Medicare and ACA questions, answered.

When should I sign up for Medicare?

Your Initial Enrollment Period is 7 months long. It starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after it. If you already get Social Security benefits at least 4 months before you turn 65, you're enrolled in Parts A and B automatically.

Sign up in the 3 months before your birthday month and your coverage starts the first day of your birthday month.

Do I have to sign up for Medicare at 65 if I'm still working?

It depends on the size of your employer. If you or your spouse are still working for an employer with 20 or more employees and have health coverage through that job, you can usually delay Part B without a penalty. If the employer has fewer than 20 employees, Medicare usually pays first, so you should enroll at 65.

When the job or the coverage ends, whichever comes first, you have 8 months to sign up for Part B without a penalty. COBRA and retiree coverage don't count as coverage from current work.

What is the Medicare Annual Enrollment Period?

The Annual Enrollment Period runs October 15 to December 7 every year. During it you can switch Medicare Advantage plans, move between Medicare Advantage and Original Medicare, or join, switch, or drop a Part D drug plan. Your changes start January 1.

What's the difference between Medicare Advantage and Medicare Supplement?

Medicare Advantage replaces Original Medicare with a private plan that usually has a provider network, set copays, a yearly out-of-pocket limit, and drug coverage. Medicare Supplement, or Medigap, works alongside Original Medicare and pays some or all of the costs it leaves behind. A Medigap policy doesn't work with a Medicare Advantage plan.

Medigap usually costs more each month but lets you see any provider in the country that takes Medicare. It doesn't include drug coverage, so most people add a Part D plan.

Can I switch from Medicare Advantage back to Original Medicare?

Yes. From January 1 to March 31, if you're in a Medicare Advantage plan you can switch to a different one or return to Original Medicare, one time. You can also switch during the Annual Enrollment Period from October 15 to December 7.

Buying a Medigap policy afterward isn't guaranteed. Outside your Medigap open enrollment period or a guaranteed issue right, insurers can ask health questions and turn you down. If you joined Medicare Advantage when you were first eligible at 65, you have a 12-month trial right to switch back and buy a Medigap policy without health questions.

Is there a penalty for signing up for Medicare late?

Yes. If you don't sign up for Part B when you're first eligible and don't have other qualifying coverage, your Part B premium goes up 10% for each full 12 months you could have had it. The Part D penalty adds 1% of a base premium for each month without drug coverage. Both usually last as long as you have Medicare.

Do I need a Part D plan if I don't take any prescriptions?

Usually yes, unless you have other creditable drug coverage, like from a current employer. If you go 63 days or more without Part D or similar coverage after you're first eligible, you'll pay a late penalty when you join later, usually for as long as you have Part D. A low-premium plan protects you if you need medications later.

What is the most I'll pay for prescriptions with Medicare in 2027?

In 2027, your out-of-pocket cost for covered Part D drugs is capped at $2,400 for the year. Once you reach it, you pay nothing more for covered drugs until January. A covered insulin costs no more than $35 for a one-month supply, and the highest deductible a Part D plan can charge is $700.

Does Medicare cover dental, vision, and hearing?

Original Medicare doesn't cover most routine dental care, eyeglasses, or hearing aids. Many Medicare Advantage plans include some dental, vision, and hearing benefits, but what's covered and how much varies by plan. You can also buy a separate dental or vision policy.

Can I keep my doctor with a Medicare Advantage plan?

Only if your doctor is in the plan's network. Medicare Advantage HMOs generally cover only in-network care except for emergencies and urgent care, while PPOs also cover out-of-network care at a higher cost. Before you enroll, we check each of your doctors against the plan's network.

What is Extra Help for Medicare drug costs?

Extra Help is a federal program that lowers Part D premiums, deductibles, and copays for people with limited income and resources. You qualify automatically if you have Medicaid, a Medicare Savings Program, or Supplemental Security Income. Otherwise you can apply through Social Security online or at 1-800-772-1213.

Does it cost more to use a health insurance agent?

No. Insurance companies pay agents a commission that's already built into every plan's price. Your premium is the same whether you enroll through an agent, on your own, or directly with the insurance company, for both Medicare and ACA plans.

What's the difference between an independent and a captive insurance agent?

A captive agent works for one insurance company and can only offer its plans. An independent agent, like ClearFocus Coverage, works with several companies, so we can compare plans from more than one. No agent offers every plan, so Medicare.gov and HealthCare.gov are always there to see all of your options.

How can I check that an insurance agent is licensed in Texas?

Use the license lookup on the Texas Department of Insurance website, tdi.texas.gov, or look up the agent's National Producer Number through NIPR. Michael Callaghan's NPN is 21775459, and he's licensed in Texas, New Mexico, and Arizona.

Where can I get free Medicare help in El Paso?

Call ClearFocus Coverage at (915) 588-2115 for free help comparing plans with a licensed agent. For free counseling that isn't tied to any insurance company, Texas has HICAP, the state's health insurance counseling program, at 1-800-252-9240. You can also call 1-800-MEDICARE (1-800-633-4227).