Medicare can feel confusing, especially with all the different parts, plans, and rules. Whether you’re new to Medicare or helping a loved one navigate their coverage, it’s natural to have questions. To make things easier, we’ve gathered some of the most common Medicare FAQs for seniors asked about Medicare — and what you should know.
1) What’s the difference between Original Medicare and Medicare Advantage?
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance) — it’s the traditional government-run program. You can visit any doctor or hospital that accepts Medicare. Medicare Advantage (Part C), on the other hand, is offered by private insurance companies approved by Medicare. These plans typically combine Parts A and B, and often include additional benefits like prescription drug coverage (Part D).
2) When can I enroll in Medicare?
You’re first eligible to enroll during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after. If you miss that window, there are Special Enrollment Periods for certain situations (like retiring or losing employer coverage). The Annual Enrollment Period (AEP) — from October 15 to December 7 — lets you make changes to your plan each year.
3) Does Medicare cover prescription drugs?
Prescription drugs are not covered under Original Medicare, but you can add a Part D plan for drug coverage. These plans are offered by private insurers and vary in cost and coverage. If you choose a Medicare Advantage plan (Part C), it may already include prescription benefits — so you wouldn’t need a separate Part D plan.
4) Can I keep my doctor with Medicare?
With Original Medicare, you can see any doctor or hospital that accepts Medicare nationwide — no network restrictions. If you’re enrolled in a Medicare Advantage plan, you’ll need to check if your doctor is in the plan’s network. Some Advantage plans require you to see specific providers to get the best coverage and rates. Be sure to make sure whichever plan you opt for covers your needs.
5) What are the out-of-pocket costs with Medicare?
Medicare helps cover a lot, but it doesn’t pay for everything. You’ll still have deductibles, copayments, and coinsurance. For example:
- Part A may have a deductible for each hospital stay.
- Part B has a small monthly premium and 20% coinsurance for most services.
To help with these costs, some people choose a Medicare Supplement (Medigap) plan or a Medicare Advantage plan that caps out-of-pocket spending.
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