Top 15 Medicare Questions Temecula Residents Ask Me

Every day, I answer Medicare questions from Temecula residents. Here are the 15 I hear most often—with straight answers.

1. "What's the difference between Medicare and Medicaid?"

Medicare: Health insurance for people 65+ (or disabled)

• Federal program

• Most people paid into it through taxes

• Not income-based

Medicaid (Medi-Cal in California): Health coverage for low-income people

• State and federal program

• Income and asset limits

• Any age

You can have both (called "dual eligible")

2. "Do I have to sign up for Medicare at 65?"

Usually yes, unless:

• You're still working with employer coverage (20+ employees)

• You're covered under your spouse's employer plan (20+ employees)

If you delay without creditable coverage: You'll pay penalties forever.

3. "Can I stay on my spouse's health insurance?"

Maybe, depends on:

Your spouse still working (employer 20+ employees):

• Yes, you can delay Medicare Part B

• Must enroll when spouse retires

Your spouse already on Medicare:

• No, Medicare doesn't cover spouses

Your spouse retired, you're on COBRA:

• Technically yes, but expensive

• Medicare is usually cheaper and better

4. "What does Medicare actually cost?"

Minimum costs:

• Part B: $202.90/month

• Total: $2,434.80/year

With Medicare Advantage:

• Part B: $202.90/month

• MA plan: $0-$100/month

• Total: ~$2,435-$3,635/year (plus copays)

With Medicare Supplement:

• Part B: $202.90/month

• Supplement: $180-$220/month

• Part D: $30-$100/month

• Total: ~$4,955-$6,275/year (minimal copays)

5. "What if I can't afford Medicare?"

Help is available!

Medicare Savings Programs:

• Income limits: ~$1,388-$1,867/month (single)

• Pays Part B premium, sometimes deductibles

• Apply through Riverside County: (951) 358-5400

Extra Help (Part D):

• Income limit: $23,495/month (single)

• Very low prescription copays

• Apply at ssa.gov

6. "Can I change my Medicare plan?"

Yes!

Annual Enrollment Period (Oct 15 - Dec 7):

• Switch Medicare Advantage plans

• Switch Part D plans

• Join or drop Medicare Advantage

Medicare Advantage Open Enrollment (Jan 1 - Mar 31):

• Switch MA plans one more time

• Drop MA and return to Original Medicare

Medicare Supplements: Can apply anytime (but medical underwriting after first 6 months)

7. "Will Medicare cover me if I travel?"

Original Medicare:

• ✅ Covers you anywhere in the U.S.

• ❌ Doesn't cover international (except rare cases)

Medicare Advantage HMO:

• ✅ Emergency coverage anywhere

• ❌ Non-emergency only in service area

Medicare Advantage PPO:

• ✅ Some out-of-network coverage

• ✅ Better for travelers

Best for frequent travelers: Medicare Supplement (works anywhere in U.S.)

8. "Does Medicare cover hearing aids?"

Original Medicare: No

Medicare Advantage: Often yes

• Usually $500-$2,000 allowance

• Varies by plan

Standalone: Buy separate hearing aid insurance

9. "What's the donut hole?"

Part D "coverage gap":

• After $5,030 total drug spending, you enter it

• You pay 25% of drug costs

• Exits when you've spent $8,000 out-of-pocket

• Then you pay almost nothing

It's been mostly closed—used to be worse.

10. "Can I see any doctor with Medicare?"

Original Medicare: Yes, any doctor that accepts Medicare (95% do)

Medicare Advantage: Only in-network doctors (except emergencies)

• HMO: Strict network

• PPO: Can go out-of-network but costs more

This is the biggest difference between Original Medicare and Medicare Advantage.

11. "Do I need a referral to see specialists?"

Original Medicare: No referrals needed

Medicare Advantage HMO: Yes, referrals required

Medicare Advantage PPO: No referrals needed

12. "What happens if I miss my enrollment deadline?"

You'll wait until General Enrollment Period:

• January 1 - March 31

• Coverage starts July 1

You'll pay penalties:

• Part B: 10% per year late (forever)

• Part D: 1% per month late (forever)

Unless: You qualify for Special Enrollment Period

13. "Can Medicare deny me for pre-existing conditions?"

No!

Medicare CANNOT:

• Deny you coverage

• Charge you more

• Exclude your conditions

• Make you wait to use coverage

Your health doesn't affect:

• If you can enroll

• How much you pay

• What's covered

14. "Should I choose Medicare Advantage or Medicare Supplement?"

Depends on your priorities:

Choose Medicare Advantage if:

• You want lower monthly costs

• You're okay with networks

• You want dental/vision included

• You don't travel much

Choose Medicare Supplement if:

• You want any doctor freedom

• You travel frequently

• You see many specialists

• You value predictability

I help people decide based on their specific situation.

15. "What's the difference between Medicare and Medigap?"

Medicare: Government health insurance (Parts A, B, C, D)

Medigap (Medicare Supplement): Private insurance that fills gaps in Original Medicare

• Not the same thing

• Medigap works WITH Medicare

• You must have Part A and Part B to buy Medigap

Bonus Questions

"When does Medicare start?"
First day of the month you turn 65 (or the prior month if you enrolled early)

"Can I have Medicare and employer insurance?"
Yes, but one will be primary depending on company size

"Does Medicare cover nursing homes?"
Only skilled nursing (short-term rehab), not long-term care

"Can I get Medicare before 65?"
Only if you're disabled (24 months on disability) or have ESRD/ALS

"What if I move to another state?"
Original Medicare works everywhere. Medicare Advantage may require plan change.

Questions I Wish People Asked More

"Should I review my plan every year?"
YES! Plans change. You might save money.

"Am I using all my preventive benefits?"
Most people leave money on the table by not using free services.

"Do I qualify for financial assistance?"
Many people don't know help is available—check!

"Is my current plan still the best value?"
Just because it was best last year doesn't mean it still is.

Still Have Questions?

That's normal! Medicare is complicated.

I'm here to help with:

• Questions not covered here

• Your specific situation

• Plan comparisons

• Enrollment assistance

FREE consultations

📞 (951) 840-1099
📧 matt@wieczorekinsure.com

No question is too simple. I explain things in plain English, no Medicare jargon.

Quick Reference

Medicare.gov: Official Medicare info
1-800-MEDICARE: 1-800-633-4227
Social Security: 1-800-772-1213
HICAP (free counseling): 1-800-434-0222

Matt Wieczorek | Licensed CA Insurance Agent #4335496 | Temecula, CA

Ask me anything about Medicare—I've probably heard it before!