❓ What is Medicare?
Medicare is the federal health insurance program for people 65 and older, and certain younger people with disabilities or End-Stage Renal Disease (ESRD). It’s administered by the Centers for Medicare & Medicaid Services (CMS) and covers hospital stays, doctor visits, prescription drugs, and more. Medicare is not the same as Medicaid, which is a state-run program for low-income individuals.
❓ What are the 4 parts of Medicare?
Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people don’t pay a Part A premium.
Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical equipment. The standard Part B premium is $185/month in 2025.
Part C (Medicare Advantage): An alternative to Original Medicare offered by private insurers. Bundles Parts A, B, and usually D into one plan, often with extra benefits like dental and vision.
Part D (Prescription Drug Coverage): Covers prescription medications through private plans. Available as a standalone plan or bundled into Medicare Advantage.
❓ When can I enroll in Medicare?
Your Initial Enrollment Period (IEP) is a 7-month window around your 65th birthday — it starts 3 months before your birthday month, includes your birthday month, and ends 3 months after. If you miss this window, you can enroll during the General Enrollment Period (GEP) from January 1 – March 31 each year (coverage starts July 1), but you may face late enrollment penalties. The Annual Enrollment Period (AEP) runs October 15 – December 7 for changing Medicare Advantage or Part D plans.
❓ How much does Medicare cost in 2025?
Part A: $0/month for most people (if you or your spouse paid Medicare taxes for 10+ years). Otherwise up to $518/month.
Part B: $185/month standard premium (higher earners pay more via IRMAA).
Part D: Varies by plan, typically $15–$80/month.
Medicare Advantage: Many plans have $0 premiums (you still pay Part B).
Medigap: Ranges from $50–$300+/month depending on plan letter, age, and location.
There’s also the Part B deductible ($257/year in 2025) and various copays depending on your coverage type.
❓ What’s the difference between Medicare and Medicaid?
Medicare is a federal program based on age (65+) or disability — regardless of income. Medicaid is a state-run program based on income and assets. Some people qualify for both (called “dual eligibles”) and may receive extra benefits like reduced premiums and lower out-of-pocket costs. In North Carolina, Medicaid expansion took effect in 2024, covering more low-income adults.
❓ Do I need Medicare if I have employer insurance?
It depends on your employer’s size. If your employer has 20 or more employees, your employer plan is primary and Medicare is secondary — you can delay Medicare Part B without penalty. If your employer has fewer than 20 employees, Medicare is primary, so you should enroll when first eligible to avoid coverage gaps and penalties. When you leave your job or lose employer coverage, you get an 8-month Special Enrollment Period to sign up for Medicare Part B.
❓ What is the Medicare Part B penalty?
If you don’t sign up for Part B when you’re first eligible and you don’t have qualifying employer coverage, you’ll pay a late enrollment penalty of 10% for each full 12-month period you were eligible but didn’t enroll. This penalty is added to your monthly Part B premium for as long as you have Medicare. Example: If you waited 2 years, you’d pay a 20% penalty on top of the standard premium — permanently.
❓ What does Medicare not cover?
Original Medicare (Parts A & B) does not cover:
• Most dental, vision, and hearing care
• Long-term care (nursing home custodial care)
• Routine foot care
• Cosmetic surgery
• Most care outside the U.S.
• Prescription drugs (you need Part D or Medicare Advantage for that)
This is why many people add a Medicare Supplement plan, Medicare Advantage plan, or separate dental/vision coverage.
❓ What is Medicare Open Enrollment?
There are two key enrollment periods people call “open enrollment”:
1. Annual Enrollment Period (AEP): October 15 – December 7. You can switch Medicare Advantage plans, change Part D plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.
2. Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31. Only for people already in a Medicare Advantage plan — you can switch to a different MA plan or drop back to Original Medicare + standalone Part D.
❓ How do I choose between Medicare Advantage and a Medicare Supplement?
There’s no one-size-fits-all answer. Medicare Advantage works well if you want lower premiums, don’t mind using a network, and like having extra benefits (dental, vision, gym). Medicare Supplement (Medigap) is better if you want the freedom to see any doctor nationwide, predictable costs, and minimal out-of-pocket surprises — but you’ll pay a higher monthly premium. An independent agent like Mike at Senior Benefits Hub can help you compare specific plans for your situation at no extra cost.
❓ Can I change my Medicare plan?
Yes, but only during specific enrollment periods:
• AEP (Oct 15 – Dec 7): Change MA or Part D plans
• MA OEP (Jan 1 – Mar 31): Switch MA plans or return to Original Medicare
• Special Enrollment Period: If you have a qualifying life event (moving, losing coverage, etc.)
• Medigap: Outside your initial open enrollment, you may need to pass medical underwriting to switch Medigap plans — except in North Carolina, where the Birthday Rule gives you a 30-day window around your birthday each year to switch without underwriting.
❓ What is the NC Medigap Birthday Rule?
North Carolina is one of the few states with a Birthday Rule for Medicare Supplement plans. Each year, during a 30-day window starting on your birthday, you can switch to any Medigap plan of equal or lesser value without medical underwriting. This means the insurance company cannot deny you or charge you more because of health conditions. It’s a powerful tool for saving money — many people use it to switch to a lower-cost carrier offering the same Plan G or Plan N benefits.
