Got Medicare Questions? 10 Straightforward Answers You Need to Know

Navigating Medicare can feel like learning a new language. Between the different parts, enrollment timelines, coverage rules, and cost structures, it’s no wonder many people, especially those turning 65, have questions. And with your health and financial well-being on the line, getting clear, trustworthy answers is essential.

This guide breaks down 10 of the most common Medicare questions. Whether you're preparing to enroll or helping a loved one, these insights can help you make confident, informed decisions about your coverage.

1. When Should I Enroll in Medicare?

Your Initial Enrollment Period (IEP) is your first window to sign up for Medicare. It begins three months before you turn 65, includes your birthday month, and continues for three months after.

If you miss this window, you could face late enrollment penalties, including higher premiums for the rest of your life. That’s why it’s important to understand your timeline.

If you have other coverage (like through an employer), you may qualify for a Special Enrollment Period (SEP) when that coverage ends or if you experience qualifying life events.

2. What’s the Difference Between Original Medicare and Medicare Advantage?

Medicare offers two main pathways for coverage:

• Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). You can visit any provider that accepts Medicare. Prescription drug coverage (Part D) and supplemental insurance (Medigap) must be added separately.

• Medicare Advantage (Part C) is a bundled plan from private insurers. These plans include Parts A and B, and often Part D, plus extras like vision, hearing, dental, and fitness benefits. They usually require you to use a network of providers.

Original Medicare offers broader provider access, while Medicare Advantage can offer more affordable out-of-pocket costs and extra perks. The right fit depends on your health needs, financial situation, and lifestyle.

3. Does Medicare Cover Prescription Drugs?

Prescription coverage isn’t automatically included in Original Medicare, but that’s where Part D comes in. You can enroll in a stand-alone Part D plan to help cover the cost of prescription medications.

If you choose a Medicare Advantage plan, drug coverage is often bundled in, but be sure to check the plan’s formulary to ensure your medications are covered. Plan drug lists can vary significantly, so reviewing your medications annually is essential.

4. How Much Does Medicare Cost?

Medicare is not free. Here's a breakdown of common costs:

• Part A: Free if you worked and paid Medicare taxes for at least 10 years. Otherwise, premiums can apply.

• Part B: Standard premium is set annually (in 2025, it's $174.70/month). Higher earners may pay more under the Income-Related Monthly Adjustment Amount (IRMAA).

• Part D: Premiums vary by plan and income, and include deductibles and copays.

You’ll also face deductibles and coinsurance for services under Part A and Part B. Knowing your projected usage can help you estimate total costs more accurately.

5. What Does Medicare Not Cover?

While Medicare covers many healthcare needs, some services fall outside its scope:

• Long-term care (such as nursing home custodial care)

• Routine dental, vision, and hearing

• Cosmetic procedures

• Routine foot care

If these services are important to you, consider Medicare Advantage plans that include these extras, or explore separate dental and vision plans.

6. Can I Delay Medicare If I’m Still Working?

Yes—if you or your spouse has creditable employer coverage, you can delay enrolling in Medicare without a penalty. However, the employer must have 20 or more employees for the coverage to count.

When your employer coverage ends, you’ll have an 8-month Special Enrollment Period to sign up for Medicare.

Transitioning from employer insurance to Medicare can be tricky, especially when coordinating with retiree benefits or COBRA. Speaking with a licensed advisor can help ensure you don’t miss deadlines or pay unnecessary penalties.

7. How Do I Get Help Paying for Medicare?

If your income is limited, help is available:

• Medicare Savings Programs (MSPs): Help pay for premiums, deductibles, and copayments.

• Extra Help: Assists with prescription drug costs under Part D.

• Medicaid: If you qualify for both Medicare and Medicaid (dual eligibility), you may pay little or nothing for your healthcare.

You can also reach out to SHIP (State Health Insurance Assistance Program) for free, unbiased counseling.

8. Can I Have Medicare and Medicaid at the Same Time?

Yes—this is called dual eligibility. If you meet the income and asset criteria for Medicaid and are also eligible for Medicare, the two programs can work together to cover most of your healthcare costs.

Benefits of dual eligibility include:

• Lower or no premiums

• Reduced prescription drug costs

• Coverage for services not included in Medicare (like long-term care)

Dual-eligible individuals often qualify for Special Needs Plans (SNPs) designed specifically for them.

9. What Are Medicare Supplemental (Medigap) Plans?

Medigap is private insurance that works alongside Original Medicare to cover out-of-pocket costs, like coinsurance, deductibles, and copayments.

Unlike Medicare Advantage, you can only buy Medigap if you have Original Medicare, not if you're enrolled in a Medicare Advantage plan.

Medigap plans are standardized by letter (e.g., Plan G, Plan N), so benefits are the same no matter which insurer you choose. Premiums, however, may vary. These plans can provide predictable costs and peace of mind, especially if you use healthcare services frequently.

10. Where Can I Get Trusted Medicare Advice?

With so many options and rules, it’s smart to get help, but not just from anyone. Rely on trusted sources like:

• Medicare.gov: The official U.S. government website for Medicare information.

• SHIP: Offers personalized help in every state.

• Licensed Brokers: Can walk you through your options based on your location, health needs, and budget.

At Unified Health, we specialize in helping Medicare-eligible individuals compare plans, understand benefits, and make confident decisions. Our licensed agents offer free, personalized consultations to help you find the plan that fits your lifestyle, without the stress.

Recap and Next Steps

Key Takeaways:

• Medicare has multiple parts and plan options, each with specific rules, costs, and coverage.

• Your enrollment timing matters; missing deadlines can lead to penalties.

• You may qualify for financial assistance, dual coverage with Medicaid, or extra benefits through Medicare Advantage.

• Support is available to help you make sense of it all.

Next Steps:

• Review your upcoming Medicare eligibility.

• Compare options across Original Medicare, Medicare Advantage, Part D, and Medigap.

• Contact Unified Health for a free consultation and support in finding the best plan for your needs and budget.

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