Medicare FAQs

Answers to help you better understand the ins and outs of Medicare, so you can choose the best plan for you.
faq

Your Common Medicare Questions Answered

Do I need Medicare if I’m still working?
Does Medicare cover long-term care?
Does Medicare cover nursing homes?
Do I have to be on the same plan(s) as my spouse?
Does Medicare cover emergency medical services while traveling outside the U.S.?
When can I sign up for Original Medicare?
Why would someone opt to buy a Medicare Advantage Plan over getting Medicare Part A and Medicare Part B?
How do I know whether it’s better to get a Medicare Advantage Plan, or Original Medicare with a Medicare Supplement Plan?
How do Medicare Supplement Plans differ from each other?
When can I enroll in a Medicare Supplement Plan?





Q: Do I need Medicare if I’m still working?
A: If you are still working and get health insurance from your employer, the best thing to do is to cost out two things:
  1. Original Medicare (Part A & Part B), with or without a Medicare Supplement Plan and a Prescription Drug Plan.
  2. A Medicare Advantage, or Medigap, Plan (Part C) that would offer the coverage you need.
  3. Then compare each of these to your employer’s current health benefits.
Even with your employer’s health coverage it may be worth it to sign up for Medicare, because Part A is usually free, and though there is a premium with Part B, it may cover medical expenses not covered by your employer.


Q: Does Medicare cover long-term care?
A: Original Medicare covers:
  • Care in a long-term care hospital
  • Some skilled nursing care in a skilled nursing facility
  • Eligible home health services
  • Hospice and respite care
Most long-term care isn’t actually medical care, but rather help with basic, personal tasks of everyday life, sometimes called “activities of daily living” or “custodial care.” Original Medicare does not cover this type of long-term care.


Q: Does Medicare cover nursing homes?
A: Original Medicare only covers skilled care given in a certified nursing facility for individuals who meet certain conditions. To learn more, visit medicare.gov and search “Medicare Coverage of Skilled Nursing Care.” Medicare Advantage Plans generally do not cover nursing home care.


Q: Do I have to be on the same plan(s) as my spouse?
A: No. All Medicare plans are issued on an individual basis. However, certain Medicare Supplement Plans offer a spousal discount. Look for that option when comparing plans.


Q: Does Medicare cover emergency medical services while traveling outside the U.S.?
A: Original Medicare covers hospitalization and doctors’ services anywhere within the U.S., but generally does not cover medical costs outside the country. However, some Medicare Supplement Plans will cover emergency services you when you’re traveling outside the U.S.


Q: When can I sign up for Original Medicare?
A: The earliest you can enroll is the seven-month window surrounding your 65th birthday: the three months before the month you turn 65, the month of your birthday, and the three months after you turn 65.

You can also sign up during a General Enrollment Period (Jan. 1 to March 31 of every year) after that seven-month window, but unless you delayed enrolling because you had health insurance through your job or your spouse’s job, you may have to pay late penalties. The government gives you an eight-month grace period after the end of your employment health insurance to sign up for Original Medicare.


Q: Why would someone opt to buy a Medicare Advantage Plan over getting Medicare Part A and Medicare Part B?
A: When it comes to Medicare, the decision is yours. However, you may want to get a Medicare Advantage Plan instead of Original Medicare if:
  • Your area has a large selection of in-network doctors and hospitals.
  • You don’t travel and your doctor is in-network for the Medicare Advantage Plan you want.
  • You’re healthy and don’t expect to need hospitalization services or medical attention beyond preventative health care.
  • You want to cap your out-of-pocket health spending. Original Medicare has no out-of-pocket maximum. You keep paying a portion of the cost of services you use, unless you have a Medicare Supplement Plan. Medicare Advantage Plans, by law, have an out-of-pocket maximum of $6,700 per year, as long as you use in-network doctors. Past that limit, the plan pays for all covered expenses.
  • You want an alternative to the 20% coinsurance charged by Original Medicare Part B. Remember, the 20% is unlimited (unless you have a Medicare Supplement Plan), whereas Medicare Advantage out-of-pocket is limited to $6,700 for in-network services.
  • You want coverage for vision and dental. Original Medicare doesn’t cover these routine services. Certain Medicare Advantage Plans do.
  • You take prescription drugs. With a few exceptions, most prescriptions aren’t covered in Original Medicare, so you will need to buy a Prescription Drug Plan. Some Medicare Advantage Plans include prescription drug coverage.
Q: How do I know whether it’s better to get a Medicare Advantage Plan, or Original Medicare with a Medicare Supplement Plan?
A: It’s a health decision as well as a financial decision.
  1. If you’re really fit and healthy and are comfortable with the risk of 20% co-insurance, stick with Original Medicare.
  2. If you want to limit your healthcare bills to a guaranteed amount every year and know that everything is covered, get Original Medicare plus a Medicare Supplement Plan. Know, however, that the premiums for a Medicare Supplement Plan could be expensive.
  3. If you’d rather use a network where costs could be lower, a Medicare Advantage Plan may be for you. But with Medicare Advantage, you could pay as much as $6,700 a year in medical expenses. Everyone’s healthcare needs are different.
To find the right plan for you, it’s best to reach out to licensed plan representatives for more information.

Q: How do Medicare Supplement Plans differ from each other?
A: There are 10 standard Medicare Supplement/Medigap plans and they are referred to by letters A-N. (Not to be confused with the four parts of Medicare A-D!) Medicare Supplement Plans A-N offer different levels of coverage and vary in price from one insurance company to the other. Some of the plans cover you if you travel abroad, while others do not. Some pay your Medicare Part B deductible, while others do not. It’s best to reach out to licensed plan representatives to find out how the policies differ.


Q: When can I enroll in a Medicare Supplement Plan?
A: The earliest you can sign up for a Medicare Supplement Plan is during the month of your 65th birthday. If you sign up within six months (including your birthday month), insurance companies are not allowed to use medical underwriting. This means you cannot be denied coverage, charged more, or made to wait for coverage due to preexisting health problems. If you miss the six-month window, you can still sign up for a Medicare Supplement Plan, but insurance companies are allowed to reject coverage based on your health.


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