Frequently Asked Questions
Find answers to common questions about Medicare Part B coverage, costs, enrollment, and the difference between Medicare and Medicaid.
Information Changes Frequently
Medicare policies and regulations change regularly. For the most current information, always verify details with official sources or consult with licensed insurance professionals.
General Medicare Questions
What is Medicare Part B?
Medicare Part B is medical insurance that covers outpatient care, doctor visits, preventive services, and medical supplies. It's one of the two main parts of Original Medicare (along with Part A). Part B requires a monthly premium and covers medically necessary services and preventive care like flu shots, cancer screenings, and annual wellness visits.
What's the difference between Medicare and Medicaid?
Medicare and Medicaid are completely different programs. Medicare is federal health insurance for people 65+ or with disabilities, while Medicaid is state-based assistance for low-income individuals and families. Many people search for "Medicaid Part B" when they actually need Medicare Part B information, which is why our site uses this domain name to help confused searchers.
How is Medicare Advantage different from Original Medicare?
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage plans bundle these benefits and often include Part D (prescription drug coverage) and additional benefits. Medicare Advantage plans typically have provider networks and may require referrals for specialists.
Can I have both Medicare Advantage and Original Medicare?
No, you cannot have both at the same time. When you enroll in a Medicare Advantage plan, you're still in the Medicare program, but your Part A and Part B benefits are provided through the private plan instead of directly through the government.
What's the 2025 Part B premium & deductible?
2025 Part B Premium: $185.00 per month. 2025 Part B Deductible: $257.00.
Will my drug costs really be capped?
Yes! Under the IRA reforms, your out-of-pocket drug costs are capped at $2,000 in 2025 and$2,100 in 2026. Once you reach this threshold, you pay $0 cost-share for covered drugs.
Enrollment & Eligibility
When can I change coverage?
AEP (Annual Enrollment Period): October 15 - December 7, with changes effective January 1.MA-OEP (Medicare Advantage Open Enrollment): January 1 - March 31, allowing one change.
What if I miss my Initial Enrollment Period?
If you miss your Initial Enrollment Period, you may face late enrollment penalties and may need to wait for the Annual Enrollment Period. It's important to enroll when you're first eligible to avoid these penalties.
Can I switch Medicare Advantage plans?
Yes, you can switch plans during the Annual Enrollment Period (October 15 - December 7). You may also qualify for Special Enrollment Periods if you experience certain life events like moving or losing other coverage.
Costs & Premiums
Do I still pay Medicare Part B premiums with Medicare Advantage?
Yes, you typically still pay your Medicare Part B premium even with a Medicare Advantage plan. However, some plans offer Part B premium givebacks that can reduce or eliminate this cost. You may also pay an additional premium for the Medicare Advantage plan itself.
What is IRMAA and how does it affect my costs?
IRMAA (Income-Related Monthly Adjustment Amount) is an additional surcharge for Part B and Part D premiums if your income is above certain thresholds. This affects both Original Medicare and Medicare Advantage plans. The surcharge is based on your tax return from two years ago.
What is a Part B giveback?
A Part B premium reduction that some Medicare Advantage plans offer. Availability and amounts vary by area and plan. Not everyone qualifies, and you must still pay your Part B premium to Medicare to be eligible.
Are there out-of-pocket maximums with Medicare Advantage?
Yes, Medicare Advantage plans have annual maximum out-of-pocket limits. Once you reach this limit, the plan pays 100% of covered services for the rest of the year. This protection is not available with Original Medicare alone.
Coverage & Benefits
Do Medicare Advantage plans cover prescription drugs?
Most Medicare Advantage plans include prescription drug coverage (Part D). These are called MAPD plans. If your plan doesn't include drug coverage, you can enroll in a separate Part D plan, but you cannot have both a Medicare Advantage plan without drug coverage and a standalone Part D plan.
Can I see any doctor with Medicare Advantage?
It depends on your plan type. HMO plans typically require you to use in-network providers, while PPO plans allow you to see out-of-network providers but at higher costs. PFFS plans may allow you to see any provider who accepts the plan's terms.
What additional benefits do Medicare Advantage plans offer?
Many Medicare Advantage plans offer benefits beyond what Original Medicare covers, such as dental, vision, hearing, fitness programs, transportation to medical appointments, and over-the-counter allowances. Benefits vary by plan and location.
Networks & Providers
How do I know if my doctor accepts Medicare Advantage?
Contact your doctor's office directly to ask if they accept the specific Medicare Advantage plan you're considering. You can also check the plan's provider directory or use Medicare's online tools to find participating providers.
What happens if I need to see a specialist?
With HMO plans, you typically need a referral from your primary care doctor to see a specialist. PPO plans usually don't require referrals. Always check your plan's specific requirements for specialist visits.
Can I keep my current doctors when switching to Medicare Advantage?
It depends on whether your doctors are in the new plan's network. Before switching, verify that your current healthcare providers participate in the plan you're considering. If they don't, you may need to find new providers or choose a different plan.
Still Have Questions?
Our FAQ covers the most common questions, but Medicare can be complex. Get personalized help from qualified professionals.
Free Resources
- • 1-800-MEDICARE (24/7)
- • State Health Insurance Assistance Program (SHIP)
- • Medicare.gov online tools
Professional Help
- • Licensed insurance agents
- • Medicare brokers
- • Healthcare navigators
Important: This FAQ provides general information about Medicare Advantage plans. Specific details, costs, and coverage vary by plan and location. Always verify current information with official sources or consult with licensed insurance professionals before making decisions about your Medicare coverage.