Question 1

What are Medicare Parts A, B, C, and D?

Accepted Answer

Part A is hospital insurance — inpatient stays, skilled nursing, hospice. Part B is medical insurance — outpatient care, doctor visits, durable equipment, preventive screenings. Part C is Medicare Advantage, a private-carrier bundle that replaces Original Medicare with an HMO or PPO plan and usually bundles drug, dental, and vision. Part D is standalone prescription-drug coverage, sold by private carriers and typically paired with Original Medicare plus a Medigap supplement. Most beneficiaries end up on some combination of A + B (+ D for original Medicare, or a C plan if they went the Advantage route).

Question 2

What is the difference between Medigap (Medicare Supplement) and Medicare Advantage?

Accepted Answer

Medigap is a private supplement that pairs with Original Medicare (Parts A + B) and fills specific cost-sharing gaps — typically the Part A deductible, Part B coinsurance, and skilled-nursing coinsurance. Plans are standardized across carriers (Plan G, Plan N, etc.), so the same plan letter from two carriers covers the same things; you compare on price and rate-history. You can see any doctor that accepts Medicare nationwide. Medicare Advantage is a private replacement for Original Medicare, usually an HMO or PPO network with drug coverage bundled in. Premiums are often $0 to low; in exchange you trade provider flexibility and nationwide access for networks, prior authorizations, and a yearly out-of-pocket maximum. The right choice depends on your doctors, your travel, your prescription list, and your tolerance for networks.

Question 3

What are IEP, AEP, and OEP, and when do they each apply?

Accepted Answer

IEP — Initial Enrollment Period — is your first window around age 65: a seven-month span starting three months before the month you turn 65 and ending three months after. Most people enroll in Parts A and B here. AEP — Annual Election Period — runs October 15 through December 7 every year; this is when anyone on Medicare can change Part D plans, switch between Original Medicare and Advantage, or change Advantage plans, with changes effective January 1. OEP — Open Enrollment Period — runs January 1 through March 31 and lets people already on a Medicare Advantage plan make a one-time switch to a different Advantage plan or back to Original Medicare. Outside these windows, most changes require a qualifying life event (a Special Enrollment Period — moving, losing employer coverage, etc.).

Question 4

What is IRMAA, and who actually pays it?

Accepted Answer

IRMAA — Income-Related Monthly Adjustment Amount — is an extra surcharge on Medicare Part B and Part D premiums for higher-income beneficiaries. It is set by Social Security using your tax return from two years prior (so 2026 premiums reflect 2024 income). The thresholds change annually; most beneficiaries never pay it, but people with continued earned income, large capital-gain years, or sizable Roth conversions can find themselves paying several hundred dollars a month extra per person on top of the base premium. IRMAA is appealable with documented life-changing events — work stoppage, marriage, divorce, loss of pension — by filing Form SSA-44 with Social Security.

Question 5

How is Mote Financial paid? Does the consultation really cost anything?

Accepted Answer

No cost to you. Mote Financial is an independent agency contracted with multiple carriers. When we help you enroll in a plan, the carrier pays us a commission — built into the plan price the same way it would be if you called the carrier directly. There is no separate fee, no hourly charge, and no upsell on our end. The first conversation — 30 minutes, phone or video, reviewing where you are with Medicare and what to watch for — is at no cost and at no obligation. The same applies to annual reviews during AEP; we are paid by the carrier, not by the client.

Question 6

I am still working past 65 and have employer coverage. Do I have to enroll in Medicare now?

Accepted Answer

Usually no, but the answer depends on the size of your employer. If you (or your spouse, if covering through a spouse) work for an employer with 20 or more employees, you can credibly defer Part B without penalty while that active group coverage is in place; a Special Enrollment Period opens when employment or coverage ends. If the employer has fewer than 20 employees, Medicare becomes primary at 65 and the group plan typically pays secondary — most people in that situation enroll in Part A and Part B at 65 to avoid claim denials. Part A is usually free at 65 if you or your spouse have enough working quarters. We walk through this on the call — bring the employer size and the group plan summary.

Question 7

How does prescription drug coverage actually work in each plan type?

Accepted Answer

Standalone Part D plans are sold by private carriers for people on Original Medicare + Medigap. You choose a plan based on the formulary, your pharmacy network, and the deductible/TIer/copay structure for your specific list — most people save the most by matching the plan to their drugs, not by picking the cheapest premium. Medicare Advantage plans typically bundle drug coverage (called MAPD) into the same plan; pharmacy network, formulary tiers, and prior-authorization rules all apply, and the same plan letter from one carrier does not equal the same formulary from another. If you take expensive brand-name or specialty medications, the difference between the best and the worst plan on your drug list can easily run four figures a year — which is why a side-by-side drug check is a standard part of every review.

Question 8

Can I keep my current doctor if I change plans?

Accepted Answer

It depends on the plan family. With Original Medicare + Medigap you can see any doctor nationwide that accepts Medicare, with no network restrictions — most doctors do. With Medicare Advantage, coverage runs through the plan’s network (HMO = in-network only, PPO = in-network + out-of-network with higher cost), and each plan’s network and provider list can vary year to year. Before recommending an Advantage plan we run your doctors and preferred hospital against the carrier’s network directory for the upcoming plan year; if any are out-of-network we flag it and discuss whether a Medigap path fits better. If keeping a specific doctor is a hard constraint, say so at the start of the call — it shapes the recommendation.

Question 9

What changes during the Annual Election Period, and why does it matter?

Accepted Answer

AEP — October 15 to December 7 — is the annual window when you can change Part D plans, switch between Original Medicare and Medicare Advantage, or change Medicare Advantage plans, with the new coverage effective January 1. Carriers release new plan details each fall: drug formularies shift, pharmacy network tiers change, premiums and out-of-pocket maximums reset, and provider networks are re-prioritized. A plan that fit last year can quietly cover less, charge more at the pharmacy counter, or drop your doctor from the network — and most people will not catch it on their own. A typical AEP review takes 30 to 45 minutes: run the new drug list against the new plan, sanity-check the doctors, and either re-up the existing plan with eyes open or switch. People who skip AEP and stay put are usually leaving real money on the table.

Question 10

I already have a plan. Do I really need to review it again this year?

Accepted Answer

Yes — preferably once a year during AEP, and certainly any year your drugs, your doctors, your budget, or your county of residence changes. Carriers re-file their plans with Medicare every year, and a plan that fit last year rarely fits this year on all four dimensions at once. The annual review is a no-cost, no-obligation re-comparison: same drugs, same doctors, same priorities, latest plans. If the existing plan still wins, you stay; if a different plan wins by enough to justify a switch, you switch. Either outcome is a good one — the goal is making the call on intent, not on inertia.

Medicare FAQ — the ten questions we hear most, answered honestly.

Five topics, ten questions.

Medicare basics

Plan types

Enrollment windows

Costs

Working with us & access

Medicare basics

Plan types

Enrollment windows

Costs

Working with us & access

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