FREQUENTLY ASKED
The questions people actually ask.
Organized by situation, not by alphabet. No preferred plan. No sales pitch. If your question isn't here, the Ask Before You Sign tool can help — or write to Dan directly.
What is the single biggest difference between Traditional Medicare and Medicare Advantage?
Traditional Medicare is a federal program that gives you access to nearly any doctor or hospital in the country that accepts Medicare — which is the vast majority. Medicare Advantage is a private insurance plan that replaces Traditional Medicare. It typically has a $0 monthly premium but restricts you to a local network and often requires prior authorizations before approving care.
Why do most people choose Medicare Advantage if it has more restrictions?
Advertising. The "$0 premium" and extra perks like gym memberships are heavily marketed. What gets less attention is that costs shift to the back end — through copays, prior authorization denials, and network limits — when you actually need care.
Is Medicare Advantage cheaper than Traditional Medicare in the long run?
Only if you stay healthy. A single serious illness on an Advantage plan can trigger thousands in out-of-pocket costs before the plan pays 100%. Adding a Medigap supplement to Traditional Medicare caps your exposure at a predictable annual amount.
What is the Medigap "one-way door"?
When you first turn 65, you can buy any Medigap plan without health questions — it's guaranteed. If you choose Medicare Advantage instead and later want to switch to Medigap, insurers in most states can review your health history and deny you. That initial window is the only time the door is fully open.
What is the 12-month Trial Right?
Federal law gives you 365 days to test a Medicare Advantage plan when you first enroll. If the plan isn't working — your doctor left the network, a procedure was denied — you can leave within that first year and get guaranteed approval for a Medigap plan, no health questions asked.
What is a state birthday rule?
About 16 states have laws allowing residents to switch Medigap plans around their birthday each year without a medical background check. If your state has one, it's a meaningful annual window to shop for better rates on the same coverage. The Protect Your Rights tool shows whether your state qualifies.
Why does Plan G cost different amounts if the benefits are identical everywhere?
The federal government standardizes what Plan G covers — it's the same benefits regardless of which insurer you buy from. But insurers set their own premiums based on your zip code, age, and state insurance rules. Shopping matters more than most people realize.
How do I choose between Plan G and Plan N?
Plan G covers everything with no copays at the doctor. Plan N saves $30–50 per month in premiums but charges up to a $20 copay per visit. If you see doctors frequently, the math often favors Plan G. If you're generally healthy and want lower monthly costs, Plan N can be worth it.
What are Part B excess charges?
A 15% surcharge some doctors can add if they don't accept Medicare's standard rates. Plan G covers this; Plan N does not. In practice, excess charges are rare and banned in several states — but worth knowing before you choose.
I have employer coverage and plan to work past 65. Do I need to sign up for Medicare?
It depends on your employer's size. If the company has 20 or more employees, your work insurance is primary and you can safely delay Medicare Part B without penalty. If it's fewer than 20 employees, Medicare becomes primary at 65 and you need to enroll immediately to avoid coverage gaps and permanent late penalties.
Does COBRA count as valid coverage for delaying Medicare?
No — and this is one of the most expensive mistakes people make. COBRA is continuation coverage, not active employer insurance. Relying on it past 65 triggers permanent Part B late-enrollment penalties. The same applies to retiree health coverage from a former employer.
What are the late-enrollment penalties?
Part B adds a permanent 10% premium surcharge for every 12-month period you delayed without qualifying coverage. Two years late means a 20% penalty for life. Part D adds roughly 1% per month of delay. These don't go away.
My parent is on Medicare Advantage and was just diagnosed with something serious. Can I switch them to Traditional Medicare now?
You can only change their plan during specific enrollment windows — the Annual Enrollment Period (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31). The harder issue: if they've been on Advantage for more than a year, switching to Medigap may require health underwriting, and a new diagnosis can affect their eligibility.
Does Medicare pay for assisted living or long-term care?
No. This surprises most families. Medicare is health insurance — it covers medical care, not residential care. It will pay for short-term skilled nursing rehab (up to 100 days) after a qualifying 3-day inpatient hospital stay, but it does not cover assisted living, memory care, or ongoing custodial help.
How do I get the legal right to speak to Medicare on my parent's behalf?
You need Form CMS-1696 (Appointment of Representative), signed by your parent and submitted to Medicare. A standard financial Power of Attorney is often rejected by Medicare's systems due to HIPAA rules. Having CMS-1696 on file before a crisis is one of the most useful things a caregiver can do.
What is the new $2,000 Part D cap and how does the Prescription Payment Plan work?
Federal law now caps out-of-pocket prescription costs at $2,000 per year. The Medicare Prescription Payment Plan lets your parent spread that cost into equal monthly installments across the year — instead of a large bill in January when deductibles reset. It requires opting in through their Part D provider.
How are The Clearing's tools different from Medicare.gov?
Medicare.gov is designed to help you compare and choose plans — which means it's built around the plans themselves. Our tools are built around your situation: your timeline, your state's rules, your income, your health history. The goal is to help you understand the decision, not steer you toward a plan.
How does Fern help with Medicare planning for a parent?
Fern is our AI guide — not a broker, not a salesperson. You can describe your parent's situation and get plain-language answers that account for their state, their timeline, and what you're actually trying to figure out. Fern doesn't have a preferred plan and doesn't earn a commission.
Can I use The Clearing's resources even if my parent already has a broker?
Yes. A broker's advice is shaped by what they can sell and what they're paid to recommend. Our resources are independent — no commissions, no preferred plans. Think of it as a second read on whatever your parent has been told.
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