Frequently Asked Questions

Your Initial Enrollment Period (IEP) is a 7-month window: the 3 months before your 65th birthday month, your birthday month itself, and the 3 months after. This is the primary window for most people to enroll in Medicare Parts A and B.

Signing up before your birthday month means coverage starts on the first day of your birthday month. Signing up during or after your birthday month delays coverage start. For more detail, see Medicare Basics: Enrollment Periods.

Yes — if you're actively employed at 65 and covered by employer-sponsored insurance from a current employer (not COBRA or retiree coverage), you may be able to delay Medicare Parts A and B without penalty. When your employer coverage ends, you'll typically have an 8-month Special Enrollment Period to sign up.

However, the rules depend on your employer's size and the type of coverage. This is an area where mistakes are common and costly — it's worth verifying your specific situation carefully before deciding to delay.

Missing your enrollment window without a qualifying special enrollment reason can result in permanent late enrollment penalties for Part B (10% per 12-month period you delayed) and Part D (1% per month without creditable coverage). These penalties are permanent — they increase your premiums for as long as you're enrolled in Medicare.

If you miss your IEP without a qualifying exemption, you'll generally need to wait for the General Enrollment Period (January 1 – March 31) with coverage starting July 1.

Original Medicare (Parts A and B) is government-run coverage that lets you see any provider in the US who accepts Medicare — without referrals or network restrictions. It has no out-of-pocket maximum, which is why most people add a Medigap (supplemental) policy to cover the cost gaps.

Medicare Advantage (Part C) is an alternative delivered by private insurance companies. It typically has lower premiums and added benefits (dental, vision, etc.) but restricts you to a network of providers, often requires referrals for specialists, and uses prior authorization for many services.

The right choice depends on your priorities — not just your premium budget. See our Decision Brief for the full five-dimension analysis framework.

You can switch Medicare Advantage plans or switch from MA back to Original Medicare each year during the Annual Enrollment Period (October 15 – December 7). However, switching from Medicare Advantage back to Original Medicare + Medigap is not as simple as it sounds.

In most states, to add a Medigap policy outside of your initial Medigap Open Enrollment Period, you'll need to pass medical underwriting — and insurers can decline you or charge significantly higher premiums based on your health status. There are exceptions (certain qualifying events, protected states like Connecticut, New York, and Massachusetts), but in most cases, your switching options are more limited than most people realize.

This is one of the key reasons the initial enrollment decision deserves careful analysis.

No — Medicare Advantage can work very well for certain people in certain situations. For someone who is generally healthy, lives in an area with robust plan options and network quality, has modest healthcare utilization, and doesn't travel extensively, MA can offer good value.

The question isn't whether MA is "good" or "bad" — it's whether it's the right structural fit for your priorities, health profile, and long-term situation. That's the evaluation the five-dimension framework is designed to help with.

The best time is during your Medigap Open Enrollment Period — a 6-month window that begins the month you're both 65 and enrolled in Part B. During this window, insurers are legally required to sell you any Medigap plan they offer at standard rates, regardless of your health status or medical history.

Outside this window, in most states, insurers can use medical underwriting — meaning they can reject you or charge more based on pre-existing conditions. This makes the initial enrollment timing a critical decision.

Both Plan G and Plan N are popular choices for new enrollees (Plan F is no longer available to those newly eligible after 2020). The main difference: Plan G covers the Part B excess charges that some physicians bill above Medicare's approved amount, while Plan N does not — but Plan N has lower premiums. Plan N also requires copays for some office visits and ER visits.

The right choice depends on the Medigap pricing in your area, whether excess charges are common with providers in your region, and your expected utilization patterns.

IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to your Part B and Part D premiums if your income exceeds certain thresholds. It applies to both Original Medicare and Medicare Advantage enrollees — it's based on your Medicare costs, not your plan type.

IRMAA is calculated based on your Modified Adjusted Gross Income from two years prior. For 2026, thresholds are based on your 2024 tax return. The surcharge is significant — for higher income earners, IRMAA can add hundreds of dollars per month to total premiums. If your income has dropped significantly since the base year (retirement, loss of spouse, etc.), you can file for an IRMAA reconsideration.

Part B premiums have a standard rate that applies to most enrollees, but are higher for those subject to IRMAA surcharges. Medigap premiums vary by insurer, plan type, your age, and your location — and can differ significantly from one company to another for the exact same standardized plan. Medicare Advantage premiums vary by plan and location. Part D premiums vary by plan formulary and location.

This is why premium comparison shopping matters — particularly for Medigap, where the same standardized plan benefits can have widely different pricing from different insurers.