What is Medicare Advantage?

Medicare Advantage, also called Part C, is offered by private insurance companies approved by Medicare. It usually combines Part A, Part B, and often Part D prescription drug coverage.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare is run by the federal government and lets you use any provider that accepts Medicare. Medicare Advantage is offered by private insurers and often uses provider networks.

What is Medicare Supplement or Medigap?

Medicare Supplement, also called Medigap, works with Original Medicare to help reduce out-of-pocket costs. It can help cover certain copays, coinsurance, and deductibles.

Does Medigap include prescription drug coverage?

Medigap plans sold today do not include prescription drug coverage. Most people need a separate Medicare Part D plan for medications.

What is Medicare Part D?

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover medication costs based on the plan’s formulary.

When is the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period usually runs from October 15 to December 7 each year. During this time, many people can review or change Medicare Advantage and Part D plans.

Can I switch Medicare Advantage plans later?

Yes, but timing matters. Most people can switch during Annual Enrollment, Medicare Advantage Open Enrollment, or a qualifying Special Enrollment Period.

What is the difference between HMO and PPO Medicare Advantage plans?

HMO plans usually require in-network care and may need referrals. PPO plans generally offer more provider flexibility but may cost more for out-of-network care.

Do Medicare Advantage plans require prior authorization?

Many Medicare Advantage plans require prior authorization for certain services. This can include imaging, surgeries, skilled nursing care, or other covered treatments.

Do Medicare Advantage plans have an out-of-pocket limit?

Yes, Medicare Advantage plans include an annual maximum out-of-pocket limit for covered medical services. Original Medicare does not include this protection by itself.

Why do Medicare plans change every year?

Plans may update premiums, copays, drug formularies, provider networks, and benefits each year. Reviewing your plan annually helps avoid unexpected changes.

How can I find a Medicare plan that includes my doctor?

You should check the plan’s provider network before enrolling. A local Medicare agent can help confirm whether your doctors and hospitals are included.

IRMAA is an income-related adjustment that can increase Medicare Part B and Part D premiums. It is based on your reported income from prior tax years.

What is a Special Enrollment Period?

A Special Enrollment Period allows certain Medicare changes outside normal enrollment windows. Qualifying events may include moving, losing coverage, or plan changes.

Why work with a local Medicare agent?

A local Medicare agent can help compare plan options, explain networks, and review coverage based on your area. This can make Medicare decisions easier to understand.

How do I switch from employer coverage to Medicare without a penalty in 2026?

August 5, 2026

If you’re leaving employer coverage, you get an 8-month Special Enrollment Period for Part B and 63 days for Part D. Enroll before your group plan ends and coverage starts the first of the following month. Miss the window and you face a lifetime Part B penalty of 10% for every 12 months you delayed.

You get an 8-month Special Enrollment Period after employer coverage ends
COBRA and retiree coverage do NOT count as creditable coverage for Part B
Part D has a much shorter 63-day window than Part B
Employers with fewer than 20 employees usually require Medicare to be primary at 65
Some employers reimburse Medicare premiums through an ICHRA or retiree HRA

Leaving employer coverage? Get a Medicare review before you enroll.

We compare your group plan against Medicare, protect your guaranteed-issue rights, and file the paperwork so there’s no gap and no penalty.

Founder, The Modern Medicare Agency · 18+ years of Medicare experience Licensed independent broker · Content reviewed for accuracy in 2026

Not sure which Medicare option is right for you?

Get a free Medicare review before you choose a plan. We’ll help you compare costs, doctors, prescriptions, and enrollment timing — with no pressure and no cost.

Employer Coverage vs. Medicare: What Changes

Feature	Employer Group Plan	Medicare + Supplement + Part D
Monthly cost to you	Employee share of premium	$185 Part B + $110–$170 Medigap + Part D
Spouse/dependent coverage	Usually included	Each person enrolls separately
Deductible	$1,500–$5,000 typical	$257 Part B deductible (Plan G)
Network	Deductible	Any US doctor accepting Medicare
Drug coverage	Bundled	Separate Part D plan
Enrollment window	Open enrollment once a year	8-month SEP after coverage ends

Common mistakes to avoid

It does not for Part B. People on COBRA past 65 routinely trigger a permanent Part B penalty and a coverage gap of several months.

Form CMS-L564 has to be signed by your employer. Start 60–90 days out so Part B begins the day your group plan ends.

Part B gives you 8 months. Part D only gives you 63 days — and the drug penalty is charged for life.

Talk to an advisor 3–6 months before your employer coverage ends, or as soon as you know your retirement date. We compare your employer plan’s true cost against Medicare, coordinate spouse coverage, and file the enrollment forms so there is no gap and no penalty.

The most expensive Medicare mistake I see isn’t picking the wrong plan — it’s timing. A retiring executive stayed on COBRA for nine months thinking he was covered. He paid a Part B penalty every month for the rest of his life. Ten minutes on the phone would have prevented it.

“Paul made Medicare feel simple. He walked us through the trade-offs, ran the numbers for our prescriptions, and never once pushed us into a plan. We saved over $1,800 in the first year.”

Not sure which Medicare option is right for you?

Get a free Medicare review before you choose a plan. We’ll help you compare costs, doctors, prescriptions, and enrollment timing — with no pressure and no cost.

Do I have to enroll in Medicare at 65 if I'm still working?

If your employer has 20+ employees, you can usually delay Part B without penalty while you have active group coverage. If your employer has fewer than 20 employees, Medicare typically becomes primary at 65 and you should enroll.

How long do I have to enroll in Medicare after leaving my job?

You have an 8-month Special Enrollment Period for Part B starting the month after employment or group coverage ends — whichever comes first — and 63 days for Part D.

Does COBRA count as creditable coverage?

Not for Part B. COBRA can count as creditable drug coverage in some cases, but it does not protect you from the Part B late-enrollment penalty.

Can my employer reimburse my Medicare premiums?

Yes, through an ICHRA or retiree HRA. Employers with 20+ employees cannot pay Medicare premiums directly for active employees, but retiree arrangements are permitted. Bring your plan documents to your review.

What happens to my spouse's coverage when I go on Medicare?

If your spouse is under 65 they’ll need marketplace or their own employer coverage. We map both people’s timelines together so nobody ends up uninsured.

Is Medicare cheaper than my employer plan?

Often yes, once you compare total cost — premium plus deductible plus out-of-pocket max. Bring your employer plan’s summary of benefits and we’ll run the side-by-side.

Do I get guaranteed-issue rights for a Medicare Supplement?

In most states, losing employer group coverage triggers a guaranteed-issue window — typically 63 days — where carriers must sell you certain Medigap plans with no health questions.

What forms do I need to avoid a penalty?

CMS-40B (Part B application) and CMS-L564 (proof of employer coverage, signed by HR). We help clients complete both.

A month-by-month checklist with every form, deadline, and question to ask HR before your group plan ends.

How do I switch from employer coverage to Medicare without a penalty in 2026?

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How do I switch from employer coverage to Medicare without a penalty in 2026?

Related Post

Helping Parents With Medicare: A Stress-Free 2026 Guide

The Medicare GLP-1 Bridge Program: What It Actually Covers and Who Actually Qualifies

The Part D Subsidy Is Ending: What It Actually Means for Your 2027 Premium

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