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Top 10 Medicare Questions from New Beneficiaries: Expert Answers from PromiseCare Medical Group

Introduction: Navigating Medicare with Confidence

Turning 65 brings exciting opportunities and important healthcare decisions. For new Medicare beneficiaries in the Inland Empire, understanding this federal health insurance program can feel overwhelming. PromiseCare Medical Group, the region’s largest Independent Physician Association with over 60 primary care physicians and 400 specialists, helps thousands of patients navigate Medicare enrollment and coverage every year.

Dr. Michael Curley, a board-certified family medicine physician with over 37 years of experience at PromiseCare Medical Group, frequently guides new beneficiaries through their Medicare journey. “The most common concern I hear is confusion about enrollment periods and coverage options,” explains Dr. Curley, who specializes in geriatric medicine and women’s health. “My patients want to make informed decisions, but they’re not sure where to start.”

This comprehensive guide answers the top 10 Medicare questions that new beneficiaries ask most frequently. Whether you’re approaching your Initial Enrollment Period or helping a loved one understand their options, these expert insights from PromiseCare Medical Group physicians will help you make confident healthcare decisions.

Question 1: What’s the Difference Between Medicare Part A, Part B, Part C, and Part D?

Understanding the different parts of Medicare is essential for new beneficiaries. Each component provides specific coverage, and knowing how they work together helps you choose the right combination for your healthcare needs.

Medicare Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes for at least 10 years during their working years.

Medicare Part B (Medical Insurance) covers doctor visits, outpatient care, preventive services, medical equipment, and some home health services. Part B requires a monthly premium, which varies based on your income level. In 2026, the standard Part B premium is $202.90 for most beneficiaries.

Medicare Part C (Medicare Advantage) offers an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. These plans combine Part A, Part B, and usually Part D into one comprehensive plan. Many Medicare Advantage plans include additional benefits that Original Medicare doesn’t cover, such as dental, vision, and hearing services.

Dr. Ratan Tiwari, a board-certified cardiologist with PromiseCare Medical Group in Hemet, frequently sees patients enrolled in Medicare Advantage plans. “Medicare Advantage can be excellent for patients who want coordinated care through a network of providers,” says Dr. Tiwari. “These plans often include prescription drug coverage and extra benefits that help with overall wellness.”

Medicare Part D (Prescription Drug Coverage) helps cover the cost of prescription medications and recommended vaccines. You can add Part D coverage to Original Medicare through a standalone prescription drug plan, or get it included in most Medicare Advantage plans.

Original Medicare refers to the combination of Part A and Part B administered directly by the federal government. With Original Medicare, you can see any doctor or specialist who accepts Medicare without network restrictions, though you’ll need to add separate Part D coverage for prescription drugs.

Question 2: When Should I Enroll in Medicare?

Timing your Medicare enrollment correctly helps you avoid coverage gaps and late enrollment penalties that could increase your healthcare costs for years to come.

The Initial Enrollment Period is your first opportunity to sign up for Medicare. This seven-month window begins three months before the month you turn 65, includes your birthday month, and extends three months after. For example, if you turn 65 in July, your Initial Enrollment Period runs from April through October.

Dr. Edivina Gonzales, an internal medicine physician with PromiseCare Medical Group, emphasizes the importance of enrolling on time. “I advise my patients to sign up during the three months before their 65th birthday,” explains Dr. Gonzales. “This ensures their coverage starts right when they turn 65, avoiding any gaps in protection.”

If you’re already receiving Social Security retirement benefits when you turn 65, you’ll be automatically enrolled in Medicare Part A and Part B. You’ll receive your Medicare card in the mail about three months before your 65th birthday.

Special Enrollment Periods allow you to enroll in Medicare or make changes to your coverage outside the normal enrollment windows when specific life events occur. Common triggers include:

The General Enrollment Period runs from January 1 through March 31 each year. This period is for people who missed their Initial Enrollment Period and don’t qualify for a Special Enrollment Period. However, coverage doesn’t begin until July 1, and you may face late enrollment penalties.

The Annual Enrollment Period (also called Medicare Open Enrollment) takes place every year from October 15 through December 7. During this time, all Medicare beneficiaries can:

Question 3: Can I Keep Working After 65 and Delay Medicare Enrollment?

Many people continue working past age 65, raising questions about whether they need to enroll in Medicare immediately or can delay enrollment without penalty.

If you or your spouse have health insurance through a current employer with 20 or more employees, you can generally delay enrolling in Medicare Part B without facing late enrollment penalties. This is called creditable coverage – health insurance that’s considered as good as or better than Medicare.

Dr. David Stanford, an internal medicine physician with PromiseCare Medical Group, works with many patients navigating employment and Medicare decisions. “I recommend my working patients confirm with their employer’s human resources department that their coverage is creditable,” says Dr. Stanford. “This documentation becomes important when you eventually enroll in Medicare.”

Key considerations for working beneficiaries:

If your employer has fewer than 20 employees, Medicare typically becomes your primary insurance at age 65, even if you keep your employer coverage. In this case, you should enroll in Medicare Part A and Part B during your Initial Enrollment Period.

You should still enroll in premium-free Part A at 65, as there’s no cost and it can provide secondary coverage. However, if you’re contributing to a Health Savings Account (HSA), enrolling in any part of Medicare makes you ineligible for future HSA contributions.

When your employer coverage ends, you have an eight-month Special Enrollment Period to sign up for Medicare Part B without penalty. This window begins the month after your employment ends or your group health coverage terminates, whichever happens first.

If you delay Medicare enrollment when you should have enrolled, you’ll face late enrollment penalties. The Part B penalty equals 10% of the current Part B premium for each 12-month period you were eligible but didn’t enroll. This penalty continues for as long as you have Medicare Part B coverage.

Question 4: What’s the Difference Between Medicare Advantage and Original Medicare with Medigap?

Choosing between Medicare Advantage and Original Medicare with supplemental coverage represents one of the most important decisions new beneficiaries face.

Original Medicare with Medigap gives you maximum flexibility in choosing healthcare providers. With Original Medicare, you can see any doctor or specialist in the United States who accepts Medicare, without needing referrals or worrying about network restrictions. You pay deductibles, copayments, and coinsurance for covered services.

Medigap (also called Medicare Supplement Insurance) helps cover the out-of-pocket costs that Original Medicare doesn’t pay. Private insurance companies offer standardized Medigap plans, designated by letters (Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N). All plans with the same letter offer identical benefits regardless of which insurance company sells them – price is the only difference.

Dr. Gordon Skeoch, a family practice physician with PromiseCare Medical Group, helps patients understand their supplement options. “Medigap can provide excellent predictability for healthcare costs,” explains Dr. Skeoch. “Patients with Plan F or Plan G typically have minimal out-of-pocket expenses when they receive care.”

Important limitations of Medigap include:

Medicare Advantage plans bundle your hospital insurance, medical insurance, and usually prescription drug coverage into one comprehensive plan offered by private insurance companies. About 81% of Medicare Advantage plans include Part D coverage.

Advantages of Medicare Advantage include:

Important considerations for Medicare Advantage:

Most plans operate as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), which means you typically need to use doctors and hospitals within the plan’s network. HMO plans usually require you to choose a primary care physician and get referrals to see specialists. PPO plans offer more flexibility to see out-of-network providers, though you’ll generally pay higher costs.

Plans can change their benefits, costs, and provider networks each year, so you should review your coverage during every Annual Enrollment Period. If you move outside your plan’s service area, you’ll need to switch to a different plan or return to Original Medicare.

Question 5: How Much Does Medicare Cost?

Understanding Medicare costs helps new beneficiaries budget accurately for healthcare expenses and choose coverage that fits their financial situation.

Medicare Part A costs:

Most people pay $0 premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. If you don’t qualify for premium-free Part A, the 2026 premium is up to $518 per month depending on work history.

Part A includes an annual deductible ($1,676 in 2026) for each benefit period. A benefit period begins when you enter a hospital and ends when you haven’t received inpatient care for 60 consecutive days.

Medicare Part B costs:

The standard Part B monthly premium is $202.90 in 2026. Higher-income beneficiaries pay more through Income Related Monthly Adjustment Amounts (IRMAA). If your modified adjusted gross income exceeds certain thresholds, your Part B premium increases on a sliding scale.

Part B also has an annual deductible ($283 in 2026). After meeting this deductible, you typically pay 20% coinsurance for most covered services.

Medicare Part D costs:

Prescription drug plan premiums vary by plan and location, averaging around $40-$50 per month. Like Part B, higher-income beneficiaries may pay IRMAA surcharges on top of their plan premium.

Part D plans include an annual deductible (up to $632 in 2026, though many plans have lower deductibles). You’ll pay copayments or coinsurance for medications based on their formulary tier.

Medicare Advantage costs:

Plan premiums range from $0 to over $100 per month, with the average around $17 per month in 2026. Remember, you still pay your Part B premium even with a $0 Medicare Advantage premium.

Medicare Advantage plans have maximum out-of-pocket limits for covered services, typically ranging from $2,000 to $8,850 annually. This cap protects you from catastrophic healthcare costs that Original Medicare doesn’t limit.

Medigap costs:

Monthly premiums vary significantly based on your age, location, tobacco use, and the specific plan you choose. On average, Medigap Plan G premiums range from $120 to $400 per month, depending on your state and insurance company.

Dr. Abid Hussain, an internal medicine physician with PromiseCare Medical Group, counsels patients on managing Medicare costs. “I encourage my patients to consider their total healthcare picture, not just premiums,” advises Dr. Hussain. “Someone who takes multiple medications might save money with Medicare Advantage despite higher premiums, while someone who rarely needs medical care might prefer Original Medicare with a high-deductible Medigap plan.”

Question 6: What Extra Financial Help Is Available for Medicare Costs?

Several assistance programs help Medicare beneficiaries with limited income and resources afford their healthcare coverage and prescription medications.

Extra Help (also called the Low-Income Subsidy) assists with Medicare Part D prescription drug plan costs. Qualifying beneficiaries receive help paying monthly premiums, annual deductibles, and prescription copayments. The program saves participants an average of $5,000 annually on drug costs.

To qualify for Extra Help in 2026, your annual income must be below $22,590 (individual) or $30,660 (married couple), and your resources must be under $17,220 (individual) or $34,360 (married couple). Resources include bank accounts, stocks, and bonds, but exclude your home, car, and personal belongings.

Medicare Savings Programs help pay Medicare premiums, deductibles, and coinsurance for people with limited income and resources. Four programs offer different levels of assistance:

Qualified Medicare Beneficiary (QMB) Program pays your Part A and Part B premiums, deductibles, copayments, and coinsurance. For 2026, income limits are $1,275/month (individual) or $1,725/month (couple).

Specified Low-Income Medicare Beneficiary (SLMB) Program pays your Part B premium only. Income limits are $1,529/month (individual) or $2,067/month (couple).

Qualifying Individual (QI) Program also pays your Part B premium and has income limits of $1,719/month (individual) or $2,320/month (couple).

Qualified Disabled and Working Individual (QDWI) Program pays Part A premiums for certain disabled individuals who lost their premium-free Part A coverage due to returning to work.

Medicaid provides comprehensive health coverage for people with limited income and resources. Some people qualify for both Medicare and Medicaid (called “dual eligible”). Medicaid can help pay Medicare premiums, deductibles, and services that Medicare doesn’t cover.

Dr. Hemchand Kolli, a family practice physician with PromiseCare Medical Group, helps connect patients with assistance programs. “Many of my patients don’t realize they qualify for help,” notes Dr. Kolli. “I always ask about financial concerns during appointments because these programs can make a huge difference in accessing necessary care and medications.”

Question 7: Can I Change My Medicare Coverage After I Enroll?

Medicare provides several opportunities throughout the year to make changes to your coverage, though the types of changes you can make depend on the specific enrollment period.

During the Annual Enrollment Period (October 15 – December 7):

All Medicare beneficiaries can make these changes, which take effect January 1:

During the Medicare Advantage Open Enrollment Period (January 1 – March 31):

If you’re already enrolled in a Medicare Advantage plan, you can make one change during this period:

During Special Enrollment Periods:

Certain life events trigger Special Enrollment Periods that allow you to make coverage changes outside normal enrollment windows. Qualifying events include:

Dr. Sylvia Gisi, a family practice physician with PromiseCare Medical Group, emphasizes the importance of annual plan reviews. “Healthcare needs change, and so do Medicare plans,” explains Dr. Gisi. “I remind my patients every fall to review their coverage during the Annual Enrollment Period. A plan that worked perfectly last year might not be the best fit this year.”

Important limitations on changing coverage:

You generally can’t drop Medigap coverage and buy a new policy later if your health has deteriorated. Medigap Open Enrollment Period occurs during your first six months of having Medicare Part B at age 65 or older. After this window, insurance companies can use medical underwriting to deny coverage or charge higher premiums.

If you switch from Medicare Advantage back to Original Medicare, you may not be able to buy a Medigap policy depending on your situation. Some states offer trial periods or special situations where you have guaranteed-issue rights to buy Medigap after leaving Medicare Advantage.

Question 8: What Preventive Services Does Medicare Cover?

Medicare’s comprehensive preventive care benefits help beneficiaries stay healthy and catch health problems early when they’re most treatable.

Covered preventive services at no cost (when provided by participating providers):

Medicare Part B covers numerous preventive services without requiring you to pay deductibles or coinsurance:

Annual wellness visits: After your first year on Medicare, you can get an annual wellness visit to develop or update a personalized prevention plan. This visit includes health risk assessments and screenings tailored to your needs.

“Welcome to Medicare” preventive visit: Within your first 12 months of Part B coverage, you’re eligible for one comprehensive preventive visit reviewing your medical and social history, depression screening, and personalized health advice.

Cardiovascular disease screening: Blood tests to check cholesterol, lipids, and triglycerides every five years help identify heart disease risk factors.

Diabetes screening: If you have high blood pressure, high cholesterol, obesity, or a family history of diabetes, you can receive screening tests up to twice yearly.

Depression screening: Annual screening helps identify mental health concerns that are common but often unrecognized in older adults.

Cancer screenings include:

Bone mass measurement: Medicare covers bone density tests every 24 months (or more frequently if medically necessary) to screen for osteoporosis.

Vaccinations: Medicare Part B covers flu shots, pneumococcal vaccines, hepatitis B vaccines (for high-risk individuals), and COVID-19 vaccines. Part D covers other vaccines like shingles.

Dr. Jorge Martinez, an internal medicine physician with PromiseCare Medical Group, encourages all his patients to take advantage of preventive services. “Preventive care is one of Medicare’s best features,” says Dr. Martinez. “These screenings catch problems early when they’re easier and less expensive to treat. I’ve diagnosed serious conditions during routine wellness visits that might otherwise have gone undetected.”

Question 9: What Happens If I Have Other Health Insurance Besides Medicare?

Many Medicare beneficiaries have additional health coverage from employers, unions, the Veterans Administration, TRICARE, or other sources. Understanding how these coverages work together (called coordination of benefits) helps you maximize your benefits and avoid overpayment.

Employer or union coverage:

If you have coverage from current employment (yours or your spouse’s) at a company with 20 or more employees, the employer plan typically pays primary and Medicare pays secondary. This means the employer plan pays first, and Medicare covers what your employer plan doesn’t pay, up to Medicare-approved amounts.

For employers with fewer than 20 employees, Medicare pays primary and your employer plan pays secondary. Even if your employer plan has better benefits than Medicare, Medicare still pays first.

Retiree health insurance:

Most retiree coverage pays secondary to Medicare, meaning Medicare pays first and your retiree plan may cover some or all of your remaining costs. Check with your benefits administrator about how your specific plan coordinates with Medicare.

Dr. William Cherry, a family practice physician with PromiseCare Medical Group, helps patients understand coordination of benefits. “I see confusion about this frequently,” notes Dr. Cherry. “Patients assume their retiree coverage means they don’t need Medicare Part B, but in most cases, they should enroll to avoid coverage gaps and late enrollment penalties.”

TRICARE coverage:

TRICARE and TRICARE for Life work as secondary payers to Medicare for beneficiaries who have both. Medicare pays first, and TRICARE covers most or all of your remaining out-of-pocket costs. You must have Medicare Part A and Part B to keep TRICARE coverage after age 65.

Veterans Affairs (VA) benefits:

VA benefits and Medicare don’t coordinate – they’re separate programs. If you’re eligible for both, you can use either system, but one doesn’t pay for care you receive through the other. Many veterans use VA for certain services while using Medicare for others.

Important consideration: Having VA coverage is not considered creditable coverage for Medicare Part D. If you don’t enroll in Part D during your Initial Enrollment Period and don’t have other creditable prescription drug coverage, you’ll face late enrollment penalties when you eventually join a Part D plan.

Medicaid:

For beneficiaries eligible for both Medicare and Medicaid (dual eligible), Medicare pays first for Medicare-covered services. Medicaid then covers Medicare cost-sharing and services that Medicare doesn’t cover. Many states offer special Medicare Advantage plans designed specifically for dual eligible beneficiaries.

Coordination of benefits saves money but requires attention:

Understanding which insurance pays primary versus secondary helps you avoid billing problems. Always provide all your insurance information to healthcare providers and keep your Medicare card accessible even if you have other coverage.

Question 10: How Do I Choose Between Medicare Advantage and Original Medicare?

Deciding between Medicare Advantage and Original Medicare with supplemental coverage depends on your healthcare needs, budget, provider preferences, and lifestyle. Both options provide comprehensive coverage, but they work very differently.

Choose Medicare Advantage if you:

Prefer comprehensive benefits in one plan including medical, hospital, and prescription drug coverage (and often dental, vision, and hearing). Most Medicare Advantage plans bundle these services together with a single membership card and one monthly premium.

Want predictable, lower monthly premiums with an out-of-pocket maximum that protects you from catastrophic medical expenses. Unlike Original Medicare which has no cap on cost-sharing, Medicare Advantage plans limit your annual spending on covered services.

Are comfortable using a network of providers and getting care coordination through a primary care physician. Many Medicare Advantage HMO plans require referrals to see specialists, which some patients appreciate for coordinated care.

Value extra benefits like gym memberships, transportation to medical appointments, over-the-counter allowances, and alternative medicine coverage. These added benefits can improve quality of life and wellness.

Have a chronic condition that benefits from disease management programs. Many Medicare Advantage plans offer specialized programs for diabetes, heart disease, asthma, and other conditions with dedicated nurse care coordinators and educational resources.

Choose Original Medicare with Medigap if you:

Want freedom to see any doctor or specialist anywhere in the United States who accepts Medicare, without network restrictions or referrals. This flexibility is particularly valuable if you travel frequently, spend time in multiple states, or want access to specialized medical centers.

Prefer predictable, minimal out-of-pocket costs for healthcare services. Comprehensive Medigap plans (like Plan F or Plan G) cover most of what Medicare doesn’t pay, leaving you with very few unexpected medical bills.

Have complex medical needs requiring frequent specialist care or multiple providers. Original Medicare allows you to self-refer to specialists and see multiple doctors without coordinating through a primary care physician or plan network.

Travel internationally and want coverage for medical emergencies abroad. Some Medigap plans cover emergency care during foreign travel, while Medicare Advantage plans typically don’t.

Don’t want your coverage to change from year to year. Medigap benefits are standardized and don’t change annually like Medicare Advantage plan benefits, networks, and costs can.

Dr. Anita Jackson, who practices family medicine and geriatric medicine at PromiseCare Medical Group in Lake Elsinore, guides patients through this decision regularly. “There’s no universal right answer,” explains Dr. Jackson. “I help patients evaluate their priorities. Someone who values provider choice and doesn’t mind paying higher premiums for predictability might prefer Original Medicare with Medigap. Others who want comprehensive benefits including dental and vision with lower monthly costs might choose Medicare Advantage.”

Important factors to consider in your decision:

Your healthcare utilization: Do you see doctors frequently or only for annual wellness visits? Higher users of healthcare services might benefit from Medigap’s comprehensive coverage, while healthier beneficiaries might save money with Medicare Advantage’s lower premiums and annual out-of-pocket maximum.

Your prescription medications: Compare the formularies (list of covered drugs) in Medicare Advantage plans or standalone Part D plans to ensure your medications are covered at affordable costs. Specialty medications in particular can vary significantly in coverage and pricing.

Your preferred doctors and hospitals: Before choosing Medicare Advantage, confirm your current physicians are in the plan’s network and will remain there. With PromiseCare Medical Group’s extensive network throughout the Inland Empire, many local Medicare Advantage plans include our physicians.

Your budget: Calculate total yearly costs including premiums, deductibles, copayments, coinsurance, and maximum out-of-pocket limits. Sometimes plans with higher premiums result in lower total costs if you use healthcare services frequently.

Your health status: If you have chronic conditions requiring regular specialist care, medication management, or hospital admissions, run scenarios for both Medicare Advantage and Original Medicare plus Medigap to see which saves money.

Your geographic stability: If you might move or spend extended time in different locations, Original Medicare’s nationwide acceptance provides more flexibility than Medicare Advantage plans’ geographic restrictions.

Conclusion: Making Informed Medicare Decisions with PromiseCare Medical Group

Understanding Medicare’s components, costs, enrollment periods, and coverage options empowers new beneficiaries to make confident healthcare decisions. While the program initially seems complex, breaking it down into these fundamental questions reveals a structure designed to provide comprehensive, affordable healthcare for seniors and people with disabilities.

PromiseCare Medical Group’s physicians throughout the Inland Empire – including Hemet, Murrieta, Temecula, Menifee, Lake Elsinore, and surrounding communities – partner with Medicare beneficiaries every day to ensure they receive excellent care regardless of which coverage option they choose. Our network accepts most Medicare Advantage plans serving the region, and we work seamlessly with Original Medicare beneficiaries.

“The most important thing is that you have Medicare coverage,” emphasizes Dr. Michael Curley. “Whether you choose Original Medicare with Medigap or a Medicare Advantage plan, you’re accessing comprehensive healthcare benefits that protect your health and financial security. Our team at PromiseCare Medical Group is here to provide exceptional care no matter which path you take.”

Taking the next steps:

If you’re approaching your 65th birthday and Initial Enrollment Period, start researching your options at least three to four months in advance. Use Medicare.gov’s Plan Finder tool to compare Medicare Advantage and Part D plans available in your area.

Schedule an appointment with your primary care physician at PromiseCare Medical Group to discuss your healthcare needs and get personalized guidance on which coverage options might work best for your situation.

Contact the Social Security Administration at 1-800-772-1213 to apply for Medicare, or visit SSA.gov to complete your application online.

Reach out to your State Health Insurance Assistance Program (SHIP) for free, unbiased Medicare counseling. California residents can find their local SHIP at www.aging.ca.gov/HICAP.

Remember that Medicare decisions aren’t permanent. If your first choice doesn’t work as well as hoped, you’ll have opportunities during future enrollment periods to make changes. The key is starting with informed decisions based on your current health status, budget, and healthcare preferences.

PromiseCare Medical Group’s commitment to serving Medicare beneficiaries throughout the Inland Empire means you have access to quality physicians, comprehensive care coordination, and local healthcare expertise as you navigate your Medicare journey.

Frequently Asked Questions

Q: Can I have both Medicare and Medicaid at the same time?

Yes, people who qualify for both programs are called “dual eligible.” Medicare provides your primary health coverage, while Medicaid helps pay Medicare premiums, deductibles, copayments, and covers services Medicare doesn’t include. Many states offer special Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) designed specifically for people with both coverages. These plans coordinate benefits between Medicare and Medicaid to simplify your healthcare experience.

Q: What happens to my Medicare coverage if I move to a different state?

Original Medicare coverage continues nationwide when you move. You can see any doctor or hospital that accepts Medicare in your new location. However, if you have a Medicare Advantage or Part D plan, coverage is typically limited to specific service areas. When you move, you’ll qualify for a Special Enrollment Period to switch to a plan available in your new location. Your coverage changes take effect the month after you enroll in your new plan.

Q: Does Medicare cover vision, dental, and hearing care?

Original Medicare provides very limited coverage for these services. Medicare Part B covers some diagnostic tests related to eye diseases and one pair of glasses or contact lenses after cataract surgery. It doesn’t cover routine eye exams, contact lenses, eyeglasses, hearing aids, or most dental care. Many Medicare Advantage plans include supplemental dental, vision, and hearing benefits as added value. Alternatively, you can purchase standalone dental and vision insurance policies.

Q: How does Medicare work with my Health Savings Account (HSA)?

Once you enroll in any part of Medicare (Part A, Part B, Part C, or Part D), you can no longer contribute to an HSA, though you can continue using funds already in your account. If you’re still working and want to keep contributing to your HSA, you should delay enrolling in Medicare Part A if possible. However, if you delay Part A enrollment beyond your Initial Enrollment Period and you’re receiving Social Security benefits, Medicare will automatically enroll you and reimburse premiums retroactively up to six months.

Q: Can I drop my Medicare Part B coverage if I have other insurance?

You can voluntarily disenroll from Part B, but this is rarely advisable. If you drop Part B and later want to re-enroll, you’ll need to wait for the General Enrollment Period (January 1 – March 31), your coverage won’t start until July 1, and you’ll face late enrollment penalties. Only drop Part B if you have creditable coverage through current employment at a company with 20+ employees. Consult with a Medicare counselor before making this decision.

Q: What’s the difference between Medicare and Medicaid?

Medicare is a federal health insurance program primarily for people 65 and older, regardless of income. Some people under 65 qualify due to disability or End-Stage Renal Disease. Medicaid is a joint federal and state program that provides health coverage for people with limited income and resources, regardless of age. Eligibility requirements, covered services, and program rules vary by state for Medicaid, while Medicare operates under uniform federal standards nationwide.

Q: Does Medicare cover care when I travel outside the United States?

Original Medicare generally doesn’t cover healthcare services outside the U.S., with limited exceptions for emergencies in Canada or Mexico when traveling between Alaska and the continental U.S. Some Medigap plans include foreign travel emergency coverage (up to plan limits). Most Medicare Advantage plans don’t provide foreign coverage except for emergency care. If you travel internationally frequently, consider purchasing travel health insurance or choosing a Medigap plan with foreign travel benefits.

Q: What do I do if my Medicare claim is denied?

You have the right to appeal any Medicare coverage or payment decision. The appeals process includes multiple levels: redetermination by your Medicare contractor or plan, reconsideration by an independent reviewer, hearing before an administrative law judge, Medicare Appeals Council review, and judicial review in federal court. Time limits apply at each level, typically 60 days to file an appeal. The back of your Medicare Summary Notice or Explanation of Benefits explains how to appeal.

Q: Can I get Medicare if I never worked or didn’t work long enough to qualify for Social Security?

If you’re married, you may qualify for premium-free Medicare Part A based on your spouse’s work record. If you’re not married or your spouse doesn’t have enough work credits, you can purchase Medicare Part A by paying monthly premiums ($518 per month in 2026 if you have fewer than 30 quarters of coverage). You can enroll in Part B regardless of work history by paying the standard monthly premium. Some people qualify for Medicare at any age due to disability or End-Stage Renal Disease.

Q: How does Medicare cover home healthcare services?

Medicare Part A and Part B cover home health services if you meet specific requirements: You must be homebound (leaving home requires considerable effort), under a doctor’s care with a plan for home health, and need skilled nursing care, physical therapy, speech therapy, or occupational therapy. Covered services include part-time skilled nursing care, physical therapy, speech-language pathology, occupational therapy, medical social services, and home health aide services. Medicare doesn’t cover 24-hour care, meals delivered to your home, or custodial care when that’s the only care you need.

About PromiseCare Medical Group

PromiseCare Medical Group is the Inland Empire’s largest and longest continually serving Independent Physician Association, providing comprehensive healthcare services to communities throughout Riverside and San Bernardino counties. Our network includes over 60 primary care physicians and more than 400 specialists dedicated to delivering exceptional patient care, clinical outcomes, and coordinated health services. We accept most Medicare Advantage plans and work seamlessly with Original Medicare beneficiaries.

For more information about PromiseCare Medical Group physicians and locations, visit promisecare.com or call (951) 390-2840.