Frequently Asked Questions
What if I plan to keep working past 65? Do I need to sign up for Medicare?
It depends on the size of your employer. If your company has 20 or more employees, your employer group health plan is considered your primary insurance, and you can generally delay enrolling in Medicare Part B without a penalty. However, it is often wise to still enroll in premium-free Part A. When you eventually retire or lose that employer coverage, you will be granted a Special Enrollment Period to sign up for Part B. If your employer has fewer than 20 employees, you will likely need to sign up for Medicare Parts A and B as your primary insurance when you turn 65 to avoid coverage gaps and penalties. Always check with your HR department for specifics. Federal tax information is at the IRS.
How do I know for sure if my doctor is in a plan’s network?
While the insurance company’s online provider directory is a good starting point, it is not always 100% up to date. The best and most reliable method is to call your doctor’s office directly. Speak to the billing or insurance coordinator and ask this specific question: “Do you accept new patients with the [Plan Name] Medicare Advantage plan from [Insurance Company]?” This direct confirmation is the safest way to ensure your trusted provider is covered before you enroll.
What if I choose a plan and realize it’s the wrong one for me?
You are not necessarily stuck for life. Every year, Medicare has an Annual Open Enrollment Period from October 15 to December 7. During this time, you can switch from Original Medicare to a Medicare Advantage plan, switch from an Advantage plan back to Original Medicare, or change from one Advantage plan to another. You can also change your standalone Part D prescription drug plan. This is your annual opportunity to re-evaluate your health coverage and make sure it still meets your needs.
What is IRMAA and how does it affect my costs?
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra charge added to your Medicare Part B (and Part D) premiums if your income is above a certain level. The Social Security Administration looks at your modified adjusted gross income from your tax return two years ago to determine if you owe IRMAA. For example, in 2024, if your 2022 individual tax return showed an income over $103,000 (or $206,000 for a couple), you will pay a higher premium for Part B. The amount increases in tiers as your income goes up. If your income has decreased significantly since then due to retirement or another life-changing event, you can appeal to have your premium lowered.
Are dental, vision, and hearing services covered by Medicare?
Original Medicare (Parts A and B) does not cover routine dental care (like cleanings or fillings), eye exams for glasses, or hearing aids. This is a major gap that catches many retirees by surprise. However, this is one of the primary selling points for Medicare Advantage (Part C) plans. The vast majority of these plans bundle some level of dental, vision, and hearing benefits into their coverage, making them an attractive option for seniors who want these services covered under a single plan.
