50 Most Asked Medicare Questions Answered (2025 Update)
Got Medicare questions? You’re not alone. We have the answers to the top questions people have about Medicare in 2025!
Medicare Basics
- What is Medicare?
Medicare is a federal health insurance program for people 65 and older and some younger people with disabilities or certain conditions.
- Who can get Medicare?
Most people qualify at age 65. Some younger people qualify if they have a disability, ALS, or end-stage renal disease.
- What are the parts of Medicare?
Medicare has four parts: Part A (Hospital insurance), Part B (Medical insurance), Part C (Medicare Advantage), and Part D (Prescription drug coverage).
- Is Medicare free?
No. Many people pay no premium for Part A, but most pay a premium for Part B and Part D.
- What does Medicare cover?
Medicare covers hospital stays, doctor visits, preventive care, some medical equipment, and prescription drugs (if you have Part D).
Signing Up & Eligibility
- When do I sign up for Medicare?
You can sign up during your Initial Enrollment Period, which starts three months before you turn 65 and ends three months after.
- What if I miss my Initial Enrollment Period?
You may have to pay a late enrollment penalty and wait until the General Enrollment Period (Jan 1–Mar 31 each year).
- Can I delay Medicare if I’m still working?
Yes, if you have employer coverage. Sign up for Medicare before employer coverage ends to avoid penalties.
- How do I sign up?
Go to SSA.gov or call Social Security.
- Can non-citizens get Medicare?
Some lawful permanent residents can get Medicare if they meet residency and work requirements.
Coverage & Costs
- What does Part A cover?
Inpatient hospital care, skilled nursing facility care, hospice, and some home health care.
- What does Part B cover?
Doctor visits, outpatient care, preventive services, and medical equipment.
- What does Part C cover?
Everything Parts A and B cover and often extra benefits like vision, dental, or hearing (varies by plan).
- What does Part D cover?
Prescription drugs (coverage and tiers vary by plan).
- How much does Medicare cost in 2025?
Here’s a quick chart for common baseline costs. Part A premium may be up to $518 if you haven’t paid enough Medicare taxes.
Coverage Type Monthly Premium (2025) Deductible Key Details Part A (most people) $0 $1,676 per benefit period Hospital insurance Part B (standard) $185.00 $257 annual Medical insurance Part D (varies by plan) Varies Varies Prescription drugs Medigap (varies by plan) Varies Varies Helps pay deductibles & coinsurance
Prescription Drug Coverage
- Do I have to get Part D?
No, but if you skip it and enroll later, you might pay a penalty.
- Can I get help paying for drugs?
Yes, Extra Help is available for those with limited income.
- How much will I pay for drugs in 2025?
Your out-of-pocket drug costs are capped at $2,000 for the year. Once you reach that, you don’t pay more for covered drugs the rest of the year.
- Does every drug plan cover all my medications?
No, check your plan’s formulary (list of covered drugs).
- Can I change drug plans?
Yes, you can switch plans during the Open Enrollment Period (Oct 15–Dec 7).
Medicare Advantage & Medigap
- What’s Medicare Advantage (Part C)?
A private plan alternative to Original Medicare that includes Part A & Part B and often Part D plus extra benefits. Must still follow Medicare rules.
- How do I choose between Original Medicare and Medicare Advantage?
Original Medicare: nationwide provider access + optional Medigap + separate drug plan. Advantage: managed network, extra perks, annual out-of-pocket max, plan rules may change yearly.
- Can I have both Medicare Advantage and Medigap?
No. Medigap only works with Original Medicare (Parts A & B).
- What’s Medigap?
Optional supplemental insurance that helps pay Part A & B deductibles, coinsurance, and other gaps. Plans are standardized by letter.
- Which Medigap plan is best?
Depends on your priorities (predictable costs vs slightly lower premiums). Common choices: Plan G (broad coverage) and Plan N (lower premium, small copays).
Here’s a simple comparison of popular Medigap plans:
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A coinsurance | Yes | Yes |
| Part B coinsurance | Yes | Yes* |
| Part A deductible | Yes | Yes |
| Skilled nursing coinsurance | Yes | Yes |
| Foreign travel emergency | Yes | Yes |
*Plan N may require a small copay for some office or ER visits. (Plan G and Plan N are the most commonly compared modern Medigap options.)
Doctors & Hospitals
- Can I keep my doctor?
If your doctor accepts Medicare you can keep them. For Advantage plans, confirm they’re in network.
- Are all hospitals covered?
Most accept Medicare, but always verify—especially for specialized services.
- Do I need a referral to see a specialist?
Not with Original Medicare. Some Advantage HMOs require referrals.
- Will Medicare cover care when I travel?
Original Medicare: anywhere in the U.S. Advantage: usually local networks; limited out-of-area coverage. Foreign travel limited unless certain Medigap plans.
- Does Medicare cover telehealth?
Yes. Broader telehealth flexibilities early 2025; core rural-origin rules reapply later except some mental health telehealth remains available from home.
Preventive & Wellness Services
- What preventive services does Medicare cover?
Many screenings and vaccines (flu, pneumonia, mammograms, diabetes, cardio, some cancer screenings).
- Does Medicare cover mental health?
Yes—outpatient therapy, depression screenings, and expanded provider types.
- Does Medicare cover dental, vision, and hearing?
Original Medicare generally doesn’t. Some Advantage plans include extras; limited Medigap added benefits via riders in some states.
- What is the wellness visit?
An annual planning visit: risk review, vitals, meds list, preventive schedule.
- Are home health services covered?
Yes if medically necessary and you meet criteria (intermittent skilled care).
Claims, Billing & Appeals
- How do I check what Medicare paid?
Review your Medicare Summary Notice (MSN) issued quarterly or use your secure online account.
- What if I get a bill I don’t understand?
Compare it to the MSN or Explanation of Benefits; then call the provider’s billing office for clarification.
- How do I appeal a Medicare decision?
Follow the appeal instructions on your MSN or plan notice; there are multiple escalating levels.
- What is “assignment”?
When a provider accepts the Medicare-approved amount as full payment (you pay standard cost sharing only).
- What is a “benefit period”?
The Part A measurement window that begins with inpatient admission and ends after 60 days without inpatient/skilled care.
Special Circumstances
- Can I have Medicare and Medicaid?
Yes—dual eligible individuals may have most cost sharing reduced.
- What’s Extra Help?
A federal program lowering Part D premiums, deductibles, and drug copays for qualifying incomes.
- What is a late enrollment penalty?
Added premium cost for delaying Part B or Part D when not covered by creditable coverage.
- Does Medicare cover long-term nursing home care?
Only limited skilled nursing stays—custodial long-term care is not covered.
- Does Medicare cover hospice care?
Yes for qualifying terminal illness (focuses on comfort care).
Changes & Updates for 2025
- What’s new in Medicare for 2025?
Part D out-of-pocket cap at $2,000; expanded mental health access; evolving telehealth flex rules; admin updates for certain federal retiree groups.
- Can I pay Medicare premiums online?
Yes—via secure online account or automatic bank draft; paper billing still available.
- How do I replace a lost Medicare card?
Request a replacement through your secure online Medicare or Social Security account.
- Can I get help choosing a Medicare plan?
Yes—organize your doctors, drugs, and budget then request a personal review to compare structured options.
- Where can I find official Medicare information?
The official federal Medicare website hosts current rules, costs, and forms (use it for verification).
Quick Reference: Enrollment Periods
| Enrollment Period | When It Happens | What You Can Do |
|---|---|---|
| Initial Enrollment | Around 65th birthday (7-month window) | Sign up for Parts A & B (and D if needed) |
| General Enrollment | Jan 1 – Mar 31 | Sign up if you missed IEP (coverage starts later) |
| Open Enrollment | Oct 15 – Dec 7 | Switch Advantage or Part D plans |
| Advantage OEP | Jan 1 – Mar 31 | One Advantage switch or drop to Original Medicare |
What Medicare Doesn’t Commonly Cover
- Routine dental care
- Routine eye exams for glasses
- Hearing aids
- Most long-term custodial care
- Cosmetic surgery (non-medically necessary)
The Bottom Line
Medicare has moving parts, but it becomes clear when you break it into steps: eligibility, coverage choices, cost management, and annual review. These 50 questions give you a structured foundation for 2025.
Next: list your doctors, drugs, and budget range—then compare a few real plan scenarios. If you want a guided walkthrough, schedule a review and bring that list so the conversation stays focused.