Medicare FAQ
Find answers to common Medicare questions. Browse by topic or search for specific information about enrollment, costs, coverage, and more.
Quick Answer
This page answers the most common Medicare questions in plain English — how enrollment periods work, what Parts A, B, C, and D cover, what Medicare costs in 2026, and how to get help. Browse the topics below, or jump to the most-asked questions for quick answers.
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Keeping Your Doctor with Medicare
Yes, you can keep your doctor with Medicare, but how depends on your coverage choice. With Original Medicare plus Medigap, you can see any doctor who accepts Medicare nationwide. With Medicare Advantage, you'll need to choose a plan that includes your doctor in its network.
Read full answerMedicare Advantage vs. Medigap
Medicare Advantage (Part C) replaces Original Medicare with an all-in-one plan that often includes extra benefits but limits you to a network. Medicare Supplement (Medigap) works with Original Medicare to cover your cost-sharing while letting you see any doctor who accepts Medicare. The right choice depends on your priorities.
Read full answerMedicare Plan Change Periods
Most people can change Medicare plans during the Annual Enrollment Period (October 15 - December 7). If you have Medicare Advantage, you can also switch during the Medicare Advantage Open Enrollment Period (January 1 - March 31). Special circumstances may qualify you for a Special Enrollment Period at other times.
Read full answerMedicare Advantage Explained
Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits through a private insurance company. These plans include all the coverage of Original Medicare (Parts A and B) plus usually include prescription drugs (Part D) and extra benefits like dental, vision, and hearing. The trade-off is that most plans limit you to a network of providers.
Read full answerMedicare Prescription Drug Coverage
Original Medicare (Parts A and B) does not cover most outpatient prescription drugs. You need Part D coverage for prescriptions, either through a standalone Part D plan with Original Medicare or through a Medicare Advantage plan that includes drug coverage (Part C with Part D). Without Part D, you pay the full cost of your medications.
Read full answerMedicare Late Enrollment Penalties
Medicare charges permanent late enrollment penalties if you don't sign up when first eligible and don't have qualifying coverage. Part B penalties add 10% to your premium for every 12-month period you delayed. Part D penalties add 1% for every month without creditable drug coverage. These penalties last for life.
Read full answerWhat Medicare Covers
Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient services, preventive care, and medical equipment. Medicare does not cover most dental, vision, hearing, or long-term care—you need additional coverage for these services.
Read full answerChoosing a Medicare Plan
Choosing a Medicare plan starts with understanding your priorities: Do you value provider freedom or lower premiums? Do you need extra benefits like dental and vision? Make a list of your current doctors and medications, then compare how different plans cover them. Consider your health status, budget, and how often you travel.
Read full answerMedicare for Snowbirds
Snowbirds who split time between Florida and northern states need to understand how their Medicare coverage works in both locations. Medicare Supplement (Medigap) works with any Medicare provider nationwide—ideal for dual-residence lifestyle. Medicare Advantage plans have networks that may not cover routine care in your second location.
Read full answerMedicare and Employer Coverage
If you have employer coverage when you turn 65, you may be able to delay Medicare enrollment. Whether you should depends on your employer's size and your specific coverage. With employers of 20+ employees, your employer coverage is primary. With smaller employers, Medicare becomes primary at 65—making enrollment important.
Read full answerWhat Is Medigap (Medicare Supplement)?
Medigap, also called Medicare Supplement, is private insurance that helps pay the out-of-pocket costs Original Medicare doesn't cover—deductibles, coinsurance, and copays. Medigap plans are standardized (Plans A-N), work with any Medicare-accepting doctor nationwide, and have predictable monthly premiums instead of per-service costs.
Read full answerWhat Is Medicare Part D?
Medicare Part D is prescription drug coverage available through private insurance plans approved by Medicare. If you have Original Medicare, you need a standalone Part D plan for drug coverage. Part D covers outpatient prescriptions with premiums, deductibles, and copays that vary by plan and medication.
Read full answerHow Do I Lower My Medicare Costs?
Lower Medicare costs by checking eligibility for Extra Help (saves $5,000+/year on drugs) and Medicare Savings Programs (pay your Part B premium). Review your plan annually—many people save $50-200/month switching plans. Use generics, preferred pharmacies, and mail order for additional savings.
Read full answerWhat Happens When I Turn 65?
At 65, you become eligible for Medicare. Your Initial Enrollment Period (IEP) starts 3 months before your birthday month and lasts 7 months total. During this window, you enroll in Parts A, B, and D, and choose between Original Medicare with Medigap or Medicare Advantage. Missing deadlines can result in permanent penalties.
Read full answerWhat Is Medicare Open Enrollment?
Medicare Open Enrollment refers to periods when you can enroll in or change Medicare coverage. The main period is Annual Enrollment (October 15 - December 7), when anyone can switch plans. Medicare Advantage Open Enrollment (January 1 - March 31) allows MA enrollees to make one additional change. Changes take effect January 1.
Read full answerDoes Medicare Cover Dental, Vision, and Hearing?
Original Medicare (Parts A and B) does not cover routine dental care, vision care, or hearing aids. These are significant coverage gaps for many seniors. Medicare Advantage plans often include dental, vision, and hearing benefits as extras. You can also purchase separate standalone coverage.
Read full answerShould I Review My Medicare Plan Every Year?
Yes. Medicare plans change every year—premiums, copays, drug formularies, and provider networks can all change. Even if you're happy with your current plan, the best option this year might be different. Many people save $50-200 per month by switching to a better-fitting plan during Annual Enrollment.
Read full answerDo I Need Medicare If I'm Still Working?
It depends on your employer's size. With employers of 20+ employees, your employer coverage remains primary and you can delay Medicare without penalty. With employers under 20, Medicare becomes primary at 65—you should generally enroll. COBRA doesn't count as current employment coverage.
Read full answerWhat Is the Difference Between Medicare and Medicaid?
Medicare is federal health insurance primarily for people 65+ or with certain disabilities, funded through payroll taxes and premiums. Medicaid is a joint federal-state program providing healthcare to people with limited income and resources. Eligibility and benefits differ significantly, though some people qualify for both.
Read full answerCan a Medicare Advisor Help Me Compare Plans?
Yes, licensed Medicare advisors can help you compare all available plans at no cost to you. We check your doctors' network status, calculate prescription costs under each plan, explain the differences, and recommend options based on your specific situation. Advisors are paid by insurance companies, not by you.
Read full answerPopular Medicare Questions
Does Medicare cover dental?
Original Medicare (Parts A and B) does not cover routine dental care like cleanings, fillings, or dentures. Many Medicare Advantage plans include a dental benefit, and you can also buy a standalone dental plan. Original Medicare may cover dental only when it is part of a covered medical procedure.
What is the Medicare donut hole?
The donut hole was a coverage gap in Part D where you paid more for drugs after reaching an initial spending limit. Starting in 2025, a $2,000 annual cap on out-of-pocket drug costs effectively eliminated the donut hole for most people — once you hit the cap, you pay nothing more for covered drugs that year.
Can I have Medicare and employer insurance?
Yes. You can have both, and which pays first depends on the employer’s size. If the employer has 20 or more employees, the group plan usually pays first; with fewer than 20, Medicare usually pays first. If you have creditable employer coverage, you may be able to delay Part B without penalty.
What is a Medicare Advantage HMO vs PPO?
Both are Medicare Advantage plan types. An HMO usually requires you to use in-network providers and get referrals to see specialists. A PPO lets you see out-of-network providers at a higher cost and generally does not require referrals.
How do I appeal a Medicare denial?
If Medicare or your plan denies coverage, you have the right to appeal, and the denial notice explains how. There are five levels of appeal, and many denials are overturned — especially with supporting documentation from your doctor. Act quickly, since each level has a deadline.
What does Medicare Part B cover?
Part B is medical insurance. It covers doctor visits, outpatient care, preventive services, lab tests, durable medical equipment, mental health care, and some home health. It has a monthly premium and an annual deductible, after which you typically pay 20% coinsurance.
Is Medicare free at 65?
No. Most people get premium-free Part A because they paid Medicare taxes while working, but Part B has a monthly premium ($202.90 in 2026), plus deductibles and coinsurance. Part D and Medigap plans have their own premiums.
What is IRMAA Medicare?
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to your Part B and Part D premiums if your income is above set thresholds. It is based on your tax return from two years earlier and is recalculated each year.
Can I change my Medicare plan anytime?
Generally no. Most changes happen during the Annual Enrollment Period (October 15 – December 7) or, for current Medicare Advantage members, the Open Enrollment Period (January 1 – March 31). A Special Enrollment Period may let you change after a qualifying life event.
What is Medicare Supplement Plan N?
Plan N is a standardized Medigap plan with somewhat lower premiums than Plan G. It covers most out-of-pocket costs, but you pay small copays for some office and emergency-room visits, and it does not cover Part B excess charges or the Part B deductible.
Does Medicare cover hearing aids?
Original Medicare does not cover hearing aids or routine hearing exams. Many Medicare Advantage plans include a hearing benefit that helps with exams and hearing aids, though coverage limits vary by plan.
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) lets you sign up for or change Medicare coverage outside the normal windows after a qualifying event, such as losing employer coverage, moving, or qualifying for Extra Help. Each SEP has its own deadline.
How does Medicare work with VA benefits?
Medicare and VA benefits are separate systems that do not coordinate like other insurance. You use VA benefits at VA facilities and Medicare for civilian providers. Most veterans keep Part B so they have coverage outside the VA, since the VA generally does not pay for non-VA care.
What is Extra Help for Medicare Part D?
Extra Help is a federal program that lowers Part D prescription drug costs — premiums, deductibles, and copays — for people with limited income and resources. Qualifying for Medicaid or a Medicare Savings Program enrolls you in Extra Help automatically.
What states does HealthPlan Connect serve?
HealthPlan Connect serves Florida, Texas, Arizona, Georgia, North Carolina, South Carolina, Pennsylvania, Ohio, Tennessee, and Virginia, with licensed advisors who know each local market.
How do I find a Medicare advisor near me?
You can request a free review with a licensed HealthPlan Connect advisor online or by phone, and we match you with an advisor licensed in your state. A good advisor compares plans across carriers, checks that your doctors and drugs are covered, and is paid by the carriers — not by you.
What is the difference between Part C and Part D?
Part C is Medicare Advantage — an all-in-one alternative to Original Medicare offered by private insurers, which usually includes drug coverage. Part D is standalone prescription drug coverage that you add to Original Medicare.
When can I switch from Medicare Advantage to Medigap?
You can drop Medicare Advantage during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period. But buying Medigap afterward is only guaranteed during your one-time Medigap open enrollment window; outside it, insurers in most states can use medical underwriting.
What is a Medicare MSA plan?
A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that pairs a high-deductible health plan with a savings account that Medicare funds. You use the account to pay for care until you meet the deductible.
How much does Medicare Part B cost in 2026?
The standard Part B premium is $202.90 per month in 2026, with a $283 annual deductible. Higher-income beneficiaries pay more through IRMAA.
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