Medicare Questions & Answers: New To Medicare
New To Medicare Q&A
Showing 29 questions
What is the biggest mistake seniors make when enrolling in Medicare?
It sounds cliché coming from me, but the biggest mistake seniors make is not having an independent agent acting on their behalf. When calling into insurance companies for help, their sole job is to sell you their product, whether it's the best option for you or not. You want someone who has a financial incentive to assist you in finding the right type of coverage by going over all your options and not leaving anything to chance. Imagine a doctor that only wrote you prescriptions from one pharmaceutical company; you'd have questions about their motives just as I would too.
How do you educate clients who are completely new to Medicare?
I give them a little history of Medicare and explain the two different ways one can take their Medicare coverage - either Original Medicare with a Supplement and a drug plan for the least restrictions, or a Medicare Advantage plan that also includes other benefits, like transportation, an over-the-counter (OTC) catalog, dental, vision, and more depending on their plans in their area.
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
First, file for Medicare Part A and Part B if you’re no longer on a company group insurance plan and continue to work past 65. If you are not on a group plan past 65 that Medicare recognizes, you must file for Medicare Part D if you don’t go with the Medicare Part C Advantage plan with built-in Medicare Part D drugs. Confusing? Contact an agent, and they should be able to explain these in detail.
Will I be penalized if I do not enroll in Medicare when I turn 65?
Yes, you may be penalized in two ways or reasons. If you don't have credible health insurance coverage, you will be punished for not having Part B once you turn 65; this is called the Part B enrollment penalty, applicable if you don't have credible health insurance in place. Second, you will be penalized if you don't have credible health insurance with prescription drug coverage in place by the time you qualify for Medicare. You must pay these penalties each month for the rest of your life.
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
If you have employer-based health insurance through your or a spouse's current employment, where there are more than 20 employees, and you're happy with the costs, such as monthly deductions/premiums and coverage, like potential out-of-pocket costs, you can delay Medicare enrollment without accruing penalties. If this is you, it's best to schedule a quick call so we can discuss your situation. Chad
I’m retiring next year—do I need to do anything with my Medicare?
If you're retiring next year and turning 65, you'll need to sign up for Medicare (Part A and Part B) through Social Security, either online or by contacting your local office, to avoid potential gaps in coverage or penalties.
What’s the most important question I should be asking about Medicare that I probably haven’t thought of yet?
If I am still working do I need to sign up for Medicare? How do I determine if a Medicare Advantage Plan or a Medicare Supplement is right for me?
I'm turning 65 soon, when can I enroll in Medicare?
When clients ask about enrolling in Medicare at 65, I explain the Initial Enrollment Period (IEP) covers three months before their birthday month, the month itself, and three months after. It’s a straightforward seven-month window.What's the difference between a Medicare broker and a Medicare agent?
The main difference between a Medicare broker and a Medicare agent is that brokers represent multiple insurance companies and can present a broader range of Medicare plans, while agents typically represent one insurance company and offer a more limited selection of plans.What if I missed my window to sign up?
If you missed your Medicare sign-up window—typically the seven-month Initial Enrollment Period around your 65th birthday—you’re not alone, and I’ve seen this trip up plenty of folks over the years, but you’ve got options to fix it depending on your situation. Without qualifying coverage like an employer plan, you’ll enroll during the General Enrollment Period (January 1 to March 31), with coverage starting the first of the next month, though you’ll face lifelong penalties—10% per year missed for Part B and about 1% per month for Part D—unless a Special Enrollment Period applies, like if you just lost job-based insurance, giving you two months to sign up penalty-free. CMS has been pushing harder lately to educate future beneficiaries about these deadlines and consequences, which I think is a smart move, so fewer people end up blindsided by costs they could’ve avoided with better knowledge upfront.
What do I need to do if I didn’t take Medicare at 65 and am now retiring?
A few things need to happen AHEAD of your retirement date. First, once you know the date you are retiring you will need to apply for Medicare Part B. You will need to create a 'special enrollment period' as you are (most likely) outside your turning 65 enrollment period. You will need to fill out Medicare Forms: CMS L564 and CMS 40B. CMS L564 is partly filled out by you and then the remainder is completed by your employer. It explains that you are retiring and losing employer coverage. CMS 40B is your application for Medicare Part B. It, along with CMS L564, explains to Medicare that you are losing coverage through your employer and now need to elect your Medicare Part B benefits.
What’s the process for signing up for Medicare if I’m already on disability benefits?
After being on Disability for 2 years you are automatically enrolled in Medicare even if you have not reached 65 yet.
I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
The gaps come from Cost Share for Part A, Deductible of $257 and co insurance of 80/20% for Part B. In Part B you are responsible for 20% of the cost which is open ended. This means there is no maximum out of pocket. An example is a $60,000 hospital bill. You would be responsible for 20% or $12,000 of this cost. Provided everything billed is an accepted Medicare expense. I would be happy to go into this in more detail, please call me for further information.
Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?
When new Medicare prospects call me, I advise them to sign up for Medicare Part B two months before their start date, so it leaves plenty of time to generate a Medicare number and start date.
How can I select the right healthcare company and representative to work with?
A good representative Will usually be very easy to spot ( Medicare agents hub ). If you End up finding someone that you trust then the carrier that you go with becomes Not as important. I have several clients and I can speak from experience in saying that putting them all on the same“good” plan Is not the right thing to do. Every individual is different, And a good representative should match up your needs with a plan that’s best for you.
Who can help me figure out this Medicare "maze and alphabet soup" it's so confusing.
Work with someone who can OFFER both Medicare Advantage and Medicare Supplement/Medigap options! Start the process well in advance of your 65 Birthday.Work with a Professional with a Financially Strong/Reputable company. Look up that Professional's Google Reviews that gives you a "spotlight" into how their clients truly feel about them and the Services they provide(d). Take a deep breath-YOU got this!
How can I avoid or reduce IRMAA charges on my Medicare premiums?
The fact is IRMAA charges are calculated based on your AGI (Adjusted Gross Income) from 2 years ago. Know this may give you and your tax accountant time to do some financial planning that will help you pay less IRMAA charges when the time comes. You can do a Google search to see the levels of additional IRMAA charges that will be added to your base Medicare premium.I'm an independent agent and am compensated for my services by the insurance companies. I never charge you additional fees for my services. I'm asked this question (IRMAA charges) quite often by higher income earners. You can contact me at 801-550-1800 to answer questions that will help you better understand what to expect.
Can I use a health savings account (HSA) to pay Medicare premiums after I retire?
Yes, absolutely. In addition to paying Medicare Part B, Part D, and Medicare Advantage (Part C) premiums, you can also use your HSA funds tax-free to cover out-of-pocket costs like copays, coinsurance, and deductibles for those plans. That includes copays at the pharmacy under Part D or doctor visit copays under a Medicare Advantage plan. HSA funds can also be used for dental, vision, and hearing expenses—even if Medicare doesn't cover them. Just remember, once you're enrolled in any part of Medicare, you can no longer contribute to your HSA, but you can continue to spend what you've already saved. It's a great preplanning tool for managing healthcare costs in retirement with tax advantages.
Why did I receive a Medicare Summary Notice, and what should I do with it?
The notice is used to Notify beneficiaries of decisions on a claim made for Medicare.I would open it and see what claim they are talking about. If you have questions I would call them.
How do you approach educating clients who are new to Medicare versus those who are considering switching plans?
If not sure you have the best plan, I would verify the current plan vs some new options. I would explain that some plans may not have wide network, while other plan may better cover your needs. Should you keep it is your decision.Can I backdate my Medicare enrollment if I missed my initial window due to a medical emergency?
If you missed your initial Medicare enrollment window because of a medical emergency, I’m sorry you had to go through that—unfortunately, Medicare doesn’t typically allow backdating for missed deadlines unless you qualify for a Special Enrollment Period (SEP), like if you were hospitalized or incapacitated during your sign-up time. The rules are strict, but if you can show proof—like hospital records or a doctor’s note—explaining how the emergency prevented you from enrolling, you might appeal to CMS for a retroactive adjustment, though approvals are rare and case-by-case. Without that, you’d face a late penalty on Part B premiums—10% per year missed, added for life.
I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare?
Number one is costevery morning number two our Benefits I will help you navigate to Medicare minefield please call me 916-628-5244
What’s the biggest frustration Medicare agents have when helping clients enroll?
Insurance companies don’t fill in Medicare brokers on changes that a client may make. The biggest frustration ends up being a lack of communication, Because when the client calls up and says that they’re frustrated with Something, they have to fill in the Medicare broker on what’s going on. This can be alleviated with simple open communication.I’m still working at 67, and I don’t know if I need Part B. Why is something so basic so hard to figure out?
It seems hard but when you know the specifics you can make the right decision for you!If you work for a company with 19 or more employees you can stay on that work plan until you retire and then get Part B!
What happens if I delay Medicare Part A enrollment because I’m still on my spouse’s employer plan?
Simple answer is nothing! Although I do suggest signing up for Part A and just delaying Part B, that way you are in the system and when Part B does need to be activated you have a fast turn around time!How does losing a spouse impact my Medicare plan if I was on their employer coverage?
When a client loses a spouse and was on their employer coverage, I explain they have 63 days to enroll in Medicare or adjust their plan without facing a penalty. It’s a qualifying event, so they’d need to switch to their own Part B if they’re 65, and I’d urge them to do it promptly to avoid any cost hikes or coverage lapses. The rules give them a clear path forward, but timing is critical.
What should I look for in a Medicare plan if I travel frequently both domestically and internationally?
If you travel within the US - reviewing plan choices that offer a Nationwide network is key.If you travel internationally - Travel insurance is available based on your dates of travel.
Review with a local Medicare Broker, contact me for specific questions.
What’s the most cost-effective way for a healthy 65-year-old to structure their Medicare coverage?
It all depends on your situation and needs. Most senior beneficiaries save money by enrolling in a Medicare Advantage Plan in their area but that may or may not be what is best for them specifically.
Can you explain how Medicare works with other types of insurance like Veterans Affairs benefits or employer plans?
Veteran Affairs benefits and separate from Medicare. If a Senior is using the VA, Medicare is not responsible for any coverage. If the Senior also has a Medicare plan and sees a doctor outside of the VA they Medicare may pay.In the case where a Senior has an employer plan and Medicare. Typically, the employer plan pays first and then it goes to Medicare as a secondary. But employee plans vary and coverage could work differently.