Medicare & Health Insurance Frequently Asked Questions

Medicare is federal health insurance primarily for people age 65 and older. Certain people under 65 may also qualify because of a disability, End-Stage Renal Disease, or another qualifying condition.

Medicare is divided into different parts. Part A generally covers inpatient hospital care and certain related services. Part B generally covers physician services, outpatient care, durable medical equipment, and many preventive services. Part D provides prescription drug coverage. Medicare Advantage, also called Part C, provides another way to receive Medicare benefits through Medicare-approved private insurance companies.

Understanding these differences is an important first step before comparing additional coverage options.

Not necessarily.

Some people are automatically enrolled in Medicare Part A and Part B, while others need to enroll themselves. Whether you need to take action can depend on circumstances such as receiving Social Security benefits and your current employment or insurance status.

Most people first become eligible for Medicare around age 65, but the correct enrollment timing can vary. Medicare recommends checking your individual circumstances before deciding when to enroll.

If your 65th birthday is approaching, reviewing your situation early can help you understand applicable deadlines and avoid last-minute confusion.

Medicare Supplement insurance is private insurance that works alongside Original Medicare.

It is commonly called Medigap because it can help pay certain out-of-pocket expenses left by Original Medicare, such as applicable copayments, coinsurance, and deductibles.

Generally, you must have Medicare Part A and Part B to purchase a Medigap policy. Medigap does not replace Original Medicare; it supplements it.

Medigap policies are standardized by plan letter in most states, although premiums can differ between insurance companies.

No. They are different types of coverage.

A Medicare Advantage plan provides an alternative way to receive your Medicare Part A and Part B benefits through a Medicare-approved private insurance company.

Medicare Supplement insurance works alongside Original Medicare and helps with certain out-of-pocket expenses.

You generally cannot have a Medicare Advantage plan and use a Medigap policy to cover Medicare Advantage expenses. Medicare specifically states that insurers generally cannot sell you a Medigap policy while you are enrolled in Medicare Advantage unless you are switching back to Original Medicare under applicable rules.

This distinction is important when comparing long-term coverage strategies.

Original Medicare Part A and Part B generally do not provide comprehensive outpatient prescription drug coverage.

Medicare Part D provides prescription drug coverage through private insurance companies that follow Medicare requirements.

If you have Original Medicare, you may choose a standalone Part D plan. Many Medicare Advantage plans include Part D prescription coverage as part of the plan.

Because formularies, pharmacies, drug tiers, and plan costs can vary, your current prescriptions should be considered when comparing coverage.

It depends on how you receive your Medicare coverage.

With Original Medicare, you can generally use any doctor or hospital in the United States that accepts Medicare.

Medicare Advantage plans may use provider networks. Depending on the type of plan, receiving non-emergency care outside the network may cost more or may not be covered.

Provider participation can also change. Medicare recommends reviewing provider access when comparing Original Medicare and Medicare Advantage.

If maintaining relationships with specific physicians, specialists, hospitals, or healthcare systems is important to you, provider participation should be checked before selecting a plan.

The Health Insurance Marketplace provides individual and family health insurance options for eligible consumers.

Marketplace coverage is commonly used by people who are self-employed, between jobs, retiring before Medicare eligibility, or otherwise do not have qualifying employer-sponsored coverage.

Eligibility generally requires living in the United States and meeting applicable citizenship or lawful-presence requirements. A person who already has Medicare coverage cannot enroll in a Marketplace health or dental plan.

Depending on household income and other factors, eligible Marketplace consumers may qualify for financial assistance with coverage costs.

Generally, no.

Marketplace plans have an annual Open Enrollment Period. Outside of that period, you typically need to qualify for a Special Enrollment Period based on an eligible life event.

Examples may include losing qualifying health coverage, getting married, having a baby, or moving under applicable circumstances. Medicaid and CHIP applications can generally be made throughout the year for eligible individuals.

If your health coverage recently changed, it is important to act promptly because Special Enrollment Periods can have deadlines.