Frequently Asked Questions
Frequently Asked Questions
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Frequently Asked Questions
Find clear answers to common questions about Medicare, making it easier for you to navigate your options with confidence.
Is Medicare Enrollment Automatic?
Medicare is only automatic if you are currently receiving social security benefits. You will automatically enrolled in Part A and Part B.
If you are not receiving Social security, you will need to enroll in Medicare. You can enroll only in Part A, or Part A and Part B.
Do I need Medicare if I am working?
Medicare is only automatic if you are currently receiving social security benefits. You will automatically enrolled in Part A and Part B.
If you are not receiving Social security, you will need to enroll in Medicare. You can enroll only in Part A, or Part A and Part B.
Do I need to take a Part D plan?
Yes, anyone that is enrolled in BOTH Part A and Part B will need to enroll in a prescription drug plan. If you don’t enroll when your Part B is effective, when you do enroll in an RX plan, you will be charged a lifetime penalty.
What are the penalties?
Medicare Part B (Medical Insurance).
Penalty: Your monthly premium may go up 10% for each 12-month period you could have had Part B but didn’t sign up.
Example: If you waited 2 full years to enroll, your premium could be 20% higher for as long as you have Part B.
Medicare Part D (Prescription Drug Plan) Penalty:
Penalty: 1% of the “national base beneficiary premium” ($34.70 in 2024) for each full month you were without Part D or other creditable prescription drug coverage. This penalty is added to your monthly premium for as long as you have Medicare Part D.
Example: If you were without Part D or creditable drug coverage for 20 months, your penalty would be 20% of $34.70, which adds an additional $6.94 to your monthly premium.
How do I enroll in Medicare?
Enrollment In Medicare is done through social security.
NEW TO MEDICARE: If you are enrolling for the first time during your initial enrollment period, you can enroll online at ssa.gov or call social security to schedule a phone appointment. Online, you can enroll only in Part A or both Part A and Part B.
LOSING CREDIBLE COVERAGE: If you are past your initial enrollment period, you will need to have your employer fill out CMS-L564 ER, which can be found at cms.gov . (can I link to this form or tell them where to get it?)
You will need to fill out CMS-40B, which can be found at cms.gov.
Once both forms are filling out, you can upload them online, fax them to your local social security office, or drop off at your local social security office.
How do I get free stuff on tv?
The “free” stuff shown in Medicare commercials generally refers to extra benefits provided by Medicare Advantage plans, not by Original Medicare. These plans are not designed for everyone and many have income requirements, are only offered in certain zip codes and can be misleading to the average consumer.
Consider that the commercials are national and not apply to you. It’s important not to be working with a trusted person that can address your specific healthcare needs.
How can you help me?
I offer you the opportunity to speak directly to one person and not an 800 number or customer service representative from an individual carrier.
I will gather information from you; your doctor’s and prescription medications and will ask you questions regarding your wants and needs.
Most importantly, I will educate you about how Medicare works and what all your options are so that you can narrow down your choices and make an educated decision.
Do you charge a fee?
How My Medicare Enrollment Services Work — At No Cost to You
I understand that navigating Medicare can feel overwhelming, but that’s where I come in. I offer my services to guide you through the Medicare process, and here’s how it works:
- No Fee for My Service:
- You do not pay me anything for helping you choose and enroll in a Medicare plan. My services are completely free to you. Whether it’s explaining your options, helping you compare plans, or handling the enrollment process, there is no out-of-pocket cost for working with me.
- How I’m Compensated:
- When you choose a Medicare Advantage, Supplement (Medigap), or Part D plan through me, I am compensated directly by the insurance company. They pay me a commission for helping you enroll.
- This payment from the insurer has no effect on your premiums or plan costs. You pay the same price whether you sign up through me, go directly to the insurance company, or enroll online.
- No Difference in Price:
- The cost of your Medicare plan will not change based on how you enroll. By working with me, you get the same rates as if you had gone directly to the insurer. The difference is that I’m here to give you personalized support and make sure you’re choosing the best plan for your needs.
- My Role Is to Guide You:
- My goal is to help you navigate the complexities of Medicare, so you don’t have to do it alone. I take the time to understand your unique situation—your health needs, budget, and preferences—and guide you to the plan that’s the right fit.
- I’m available to answer your questions not just during enrollment but throughout the year, ensuring you continue to get the most out of your coverage.
Does Medicare Cover Medical Mattresses for Seniors?
What Makes a Mattress "Medically Necessary" Under Medicare?
- A prescription from your doctor specifically for a medical-grade mattress or mattress overlay
- Documentation showing the mattress is necessary to treat or prevent a medical condition
- A condition like pressure ulcers (bedsores), severe mobility issues, or other qualifying diagnoses
What Types of Medical Mattresses Does Medicare Cover?
- Pressure-reducing mattress overlays – These go on top of your existing mattress to prevent or treat pressure sores
- Alternating pressure mattresses – Used for patients at high risk of developing bedsores
- Low air loss mattresses – For severe wounds or advanced pressure ulcers
How Do I Get Medicare to Cover a Medical Mattress?
- Get a prescription – Your doctor must write an order stating why you need a medical mattress
- Use a Medicare-approved supplier – The supplier must be enrolled in Medicare and accept assignment
- Meet Medicare’s coverage criteria – Your doctor’s documentation must show medical necessity
- Pay your share – You’ll typically pay 20% of the Medicare-approved amount after meeting your Part B deductible
How Much Will I Pay Out-of-Pocket?
- Your annual Part B deductible ($240 in 2025)
- 20% coinsurance of the Medicare-approved amount
- The full cost if you use a non-participating supplier
What If Medicare Denies My Claim?
- Ask your doctor to provide additional documentation supporting medical necessity
- File an appeal with Medicare—you have 120 days from the denial date
- Consider whether a Medicare Supplement plan (Medigap) might help cover your 20% coinsurance for approved equipment
Questions About Your Medicare Coverage?
How Do I Choose the Best Medicare Plan for My Needs?
Choosing the right Medicare plan isn’t about finding the “best” plan—it’s about finding the best plan for you. After helping New Yorkers navigate Medicare since 2007, I can tell you that the perfect plan for your neighbor might be completely wrong for you. Here’s how to make a confident decision.
What Are My Medicare Plan Options?
You have two main paths when you enroll in Medicare:
Original Medicare (Parts A & B) + Medigap Supplement
- Part A covers hospital stays
- Part B covers doctor visits and outpatient care
- You add a Medigap plan (like Plan G or Plan N) to cover your out-of-pocket costs
- You add a separate Part D plan for prescription drug coverage
Medicare Advantage (Part C)
- An all-in-one alternative that replaces Original Medicare
- Includes hospital, medical, and usually prescription drug coverage
- Often includes extras like dental, vision, and hearing coverage
- Works like an HMO or PPO with provider networks
What's the Difference Between Medicare Advantage and Medigap Supplements?
This is the biggest decision you’ll make, and it fundamentally changes how you use Medicare.
Medicare Advantage Plans:
- Lower monthly premiums (often $0)
- Networks of doctors and hospitals you must use
- Copays every time you visit the doctor or get services
- Maximum out-of-pocket limits (protection if you get really sick)
- May require referrals and prior authorizations
- Can change benefits and costs every year
Medigap Supplement Plans:
- Higher monthly premiums (in , typically $150-400+) Depending where you live.
- Complete freedom to see any doctor who accepts Medicare nationwide
- Minimal to no copays when you get care
- Predictable costs that don’t change when you’re sick
- Guaranteed renewable—your coverage can’t be reduced
- More stable year-to-year
How Do I Know Which Type of Plan Is Right for Me?
Ask yourself these key questions:
About Your Doctors:
- Do you have specialists or doctors you absolutely want to keep seeing?
- Do you travel frequently or spend winters in another state?
- Do you want complete freedom to see any Medicare doctor without network restrictions?
If doctor choice matters deeply to you, Medigap supplements typically offer more flexibility.
About Your Health:
- Do you have chronic conditions that require frequent care?
- Are you managing multiple medications?
- Do you anticipate needing surgery or significant medical care?
- How would you handle unexpected $3,000-7,000 in medical bills if you got seriously ill?
If you use healthcare frequently or want predictable costs, consider how each plan handles your expected usage.
About Your Budget:
- Can you afford $200-400/month in premiums for peace of mind?
- Would you rather pay lower premiums and budget for copays as you use care?
- Do you have savings set aside for unexpected medical expenses?
There’s no wrong answer here—it’s about what gives you financial comfort.
What Specific Medicare Plan Should I Choose?
Once you’ve decided between Medicare Advantage or Original Medicare + Medigap, you’ll need to pick a specific plan.
Choosing a Medicare Advantage Plan:
Compare these factors:
- Monthly premium – What you pay whether you use care or not
- Maximum out-of-pocket limit – Your worst-case scenario costs
- Doctor and hospital networks – Confirm your providers are in-network
- Prescription drug coverage – Check if your medications are covered and at what cost
- Copays for common services – Primary care, specialists, urgent care, outpatient surgery
- Extra benefits – Dental, vision, gym memberships, over-the-counter allowances
Popular carriers in New York include EmblemHealth, Aetna, Humana, and UnitedHealthcare.
Choosing a Medigap Supplement Plan:
The most popular Medigap plans are:
Plan G – The gold standard that covers nearly everything except your Part B deductible ($282 in 2026). Most comprehensive coverage available.
High Deductible Plan G – Same great coverage as Plan G after you meet a $2,870 deductible (2025). Monthly premiums typically $50-90, potentially saving you $1,500-3,000 annually if you stay healthy.
Plan N – Slightly lower premiums than Plan G with small copays ($20 for doctor visits, $50 for ER). Good middle-ground option.
In New York, Medigap premiums are community-rated, meaning everyone pays the same price regardless of age or health. Premium differences between carriers can be $100+ per month for identical coverage, so shopping around matters.
When Should I Enroll in a Medicare Plan?
Timing is critical because it affects your rights and options:
Your Initial Enrollment Period (IEP):
- Begins 3 months before your 65th birthday month
- Includes your birthday month
- Ends 3 months after your birthday month
This is your best opportunity to enroll in any Medigap plan without health questions. Miss this window, and you could be declined or charged higher rates based on your health.
Special Enrollment Periods:
- When you retire and lose employer coverage
- When you move to a new service area
- In certain other qualifying situations
Annual Enrollment Period (October 15 – December 7):
- When you can switch Medicare Advantage plans
- When you can add, drop, or change Part D drug coverage
- When you can move from Medicare Advantage back to Original Medicare
What Mistakes Should I Avoid?
After nearly two decades in this business, I’ve seen these mistakes repeatedly:
Choosing Based on Premium Alone – A $0 premium Medicare Advantage plan might cost you $3,000+ in copays if you get sick. A $300/month Medigap plan might save you thousands in a bad health year.
Not Checking Your Doctors – Assuming your cardiologist takes all Medicare plans is a recipe for disappointment. Always verify before enrolling.
Ignoring Prescription Drug Costs – Your medications might be $20/month on one plan and $400/month on another. Always run your drugs through Medicare’s Plan Finder.
Delaying Your Decision – Missing your Initial Enrollment Period can mean late penalties and losing your guaranteed-issue rights for Medigap plans.
Picking a Plan Because Your Friend Has It – Your friend’s health needs, doctors, and medications are different from yours. What works for them might be expensive for you.
Not Reviewing Your Plan Annually – Medicare Advantage plans change every year. That great plan from 2024 might have cut benefits or raised costs for 2025.
How Do I Compare Medicare Plans Side-by-Side?
Use these resources:
Medicare.gov Plan Finder – Official tool to compare Medicare Advantage and Part D plans. Enter your medications to see exact costs.
Medicare.gov Medigap Plan Comparison – Shows Medigap plans available in your area with monthly premiums.
Work with an Independent Broker – Brokers like me represent 40+ carriers and 200+ plans. We can show you all your options side-by-side without bias toward any single company. Our services are free—insurance companies pay us, not you.
What If I'm Still Working at 65?
If you have employer coverage when you turn 65, you might be able to delay Medicare enrollment without penalties. However, the rules depend on your employer’s size:
- Large employers (20+ employees) – You can typically delay Part B
- Small employers (under 20 employees) – Medicare becomes primary; you usually need to enroll
Always check with your HR department before making this decision. The wrong choice can cost you 10% lifetime late penalties on Part B.
Can I Change My Medicare Plan If I Don't Like It?
It depends on which type of plan you have:
Medicare Advantage – Yes, you can switch during Annual Enrollment (Oct 15 – Dec 7) or during the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31).
Medigap Supplements – You can apply to switch plans anytime, but after your Initial Enrollment Period, insurance companies can ask health questions and potentially decline you or charge higher rates. In New York, you have a one-time opportunity within 12 months of enrolling in Medicare Advantage to switch to Medigap with guaranteed-issue rights.
What's the Bottom Line?
Ready to Find Your Best Medicare Plan?
Is Medicare Enrollment Automatic?
Medicare is only automatic if you are currently receiving social security benefits. You will automatically enrolled in Part A and Part B.
If you are not receiving Social security, you will need to enroll in Medicare. You can enroll only in Part A, or Part A and Part B.
Do I need Medicare if I am working?
Medicare is only automatic if you are currently receiving social security benefits. You will automatically enrolled in Part A and Part B.
If you are not receiving Social security, you will need to enroll in Medicare. You can enroll only in Part A, or Part A and Part B.
Do I need to take a Part D plan?
Yes, anyone that is enrolled in BOTH Part A and Part B will need to enroll in a prescription drug plan. If you don’t enroll when your Part B is effective, when you do enroll in an RX plan, you will be charged a lifetime penalty.
What are the penalties?
Medicare Part B (Medical Insurance).
Penalty: Your monthly premium may go up 10% for each 12-month period you could have had Part B but didn’t sign up.
Example: If you waited 2 full years to enroll, your premium could be 20% higher for as long as you have Part B.
Medicare Part D (Prescription Drug Plan) Penalty:
Penalty: 1% of the “national base beneficiary premium” ($34.70 in 2024) for each full month you were without Part D or other creditable prescription drug coverage. This penalty is added to your monthly premium for as long as you have Medicare Part D.
Example: If you were without Part D or creditable drug coverage for 20 months, your penalty would be 20% of $34.70, which adds an additional $6.94 to your monthly premium.
How do I enroll in Medicare?
Enrollment In Medicare is done through social security.
NEW TO MEDICARE: If you are enrolling for the first time during your initial enrollment period, you can enroll online at ssa.gov or call social security to schedule a phone appointment. Online, you can enroll only in Part A or both Part A and Part B.
LOSING CREDIBLE COVERAGE: If you are past your initial enrollment period, you will need to have your employer fill out CMS-L564 ER, which can be found at cms.gov . (can I link to this form or tell them where to get it?)
You will need to fill out CMS-40B, which can be found at cms.gov.
Once both forms are filling out, you can upload them online, fax them to your local social security office, or drop off at your local social security office.
How do I get free stuff on tv?
The “free” stuff shown in Medicare commercials generally refers to extra benefits provided by Medicare Advantage plans, not by Original Medicare. These plans are not designed for everyone and many have income requirements, are only offered in certain zip codes and can be misleading to the average consumer.
Consider that the commercials are national and not apply to you. It’s important not to be working with a trusted person that can address your specific healthcare needs.
How can you help me?
I offer you the opportunity to speak directly to one person and not an 800 number or customer service representative from an individual carrier.
I will gather information from you; your doctor’s and prescription medications and will ask you questions regarding your wants and needs.
Most importantly, I will educate you about how Medicare works and what all your options are so that you can narrow down your choices and make an educated decision.
Do you charge a fee?
How My Medicare Enrollment Services Work — At No Cost to You
I understand that navigating Medicare can feel overwhelming, but that’s where I come in. I offer my services to guide you through the Medicare process, and here’s how it works:
- No Fee for My Service:
- You do not pay me anything for helping you choose and enroll in a Medicare plan. My services are completely free to you. Whether it’s explaining your options, helping you compare plans, or handling the enrollment process, there is no out-of-pocket cost for working with me.
- How I’m Compensated:
- When you choose a Medicare Advantage, Supplement (Medigap), or Part D plan through me, I am compensated directly by the insurance company. They pay me a commission for helping you enroll.
- This payment from the insurer has no effect on your premiums or plan costs. You pay the same price whether you sign up through me, go directly to the insurance company, or enroll online.
- No Difference in Price:
- The cost of your Medicare plan will not change based on how you enroll. By working with me, you get the same rates as if you had gone directly to the insurer. The difference is that I’m here to give you personalized support and make sure you’re choosing the best plan for your needs.
- My Role Is to Guide You:
- My goal is to help you navigate the complexities of Medicare, so you don’t have to do it alone. I take the time to understand your unique situation—your health needs, budget, and preferences—and guide you to the plan that’s the right fit.
- I’m available to answer your questions not just during enrollment but throughout the year, ensuring you continue to get the most out of your coverage.