Medicare Questions Answered Clearly
Detailed answers organized by topic about enrollment, plan types, coverage rules, and working with an independent Medicare advisor in Kansas City.
Browse the FAQ below or jump to the topic of your choice:
Medicare Basics
Foundational answers about how Medicare is structured and what each part covers.
What is Medicare?
Medicare is a federal health insurance program for individuals age 65 and older, as well as certain individuals under 65 with qualifying disabilities. It is administered by the Centers for Medicare & Medicaid Services (CMS). Medicare does not cover all healthcare costs. It covers a defined set of medical services, and beneficiaries are responsible for premiums, deductibles, copays, and coinsurance depending on the coverage they select. Understanding what Medicare does and does not cover is essential before choosing a plan.
An independent Medicare broker can help you compare your options across carriers at no cost to you. Learn more about Medicare coverage options or schedule a no-cost consultation.
What are the different parts of Medicare?
Medicare includes four parts. Each serves a different purpose.
Part A covers inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.
Part B covers outpatient medical services like doctor visits, preventive care, lab work, durable medical equipment, and some home health services. Part B requires a monthly premium, which is income-adjusted.
Part C (Medicare Advantage) is an alternative to Original Medicare offered through private insurance carriers approved by Medicare. These plans bundle Part A, Part B, and usually Part D into a single plan, often with additional benefits such as dental, vision, and hearing.
Part D covers prescription drug costs. It is available as a standalone plan for those enrolled in Original Medicare, or it may be included in a Medicare Advantage plan.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare consists of Part A and Part B administered directly by the federal government. It is accepted by any provider in the United States who accepts Medicare. There are no network restrictions, but there is also no out-of-pocket maximum. This means your costs are not capped in a given year without a supplemental policy.
Medicare Advantage (Part C) is offered by private carriers approved by Medicare. These plans must cover everything Original Medicare covers, but they operate through networks (HMO or PPO) and typically include an annual out-of-pocket maximum. Many plans include additional benefits not covered by Original Medicare, such as dental, vision, hearing, and fitness programs.
The right choice depends on your health needs, your preferred providers, your prescriptions, and your budget. Neither option is universally better. Our Medicare solutions page outlines both options in detail.
What is a Medicare Supplement (Medigap) plan?
A Medicare Supplement plan, also called Medigap, is a private insurance policy designed to cover some or all of the out-of-pocket costs left by Original Medicare — including deductibles, copays, and coinsurance. Medigap plans are standardized by the federal government, meaning Plan G from one carrier covers the same benefits as Plan G from another carrier.
Medigap plans do not include prescription drug coverage. Enrollees in a Medigap plan must also enroll in a standalone Part D plan to cover prescriptions.
Medigap plans are typically paired with Original Medicare, not Medicare Advantage. If you are comparing Medigap and Medicare Advantage options in the Kansas City metro area, contact AIS Health Insurance Advisors for a side-by-side comparison.
Do I need Part D if I don't take prescriptions?
Part D is not required, but enrolling when you are first eligible is strongly recommended even if you do not currently take prescriptions. If you go without creditable drug coverage for 63 or more consecutive days after your Initial Enrollment Period ends, you may face a late enrollment penalty when you do enroll, and that penalty is permanent.
The late enrollment penalty is calculated as 1% of the national base beneficiary premium for each full month you went without coverage. It is added to your Part D premium for as long as you have Medicare drug coverage.
Many low-cost Part D plans are available in Kansas and Missouri. Enrolling in a basic plan now protects you from penalties and provides coverage if your prescription needs change.
Enrollment & Timing
Enrollment windows, deadlines, and the consequences of missing them.
When can I enroll in Medicare?
Most people become eligible for Medicare at age 65. The primary enrollment opportunity is the Initial Enrollment Period (IEP), which begins three months before your 65th birthday month and ends three months after it — a seven-month window in total.
After the IEP, you can enroll or make changes during the Annual Enrollment Period (AEP), which runs October 15 through December 7 each year. Changes made during AEP take effect January 1 of the following year.
Certain qualifying events — such as losing employer-sponsored coverage — may trigger a Special Enrollment Period that allows you to enroll outside of these standard windows.
What is my Initial Enrollment Period?
Your Initial Enrollment Period (IEP) is a seven-month window centered on your 65th birthday month. It begins three months before the month you turn 65 and ends three months after that month.
Enrolling during the first three months of your IEP (before your birthday month) ensures your coverage begins on the first day of your birthday month. Enrolling during or after your birthday month may delay the start of your coverage.
If you are still working at 65 and covered by an employer plan, you may be able to delay Medicare enrollment without penalty. The rules depend on the size of your employer. Speak with an advisor before making this decision.
Where do I go to enroll in Medicare?
Enrollment into Original Medicare, which includes Part A and Part B, is completed through the Social Security Administration.
You can enroll online at https://ssa.gov, by calling Social Security directly, or by scheduling an appointment at a local Social Security office.
While enrollment in Part A and Part B is handled by Social Security, AIS Health Insurance Advisors guides clients through the process to ensure enrollment is completed correctly and on time. After you are enrolled in Part A and Part B, we assist with selecting and enrolling in Medicare Advantage, Medicare Supplement, and Part D prescription drug plans
What is the Annual Enrollment Period?
The Annual Enrollment Period (AEP) runs from October 15 through December 7 each year. During this period, Medicare beneficiaries can switch from Original Medicare to Medicare Advantage, switch from Medicare Advantage back to Original Medicare, change Medicare Advantage plans, or change their Part D drug plan. Changes take effect January 1 of the following year.
AEP is the most important enrollment window for existing Medicare beneficiaries. Plans change their premiums, networks, and drug formularies each year. Reviewing your coverage annually (before AEP ends) ensures your plan still aligns with your providers, prescriptions, and budget.
AIS Health Insurance Advisors proactively contacts clients before each AEP to review their current coverage. We recommend scheduling a review before October 15 to avoid last-minute decisions.
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) is a window outside of standard enrollment periods that allows you to enroll in or change Medicare coverage due to a qualifying life event.
Common qualifying events include losing employer-sponsored health coverage, moving out of your plan’s service area, your plan leaving the Medicare program, or qualifying for Medicaid. The length of the SEP and what changes are allowed depend on the specific qualifying event.
If you have experienced a qualifying event and are unsure whether you are eligible for a Special Enrollment Period, contact AIS Health Insurance Advisors to review your options.
What happens if I miss my enrollment window?
If you miss your Initial Enrollment Period and do not have other creditable coverage, you will generally need to wait until the General Enrollment Period (January 1 – March 31) to enroll in Part B, with coverage beginning July 1. You may also face a late enrollment penalty.
For Part D, missing your enrollment window without having creditable drug coverage for 63 or more consecutive days results in a permanent late enrollment penalty added to your monthly premium.
If you believe you may have missed an enrollment window, speak with an advisor before assuming you have no options. Certain circumstances may qualify you for a Special Enrollment Period.
Are there late enrollment penalties?
Yes. Medicare imposes late enrollment penalties for Part B and Part D if you do not enroll when first eligible and do not have other qualifying coverage.
The Part B late enrollment penalty is 10% of the standard Part B premium for each full 12-month period you were eligible but did not enroll. This penalty is permanent and added to your monthly premium for as long as you have Part B.
The Part D late enrollment penalty is 1% of the national base beneficiary premium for each full month you went without creditable drug coverage. This penalty is also permanent.
These penalties are avoidable with proper planning. Speak with an advisor before your Initial Enrollment Period ends.
If I have retiree benefits, do I still need Medicare?
In many cases, yes. Retiree benefits often work alongside Medicare rather than replacing it.
Some retiree plans require enrollment in Medicare Part A and Part B in order to remain eligible for coverage. The coordination rules vary by employer and plan design, so it is important to review your specific retiree benefits before delaying enrollment.
Costs & Coverage
What Medicare costs, what it covers, and how to evaluate your options.
How much does Medicare cost?
Medicare costs vary depending on which parts and plans you enroll in. Premiums, deductibles, and cost-sharing amounts are set annually by Medicare and may change from year to year.
Part A: Most people do not pay a premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years. Part A includes a deductible for each benefit period and cost-sharing for extended hospital or skilled nursing stays.
Part B: Part B requires a monthly premium. The standard premium is set annually and may be higher for individuals with higher incomes through Income-Related Monthly Adjustment Amounts (IRMAA). Part B also includes an annual deductible and coinsurance for covered services.
Part C (Medicare Advantage): Premiums vary by plan and carrier. Some plans have low or $0 premiums, though you must still pay your Part B premium. Cost-sharing, provider networks, and out-of-pocket maximums vary by plan.
Part D: Prescription drug plan premiums vary by carrier and coverage level. Drug costs depend on the plan’s formulary and the tier placement of your medications.
Medigap (Medicare Supplement): Premiums vary by plan type, carrier, age, and location. Medigap plans are standardized by the federal government, meaning the benefits of each plan letter are consistent across carriers, though pricing differs.
For the most current Medicare premiums and deductibles, visit Medicare.gov or contact AIS Health Insurance Advisors for updated figures specific to your situation.
What costs should I expect beyond premiums?
Premiums are only one component of your total Medicare cost. Depending on your coverage, you may also be responsible for deductibles, copays, coinsurance, and out-of-pocket maximums.
Under Original Medicare alone, there is no annual out-of-pocket maximum. Your cost exposure is theoretically unlimited without a Medigap plan. A Medicare Supplement plan covers most or all of these remaining costs, depending on the plan type you select.
Medicare Advantage plans include an annual out-of-pocket maximum, which caps your in-network cost exposure for the year. However, out-of-network costs may be higher or not covered at all depending on the plan type (HMO vs. PPO).
When comparing plans, it is important to evaluate the full cost picture rather than focusing solely on the monthly premium. We review premiums, deductibles, copays, and drug costs together to give you an accurate picture of your annual exposure. Request a comparison with a trusted advisor so you can feel confident and informed.
Does Medicare cover dental services?
Original Medicare generally does not cover routine dental care such as cleanings, fillings, dentures, or exams.
Some Medicare Advantage plans include dental benefits as part of their coverage. Standalone dental plans are also available. Coverage levels and provider networks vary, so reviewing plan details carefully is important before enrolling.
If you are evaluating dental coverage options in the Kansas City area, review our Dental & Vision solutions to compare available plan types and benefit structures.
Does Medicare cover nursing home or long-term care?
Medicare covers short-term skilled nursing facility care following a qualifying hospital stay, but it does not cover long-term custodial care.
Long-term care, including extended nursing home stays, is typically not covered by Medicare and may require private pay, long-term care insurance, or Medicaid eligibility. Understanding this distinction is important when planning for future healthcare needs.
To explore coverage options for in-home support and related services, check out our Home Healthcare solutions for additional information.
Can I keep my current doctors?
Under Original Medicare, you can see any provider in the United States who accepts Medicare. There are no network restrictions.
Under Medicare Advantage, coverage is typically limited to providers within the plan’s network. HMO plans generally require you to use in-network providers except in emergencies. PPO plans allow out-of-network care, but at higher cost.
Before enrolling in any Medicare Advantage plan, it is important to verify that your preferred physicians, specialists, and hospitals are in-network. AIS Health Insurance Advisors confirms network participation before recommending any plan. If you are in the Kansas City metro area and want to verify whether your providers are covered, contact us.
How do I check if my prescriptions are covered?
Each Medicare Part D plan and Medicare Advantage plan with drug coverage maintains a formulary, which is a list of covered drugs organized into tiers. The tier a drug falls on determines your copay or coinsurance for that medication.
You can check a plan’s formulary on Medicare.gov or through the plan’s website. However, formularies change annually, which is why reviewing your drug coverage before each Annual Enrollment Period is important.
AIS Health Insurance Advisors runs a formulary comparison for clients before recommending any plan to confirm that prescriptions are covered at the lowest available cost. If your medications are not covered or are placed on a high-cost tier, we identify alternatives before enrollment.
How often can I change plans?
The primary window to change Medicare plans is the Annual Enrollment Period (AEP), October 15 – December 7. Changes take effect January 1.
There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31. During this window, individuals already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or return to Original Medicare.
Outside of these windows, plan changes are generally only permitted during a Special Enrollment Period triggered by a qualifying event. Medigap plans have different rules, and switching outside of your guaranteed issue period may require medical underwriting.
Can my spouse or dependent be covered under my Medicare plan?
No. Medicare is individual coverage. Each person enrolls separately once they become eligible, typically at age 65 or earlier if they qualify due to disability. Unlike employer-sponsored insurance, Medicare does not offer family or dependent coverage. If your spouse is not yet eligible for Medicare, they will need to maintain employer coverage, Marketplace coverage, or another wqualifying health plan until they become eligible.
What is creditable coverage?
Creditable coverage refers to health or prescription drug coverage that is considered at least as good as standard Medicare coverage.
If you have creditable coverage through an employer or union plan, you may be able to delay enrolling in certain parts of Medicare without incurring late enrollment penalties. Always confirm in writing whether your current coverage is considered creditable before delaying enrollment.
Working With AIS Health Insurance Advisors
How AIS Health Insurance Advisors works, how we are compensated, and what to expect.
Is there a cost to work with AIS Health Insurance Advisors?
No. There is no fee to work with AIS Health Insurance Advisors. Our services, including plan comparisons, enrollment guidance, network verification, and ongoing annual reviews, are provided at no cost to you.
We are compensated by the insurance carriers when you enroll in a plan through us. This compensation is set by the carriers and does not affect your premium. You pay the same amount whether you work with a broker or enroll directly.
How are Medicare brokers compensated?
Medicare brokers are compensated through commissions paid by insurance carriers. These commissions are regulated by the Centers for Medicare & Medicaid Services (CMS) and are standardized, meaning a broker receives the same commission regardless of which plan you choose. This structure is designed to eliminate financial incentives to recommend one plan over another.
As an independent broker, AIS Health Insurance Advisors represents multiple carriers. Our recommendations are based on your providers, prescriptions, and budget.
Do you meet in person?
Yes. AIS Health Insurance Advisors is based in Overland Park, Kansas, and serves clients throughout the Kansas City metro area in person, by phone, and virtually. We accommodate whichever format is most convenient for you.
For clients in Overland Park, Olathe, Leawood, and surrounding Johnson County communities, in-person consultations are available at our office or at a location convenient to you.
Are you independent?
Yes. AIS Health Insurance Advisors is an independent insurance agency. We are not captive to any single carrier, which means we are not required to recommend or prioritize any one company’s products.
We represent all major Medicare and health insurance carriers in Kansas, Missouri, and many other states. Our recommendations are based entirely on your needs, your preferred providers, your prescriptions, and your budget. We do not receive higher compensation for recommending one carrier over another.
We are not affiliated with or endorsed by the U.S. government or the federal Medicare program.
Can you help if I move out of Kansas?
In many cases, yes. AIS Health Insurance Advisors holds insurance licenses in multiple states, which allows us to continue serving clients who relocate or who split time between Kansas, Missouri, and other states.
We are currently licensed in: Alabama, Arkansas, Arizona, Colorado, Florida, Georgia, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Missouri, Mississippi, North Carolina, Nebraska, New Mexico, Nevada, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, West Virginia, and Wyoming.
If you are planning a move and are concerned about continuity of coverage, contact us before you move. We can review your current plan’s portability, identify whether your coverage will remain valid in your new location, and help you transition to a plan that covers your new service area if needed.
Still Have Questions About Medicare?
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