Medicare Questions & Answers: New To Medicare
New To Medicare Q&A
Showing 44 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.
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.
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. ChadI'm turning 65 soon, when can I enroll in Medicare?
You are guaranteed coverage with no underwriting evaluations starting three months before your 65th birthday month and continuing for three months after that month. I always advise people to start thinking about their Medicare coverage at least six months before they turn 65.What if I missed my window to sign up?
There are various circumstances and specific conditions to consider before providing a final answer to this questionnaire. Most likely, penalties will apply if you miss your initial enrollment window for Medicare’s Parts A, B, or D. A Medicare health insurance agent can review your situation and provide you with the necessary details.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 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.So my friend told me I should just go with the cheapest Medicare plan. That sounds too simple - what am I missing?
Medicare comes in different parts (A, B, C, and D), and your choices determine your cost. Choosing a cheap or simple plan during your initial enrollment could jeopardize your ability to choose other plans later in life that could benefit you the most regarding health coverage.An independent health insurance agent should be able to show you the difference in these areas. If you choose this cheaper plan today, ask your agent lots of questions about your long-term goals, coverage, and premium costs five, ten, or fifteen years from now.
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! Work with someone like me-who works with Medicare Planning every day for clients! We give great information so folks can make good decisions!
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.
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! WE can HELP YOU!
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?
Yes. After you`ve been on disability for 24 months, you should be automatically enrolled in Medicare in the 25th 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.
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 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.I'm turning 65 next month and the amount of Medicare mail I'm getting is overwhelming. How do I sort through all this?
Throw all of it in a bag for recycling! Work with a Professional who's been helping folks for decades with Medicare Planning! Work with someone who can offer BOTH Medicare Supplement/Medigap AND Medicare Advantage and make sense of the "Medicare Alphabet Soup" for you! WE do that! WE make is simple and understandable! You got this!
I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
My best advice is to meet with a local agent who specializes in ALL Medicare products and is referred to you by your doctors office or a friend who has good knowledge of that agents reputation
Can you explain what "creditable coverage" means and when it applies?
As it regards to Medicare, creditable coverage for prescription drugs means that your current coverage is as good or better than what is provided under the standard Medicare Part D benefit. And upon proof that you have had creditable coverage under your current health plan, you can delay Medicare Part D enrollment without incurring the dreaded Part D enrollment penalty.
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.
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?
Part B has a deductible each year (increases a little each year-2025 is $257) and a 20% co-pay WITHOUT a maximum out of pocket! Have you looked into either a Medicare Supplement/Medigap OR Medicare Advantage Plan that can help with the Part B "out of pocket costs"?
Will Medicare cover everything my current employer plan does?
Medicare may NOT cover all that your current employer plan does or has in the past. It is a great idea to always compare your current employer Health Plan to your Medicare plan options to find out what plans in your area cover.I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare?
You should sit down with a Medicare Agent to go over all your options! I usually have folks come in for a quick meeting and see exactly where they are and what their plans and goals and objectives are! We'd be glad to help you! :)When is the best time of the year to start looking at Medicare options?
The best time to enroll in Medicare is during your Initial Enrollment Period (IEP), around your 65th birthday, or when you are coming off a Medicare-approved company group Insurance plan. After this period has elapsed, the next best time will depend upon your circumstances. For most of us already on Medicare, it would be between October 15 and December 7 of each year.Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?
Original Medicare (OM) is a government administered 80/20 health plan. An Advantage plan covers some of the costs not covered by OM plus prescription drug, vision, dental and hearing coverage. Advantage plans are available at low or no monthly premium.
Can you explain Special Needs Plans in Medicare?
There are people who have special circumstances that CMS has determined qualify for extra help and benefits.There are several different categories.
Dual Special Needs - Medicare / Medicaid eligible.
Chronic Special Needs - Those with listed health conditions
SNP - facility plasn - Those who are confined to a facility.
each case is different it is best to talk with a professional
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.
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?
Medicare Part A is free to us if you meet the number of paid-in working units required by the Medicare statutes, over the course of your career. Suppose you are under a Medicare-qualified employee group plan at turning 65. In that case, you do not need to take out anything else, and all penalties will be waived until you leave the employee group plan sometime in the future. The Medicare Part A insurance will be utilized with your group insurance for your claims. However, if the Medicare employee group plan does not include prescription drugs, taking on a Medicare Part D prescription drug plan may be necessary to avoid penalties. Your plan needs to be evaluated by a licensed Medicare insurance agent that you trust to ensure the accuracy of 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.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's the most cost-effective way for a healthy 65-year-old to structure their Medicare coverage?
Enroll in a Medicare Advantage plan that has prescription drug coverage, vision, dental and hearing coverage for a low or no monthly premium. There is a maximum-out-of-pocket (MOOP) per year which differs with each plan.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.
Why did I receive a Medicare Summary Notice, and what should I do with it?
Your plan changes every year. That is why you need to make sure and have your agent quote even if your plan is currently working for you.
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.
