Medicare & Marketplace Insurance FAQs

When should I sign up for Medicare?

Most people should enroll during their Initial Enrollment Period, which starts 3 months before the month they turn 65, includes their birthday month, and ends 3 months after.

Do I have to sign up for Medicare at 65?

Not always. If you are still working and have qualifying employer coverage, you may be able to delay certain parts of Medicare without penalty. It is important to review your situation before making that decision.

What do Medicare Part A and Part B cover?

Part A helps cover hospital care, skilled nursing, hospice, and some home health care.

Part B helps cover doctor visits, outpatient care, preventive services, lab work, and medical equipment.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare includes Part A and Part B and lets you see any provider that accepts Medicare. Many people add a Medicare Supplement and a Part D drug plan.

Medicare Advantage plans are offered by private insurance companies and often include drug coverage plus extras like dental, vision, or hearing. These plans usually use provider networks.

Which is better: Medicare Supplement or Medicare Advantage?

That depends on your needs. Medicare Supplement plans often offer more flexibility and predictable costs. Medicare Advantage plans may offer lower premiums and bundled extra benefits. The best choice depends on your doctors, prescriptions, and budget.

Do I need a Part D prescription drug plan?

If you want coverage for prescriptions, you usually need a Part D plan unless your Medicare Advantage plan already includes drug coverage. Waiting too long to enroll can lead to a late enrollment penalty.

Does Medicare cover dental, vision, and hearing?

Original Medicare usually does not cover routine dental, routine vision, or hearing aids. Some Medicare Advantage plans may include these benefits.

Will my doctor accept my Medicare plan?

With Original Medicare, you can usually see any provider that accepts Medicare. With Medicare Advantage, you should always check the doctor and hospital network before enrolling.

Can I change my Medicare plan later?

Yes. Depending on the time of year and your situation, you may be able to change your Medicare Advantage plan, drug plan, or return to Original Medicare.

What is the Medicare Annual Enrollment Period?

The Annual Enrollment Period runs from October 15 through December 7 each year. This is when many Medicare beneficiaries review and change their coverage for the following year.

Are there programs to help pay Medicare costs?

Yes. Some people may qualify for Extra Help or Medicare Savings Programs to help with premiums, prescription costs, and other out-of-pocket expenses.

Can I have Medicare and Marketplace coverage at the same time?

In most cases, once Medicare begins, you do not want to keep a Marketplace plan. It is important to time that transition correctly to avoid unnecessary costs.

What is the Health Insurance Marketplace?

The Health Insurance Marketplace is where individuals and families can shop for health insurance plans and see whether they qualify for financial help based on income.

Who can enroll in a Marketplace plan?

Most people can enroll if they live in the service area, are lawfully present, and do not have certain other qualifying coverage available to them.

When can I sign up for a Marketplace plan?

Most people enroll during Open Enrollment, but you may also qualify for a Special Enrollment Period if you have a life change such as losing coverage, getting married, having a baby, moving, or certain other qualifying events.

How do Marketplace subsidies work?

Depending on your household income and family size, you may qualify for premium tax credits to lower your monthly premium and, in some cases, cost-sharing reductions to lower your out-of-pocket costs.

What income counts for Marketplace subsidies?

Marketplace financial help is generally based on your household income for the year. Because estimating income correctly is important, it is a good idea to review your situation carefully before enrolling.

What if my income changes during the year?

If your income goes up or down, you should report the change as soon as possible. This can affect the amount of financial help you receive and may help prevent surprises at tax time.

Can I get a Marketplace plan if I have employer coverage?

Maybe. If your employer coverage is considered affordable and meets minimum value standards, you may not qualify for Marketplace financial help. In some cases, it may still be possible to enroll, but the subsidy rules matter.

Can I get a Marketplace plan if I am self-employed?

Yes. Many self-employed individuals use Marketplace coverage. Your eligibility for financial help will depend on your estimated household income and other factors.

What does a Marketplace plan cover?

Marketplace plans cover essential health benefits such as doctor visits, hospital care, preventive care, prescriptions, maternity care, mental health services, and more. The exact costs and networks vary by plan.

How do I know if my doctor is in network?

Each Marketplace plan has its own network. Before enrolling, it is important to check your doctors, hospitals, prescriptions, and preferred pharmacies.

What is the difference between Bronze, Silver, and Gold plans?

These metal levels describe how you and the insurance company share costs.

• Bronze plans usually have lower monthly premiums and higher out-of-pocket costs.
• Silver plans often balance premium and out-of-pocket costs.
• Gold plans usually have higher monthly premiums but lower out-of-pocket costs when you use care.

What is the best Marketplace plan?

There is no single best plan for everyone. The right choice depends on your doctors, prescriptions, budget, expected medical use, and whether you qualify for financial help.

Do I have to pay back my subsidy?

Possibly. If your actual yearly income ends up being higher than what you estimated when you enrolled, you may have to repay some or all of the premium tax credit when you file your taxes.

What happens if I miss Open Enrollment?

If you miss Open Enrollment, you usually need a qualifying life event to enroll in coverage before the next Open Enrollment period.