Frequently Asked QuestionsWe know Medicare and health coverage can feel confusing. Here are answers to the questions we hear most often - so you can feel confident about your choices.

MEDICARE BASICS

Medicare is the federal health insurance program for people age 65 and older, and for certain younger individuals with disabilities and those with (ALS) Lou Gehrig’s Disease or (ESRD) End-Stage Renal Disease.
Part A covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health care. Part B includes outpatient services like doctor visits, hospital outpatient care, preventive services, lab tests, medical equipment, supplies, and ambulance services. Medicare Advantage (Part C) is provided by private insurers, combining Parts A and B, and often Part D drug coverage. Part D, also offered by private insurers, covers prescribed brand name and generic drugs.
We recommend starting 6 months to a year before your 65th birthday to give yourself plenty of time to understand what Medicare covers, what is costs and how it fits with any employer or retiree health coverage you may have.
Yes, but you must meet specific requirements such as having received social security disability for at least 24 months or have (ALS) Lou Gehrig’s Disease or (ESRD) End-Stage Renal Disease.
You will have the option to delay your Part B and Part D so long as you have employer health coverage.
Original Medicare is the traditional government-run program (Parts A & B). Medicare Advantage (Part C) is offered by private insurers.

Medicare Costs

Generally, individuals pay a monthly premium for Part B medical insurance, while Part A hospital insurance is free for those who have sufficient work history. Enrolling in Part C Medicare Advantage or Part D Prescription Drug Plans may result in extra costs, which vary based on the specific plan chosen.
The federal government sets the Part B premium each year. Most people pay the same standard monthly premium, but if your modified gross income exceeds a certain threshold, you may have to pay a higher amount.
Yes, because of inflation and increasing healthcare expenses, premiums and deductibles are reviewed and updated on an annual basis.
Not signing up for certain Medicare parts when you first qualify, or lacking adequate coverage, can result in additional premium costs. For example, if you postpone enrolling in Part B without credible coverage, your monthly premium may rise by 10% for every year you were eligible but did not enroll. Similarly, if you go 63 days or longer without qualifying prescription drug coverage, you might be penalized 1% of the national base premium.
You may be eligible for Medicare Savings programs to help with Part A and B costs, as well as Extra Help to reduce or eliminate your Part D prescription expenses. Some individuals also qualify for Medicaid to cover costs not paid by Medicare. You can apply through your state Medicaid office or Social Security.
By enrolling during your Initial Enrollment Period or a Special Enrollment Period, you avoid lifelong penalties. We’ll help you stay on track.

MEDICARE SUPPLEMENT INSURANCE

It is a type of plan that helps pay for out-of-pocket costs not fully covered by Original These “gaps” include deductibles, coinsurance, copayments, hospital costs after Medicare stops paying, and with some plans Skilled Nursing Facility coinsurance and foreign travel emergency coverage.
Medicare Supplement Plans come in 10 standardized types, each labeled with a letter. A,B,C,D,F,G,K,L,M, and N. Each covers a different combination of Medicare “gaps”, so the right choice depends on your medical needs, budget, and how much you want to pay out-of-pocket.
No, you must enroll in a separate stand-alone Part D Prescription Drug plan.
A Medicare Supplement Plan allows you to see any doctor, hospital, or specialist anywhere in the US who accepts Medicare, without needing to use specific networks or get referrals for covered services.
During your Medicare Supplement Open Enrollment Period when you cannot be denied a Medicare Supplement Insurance plan due to health conditions or charged more because of past or current medical issues. This is the one time when coverage is guaranteed, no medical underwriting.
Yes. Insurance companies can require medical underwriting and may deny you or charge more based on your health.

PART C MEDICARE ADVANTAGE

A plan that combines Part A, Part B, and often Part D prescription drug coverage. Provided by private insurance companies, these plans must cover all Original Medicare services, may offer additional benefits and lower costs, but require you to follow network rules.
Part C Medicare Advantage Plans are required to include all services covered by Original Medicare. Each Medicare Advantage Plan is unique, and the additional benefits can differ from one plan to another.
An HMO (Health Maintenance Organization) limits you to using doctors and hospitals within its network and typically asks for a referral if you want to see a specialist. Generally, care outside the network isn't covered unless it's an emergency or urgent situation.
A PPO (Preferred Provider Organization) lets you visit any doctor, though you'll save money by staying in-network, and you usually don't need referrals. While out-of-network care is available, it costs more than in-network services.
Yes, HMOs must offer a maximum out-of-pocket limit (MOOP), which only applies when you use providers within their network. After reaching this MOOP, your plan covers 100% of eligible Part A and Part B expenses for the rest of the year.
Similarly, PPOs are required to have a MOOP, but there are two kinds: one for in-network providers and another that combines both in- and out-of-network providers. The combined MOOP is typically higher, yet it still protects you when using out-of-network care. Once you've met your MOOP, your plan pays 100% of all covered services.
Medicare Advantage and Medicare Supplement Insurance cannot be used at the same time. It is illegal for insurance companies to sell you a Medicare Supplement Insurance plan if you are already enrolled in Medicare Advantage.
This Medicare Advantage Plan is designed for individuals with specific health conditions, financial situations, or living arrangements. It customizes its benefits, provider networks, and drug formularies to suit the unique needs of its members. Each Special Needs Plan (SNP) must include Part A & B coverage, Part D Prescription Drug Coverage, a network that serves the targeted population, and ongoing care coordination tailored to each member's requirements.

Part D Prescription Drug

Individuals enrolled in Original Medicare without other creditable drug overage will require a Part D Prescription Drug Plan, as Parts A and B do not provide coverage for most prescription medications. However, if you have creditable coverage through an employer plan, the VA, TRICARE, or a Medicare Advantage Plan that includes prescription drug benefits, enrollment in a stand-alone Part D Prescription Drug Plan is unnecessary.
This is an additional monthly charge applied to your Part D premium if you experience a gap of 63 or more consecutive days without prescription drug coverage after becoming initially eligible. The penalty is calculated by Medicare as 1% of the national average beneficiary premium for each complete month without creditable coverage, and this amount will be added to your monthly premium for the duration of your Medicare drug coverage.
You can enroll in a stand-alone Part D Prescription Drug Plan or A Medicare Advantage Plan that includes prescription drug coverage.
A formulary is a list of prescription medications that are covered by a Part D or Medicare Advantage plan. Each plan maintains its own formulary, which may differ in terms of covered drugs and costs. Medications within the formulary are typically categorized into tiers (Tiers 1 through 5), including generic, brand-name, and specialty drugs. Formularies are subject to annual changes and plans are required to notify you if a medication is removed or reassigned to a different tier.
It depends on the specific plan that is providing your prescription drug benefits. Each plan maintains a network of contracted pharmacies, and while you can generally access any pharmacy within this network, certain pharmacies are designated as preferred and may offer reduced copays or coinsurance, while standard network pharmacies may result in higher medication costs.
Yes. Drug costs can fluctuate, and you may enter different coverage phases (Deductible, Initial Coverage & Catastrophic). As you move thru these stages, your out-of-pocket changes.
If you have limited income and resources, you can apply anytime for the Low-Income Subsidy (LIS), or extra help, through your state Medicaid office or Social Security Administration. You may also qualify for State Pharmaceutical Assistance Programs, drug manufacturer, or pharmacy discount programs. You can also talk to you doctor or pharmacist about affordable alternatives.

Medicare Enrollment

You can first sign up for Medicare during your Initial Enrollment Period, which starts three months before your 65th birthday, includes your birthday month, and extends for three months after. If you miss this window, you have another chance to enroll from January 1 to March 31 during the General Enrollment Period, although late penalties may apply. Additionally, you might be eligible for a Special Election Period if you lose employer coverage or other qualifying insurance.
The primary method for enrolling in Medicare Part A and Part B is through the Social Security Administration. Individuals may contact a representative by calling 1-800-772-1213, apply online at ssa.gov/medicare, or arrange an appointment at their local Social Security Office.
You may still qualify for a Special Enrollment Period based on life events like retirement, moving, or losing employer coverage.

ANNUAL PLAN REVIEW

The time of year when you review your current Medicare coverage to make sure it’s still meeting your healthcare needs and budget.
Plans change over time, as do your needs. Conducting an annual review of your plan's costs, provider network, and covered medications can help prevent unexpected issues and may result in cost savings.
Consider factors such as premiums, deductibles, provider networks, and copays to make sure they match your needs so you can be confident in your plan for the upcoming year.
Yes, by reviewing your plan and other available options, we can talk through costs and coverage and help you select the plan most suited to your individual needs.
We can do a quick review to confirm it’s still the best fit. If nothing has changed, you can confidently stay where you are.
During the Annual Election Period (Oct 15 – Dec 7), but we can start preparing earlier so you’re ready to make changes if needed.

WORKING WITH BEWELL

We educate people about Medicare, helping you save time, money, and confusion. By comparing options from different insurance providers, we focus on meeting your health needs while staying within your budget. We offer clear, personalized guidance and explain plan details simply, ensuring you don't face expensive gaps in coverage or pay more than necessary.
We serve as your dedicated Medicare resource, remaining accessible throughout the year for inquiries, updates, and plan reviews. You can rely on our guidance and support year round.
If you are a Medicare beneficiary, you do not pay for our services. You pay the same price for your plan whether you work with us or enroll directly — but with us, you get personal guidance and support.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact medicare.gov or 1-800-MEDICARE to get information on all of your options.