Medicare questions, answered

Part A is usually premium-free if you or your spouse paid Medicare taxes for at least 10 years. Part B costs $202.90 a month for most people in 2026, more if you owe IRMAA. Medicare Advantage and Part D plans have their own premiums, and some Advantage plans charge $0 — which is not the same as free.

No. Medicare is federal health insurance based mainly on age or disability. Medicaid is a joint federal-state program based on income and resources. Some people qualify for both — they're called dual-eligible, and they often qualify for a Special Needs Plan.

Not if you have qualifying coverage from active employment — you can delay Part B and Part D without penalty and get a Special Enrollment Period later. Retiree coverage, COBRA, and marketplace plans do not count for this purpose, and getting that wrong is expensive.

Medicare Advantage replaces how you get Original Medicare, using a network and copays, usually with drugs and extras bundled in. Medigap works alongside Original Medicare to pay your share, with no networks, and needs a separate Part D plan.

Budget the $202.90 Part B premium plus either a Medigap premium and a Part D premium, or a Medicare Advantage plan premium and its copays. What varies most between people is not the premium but the cost sharing when you actually use care.

Yes — after 24 months of Social Security Disability Insurance, immediately with ALS when SSDI begins, or generally in the fourth month of dialysis with end-stage renal disease.

No. Work credits determine whether Part A is premium-free, not whether you're eligible. With 30–39 quarters Part A costs $311 a month in 2026, and under 30 quarters $565. Part B is available to everyone eligible at the standard premium.

Only if you're already receiving Social Security or Railroad Retirement benefits. If you've delayed claiming Social Security — which more people now do — nothing happens automatically and you must sign up yourself.

Yes, including a former spouse if the marriage lasted at least 10 years, or a deceased spouse. You must generally be 65, and specific rules apply, so it's worth confirming with Social Security.

No, but delaying without qualifying employer coverage triggers permanent late penalties on Part B and Part D, and costs you your one guaranteed Medigap window. Eligibility and the decision to enrol are separate questions.

October 15 – December 7 every year, with changes effective January 1. You can join, switch, or drop a Medicare Advantage or Part D plan, or move between Original Medicare and Advantage.

Unless you qualify for a Special Enrollment Period, you wait for the General Enrollment Period (January 1 – March 31) and pay a permanent Part B penalty of 10% of the standard premium for each full 12-month period you could have had Part B but didn't.

Not with a guarantee. AEP covers Medicare Advantage and Part D. Medigap has its own 6-month window at 65, and outside it — or a specific guaranteed-issue situation — carriers can use medical underwriting.

Yes, if you have coverage from active employment at an employer with 20 or more employees. You then get a Special Enrollment Period of 8 months after the employment or the group coverage ends, whichever comes first. Retiree coverage and COBRA do not qualify.

You're not required to, but you're auto-renewed into next year's version of your plan. Since premiums, formularies, and networks change annually, a 15-minute review each fall is how you avoid paying for a plan that no longer fits.

Parts A and B are through Social Security — online at ssa.gov, by phone on 1-800-772-1213, or at a local office. Plan choices (Medicare Advantage, Medigap, Part D) are made with a private insurer or a licensed agent.

Three months before your 65th-birthday month. Enrolling in those first three months means coverage starts the first day of your birthday month with no gap.

No. Licensed agents are paid by the insurance carriers, not by you, and the plan costs the same whether you enrol yourself or with help.

Your Social Security number and proof of citizenship or lawful presence. If you're enrolling after 65 because you had employer coverage, you'll also need forms CMS-40B and CMS-L564 signed by your employer.

Plan choices can change each Annual Enrollment Period (October 15 – December 7), and Advantage members get one switch during January 1 – March 31. The exception is Medigap — your guaranteed-acceptance window lasts the 6 months that begin the month you're 65 or older AND enrolled in Part B and does not return.

Yes — that's called being dual-eligible. Medicare pays first and Medicaid covers much of the rest, often including your Part B premium and cost sharing. You also get Extra Help with drug costs automatically.

Medicaid does, for long-term custodial care, once you meet state income and asset limits. Medicare covers only short skilled stays after a qualifying hospital admission.

You may still qualify for a Medicare Savings Program, which pays your $202.90 Part B premium and sometimes more. The income limits are considerably higher than for full Medicaid, and the programmes are underused.

Through the New Mexico Health Care Authority — online, by phone, by post, or in person. Medicare is a separate application through Social Security.

Usually yes. Low-premium plans exist for exactly this situation, and enrolling on time avoids a permanent penalty of 1% of the national base beneficiary premium for each month you went without creditable drug coverage later — which matters because most people eventually need medication.

$2,100. Once you reach it, covered drugs cost you nothing for the rest of the calendar year. It resets every January 1.

No. The coverage gap was eliminated and replaced with a hard out-of-pocket cap, which is a considerably better deal for anyone taking expensive medication.

You can request a formulary exception with your prescriber's support, switch to a covered alternative, or change plans at the next enrollment period. Checking your full list before enrolling avoids the problem entirely.

Generally no — most Advantage plans include drug coverage, and joining a separate Part D plan can disenrol you from your Advantage plan. The exception is certain plan types that exclude drugs; we'll tell you which you have.

Usually yes. VA coverage generally applies only at VA facilities, and it does not give you a Special Enrollment Period later — so declining Part B risks a permanent penalty of 10% of the standard premium for each full 12-month period you could have had Part B but didn't plus a gap in community and emergency care.