Frequently Asked Questions

Medicare is a federal health insurance program for individuals that are 65 and older or have been on disability for more than 24 months. 

Medicare has four parts: Part A (hospital coverage), Part B (medical coverage), Part C (Medicare Advantage), and Part D (drug coverage). We will cover Part D before Part C as it will ultimately make things easier to understand. 

Part A covers hospital, skilled nursing, hospice, and home health care. If you’ve worked and paid into social security for at least 10 years, your enrollment into Part A will likely be automatic and take effect the first day of the month of your 65th birthday. 

Almost all hospitals in the United States accept Part A (exceptions are Veterans Affairs hospitals, active military hospitals, and a few others although they’re very rare). Part A does not have a monthly premium for the vast majority of Medicare beneficiaries. 

Part B covers medically necessary services like doctors, outpatient care, home health services, and more. Part B also covers some preventive services. Part B can be delayed past age 65 if you have work insurance or are eligible to be covered under a spouse’s work insurance (but it may be more economical to enroll in Part B as soon as you are able, even if you do still qualify for work insurance). 

Roughly 93% of doctors accept Part B, which means Medicare is the largest doctor network in the United States. The standard monthly Part B premium in 2024 starts at $174.70 a month but can increase depending on your income.

If you are still employed, you can enroll into Part B by completing the Part B enrollment form (CMS 40B) and having your employer fill out the Request for Employment Information Form (CMS-L564), which then both get sent to Social Security. 

Part A and Part B, together, comprise “original Medicare,” which is the base level of coverage offered by Medicare when you enroll in and elect to have Medicare become your primary insurance. Because Part A covers only 80% of hospital expenses and Part B covers only 80% of medical expenses, many Medicare beneficiaries purchase a “Medicare supplement,” also known as a “Medigap” policy, to cover the remaining 20% of costs not covered by original Medicare.

Original Medicare on its own has high deductibles, copays, and coinsurances among other miscellaneous “out of pocket” costs that represent the 20% of costs original Medicare does not cover. Medicare supplements/Medigap policies (same thing) are designed to cover all or some of these costs for an additional monthly premium. Below is a chart that outlines the 20% “gap” of costs original Medicare does not cover and how each of the roughly 10 Medicare supplement plans cover those costs: 

These plans are “standardized,” which means they have these things in common:

• Coverage. Every “Plan G,” for instance, covers the same out of pocket costs at the same percentage regardless of the insurance company that provides it. 
• Claims. All Medicare supplement plans will pay on any claim as long as that claim is approved by Medicare. 
• Network. Because these are Medicare “supplement” plans, they tag along and work with any hospital or doctor that accepts your primary insurance, which is Medicare. 
• Guaranteed renewability. As long as you continue to pay the monthly premium, your policy will never cancel or no longer be offered because of a certain claim or “pre-existing condition.”

If supplement plans are identical between carriers based on the plan letter, pay on all claims approved by Medicare, are accepted by all of the same doctors, and can’t be taken away from you because of your health, in what meaningful way do they differ? 

Just one: price. That’s where our team at Medicare Complete shines – we navigate the market with a sophisticated quoting engine that shows the most competitive supplement rates based on the four criteria insurance companies are allowed to use to determine your rate: age, gender, zip code, and tobacco usage. 

Part D is prescription drug coverage. It is offered to everyone with Medicare Parts A and/or B. This can be obtained by purchasing a stand-alone prescription drug plan (PDP) alongside a Medicare supplement plan, or by enrolling in a Medicare Advantage plan with prescription drug coverage (MAPD). We can help you sign up for Part D through Medicare approved private insurance companies.

Part C is known as “Medicare Advantage” and is optional. Although Medicare Advantage is not technically a replacement of your Medicare coverage, it functions as an alternative to traditional Medicare. 

By enrolling into a Medicare Advantage plan, you agree to allow a private insurance company to manage your Medicare benefits in exchange for reduced cost shares at the hospital/doctor and other benefits such as vision, dental, gym membership, and more that are not included in original Medicare. Most Medicare Advantage plans also build in drug coverage, removing the need for a stand-alone prescription drug plan.

Unlike original Medicare, Medicare Advantage plans tend to have a smaller network and sometimes require preauthorizations for certain services. Unlike Medicare supplement plans, there are over 4,000 Medicare Advantage plans nationwide and the benefits are not standardized.

Medicare Disability is offered to those who are under 65 who have been receiving Social Security Disability Income for 24 consecutive months or have been diagnosed with ESRD or ALS. Medicare Disability is the same as Original Medicare, but the secondary plans available to you may be slightly different compared to those 65 and older.

People who receive both Medicare and Medicaid are known as “Dual-Eligible”. People with Dual Eligible status can be offered additional secondary options such as D-SNP (Dual Eligible Special Needs Plans) depending on their locations. Dual Eligible plans often provide benefits Original Medicare does not, such as Care Coordinators, OTC Cards, and more.

There are many different enrollment periods for joining Medicare initially, or for switching Medicare secondary plans. Here are a few of the biggest ones: 

Initial Enrollment Period

Your Initial Enrollment Period is when you can first take Medicare Parts A and B and a secondary plan. This is typically due to turning 65, or going onto Medicare Disability. The Initial Enrollment Period may also be coupled with the Medicare supplement Open Enrollment period, which allows you to enroll in just about any Medicare secondary plan available in your area regardless of your health and pre-existing conditions. 

Medicare Annual Enrollment Period

This period is from October 15th to December 7th every year. During this time, you can evaluate your health and financial needs and decide what Medicare plans you would like to have in the upcoming calendar year. What plans you can switch to and what plans require health questions for enrollment often depends on your state and zip code. 

Special Enrollment Periods

Special Enrollment Periods are designed to help you join Medicare initially or switch Medicare options if you are affected by major life events. Some common Special Enrollment Periods (SEPs) include moving, leaving or losing work insurance, losing Medicaid, and more. Each Special Enrollment Period has a unique time window and options for changing your Medicare coverage.