Your Medicare questions, answered
Medicare comes with a lot of moving parts. We have gathered the questions people ask us most and answered them in plain language, grouped by topic so you can find what you need fast.
The basics
How Medicare is built and who it covers.
I am turning 65 and plan to retire. When can I enroll in Medicare?
Assuming you have met the work-related eligibility requirements, you can begin enrolling about three months before the month you turn 65. That initial window continues through the three months after your birthday month, giving you a seven-month period in all.
Can my spouse be on my Medicare plan?
No. Medicare does not have spousal or dependent coverage. It is strictly individual, so each person enrolls on their own. Once your spouse reaches age 65 they can enroll in their own Medicare beginning about three months before their birthday month.
Do I need to enroll in both Part A and Part B?
Part A, the hospital benefit, is usually in place and premium-free for most people at 65. Part B, the outpatient and doctor benefit, is different. Unless you are already receiving Social Security before age 65, you are not enrolled automatically. You will need to sign up for Part B and begin paying its premium when you are ready for it.
What is a Part C plan?
Part C is another name for Medicare Advantage. These plans are offered by private carriers approved by Medicare and bundle your Part A and Part B benefits, often with added features. You may see them labeled MA, MSA, or MA-PD when prescription coverage is included.
What is Part D?
Part D is Medicare's prescription drug coverage, introduced in 2006. Original Medicare on its own does not include outpatient prescription coverage, so a standalone Part D plan or a Medicare Advantage plan that includes drug coverage fills that gap.
Enrollment & timing
When to sign up and how to avoid penalties.
Can I keep my employer coverage instead of taking Part B?
Sometimes. If your employer group has 20 or more employees and you plan to keep working, staying on the group plan and delaying Part B can be an option. There are several factors to weigh first, so it is worth reviewing your specific situation with an agent before you decide.
What happens if I miss my enrollment window?
Beyond a gap in coverage, you will likely face lifelong late-enrollment penalties. The Part B penalty can add 10 percent to your premium for each full 12-month period you went without it. The Part D penalty adds roughly one percent of the national base premium for each month you went without creditable drug coverage.
What is creditable coverage?
Creditable coverage is a Medicare term for prior coverage that is at least as good as Medicare's. It most often comes up with Part D. If you kept creditable drug coverage during any time you were eligible but not enrolled in Part D, you can avoid the Part D late-enrollment penalty.
Where do I go to sign up for Medicare?
You enroll through Social Security, either online at SSA.gov, by phone, or in person at a local Social Security office. We are glad to walk you through the steps so nothing falls through the cracks. You can also see our enrollment resources page for a step-by-step guide.
Costs & coverage
What is covered, what is not, and where the gaps are.
Can I just use Original Medicare (A and B) as my coverage in retirement?
You can, but it leaves you exposed. Original Medicare alone does not include prescription drug coverage, and it has no annual out-of-pocket limit, so a serious illness could lead to very high costs. Most people add either a Medicare Supplement plus a Part D plan, or a Medicare Advantage plan, to close those gaps.
Can I keep all of my same doctors on Medicare?
Usually yes. The key is making sure your doctor accepts Medicare, since some do not. With Medicare Advantage you will also want to confirm your doctors are in the plan's network. We can verify this for you before you enroll so there are no surprises.
Does Medicare cover a nursing home stay?
Medicare can cover skilled nursing care for up to 100 days, but only after a qualifying hospital stay of at least three days. It is meant for short-term recovery, not long-term custodial care, which is an important distinction when planning ahead.
I have retiree benefits. Does that mean I do not need Medicare?
No. A retiree plan typically wraps around Medicare rather than replacing it, with Medicare paying first as your primary coverage. It is important to understand how the two work together, and we are happy to help you coordinate them.
These answers cover the questions we hear most. Your situation is unique, so for guidance tailored to you, reach out for a free consultation.
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