It is common to have many Medicare-related questions running through your mind at any given time. However, finding the answer to these Medicare questions may prove to be harder than expected.
In this article, we have compiled a list of the top 25 most frequently asked Medicare questions that our clients are asking our Medicare experts.
While browsing the list of questions and answers below, it is our hope that you find this list helpful to answering your most common Medicare questions and maybe even answer some questions you didn’t know you had.
Top 25 Medicare Questions in 2022:
The following are the top 25 most asked questions by you – our clients- to our licensed Medicare agents. These questions are listed in no particular order.
- Who is Eligible for Medicare?
- Will I automatically be enrolled in Medicare when I turn 65?
- Do I need to enroll in Medicare if I work past 65?
- Is Medicare Supplement and Medicare Advantage the same thing?
- I delayed Medicare at 65, how do I enroll now?
- How much does Medicare cost?
- Can I enroll in Medicare Advantage and Medigap?
- Do I need to renew Medicare every year?
- What happens to my Medicare plans when I move?
- What is the Medicare deductible?
- Does Medicare cover prescription medications?
- How do I change my address with Medicare?
- What if I lose my Medicare Card?
- Does Medicare cover dentures?
- Will Medicare cover hearing-aids?
- Do I need Medicare if I have VA benefits?
- Can Medicare drop you for health reasons?
- What do I do if I cannot afford my Medicare premiums?
- What is the difference between Medicare HMO and Medicare PPO?
- Does Medicare have a network?
- Am I required to enroll in Medicare?
- Will Medicare cover all my medical bills?
- Can I change my Medicare Part D Plan?
- I enrolled in Medicare Advantage and want a Medigap plan, how can I switch plans?
- Do Medicare benefits change each year?
To be eligible for Original Medicare, you must be an American citizen for at least five years AND one of the following:
- Age 65 or older
- Under age 65 and receiving Social Security Disability Income for 24 months
- Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis
To enroll in Original Medicare, you may be required to reach out to your local Social Security office in some circumstances.
You will automatically be enrolled in Medicare at age 65 if you are receiving Social Security benefits or railroad retirement board benefits at least four months before you enroll in Medicare.
However, if you are not receiving Social Security benefits or railroad retirement board benefits, you will need to contact your local Social Security office to enroll in Medicare up to three months before your 65th birth month.
If you must contact your local Social Security office, you can sign up for Part A and Part B at the same time. Once you complete the application and provide the required documentation, you will begin receiving benefits on the first day of your 65th birth month.
To complete the application, you can do so online, in person, or over the phone.
While it is not mandatory, it is recommended to enroll in Medicare Part A coverage as soon as you become eligible if you qualify for premium-free Part A coverage. However, if you delay Medicare Part A, you will be able to enroll later during the General Enrollment Period or a Special Enrollment Period if you qualify. But, if you dealy enrollment to the General Enrollment period, you will be required to pay late enrollment penalties.
If your employer offers creditable health coverage, you do not need to enroll in Medicare Part B if you are working past age 65. Creditable coverage is healthcare coverage that provides at least equal benefits to Original Medicare. If you do not have creditable coverage and you do not enroll in Medicare Part B when you first become eligible, you could be required to pay the Medicare Part B late enrollment penalty as long as you are enrolled in Medicare Part B.
Keep in mind, even if you have creditable coverage, it is important to compare your current plan to Original Medicare with a Medigap plan and Part D. Often, combining these Medicare plans will provide you with the most comprehensive coverage possible.
Medicare Supplement plans and Medicare Advantage plans are not the same thing. While both Medicare Supplement and Medicare Advantage plans bring additional benefits to Original Medicare, they work very differently.Medicare Supplement plans, also known as Medigap plans, work as a secondary to Original Medicare (Medicare Part A and Part B). The plan will only pay after Original Medicare has paid their portion. These plans have no networks, no restrictions, and no referrals to see specialists.
Medicare Advantage plans, also known as Medicare Part C, on the other hand, become your primary coverage over Original Medicare. They often require you to follow a strict network of doctors and have higher out of pocket costs. However, they often provide additional benefits.
These additional benefits provided by Medicare Advantage plans often include dental, vision, hearing, and prescription drug coverage as well as transportation assistance and gym memberships. However, not every plan or every carrier are required to offer these additional benefits.
If you delayed Medicare coverage past age 65 with creditable coverage, you will need to contact Social Security to enroll in Original Medicare.
Since you have creditable coverage, you will receive a Special Enrollment Period to enroll in Medicare Part A and Medicare Part B benefits. From there, you can enroll in a Medicare Part D prescription drug plan and Medicare Part C or Medicare Supplement.
However, if you delayed Medicare coverage without creditable coverage, you would need to enroll in Original Medicare during the General Enrollment Period. This is an annual period that runs from January 1 to March 31 each year. Keep in mind, coverage does not begin until June 1 when you enroll during the General Enrollment Period.
For most, the Medicare Part A premium is $0 per month. However, if you do not qualify for zero-premium Part A, the premium can be as high as $499. To qualify for zero premium, you must have worked at least 40 quarters or 10 years paying Medicare taxes. If you did not meet this qualification, you will be required to pay the Medicare part A premium.
The standard Medicare Part B premium in 2022 is $170.10. This can increase based on income. This difference in premium reflects your Income Related Monthly Adjustment Amount (IRMAA).
For example, if you and your spouse make $230,000 combined you will each pay $340.20 per month for Medicare Part B. If you are subject to IRMAA, you will receive a determination letter with your new monthly premium.
|2020 annual income: Individual||2020 annual income: Filing Jointly||2020 annual income: Filing separately||Medicare Part B Premium 2022|
|$0 – $91,000||$0 – $182,000||$0 – $91,000||$170.10|
|$91,001 – $114,000||$182,001 – $228,000||–||$238.10|
|$114,001 – $170,000||$228,001 – $284,000||–||$340.20|
|$142,001 – $170,000||$284,001 – $340,000||–||$442.30|
|$170,001 – $500,000||$340,001 – $750,000||$91,001- $409,000||$544.30|
|> $500,001 +||$750,001 +||$409,001 +||$587.30|
It is illegal to enroll in both a Medicare Supplement plan and a Medicare Advantage plan. If you were to enroll in both plans, neither plan would be recognized as primary coverage which would lead to denial of services. This could leave you paying out-of-pocket for all your healthcare services, regardless of having both coverages.
To avoid this, it is illegal for an agent to enroll you in one plan if you are already enrolled in the other and do not have a valid way out of the plan.
Original Medicare coverage is automatically renewable each year you are eligible. Thus, you do not need to renew your Medicare parts each year.
Medicare Supplement plans work the same way, once you are accepted, the plan is automatically renewable as long as you continue to pay the monthly premium.
Medicare Advantage plans work similarly. However, you have the option to change your plan each year if you do not like the benefits of your current plan.
If you move to a new city or state, you will need to change your address with Social Security.
Because Original Medicare is a federal program, benefits are the same nationwide. So, your benefits will not change.
However, if you are enrolled in a Medicare Supplement or Medicare Advantage plan, you may be required to choose a new plan or pay a higher (or lower) monthly premium. If you are in the process of moving, our Medicare agents will be able to help you easily find a new top-rated plan in your area.
Medicare Part A and Medicare Part B have deductibles and costs that change annually.
In 2022, the Medicare Part A per occurrence deductible is $1,556 and the Medicare Part B annual deductible is $233.
These deductibles must be met before the respective Medicare Part will cover its portion of the services you receive. The Medicare Part A deductible is per occurrence, meaning you could pay that cost multiple times in one year. The Medicare Part B deductible on the other hand is annual. Thus, you will only pay it once per calendar year.
Medicare Part C plans often have an annual deductible that can be different for each plan. You will need to review your plans information to find your annual deductible. Lastly, Medicare Part D plans have an annual deductible as well. In 2022, the maximum deductible is $480. However, each plan can set their own deductible.
Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription Medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, some Medicare Advantage plans provide prescription drug coverage as well.
If you do not enroll in Medicare Part D, you may be subject to the Medicare part D late enrollment penalty. This penalty is assessed for those who delay Part D benefits without creditable coverage. You will be required to pay the additional premium cost for as long as you are enrolled in Medicare Part D.
To change your address with Medicare, you must contact your local Social Security office and verify your identity. From there, they can change your address on file by answering a few simple questions and providing supporting documentation.
If you have multiple addresses, you must provide your permanent residence. This is determined by where you spend the majority of your time throughout the year.
If your Medicare card is lost or stolen it is important to report the missing card to Social Security as soon as possible.
To report a lost or stolen card and request a replacement, you can log into (or create) a MyMedicare account through Medicare.gov. From there you can print a temporary replacement card.
To receive a new card in the mail, you will need to contact Medicare at 1-800-633-4227.
Original Medicare does not offer coverage for dentures.
However, some Medicare Advantage plans may provide this benefit.
If you would rather enroll in a Medicare Supplement plan or stick to Original Medicare, you can always enroll in a separate dental plan that offers coverage for dentures.
These plans are designed to work with Medicare to create full-circle benefits for you.
Original Medicare does not offer coverage for hearing-aids.
However, some Medicare Advantage plans may provide this benefit. CMS does not deem hearing-aids medically necessary, so they are not covered by the federal healthcare program.
If you need hearing coverage but do not want to enroll in a Medicare Advantage plan, there are several options. You can enroll in a stand-alone benefits plan that has the option for hearing coverage to work alongside your Medicare plan.
It is not required for you to enroll in Medicare if you have VA benefits. However, if you ever receive coverage outside of the VA system, you will need medical coverage to cover these costs.
Keep in mind. If you have VA coverage and delay Medicare Part B enrollment, you will have to pay the Medicare Part B penalty if you decide to enroll in Medicare coverage later in life. Once you enroll in Medicare, it pays primary, and the VA pays secondary.
Original Medicare, Medicare Advantage, and Medicare Supplement plans are NOT able to drop you based on your health status.
Original Medicare, Medicare Advantage, Medicare Part D, and Medicare Supplement plans are guaranteed renewable as long as you continue to pay the monthly premiums.
Keep in mind, if you want to change plans, there may be restrictions or roadblocks due to health. Medicare Supplement plans can deny your application based on pre-existing conditions. Medicare Part D and Medicare Advantage plans do not review your health history. However, you can only apply during certain times of the year.
If you cannot afford your Medicare premiums, there are several assistance programs available to help cover these costs.
First, you should visit your local Medicaid office to see if you qualify. If so, Medicaid will cover your monthly premiums and provide you with extra benefits.
Additionally, there are several Medicare Savings Plans available to help cover low-income earners. These plans help pay your Medicare premiums and out-of-pocket costs.
Medicare HMO and PPO plans are Medicare Advantage plans.
HMO plans are the most restrictive with tight networks and require referrals to see specialists. PPO plans are more lenient and have a wider network of doctors and hospitals you can utilize. HMO plans typically cost less than PPO plans.
However, both types of plans have restrictions and guidelines you must follow to receive care.
Original Medicare does not have a typical network of doctors and hospitals. Rather, doctors and hospitals can opt-in or opt-out of accepting Medicare. In 2022, close to 93% of doctors and hospitals nationwide accept Medicare.
When you enroll in a Medicare Advantage plan, you will have to follow the network of doctors who accept your plan. This is one of the downsides of enrolling in an Advantage plan. You lose the freedom to fully choose your care team.
However, with a Medicare Supplement plan, you will be able to see any doctor nationwide. This is a bonus if you travel often or have dual residency.
Enrolling in Medicare coverage is not mandatory. So, you are not required to have the coverage at any point. However, if you delay Medicare enrollment without creditable coverage, you may be required to pay late enrollment penalties that do not go away. Thus, it is often more cost effective in the long run to enroll in Medicare coverage when you are first eligible.
Medicare Part A is typically zero-premium for those who qualify and delaying Medicare Part B can end in a large penalty if you do not have creditable coverage. The Medicare Part B penalty adds 10% to the base premium for each 12-month period you go without coverage.
Original Medicare does not cover 100% of your medical costs once you enroll in coverage. Medicare Part A requires you to pay a per occurrence deductible and copayments. Then, Medicare Part B requires an annual deductible and a coinsurance of 20%.
If you wish to be covered fully, you will need to enroll in a Medicare Supplement plan to help cover these gaps in coverage left by Original Medicare. By doing so, you will reduce your out-of-pocket spending with Medicare.
If you are enrolled in Medicare Part D, you have the opportunity once per year to enroll in a new plan during the Annual Enrollment Period each fall.
Medicare Part D plans do not require you to answer health questions, so you can enroll in any plan you wish during this enrollment period. Keep in mind, any changes made to your Medicare Part D plan during the Annual Enrollment Period go into effect on January 1 of the following year.
Each year, Medicare Part D plan formularies change to reflect the needs of the majority consumer. This means that your plan may change the way it covers your specific drugs and your copayments and deductibles may change each year.
So, even if you are satisfied with your benefits, it is important to review the changes for the upcoming year and ensure that your drugs will still be adequately covered.
If you have a Medicare Advantage plan and wish to switch to a Medicare Supplement plan you may have to wait until the Annual Enrollment Period to do so.
Unlike Medicare Supplement plans, Medicare Advantage plans require you to enroll for one year unless you have a life changing event that would allow you to leave the plan early. This means that you cannot change plans whenever you wish throughout the year. With an exception of your first year on Medicare, Medicare Advantage plans are a 12 month term lasting from January to December.
To change your plan for the upcoming year, you will need to enroll during the Annual Enrollment Period. By doing so, you must to answer underwriting health questions to enroll in a Medicare Supplement plan. This means that your application for coverage may be denied depending on your answers to the health questions.
Original Medicare benefits do not change each year. However, the premiums, deductibles, and covered services may change each year.
New prices are generally released in October and reflect changes for the upcoming year. Also, if there is a change in covered services, you will receive notice in advance that Medicare will no longer provide coverage.
Medicare Advantage plan benefits do change on a yearly basis. Thus, it is important to review the changes for your plan each year during the Annual Enrollment Period. During this time, you do have the option to change your plan if you do not like the new changes for the year.
Any changes made during this enrollment period will be effective on January 1 of the upcoming year.
Medicare Supplement plans do not typically change on a yearly basis. However, the deductible and premium costs may differ each year.
How to Find Answers to All Your Medicare Questions
If you have additional Medicare questions that are not mentioned on the list, or if you are ready to review Medicare plans in your area, contact us at the number above. Our licensed agents are Medicare experts who are dedicated to helping you find the right Medicare plan for your budget and healthcare needs.
Can’t call now? No problem! Complete our online rate form to review your side-by-side Medicare plan comparison today!
Enter your zip code to pull plan options available in your area.
Select which Medicare plans you would like to compare in your area.
Compare rates side by side with plans & carriers available in your area.
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Supplements & other insurance, Medicare. Accessed June 2022.
- Find a Medigap policy that works for you, Medicare. Accessed June 2022.
- Medicare Supplement Insurance, Medicare. Accessed June 2022.
- When can I buy Medigap, Medicare. Accessed June 2022.
- How to compare Medigap policies, Medicare. Accessed June 2022.