Top 7 Most Common Medicare Questions Answered

New to Medicare and feeling overwhelmed by all the options? You’re not alone. After working with thousands of Medicare beneficiaries over the years, I’ve noticed the same seven questions come up in nearly every conversation. Whether you’re turning 65 soon or helping a parent navigate their options, understanding these fundamentals will set you up for success.

What is Medicare and How Does It Work?

Medicare is a federal health insurance program that serves as the foundation of healthcare coverage for Americans 65 and older, as well as certain individuals under 65 with disabilities. The program consists of several parts that work together to provide comprehensive coverage.

The core components are Part A and Part B, which together make up what’s called Original Medicare. Part A covers hospital stays, skilled nursing facility care, and other facility-based services. Most people don’t pay a premium for Part A because they’ve earned it through payroll taxes during their working years — specifically, you need 40 quarters (10 years) of work history.

Part B covers doctor visits, outpatient services, preventive care, and medical equipment. Unlike Part A, Part B requires a monthly premium. There are also Part C (Medicare Advantage plans) and Part D (prescription drug coverage), which are offered through private insurance companies but regulated by Medicare.

Finally, there are Medicare Supplement plans (also called Medigap), which are private insurance policies that help pay for the gaps in Original Medicare coverage.

What Does Medicare Actually Cost?

One of the biggest surprises for new Medicare beneficiaries is learning that Medicare isn’t free, even though you’ve been paying into it your entire working life. Let me break down the real costs you’ll face.

Part A is premium-free for most people who have worked and paid Medicare taxes for at least 10 years. However, there’s still a deductible of $1,736 per benefit period for hospital stays.

Part B comes with a standard monthly premium of $202.90 in 2026. You’ll also pay an annual deductible of $283, after which you’re responsible for 20% of most Part B services — and this 20% has no annual cap.

Agent Tip

Many clients are shocked to learn that Medicare’s 20% coinsurance has no annual limit. A major surgery could leave you with thousands in out-of-pocket costs, which is why most people need additional coverage.

Higher-income individuals pay more through IRMAA (Income-Related Monthly Adjustment Amount). The government looks back two years at your tax return to determine if you’ll pay extra for both Part B and Part D. For 2026, this affects individuals with modified adjusted gross income above $103,000 and couples above $206,000.

When and How Do I Sign Up for Medicare?

Timing your Medicare enrollment correctly is crucial to avoid penalties and coverage gaps. The rules vary depending on your situation, so let’s cover the main scenarios.

If you’re turning 65, you have what’s called an Initial Enrollment Period (IEP). This seven-month window includes the three months before your 65th birthday month, your birthday month itself, and the three months after. The best time to enroll is during the three months before your birthday month to ensure coverage starts on time.

If you’re still working and covered under an employer plan with more than 20 employees, you may be able to delay Medicare without penalty. However, if you’re coming off employer coverage, you’ll want to sign up for Medicare one to two months before your employer coverage ends to avoid any gaps.

Missing your enrollment window can result in permanent late enrollment penalties, so don’t wait until the last minute to start this process.

Medicare Supplement vs Medicare Advantage: What’s the Difference?

This is probably the most important decision you’ll make regarding your Medicare coverage, and unfortunately, it’s also the most confusing for many people. The difference between Medicare Supplement and Medicare Advantage comes down to how they work with Original Medicare.

Medicare Supplement plans (Medigap) work alongside Original Medicare. You keep Parts A and B, and the supplement plan helps pay for the deductibles, coinsurance, and copayments that Original Medicare doesn’t cover. With a supplement plan, you can see any doctor in the country who accepts Medicare, and you typically don’t need referrals to see specialists. Most supplement plans cost $100 or more per month, depending on your area and the plan you choose.

Medicare Advantage plans replace Original Medicare entirely. When you enroll in Medicare Advantage, that plan becomes your primary insurance instead of Parts A and B. These plans typically have $0 monthly premiums and often include extras like dental, vision, and prescription drug coverage. However, you’re limited to the plan’s network of doctors and hospitals, and you may need referrals to see specialists.

You cannot have both a Medicare Supplement plan and a Medicare Advantage plan at the same time — it’s one or the other.

Do I Need a Medicare Supplement Policy?

Whether you need a Medicare Supplement policy depends on your comfort level with potential out-of-pocket costs and your healthcare needs. Let me explain why most people choose to get additional coverage.

Original Medicare by itself leaves significant gaps in coverage. Part B only pays 80% of approved charges, leaving you responsible for the remaining 20% with no annual maximum. For routine care, this might mean $20-40 copays for doctor visits. But for major medical events, that 20% can add up to thousands of dollars.

Part A also has cost-sharing requirements, including the $1,736 deductible for each hospital stay and daily copays for extended stays.

Agent Tip

I always tell clients to think of Medicare Supplement as catastrophic protection. While you might be healthy now, none of us can predict what health challenges we’ll face. The monthly premium provides peace of mind and budget predictability.

Some people do choose to go without additional coverage, essentially self-insuring against these potential costs. This can work if you have substantial savings and are comfortable with the financial risk. However, for most retirees on fixed incomes, getting a Medicare Supplement plan provides important financial protection.

Does Medicare Cover Dental and Prescription Drugs?

Original Medicare has significant limitations when it comes to dental care and prescription drugs, which catches many new beneficiaries off guard.

For prescription coverage, you’ll need to enroll in a separate Part D plan if you choose Original Medicare with a supplement plan. Part D plans are offered by private insurance companies and have their own premiums, deductibles (up to $615 in 2026), and formularies (lists of covered drugs). If you choose Medicare Advantage, prescription drug coverage is typically included in the plan.

Dental coverage is even more limited. Original Medicare only covers dental care that’s directly related to a medical condition or emergency. Routine dental care like cleanings, fillings, and crowns aren’t covered. You’ll need to purchase a separate dental insurance plan or choose a Medicare Advantage plan that includes dental benefits.

The same limitation applies to vision care — Original Medicare covers eye exams related to medical conditions but not routine eye exams or eyeglasses. Many Medicare Advantage plans include dental and vision benefits, which is one reason they’re attractive to many beneficiaries.

Can I Delay Medicare If I’m Still Working?

If you’re still working past 65, you may be able to delay Medicare enrollment without penalty, but there are important rules to follow.

The key requirements are that you must be actively working (not just employed), you must be covered under an active employer group health plan, and your employer must have more than 20 employees. If these conditions are met, you can delay Part B enrollment without facing the permanent late enrollment penalty.

When you do decide to retire and lose your employer coverage, you’ll have an eight-month Special Enrollment Period to sign up for Medicare. You’ll need to provide documentation showing you had creditable employer coverage to avoid penalties.

Working past 65 with Medicare requires careful coordination between your employer plan and Medicare to ensure you maintain continuous coverage and avoid any gaps or penalties.

Frequently Asked Questions

What happens if I miss my Medicare enrollment deadline?

Missing your Initial Enrollment Period can result in permanent late enrollment penalties for Part B and Part D. The Part B penalty is 10% of the premium for each 12-month period you were eligible but didn’t enroll. You may also have to wait until the next General Enrollment Period (January-March) to sign up, with coverage starting in July.

Can I change my Medicare plan if I’m not happy with it?

Yes, but your options depend on what type of plan you have. Medicare Advantage plans can be changed during the annual Open Enrollment Period (October 15 – December 7). Medicare Supplement plans can be changed anytime, but you may face medical underwriting unless you qualify for a guaranteed issue period.

Does Medicare work if I travel or live in multiple states?

Original Medicare works nationwide at any facility that accepts Medicare. Medicare Advantage plans typically only work in their service area, which can be problematic for frequent travelers or snowbirds. Some Medicare Supplement plans also provide limited coverage for foreign travel.

How much do Medicare Supplement premiums increase each year?

Premium increases vary by company and pricing method. Most Medicare Supplement plans increase 3-8% annually, but some years may see larger increases depending on the company’s claims experience and the pricing structure they use.

What’s the difference between Plan G and Plan N?

Plan G covers all Medicare cost-sharing except the Part B deductible, while Plan N requires small copays for doctor visits and emergency room visits that don’t result in admission. Plan N also doesn’t cover excess charges, which are rare but can occur when doctors charge more than Medicare’s approved amount.