Question 1

What is Medicare?

Accepted Answer

Medicare is federal health insurance for people 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease. It has Part A (hospital), Part B (medical), and optional Part C (Medicare Advantage), Part D (prescription drugs), and Medigap (supplement) coverage.

Question 2

What does Medicare not cover?

Accepted Answer

Original Medicare does not cover routine dental care, routine eye exams, hearing aids, long-term custodial care, cosmetic surgery, or most prescription drugs taken at home. You need a Part D plan or a Medicare Advantage plan that includes drug coverage for prescriptions.

Question 3

Do I have to sign up for Medicare if I am still working?

Accepted Answer

It depends on your employer size. If your employer has 20 or more employees, their group plan usually pays first and you may delay Part B without a penalty. If the employer has fewer than 20 employees, Medicare generally pays first and you should enroll in Parts A and B to avoid gaps and penalties.

Question 4

What is the difference between Medicare and Medicaid?

Accepted Answer

Medicare is federal health insurance mainly for people 65+ (and some younger people with disabilities). Medicaid is a joint federal-state program for people with limited income and resources. You can have both Medicare and Medicaid in some situations.

Question 5

What is the difference between Medicare Advantage and Medigap?

Accepted Answer

Medicare Advantage (Part C) replaces Original Medicare with an all-in-one private plan, often with lower premiums but network rules (HMO/PPO). Medigap works alongside Original Medicare to pay deductibles, copays, and coinsurance, with more doctor freedom but usually a higher monthly premium.

Question 6

What is an HMO vs. a PPO Medicare Advantage plan?

Accepted Answer

HMO plans typically require you to use in-network doctors and get referrals for specialists, often at lower cost. PPO plans let you see out-of-network providers for a higher share of cost and usually do not require referrals. Networks and costs vary by plan and ZIP code.

Question 7

Can I change my Medicare plan if I do not like it?

Accepted Answer

Yes, during specific enrollment periods. The Annual Enrollment Period (October 15 – December 7) lets most people switch Medicare Advantage or Part D plans. Medigap changes may require medical underwriting outside guaranteed-issue windows.

Question 8

Why should I compare plans every year during AEP?

Accepted Answer

Carriers change premiums, drug formularies, and provider networks annually. A plan that worked well last year may no longer cover your doctors or prescriptions at the lowest total cost. Reviewing during AEP helps avoid surprise bills in January.

Question 9

What is my Initial Enrollment Period (IEP)?

Accepted Answer

Your IEP is usually the 7-month window around your 65th birthday: the 3 months before, the month of, and the 3 months after you turn 65. This is often the best time to enroll in Part B and choose supplemental or Advantage coverage without penalties.

Question 10

What is the Annual Enrollment Period (AEP)?

Accepted Answer

AEP runs from October 15 through December 7 each year. During this time, most people with Medicare can join, switch, or drop Medicare Advantage and Part D plans, with changes effective January 1.

Question 11

What is a Special Enrollment Period (SEP)?

Accepted Answer

An SEP is a time outside normal enrollment windows when you can make changes due to qualifying events—such as moving, losing employer coverage, or qualifying for Extra Help. Rules and deadlines depend on the specific event.

Question 12

What is the Medicare Advantage Open Enrollment Period (OEP)?

Accepted Answer

From January 1 through March 31, if you already have a Medicare Advantage plan, you may switch to another Advantage plan or return to Original Medicare and join a standalone Part D plan. Options are more limited than during AEP.

Question 13

What is the Part B late enrollment penalty?

Accepted Answer

If you do not sign up for Part B when you are first eligible and do not have qualifying coverage (such as large-group employer insurance), you may pay a 10% premium penalty for each full 12-month period you delayed. In most cases, this penalty lasts as long as you have Part B.

Question 14

What is the Part D late enrollment penalty?

Accepted Answer

If you go without creditable prescription drug coverage for 63 or more days after your initial enrollment period, you may owe a permanent penalty added to your Part D premium, calculated based on how long you were without coverage.

Question 15

What is IRMAA and who pays it?

Accepted Answer

Income-Related Monthly Adjustment Amount (IRMAA) is an extra charge on Part B and Part D premiums for people with higher modified adjusted gross income. Social Security uses tax returns from about two years prior to determine if IRMAA applies. You can appeal if your income has dropped due to a life-changing event.

Question 16

Will my doctor accept my Medicare plan?

Accepted Answer

With Original Medicare plus Medigap, any provider who accepts Medicare assignment is generally available. Medicare Advantage plans use networks—verify that your doctors, hospitals, and specialists are in-network before enrolling.

Question 17

How do I check if my prescriptions are covered?

Accepted Answer

Each Part D and Medicare Advantage plan has a formulary (drug list) with tiers and rules like prior authorization. We compare plans in your ZIP code against your medication list during a consultation to estimate your annual drug costs.

Question 18

Can I use Medicare when I travel?

Accepted Answer

Original Medicare covers emergencies in the U.S. Medigap plans may include foreign travel emergency benefits. Medicare Advantage plans often have limited out-of-network or out-of-area coverage except for emergencies—check your plan documents before extended travel.

Question 19

How much does it cost to use a Medicare agent?

Accepted Answer

Nothing. Our services are free to you. Independent Medicare agents are compensated by insurance carriers when you enroll. Your premium is generally the same whether you use an agent or enroll directly with the carrier.

Question 20

Why use an independent agent instead of calling one carrier?

Accepted Answer

Carrier representatives can only sell that company's products. An independent agent compares multiple carriers in your area to find coverage that fits your doctors, prescriptions, and budget without bias toward a single brand.

Question 21

What happens after I submit the contact form?

Accepted Answer

A Medicji advisor reviews your ZIP code and plan interests, then contacts you within one business day to schedule a consultation. We explain options in plain language—there is no obligation to enroll.

Question 22

Does Medicji sell my information?

Accepted Answer

No. Your information is used only to provide Medicare guidance and follow up on your request. We do not sell lead data to third-party marketers.

Frequently Asked Questions

Medicare Basics

Costs & Plans

Enrollment Periods

Penalties & IRMAA

Networks & Prescriptions

Working With an Agent

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