Between enrollment, billing, coverage, and eligibility, there are plenty of common Medicare questions that are important to think about as you near the age of 65.  

In this Medicare frequently asked questions guide, we’ll give you all the answers you need to find peace of mind in moving forward with all your healthcare decisions.   

Medicare questions about coverage 

Coverage is a very important factor in health insurance. Ensuring you are covered for all your healthcare needs is vital in deciding on a particular plan. Let’s dive into common Medicare questions and answers about coverage.  

How soon after I enroll will my coverage start? 

Medicare coverage starts based on when you enroll: 

  • If you sign up before you turn 65, coverage starts the month you turn 65;  
  • If you sign up the month you turn 65 or the three months after, coverage starts the following month;
  • If you sign up outside of your Initial Enrollment Period, your coverage starts the month after you enroll.  

What does Medicare Part A cover? 

Medicare Plan A is hospital insurance. It covers: 

What does Medicare Part B cover? 

Medicare Plan B is medical insurance. It covers medically necessary and preventative services like: 

The combination of Part A and Part B is also referred to as Original Medicare, as this is what is originally covered by the federal program. 

What does Medicare Part C cover? 

Medicare Part C, also called Medicare Advantage, are private insurance plans from Medicare-approved companies. Part C covers hospital and medical insurance (in other words, everything that Original Medicare covers) as well as other benefits including: 

The coverage differs from plan to plan, therefore be careful when enrolling and verify the services included in a plan to make sure your needs will be met.

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What does Medicare Part D cover? 

Medicare Part D is coverage for prescription drugs. This coverage helps to cover the costs of your prescriptions.  

Does Medicare cover dental care? 

Original Medicare does not cover dental care. To receive dental benefits, you will need to enroll in a Medicare Advantage plan (these plans typically cover dental, but you need to look at the specifics of each plan) or in a private dental insurance plan.  

Does Medicare cover vision services? 

Original Medicare does not cover most vision services. It does not cover eye exams. However, Part B will partially cover eye exams if you’re at high risk for developing conditions like glaucoma or other eye complications. Medicare Advantage, Part C, typically does cover vision services (make sure to check your plan for details on what is covered).  

Does Medicare cover hearing aids? 

Original Medicare does not cover the costs of hearing aids. You will need to pay 100% of the costs for these services unless you enroll in a Medicare Advantage plan that has hearing aids coverage.   

What healthcare services are not covered by Medicare? 

Original Medicare (Part A and Part B) for hospital and medical insurance helps to cover the costs of a lot of things. However, it is important to know what it doesn’t cover to make sure you have the right supplemental insurance to help with all your healthcare needs. 

Original Medicare does not cover: 

  • Dental; 
  • Vision; 
  • Hearing;
  • Long-term care; 
  • Routine physical exams;
  • Cosmetic surgery; 
  • Massage therapy. 

Medicare billing questions 

An important part of reaching retirement age is coming up with a budget to make sure you are well taken care of in your later years. Factoring healthcare and Medicare into your budget is vital to prioritize health and well-being. Here are some Medicare financial questions frequently asked by seniors nearing age 65.  

How much does Original Medicare cost? 

The cost of Original Medicare varies on a few factors. Here is a general guideline for costs for most people: 

  • Part A Premium costs $0 a month; 
  • Part B costs $174.70 per month in 2024 but may be higher based on your income.  

What does Medicare Advantage cost?

Premiums and deductibles vary significantly for Medicare Advantage Part C coverage. For a rough estimate, most people pay anywhere from $0-$200 per month for Part C coverage.  

What if I can’t afford my premium? 

If you are worried about your ability to pay for your Medicare premium, you can apply for Medicare Savings Programs (MSP) to help with premiums and out-of-pocket costs.  

How much should I anticipate spending out-of-pocket with Medicare coverage? 

Out-of-pocket expenses depend widely on the amount and costs of services you receive each year. Here are some rough estimates from 2016 according to a Kaiser Family Foundation (KFF) analysis of the Medicare Current Beneficiary Survey (MCBS): 

  • The average person with Medicare coverage paid $5,460 out-of-pocket including paying for premiums and out-of-pocket costs;  
  • Those with no supplemental coverage paid the most on average at $7,473;  
  • Beneficiaries with Medigap coverage paid an average of $6,621; 
  • Those with both Medicare and Medicaid coverage paid an average of $2,665;  

What happens if I don’t pay my premiums? 

Not paying Medicare premiums will put you at risk of losing coverage. For most beneficiaries, Part A is premium-free. Those who are enrolled in Social Security can set up their coverage for Part B and Part D to automatically be deducted from their benefits to ensure no bills are missed. If you are having trouble affording your premiums, there are options like Medicare Savings Programs (MSP) available to assist those who qualify.  

Medicare eligibility questions 

Medicare eligibility most commonly starts when you turn 65. So long as you have been a U.S. citizen for at least five years, you are eligible to receive Medicare coverage. Eligibility for certain aspects of Medicare may not be as clear. Let’s dive into some common Medicare eligibility questions.  

What are the income limits for Medicare eligibility? 

The income limits for Medicare do not make beneficiaries ineligible but they do affect the cost of premiums for Part B and Part D. The premium surcharge, or Income-Related Monthly Adjustment Amount (IRMAA), affects those over a certain income limit. For 2024, the premium surcharge affects those with incomes over $103,000 for individuals and $206,000 for couples.  

If Single or Divorced:If Married & Filed Joint:If Married & Filed Separate:Part B Premium
$103,000 or less$206,000 or less$103,000 or less$174.70
$103,001–$129,000$206,001 – $258,000—-$244.60
$129,001–$161,000$258,001 – $322,000$349.40
$161,001–$193,000$322,001 – $386,000$454.20
$193,001–$499,999$386,001 – $749,999$103,001–$397,999$559.00
$500,000 or above$750,000 or above$397,000 or above$594.00
The table shows the Medicare Part B monthly premium amounts for 2024 based on your reported income for 2022 (filed in 2023). These amounts may change each year. IRMAA = Income Related Monthly Adjustment Amount.

Does Medicare coverage require me to be on Social Security? 

Many seniors start receiving Social Security benefits and Medicare around the same time. The programs are independent of each other; you do not need to be enrolled in both Social Security and Medicare at the same time. You can enroll in Medicare at 65 and wait to receive Social Security until you are ready.  

How do I figure out if I’m eligible for Medigap? 

You are eligible to enroll in Medigap coverage if you are already enrolled in Original Medicare (Part A and Part B). Open enrollment for Medigap lasts six months from when your Part B coverage begins. 

What qualifies me for Medicare’s Extra Help program? 

Beneficiaries with lower incomes can receive financial assistance affording their premiums from Medicare’s Extra Help Program. To qualify, your income cannot exceed $21,870 for individuals or $29,850 for married couples living together.  

What are the eligibility requirements for Medicare? 

Medicare eligibility is based primarily on age. You become eligible for Medicare at age 65 so long as you have been a U.S. citizen or have legally lived in the U.S. for at least five years.  

Medicare enrollment questions

Enrolling in Medicare can be an overwhelming task for many. Understanding as much as possible about the process can help ensure you feel confident about your decisions regarding Medicare.  

When is the best time to enroll in Medicare? 

The best time to enroll in Medicare is during the Initial Enrollment Period. This begins three months before you turn 65 and ends three months after you turn 65. Enrolling outside of this period may lead to higher premiums and penalties.  

Should I enroll in Medicare if I am still working? 

Generally, it is best to enroll at 65 to avoid penalties and higher premiums. However, deciding whether or not to enroll in Medicare while you are still working depends largely on the company you work for: 

  • Smaller companies with less than 20 employees are not liable to continue to cover you and your insurance will likely switch over to Medicare;
  • For larger companies with more than 20 employees with a group health plan, you do not have to enroll in Medicare right away.  

It’s best to talk to your employer as you near age 65 to determine whether it would be best to enroll in Medicare.  

How do I enroll in Medicare online? 

Enrolling in Medicare online is quick and easy. Here’s what you’ll need to do: 

  • Create an account on the Social Security Administration’s website; 
  • Provide basic information like a birth certificate, driver’s license, or proof of citizenship;  
  • Decide which plans you will enroll in;  
  • Consult late penalty information to avoid higher premiums. 
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When can I enroll in Original Medicare? 

You can enroll in Original Medicare during three main times: 

  • Initial Enrollment Period: three months before and after the month you turn 65; 
  • General Enrollment Period: January 1st – March 31st, you may face late penalties.  
  • Special Enrollment Period for those who qualify.  

When can I enroll in Medicare Advantage? 

Once you are enrolled in Original Medicare, you can enroll in the Medicare Advantage plan during the General Enrollment Period: January 1 to March 31, or the Medicare Advantage Open Enrollment Period from January 1st to March 31.  

How do I switch or drop plans with Medicare? 

You can switch, drop, or change Medicare coverage during the Open Enrollment Period from October 15th to December 7th.  

Who do you call for Medicare questions? 

If you have any further questions about Medicare, you can consult these additional resources to get any other clarification you need.  

Call Medicare Directly 

You can call Medicare directly at 1-800-MEDICARE (1-800-633-4227) for help. 

Contact Hella Health 

If you are looking for more information, contact Hella Health to get assistance with every step of the Medicare enrollment process.  

Article updated on October 16, 2023.