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Top Questions about Medicare Coverage

Updated: Nov 16, 2021

Most Americans spend decades on employer provided, private health care plans. As we approach our senior years, many look forward to the prospect of switching to Medicare. Then, when the time comes, they find themselves with a million questions. For one, they may have heard that original Medicare doesn’t cover everything and wonder how they will close the gaps. In this post, we will answer some of the basic questions that kupuna may have as they look to transition into their senior healthcare options.

Top questions about Medicare coverage

What is Original Medicare (Part A and B)?

Original Medicare is made up of Medicare Part A and Medicare Part B. It is managed by the federal government through the Centers for Medicare & Medicaid Services (CMS) and provides Medicare coverage to eligible Americans, 65 years of age and older. Original Medicare provides coverage for and access to any doctors, hospitals, or other health care providers who accept Medicare. Enrollees do not need a referral to see a specialist. It is a fee-for-service plan, which means that the beneficiary usually pays a fee for each service; the percentage that Medicare doesn’t pay. In addition, an annual deductible must usually also be met.

Original Medicare is funded by payroll taxes paid by workers and their employers and by monthly premiums paid by beneficiaries, that may be deducted from Social Security checks.

How much does original Medicare cost?

As long as a person or their spouse paid Medicare taxes while working, there is usually no fee for Medicare Part A. Most people pay a standard monthly premium for Medicare Part B. Those with a larger income may be asked to pay a higher premium.

When is Original Medicare’s initial enrollment period?

Original Medicare’s initial enrollment period is a 7-month window around a senior's 65th birthday; starting three months before you turn 65, and ending three months after the month you turn 65.

When initially enrolling in Medicare Part B, the government gives seniors six months to purchase supplemental plans – also known as Medigap - with no medical questions asked. When a senior switches to Medicare Advantage, they have 12-months to switch back to Original Medicare and resume their supplemental policy without any medical underwriting.

What is Medigap?

Medigap, also known as Medicare supplement insurance or Medicare supplemental insurance, is a list of private health insurance plans sold to supplement Medicare. Medigap insurance provides coverage for a lot of the co-pays and some of the co-insurance charged to Medicare recipients for services rendered in hospitals, skilled nursing facilities, ambulance rides, home health care, durable medical equipment, and doctor charges.

What are Medicare Advantage Plans (Part C)?

Medicare Advantage Plans are a type of Medicare health plan sold by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage and many cover vision, hearing and dental services.

When is Medicare Advantage’s annual enrollment period?

The Medicare Advantage annual enrollment period is October 15 through December 7. By September, it’s a good idea to take a look at the plan you’re currently on and any expected changes to it or your needs to determine whether you want to look into other options.

What is a Medicare Part D prescription drug plan?

Medicare Part D, also referred to as the Medicare prescription drug benefit, is optional supplemental coverage for prescription drug premiums offered to Medicare beneficiaries by the United States federal-government.

What does a Medicare Part D prescription drug plan cost?

The cost varies depending on several factors including the drugs you use. Visit for more information.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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