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Medicare FAQs
The following Frequently Asked Questions are mainly for the state of Tennessee, as each state has different Medicare Health Insurance programs.
These are my personal responses to the questions I receive the most when meeting with individuals.
Note that these answers are general in nature, and remember that every person's needs, income level, and health are different and unique to them
It's important to talk to a professional to discuss your personal scenario.
When Will I Receive My Medicare Card?
It depends. If you already receive Social Security income, the card will be sent to you by mail.
If you are NOT already receiving Social Security income, you need to apply for Medicare manually. There are 3 ways to do so:
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Online at ssa.gov
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Visit or call your local Social Security office (you can schedule an appointment or walk in)
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Give me a call, and I can help you.
Is Medicare Advantage or MediGap (Medicare Supplement better?
Everyone is different.
What I tell my clients is that no two people are alike. Nobody has the same job, given the same benefits, has the same income, sees the same doctors, takes the same prescriptions, has the same needs, wants, and concerns.
EVERY PERSON IS DIFFERENT. Let me help you customize a plan specific to your needs, your income, and your comfort level.
Do I need Medicare if I’m still working beyond age 65?
It depends, and it's easier if I separate this into 3 different scenarios:
Option 1: You are retired and need Medicare.
Medicare is better and/or cheaper than your current work coverage. Medicare can be a good alternative.
Option 2: If your work coverage is better and/or cheaper AND you ARE NOT contributing to a HSA (Health Savings Account), and you work for an employer with 20 or more employees.
I will recommend picking up Medicare Part A only. This will make the transition to get Part B later on easier.
Option 3: If your work coverage is better and/or cheaper, AND you ARE contributing to an HSA (Health Savings Account).
Do not pick up Medicare at all. However, you must STOP contributing to your HSA 6 months before enrolling in Medicare, or you will be penalized.
There are a few extra steps you need to take if you take this route.
Option 4: If you are covered by an employer with fewer than 20 employees or by an ACA individual policy, please call me! These are both special scenarios that I can help you understand what you need to do.
What do I do if I delayed Medicare past my turning 65 Initial Enrollment Period?
It depends on whether you choose Option 2 or Option 3 above.
Regardless you need to complete 2 forms: CMS-40B (I want to pick up Medicare Part B) & CMS-L564 (this form states that you had creditable coverage through work) and send them to your local Social Security office.
Completing these forms will avoid penalties from you delaying Medicare. Make sure you complete these forms in a timely manner so you don’t have a gap in coverage.
Please give me a 3 month heads up for Option 2 and a 6 month heads up for Option 3 for a smooth transition!
Because working after age 65 involves multiple scenarios, give me a call or email me so we can develop a plan for you based on your specific circumstances.
How do I avoid penalties?
Their are a variety of different penalties associated with Medicare. The easy answer is by having a SEP (Special Enrollment Period), creditable coverage and no gap in coverage.
There are many types of SEPs that you may qualify for. Be aware that COBRA and AHCT do not count towards having creditable coverage.
I am a Veteran, do I need Medicare?
Depends. Some Veterans only have Medicare Part A only and are happy with their existing VA benefits. Although Medicare can be a great alternative for getting a second pair of eyes outside of your VA clinic or if you are a traveler and don’t want to worry about the VA out of state.
If you get your Rx’s through the VA, you have an option to not pick up a Part D or a MAPD plan, you have an option to pick up a MA (Medicare Advantage) plan without the PD (prescription drugs). If you choose to pick up a Part D or MAPD plan later on, you will not be penalized.
If you are receiving TriCare for Life, I would usually only recommend picking up Medicare Part A and Part B alone, and usually. I would not recommend getting anything else since TriCare for Life is amazing! But you do have an option to get an alternative plan as well; however submitting claims would become a regular occurrence.
Also, THANK YOU FOR YOUR SERVICE!
Can I just keep my Medicaid through TennCare in Tennessee?
If you are turning 65 you need to transition to the MSP (Medicare Savings Program). This transition to MSP will help you pay for Medicare Part B premiums and possibly cover all medical services.
There are 3 different levels to MSP in Tennessee: QMB, SLMB, and QI-1. What you qualify for is based on your income.
After you transition to MSP, you are now eligible for a Medicare DSNP Advantage Plan that can add some awesome extra benefits. Let me help you complete the proper paperwork for a smooth transition and shop your benefits! Click HERE to see the income levels in Tennessee.
How do I get help with paying the Medicare Part B premium of $202.90 per month for 2026?
Every state is different. In Tennessee, you need to qualify for MSP (Medicare Savings Program), which is based on income and assets in Tennessee. Click HERE for income levels in TN.
How do I know what plan I should choose?
1. Do not call 1-800 TV commercials.
2. Do not call solicitations mailed to you.
3. Call me, your local Medicare Broker, for a FREE Medicare comparison schedule and a FREE Medicare formulary review!
How much does it cost to speak to you?
You will never pay for my education and insurance services. I can promise you one thing, you will not be disappointed!
Can I switch my plan, MAPD to MediGap, MediGap to MAPD?
It depends on the state. In Tennessee, there is no medical underwriting, and no pre-existing conditions are necessary for initial plan selections. If you have a MAPD plan, you can change to any plan you want during AEP (Annual Enrollment Period - October 15th to December 7th), effective for a January 1st start date the following year. If you wish to switch from one MAPD to another, you can do so during the AEP period or the OEP (open enrollment period - January 1-March 31) with no medical underwriting and cannot be denied coverage due to pre-existing conditions.
However, note that in Tennessee, if you have a MAPD and wish to switch to a Medigap plan, you generally cannot switch without medical underwriting and can be denied due to pre-existing conditions.
How much will I pay for my Rx’s?
I can run a formulary review to find the best plan that will save you the most money throughout the year. However, Rx formularies in every plan do change annually. Generic Rx’s will always be cheaper than brand-name Rx’s. And pharmacies can make a difference; there are preferred and standard pharmacies for every plan, as well as mail order options. You can also consider using 3rd party Rx discount providers such as GoodRx or SingleCare to help reduce your costs for some Rx’s. Give me a call for a formulary review!
I don’t have any Rx’s, do I need an Rx plan?
No. However, every month you do not have a Rx plan (Part D or MAPD) Medicare will penalize you. This penalty is for your entire lifetime. Having that said, I do recommend you have a Rx plan in place from the start.
Does Original Medicare cover dental, hearing, and vision?
No. Medicare alone does NOT cover dental, hearing, or vision. However, your MediGap plan might offer only a discount; a standalone Dental/Hearing/Vision plan might be recommended if you take this route and it is important to your healthcare needs and wants. Your Part C - Medicare Advantage Plan generally includes dental, hearing, and vision insurance built into the plan. Whatever you choose, every plan and every company has their own unique benefits.
Should I shop my plan every year?
Depends. I would recommend shopping your MAPD/PDP plan at least every other year. New plans do come out every year, and you can be missing out on better benefits or saving money. As your health and Rx needs change, I might recommend transitioning to another plan. My service to my clients is to reach out every AEP (October 15th to December 7th) for our annual review to make sure you will be best matched for the next calendar year.
What if I’m planning on moving out of Tennessee?
I have great connections with local brokers in all 50 states thanks to my partnerships. You will be required to change to a plan in your new servicing area if you have a Medicare Advantage Plan. If you have a Medigap plan, generally, you can keep your plan, and your monthly premium may change, but it's important that you confirm. And if you have a standalone Part D prescription plan, it must be changed, as these plans are regional. As I mentioned before, EVERY STATE IS DIFFERENT. I will be able to help you with a smooth move!
Will I be covered while out of the country?
Yes. MediGap and MAPD plans generally provide coverage for out-of-country emergency and urgent care only. Not for regular doctor visits. The amount of coverage depends on the plan you have.
Will my monthly premium increase?
Depends. The base Medicare Part B in 2021 was $148.50/month, in 2022 was $170.10/month, in 2023 is $164.90/month, in 2024 was $174.70/month, in 2025 was $185/month, and is currently $202.90. Medicare Part B does change every year, however so does your Social Security income. When it comes to your MediGap and MAPD plan, premiums can change as well. I will make sure to keep you informed about premium changes on an annual basis!
Why is my Medicare Part B and Part D more than $202.90 per month?
This will apply to higher-income earners. Medicare Part B and Part D premiums are based on your income from 2 years ago. Example: what you pay for 2026 is based on your income from 2024. Income is based on your MAGI (Modified Adjusted Gross Income). The increase in premium is called IRMAA (Income Related Monthly Adjustment Amount). This increase in premium can be reduced by completing an IRMAA Form since you might have had a life changing event, like retirement/reduction of income.
How do I pay for my Medicare Part B premium?
If you are collecting your Social Security income, they will automatically deduct the $202.90 from your retirement benefits. If you are not collecting, Medicare will bill you by mail quarterly. If you do not want to pay quarterly and do not want to collect your benefits, you can create an account on MEDICARE.GOV to set up automatic bank deductions. I highly recommend setting up automatic bank deductions so you never forget to pay the premium or Medicare does not receive the premium payment in the mail. I can help you create an account and set up automatic bank deductions.
When should I start collecting my Social Security Income?
Depends. Everyone is different. You can collect as early as 62 or delay collecting until 70 or somewhere in between. The longer you wait, the more your benefits accumulate over time. After 70 years old, your Social Security income will no longer increase, and you should definitely start collecting then. Your Full Retirement Age (FRA) is based on the year you are born. For example, if you are born in 1957, your FRA is 66 and 6 months. If you are born in 1958, your FRA is 66 and 8 months. If you are born in 1959, your FRA is 66 and 10 months. If you are born in 1960 or later, your FRA is 67.
If you start collecting your income before your FRA, you are limited to earning less than $24,480 for 2026 if you decide to continue working. However, you can make more than $24,480, but for every $2 you make over that, they will take $1 from your retirement benefits. Starting with the month you reach full retirement age (FRA), there is no limit on how much you can earn and you will receive your full adjusted benefits.
How do you get paid if all of your services are FREE?
As I represent all major healthcare carriers in TN and RI, once I help you choose the best possible plan, the carriers compensate me. Not you. This goes for all areas of your retirement planning. I am here to help!
Click HERE to see some of my strategic partners.
Terri O'Brien
Your Local Independent Medicare Advisor
