
There can also be an important enrollment advantage. If you develop or already have a qualifying condition and a C-SNP serving that condition is available where you live, Medicare provides a Special Enrollment Period that can allow you to join the plan outside the normal fall enrollment period.
But qualifying does not automatically mean the C-SNP is your best choice. I would still check your doctors, hospitals, prescriptions, copays and maximum out-of-pocket costs before enrolling.
The real benefit is not simply that the plan has “extra benefits.” It is that the medical coverage, drug coverage and care coordination are designed around the health condition you are actually managing.
I’m retiring and losing my health insurance through work. When do I need to enroll in Medicare in Louisiana?
Employer with 20+ employees: You get an 8-month Special Enrollment Period starting the month after employment or coverage ends, whichever comes first. No late penalty during this window.Employer with fewer than 20 employees: Medicare is already primary at 65, so enroll right at 65 rather than waiting for retirement — the group plan likely won't cover much without Medicare in place.
Best timing: File for Part B a month or two before coverage ends, so Medicare starts the day after, with no gap. You'll need Form CMS-L564 (employer completes) plus CMS-40B, filed with Social Security.
Watch for: COBRA doesn't count as coverage that delays Medicare — enrolling in COBRA instead is a common costly mistake.
Can I be turned down for a Medicare Supplement plan because of a pre-existing condition?
Yes, in some situations you can — but not when you are in your protected Medicare Supplement enrollment period.When you are 65 or older and first enroll in Medicare Part B, you get a 6-month Medicare Supplement Open Enrollment Period. During that time, an insurance company cannot turn you down, charge you more because of your health, or use medical underwriting to deny your application.
After that 6-month period ends, the rules can change. In many states, an insurance company may ask health questions and can deny your application if you do not meet its underwriting requirements.
There are also federal guaranteed-issue rights that protect you in certain situations, such as losing specific coverage or leaving Medicare Advantage under certain circumstances. When one of those rights applies, an insurance company cannot use your health to deny the Medigap coverage you are entitled to buy.
Your state may also have its own specific Medigap enrollment protections beyond the federal rules. Those protections are different from state to state, so the rule where you live needs to be checked before assuming medical underwriting will apply.
That is why your first Medicare Supplement enrollment opportunity is so important. It may be the easiest time you will ever have to get the coverage you want without your health history standing in the way.
Can a Medicare Part D plan be reinstated after termination for unpaid premiums if the missed payments were caused by the member’s dementia?
Yes, it may be possible.Medicare allows a Part D plan to reinstate someone who was dropped for unpaid premiums when there is “good cause” for the missed payments. Dementia can support a good-cause request if the cognitive impairment prevented the member from understanding the bills, managing finances, or arranging for the premiums to be paid.
But the diagnosis by itself does not automatically restore coverage. The plan reviews the circumstances individually.
Act quickly. The member or an authorized representative generally must request reinstatement within 60 days of the disenrollment effective date and explain how the dementia caused the missed payments. The plan may ask for a credible statement or other information supporting what happened.
If good cause is approved, all premiums that were owed when the coverage ended must be paid in full within three months of the disenrollment date. The reinstatement can then restore the Part D coverage without a break.
So I would contact the Part D plan immediately and specifically say: “We are requesting reinstatement for good cause because the member’s dementia prevented the premiums from being paid.”
Have the disenrollment notice, dates of the missed payments, information about the dementia, and details about who was handling the member’s finances available.
The important thing is not to assume the termination is final. There is a Medicare reinstatement process specifically for situations where circumstances outside the member’s control caused the nonpayment.
Can I collect Social Security benefits without signing up for Medicare?
Yes — before age 65, you can collect Social Security retirement benefits without having Medicare.But once you reach 65, the rules change.
If you are already receiving Social Security benefits before you turn 65, you will generally be automatically enrolled in Medicare Parts A and B when you become eligible. You can decline Part B if you have other qualifying coverage and delaying it makes sense.
If you are 65 or older and then apply for Social Security, premium-free Part A generally comes with your Social Security benefits. You can decide whether to enroll in Part B when you apply.
There is one especially important issue if you are still working and contributing to an HSA. Starting Social Security after 65 can also trigger Medicare Part A, and Part A can be backdated up to 6 months. That can create excess HSA contributions and tax problems. SSA recommends stopping HSA contributions at least six months before applying for Social Security or Medicare when this rule applies.
So if you are over 65 and still working, don’t start Social Security without first looking at your employer coverage, Medicare timing, and HSA contributions.
Social Security and Medicare are separate decisions before 65, but after 65 they can become closely connected.
What are the different types of Special Needs Plans (SNPs) in Medicare?
Medicare has three main types of Special Needs Plans, or SNPs. They are Medicare Advantage plans designed for people with specific health or financial needs.C-SNP — Chronic Condition Special Needs Plan
These plans are for people with certain serious or disabling health conditions, such as diabetes, chronic heart failure, certain cardiovascular or lung conditions, cancer, dementia, kidney disease and other qualifying conditions.
The plan is designed around the condition, including its doctors, prescription coverage and care coordination.
D-SNP — Dual Eligible Special Needs Plan
These plans are for people who qualify for both Medicare and Medicaid. A D-SNP helps coordinate the Medicare and Medicaid benefits and may include additional help with costs and services depending on the person's Medicaid eligibility.
I-SNP — Institutional Special Needs Plan
These are generally for people who live in a nursing home or other qualifying care facility, expect to live there for at least 90 days, or in some cases live at home but need the same level of care provided in an institution.
All SNPs include Medicare Part D prescription coverage. You also need Medicare Parts A and B, must live in the plan's service area, and must meet that particular plan's eligibility requirements.
The important thing is that a Special Needs Plan is not simply a Medicare Advantage plan with better extras. It is designed around a specific health, Medicaid, or care situation, so the first question is which type of SNP, if any, actually fits your circumstances.
What is the 6-month HSA rule for Medicare?
The “6-month HSA rule” can be a little confusing because it doesn’t mean everyone has to stop contributing to an HSA six months before turning 65.The issue comes up when someone delays Medicare past age 65 and continues contributing to an HSA. When they eventually apply for Medicare, Medicare Part A can be retroactive for up to six months (but not earlier than the month they turned 65).
Since you cannot contribute to an HSA for any month you are enrolled in Medicare, that retroactive Part A coverage could cause some of your HSA contributions to become excess contributions.
Example: If you’re 68, still working, covered by an HSA-qualified employer plan, and contributing to your HSA, you can generally continue those contributions while you delay Medicare. But when you’re ready to enroll in Medicare, you should generally stop HSA contributions at least six months before applying.
Also remember that employer HSA contributions count toward the contribution limit too.
So the simple rule of thumb is: If you’re over 65, still contributing to an HSA, and getting ready to enroll in Medicare, plan ahead and stop HSA contributions about six months before applying for Medicare or Social Security.
Can my employer reimburse my Medicare premiums?
Yes, an employer can reimburse Medicare premiums, but it generally needs to be done through a properly structured arrangement rather than simply paying an employee’s Medicare premium informally.For example, an Individual Coverage HRA (ICHRA) can be designed to reimburse an employee for Medicare Part A (if a premium applies), Part B, Medicare Advantage (Part C), Part D, and even Medicare Supplement premiums. Medicare Part B and Part D premiums are recognized as medical expenses under the tax code.
There are some important rules, particularly if the employer also offers a traditional group health plan. An employer generally cannot single out Medicare-eligible employees and simply pay them to leave the group plan and enroll in Medicare, because Medicare Secondary Payer and other benefit rules can come into play. Also, an Excepted Benefit HRA cannot reimburse Medicare Part A, B, C, or D premiums.
So if you’re asking this for an employer/client situation, tell me how many employees the company has and what coverage they currently offer, and I can tell you which reimbursement structure would likely work.
Do retired federal employees need to enroll in Medicare if they already have FEHB coverage?
Short answer: no, you're not required to enroll in Medicare if you have FEHB. Your FEHB coverage continues into retirement, and you won't lose it by skipping Medicare. But before you close this tab, there are a few things you really need to know, because this decision is a bigger deal than most federal retirees realize.First, most people take Part A regardless. If you worked and paid Medicare taxes, Part A doesn't cost you a monthly premium, so there's usually no downside to having it.
Part B is where the real decision lives. Here's the catch that trips people up: once you're retired, FEHB doesn't count as coverage from active employment. That matters because if you skip Part B at 65 and change your mind years later, you'll pay a late enrollment penalty for the rest of your life, and you may have to wait for a general enrollment window to sign up. The flexibility you had while working goes away when you retire.
Why would you pay for Part B if FEHB already covers you? Because the two can work together, and many FEHB plans reduce your out-of-pocket costs when Medicare pays first. Some even help offset the Part B premium. For plenty of retirees the math works out in their favor, but it depends on your specific plan and situation, so it's worth sitting down and running the numbers before your window closes.
One piece of good news: FEHB drug coverage is considered creditable, so most federal retirees don't need to add separate drug coverage, and there's no penalty if you skip it.
The bottom line: you don't have to enroll, but the choice you make around your 65th birthday can follow you for life. This is one of those decisions worth talking through with someone before the deadline, not after.
How likely am I to qualify for Medigap at 73 after the six-month enrollment period? I have some medical history and a possible cancer workup, but no diagnosis, hospitalizations, or treatment.
This comes up a lot, and the honest answer is: it depends on your state and on timing more than on your age. Outside your six-month Medigap Open Enrollment window, most states let carriers ask health questions, and they can approve, rate you up, or decline.Here's the part that matters in your situation: Medigap applications don't just ask about diagnoses — they ask about pending tests, recommended treatment, and symptoms under investigation. A "possible cancer workup" with no diagnosis usually isn't a decline for being sick; it's a postpone for being unresolved. Most carriers won't approve while a workup is open, because they can't underwrite an unknown. Once the workup closes with a clean result, your odds improve dramatically — no hospitalizations, no diagnosis, and no treatment history is actually a decent underwriting profile at 73.
So the practical path is usually: (1) let the workup resolve first, (2) answer every application question truthfully — a misstatement can void the policy later, and (3) check your state's rules before assuming you'll be underwritten at all. A handful of states have birthday rules or year-round guaranteed-issue windows, and there are federal guaranteed-issue situations (like losing certain coverage) where health questions can't be asked. An independent agent who works with several Medigap carriers can pre-screen you against each carrier's health questions before you ever submit an application, so a decline never hits your record.
In NC, I’m on my husband’s active employer plan with 20+ employees. Since it’s credible coverage, can I delay Medicare, including Part D?
Yes, since your husband's employer plan covers 20+ employees, it counts as creditable coverage for both Medicare and Part D. So you can delay enrolling in Part A, Part B, and Part D without a late enrollment penalty as long as that coverage stays in place. Once the employer coverage ends, you'll get an 8-month Special Enrollment Period to sign up for Part A and B, and a separate 2-month window to enroll in a Part D or Medicare Advantage plan with drug coverage
How do eligibility rules differ for those on TRICARE or Veterans Affairs (VA) benefits?
For Medicare in 2026, eligibility itself doesn’t change for people with military benefits, but the rules around enrollment and coordination do. Those eligible for TRICARE must enroll in Medicare Parts A and B at age 65 to keep coverage, at which point they move into TRICARE For Life, with Medicare as the primary payer and TRICARE acting as secondary “wraparound” coverage—skipping Part B can mean loss of TRICARE and permanent penalties. In contrast, Veterans Affairs (VA) health benefits are based on military service rather than age and do not require Medicare enrollment; however, VA and Medicare generally do not coordinate for the same care, so veterans often enroll in Medicare (especially Part B) to avoid late penalties and to have access to non-VA providers. In short, Medicare enrollment is mandatory to keep TRICARE but optional (though strongly recommended) for those relying on VA benefits.What life events qualify me for a Medicare Special Enrollment Period?
A Special Enrollment Period, or SEP, is an opportunity to change Medicare coverage outside the normal annual enrollment periods because something in your life changed.Some of the most common situations include:
Retiring or losing employer or union coverage
Moving to a new address where your current plan is not available or where different plans become available
Losing Medicaid or Extra Help, or having a change in that assistance
Moving into or out of a nursing home, rehabilitation facility or other qualifying institution
Moving back to the United States after living overseas
Developing a serious chronic condition that qualifies you for a Chronic Condition Special Needs Plan
Your Medicare plan leaving your area or ending its Medicare contract
Certain other changes involving employer coverage, prescription coverage or special circumstances
The important thing is that there is not one universal Special Enrollment Period. What you are allowed to change and how long you have to do it depend on what actually happened. For example, moving may give you a different window than losing employer coverage or Medicaid.
So if something in your life changes, don't assume you have to wait until October. Ask: What changed, when did it happen, and does that event give me an opportunity to change my Medicare coverage now?
And don't wait too long to ask. Many Special Enrollment Periods only last a few months.
When do I get the ANOC(Annual Notice of Change) and what should I do if I have questions about my ANOC?
The Annual Notice of Change (ANOC) has to be mailed no later than September 30th each year and prior to Annual Enrollment Period(AEP).VERY IMPORTANT INFORMATION RE: Annual Notice of Change
1- Be On Look Out (BOLO) for it in the mail.
2- Keep It
3- Review It and Understand what is changes are happening with your current cover plan (Medicare Advantage and Part D-Prescription Drug Plan).
Here are a list of key items to review:
- Is Your Plan Available in 2027, or will you need to identify a new plan
- Cost Shares (Co Pays, Coinsurance, and Deductibles (Medical and Prescription)
- Max Out of Pocket (MOOP) Costs
- Network Changes (doctors, specialists, hospitals enter or leaving your plan network)
- Extra Benefits Changes (Dental, Vision, Hearing, Over The Counter (OTC), Fitness/Gym)
- Optional Supplemental Benefits (OSP)- What's available for your plan and costs of them
- Review your Medications / Plan Formulary / Co Pays / Coinsurance, Deductibles, Tiers (Preferred Generic, Generic, Preferred Brand, Brand, Specialty, Non Formulary)
- Preferred Pharmacy vs In-Network Pharmacy (Additional Savings Available)
- Plan Vendor Partners (this can change from year to year as well ) like EyeMed, DentaMax, LIbertyDental, Carreigton, TruHearing, etc..
Industry Hack:
If you work with a broker, they will do all of the above for you and highlight the differences, best options, and help you navigate any changes you may see with you plan from one year to the next. There is no additional costs to work with a broker and there is no fees charged for their services.
Can green card holders get Medicare?
Yes. Lawful permanent residents, commonly called green card holders, can qualify for Medicare.For someone age 65 or older, there are two important pieces to look at.
First is work history. If you or your spouse worked and paid Medicare taxes long enough — generally about 10 years — you may qualify for premium-free Medicare Part A, just like a U.S. citizen.
If you do not have enough work history for premium-free Part A, there is another rule to consider. A lawful permanent resident who is at least 65 and has lived continuously in the United States for the five years immediately before applying can generally enroll in Medicare Part B and may be able to purchase Part A.
So the important questions are:
How old are you?
How long have you been a lawful permanent resident living in the United States?
How many years did you or your spouse work and pay Medicare taxes?
Someone under 65 may also qualify for Medicare because of disability or certain medical conditions, but those eligibility rules are different.
The key point is: a green card can make Medicare eligibility possible, but citizenship status alone does not determine whether Medicare is free or when you can enroll. Work history and residency matter too.
Can children be on Medicare?
It surprises many people, but yes, in very specific situations.Medicare isn't only for people 65 and older. The main way a child can qualify is through End-Stage Renal Disease (ESRD): a child whose kidneys have failed and who needs regular dialysis or a kidney transplant can get Medicare at any age, as long as a parent (or the child's own record, in rare cases) has enough work history under Social Security.
Young adults under 65 can also qualify: after receiving Social Security disability benefits for 24 months, Social Security enrolls them in Medicare Parts A and B automatically, no application needed, and the Medicare card simply arrives in the mail about three months before coverage begins. For Amyotrophic lateral sclerosis (ALS), Medicare starts immediately, with no 24-month wait. That pathway generally applies from adulthood, not to minors.
For most children who need health coverage, the right doors are usually Medicaid or CHIP (the Children's Health Insurance Program), which are designed for kids and are based on family income, or a family plan through the Health Insurance Marketplace.
So the practical answer: if a child in your family has kidney failure, ask about Medicare specifically, it's a real option that many families don't know exists. For any other situation, Medicaid, CHIP or a Marketplace plan is usually the path. A licensed agent can help you figure out which door fits your family's situation at no cost.
What happens when my doctor stops taking my insurance?
It depends on what kind of Medicare coverage you have.On a Medicare Advantage plan: Your doctor leaving the network is the most common version of this. After that:
- HMO: Visits with that doctor usually aren't covered anymore, except in an emergency.
- PPO: You can still see the doctor, but you'll pay higher out-of-network costs.
- Mid-treatment: Your plan should let you know ahead of time. If you're in the middle of treatment, ask the plan about continuity of care, since some will cover you for a transition period.
- Your options: Pick a new in-network doctor, or switch plans. Annual Enrollment runs October 15 to December 7, and Advantage members get another chance from January 1 to March 31. If a lot of doctors leave your plan's network at once, Medicare may give you a Special Enrollment Period to change plans sooner.
On Original Medicare (with or without a Supplement): There are no networks, so you can see any doctor in the country who accepts Medicare. If your doctor stops taking Medicare entirely, though, you'd have to pay out of pocket under a private contract, and Medicare won't reimburse you. Some doctors still see Medicare patients but don't "accept assignment." They can charge up to 15% more than Medicare's approved amount, and Plan G covers that extra charge.
If keeping a specific doctor matters to you, make it the first thing you check when you're choosing or renewing a plan. With Annual Enrollment starting soon, now's a great time to confirm your doctors are still in network for next year.
A man has Medicare Parts A and B through SSDI and turns 65 on September 28, 2026. When does his new Medicare Supplement Open Enrollment Period begin and end?
It starts September 1, 2026, and ends February 28, 2027.People who get Medicare early because of a disability receive a new six-month Medigap Open Enrollment Period when they turn 65, even though they already have Part B. The window opens on the first day of the month he is both 65 and enrolled in Part B. Since his birthday falls in September, that's September 1. Six full months (September through February) puts the end date at February 28, 2027.
During this window, he can buy any Medicare Supplement plan sold in his area without medical underwriting, and the carrier can't decline him or charge more for health conditions. Because he's already on Part B, he can't postpone the window, and he only gets it once.
I hear about these Food Benefit cards all the time. How much are they worth and how do I get one?
Those “food benefit” or “grocery” cards you see advertised are not a standard Medicare benefit.They are usually extra benefits offered by certain Medicare Advantage plans. Some plans may provide an allowance for approved groceries or healthy foods, often through a debit-style card. The amount varies widely by plan, where you live, and whether you qualify. There is no one Medicare amount that everyone receives.
Eligibility is important. Some food benefits are available only to members who meet certain health requirements, such as having a qualifying chronic condition. CMS — the Centers for Medicare & Medicaid Services, the federal agency that oversees Medicare — allows some Medicare Advantage plans to provide food and produce benefits to eligible chronically ill members.
Be careful with advertisements that promote a large dollar amount. Sometimes that number represents a yearly total, or combines several benefits such as groceries, over-the-counter items or other allowances. It does not necessarily mean you will receive that amount in cash to spend however you want.
You also don't apply to Medicare for a universal “food card.” You have to be enrolled in a Medicare Advantage plan that offers the benefit and meet that plan's eligibility requirements.
Most importantly, don't choose a Medicare plan because of the grocery card alone. Check your doctors, prescriptions, hospitals, copays and maximum out-of-pocket costs first.
A few hundred dollars in grocery benefits can disappear pretty quickly if the plan creates a much larger healthcare expense somewhere else.
I have a SCAN Medicare Advantage plan and turn 66 in November. Can I switch back to Original Medicare during this enrollment period?
Yes. If you mean the October 15 through December 7 Medicare Open Enrollment period, you can leave your SCAN Medicare Advantage plan and return to Original Medicare. The change would generally take effect January 1.But before you drop SCAN, there are two important things to work through.
First, how will you cover the costs Original Medicare leaves behind? Many people look at a Medicare Supplement. Since you are turning 66, your original six-month Medigap enrollment period may already be ending or over. If SCAN was the Medicare Advantage plan you joined when you first became eligible for Medicare at 65, you may have a special 12-month trial right that gives you additional Medigap protections. The exact dates matter, so check that before making the change.
Second, if your SCAN plan includes prescription coverage, you will normally need a separate Part D plan when you return to Original Medicare.
There are important exceptions. If you also have TRICARE For Life, CHAMPVA, VA benefits, retiree coverage or another form of secondary coverage, that can change whether you need a Medicare Supplement, Part D plan, or both. Those benefits should be reviewed before changing anything.
So yes, you can switch. But do not cancel your current Medicare Advantage coverage until you know exactly what will replace it and the new coverage has been approved with the correct effective dates.
The goal is a clean handoff from one set of coverage to the next — not a gap while you are waiting for something to be approved.
I have Medicare Parts A and B and drug coverage through my wife’s employer plan. Could I face a Part D late-enrollment penalty later?
If you have Medicare Parts A and B but receive prescription drug coverage through your wife’s employer, you can generally delay Part D without a late-enrollment penalty as long as the employer drug coverage is considered creditable. Creditable coverage means it is expected to pay, on average, at least as much as Medicare’s standard Part D coverage. Your employer or health plan should provide a notice each year confirming whether the drug coverage is creditable - keep those notices for your records. If that coverage ends, be careful not to go 63 consecutive days or more without creditable drug coverage, or you could face a Part D late-enrollment penalty later.I'm a military retiree with TRICARE For Life - do I still need to sign up for Medicare Part B?
Yes. If you are a military retiree and eligible for premium-free Medicare Part A, you generally must also have Medicare Part B to keep TRICARE For Life.TRICARE For Life works as Medicare-wraparound coverage. Medicare generally pays first for Medicare-covered services, and TRICARE For Life may then pay eligible remaining costs. Your TRICARE For Life coverage normally begins automatically once you have both Medicare Part A and Part B.
You will need to pay the Medicare Part B premium. If you decline Part B, drop it, or stop paying the Part B premium, you generally lose your TRICARE coverage.
One important difference from many other Medicare situations is prescription coverage. TRICARE For Life includes the TRICARE Pharmacy Program, so you generally do not need a separate Medicare Part D plan simply to have prescription coverage.
If you are approaching 65, make sure your Medicare Part A and Part B effective dates are lined up so there is no break between your current TRICARE coverage and TRICARE For Life.
My Medicare PPO Blue plan in Texas has lapsed. What options do I have for getting new coverage?
A few different situations fall under "lapsed," so the right move depends on why:If the plan was cancelled for non-payment of premium:
Most MA plans have a grace period (typically 2-3 months) — check if reinstatement is still possible by paying the past-due premium.
If reinstatement window has passed, you're generally locked out until the next enrollment period (Medicare Advantage Open Enrollment, Jan 1–Mar 31, or the Annual Election Period, Oct 15–Dec 7) — unless a Special Enrollment Period applies (see below).
If the plan was terminated by the insurer or left the market (not your fault):
This creates an involuntary-loss SEP — you can enroll in a new MA plan or Original Medicare + Part D starting 2 months before the loss and up to 3 months after.
This does NOT require waiting for AEP.
If you moved out of the plan's service area:
Also triggers an SEP, similar window as above.
Coverage options once eligible to enroll:
Another Medicare Advantage plan available in the area, or
Original Medicare (Part A + B) + a standalone Part D drug plan, with the option to also add a Medigap policy — though Medigap underwriting may apply outside guaranteed-issue windows in Texas.
I hear about these OTC cards all the time. How much are they worth and how do I get one?
You’ve probably seen a lot of advertisements for “Medicare OTC cards,” but there isn’t one standard Medicare card or dollar amount that everyone receives.An OTC allowance is an extra benefit offered by some Medicare Advantage plans. Medicare.gov confirms that some Medicare Advantage plans cover over-the-counter items that Original Medicare doesn’t cover.
How much is it worth?
There is no universal amount. The allowance depends on the specific Medicare Advantage plan available where you live. Some plans provide an allowance monthly, while others provide it quarterly. The amount, the products you can purchase, where you can use the benefit, and whether unused funds carry over are all determined by the individual plan.
Depending on the plan, covered items might include things such as pain relievers, first-aid supplies, vitamins, cold medicines, dental-care products, and other approved health-related items.
How do you get one?
You generally get the benefit by enrolling in a Medicare Advantage plan that includes an OTC allowance. It is not a separate benefit that you apply for through Social Security or Medicare.
Some Special Needs Plans may also provide additional supplemental benefits to people who meet certain eligibility requirements.
One caution: I would never recommend choosing a Medicare Advantage plan just because it advertises a large OTC allowance. Your doctors, hospitals, prescriptions, copays, maximum out-of-pocket amount, pharmacy network, and other benefits are much more important.
The OTC benefit can be helpful, but it should be looked at as one piece of the plan... not the reason you choose it. I can help you compare the plans available in your area and see which ones include an OTC benefit while still making sure your doctors, prescriptions, and overall costs fit your needs.
What happens to my Covered California plan when I turn 65?
When you become eligible for Medicare at 65, your Covered California plan does not automatically turn into Medicare or automatically cancel. You need to coordinate the transition.If you qualify for premium-free Medicare Part A, you generally will no longer qualify for the financial help or premium tax credits that were lowering the cost of your Covered California plan.
The most important rule is: do not cancel your Covered California coverage until your Medicare enrollment has been approved and you have confirmed your Medicare effective date.
Once that date is confirmed, contact Covered California and have them schedule the Marketplace coverage to end so it transitions directly into Medicare without a gap in coverage.
Covered California recommends reporting your Medicare eligibility promptly and giving them advance notice when ending the plan.
If your spouse or other family members are younger than 65, they may be able to remain on Covered California even though you are moving to Medicare.
The goal is simple: confirm Medicare first, then coordinate the Covered California end date carefully so one coverage hands off to the other without leaving you uninsured.
Can I be turned down for a Medicare Supplement plan because of a pre-existing condition?
Yes, in some situations you can — but not when you are in your protected Medicare Supplement enrollment period.When you are 65 or older and first enroll in Medicare Part B, you get a 6-month Medicare Supplement Open Enrollment Period. During that time, an insurance company cannot turn you down, charge you more because of your health, or use medical underwriting to deny your application.
After that 6-month period ends, the rules can change. In many states, an insurance company may ask health questions and can deny your application if you do not meet its underwriting requirements.
There are also federal guaranteed-issue rights that protect you in certain situations, such as losing specific coverage or leaving Medicare Advantage under certain circumstances. When one of those rights applies, an insurance company cannot use your health to deny the Medigap coverage you are entitled to buy.
Your state may also have its own specific Medigap enrollment protections beyond the federal rules. Those protections are different from state to state, so the rule where you live needs to be checked before assuming medical underwriting will apply.
That is why your first Medicare Supplement enrollment opportunity is so important. It may be the easiest time you will ever have to get the coverage you want without your health history standing in the way.
My Medicare Advantage plan with UHC has been closed and will not be available next year. Can I switch to enrolling in a Medicare Supplemental plan for 2027 without having to pre-qualify
It’s called a plan exit, and yes, you can get a guaranteed issue Medicare Supplement without having to qualify medically. Generally, when your Medicare Advantage plan is discontinued in your area, you have the right to enroll in certain Medicare Supplement plans without answering health questions. You’ll need to return to Original Medicare, and there are specific deadlines to take advantage of this opportunity.
I turn 65 in January 2027, have disability Medicare with an ESKD C-SNP in Indiana (47331), and am awaiting a kidney transplant. I need coverage for out-of-pocket costs and post-transplant medications, including immunosuppressants, plus an O+ or O- kidney donor.
Turning 65 is your golden opportunity to get the best coverage available through a Medicare Supplement Plan G without any medical underwriting. (Your health problems won’t keep you from getting the best plan available at the preferred rate!) Enrollment is available now for a supplement. You can also enroll in any drug plan that will cover the medications you need; however, you can also get your provider to write a pre-authorization letter if necessary for drugs Medicare may not initially cover. You can enroll in your drug plan 90 days before your 65th birthday. A qualified Medicare agent can help you with the options, enrollment process, timing, and may even help you with future plan changes. Call me if you need someone in your corner!I live in Illinois and have a Medicare Supplement plan. Can I switch to another Medigap plan without going through medical underwriting?
Answering with current data as of September 11, 2026, Illinois gives some Medicare Supplement policyholders a special opportunity to change plans without medical underwriting.If you are between ages 65 and 75, you have a 45-day window beginning on your birthday each year. During that time, you may be able to move to a plan with the same insurance company, or an affiliated company, as long as the new plan has the same or lesser benefits.
The pitfall is thinking this gives you the freedom to switch to any Medicare Supplement company or any plan without health questions. It does not.
Outside of that birthday window, medical underwriting may still apply unless you have another guaranteed-issue right.
Before making a change, make sure you understand exactly what you qualify for. And never cancel your current Medicare Supplement until the new coverage has been approved.
I had Medicare Part B for one year, then dropped it when I took a job and re-enrolled a year later. Why was I charged three months of back premiums and a lifetime penalty that I’ve been paying since 2020?
I can’t see your specific records, but a Part B late enrollment penalty applies when you were eligible for Part B and went without it, and without group health coverage based on current employment (yours or your spouse’s), for 12 months or more. Other coverage, like COBRA, retiree plans, or marketplace plans, doesn’t count. If you had qualifying job-based coverage during the gap, those months shouldn’t count toward the penalty, but you’ll need to prove it. Ask your employer’s HR to complete their part of the CMS-L564 form, and submit it to Social Security along with a request to review the penalty. Employer size can matter, so ask SSA whether it affects your situation. The appeal deadline is 60 days from receiving the penalty letter. If that’s passed, you can still ask whether a late request will be accepted for good cause, especially if documentation was missing or you were given wrong information.Browse Other Questions & Answers
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