Questions about Medicare Enrollment
When do I need to enroll for Medicare? I’m turning 65
You can enroll in Medicare starting three months before the month of your 65th birthday, in most cases. Your coverage may begin as early as the first day of your birthday month. This enrollment window, known as your Initial Enrollment Period (IEP), continues for three months after the month you turn 65.
How can I tell if I’m eligible for Medicare coverage?
Medicare eligibility generally begins at age 65, though some people may qualify earlier due to certain disabilities. You can receive Medicare benefits regardless of your income or past medical conditions, as long as you are a U.S. citizen or are a lawful permanent resident residing in the U.S. continuously for at least five years preceding your application.
What are the differences between Medicare’s enrollment periods?
Medicare offers five primary enrollment periods that every beneficiary should recognize. For a comparison of what each one covers, when it occurs, and who it’s for, Please view our comparison chart below.
Do I need to sign up for Medicare at age 65 if I’m covered by employer insurance?
If you’re still working at 65 and covered by an employer health plan, either your own or your spouse’s, you may be able to postpone signing up for Medicare, as long as that employer has 20 or more employees. In this situation, it’s wise to confirm with the benefits department that your group plan will remain in force and that it will be treated as your primary insurance, not secondary. If that employer coverage ends (either voluntarily or involuntarily) or is no longer primary, you will have a limited window to enroll in Medicare without a late penalty by using a Special Enrollment Period.
If I apply for Social Security, will I be automatically enrolled in Medicare Parts A and B?
You will be automatically enrolled only if you have been receiving Social Security benefits for at least four months before the month you turn 65. If you have not been receiving benefits for at least four months before your 65th birthday, you will need to submit an application for Medicare benefits.
Does Medicare ever turn people away due to pre-existing conditions?
A Medicare beneficiary cannot be refused Medicare coverage or charged a higher premium because of a pre‑existing condition. However, certain supplemental insurance plans may have limitations due to pre-existing conditions. Check with your agent for details.
Questions about Medicare Coverage
What is Medicare?
Medicare is a federal health insurance program for people age 65 and older, as well as certain individuals under 65 with qualifying disabilities. U.S. citizens can qualify for Medicare coverage regardless of their income level or past medical conditions.
When can I review and change my Medicare coverage?
If you have a Medicare Advantage plan, you can change plans during the Annual Enrollment Period (October 15–December 7) or during the Medicare Advantage Open Enrollment Period (January 1–March 31). If you have a Medicare Supplement plan, it is generally best to make changes during the Annual Enrollment Period, though in many states you may also switch outside this window if you qualify through medical underwriting. Because the rules can be complex, we strongly recommend speaking with a licensed independent agent before making any changes to your coverage.
Will my prescriptions be covered?
Outpatient prescription drugs are covered by Medicare Part D plans. These plans are optional; however, most people choose to sign up for one. Most areas of the country have numerous plans to choose from with different plan specifics such as monthly premiums, deductibles, and copayments. Our agents carefully review your exact prescriptions and dosages to help you select a plan that's appropriate for your situation.
Do I have to change doctors or specialists when I enroll in Medicare?
Keeping your current doctors and specialists is our agents’ top priority. We work hard to match you with a plan that your providers will accept. Because every situation is unique, your agent will review your specific options in more detail during your appointment.
Does Medicare or my employer's health plan pay first?
Which coverage pays first depends on the size of your employer group. For employers with fewer than 20 employees, Medicare is usually the primary payer, while employer plans for groups of 20 or more typically pay before Medicare. In some cases, such as certain self‑funded or union plans, there may be exceptions to these rules.
Are ambulance services paid for by Medicare?
Medicare Part B generally covers ambulance transport to a hospital, critical access hospital, or skilled nursing facility when it is medically necessary. If an ambulance is used and the situation is later deemed not to have been an emergency or necessary, you may be responsible for the cost of that trip.
Questions about Medicare Costs
Do I have to pay anything for Medicare coverage?
Medicare isn’t completely free; most people pay premiums, deductibles, and coinsurance for their coverage. However, many people qualify for premium‑free Part A if they or their spouse worked at least 10 years.
What choices do I have to cover the 20% gap with Original Medicare?
The two most common coverage types are either a Medicare Supplement (Medigap) or Medicare Advantage plan. Medicare Supplements are secondary policies that pay most or all of the 20% after Medicare pays. Medicare Advantage plans are managed care plans like HMOs (Health Maintenance Organization) or PPOs (Preferred Provider Organizations). Depending on your situation, one over the other may have lower out-of-pocket costs. One of our agents can help explain the differences between these policies during your appointment.
What is the annual deductible for Medicare Part B?
The annual Part B deductible is the amount you must pay for health care services before Medicare begins to pay its share (usually 80% of the Medicare-approved amount).
For 2026: The annual deductible is $283.
After you meet your deductible for the year, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment (DME), unless covered by a Medicare Supplement or Medicare Advantage plan.
How much is the Medicare Part A hospital deductible, how often do I pay it?
Unlike Part B, the Medicare Part A deductible is not an annual deductible. You pay it for each benefit period. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF) and ends when you have not received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.
For 2026: The Part A inpatient hospital deductible is $1,736.
If your hospital stay lasts longer than 60 days, you will pay "coinsurance" rather than a deductible:
Days 61–90: You pay $434 per day of each benefit period.
Days 91 and beyond: You pay $868 per "lifetime reserve day" after day 90 (up to 60 days over your lifetime).
Beyond lifetime reserve days: You pay all costs.
Questions about Medicare Supplements
What exactly is Medicare Supplement insurance?
A Medicare Supplement insurance plan, often called Medigap, is a private policy that helps pay some of the costs not covered by Original Medicare (Parts A and B). These can include deductibles, coinsurance, and copayments. Medigap plans are offered by private insurance companies and are designed to work alongside Original Medicare, not replace it.
Can my Medicare Supplement insurer drop me if my medical costs increase?
You cannot be removed from your Medigap plan just because your medical costs increase. Medicare Supplement policies are guaranteed renewable, so as long as you keep paying your premiums, your coverage will remain in place.
Is it possible to purchase two Medicare Supplement plans?
No. You cannot have more than one Medicare Supplement plan at the same time.
Does a Medigap policy cover my Medicare deductibles?
Part A Deductible: Plans B, C, F, G and N cover 100% of the Part A hospital deductible
Part B Deductible: Only plans C and F cover the Part B deductible. However, these plans are not available to people who became eligible for Medicare on or after January 1, 2020. If you have plan G or plan N, you will still need to pay the annual Part B deductible ($283 in 2026).
Questions about Part D
What is Medicare Part D?
Medicare Part D is optional prescription drug coverage that helps pay for outpatient prescription medications (brand-name and generic drugs) and is offered by private companies approved by Medicare.
What drugs do Medicare Part D plans cover?
Medicare drug plans cover a range of brand-name and generic prescription medications, using a list of covered drugs called a formulary, and each plan’s formulary must meet Medicare standards.
Does Part D cost anything?
With Medicare Part D, you generally pay a monthly premium, and you may also have a deductible and copayments or coinsurance for your prescriptions. If you waited to sign up for medicare Part D and don’t have other creditable drug coverage, you could also be subject to a late enrollment penalty. Higher income enrollees may also pay an Income Related Monthly Adjustment Amount (IRMAA).
How much is the Medicare part D deductible?
Medicare Part D plan deductibles vary by plan, but the federal government sets a maximum limit that no plan can exceed.
For 2026: The maximum annual deductible is $615.
Note: Due to the Inflation Reduction Act, the Part D benefit structure has changed significantly. In 2026, once you (or others on your behalf) have spent $2,100 out-of-pocket on covered drugs, you reach the "Catastrophic Coverage" phase and will pay $0 for covered Part D medications for the rest of the year.
How does part D Coverage work? What's changed in 2026?
Check out our 2026 part D refresher video. If you have additional questions, don't hesitate to give us a call!
Questions about Medicare Advantage plans
What is a Medicare Advantage Plan?
A Medicare Advantage plan (also called Part C) is a Medicare-approved health plan from a private company that provides your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits in place of Original Medicare. Most Medicare Advantage plans also include prescription drug coverage (Part D) and may offer extra benefits, such as vision, hearing, or dental, that are not covered by Original Medicare.
How do Medicare Advantage plans work with Original Medicare?
When you join a Medicare Advantage plan, you still have Medicare, but your Part A and Part B services are covered and managed by the private plan rather than by Original Medicare. Medicare pays the plan a fixed amount each month to provide your Medicare-covered services, and you must follow the plan’s rules, such as using network doctors and hospitals in many cases. Most plans include an annual limit on your out-of-pocket costs for Part A and Part B services, after which you pay nothing for those covered services for the rest of the year.
When can I enroll in or switch a Medicare Advantage plan?
You can first join a Medicare Advantage plan when you are new to Medicare. This first chance usually starts three months before the month you get both Part A and Part B and lasts until three months after that month. After that, you can join, switch, or drop a Medicare Advantage plan every year from October 15 to December 7. If you’re already in a Medicare Advantage plan, you also have another chance to change plans or go back to Original Medicare each year from January 1 to March 31.
Do Medicare Advantage Plans have deductibles?
Yes, many Medicare Advantage Plans have deductibles, but they work differently than Original Medicare. Because these plans are offered by private insurance companies, the deductible amounts are set by the carrier itself, not the federal government.
Health Deductibles: Some plans have a deductible you must meet before the plan covers medical services.
Drug Deductibles: If the plan includes prescription drug coverage, it may have a separate deductible for medications. For 2026: The maximum annual deductible is $615.
You should check your plan's Evidence of Coverage (EOC) or Annual Notice of Change (ANOC) for your specific deductible amount.
I received a letter stating my plan is discontinuing, what do I do?
Many 2026 Medicare Advantage plans are being canceled. The good thing is you have special rights known as "Special Enrollment Periods" and "Guaranteed Issue Rights" in these cases. We recommend meeting with an agent to know your options.
Questions about MrMedicare and Total Retirement Insurance
What is the cost of your services?
Do you work with every Medicare plan available in my area?
We work with a wide range of Medicare plans available in the market. We’re glad to share our experience and insight on all of your options, and if a plan we don’t represent is the best fit for you, we’ll gladly recommend it.
How exactly do you earn money for your Medicare advice?
Total Retirement Insurance is compensated by the plans that work with us. Our customers never pay for this service, either directly or indirectly
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Trusted consultant in guiding me through the Medicare process and choosing the right benefits/supplements for my needs. Bill was very clear in his communication and explanation of all options. Under his direction, I was able to get my Medicare number quickly and efficiently. Great follow up, and prompt with appointments (by phone in my case). Also, no direct cost to me for his services! Thanks Bill.
For retirees, navigating Medicare and insurance issues can be confusing and complicated. I have not met anyone as knowledgeable, easy to talk to, efficient, and friendly as Bill Gundelfinger. I have worked with him for five years and have complete trust and confidence in him and his staff.