Medicare Frequently Asked Questions

Medicare is a federal health insurance program established to provide medical coverage for individuals age 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. It is administered by the Centers for Medicare & Medicaid Services (CMS) and funded primarily through payroll taxes, premiums, and federal revenues. 

Most people qualify at age 65 if they’re U.S. citizens or legal residents who’ve lived in the U.S. for at least five years. Some under 65 qualify due to disability, ALS, or end-stage renal disease 

You are only automatically enrolled in Medicare if you are already receiving Social Security benefits. Otherwise, you must enroll yourself — and if you miss your window, you could face penalties. 

Medicare Part A - Hospital Insurance

Covers inpatient hospital stays, skilled nursing facility care, hospice, and limited home health services.

• Most people pay no monthly premium for Part A if they paid Medicare taxes while working. 
• In 2025, the Part A deductible is $1,676 per benefit period.

Medicare Part B - Medical Insurance

Covers outpatient care, doctor visits, preventive services, durable medical equipment, and some home health care.

• Most beneficiaries pay a monthly premium (standard amount in 2025 is $174.70). 
• Includes an annual deductible and 20% coinsurance for most services.

Medicare Part C - Medicare Advantage

An alternative to Original Medicare, these plans are offered by private insurance companies approved by Medicare. They must cover everything Original Medicare covers and may include:

• Prescription drug coverage 
• Vision, dental, and hearing benefits 
• Wellness and fitness programs

You must have Parts A and B to enroll in a Medicare Advantage Plan.
 

Medicare Part D - Prescription Drug Coverage

 Helps cover the cost of prescription drugs, including many recommended vaccines. Plans are offered by private insurers and can be added to Original Medicare or included in some Medicare Advantage Plans.

Costs vary by plan and may include:

• Monthly premium 
• Annual deductible 
• Copayments or coinsurance  

Timing matters. These are the key Medicare enrollment periods:

• Initial Enrollment Period (IEP): Begins 3 months before your 65th birthday and ends 3 months after. 
• General Enrollment Period (GEP): January 1 – March 31 (coverage starts July 1) 
• Annual Enrollment Period (AEP): October 15 – December 7 (for making coverage changes) 
• Special Enrollment Periods (SEPs): For life events like losing employer coverage

Please visit www.ourseniorjourney.com for our comprehensive overview of Medicare, Medicare Supplement and Prescription Drug Plans. Everything you need to know plus checklists, guides and resource material can be found on this site. 

False. Most people do not pay a premium for Part A (hospital insurance), but Part B (doctor visits and outpatient care) and Part D (prescription drugs) come with monthly premiums. You may also have deductibles, copays, and coinsurance. 

False.  Medicare does NOT cover routine dental, vision, hearing aids, long-term care, or custodial care. You will need additional coverage or pay out-of-pocket for these. 

You are only automatically enrolled in Medicare if you are already receiving Social Security benefits. Otherwise, you must enroll yourself — and if you miss your window, you could face penalties. 

False. If you do not enroll in Part B or Part D during your Initial Enrollment Period (unless you have other credible coverage), you could face lifetime late enrollment penalties. 

False.  Medicare Advantage (Part C) is an alternative to Original Medicare, offered by private insurers. It often includes extra benefits, but has different networks, rules, and costs. It is not the same plan run by Medicare. 

False.   Plans and drug formularies change every year — and so do your health needs. Reviewing your plan annually can save money and improve coverage. 

It depends on the size of your employer. If you work for a small employer (<20 employees), you may need to enroll in Medicare as your primary insurance — otherwise, you may face coverage gaps or penalties.

False.  You can make changes every year during the Annual Enrollment Period (Oct 15–Dec 7) or during special enrollment periods. You are not locked in forever. 

False.   They are very different. Medigap (Medicare Supplement) works with Original Medicare to cover out-of-pocket costs. Medicare Advantageis a replacement for Original Medicare with its own rules and networks.

False.   You are eligible for Medicare at age 65, whether you are still working or not. You can also qualify earlier if you have certain disabilities or end-stage renal disease.