Questions
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Getting started
- When exactly can I sign up for Medicare?
- Your Initial Enrollment Period is seven months long: the three months before the month you turn 65, your birthday month, and the three months after. If your birthday falls on the first of a month, Medicare treats you as turning 65 in the previous month, which shifts the whole window one month earlier. Enrol in the first three months and coverage starts on the first day of your birthday month.
- I am still working at 65. Do I have to enrol?
- If you have creditable coverage through an employer with 20 or more employees, you can usually delay Part B without a penalty and pick it up later through a Special Enrollment Period. Most people still take premium-free Part A. If the employer has fewer than 20 employees, Medicare generally pays first and delaying Part B can leave you badly exposed. Confirm the employee count before you decide anything.
- Does COBRA count as creditable coverage for Part B?
- No. COBRA is not considered active employer coverage for Part B purposes. Your eight-month Special Enrollment Period starts the month after your employment or your group coverage ends, whichever comes first — not when COBRA runs out. This is one of the most expensive misunderstandings in Medicare.
Choosing
- Advantage or Supplement — which is better?
- Neither, in the abstract. A Supplement buys predictability and freedom of provider at a higher fixed monthly cost. An Advantage plan buys a lower fixed cost and extra benefits, and asks you to accept a network, prior authorisation and variable copays up to an annual maximum. The right answer depends on your doctors, your prescriptions, your travel and how much variability you can live with.
- Why can I not buy Plan F any more?
- Plans F and C cover the Part B deductible, and federal law closed them to anyone who became newly eligible for Medicare on or after 1 January 2020. If you were eligible before that date you may still be able to buy Plan F where it is offered. Plan G is the closest equivalent still open to everyone: identical cover except that you pay the Part B deductible yourself once a year.
- What is the difference between Plan G and Plan N?
- Two things. Plan N asks for a copay of up to $20 on some office visits and up to $50 on an emergency room visit that does not lead to admission. And Plan N does not cover Part B excess charges, which is what a doctor who has not accepted Medicare assignment may bill above the approved amount. In exchange, Plan N usually costs less each month.
- Can I have a Supplement and a Medicare Advantage plan at the same time?
- No. They are alternative ways of covering the same gaps and it is illegal for someone to sell you a Medigap policy while you are enrolled in an Advantage plan, except when you are in the process of moving back to Original Medicare.
Cost
- What is IRMAA and will it apply to me?
- IRMAA is the income-related monthly adjustment amount — an extra charge on your Part B and Part D premiums if your modified adjusted gross income is above the threshold. Social Security uses your tax return from two years earlier, so a high year long past can raise this year’s premium. If you have had a life-changing event such as retirement, marriage, divorce or the death of a spouse, you can ask for it to be reconsidered using form SSA-44.
- What happened to the Part D donut hole?
- The coverage gap no longer exists as a separate phase. Part D now runs on a simpler structure with a single annual cap on what you pay out of pocket for covered drugs, reset by CMS each year. Once you reach it, covered drugs cost you nothing for the rest of the calendar year. You can also ask to spread your out-of-pocket drug costs evenly across the months of the year through the Medicare Prescription Payment Plan.
- What does it cost to work with an advisor?
- Nothing. Licensed advisors are paid a commission by the insurance carrier, set by CMS, and it is the same whichever plan you choose. That is exactly why we tell you when the answer is a plan we do not offer — there is no financial reason for us not to.
Changing plans
- I chose the wrong plan. When can I change it?
- The Annual Enrollment Period, 15 October to 7 December, lets anyone on Medicare change almost anything, effective 1 January. If you are in an Advantage plan on 1 January, the Medicare Advantage Open Enrollment Period from 1 January to 31 March gives you one further move — to another Advantage plan, or back to Original Medicare with a standalone Part D plan. Outside those, you need a Special Enrollment Period.
- Can I be turned down for a Medigap policy?
- Outside a guaranteed-issue window, yes, in most states. Your Medigap Open Enrollment Period is the six months that begin the first month you are both 65 or older and enrolled in Part B. During those six months an insurer must sell you any policy it offers at its best available rate regardless of your health. After that, most states allow medical underwriting. A few states — including New York and Connecticut — do not.
- What are Star Ratings and should I care?
- CMS rates every Advantage and Part D plan from one to five stars each autumn for the following plan year, weighing about forty measures including chronic condition management, customer service, complaints and member experience. They are a genuine signal about how a plan behaves once you need it. There is also a Special Enrollment Period that lets you move to a 5-star plan once between 8 December and 30 November.
Working with us
- Do you offer every plan in my area?
- No, and no agency does. We are appointed with 31 carriers and we tell you plainly when the plan that fits you best is one we cannot sell. For a complete list of every option available to you, contact Medicare.gov or call 1-800-MEDICARE.
Not here?
Ring us and ask. If the answer is “that depends”, we will tell you what it depends on rather than leaving it there.
Ask us the one you are embarrassed to ask.
Nobody is born knowing what a benefit period is. Every advisor here has explained it a thousand times and none of them mind explaining it again.