Medicare questions, answered

Not entirely. Part A is usually premium-free if you or your spouse paid Medicare taxes for 10+ years. Part B has a standard monthly premium set each year, and Part D and Medicare Advantage premiums vary by plan — some Advantage plans are $0 premium, but $0 premium is not the same as free, because you still have copays and deductibles.

No. Medicare is federal health insurance based mainly on turning 65 (or disability), regardless of income. Medicaid is a joint state-federal program based on limited income and resources. Some people qualify for both and are called 'dual-eligible,' which often unlocks extra help.

About 6 months before you turn 65. That gives you time to understand your options before your Initial Enrollment Period opens (the 7 months around your birthday) so coverage is ready the day you're eligible.

Usually yes, to avoid a permanent late-enrollment penalty later. A low-cost Part D plan now is almost always cheaper than the penalty you'd owe for life if you sign up after going without creditable coverage.

Yes. We're based in Grand Junction, CO and serve the whole Western Slope plus Moab (Grand County) and Monticello (San Juan County), Utah — and Brian is licensed in 18 states. We meet by phone, video, or in person.

Yes — that's called being dual-eligible. It usually unlocks lower costs and extra benefits through a D-SNP (Dual Special Needs Plan), and often automatic Extra Help with your drug costs.

Yes — most importantly long-term custodial care (help with daily living in a nursing facility), which Original Medicare and Medicare Advantage generally do not cover. That's one reason dual eligibility matters so much.

Possibly. Medicare Savings Programs and Part D Extra Help have higher income limits than full Medicaid and can still pay your Part B premium and cut drug costs. We can check your eligibility for free.

In Colorado it's Health First Colorado; Utah administers its own Medicaid program. Rules and income limits differ by state — we work with both since we serve the Western Slope and Southeast Utah.

Not always. If you have creditable coverage from a large employer, you can usually delay Part B penalty-free and enroll later through a Special Enrollment Period. Without creditable coverage, delaying causes lifelong Part B and Part D penalties. We check your specific situation.

You or your spouse must have paid Medicare taxes for at least 10 years (40 quarters). If you have fewer quarters you can still buy Part A, or a spouse's work record may qualify you.

Yes — after 24 months of Social Security Disability benefits, or immediately with ALS or End-Stage Renal Disease. The starting rules differ for each, so ask us if this applies to you.

It depends on the size of the employer and whether that plan is creditable. This is exactly the kind of timing question we sort out for free so you don't accidentally take on a penalty.

October 15 to December 7 each year. Changes you make take effect January 1. We review your plan every fall to make sure it's still your best fit before the window closes.

AEP (Oct 15–Dec 7) is open to everyone and allows any plan change for next year. MA-OEP (Jan 1–Mar 31) is only for people already in a Medicare Advantage plan and allows one switch.

Yes. Moving out of your plan's service area triggers a Special Enrollment Period. If you're relocating anywhere across the Western Slope or into Utah, let us know and we'll handle the switch inside your window.

You may have to wait for the General Enrollment Period and could face lifelong Part B and Part D penalties. If you had creditable employer coverage, a Special Enrollment Period may protect you — we'll confirm which applies.

Parts A and B are through Social Security — online at ssa.gov, by phone, or at a local office. For your plan choice (Advantage or Medigap + Part D), a local agent like us compares your options and enrolls you, free.

Only if you're already receiving Social Security benefits before 65 — then Parts A and B start automatically. Otherwise you must enroll yourself during your Initial Enrollment Period.

Signing up for Parts A and B is quick. Choosing the right plan is the part worth doing carefully — we usually complete a full comparison and enrollment in one or two conversations.

No, but you should choose within your Initial Enrollment Period to avoid gaps and penalties. We help you get it done inside your window.

The coverage-gap 'donut hole' has been replaced by an annual out-of-pocket cap (about $2,100 in 2026). After you reach it, covered drugs cost you $0 for the rest of the year. Check Medicare.gov for the current figure.

Usually yes, to avoid a lifelong penalty. A low-cost Part D plan now is almost always cheaper than the permanent penalty you'd owe if you enroll later without creditable coverage.

Match your exact medication list to each plan's formulary and tiers — not just the premium. We run your prescriptions against the plans we offer in your county to find your lowest total annual cost.

Yes. During the Annual Enrollment Period (Oct 15–Dec 7) you can switch Part D plans for the next year. We review yours every fall, because formularies and prices change annually.

You may qualify for Extra Help, which can eliminate your Part D premium and deductible and cut copays. We screen for it at no cost and enroll you if you're eligible.

Most should enroll in Part B to protect access to non-VA doctors and hospitals and to avoid a lifelong penalty. VA and Medicare cover different settings, so together they give you the most flexibility.

Usually no — VA drug coverage is creditable, so you generally avoid the Part D penalty. Some veterans still add Part D to fill prescriptions at local pharmacies. We'll help you weigh it.

TRICARE For Life requires Medicare Parts A and B once you're eligible, then pays as secondary coverage — often leaving very low out-of-pocket costs. Skipping Part B can suspend your TRICARE For Life benefit.

Yes, but they don't coordinate benefits with each other, so you'll want to plan how you use each. We help veterans decide whether Advantage adds value on top of VA care.