Medicare FAQs

Original Medicare provides basic hospital and medical coverage through Parts A and B, with the flexibility to see any doctor or hospital that accepts Medicare, but it does not include prescription drug coverage and can have higher out-of-pocket costs. In contrast, private Medicare plans, such as Medicare Advantage (Part C) and Medicare Part D, offer additional benefits like prescription drug coverage, dental, and vision care, often with lower premiums and a cap on out-of-pocket expenses. However, Medicare Advantage plans typically require you to use a network of providers, which can limit your choice of healthcare providers.

You can enroll in Medicare during your Initial Enrollment Period, which starts three months before you turn 65 and lasts for seven months. If you miss this period, you can enroll during the General Enrollment Period from January 1 to March 31, with coverage starting July 1. Each year, you can also make changes to your Medicare plan during the Open Enrollment Period from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31 if you’re already enrolled in a Medicare Advantage plan. Special Enrollment Periods are available for qualifying life events.

If you need to make changes to your Medicare coverage, you can do so during specific enrollment periods. During the Open Enrollment Period (October 15 to December 7), you can switch between Medicare plans or adjust your coverage. If you're already in a Medicare Advantage plan, you can make changes during the Medicare Advantage Open Enrollment Period (January 1 to March 31). For changes due to specific life events, such as moving or losing other coverage, you may qualify for a Special Enrollment Period. Making changes outside these periods may result in delays or penalties.

If you already have Medicare, Integrity Health Advisors can review your current coverage and ensure you are on the best plan.

You will automatically be enrolled in Medicare at age 65 if you are receiving Social Security benefits or railroad retirement board benefits at least four months before you enroll in Medicare. 

If you are not collecting Social Security or RailRoad retirement income, you must contact your local Social Security office to sign up for both Part A and Part B. Once you complete the application and provide the required documentation, you will begin receiving benefits on the first day of your 65th birth month. You can also do this online at www.ssa.gov.

While it is not mandatory, we recommend you enroll in Medicare Part A coverage as soon as you become eligible if you qualify for premium-free Part A coverage. However, if you delay Medicare Part A, you will be able to enroll later during the General Enrollment Period or a Special Enrollment Period if you qualify. But, if you delay enrollment to the General Enrollment period, you will be required to pay late enrollment penalties. 

If your employer offers creditable health coverage, you do not need to enroll in Medicare Part B if you are working past age 65. Creditable coverage is healthcare coverage that provides at least equal benefits to Original Medicare. Suppose you do not have creditable coverage and do not enroll in Medicare Part B when you first become eligible. In that case, you may have to pay the Medicare Part B late enrollment penalty as long as you have Medicare Part B. 

For most, the Medicare Part A premium is $0 per month. To qualify for zero premium, you must have worked at least 40 quarters or ten years paying Medicare taxes. If you did not meet this qualification, you would be required to pay the Medicare part A premium. 

The standard Medicare Part B premium in 2023 is $164.90. This can increase based on income. This difference in premium reflects your Income Related Monthly Adjustment Amount (IRMAA). 

Original Medicare coverage is automatically renewable each year you are eligible. Thus, you do not need to renew your Medicare parts each year. 

Medicare Supplement plans work the same way, once you are accepted, the plan is automatically renewable as long as you continue to pay the monthly premium. 

Medicare Advantage plans are contracted on an annual basis.  If the plan renews, you can choose to have it automatically renewed.  If you choose to evaluate a change, you can do so during the Annual Enrollment Period. 

If you move to a new city or state, you will need to change your address with Social Security. If you have a private plan such as a Medicare Supplement, Medicare Advantage or Part D plan, you maybe required to change your plan based on the new location.

Medicare Part A and Medicare Part B have deductibles and costs that change annually. 

In 2023, the Medicare Part A per occurrence deductible is $1,600, and the Medicare Part B annual deductible is $226. 

Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription Medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, some Medicare Advantage plans provide prescription drug coverage as well. 

If you do not enroll in Medicare Part D, you may be subject to the Medicare Part D late enrollment penalty. This penalty is for those who delay Part D benefits without creditable coverage. You will be required to pay the additional cost as long as you have Medicare Part D.

Medicare HMO and PPO plans are Medicare Advantage plans. 

HMO plans are in network only and typically require referrals to see a specialist. PPO plans have a preferred and non-preferred network which typically give you a larger network to work with. 

Original Medicare does not cover 100% of your medical costs once you enroll in coverage. Medicare Part A requires you to pay a per occurrence deductible and copayments. Then, Medicare Part B requires an annual deductible and a coinsurance of 20%.

Original Medicare benefits do not change each year. However, the premiums, deductibles, and covered services may change each year.