Medicare FAQ: Common Questions Answered | James Hughes

Question 1

When can I first enroll in Medicare?

Accepted Answer

Your Initial Enrollment Period (IEP) is a 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. Enrolling during the first 3 months ensures your coverage starts on time and helps you avoid late-enrollment penalties.

Question 2

What is the Annual Enrollment Period (AEP)?

Accepted Answer

The Annual Enrollment Period runs October 15 – December 7 each year. During this window you can switch Medicare Advantage plans, switch from Original Medicare to Medicare Advantage (or vice versa), and join, switch, or drop a Part D drug plan. Changes take effect January 1 of the following year.

Question 3

What is a Special Enrollment Period?

Accepted Answer

A Special Enrollment Period (SEP) lets you make changes to your Medicare coverage outside of standard enrollment windows when a qualifying life event occurs — such as losing employer coverage, moving to a new service area, or your plan leaving Medicare. SEPs are time-sensitive, so it's important to act quickly.

Question 4

What happens if I miss my enrollment window?

Accepted Answer

If you don't enroll in Part B when first eligible and don't have other qualifying coverage, you may face a permanent late-enrollment penalty — your monthly premium increases 10% for each full 12-month period you were eligible but didn't enroll. Part D has a similar penalty. Enrolling on time is one of the most important steps you can take.

Question 5

I'm still working at 65. Do I need to enroll in Medicare?

Accepted Answer

It depends on the size of your employer. If your employer has 20 or more employees, your group plan is primary and you can delay Medicare Part B without penalty. If your employer has fewer than 20 employees, Medicare becomes primary and you should enroll to avoid gaps in coverage. Always check with your HR department and a licensed broker before deciding.

Question 6

What is the difference between Original Medicare and Medicare Advantage?

Accepted Answer

Original Medicare (Parts A & B) is the federal program that covers hospital and medical services. You can see any doctor who accepts Medicare nationwide. Medicare Advantage (Part C) is offered by private insurers approved by Medicare — it bundles Parts A and B (and usually Part D) into one plan, often with extra benefits like dental and vision, but typically uses a network of providers.

Question 7

What is a Medicare Supplement (Medigap) plan?

Accepted Answer

A Medicare Supplement plan, also called Medigap, works alongside Original Medicare to cover costs Medicare doesn't pay — like copays, coinsurance, and deductibles. You keep your Original Medicare card and use your Medigap plan to cover the gaps. Medigap plans are standardized by letter (Plan G, Plan N, etc.) so benefits are the same regardless of which insurer you choose.

Question 8

What does Part D cover?

Accepted Answer

Medicare Part D covers prescription drugs. It is offered through private insurance companies approved by Medicare. Each plan has a formulary (list of covered drugs), and costs vary by plan and medication. If you have Original Medicare with a Medigap plan, you'll need a standalone Part D plan. Medicare Advantage plans usually include drug coverage.

Question 9

How do I know which plan is right for me?

Accepted Answer

The right plan depends on your health needs, budget, preferred doctors, and prescription medications. There is no one-size-fits-all answer. That's exactly why James offers free, no-obligation consultations — to walk through your specific situation and help you compare options side by side before you decide.

Question 10

How much does Medicare Part B cost?

Accepted Answer

The standard Part B premium in 2024 is $174.70 per month, though higher-income beneficiaries pay more through an Income-Related Monthly Adjustment Amount (IRMAA). Part B also has an annual deductible ($240 in 2024), after which Medicare pays 80% of approved costs and you pay the remaining 20%.

Question 11

Are Medicare Advantage plans really free?

Accepted Answer

Some Medicare Advantage plans have $0 monthly premiums, but you still pay your Part B premium. You may also have copays, coinsurance, and out-of-pocket costs when you use services. It's important to look beyond the premium and understand the full cost structure — including the plan's annual out-of-pocket maximum — before enrolling.

Question 12

Does Medicare cover dental and vision?

Accepted Answer

Original Medicare generally does not cover routine dental, vision, or hearing. Some Medicare Advantage plans include these benefits as extras. If you have Original Medicare with a Medigap plan, you would need separate dental and vision coverage. James can help you find a plan that includes the benefits most important to you.

Question 13

What is IRMAA?

Accepted Answer

IRMAA stands for Income-Related Monthly Adjustment Amount. If your income reported to the IRS two years ago exceeds certain thresholds, you'll pay a higher Part B and Part D premium. IRMAA is recalculated each year based on your tax return. If your income has dropped significantly due to a life event (retirement, divorce, death of spouse), you can appeal to have it recalculated.

Medicare FAQ

Enrollment Periods

Plan Differences

Costs & Coverage

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