Let’s be honest—Medicare can be confusing. Original Medicare, Advantage plans, Medigap, prescription drug coverage... it’s a lot to take in, especially when you’re trying to make the right decision for your health and finances.

Whether you're getting close to age 65 or helping a loved one navigate the system, here are answers to the Medicare questions we hear most often from our clients.

1. When can I sign up for Medicare?

You’re eligible for Medicare when you turn 65—unless you already qualify through disability.

There’s a 7-month Initial Enrollment Period (IEP):

• Starts 3 months before your 65th birthday

• Includes your birth month

• Ends 3 months after your birthday

Kevin’s Advice: Even if you’re still working and have insurance, it’s worth checking your options. Timing matters—miss your window and you could face penalties.

2. What’s the difference between Medicare Parts A, B, C, and D?

Here’s the breakdown—plain and simple:

• Part A = Hospital insurance (inpatient care, skilled nursing, hospice)

• Part B = Medical insurance (doctor visits, outpatient care, preventive services)

• Part C = Medicare Advantage (bundled alternative to A & B, often includes D)

• Part D = Prescription drug coverage

Kevin’s Tip: If you want the most flexibility and don’t mind paying more out-of-pocket for better coverage, Original Medicare + Medigap + Part D might be your path. If you prefer lower premiums and "one card" simplicity, look at Medicare Advantage plans.

3. What does Medicare cost?

• Part A: Usually free if you (or your spouse) paid into Medicare for 10+ years

• Part B: Standard premium is $174.70/month in 2024 (higher if your income is higher)

• Part C (Advantage plans): Varies—some plans have $0 premiums, but watch for copays

• Part D: Also varies by plan; higher-income earners may pay more

• Medigap (Supplemental insurance): Depends on your state, age, and plan type

Heads up: Medicare doesn’t cover everything. You’ll still have deductibles, coinsurance, and gaps unless you get a supplement or Advantage plan.

4. Do I need to sign up for Medicare if I’m still working?

It depends on your employer coverage:

• If your company has fewer than 20 employees: Yes, you should enroll in Parts A and B when you turn 65—Medicare becomes your primary insurance.

• If your company has 20+ employees: You can delay Part B without penalty and keep your employer plan. Still worth checking if Medicare would give you better value.

5. What if I miss my enrollment window?

You could face late enrollment penalties, especially for Part B and Part D. And the longer you wait, the bigger the penalty gets.

• Part B penalty: 10% for each full 12-month period you were eligible but didn’t enroll

• Part D penalty: 1% of the national base premium for each uncovered month

Kevin’s Rule: When in doubt, enroll during your IEP. If you're delaying for good reason (like credible employer coverage), make sure you have proof to avoid penalties later.

6. What does Medicare not cover?

A lot of folks are surprised by what isn’t covered:

• Long-term care (nursing homes)

• Dental, vision, and hearing (unless you have a Medicare Advantage plan that includes them)

• Routine foot care

• Most alternative therapies (acupuncture, massage, etc.)

• Overseas medical care (except in specific Medigap plans)

7. What’s the difference between Medicare Advantage and Medigap?

When deciding between Medicare Advantage (Part C) and a Medigap (Supplement) plan, understanding the key differences can help you make the best choice for your healthcare needs.

Medicare Advantage plans combine Parts A and B—and often Part D—into one plan and typically operate through local HMO or PPO networks. These plans often come with lower monthly premiums, sometimes even $0, but you'll usually pay copays and deductibles for services.

Many Medicare Advantage plans also offer added benefits like dental, vision, and gym memberships. In contrast, Medigap plans are designed to supplement Original Medicare by covering many out-of-pocket costs such as copayments, coinsurance, and deductibles.

While Medigap usually has a higher monthly premium, it offers greater flexibility by allowing you to see any doctor who accepts Medicare nationwide. However, it doesn’t include extra perks—coverage is strictly medical.

8. Can I change my Medicare plan later?

Yes, during Medicare Open Enrollment:

October 15 – December 7 each year.

During this time, you can:

• Switch between Original Medicare and Medicare Advantage

• Change Part D plans

• Drop a plan altogether

There’s also a Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31), but it’s more limited.

9. Will I need a prescription drug plan?

If you’re on Original Medicare, yes—you should enroll in a Part D plan, even if you don’t take medications now.

Otherwise, you may face a late enrollment penalty if you sign up later.

If you have Medicare Advantage, check whether drug coverage is included in the plan.

10. What if I need help choosing a plan?

There are great resources to guide you:

• Medicare.gov: The official source for plan comparisons

• State Health Insurance Assistance Program (SHIP): Free 1-on-1 guidance

• Trusted advisors: Like our team—we help clients compare options based on health, lifestyle, and finances

Kevin’s Advice: Don’t guess. Make your decision based on real numbers and your actual needs—not just a slick postcard in the mail.

Final Thought: Don’t Wait to Get This Right

Medicare is a huge part of your retirement puzzle. The wrong plan can cost you—financially and medically. But with a little education and the right help, you can find a plan that fits like a glove.

If you still have questions or want help reviewing your Medicare options alongside your full retirement plan, let’s connect. This stuff doesn’t have to be overwhelming.