Common Medicare Questions (Q&A)

If you’re feeling confused about Medicare - you’re not alone. Most people have the same questions when they first become eligible.

Below are simple answers to some of the most common Medicare questions I hear every day.

When should I enroll in Medicare?

Most people become eligible for Medicare at age 65. Your Initial Enrollment Period is a 7-month window:

• 3 months before your 65th birthday

• Your birthday month

• 3 months after

Enrolling on time is important to avoid potential late penalties.

Is Medicare free?

Not exactly.

Some parts of Medicare are premium-free for many people (like Part A if you’ve worked enough years), but:

• Part B has a monthly premium

• Most prescription drug and Medicare Advantage plans also have costs

• You may also have deductibles, copays, or coinsurance

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare includes Part A (hospital) and part B (medical).

Medicare Advantage (Part C) is an alternative offered by private insurance companies that bundles your Medicare benefits and often includes extra coverage like dental, vision, hearing, and prescriptions (varies by plan).

Do I have to sign up for Medicare at 65 if I’m still working?

Not always.

If you have creditable employer coverage, you may be able to delay certain parts of Medicare without penalty. However, the rules depend on your specific situation, so it’s important to review your coverage before deciding.

Does Medicare cover prescriptions?

Original Medicare does not cover most outpatient prescription drugs.

You typically need either:

• A Medicare Part D plan, or

• A Medicare Advantage plan that includes drug coverage

Can I keep my doctor with Medicare?

It depends on your plan:

• With Original Medicare, you can see any doctor who accepts Medicare

• With Medicare Advantage, you may need to stay within a provider network (depending on the plan type)

What is the difference between HMO and PPO Medicare Advantage plans?

• HMO plans usually require you to use in-network doctors and get referrals

• PPO plans offer more flexibility and may allow out-of-network care at a higher cost

Do I need Medicare if I already have insurance?

It depends on your current coverage.

Some people delay Medicare if they have qualifying employer insurance. Others may need to enroll at 65 to avoid penalties. It’s important to evaluate your specific situation before deciding.

What happens if I miss my Medicare enrollment period?

You may have to wait for a General Enrollment Period and could face late penalties depending on the part of Medicare you delayed.

Still have questions?

Medicare can feel overwhelming at first- but you don’t have to figure it out alone.

If you want help understanding your options, I’m happy to walk you through it in a simple, no-pressure way.

Disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We are not affiliated with or endorsed by the U.S. government or the federal Medicare program.