Common Medicare Questions Answered

When it comes to Medicare and Medigap health insurance there is a ton of confusion.  Here are the top questions that our Medicare agents get when Medicare enrollees are seeking more information on Medigap supplemental insurance plans.

When can beneficiaries enroll in Medicare?

There is a seven-month window in which beneficiaries can sign up for Medicare Part A, Part B, prescription drug coverage, and Medigap supplemental insurance.  This period of time includes three months before you turn 65, the month of your birthday, and the three months after you have turned 65.  When you are receiving Social Security, beneficiaries will automatically be signed up for both Medicare Part A and Part B starting the first day of the month in which you turn 65.

Do my spouse and I have the same plan?

Spouses do not share Medicare plans.  Each Medicare and Medigap plan are issued on an individual basis.

Does Medicare offer coverage for long-term care?

Long-term care is not medical care, in most circumstances, but instead long-term care covers the basics of what it takes to live daily life.  Medicare will not cover long-term care if that is the only service that is needed.  Medicare covers: care within a long-term care hospital, certain skilled nursing care within a skilled nursing facility, home health services that are eligible, and hospice/respite care.

 Does Medicare cover nursing homes?

Skilled care within a certified nursing facility for Medicare beneficiaries is covered under Medicare Part A.  More information can be found by reaching out to our Medicare agents or visiting

Why would Medicare beneficiaries choose a Medicare Advantage Plan over Original Medicare?

The decision to choose between Original Medicare and Medicare Advantage Plans is up to each individual beneficiary.  Medicare Advantage Plans are popular in situations when:

  • You need prescription drugs. With very few exceptions, prescription coverage isn’t covered under Original Medicare.  Many Medicare Advantage Plans include prescription coverage whereas under Original Medicare a separate Medigap policy is needed, Medigap Plan D.
  • You would like to cap out-of-pocket spending. Original Medicare does not have out-of-pocket maximums.  With Original Medicare you will continue to pay a portion of the costs of your services whereas with Medicare Advantage plans there is a $6,700 out-of-pocket maximum.  Once this limit is reached the rest of the financial burden is covered through Medicare.
  • You want an alternative to the 20% coinsurance that is charged by Original Medicare Part B.
  • You need vision and dental coverage. Original Medicare Part A and Part B does not cover these services.  Some of the Medicare Advantage Plans offer vision and dental coverage.
What makes a participant choose between Medicare Advantage HMO and PPO?

Medicare Advantage Health Maintenance Organization plans (HMO’s) allow participants choose from a network of doctors that are contracted to provide services.  Beneficiaries will choose one primary care physician from doctors within the planned network.  This physician will then refer beneficiaries to specialists when further care is needed.  The specialists need to be within the plan network. The highlights of a Medicare Advantage HMO are:

  • Low out of pocket costs
  • Must go to physicians within the network
  • May include prescription drug coverage

This type of plan is often chosen because of the cost-savings.   If you can live with the restriction of choosing a physician within the network, then a Medicare HMO would work well.

Medicare Advantage Preferred Provider Organization plans (PPO’s) are similar to HMO plans in that participants choose from a network of doctors that are contracted to provide services.   Unlike an HMO plan, you are also allowed to see physicians outside of the network and hospital, you will just pay more out of pocket.  The highlights of a Medicare Advantage PPO are:

  • Can see physicians in and out of network
  • Monthly premiums are often higher than Medicare Advantage HMO plans
  • Out-of-pocket expenses
  • May include prescription drug coverage
How do prescription drug plans, Medicare Plan D, differ?

Each Plan D have its own list of covered generic and brand-name drugs.  Each Plan D covers certain drug categories however drugs covered in each category may differ by carrier.  Medigap Plan D plans set monthly premiums and costs may differ between carriers.

How do I know what is best for me Medicare Advantage Plans or Original Medicare Plans with Medigap Plans?

Each and every participants health care and budget needs are different.  In order for you to find what the best option for you is to reach out to our Medicare Agents to find out more information on each plan and how it benefits you.

How do Medicare Supplemental Insurance/Medigap Plans Differ? 

Each Medicare Supplemental Insurance Plan, letters A-N offer different levels of coverage.  Each lettered plan includes the exact same coverage regardless of where you live and what carrier it is offered through.  Price differs based on each carrier.  Some supplemental plans offer services that Original Medicare doesn’t like travel outside of the United States.

The experts at eMedigap Plans, powered by Omega, have all the answers you are looking for when it comes to your Medigap Supplemental Insurance needs.  More information can be found at

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