Medicare Facts & FAQs

Medicare is a government funded health insurance program designed to serve people over the age of 65 and younger individuals with disabilities, or End Stage Renal Disease.

Medicare helps with a portion of the costs associated with hospitalization, doctors visits, medical equipment and prescriptions drugs₁. “Traditional Medicare”, as it is sometimes called, generally pays 80% of covered services₁. Medicare Beneficiaries (people who are entitled to, and enrolled in Medicare) are generally responsible for the remaining 20%.

There are options to help cover the Medicare beneficiary's portion of Medicare covered expenses (the 20% co-insurance as it's often referred to). Talk to a Local Medicare Specialist to learn more about how Medicare Advantage, Medicare Supplements and Prescription Drug Plans can help reduce out of pocket expenses.

Medicare Advantage plans are an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans combine Part A (hospital), Part B (medical), and usually Part D (prescription drugs) into a single plan.

Most Medicare Advantage plans have a $0 or low monthly premium and offer extra benefits like dental, vision, and hearing that Original Medicare doesn't cover. Plans vary by carrier and county — a local Medicare plan specialist can help you compare what's available in your area.

Traditional Medicare (Part A & B) covers 80% of “medically necessary” hospitalization and medical care expenses. This leaves 20% to be paid out of pocket by the Medicare Beneficiary (you).

Medicare Supplement plans work alongside Original Medicare (Parts A & B) — they help pay the 20% that Original Medicare doesn't cover, including copays, coinsurance, and deductibles. Unlike Medicare Advantage, Medigap plans typically allow you to see any doctor that accepts Medicare, anywhere in the country. The most popular plans are Plan G and Plan N.

There are many options available for Medicare Supplements, and each one has unique features covering different types of medical expenses. It's important to discuss your options with one of our Local Medicare Specialists to find the best supplement for your needs.

This is one of the most important decisions a Medicare beneficiary makes. Medicare Advantage plans typically have lower or $0 premiums but require you to use a network of doctors and may have copays for services. Medicare Supplement plans have higher monthly premiums but offer more predictable costs and broader access to providers.

The right choice depends on your health situation, your preferred doctors, your prescription needs, and your budget. A local Medicare plan specialist can walk you through both options side by side.

This is a very common question, and one that is extremely important. There are 4 different parts to Medicare, and depending which parts you qualify for, you're entitled to the coverage under those.

So what does each part cover? We always recommend speaking to one of our experienced Local Medicare Specialists for more in depth information—however, here's a quick rundown:

Part A – covers hospitalization, skilled nursing facilities (post hospitalization), hospice care and some home health services₂.

Part B– covers medically necessary “medical expenses”. This includes doctor's services, outpatient care, preventative care and medical equipment₂.

Part C – is an agreement between Medicare and a private insurance company (contracted with Medicare), to administer Part A, B and often Part D on behalf of the government. This is also called Medicare Advantage.

Part D – covers the cost of some prescription drugs* and is also administered by private insurance companies.

Talk to a Local Medicare Specialist to learn more about how Medicare Advantage, Medicare Supplements and Prescription Drug Plans can help reduce out of pocket expenses.

Medicare Part D plans help cover the cost of prescription drugs. They are offered by private insurance companies approved by Medicare. If you have Original Medicare without a Medicare Advantage plan that includes drug coverage, you'll need a standalone Part D plan to get prescription drug coverage.

Missing your Part D enrollment window can result in a lifetime penalty added to your premium, so timing matters. Talk to a Local Medicare Specialist to find a plan that covers your specific medications.

Choosing the right moment to enroll in, or enquire about Medicare options often leaves people a little confused. We suggest consulting with one of our agents, as they'll look at the entirety of your situation and can assist in timing. However, there are a few options for jumping in:

MILESTONE BIRTHDAYS
Turning 65 means that you're now eligible for Medicare. However, it's important to weigh all of your options, and all future variables before making a decision.

OPEN ENROLLMENT
Every year from Jan 1 to Mar 31, beneficiaries get the chance to reevaluate their coverage, and make the switch to a new plan.

ENROLLMENT FOR PART C & D
From Oct 15 to Dec 7, beneficiaries have the opportunity for specific Medicare and drug plan changes.

UPGRADES
During open enrollment periods, beneficiaries can reevaluate and upgrade certain coverage.

If you or your spouse are still working and covered by an employer health plan, you may be able to delay Medicare enrollment without penalty. However, the rules vary depending on the size of your employer.

It's important to understand how your employer coverage coordinates with Medicare before making any decisions — enrolling at the wrong time can result in gaps in coverage or late enrollment penalties. A Local Medicare Specialist can help you navigate this.

Yes and no. There are instances when a Medicare Beneficiary is entitled to a guaranteed issuance of a Medicare Supplement. However, there are times when enrollment in a supplement is subject to “underwriting”. This is the process of answering questions about health conditions and circumstances.

Medicare Advantage, Medicare Supplement, and Part D plans are all administered by private insurance companies that are approved and regulated by Medicare. These companies must follow Medicare's rules but can vary in their premiums, networks, and extra benefits.

Because plans differ by carrier and by county, it's important to compare options available specifically in your area. Local Medicare Specialists partners only with agents who know the local plans and providers — so you get advice that's actually relevant to where you live.