Medicare FAQs – Answered by a Local Missouri Expert

Medicare is a federal health insurance program for people 65 or older, or younger individuals with qualifying disabilities. It consists of four parts:

• Part A: Hospital insurance
• Part B: Medical insurance (doctor visits, outpatient care)
• Part C (Medicare Advantage): Private plans that bundle A, B, and usually D
• Part D: Prescription drug coverage

We help you understand how each part works and how to enroll at the right time.

Your Initial Enrollment Period starts 3 months before your 65th birthday, includes your birth month, and extends 3 months after. You may also enroll:

• During Annual Enrollment (Oct. 15 – Dec. 7) to change plans
• During a Special Enrollment Period (after losing coverage, moving, etc.)
• During Open Enrollment for Medigap (first 6 months after enrolling in Part B)

Missing these windows can lead to late penalties — we’ll help you avoid that.

It depends. If you're covered by employer health insurance and your employer has 20+ employees, you may delay Part B without penalty. If the employer is smaller, Medicare may become your primary coverage. We help you decide what’s best based on your specific situation.

• Original Medicare: Coverage from the federal government (Parts A and B), often paired with a Medigap and Part D plan
• Medicare Advantage (Part C): A private insurance plan that bundles hospital, doctor, and often prescription coverage, plus extras like dental or vision

We help you compare both options based on cost, flexibility, and benefits.

That depends on the plan type. HMO plans require you to stay in-network, while PPO plans allow out-of-network providers at a higher cost. We help you choose a plan that includes your preferred doctors.

Some plans have $0 premiums, but they still have copays, coinsurance, and maximum out-of-pocket limits. We walk you through all plan costs, not just the headline.

Yes — unless you have other credible drug coverage, enrolling late in Part D may result in permanent penalties added to your premium. Even a basic plan protects you from penalties and ensures you're covered if your health changes.

Yes, if your pharmacy is in-network for your plan. We help check that during the comparison process to avoid surprises at the counter.

Each plan has a formulary, or list of covered drugs. We match your prescriptions against every plan’s formulary to ensure coverage — and check if there are cheaper alternatives or ways to appeal for coverage if needed.

Medigap policies help cover costs not paid by Original Medicare, such as:

• Part A hospital coinsurance
• Part B copayments and deductibles
• Foreign emergency travel
• Skilled nursing coinsurance

Plans are standardized, so the main difference is monthly premium and company service. We help you choose the right plan for your needs and budget.

During your Medigap Open Enrollment Period — the 6 months after you enroll in Part B. During this time, you can get a policy without medical underwriting. If you wait, you could be denied or pay more.

Each plan has a formulary, or list of covered drugs. We match your prescriptions against every plan’s formulary to ensure coverage — and check if there are cheaper alternatives or ways to appeal for coverage if needed.

A Dual-Eligible Special Needs Plan (DSNP) is for individuals who qualify for both Medicare and Medicaid. These plans offer enhanced benefits, such as dental, transportation, and OTC items, often at no cost. We help you check eligibility and enroll.

There are state and federal programs that can help cover:

• Part B premiums
• Prescription drug costs
• Out-of-pocket expenses

These include Medicaid, Extra Help (LIS), and Medicare Savings Programs. We help you apply if you qualify.

Each plan has a formulary, or list of covered drugs. We match your prescriptions against every plan’s formulary to ensure coverage — and check if there are cheaper alternatives or ways to appeal for coverage if needed.

Original Medicare does not cover routine dental or vision care. We offer standalone plans for exams, cleanings, dentures, glasses, and more — or help you find a Medicare Advantage plan that includes these services.

It’s supplemental insurance that pays you cash for hospital stays, ER visits, outpatient surgery, and more. It’s a great way to protect yourself from unexpected Medicare copays. We help you decide if it’s a good fit for your plan.