Medicare FAQs
Medicare Basics
Part A covers inpatient hospital stays, nursing facility care, hospice care, and some health care.
Part B is outpatient medical coverage. It helps to pay for medically necessary services performed on an outpatient basis needed to diagnose and treat a medical condition. This can include surgery, lab work, and preventive services.
Part C is also called Medicare Advantage, or MA. It is an alternative to Original Medicare. MA may include prescription drug coverage, among other benefits. It is offered through private insurance companies, so you do not enroll in it via Social Security.
Part D is also known as prescription drug coverage. It is available as a stand-alone option (PDP) or as part of a Medicare Advantage plan (Part C).
Part D plans are offered through private insurance companies that are contracted and approved by Medicare.
Medicare Supplement plans, also called Medigap, are designed to work with Parts A and B. These policies help to pay for some health care costs not covered by Original Medicare, such as deductibles, foreign travel emergencies and co-insurance. These plans are offered by private insurance companies and are available to individuals with Medicare Part A and B. If you have Original Medicare and a Medicare Supplement, you can choose any stand-alone Part D plan to help pay for prescriptions.
Those who are enrolled in Part C are not eligible for a Medicare Supplement policy.
Parts of Medicare
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Compare Options
You can compare options by looking at coverage, costs, and network providers. Teton Medicare offers personalized comparisons to help you make the best choice.
Original Medicare is government-provided coverage, while Medicare Advantage plans are offered by private insurance companies and often include additional benefits.
Yes, you can switch during specific enrollment periods. Teton Medicare can guide you through the process and timing.
Enrollment & Eligibility
Your initial enrollment period begins three months before the month you turn 65 and ends three months after your birthday month.
The only exception is if your birthday falls on the first of the month, which causes the enrollment period to start one month early.
During the initial enrollment period, you can enroll in Medicare Parts A, B, C, and/or D.
Once you are enrolled in Medicare Part A and B (Original Medicare), there is a six-month open enrollment period for Medigap (Medicare Supplement) plans. This window begins with your effective date for Part B and is a one-time election period.
If you missed your initial enrollment period, you may face some penalties, but only if you do not have any other credible coverage.
If you do not enroll in Part B during initial enrollment, you’ll pay a late enrollment penalty of an extra 10% of your premium for every 12-month period you should have had Part B. This penalty is added to each month as long as you have coverage.
If you don’t have Part D coverage and missed your enrollment period, you’ll also pay a late enrollment penalty of an extra 1% of your premium for as long as you have coverage.
If you do not qualify for free Part A coverage for whatever reason and you miss your enrollment period, you may also pay an extra penalty of an extra 10% of your premium for twice the number of years you didn’t have coverage.
Many individuals work beyond the age of 65 and would like to continue their employer coverage, instead of signing up for Medicare health insurance. When you do retire, you’ll be able to enroll during a special enrollment period. This period is eight months long and begins either the month after you or your spouse retires or the month your employer-provided coverage ends, whichever happens first. Oftentimes, Medicare plans are less expensive and offer better benefits than employee plans. Request a free consultation today; it’s worth knowing all your options and comparing benefits.
If you work beyond age 65 and have employer-provided coverage you would like to continue with, you can delay enrollment into Medicare without penalty.
If you move outside of a plan’s service area, this triggers a two-month enrollment period during which you could switch to a Medicare Advantage or Part D plan. You could also return to Original Medicare without a penalty and possibly enroll in Medigap.
The annual enrollment period for Medicare Part C and D begins October 15 and ends December 7, respectively, each year. If you miss this period, you may be required to wait for the next valid enrollment period.
During annual enrollment, you can switch to Medicare Advantage from Original Medicare (Plans A and B). You can also switch your Medicare Advantage plans and Part D plans.
Medicare now provides an additional enrollment period specifically for Medicare Advantage plans. This enrollment period begins January 1st through March 31st and allows you to make a change from one Advantage plan to another.
Medicare Supplements
Medicare Supplement plans, also called Medigap, help cover some of the out-of-pocket costs not covered by Original Medicare. Each standardized Medigap plan covers:
- Medicare Part A hospitalization costs, such as coinsurance amounts, for up to a year after Part A benefits have been used up.
- At least a portion of Medicare Part B copayments or coinsurance amounts.
Beyond that, each plan offers different benefits, and some can pay 100 percent of your cost-sharing responsibility. You can trust Teton Medicare to help you select the right Medigap plan to meet your needs and fit into your finances. Call our family-owned business and set up an appointment to get started.
No, Medicare Supplement plans don’t cover prescription drugs. You’ll need a separate Part D plan for drug coverage.
No, you cannot have both at the same time. Teton Medicare can help you choose the best option for your needs.
Original Medicare only covers 80 percent of your Part B expenses, so the other 20 percent comes out of your pocket if you do not have a Medigap policy.
The following are not covered by Original Medicare or your Medicare Supplement:
- Eyeglasses or contacts (Except post cataract surgery)
- Hearing aids
- Long-term care or custodial care
- Retail prescription drugs
- Routine dental, vision, and hearing exams
Yes, there are. Every insurance provider has to follow the standardized guidelines set by Medicare. The Medigap plans are Plans A, B, C, D, F, G, K, L, M, and N.
No matter which company you purchase your Medigap plan from, their plans all feature the same set of benefits. The only difference is the monthly premium.
Medicare Advantage Plans
Medicare Advantage plans often include additional benefits like dental, vision, and hearing coverage, which Original Medicare doesn’t provide.
It depends on the plan’s network. Teton Medicare can help you find a plan that includes your preferred healthcare providers.
Consider your health needs, budget, and preferred doctors. Teton Medicare can provide personalized guidance to help you decide.
Medicare Part D
Medicare Part D covers prescription drugs. Each plan has its own list of covered medications called a formulary.
It’s often recommended to enroll when first eligible to avoid late enrollment penalties. Teton Medicare can help you weigh your options.
Consider your current medications, preferred pharmacies, and costs. Teton Medicare can help you compare plans to find the best fit.
Life Insurance FAQs
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Medicare Basics
Parts of Medicare
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Other Insurance FAQs
Supplemental Coverage Plans
Travel Insurance Plans
Part A covers inpatient hospital stays, nursing facility care, hospice care, and some health care.
Usually, Part A does not cost you a cent.
Part B is outpatient medical coverage. It helps to pay for medically necessary services performed on an outpatient basis needed to diagnose and treat a medical condition. This can include surgery, lab work, and preventive services.
Part C is also called Medicare Advantage, or MA. It is an alternative to Original Medicare. MA may include prescription drug coverage, among other benefits. It is offered through private insurance companies, so you do not enroll in it via Social Security.
Part D is also known as prescription drug coverage. It is available as a stand-alone option (PDP) or as part of a Medicare Advantage plan (Part C).
Part D plans are offered through private insurance companies that are contracted and approved by Medicare.
Medicare Supplement plans, also called Medigap, are designed to work with Parts A and B. These policies help to pay for some health care costs not covered by Original Medicare, such as deductibles, foreign travel emergencies and co-insurance. These plans are offered by private insurance companies and are available to individuals with Medicare Part A and B. If you have Original Medicare and a Medicare Supplement, you can choose any stand-alone Part D plan to help pay for prescriptions.
Those who are enrolled in Part C are not eligible for a Medicare Supplement policy.
Individual Health Insurance (Under 65)
Medicare has four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years while working.
Not necessarily. Teton Medicare can help you determine which parts of Medicare insurance are right for your specific needs and situation.
Group Health Plans
You can compare options by looking at coverage, costs, and network providers. Teton Medicare offers personalized comparisons to help you make the best choice.
Original Medicare is government-provided coverage, while Medicare Advantage plans are offered by private insurance companies and often include additional benefits.
Yes, you can switch during specific enrollment periods. Teton Medicare can guide you through the process and timing.
Long-Term Coverage
Your initial enrollment period begins three months before the month you turn 65 and ends three months after your birthday month.
The only exception is if your birthday falls on the first of the month, which causes the enrollment period to start one month early.
During the initial enrollment period, you can enroll in Medicare Parts A, B, C, and/or D.
Once you are enrolled in Medicare Part A and B (Original Medicare), there is a six-month open enrollment period for Medigap (Medicare Supplement) plans. This window begins with your effective date for Part B and is a one-time election period.
If you missed your initial enrollment period, you may face some penalties, but only if you do not have any other credible coverage.
If you do not enroll in Part B during initial enrollment, you’ll pay a late enrollment penalty of an extra 10% of your premium for every 12-month period you should have had Part B. This penalty is added to each month as long as you have coverage.
If you don’t have Part D coverage and missed your enrollment period, you’ll also pay a late enrollment penalty of an extra 1% of your premium for as long as you have coverage.
If you do not qualify for free Part A coverage for whatever reason and you miss your enrollment period, you may also pay an extra penalty of an extra 10% of your premium for twice the number of years you didn’t have coverage.
Many individuals work beyond the age of 65 and would like to continue their employer coverage, instead of signing up for Medicare health insurance. When you do retire, you’ll be able to enroll during a special enrollment period. This period is eight months long and begins either the month after you or your spouse retires or the month your employer-provided coverage ends, whichever happens first. Oftentimes, Medicare plans are less expensive and offer better benefits than employee plans. Request a free consultation today; it’s worth knowing all your options and comparing benefits.
If you work beyond age 65 and have employer-provided coverage you would like to continue with, you can delay enrollment into Medicare without penalty.
If you move outside of a plan’s service area, this triggers a two-month enrollment period during which you could switch to a Medicare Advantage or Part D plan. You could also return to Original Medicare without a penalty and possibly enroll in Medigap.
The annual enrollment period for Medicare Part C and D begins October 15 and ends December 7, respectively, each year. If you miss this period, you may be required to wait for the next valid enrollment period.
During annual enrollment, you can switch to Medicare Advantage from Original Medicare (Plans A and B). You can also switch your Medicare Advantage plans and Part D plans.
Medicare now provides an additional enrollment period specifically for Medicare Advantage plans. This enrollment period begins January 1st through March 31st and allows you to make a change from one Advantage plan to another.
Travel Insurance
Medicare Part D covers prescription drugs. Each plan has its own list of covered medications called a formulary.
It’s often recommended to enroll when first eligible to avoid late enrollment penalties. Teton Medicare can help you weigh your options.
Consider your current medications, preferred pharmacies, and costs. Teton Medicare can help you compare plans to find the best fit.