Medicare Frequently Asked QUestions

We have been working with Medicare Beneficiaries for over 10 years and helped 25,000+ Medicare Beneficiaries across the country with their Medicare Planning Needs and Questions.  We wanted to gather some of the most common questions we have heard and provide some answers so we can help even more people.  The information below is broken down into categories of questions that we hear frequently.

​DISCLAIMER: This is not meant to be an all-encompassing list of every Medicare question for every situation. Additionally, it is highly recommended that you speak with one of our advisors before taking any actions (or not taking any actions) with your Medicare decisions.

Categories of Frequently asked medicare questions

When to Enroll

If I am turning 65, do I have to enroll in Medicare if I am still working and covered by my employer's plan?
  • Answer: It depends on the number of employees at your company. 
    • If there are less than 20 employees at your company, then you will need to sign-up for Medicare Part A (Hospital) and Part B (Medical) coverages because Medicare will be your primary insurance when you become Medicare eligible.  In this case, if you don't sign up for Medicare Part A and Part B and remain on the Group Insurance Plan, the Insurance Carrier doesn't have to pay the first portion of your claims (e.g. 80%) which leaves you heavily exposed for Medical costs.
    • If there are 20 or more employees at your company, then the Group Health Plan will continue to be your primary payer.  In this situation, it is up to the individual whether they stay on the Group Health Plan or enroll in Medicare. Another factor to consider in this situation is that you can no longer contribute to a Health Savings Account (HSA) if you are enrolled in Medicare Part A.  So, you may not want to enroll in Part A even if it is premium free if you are continuing to stay covered on the Group Health Plan in this scenario.  If you would like help with a comparison of Coverage & Costs between the Group Health Plan and Medicare, you can give Senior Advisors a call and we would be happy to assist with this comparison for you.  You can also watch our short video that explains working past age 65 with Medicare.

If I am turning 65 and covered by my Spouse's Employer's Plan, do I have to enroll in Medicare?
  • Answer: It depends on the number of employees at your Spouse's company.  The same Medicare Secondary Payer rules apply as mentioned in the question above, based on the number of employees at the company that is providing the Group Health Insurance (e.g. Spouse's company, in this case). 

​If I am turning 65 and covered on an Individual Health Insurance Plan (e.g. ACA/Obamacare Plan), do I have to enroll in Medicare or can I keep my plan?
  • Answer: When you become Medicare-eligible, you are no longer able to be enrolled in the Individual pre-65 Health Plan. So, you will need to enroll in Medicare Parts A & B when you become eligible for Medicare. 

How to Enroll

Someone told me that I will be automatically enrolled in Medicare at age 65.  Is this true?
  • ​Answer:
    • If you are enrolled in Social Security benefits prior to age 65, you will be automatically enrolled in Medicare Part A & Part B, and the government will mail you a Medicare ID Card about 3-months before your 65th birthday.  Your effective date will be the 1st of the month you turn 65 (unless you are born on the 1 day of the month in which case your effective date will be the 1st of the month prior).  In this example, if you have other Group Health Insurance that you would prefer to keep, you can call the government to remove the Part B coverage and they will send a new Medicare Card with just Part A.  You cannot cancel the Part A coverage if you are taking Social Security Benefits.
    • If you are not enrolled in Social Security benefits prior to age 65, you will NOT be automatically enrolled in Medicare.

If I am not signed up for Medicare at age 65, what happens when I enroll in Social Security benefits at a future date (e.g. age 66)?
  • Answer: In this example, if you enroll in Social Security benefits (and not Medicare), you will be automatically enrolled in Medicare Part A, and the Part A effective date will be back-dated up to 6-months.  This is important if you are still working and are contributing to a Health Savings Account (HSA), because you are no longer able to contribute to an HSA after you are enrolled in Medicare Part A.  Any HSA contributions would be considered excess contributions which could be taxed and penalized.

If I am not enrolled in Social Security benefits, and I do want to enroll in Medicare at age 65, how do I enroll?
  • Answer: The simplest way to enroll in this situation is directly online at the Social Security website.  You can use the following link and it should only take about 5-10 minutes.  https://ssa.gov/benefits/medicare. Another option would be to call Social Security to enroll in Medicare, 1-800-772-1213 but you could have wait times as long as 1 hour or more depending on the time of year.​

​If I am enrolling in Medicare Part B for the first time after my Initial Enrollment Period (age 65), how do I enroll to avoid any penalties or delays in my Medicare coverage?
  • Answer: There are a couple of different ways to enroll in this scenario.  With either option, you need to show proof that you were covered on the Group Health Plan since you were age 65 to avoid any penalties or delays in your Part B coverage.
    • ​Option 1 - you can submit the Part B enrollment online using the web portal that the government released in May of 2020.  This option will require you to upload a document showing proof of coverage (e.g. a copy of your Group Health insurance ID card). Note, if you and your spouse are enrolling after age 65, you will need to submit the Online forms for each of you.
    • Option 2 - you can complete the Enrollment in Part B form and your employer (or spouse's employer if you are covered on your Spouse's company plan) needs to complete the Employment Information form. After these two forms are complete, you can fax them or mail them to your local Social Security office for processing. Note, if you and your spouse are enrolling after age 65, you will need both forms for each of you.​

Medicare costs

How much is Medicare going to cost me?
  • Answer: It depends on a number of factors (age, income, sex, zip code, and more), but most people end up paying about $300/month.  There are three main premiums for most people: Part B, Medigap aka Medicare Supplement, and Part D.
    • Part B - most people will pay $164.90 / month for the base income bracket ($97k/year for single, $194k/year for joint filers).  However, if you are in a higher income bracket you will pay more to the Federal Government, up to over $600/month for the highest income brackets (> $500k as single income, >$750k for joint filers).  You can watch this video to learn more about the Part B premiums and IRMAAs in 2023.  You can also see the IRMAA FAQ section below
    • Medigap / Medicare Supplement - these premiums could vary greatly based on where you live, age, sex, and potentially medical condition.  But, most of our clients pay around $150/month for a Medicare Supplement.  If you would like to get a quote for Medigap, you can contact us and we will let you know the best rates in your area.
    • Part D - there are about 30 different Part D Plans available in each state.  The Part D Prescription Drug premiums can vary from $10+/month up to $120+/month most years.  Most of our clients pay around $10-$15/month for Part D coveraage.  You can watch this video to see how to pick the most cost effective Part D Plan.

How much will it cost to work with Senior Advisors?
  • Answer: There is no fee to work with Senior Advisors. We are compensated by the Insurance Company if we help you enroll in a Plan.  We work with all the A-Rated insurance companies including Aetna, Mutual of Omaha, Cigna, BCBS, and more.  You will pay the same premium if you enroll directly with the Carrier or if you work with a broker like Senior Advisors.  Also, we provide a FREE annual review of the Part D Drug Plans for all of our clients as well.


IRMAAs (Income Related Monthly Adjustment Amounts)

Do I have to pay these IRMAAs (Income Related Monthly Adjustment Amounts) for Part B and Part D?
  • Answer: If your income will still be in a higher income bracket, yes you will have to pay IRMAAs for Part B and Part D to the federal government.  If your income will no longer be in the same income bracket due to a life event (e.g. Work Stoppage, Work Reduction), you can appeal the IRMAAs using the SSA-44 form.

What income is being used to determine the IRMAAs?
  • Answer: The government is using your MAGI (Modified Adjusted Gross Income) from the last tax return the government has processed.  For most people, MAGI is the same as your AGI (Adjusted Gross Income), but MAGI can be higher because tax-exempt interest gets added back in.  

Does my spouse have to pay the IRMAA too even though she hasn't been working?
  • Answer: The income brackets for the IRMAAs are determined based on how you file your tax returns. So, if you file a joint tax return, you and your spouse will pay the same IRMAA regardless of which one of you is generating the income.

When can I start the appeal for the IRMAAs?
  •  Answer: The IRMAA letter generally arrives about 3-4 weeks after you enroll in Medicare Part B.  You should start the appeal process after receiving the IRMAA letter.

If my spouse and I file a joint tax return, do we both have to appeal the IRMAA or just one of us?
  • Answer: You will both still need to appeal the IRMAA.

What proof do I need to provide the government to appeal the IRMAAs for Work Stoppage/Reduction?
  • Answer: Most people won't have any proof/documentation to provide so the SSA-44 form basically indicates that the government will accept your signature as your proof.  Per SSA-44, "In the absence of such proof, we will accept your signed statement, under penalty of perjury, on this form, that you partially or fully stopped working or accepted a job with reduced compensation." 

How long does it take to process the IRMAA Appeal?
  • Answer: Generally, it only takes a few weeks to process and your first bill should NOT include the IRMAAs if you appeal in a timely fashion. 

What happens if I actually make more money after I have appealed the IRMAA?
  • Answer: If you appealed your IRMAAs based on a projected lower income tier, and your income actually comes in at a higher income tier (than you appealed down to), the government will come back at you for the incremental IRMAAs after they process your tax return.

Do I need to appeal the IRMAA each year?
  • Answer: If you are in a higher income bracket, you will receive a letter each December (based on your income return from the prior year's income) that explains the IRMAAs you will need to pay for the following year. For example, in December of 2023, the government is using the 2022 Tax return (latest one they have) to determine your 2024 IRMAAs. So, it is possible, you may have to appeal the IRMAAs twice because the IRMAA determination (e.g. 2024) will be based on a tax return from two year behind (e.g. 2022 income).​​

medicare supplements vs medicare advantage

I keep seeing these commercials with Joe Namath about Medicare coverage with Dental, Vision, Hearing and free meals.  Is this a good plan for me?
  • Answer: These commercials are for Medicare Advantage Plans, which is the fully privatized Medicare option that replaces your Original Medicare coverage. If you sign-up for Medicare Advantage, you are no longer on Medicare.  Here is a link to a video that explains the differences, and below you will find the high-level differences between Medicare Advantage and Original Medicare with a Medicare Supplement:
    • Medicare Advantage is a fully privatized Plan provided by an insurance company, which replaces your Part A & Part B Benefits. A Medicare Supplement just Supplements Original Medicare so you are still on Part A and Part B of Medicare and the Supplement is paying its portion after Medicare.
    • Most Medicare Advantage Plans require Private Networks (e.g. HMOs) within a particular service area. Medicare Supplements allow you to go to ANY doctor/hospital in the country that accepts Medicare.
    • Some Medicare Advantage Plans require Referrals if you want to see a specialist. Medicare Supplements do NOT require referrals if you want to see a specialist (e.g. Chiropractor, Podiatrist, etc.)
    • Part D is included with most Medicare Advantage Plans. If you choose a Medicare Supplement, you will need a separate Part D plan for prescriptions.
    • Monthly Premiums are generally lower with a Medicare Advantage Plan (some as low as $0/month).
      Maximum out of Pocket (MOOP) Expense is up to $7,550 per year with a Medicare Advantage Plan. MOOP is $233 with a Medicare Supplement Plan G, in 2022.
    • Medicare Supplements are Guaranteed Renewable for Life with Federally regulated coverage. Medicare Advantage Plans change every year and you have one opportunity each year (during AEP Oct 15 - Dec 7) to review and change a Medicare Advantage Plan.
  • Additionally, these commercials are not compliant with CMS Marketing Guidelines. But, even without the marketing compliance issues you should be aware of the key differences mentioned above.

My friends pay $0 / month for their Medicare Plan. Why am I paying $150/month for my Medicare Supplement?
  • Answer: Your friend has a Medicare Advantage Plan (not a Supplement) if he/she is paying $0/month.  We can help with Medicare Advantage Plans or Medicare Supplements, but you should be aware of the key differences between the two paths mentioned above.

part d of Medicare

I don't take any medications. Why do I need a Part D Prescription Plan?
  • Answer: There are two reasons we recommend Part D Coverage even if you aren't taking any drugs: 
    • The government will charge a penalty of 1% per month for every month that you don't have Part D coverage when you are supposed to have Part D.  This late enrollment penalty applies for the rest of your life after you eventually sign-up for Part D.
    • If you do get prescribed a medication in the middle of the year, you will have to pay full price which could be hundreds or even thousands of dollars per month until you can sign-up for a Part D Plan the following year.

What if I sign-up for the least expensive Part D Plan and then I get prescribed a drug in the middle of the year?  Will the "cheap Part D Plan" cover me?
  • Answer: Every Part D Plan has to cover at least two drugs in each therapeutic category so there is a high probability that any Part D Plan you select will cover the medication you are prescribed in the middle of the year.  Additionally, there is a possibility that the copay for the specific drug could actually be lower on the "cheap Part D Plan" versus a higher premium Part D Plan.  Finally, you get an opportunity every year (between October 15 - December 7 during the Annual Enrollment Period) to review and update your Part D Coverage for the following year.  We send out a reminder every September to get your latest drug information so we can review your Part D Plans for the following year during the Oct 15 - Dec 7 AEP.

There are so many Part D Plans to choose from... how do I pick the right plan for me?

What's Covered

There is a very good application from Medicare called the "What's Covered" application which allows you to search for any medical service and see if it is covered by Medicare.  Check it out here on the web --- https://www.medicare.gov/coverage
or download the app here.

Some of the frequent questions we get are below.

Will my Chiropractor be covered?
  • Answer: Yes, Chiropractic care is covered under Part B of Original Medicare if the Provider participates in Medicare. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible.

Will expensive things like chemotherapy, kidney dialysis, and infusion therapy be covered?
  • Answer: Yes, these outpatient services are covered under Part B of Medicare. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible.  (Or, if you have a Medicare Advantage Plan, you will be responsible for 20% of the costs up to the Maximum out of Pocket of $7,550.

Are Dental, Vision & Hearing covered by Medicare?
  • Answer: Medically necessary services like Cataracts, Glaucoma, Wet Macular Degeneration, and Diabetes related vision issues would be covered by Medicare Part B. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible.  Non-Medically necessary, Dental, Vision & Hearing services are NOT covered by Original Medicare.  There are some individual plans available for these services.


provider networks

Will all of my doctors accept my Medicare coverage?
  • Answer: The answer will vary based on what coverage you enroll in.
    • If you keep Original Medicare and get a Medicare Supplement, you are able to go to ANY doctor or Hospital in the country that accepts Medicare, which is about 90% of doctors and 99% of hospitals.  It does not matter which Medicare Supplement Carrier you enroll in, the Provider must see you if they are a Medicare Participating Provider. There is NOT a Private network with a Medicare Supplement Plan.  There is a new tool available from Medicare that allows you to Search and Compare Medicare Participating Providers.
    • If you enroll in a Medicare Advantage Plan, you will need to use In-Network Providers, in most cases.  So, you would need to check to see if your doctors accept a particular Medicare Advantage Plan.  Some Medicare Advantage Plans offer Out-of-Network benefits but you would still need to check with your Provider to see if they would accept the Plan.

Dental, Vision, & Hearing

Are Dental, Vision & Hearing covered by Medicare?
  • Answer: Medically necessary services like Cataracts, Glaucoma, Wet Macular Degeneration, and Diabetes related vision issues would be covered by Medicare Part B. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible.  Non-Medically necessary, Dental, Vision & Hearing services are NOT covered by Original Medicare.  There are some individual plans available for these services.​