Medicare can be difficult to understand when you’re first getting started—or when your coverage needs change.

Below are answers to common Medicare questions we hear from Minnesota residents.

Some Medicare rules are federal and apply nationwide. Medicare Supplement insurance, however, has important Minnesota-specific rules, so Minnesota residents should not rely solely on national Medigap information.

Learn First. Decide With Confidence.

1. What Is Medicare?

Medicare is the federal health insurance program primarily for:

People age 65 and older
Certain people under 65 with qualifying disabilities
People with End-Stage Renal Disease (ESRD) who meet Medicare’s requirements
People with ALS who qualify for Medicare through Social Security disability benefits

Medicare consists of several parts that cover different types of health care.

2. What Are Medicare Parts A, B, C and D?

Medicare Part A — Hospital Insurance

Part A primarily helps cover:

Inpatient hospital care
Qualifying skilled nursing facility care
Hospice
Certain home health services

Medicare Part B — Medical Insurance

Part B primarily helps cover:

Doctors and other health care providers
Outpatient care
Preventive services
Diagnostic services
Durable medical equipment
Certain home health services

Medicare Part C — Medicare Advantage

Medicare Advantage is an alternative way to receive your Medicare Part A and Part B benefits through a private Medicare-approved plan.

Most Medicare Advantage plans also include Part D prescription drug coverage, and plans may offer additional benefits.

Medicare Part D — Prescription Drug Coverage

Part D helps pay for covered prescription drugs.

You can get Part D through a standalone Medicare drug plan or through many Medicare Advantage plans.

Medicare Supplement — Medigap

Medicare Supplement insurance works with Original Medicare to help pay certain deductibles, copayments, coinsurance and other covered expenses.

Medigap is not a separate “part” of Medicare.

3. What Is the Difference Between Original Medicare and Medicare Advantage?

There are two main ways to receive your Medicare health coverage after enrolling in Medicare Parts A and B.

Original Medicare

With Original Medicare:

Medicare administers your Part A and Part B benefits.
You can generally see any doctor or hospital in the United States that accepts Medicare.
You can add a standalone Medicare Part D drug plan.
You may be able to purchase Medicare Supplement insurance.
Original Medicare by itself does not have an annual maximum out-of-pocket limit for Part A and Part B services.

Medicare Advantage

With Medicare Advantage:

A private Medicare-approved plan provides your Part A and Part B benefits.
Most plans include Part D prescription drug coverage.
Many plans use provider networks.
Prior authorization may be required for certain services.
Plans may offer additional benefits that Original Medicare doesn’t cover.
Medicare Advantage plans have an annual maximum out-of-pocket limit for covered Part A and Part B services.

Neither choice is automatically better for everyone.

Your doctors, prescriptions, expected health care use, travel, budget and preferences should be considered.

4. When Should I Enroll in Medicare?

For most people becoming eligible at age 65, the Medicare Initial Enrollment Period lasts 7 months:

3 months before the month you turn 65
The month you turn 65
3 months after the month you turn 65

Some people are automatically enrolled in Medicare, while others need to enroll through Social Security.

Coverage start dates depend on when you enroll.

If you miss your Initial Enrollment Period and don’t qualify for another enrollment opportunity, you may have to use the Medicare General Enrollment Period.

The General Enrollment Period runs:

January 1 through March 31

Coverage generally begins the month after you enroll.

Late-enrollment penalties may apply in some circumstances.

5. Do I Have to Enroll in Medicare at 65 If I’m Still Working?

Not necessarily.

If you or your spouse are actively working and you have group health plan coverage based on current employment, you may be able to delay Medicare Part B without a late-enrollment penalty.

But don’t assume that simply having health insurance means it is safe to delay Part B.

Important questions include:

Is the coverage based on current employment?
How many employees does the employer have?
Does Medicare or the employer plan pay first?
Does the employer require Medicare enrollment?
Do you contribute to a Health Savings Account?
When will employment or employer coverage end?

For people eligible for Medicare because of age, Medicare specifically warns that coverage through an employer with fewer than 20 employees might not pay properly if the person doesn’t have Medicare Parts A and B.

Check with the employer’s benefits administrator before delaying Medicare.

6. What Happens When I Retire and Lose Employer Coverage?

If you delayed Part B because you had qualifying group health plan coverage based on current employment, you generally have a Special Enrollment Period.

The Part B SEP generally continues for:

8 months after the employment or qualifying group health plan coverage ends, whichever occurs first.

COBRA does not extend that eight-month Part B Special Enrollment Period.

Retiree coverage also does not provide the same current-employment SEP protection.

If you want Part B to begin when employer coverage ends, plan ahead rather than waiting until the end of the eight-month period.

7. What If I Have a Health Savings Account?

Medicare and Health Savings Accounts require special planning.

Once you are enrolled in Medicare, you generally can no longer make contributions to an HSA.

There is another important issue for people who delay Medicare:

Premium-free Medicare Part A can be retroactive for up to 6 months when you enroll after age 65, but not earlier than the month you first became eligible for Medicare.

That retroactive Part A coverage can create an HSA tax problem if you continue contributing too close to your Medicare enrollment date.

If you are working past 65 and contributing to an HSA, coordinate your HSA contributions with your intended Medicare enrollment date.

8. What Is Medicare Supplement Insurance in Minnesota?

Medicare Supplement insurance—also called Medigap—is private insurance designed to work with Original Medicare.

It can help pay certain Medicare deductibles, coinsurance and copayments.

Minnesota standardizes Medicare Supplement insurance differently from most states.

Insurers selling Medicare Supplement coverage in Minnesota are required to offer:

Basic
Basic with Optional Rider(s)
Extended Basic

Some insurers may offer additional Minnesota-approved policy designs.

Because Minnesota is different, don’t assume national information about plans such as Plan G accurately describes your Minnesota Medicare Supplement choices.

9. Can I Have Medicare Advantage and Medicare Supplement at the Same Time?

Medicare Supplement is designed to work with Original Medicare, not Medicare Advantage.

You cannot use a Medigap policy to pay your Medicare Advantage plan’s:

Copayments
Coinsurance
Deductibles
Premiums

A Medicare Supplement policy generally cannot be sold to someone enrolled in Medicare Advantage unless that person is switching back to Original Medicare.

If you’re considering leaving Medicare Advantage for Original Medicare and Medigap, verify your Minnesota Medicare Supplement enrollment rights before changing coverage.

10. When Can I Buy a Medicare Supplement Policy in Minnesota?

Minnesota has several Medicare Supplement enrollment protections.

A key initial protection is the six-month Minnesota Medigap Open Enrollment Period that begins when you first enroll in Medicare Part B.

Minnesota provides Medigap rights to qualifying people under 65 as well as people age 65 and older.

Minnesota also has guaranteed-issue protections for certain circumstances.

In addition, Minnesota added new Medicare Supplement enrollment provisions effective August 1, 2026.

Those newer rights have specific statutory requirements involving such factors as age, enrollment history and timing.

Do not assume that every Minnesota Medicare beneficiary can switch to any Medicare Supplement policy at any time without underwriting.

Before cancelling or changing Medigap coverage, verify the rule that applies to your circumstances.

11. How Do I Choose a Medicare Part D Plan?

Don’t choose a Part D plan based only on its monthly premium.

Compare the plan using your actual:

Prescription drugs
Dosages
Preferred pharmacies
Formulary
Drug tiers
Deductible
Copayments and coinsurance
Prior authorization requirements
Step therapy requirements
Quantity limits

A low-premium plan may not be the lowest-cost choice for your prescriptions.

Part D plans can change their premiums, formularies, pharmacy networks and cost sharing from one year to another, so review your coverage annually.

12. Can I Be Penalized for Delaying Medicare Part D?

Yes, in some circumstances.

You may owe a Part D late-enrollment penalty if, after your applicable enrollment period, you go 63 consecutive days or more without:

Medicare prescription drug coverage, or
Other creditable prescription drug coverage.

“Creditable” has a specific meaning for prescription drug coverage: the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

This is different from the rules for delaying Part B, which generally depend on group health plan coverage based on current employment.

13. When Can I Change Medicare Advantage or Part D Plans?

Medicare Open Enrollment

Medicare Open Enrollment runs each year:

October 15 through December 7

During this period, eligible beneficiaries can:

Switch from Original Medicare to Medicare Advantage
Switch from Medicare Advantage to Original Medicare
Switch Medicare Advantage plans
Join, drop or switch Medicare drug plans when applicable

Changes generally take effect January 1 of the following year.

Medicare Advantage Open Enrollment

If you’re already enrolled in Medicare Advantage, another enrollment period runs:

January 1 through March 31

During this period, you can generally make one change:

Switch to another Medicare Advantage plan, or
Leave Medicare Advantage and return to Original Medicare.

If you return to Original Medicare, you can also join a standalone Medicare drug plan.

You cannot use this period to switch from Original Medicare into Medicare Advantage.

Special Enrollment Periods

Certain events may allow changes outside the normal enrollment periods.

Examples include certain moves, losses of coverage and other qualifying circumstances.

The exact SEP and deadline depend on the event.

14. How Much Does Medicare Cost?

Medicare costs depend on the coverage you have.

Possible costs include:

Part A premium, if you don’t qualify for premium-free Part A
Part A deductibles and coinsurance
Part B monthly premium
Part B annual deductible and coinsurance
Medicare Advantage premiums and cost sharing
Part D premiums, deductibles and prescription costs
Medicare Supplement premiums

Part A and Part B amounts can change annually.

Medicare Advantage, Part D and Medicare Supplement costs vary by plan or policy.

Higher-income beneficiaries may also pay additional amounts for Part B and Part D through the Income-Related Monthly Adjustment Amount (IRMAA).

For 2026, Social Security generally determines IRMAA using the most recent federal tax return supplied by the IRS, usually the 2024 tax return filed in 2025.

15. Does Medicare Cover Dental, Vision and Hearing?

Original Medicare generally does not cover routine:

Dental care
Eye exams for prescription glasses
Hearing aids
Hearing-aid fitting exams

There are exceptions when certain services are medically necessary and meet Medicare coverage rules.

Some Medicare Advantage plans may offer additional dental, vision or hearing benefits.

Those benefits vary by plan and shouldn’t be assumed to be identical.

16. Can My Medicare Advantage or Part D Plan Change Every Year?

Yes.

Medicare health and drug plans can change from one plan year to another within Medicare requirements.

Changes can involve:

Premiums
Deductibles
Copayments and coinsurance
Provider networks
Prescription formularies
Pharmacy networks
Prior authorization requirements
Supplemental benefits

Review your plan’s Annual Notice of Change and current plan information each year.

A plan that fits your needs this year should not automatically be assumed to be your best choice next year.

17. Where Can I Get Help With Medicare in Minnesota?

For official Medicare information:

Medicare.gov
1-800-MEDICARE (1-800-633-4227)

For Minnesota-specific Medicare Supplement and insurance information:

Minnesota Department of Commerce

Minnesota’s State Health Insurance Assistance Program also provides free Medicare counseling.

YourMedicareMN provides educational assistance and can help you compare Medicare insurance options offered by the companies we represent.

When comparing coverage, consider your:

Doctors
Hospitals
Prescriptions
Pharmacies
Budget
Travel needs
Preference for Original Medicare or Medicare Advantage

Get Personalized Guidance: A Medicare advisor can help you make sense of the choices

📞952-201-5991
📍 Serving all of Minnesota
💻 Phone and virtual appointments available

Visit Contact Us to schedule a personalized Medicare review and get answers tailored to your situation.

For official Medicare information, visit the Medicare.gov website.