Medicare is a federal health insurance program for people age 65 and older, as well as certain younger individuals with disabilities or qualifying conditions. It helps cover hospital stays, doctor visits, and other essential medical services.

Medicare is divided into Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans offered by private insurers), and Part D (prescription drug coverage). Many people also add a Medigap plan to cover out-of-pocket costs.

If you’re already receiving Social Security or Railroad Retirement benefits, you’ll be automatically enrolled in Medicare Parts A and B. Otherwise, you’ll need to sign up during your Initial Enrollment Period, which begins three months before your 65th birthday.

Original Medicare includes Part A and Part B. Part A covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services. Part B covers doctor visits, outpatient care, preventive services, and medical equipment.

Medicare doesn’t cover long-term care (custodial care), most dental care, vision exams and glasses, hearing aids, cosmetic procedures, or routine foot care. You may need separate coverage or pay out of pocket for these services.

Medicare is a federal program primarily for people 65 and older or those with certain disabilities, regardless of income. Medicaid is a state and federal program that provides health coverage for people with low income and limited resources, regardless of age.

Yes. Many people have Medicare alongside employer insurance, retiree plans, Medicaid, or Medicare Supplement (Medigap) coverage. In these cases, Medicare may be the primary or secondary payer depending on your situation.

You can sign up for Medicare during your Initial Enrollment Period (IEP), which starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. That gives you a 7-month window to enroll in Parts A and B.

If you're already receiving Social Security or Railroad Retirement benefits, you'll be enrolled in Medicare Parts A and B automatically. If not, you need to sign up manually through Social Security online, by phone, or at your local office.

If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you’ll need to wait until the General Enrollment Period (January 1 – March 31). Your coverage will then start on July 1. Late enrollment penalties may apply.

Yes. If you're still working and have creditable health coverage through your employer (or your spouse’s), you can delay Medicare Part B without penalty. Once that coverage ends, you’ll have an 8-month Special Enrollment Period to sign up.

A Special Enrollment Period lets you enroll in Medicare outside the usual windows if you've lost other coverage, moved, or experienced certain life events. Most people qualify for an SEP when they leave employer coverage after age 65.

The General Enrollment Period runs from January 1 to March 31 each year. If you missed your initial enrollment and don't qualify for a Special Enrollment Period, this is when you can sign up—but your coverage won’t start until July 1.

You can sign up for Medicare online at ssa.gov/medicare, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office. Enrollment typically takes about 10–15 minutes online.

Yes. While full Social Security retirement age is 67 for those born in 1960 or later, your *Medicare Initial Enrollment Period* still starts at age 65. If you’re working with creditable coverage, you can delay Part B (and possibly Part A) and sign up during a Special Enrollment Period after ending that coverage.

Not necessarily. If you have employer coverage through a large employer, you can delay Part A and Part B without penalty. But since most people get Part A premium-free, many choose to enroll in it at 65 even if they delay Part B until their job ends.

You can change your Medicare Advantage or Part D drug plan once a year during the Annual Enrollment Period, from October 15 to December 7. Your new plan will begin January 1 of the following year.

Yes. You can drop a Medicare Advantage plan and return to Original Medicare during the Annual Enrollment Period (Oct 15–Dec 7), or during the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31 each year). You may not be guaranteed a Medigap policy unless you're in a protected window.

A Special Enrollment Period allows you to make changes to your coverage outside the normal dates if you experience certain life events—such as moving, losing other coverage, qualifying for Medicaid, or entering a nursing home.

Yes—but in most states, after your initial Medigap enrollment window ends, you may be subject to medical underwriting. This means the insurance company can deny you or charge more based on your health history. Some states offer limited "birthday rules" or switching windows—check locally.

If you tried a Medicare Advantage plan for the first time and decide it’s not for you, you have a “trial right” to return to Original Medicare and buy a Medigap policy—usually within the first 12 months of joining the Advantage plan. You may also qualify if you leave a Medigap plan to try Advantage for the first time and switch back within that same timeframe.

If you miss your enrollment window and don’t qualify for a Special Enrollment Period, you’ll need to wait for the next General or Annual Enrollment Period. Delays can mean gaps in coverage or even late penalties, so mark your calendar or get help early.

Medicare’s hospital fund (Part A) is projected to face funding shortfalls by the early 2030s if no changes are made. But this doesn’t mean Medicare will disappear — Congress is expected to act to preserve coverage by adjusting taxes, spending, or both.

Possibly. Recent changes like the Part D out-of-pocket cap and insulin cost reductions show that lawmakers are interested in expanding protections. Hearing, dental, and vision coverage are frequently discussed, but not guaranteed yet.

Yes. Over 50% of Medicare beneficiaries are now enrolled in Advantage plans. That trend is expected to continue due to lower premiums and bundled perks — but critics warn of reduced flexibility and rising denial rates.

Yes. Starting in 2025, Traditional Medicare will require prior authorization for 17 specific services and procedures—including things like deep brain stimulation and skin substitutes. Providers must get approval before you receive care, or risk denial of payment after.

No — the donut hole is officially closed in 2025. Now, your out-of-pocket prescription drug costs are capped at $2,000 per year, thanks to the Inflation Reduction Act. You can even pay that cap in monthly installments if needed.

Yes, slightly. The standard Part B premium will increase to $185/month, with a deductible of $257. These are modest but important increases to account for inflation and service expansion.

Mostly stable. While premiums are expected to stay the same or drop slightly, some plans are cutting back on extra perks like dental or fitness benefits. Always review your plan details during open enrollment.

CMS raised compensation caps for Medicare Advantage sign-ups in 2025. This should reduce inconsistent commissions and help ensure agents focus more on helping you find the right plan—not just the one that pays the most.

Yes. As part of the Inflation Reduction Act, Medicare is now negotiating prices on select high-cost medications. This is expected to lower prices for common name-brand prescriptions and save billions in taxpayer money over time.

Lawmakers are working to close loopholes that allow Medicare Advantage plans to bill for veteran care while VA still pays—possibly redirecting $44 billion. Also, there’s political pressure to push more people into Advantage plans and reduce premium assistance. Stay alert during election cycles.

Medigap is private insurance that fills the “gaps” left by Original Medicare (Parts A & B), such as deductibles, coinsurance, and copayments. Plans are standardized (Plan A–N) and automatically renew each year as long as you pay your premium—even if your health changes.

Medicare Advantage is a private insurance alternative to Original Medicare. It combines Parts A and B, often includes Part D (prescriptions), and may offer extras like dental, vision, and gym memberships. You’ll use a network of providers and have different rules than traditional Medicare.

No. You must choose one or the other. If you enroll in a Medicare Advantage plan, it is illegal for someone to sell you a Medigap policy. If you want to switch back to Original Medicare and add a Medigap plan, you may need to pass medical underwriting unless you're in a protected enrollment window.

Medicare Advantage plans may look attractive, but they come with trade-offs: Limited networks – You may not be able to see your preferred doctors or specialists. Prior authorizations – Many procedures require insurer approval, which can delay or deny care. Annual plan changes – Benefits, premiums, and networks can change every year without much notice. Hidden costs – While the premiums may be low, copays and out-of-pocket costs can add up quickly if you need care. Keep these facts in mind; again, the price may be attractive, but many times, you'll be left with a bill because it wasn't covered.

Medicare Advantage plans often include extras not covered by Original Medicare, such as dental, vision, hearing, transportation, and wellness programs. Some plans have premiums as low as $0/month, and all have an annual out-of-pocket maximum to limit your total expenses.

Medigap offers predictable, stable coverage with no networks—you can see any doctor or hospital that accepts Medicare nationwide. There are no prior authorizations required for procedures, and plans don’t change annually. You pay your premium, and you’re covered.

In 2025, Medicare Advantage plan premiums average around $17/month, with many options as low as $0/month. Medigap plans—especially Plan G—can range from $65 to $450/month depending on your age, location, and the insurer.

Focus on what matters most to you: cost, doctor access, and predictability. Medigap offers freedom and consistency; Medicare Advantage offers extras but has rules, networks, and changes year to year. One isn’t “better”—it depends on your needs.

Use the Medicare Plan Finder at medicare.gov/plan-compare. Check: Your doctors are in-network Your prescriptions are covered (and affordable) Out-of-pocket maximum fits your budget Extra benefits (like dental or vision) are useful to you

All Medigap plans are standardized by law. Plan G from one company is the same as Plan G from another—only the monthly premium and service differ. Compare quotes from multiple insurers and check reviews for customer service and rate stability.

Yes—but they work differently: Medicare Advantage can change benefits, premiums, and provider networks every year. Medigap plans don’t change coverage, but premiums can increase over time due to age or inflation. Some companies raise rates more than others—check their track record.

You can: Use medicare.gov to compare plans directly Call your local State Health Insurance Assistance Program (SHIP) for free counseling Work with a licensed, independent Medicare agent—just be sure they show you multiple plan options, not just one company

Most people pay $0/month for Part A if they worked and paid Medicare taxes for at least 10 years. In 2025, the hospital deductible is around $1,632 per benefit period. These numbers can change each year—always check Medicare.gov for the latest.

In 2025, the standard monthly premium for Part B is around $185. The annual deductible is about $257. Higher-income individuals may pay more based on their tax return. These are **estimates**—actual costs depend on your situation.

Some Medicare Advantage plans have premiums as low as $0/month, but that doesn’t mean free. You still pay your Part B premium and may have copays, coinsurance, or higher costs for out-of-network care. Plans vary widely by zip code and provider.

Medigap plans vary by provider, location, age, and health. As a rough example, a 65-year-old may pay between $110–$250/month for Plan G. These are estimates—always compare quotes from multiple insurers.

In 2025, drug costs are capped at $2,000 per year under any Part D plan. Most people pay around $20–$40/month for their plan, plus copays at the pharmacy. Plans and pricing vary based on your medications.

Medicare doesn’t have “gotcha” fees, but costs can add up if you need care. Common surprises include: Copays for doctor visits or tests Hospital stays longer than 60 days Out-of-network charges in Advantage plans Part B excess charges (rare, but possible) Understanding your plan upfront helps avoid surprises.

Yes. You may qualify for programs like: Medicare Savings Programs – helps pay Part A & B premiums Extra Help – helps with Part D drug costs Medicaid – covers additional expenses for those with limited income Apply through your state Medicaid office or ssa.gov.