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Medicare Parts A&B Basics

Medicare Frequently Asked Questions

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Medicare options vary enormously from state to state. Medicare Advantage, Medicare Part D and Medicare Supplement plans are regulated differently in every state. Every state has a different selection of available Medicare carriers, networks of hospitals, doctors and pharmacies, as well as licensed insurance agents.

Your Medicare Options: Original Medicare vs. Medicare Advantage

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. The two primary ways are Original Medicare and Medicare Advantage. Choose your state to find Medicare plans and the best Medicare agents near you.

Original Medicare Includes:
But… You May Have to Buy:
  • Original Medicare can be expensive!
    You pay 20% coinsurance of the Medicare-approved amounts. There’s no limit to your out-of-pocket costs.
  • Drug coverage is NOT included with Original Medicare.
    This creates a big coverage gap for most. If you want drug coverage with Original Medicare, you will have to buy a separate Medicare drug plan (Part D).
  • Unlimited out-of-pocket expenses on fixed-income budget is difficult.
    You may be able to buy a Medicare Supplemental plan to save money.
  • Choice of Doctors and Hospitals.
    As long as they accept Medicare, you can select any doctor or hospital with Original Medicare.
Medicare Advantage Bundles:
Added Value. Most Plans Include:

What are the Different Medicare Eligibility Deadlines and Enrollment Dates?

If you’re planning to enroll in Medicare, there are 4 important Medicare enrollment periods when you a either: (1) Enroll in, or (2) Change your Medicare Plan.

When is my Initial Medicare Enrollment Period?
Your initial Medicare enrollment period is a 7-month window around your 65th birthday. Your Medicare IEP begins 3 months before your 65th birthday, includes the month of your 65th birthday, and continues 3 months after your 65th birthday.

Medicare AEP Open Enrollment

When can I switch from Original Medicare to an Advantage Plan? Medicare Annual Enrollment Period (AEP)
Medicare’s “open enrollment” period (AEP) opens and closes at exactly the same time every year: October 15 to December 7. During Medicare’s AEP, you can switch from Original Medicare to a Medicare Advantage plan; switch from a Medicare Advantage plan and return to Original Medicare; or you and add, removed or change your Part D (Medicare prescription drug plan).

What if I missed my Medicare Initial Enrollment Period? General Enrollment Period
If you missed your Initial Enrollment Period, Medicare’s General Enrollment Period opens every year between January 1 and March 31. The General Enrollment Period allows you to sign up for Medicare in case you missed your Initial Enrollment Period.

How can I make changes to my Medicare Plan outside of AEP?
Medicare’s Special Enrollment Period (SEP) allows enrollees to make changes to their Medicare plan due to special circumstances such as moving or losing your insurance cover, outside of the normal Annual Enrollment Period (AEP) or Initial Enrollment Period. There are different types of SEPs, including Dually-Eligible beneficiaries and individuals who had a plan that terminated. Sometimes the government will create SEPs following a federal emergency/disaster such as COVID-19 and hurricanes.

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