Medicare Common FAQs

Navigating Medicare can be complex, and it’s natural to have many questions. Below are answers to some of the most frequently asked questions about Medicare:

1. What is Medicare?

   Medicare is a federal health insurance program primarily for individuals aged 65 and older, but it also covers certain younger people with disabilities and those with End-Stage Renal Disease. It consists of different parts that cover specific services:

   • Part A: Hospital Insurance
   • Part B: Medical Insurance
   • Part C: Medicare Advantage Plans
   • Part D: Prescription Drug Coverage

2. How do I enroll in Medicare?

   If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Parts A and B when you turn 65. If not, you need to sign up during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after. You can enroll through the Social Security Administration’s website or by visiting your local Social Security office.

3. What does Medicare cover?

   • Part A: Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
   • Part B: Covers outpatient care, preventive services, ambulance services, and durable medical equipment.
   • Part C (Medicare Advantage): Offers all Part A and Part B benefits through private insurers and may include additional services like vision, dental, and hearing.
   • Part D: Provides prescription drug coverage.

4. How much does Medicare cost?

   • Part A: Most people don’t pay a premium if they have at least 10 years of Medicare-covered employment. Otherwise, premiums can be up to $506 per month in 2025.
   • Part B: The standard premium is $185.00 per month in 2025, with an annual deductible of $257.
   • Part C and Part D: Costs vary by plan and provider.

5. What is the difference between Original Medicare and Medicare Advantage?

   • Original Medicare: Includes Part A and Part B, allowing you to visit any doctor or hospital that accepts Medicare. It doesn’t cover prescription drugs, so you may need a separate Part D plan.
   • Medicare Advantage (Part C): Offered by private companies, these plans provide Part A and Part B coverage and often include Part D, along with additional benefits like vision and dental.

6. Do I need a Medicare Supplement (Medigap) policy?

   Medigap policies help cover out-of-pocket costs not paid by Original Medicare, such as copayments and deductibles. If you have Original Medicare and want help with these costs, a Medigap policy might be beneficial. However, you cannot have both a Medigap policy and a Medicare Advantage Plan.

7. When can I change my Medicare coverage?

   The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can switch between Original Medicare and Medicare Advantage, change Part D plans, or make other coverage changes.

8. What if I work past age 65?

   If you have health coverage through your employer, you may delay enrolling in Part B without penalty. Once your employment or coverage ends, you’ll have a Special Enrollment Period to sign up for Part B.

9. Does Medicare cover prescription drugs?

   Original Medicare doesn’t cover most prescription drugs. To get this coverage, you can enroll in a standalone Part D plan or choose a Medicare Advantage Plan that includes drug coverage.

10. Are dental, vision, and hearing services covered?

    Original Medicare generally doesn’t cover routine dental, vision, or hearing services. Some Medicare Advantage Plans offer these benefits.

11. What is the Medicare Part D coverage gap (donut hole)?

    The coverage gap refers to a temporary limit on what the drug plan will cover for prescription drugs. In 2025, out-of-pocket spending for covered Part D drugs will be capped at $2,000, effectively closing the coverage gap.

12. How do I report Medicare fraud?

    To report suspected Medicare fraud, call 1-800-HHS-TIPS (1-800-447-8477).

13. Can I get help with Medicare costs?

    Yes, programs like Medicaid, Medicare Savings Programs, and Extra Help can assist with premiums and other costs for those who qualify based on income and resources.

14. What is the difference between Medicare and Medicaid?

    Medicare is a federal program providing health coverage primarily for people 65 and older or with certain disabilities, regardless of income. Medicaid is a state and federal program offering health coverage to individuals and families with low income and resources.

15. How do I replace a lost Medicare card?

    You can request a replacement card by logging into your Social Security account online or by calling the Social Security Administration at 1-800-772-1213.

16. Does Medicare cover long-term care?

    Medicare doesn’t cover custodial long-term care, such as assistance with daily living activities. It may cover short-term skilled nursing facility care under specific conditions.

17. What preventive services does Medicare cover?

    Medicare Part B covers various preventive services, including screenings, vaccines, and annual wellness visits, to help prevent or detect illnesses early.

18. How does Medicare handle emergency care abroad?

    In general, Medicare doesn’t cover medical care outside the U.S. Some Medigap policies and Medicare Advantage Plans may offer limited emergency coverage abroad.