Question 1

What is the difference between Medicare Advantage and Medicare Supplement?

Accepted Answer

Medicare Advantage (Part C) replaces Original Medicare by bundling Part A hospital coverage, Part B medical coverage, and usually Part D prescription drug coverage into a single plan from a private insurer. These plans often include additional benefits like dental, vision, hearing, and fitness programs, and typically use provider networks such as HMOs or PPOs. Medicare Supplement (Medigap) works alongside Original Medicare to cover out-of-pocket costs like deductibles, copays, and coinsurance. Medigap plans are standardized by letter (A through N) and allow you to see any doctor that accepts Medicare without network restrictions.

Question 2

When should I sign up for Medicare?

Accepted Answer

Your Initial Enrollment Period begins three months before the month you turn 65, includes your birth month, and extends three months after. If you are still working and covered by an employer group plan with 20 or more employees, you may delay Part B enrollment without penalty. Once your employer coverage ends, you have an eight-month Special Enrollment Period to sign up. Missing enrollment windows can result in late enrollment penalties that increase your Part B premium permanently. If you receive Social Security Disability Insurance, you are automatically enrolled in Medicare after 24 months of benefits.

Question 3

Does Medicare cover prescription drugs?

Accepted Answer

Original Medicare (Parts A and B) generally does not cover outpatient prescription drugs. To get drug coverage, you need to enroll in a standalone Medicare Part D prescription drug plan or join a Medicare Advantage plan that includes drug coverage. Part D plans vary in their formularies, cost-sharing tiers, and which pharmacies are in network. During the Annual Enrollment Period each fall, you can compare drug plans to ensure your medications are covered at the lowest cost. Failing to enroll in Part D when first eligible may result in a late enrollment penalty.

Question 4

Can I have both Medicare Advantage and a Medicare Supplement plan?

Accepted Answer

No, you cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. Federal law prohibits Medigap insurers from selling you a Supplement policy if you are enrolled in a Medicare Advantage plan. You must choose one path or the other. If you are enrolled in Medicare Advantage and want to switch to Original Medicare with a Medigap plan, you can do so during the Medicare Advantage Open Enrollment Period or the Annual Enrollment Period, but Medigap guaranteed issue rights may be limited depending on your state and circumstances.

Question 5

What does Medicare Part B cover?

Accepted Answer

Medicare Part B covers medically necessary outpatient services including doctor visits, preventive screenings, lab tests, diagnostic imaging, outpatient surgery, durable medical equipment, mental health services, and ambulance transportation when medically necessary. Part B also covers many preventive services at no cost including annual wellness visits, flu shots, mammograms, colonoscopies, and cardiovascular screenings. The standard Part B premium for 2026 is determined annually by CMS and may be higher for beneficiaries with income above certain thresholds through Income-Related Monthly Adjustment Amounts.

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