Answers to common Medicare questions

Get answers to some of the most common Medicare questions about coverage, costs, enrollment, Medicare Supplement plans and Medicare Advantage plans.

January 20, 2026

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Understanding Medicare can feel overwhelming. From enrollment decisions to prescription drug coverage and provider networks, there are many factors to consider. To help you make informed decisions, we've gathered answers to some of the most common Medicare questions we hear from members and prospective members.

Do I need to worry about pre-certifications with Medicare and a Medicare Supplement plan?

In most cases, no. Original Medicare generally does not require prior authorization for most services. If Medicare approves a claim, your Medicare Supplement plan typically pays its portion automatically.

How do I know if Medicare will cover a service?

You can ask your healthcare provider to check with Medicare before your appointment. You can also search Medicare's covered services database at Medicare Coverage to determine whether a service is covered and under which part of Medicare coverage it falls.

Is the lowest-premium Medicare plan always the best deal?

Not necessarily.

When comparing Medicare plans, it's important to look beyond the monthly premium and consider:

Deductibles
Copayments
Coinsurance
Out-of-pocket maximums
Provider network restrictions

Medicare Supplement plans often have higher monthly premiums but lower out-of-pocket healthcare expenses, providing more predictable costs. Medicare Advantage plans may offer lower or even $0 premiums, but beneficiaries are generally responsible for more out-of-pocket costs when receiving care.

With either a Medicare Supplement or Medicare Advantage Plan, you are still responsible for the Medicare Part B premium.

The best value depends on your healthcare needs, budget and long-term goals.

Should I choose the plan that fits my needs today?

It's important to think about more than your current health.

Many people enter Medicare in good health, but healthcare needs often change over time. Hospitalizations, rehabilitation services and chronic health conditions can become more common as you age.

A good Medicare strategy considers both your current situation and your future healthcare needs.

Do Medicare Supplement and Medicare Advantage plans provide access to the same providers?

No.

With Medicare Supplement plans, you generally have access to any doctor, hospital or healthcare provider nationwide that accepts Medicare.

With Medicare Advantage plans, you typically must use providers within the plan's network. Going outside the network may result in higher costs or reduced coverage.

For people who travel frequently or live in multiple locations throughout the year, provider flexibility can be an important consideration.

Can I switch between Medicare Advantage and Medicare Supplement plans later?

Not always.

You can generally enroll in a Medicare Advantage plan during annual enrollment periods. However, switching from Medicare Advantage to a Medicare Supplement plan later may require medical underwriting, depending on your situation and state regulations.

Because health status can affect eligibility, it's important to understand your long-term options before initially enrolling.

What about coverage for durable medical equipment such as CPAP machines or orthotics?

Medicare Part B covers durable medical equipment (DME), including CPAP machines, orthotics and other prescribed devices when they are medically necessary and ordered by your doctor.

After Medicare pays its share, your Medicare Supplement plan can help cover remaining eligible costs, including deductibles and coinsurance.

I'm getting a lot of phone calls about Part D plans and food cards. Should I answer them?

Use caution.

Many of these calls come from marketers rather than your insurance company. Never provide personal information or your Medicare number to unsolicited callers.

If you have questions about your prescription drug coverage, contact your Part D plan directly using the phone number listed on your member card.

What do I need to know about medications like Zepbound?

Medicare Part D generally covers medications only for FDA-approved uses.

If you're prescribed a medication such as Zepbound, check with both your doctor and your Part D plan to determine whether the medication is covered for your specific diagnosis and circumstances.

How does Medicare coverage work outside the United States?

Original Medicare generally does not cover healthcare services received outside the United States.

However, some Medicare Supplement plans include limited foreign travel emergency benefits that may help cover emergency medical expenses while traveling internationally.

If international travel is important to you, review your coverage options carefully before enrolling.

Why do I pay an additional amount for Medicare Part B or Part D (IRMAA)?

IRMAA stands for Income-Related Monthly Adjustment Amount.

This additional premium is established by the federal government and applies to Medicare beneficiaries with higher incomes. Depending on your income level, you may pay additional amounts for Medicare Part B and Part D coverage. Everyone pays a premium for Medicare Parts B and D. However, some higher-income individuals may pay an additional premium.

What are the rules for changing from one Medicare Supplement plan to another?

Rules vary by state and individual circumstances.

Depending on where you live, changing Medicare Supplement plans may require medical underwriting or other eligibility requirements.

An Everence Medicare specialist can help review your specific options and explain any applicable state rules.

Does Medicare include SilverSneakers^® or fitness benefits?

Everence Medicare Supplement plans do not include SilverSneakers.

However, Everence offers a fitness reimbursement benefit for eligible Medicare Supplement members. Members may receive up to $10 per month, or $120 annually, to help cover gym memberships, fitness classes or online fitness programs.*

Many local fitness centers also offer senior discounts and Medicare-friendly wellness programs.

Will I receive a late enrollment penalty if I sign up for a Part D plan now?

Possibly.

If you've gone more than 63 consecutive days without creditable prescription drug coverage after becoming eligible for Medicare, you may be charged a Part D late enrollment penalty when you enroll.

The penalty amount depends on how long you were without qualifying prescription coverage. Check with you Everence representative before you are in this situation to determine if your current coverage is creditable or not.

Can the cost of my medications change during the year?

Yes.

Prescription drug costs can change as you move through the various stages of your Part D coverage, including:

Annual deductible
Initial coverage phase
Catastrophic coverage phase

Drug pricing, plan formularies and copayments may also change from year to year.

Is Medicare financially secure for the future?