Question 1

What is Medicare and what are its different parts?

Accepted Answer

Medicare is the federal health insurance program for people age 65 or older, younger people with certain disabilities, and people with End-Stage Renal Disease (permanent kidney failure). It is divided into four main parts: Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B (Medical Insurance): Covers outpatient medical services like doctor visits, preventive care, medical supplies, and outpatient procedures. Part C (Medicare Advantage): Private health plan bundles that replace Original Medicare (A & B) and usually include Part D and extra benefits. Part D (Prescription Drug Coverage): Standalone private plans that cover the costs of retail prescription drugs.

Question 2

Are dental, vision, and hearing covered by Original Medicare?

Accepted Answer

No. Original Medicare (Parts A and B) does not cover routine dental cleanings, fillings, crowns, routine eye exams, eyeglasses, contacts, or hearing aids. To secure these essential health benefits, you can either select a Medicare Advantage plan that includes routine allowances or purchase a standalone, comprehensive Dental, Vision, & Hearing (DVH) supplemental policy with no network restrictions.

Question 3

When should I first enroll in Medicare?

Accepted Answer

Most individuals should enroll during their Initial Enrollment Period (IEP). This is a 7-month window that begins 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after. If you are already receiving Social Security benefits, you will be enrolled automatically. If you delay without having "creditable" employer health insurance, you could face permanent lifetime late enrollment penalties.

Question 4

Can I delay enrolling in Medicare if I am still working?

Accepted Answer

Yes, but only if your employer has 20 or more active employees and the health coverage is legally deemed "creditable" by Medicare standards. If your employer coverage qualifies, you can delay Part B and Part D without a penalty. Once you retire or your employer coverage ends, you will have an 8-month Special Enrollment Period (SEP) to enroll in Medicare with zero penalties.

Question 5

What is the difference between Medicare Advantage and Medicare Supplement (Medigap)?

Accepted Answer

They are completely separate, mutually exclusive paths: Medicare Supplement (Medigap) works alongside Original Medicare. It covers your 20% outpatient coinsurance and hospital deductibles. You pay a higher monthly premium, but you get broad doctor freedom (see any doctor in the US who accepts Medicare) without network restrictions. Medicare Advantage (Part C) replaces Original Medicare with a private managed network (HMO or PPO). You enjoy low or $0 monthly premiums and extra benefits (dental, vision, fitness), but you generally use in-network providers, may need referrals on HMO plans, and pay copays as you go up to an annual maximum out-of-pocket limit.

Question 6

How do I check if my preferred doctors are in-network?

Accepted Answer

With a Medicare Supplement (Medigap) plan, you do not need to worry about networks-if your doctor accepts Medicare, they accept your plan. For Medicare Advantage plans, you must search the private insurance company's specific provider directory. Since doctor networks change frequently, we strongly recommend calling your doctor's billing department or utilizing our complimentary provider look-up service before enrolling.

Question 7

How much does Medicare cost in 2026?

Accepted Answer

Your Medicare premium costs are split across the parts: Part A: Free for most people (who worked and paid Medicare taxes for at least 10 years / 40 quarters). Part B: The standard monthly premium in 2026 is $202.90/month for most enrollees, with higher amounts for those above certain income thresholds (IRMAA). Use our IRMAA calculator at /irmaa-calculator for an estimate. Part C & D: Premium rates vary widely based on the specific plan you select, with many Medicare Advantage plans offering $0 additional monthly premiums. Medigap: Monthly premiums depend on your age, location, and plan letter, typically ranging from $100 to $280+.

Question 8

What is the Part D Late Enrollment Penalty, and how does it work?

Accepted Answer

If you go without "creditable" prescription drug coverage for 63 continuous days or more after your Initial Enrollment Period ends, you will face a permanent monthly penalty when you eventually enroll. The federal government calculates this penalty as 1% of the national base beneficiary premium for every full month you went without coverage. This penalty is rounded to the nearest $0.10 and added to your monthly Part D drug premium for as long as you have Medicare.

Question 9

Do Medicare Advantage plans vary by county?

Accepted Answer

Yes. Medicare Advantage plans are offered at the county level. A plan available in one county, whether in Florida, Georgia, Alabama, or North Carolina. May not be available in a neighboring county. Networks, premiums, and benefits can differ significantly even within the same metro area. SwitchBlue helps you review plans available in your specific zip code.

Question 10

Can I change my Medicare plan after I enroll?

Accepted Answer

Yes. You can change Medicare Advantage or Part D plans during the Annual Enrollment Period (October 15 – December 7 each year). Medicare Supplement (Medigap) plan changes have different rules. Switching carriers after your initial enrollment window typically requires medical underwriting in FL, AL, GA, and NC. We help beneficiaries understand their options during every enrollment period.

Question 11

How much does working with SwitchBlue cost?

Accepted Answer

SwitchBlue provides no-cost Medicare guidance to consumers. Our services are funded through standard commissions paid by insurance carriers when you enroll in a plan. We do not charge consultation fees. You pay the same plan premium whether you enroll on your own or with an independent advisor. There is no financial reason to navigate Medicare enrollment alone.

Question 12

What is the difference between Medicare and Medicaid?

Accepted Answer

Medicare is a federal health insurance program based primarily on age (65+) or disability, regardless of income. Medicaid is a joint federal and state program that helps people with limited income and resources pay for care. Some people qualify for both. They are called "dual eligible" and may be eligible for Dual Eligible Special Needs Plans (D-SNPs) that coordinate both programs. See our dual-eligible Medicare guide for how D-SNPs work in your county.

Question 13

What is the Medicare Advantage Open Enrollment Period?

Accepted Answer

Separate from the Annual Enrollment Period, the Medicare Advantage Open Enrollment Period runs January 1 – March 31 each year. If you are already in a Medicare Advantage plan, you can switch to a different Advantage plan once during this window, or drop it and return to Original Medicare (and add a Part D plan). You cannot use this period to switch from Original Medicare into an Advantage plan.

Question 14

What happens to my Medicare if I move to a new state?

Accepted Answer

Original Medicare (Parts A and B) travels with you nationwide. However, Medicare Advantage and Part D plans are tied to a local service area, so a move usually triggers a Special Enrollment Period to pick a new plan available in your new county. Medigap policies generally continue, though premiums are set by state and issue rules vary. If you're relocating within or into Florida, Alabama, Georgia, or North Carolina, we can review your new county's options.

Question 15

Can I have both a Medicare Advantage plan and a Medigap policy?

Accepted Answer

No. Medicare Advantage and Medicare Supplement (Medigap) are mutually exclusive. Medigap only works with Original Medicare. It cannot be used to pay costs under a Medicare Advantage plan. You choose one path or the other. If you're deciding between them, we can walk through the trade-offs of network freedom versus lower monthly premiums.

Question 16

What are Medicare Star Ratings?

Accepted Answer

Medicare rates Medicare Advantage and Part D plans on a 1-to-5 scale (5 is best) based on quality of care, member experience, customer service, and how well the plan manages chronic conditions. Ratings are updated each fall before the Annual Enrollment Period. Star Ratings are a helpful quality signal, but the right plan still depends on your doctors, prescriptions, and budget.

Question 17

What is IRMAA and will I have to pay it?

Accepted Answer

IRMAA (Income-Related Monthly Adjustment Amount) is an extra charge added to your Part B and Part D premiums if your income is above certain thresholds. Social Security determines it using your tax return from two years prior (so 2026 IRMAA is based on 2024 income). Most beneficiaries do not pay IRMAA. If your income has dropped due to a life-changing event like retirement, you can ask Social Security to reconsider.

Question 18

Is there a limit on what I pay out of pocket each year?

Accepted Answer

It depends on your coverage. Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit for in-network covered services. Once you reach it, the plan pays 100% for the rest of the year. Original Medicare by itself has no annual out-of-pocket cap, which is one reason many people add a Medigap policy to limit their exposure.

Question 19

Does SwitchBlue help with health insurance before Medicare?

Accepted Answer

Yes. SwitchBlue is an independent health insurance agency specializing in Medicare, and we also help under-65 households in Florida, Alabama, Georgia, and North Carolina compare individual and family medical plans, ACA Marketplace coverage, and small-group employer benefits. Guidance is at no cost to you. Start with our health insurance overview to choose the individual, Marketplace, or group path that fits your situation.

Question 20

What is ACA Marketplace health insurance and who should use it?

Accepted Answer

The ACA Marketplace at Healthcare.gov is where many households shop for comprehensive individual and family health plans, apply for premium tax credits, and enroll during open or special enrollment periods. It often fits self-employed workers, early retirees under 65, and households without affordable employer coverage. Florida, Alabama, Georgia, and North Carolina use the federally facilitated Marketplace. Official subsidy calculations run through Healthcare.gov; we help you compare plan networks and metal tiers before you enroll.

Question 21

What if I lose employer coverage mid-year?

Accepted Answer

Loss of job-based health coverage typically opens a special enrollment period on the Marketplace, usually with about 60 days to enroll and submit proof of the coverage loss. COBRA continuation on your former employer plan is another option. The right path depends on premium after any tax credit, your doctors, and prescriptions. Compare both before the election window closes. We walk through COBRA versus Marketplace scenarios for households in our licensed states at no cost.

Question 22

Can SwitchBlue help my small business with group health insurance?

Accepted Answer

Yes. We help small employers in Florida, Alabama, Georgia, and North Carolina compare group medical plans from carriers we represent, review networks and contribution strategies, and coordinate enrollment. Very small or owner-only businesses may need individual or Marketplace coverage instead of group markets. If you are evaluating benefits for staff while staying on personal coverage yourself, we can model both paths in one conversation.

Health & Medicare Frequently Asked Questions

Frequently Asked Health & Medicare Questions