Medicare Questions Answered

Medicare is federal health insurance for people age 65 or older and for certain younger people with disabilities, End-Stage Renal Disease, or ALS.

Some people qualify after receiving Social Security Disability Insurance for the required period. People with ALS or End-Stage Renal Disease may qualify under separate rules.

Some people receiving Social Security or Railroad Retirement benefits before age 65 are enrolled automatically. Others must actively apply through Social Security.

Part A is hospital insurance. Part B is medical insurance. Part C is Medicare Advantage. Part D is outpatient prescription drug coverage.

Original Medicare is Part A and Part B administered by the federal government. You may add a standalone Part D plan and a Medicare Supplement policy.

Most people who want complete Medicare medical coverage enroll in both. Part B is also generally required for Medicare Advantage and Medicare Supplement coverage.

No. Medicare is individual coverage. Each spouse must qualify and enroll separately.

With Original Medicare, you may generally use providers nationwide who accept Medicare. Medicare Advantage plans may have provider networks, so check each doctor and facility before enrolling.

It generally starts three months before the month you turn 65, includes your birthday month, and ends three months afterward.

Your effective date depends on when you enroll and whether you qualify for automatic enrollment or a Special Enrollment Period.

You may be able to delay Part B without penalty when you have qualifying group health coverage based on your or your spouse’s current employment. Employer size and employment status matter.

You may qualify for an eight-month Special Enrollment Period for Part B. Medicare Advantage and Part D enrollment windows are generally shorter, so coordinate all effective dates carefully.

COBRA generally does not count as current-employment coverage for the Part B Special Enrollment Period. Do not rely on COBRA to extend your Part B deadline.

You can keep it, but Marketplace premium tax credits generally end once you are eligible for premium-free Part A. Marketplace coverage does not usually protect you from Medicare late-enrollment penalties.

The General Enrollment Period runs January 1 through March 31 each year for people who missed earlier Part A or Part B enrollment opportunities.

October 15 through December 7 is the Annual Enrollment Period. You can change Medicare Advantage or Part D coverage for January 1.

January 1 through March 31, people already enrolled in Medicare Advantage can switch to another Medicare Advantage plan or return to Original Medicare and add Part D.

A Special Enrollment Period is a limited opportunity to change coverage after a qualifying event such as moving, losing coverage, gaining Medicaid, or entering an institution.

Most people pay no Part A premium. The standard Part B premium is $202.90 per month in 2026, and the Part B deductible is $283. Other costs depend on coverage and services.

The Part A inpatient hospital deductible is $1,736 per benefit period in 2026. More than one benefit period can occur in a year.

No. Original Medicare by itself does not have an annual maximum out-of-pocket limit. Medigap or Medicare Advantage can provide additional protection.

The penalty is generally 10% of the standard Part B premium for each full 12-month period you could have had Part B but did not. It usually continues as long as you have Part B.

It may apply after 63 consecutive days without Part D or other creditable prescription coverage. The amount is based on the number of uncovered months and the national base beneficiary premium.

IRMAA is an income-related surcharge added to Part B and Part D for certain higher-income beneficiaries. Social Security generally uses tax information from two years earlier.

Yes. You may request a new determination after certain life-changing events, including retirement, marriage, divorce, death of a spouse, or loss of income-producing property.

Medicare Savings Programs may help with premiums and cost sharing. Extra Help can reduce Part D costs. Eligibility is based on state and federal rules.

Medicare Advantage, or Part C, is a private Medicare-approved plan that provides Part A and Part B benefits. Most plans include Part D prescription coverage.

Yes. You remain enrolled in Medicare Parts A and B, continue paying the Part B premium, and receive covered services through the plan.

Yes. Some plans have a $0 additional premium, but you still pay the Part B premium and applicable copays, coinsurance, and deductibles.

Yes. Each plan has an annual limit for covered Part A and Part B services. Prescription drug costs and some supplemental benefits generally do not count toward it.

HMOs usually require network providers except for emergencies and urgent care. PPOs generally allow out-of-network care at a higher cost, subject to plan rules.

Many plans require prior authorization for selected services, equipment, procedures, rehabilitation, or medications.

Many plans offer these extra benefits, but coverage limits, networks, allowances, frequency, and prior authorization vary.

Emergency and urgent care are covered in the United States. Routine care away from home depends on the plan’s network and travel benefits.

Yes, during permitted enrollment periods. Always recheck doctors, hospitals, medications, premiums, copays, and extra benefits.

Medicare Supplement, also called Medigap, works with Original Medicare and helps pay selected deductibles, coinsurance, and copays.

Your federal Medigap Open Enrollment Period lasts six months beginning when you are age 65 or older and enrolled in Part B.

Outside open enrollment or guaranteed-issue protections, medical underwriting may apply depending on state law and circumstances.

No. Modern Medigap policies do not include outpatient prescription coverage. Most beneficiaries add a standalone Part D plan.

Plan G covers most standardized gaps in Original Medicare, including the Part A deductible and Part B coinsurance. You pay the annual Part B deductible.

Plan N may have a lower premium but can include office and emergency-room copays and does not cover Part B excess charges.

You pay eligible Medicare cost sharing until reaching the annual high deductible. After that, the plan provides standard Plan G benefits for the rest of the year.

No. Medigap is designed to work with Original Medicare and does not pay Medicare Advantage copays or deductibles.

You may generally use any provider nationwide who accepts Medicare. The policy does not use a traditional provider network.

Part D is optional, but delaying without creditable drug coverage may cause a lifelong penalty and leave you without coverage when medication needs change.

Check the plan formulary for the exact medication, dosage, tier, pharmacy network, and restrictions such as prior authorization or step therapy.

Extra Help is a federal program that can reduce Part D premiums, deductibles, copays, and the late-enrollment penalty for eligible people.

Yes. Formularies, pharmacy networks, premiums, deductibles, and medication costs can change annually, so review coverage every fall.

It means the plan must approve coverage before paying for the prescription. Your prescriber can submit medical information or request an exception.

It allows eligible Part D out-of-pocket costs to be spread across the calendar year. It changes when you pay, not the total amount owed.

Yes. People with both are called dual eligible. Medicare generally pays first, and Medicaid may help with premiums, cost sharing, and additional services.

A Dual Eligible Special Needs Plan is a Medicare Advantage plan designed for people with Medicare and qualifying Medicaid.

A Medicare Savings Program may pay the Part B premium when eligibility requirements are met.