Medicare Frequently Asked Questions

You should start planning about 6 months before turning 65. This ensures you understand your options and can enroll during your Initial Enrollment Period to avoid potential penalties.

Key Timeline:
6 months before 65: Begin researching Medicare options
3 months before 65: Initial Enrollment Period begins
Month of 65th birthday: Continue enrollment window
3 months after 65: Initial Enrollment Period ends

Starting early gives you time to compare plans, understand your prescription drug coverage needs, and make informed decisions about your healthcare coverage.Add image

Medicare Part B and Part D premiums are means-tested through Income-Related Monthly Adjustment Amount (IRMAA) surcharges. Higher income results in higher premiums. Key considerations:

IRMAA is based on tax return income from 2 years prior
Strategic Roth conversions, timing of IRA withdrawals, and capital gains recognition can affect IRMAA
Social Security claiming decisions affect IRMAA calculations
Appeals are available for life-changing events (retirement, marriage, divorce, etc.)

This is an area where financial planning and Medicare intersect. We help clients coordinate retirement income strategies with Medicare premium management as part of comprehensive financial planning. However, for IRMAA appeals and Medicare-specific questions, contact Social Security or Medicare directly.

Original Medicare (Parts A & B):
Run by the federal government
Freedom to see any doctor or specialist accepting Medicare
Predictable costs with Medigap supplement plans
Separate Part D needed for prescription drug coverage
No network restrictions

Medicare Advantage (Part C):
Offered by private insurance companies approved by Medicare
Includes Part A, Part B, and usually Part D coverage
Network restrictions (HMO or PPO)
Lower monthly premiums (sometimes $0)
Annual out-of-pocket maximum
May include extra benefits like dental, vision, or gym memberships

When working with clients who engage our services, we provide financial analysis of how different Medicare options affect your overall retirement strategy and budget. However, specific Medicare plan recommendations and enrollment must be done through a licensed insurance agent. We do not recommend specific insurance plans or carriers.

Yes, you have several opportunities to change Medicare coverage:

Annual Open Enrollment (October 15 – December 7): You can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or change Part D prescription drug plans. Changes take effect January 1.
Medicare Advantage Open Enrollment (January 1 – March 31): If you’re in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare.
Special Enrollment Periods: Available for qualifying life events like moving, losing other coverage, or qualifying for Extra Help with prescription costs.

Important Note: If you want to add a Medicare Supplement (Medigap) policy when returning to Original Medicare outside your initial enrollment period, you may need to go through medical underwriting unless you qualify for guaranteed issue rights.

When working with clients who engage our services, we help you understand when you can make changes and evaluate whether changes might benefit your situation.

We provide education and analysis to help you understand your Medicare options, but we don’t enroll you in specific Medicare plans or sell Medicare products.

What we do provide:
Education about different Medicare plan types and how they work
Analysis of plan options available in your area
Help understanding what to look for based on your healthcare needs
Coordination of Medicare planning with your overall retirement strategy
Support in evaluating whether plan changes make sense

What you’ll need from other professionals:
Licensed insurance agents for Medicare plan enrollment
Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for official enrollment
OSHIIP (Ohio Senior Health Insurance Information Program) for free counseling

We maintain relationships with licensed insurance agents who specialize in Medicare. We do not receive referral fees or compensation from insurance agents we recommend. Referrals are based solely on our assessment of their qualifications. You are free to work with any licensed agent of your choosing.

If you don’t enroll in Medicare Part B when you’re first eligible (unless you qualify for a Special Enrollment Period), you may have to pay a late enrollment penalty for as long as you have Part B coverage.

*Penalty Calculation: Your monthly premium increases by 10% for each full 12-month period you were eligible but didn’t enroll. This penalty is permanent.

Example: If you were eligible for 2 years before enrolling, your premium would increase by 20% for life.

How to Avoid It: Enroll during your Initial Enrollment Period or qualify for a Special Enrollment Period through employer coverage or other creditable coverage.

When working with clients who engage our services, we help you understand enrollment deadlines and avoid penalties.

*Penalty calculations shown are general examples based on current Medicare rules. Actual penalties depend on your specific situation and enrollment timeline. For official information about your penalty status or how to avoid penalties, contact Medicare directly at 1-800-MEDICARE or Social Security at 1-800-772-1213.

Medicare Part D prescription drug coverage (standalone or included in Medicare Advantage) is highly individualized. Key considerations:

Each plan has a formulary (list of covered drugs) with different tiers and costs
Preferred pharmacies affect copays
Coverage gap (‘donut hole’) rules apply
Prior authorizations may be required for some medications

Use Medicare’s Plan Finder tool at Medicare.gov or work with a licensed insurance agent to compare plans based on YOUR specific medications and pharmacies. We can help you understand the financial impact of drug costs as part of retirement budgeting but cannot recommend specific Part D plans.

If you or your spouse have employer health coverage when you turn 65, you may be able to delay Medicare enrollment without penalty. Key rules:

Employers with 20+ employees: Coverage is creditable, can delay Part B
Employers with fewer than 20 employees: Medicare is primary, should enroll in Part B
COBRA is NOT creditable coverage for delaying Medicare
HSA contributions must stop the month before Medicare enrollment

Coordination between employer coverage and Medicare is complex and mistakes can result in penalties. Consult with your HR benefits department and Medicare before making enrollment decisions. We can help analyze the financial implications but cannot provide Medicare enrollment advice.

Original Medicare does not cover routine dental, vision, or hearing services. Medicare Advantage plans may include these benefits. Standalone dental and vision insurance is available but has limitations and waiting periods. Evaluate whether premium costs justify benefits based on your expected usage.

No. Medicare covers skilled nursing care for limited periods after a qualifying hospital stay but does not cover long-term custodial care (help with daily living activities). Long-term care requires separate insurance or self-funding. This is an important consideration in comprehensive retirement planning that we address with clients.