Medicare Questions & Answers: New To Medicare
New To Medicare Q&A
Showing 48 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.
What's the most important question I should be asking about Medicare that I probably haven't thought of yet?
The question you aren't asking might just be what options give me most control of my healthcare? The opposite question is important as well, What might limit my healthcare? With Advantage plans you have to stay in-network for your care and often there are prior authorization hoops to jump through.With Medicare supplements there are fewer prior authorizations and when there is one they are generally just looking for Fraud, Waste, and Abuse. What they are not looking for are ways to protect their profits. They aren't looking for how they can squeeze more money out of the system to pay their CEO or have more money for their marketing budget.
Yes, there are times when an Advantage Plan is the right fit. It does depend on your budget and the amount of control you have really depends on the company you go with. In general though I think you retain more control of your healthcare with traditional Medicare and a supplement.
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
Enrollment Period (IEP), which is a 7-month window that includes:3 months before your 65th birthday month
Your birthday month
3 months after
Here are the first steps you should take:
1. Determine if you need to enroll now
If you're already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B.
If you're not receiving Social Security, you’ll need to manually enroll via the Social Security website or call them.
2. Decide if you want Original Medicare or Medicare Advantage
Original Medicare = Part A (hospital) + Part B (medical), with the option to add:
a Part D drug plan, and
a Medigap supplement (to cover costs Original Medicare doesn’t)
Medicare Advantage (Part C) = All-in-one plan offered by private insurers (includes Part A, Part B, usually Part D, and often extras like dental/vision)
3. Compare plans
Work with a licensed Medicare agent (like me!) who can help you compare plans from multiple companies — based on your doctors, prescriptions, and budget.
4. Enroll on time
Enrolling during your IEP helps you avoid:
Late enrollment penalties (especially for Part B and Part D)
Gaps in coverage
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 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.
I'm turning 65 soon, when can I enroll in Medicare?
3 months before your 65th birthday. And up to 3 months after. You may delay enrollment if you have a job that gives you creditable coverage if you want to delay signing up for Medicare. Normally if you are receiving Social Security you will be signed up automatically.
I've been on disability for years and am about to turn 65. Do I automatically get Medicare because I'm on Social Security, or do I need to do something?
If you already have Medicare benefits due to disability, you just continue to have your Medicare benefit. If you like to change your plan such as the Medicare supplement plan, you are eligible to an open enrollment period that begins three months before your 65th birthday and ends three months after your 65th birthday. Please ask your Medicare insurance agent.If you don't have Medicare benefits now and have enough Medicare credit, you will automatically receive your medicare benefit.
I prefer to access to Social Security Administration on WEBSITE.
https://www.ssa.gov/medicare/sign-up
What if I missed my window to sign up?
If you missed your window to sign-up for Medicare you could qualify for a Special Enrollment Period (SEP) , such as when you loose employers insurance (or other reasons). If you do not qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the Open Enrollment Period which runs from January 1 through March 31 each year. Check the medicare.gov website or talk to a Medicare Insurance agent to find out what applies for you and how to go about the application process.Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?
Why Seniors Delay Enrollment:1. Lack of Awareness or Understanding
Many seniors aren’t fully aware of their Medicare Initial Enrollment Period (IEP), the penalties for late enrollment, or the options they have. They might assume they’ll automatically be enrolled or think they don’t need to worry until a later time.
2. Fear or Overwhelm
The Medicare system can feel overwhelming with its various parts (A, B, C, D, Medigap). The fear of making the wrong choice often leads to procrastination.
3. Health or Work Factors
If seniors are still working or have employer-provided health insurance, they may think they can delay Medicare enrollment without consequences. However, this can be risky if their employer insurance isn’t considered "creditable" (as good as Medicare).
4. Waiting for a "Perfect" Plan
Some seniors wait until they are sure about which plan is best, hoping to get more information or thinking they’ll figure it out later. However, waiting can often result in missed opportunities or more limited choices.
So my friend told me I should just go with the cheapest Medicare plan. That sounds too simple - what am I missing?
The cheapest plan may or may not be your best choice. Depending on your personal needs and budget. It’s always best to look at and compare all your options and be sure you understand the differences in each plan. There is no one size fits all and it’s much better to discuss your choices with a licensed agent rather than depending on options of anyone that isn’t trained and certified to explain all options and not just select plans.
Who can help me figure out this Medicare "maze and alphabet soup" it's so confusing.
Always try to find a licensed Medicare Broker or Agent when looking at enrolling, changing plans, or for more information on copays/benefits. Meeting with them and possibly becoming their client does not cost you anything, we are paid directly by the companies. If you decide to enroll with one they will become your agent and you may contact them with future questions about your plan.
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.
I'm turning 65 next month and the amount of Medicare mail I'm getting is overwhelming. How do I sort through all this?
My advice to people is to put all of it aside. If you try and read all of it your head will explode. Find an Independent Medicare Broker and use them as your Adviser, their services are free and if you choose one that only does Medicare, you'll be getting an expert
I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
All parts of Medicare have some cost associated, whether it be a premium, deductibles, copays for services, or even a max out-of-pocket.Premiums are the payments you make for the coverage. Deductibles are the amount you must pay out-of-pocket before your coverage will pay anything. Copays are the amount you pay for specific services after meeting your deductible.
Medicare Part A is free once you retire if you or your spouse worked for the last 40 quarters (10 years) before you signed up, because you paid taxes while working. Medicare Part A:
* Has a deductible for each benefit period (every 60 days) for inpatient hospital stays.
* Has copays for hospital stays longer than 60 days.
* Has daily coinsurance for days 61-90 and 91-150.
Medicare Part B has a premium that comes out of your Social Security check before it is dispersed to you. If you are not receiving Social Security, you must pay the premium for Part B out-of-pocket until you start drawing your Social Security. Medicare Part B:
* Has an annual deductible.
* Does not have copays for most services.
* Has a 20% coinsurance for most services after the deductible is met.
Medicare Supplements (Medigap) provide benefits to help cover out-of-pocket costs like deductibles, coinsurance, & copays. Each Med Sup has a premium, & each one has different benefits. Medigaps:
* Help pay the 20% coinsurance for services covered by Original Medicare Part B (medical insurance).
* Many cover the Medicare Part A (hospital insurance) deductible.
* May cover additional days in the hospital after Medicare benefits are used up.
* Some may cover costs for skilled nursing facilities, hospice care, excess charges from non-participating providers, & foreign travel health care emergencies.
Medicare Advantage usually does not have premiums, but may have a deductible(s), has copays for services, & an annual max out-of-pocket.
I thought I signed up for both Part A and B when I got my Social Security, but now I'm getting bills for Part B. Did I miss something during the enrollment period?
Yup. If you don't speak to an experienced and honest agent, you won't know what your monthly payments will be. For example, there is a premium for the Part B, for the Part B one-time per year deductible, possibly a Medigap plan along with a Part D(rug) plan. If you want better coverage for the more expensive Dental, Vision & Hearing procedures, that can also be an extra cost per month. Sounds like you tried to get around using an agent whereas YOU are not paying for the agent's commission since the firm you chose pay the agents!
How do you approach educating clients who are new to Medicare versus those who are considering switching plans?
For my Turning 65 clients, I start with the ABC's of Medicare so that they understand the basics of Original Medicare. I want them to understand the differences between Original Medicare, Medicare Supplements, and Medicare Advantage plans so they are confident in making good decisions. Specifically, what gaps they want to supplement with a Medicare Supplement or what benefits they want to replace with a Medicare Advantage Plan. I also spend a good bit of time educating them on what they need to know if they plan to work past 65. The average retirement age is now well beyond 66, so comparing employer group health plan benefits to Medicare is a critical step in the decision making process. I want to ensure seniors set themselves up for success down the road, which includes the best coverage for the best price- and to avoid potential late penalties.For my clients that are considering switching plans, because I am a broker that represents all major carriers, I routinely monitor any changes in their health/financial situation against the changes that the carriers are making. Each year carriers make changes, and each year I ensure all my clients have a complete review of their current plan, so they can compare and make changes if needed- leaving them with the confidence that they know they are in the best possible plan for them.
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.
I am on disability insurance Medicare now I will be 65 in October do I have to to sign up for Medicare again?
Since you’re already on Medicare due to disability insurance and will turn 65 in October 2025, you do not need to sign up for Medicare again. When you turn 65, your Medicare coverage will continue seamlessly, but your eligibility reason shifts from disability to age. This happens automatically—no need to reapply.
Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?
There are two types of plans that go with medicare. A Medicare Supplement plan and a medicare Advantage plan. Medicare Advantage comes with dental, vision, hearing and a drug card. They are co pay driven. Example is primary care doctor no co pay, specialists (depending on the plan) you pay $15 to $50 for a visit. They come with other benefits too.
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.
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?
Answering the first question first: it’s hard to figure out because the government wrote it! They don’t really understand how to make things simple.…Here’s the quick rule about employer insurance after age 65: if your employer has 20 or more employees and you are covered by the employer’s insurance and still working, you can delay part B as long as you want with no concern about having a penalty later. The moment that you stop working for that employer or discontinue that insurance, that’s the time that you need to enroll into Medicare part B in order to avoid a penalty.
I always advise my clients to compare the costs and coverage of the employer plan versus Medicare so they can make an informed 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.
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.
Are Medicare Supplement plans the same thing as "Medicare Secondary Insurance"?
Yes. Medicare supplement plans are often referred to as Medigap plans. These plans work in conjunction with your traditional Medicare, but do not take the place of traditional Medicare, as Medicare Advantage plans do.
Can you explain what "creditable coverage" means and when it applies?
Credible coverage refers to health insurance that is considered as good as or better than Medicare, particularly for part B and part D. It’s most commonly relevant when someone is delaying Medicare because they’re still working and have an employer sponsored coverage. As long as that coverage is deemed credible, you can delay enrolling in Medicare without facing late enrollment penalties. When you do retire or lose that coverage, you’ll get a special enrollment period to sign up for Medicare without penalty
Will Medicare cover everything my current employer plan does?
In general, most people on Medicare who receive employer health insurance will delay Medicare Part B enrollment. In this case Medicare Part A (in-patient services) is billed first. I would contact your employer health insurance plan to find out what your cost sharing would be for specific services.
I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare?
First and foremost enroll in both Part A and B if you havent already done so.Make a list your important doctors and prescriptions. Contact an independant agent that works with many if not all of the carriers and different types of plans ie Med Sups, Medicare Advantage, Prescription Drug plans to narrow down your options for you. While you can find most of this information independently, what you wont find is the detailed information that can make a difference in your coverage. Especially in 2025 with the significant changes in ALL of the prescription drug plans. You can start the rieview and application process as early as 3 months before needing it in place...
Focus on actual care thats needed now and will happen in the future.. One of those calls I get from time to time starts with "remember that plan we talked about, I should have listened to you instead of goin out on my own" There's no cost in working with an independant agent, there could be a significant cost in not doing so..
What's the biggest frustration Medicare agents have when helping clients enroll?
Medicare and Social Security do not do a good enough job helping clients understand that Social Security and Medicare are two different things. Many people are waiting past the age of 65 to retire because full Social Security benefits comes much later at age 67. If you are not yet collecting your SS, then you are not automatically enrolled. Clients need to enroll early and allow 4-6 weeks sometimes to show up in the system. Waiting for clients to finally get in system, even when they already had Part A and are waiting to get Part B, can be frustrating for clients, and I am frustrated for them.
Can you help me understand Maximum Out-of-Pocket (MOOP) limits in Medicare plans, from your experience as an agent?
There are two maximums out of pocket limits to consider.The first one is on prescription drugs.
In 2024, Medicare changed the way prescription drug plans work. Out with the old and in with the new $2,000 maximum amount you will pay for your covered prescription drugs. Our prescription drug plan insurance company keeps track of how much you've paid for your prescriptions and when you have reached your maximum, your covered prescriptions will drop to zero amount for the rest of the year.
The second maximum out of pocket to know about is with the Medicare Advantage plans.
If you have a Medicare Advantage Plan, commonly known as a Part C, the insurance company keeps track of how much you pay for co-pays and co-insurance through the year. Once you reach the plans maximum out of pocket amount, then the insurance company pays the remaining co-pays and co-insurance for the rest of the year. Each plan has a different Maximum out of pocket amount, so knowing what that amount is important.
Make note that if you only have original Medicare, there is no maximum out of pocket amount for your 20% co-insurance.
When is the best time of the year to start looking at Medicare options?
For seniors turning 65 - its best to start reviewing options 3 month prior to your birthday month. For Senior already receiving Medicare Benefits, it's important to review your Part D Prescription drug plans during Annual Enrollment Period, October 15 - December 7th. I encourage clients to review their Medicare Supplement rate annually after the first of the year.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?
You can wait as long as you are maintaining employer coverage. Medicare part A will still get assigned to you but (as long as you are not receiving SS benefits) not part B. When you do choose to leave employer coverage make sure you visit SSA.gov and “apply for Medicare part B only”. Keep in mind this may take at least a few weeks and you may have to collect some signatures from your employers HR dept so start this process at least a month before you plan on quitting/ leaving employer coverage.
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 Original Medicare ( Part A and Part B) only covers part of your healthcare costs. Beneficiaries must enroll in supplemental insurance plans to cover prescription drug costs, deductibles, co-pays, co-insurance, and the lack of a yearly out-of-pocket limit.The coverage gaps include prescription drug coverage, you can enroll in a stand-alone Part D drug plan.
Other gaps are routine vision, dental, and hearing. Consider enrolling in a Medicare Advantage plan. These plans are an alternative way to get the Original
Medicare, Part A, Part B, and additional benefits.
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
You will be considered “guaranteed issue” as long as your employer coverage is considered credible coverage, which in most cases it is. There are a few other instances where you can be considered guaranteed issue.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.
Why did I receive a Medicare Summary Notice, and what should I do with it?
A Medicare Summary Notice (MSN) is a quarterly statement sent to individuals with Original Medicare (Parts A and B) that summarizes their claims for services and supplies billed to Medicare during that period. It details what Medicare paid, what you owe, and if the service was approved. MSNs are not bills; they are a record of claims and payments. There is nothing you need to do with the statement.
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.
Can you explain Special Needs Plans in Medicare?
Sure. If you are already qualified for Medicaid and are about to enroll with Medicare, you're going to qualify for a "SNP" or Special Needs Plan. This means that you are not going to pay for ANYTHING at all since your status (financially speaking) has been approved. Not every insurance firm offers a SNP plan. You will have to do a little searching but it should be fairly easy to do. By the way, if you've been granted Medicaid status by either a State or Federal agency and two years have elapsed, no matter what your age, you can enroll with Medicare! There are clients who are in their 50's who were approved for Medicaid and then 24 months later, they were able to only enroll into an Advantage plan with drug coverage. But, when you are Medicare-eligible at age 65, you can transition to a Medicare Supplement and a Part D(rug) plan, each with a monthly premium, if that is your preference.
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.
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!
Can I enroll in Medicare if I've never paid into Social Security due to working overseas?
Yes, you can enroll in Medicare even if you've never paid into Social Security due to working overseas. However, your eligibility and costs will depend on your residency status and work history.Medicare Eligibility Without U.S. Work History
To qualify for Medicare, you must be either a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five continuous years before applying.
While most people receive Medicare Part A (hospital insurance) premium-free by earning 40 work credits (approximately 10 years of work paying into Social Security), you can still enroll in Medicare by paying premiums if you haven't met this requirement
Costs Without Work Credits
Part A (Hospital Insurance): If you have fewer than 30 work credits, you'll pay the full premium for Part A. For 2025, this premium is up to $505 per month.
Social Security
Part B (Medical Insurance): Part B requires a monthly premium for all enrollees, regardless of work history. In 2025, the standard Part B premium is $185 per month
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.
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.
Is it ok to meet with multiple Medicare Brokers and Agents as I start looking for help?
I would meet with a broker like me that has been licensed for over 20 years and does all the plans and is licensed in several states.
How can I tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker?
An experienced Medicare broker will ask about your doctors, meds, and budget — not just push one plan. A newbie might seem unsure, skip important questions, or only talk about one company.
I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?
You must have lived in the US for a min of 5 years. At that time you will likely have a Premium for Part A as well as the normal Part B premium since you have not lived her and worked at least 40 Quarters.Browse Other Questions & Answers
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