Medicare FAQ

Sansone Advisory Group

Medicare Frequently Asked Questions

Straightforward answers to some of the Medicare questions Sean and Cindy hear most often from people in Oklahoma.

Medicare doesn't have to be confusing.

Medicare rules can vary depending on your work situation, income, health coverage and the type of plan you choose. These answers are designed to give you a clear starting point. If your situation is different, give us a call and we'll help you sort through it.

Not necessarily. If you or your spouse are still actively working and you're covered by an employer group health plan, you may be able to delay Part B without a late-enrollment penalty.

The rules depend on the type of employer coverage you have and, in some cases, the size of the employer. That's why we recommend checking with your employer's benefits or HR department before making a decision.

Some people enroll in premium-free Part A and delay Part B while they continue working. Others enroll in both Medicare Parts A and B and coordinate Medicare with their employer coverage.

One important exception: if you contribute to a Health Savings Account (HSA), enrolling in Medicare can affect your ability to continue making HSA contributions. Check before enrolling.

For most people, yes. If you or your spouse worked and paid Medicare taxes for at least 40 quarters — generally 10 years — you usually qualify for premium-free Part A.

In 2026, people with 30–39 quarters of Medicare-covered work may purchase Part A for $311 per month. People with fewer than 30 quarters may pay $565 per month.

These amounts can change each year, so we always verify the current Medicare figures before someone enrolls.

The standard Medicare Part B premium is $202.90 per month in 2026. See official Medicare costs. Premiums can change each year.

Some higher-income beneficiaries pay more because of the Income-Related Monthly Adjustment Amount, commonly called IRMAA.

On the other hand, people with limited income and resources may qualify for a Medicare Savings Program through their state. Depending on eligibility, these programs can help pay the Part B premium and sometimes other Medicare costs.

This is one of the questions we hear most often, especially because of television and phone advertisements.

Original Medicare does not provide a general “food card.” Some Medicare Advantage plans may offer grocery, healthy-food or similar supplemental benefits to people who meet specific eligibility requirements.

These benefits are often associated with certain Dual Eligible Special Needs Plans for people who have both Medicare and Medicaid, or with certain plans that provide additional benefits to qualifying members with chronic health conditions.

Eligibility, benefit amounts, covered items and participating stores vary by plan and by individual circumstances.

Seeing a television advertisement does not mean everyone with Medicare qualifies for the advertised benefit. We can check the actual plan rules before you make any changes.

Unfortunately, there is no perfect way to stop every unwanted call.

You can register your number with the National Do Not Call Registry and use your phone carrier's spam-blocking tools, but illegal callers and scammers may ignore those protections.

Never give your Medicare number, Social Security number, banking information or other personal information to an unexpected caller just because they claim to represent Medicare or an insurance company.

Our advice to our customers is simple: if somebody calls with an offer that sounds too good to be true, don't feel pressured to make a decision. Hang up and call us. We'll help you check the facts.

First, don't assume you've missed your only opportunity. You may qualify for a Special Enrollment Period depending on your circumstances, particularly if you had qualifying coverage through current employment.

If you don't qualify for a Special Enrollment Period, Medicare's General Enrollment Period runs from January 1 through March 31 each year. Coverage generally begins the month after you enroll.

A late-enrollment penalty may apply if you went without qualifying coverage when you were eligible for Medicare.

Before assuming you'll owe a penalty, let us look at your circumstances. Enrollment rules depend on what coverage you had and why you delayed Medicare.

There may be opportunities to make a change.

If you're already enrolled in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. During that period, you can generally make one change to another Medicare Advantage plan or return to Original Medicare.

People newly enrolled in Medicare Advantage also have a Medicare Advantage Open Enrollment opportunity during the first three months they have Medicare.

Medicare's annual Open Enrollment Period runs from October 15 through December 7. Changes made during that period generally begin January 1.

Certain life events may also give you a Special Enrollment Period at other times of the year.

This is an important question because Medicare Supplement — also called Medigap — enrollment rules are different from Medicare Advantage rules.

If you joined a Medicare Advantage plan when you were first eligible for Medicare at age 65 and decide within your first 12 months that you want to return to Original Medicare, you may have a Medicare “trial right” that gives you special rights to purchase certain Medigap policies.

A separate trial right may also apply if you previously had a Medigap policy, dropped it to try Medicare Advantage for the first time, and return to Original Medicare within 12 months.

Outside of a guaranteed-issue or trial-right situation, an insurance company may be allowed to use medical underwriting when you apply for Medigap, depending on applicable rules.

Don't cancel a Medicare Advantage plan until you understand whether you can obtain the Medigap coverage you want and when each coverage will begin.

Start by finding out exactly why the claim or service was denied.

In our experience, some problems turn out to be relatively simple issues — a billing or coding mistake, a claim sent to the wrong insurance company, missing information, or a prior-authorization issue. Sometimes the doctor's billing office can review and resubmit the claim.

But a true coverage denial is different. If Medicare, a Medicare Advantage plan or a Medicare drug plan refuses to cover or pay for something you believe should be covered, you have appeal rights.

Call us before assuming the bill is final. We can help you understand what happened and determine the appropriate next step.

First, check the plan's formulary — its list of covered drugs. In many cases there may be another covered medication in the same therapeutic category that your doctor believes is appropriate for you.

Medicare Part D formularies are generally required to include at least two drugs in each approved category and class, with certain exceptions and additional protections for particular drug classes.

If the medication your doctor believes you need isn't covered, your doctor or other prescriber can request a formulary exception. The prescriber will generally need to explain why the requested drug is medically necessary or why covered alternatives aren't appropriate for you.

Don't simply assume you're stuck paying full price for a non-covered medication. Call us and we'll help you understand the plan's formulary and exception process.

Personal Medicare help in Tulsa: five practical answers

Updated October 22, 2026. These answers provide a starting point for a conversation with Sean or Cindy.

Where can I get personal Medicare help in Tulsa?

Sansone Advisory Group helps people in Tulsa and across Oklahoma understand the Medicare plans we offer. Meet Sean and Cindy at Corporate Place, 5800 E. Skelly Dr., Suite 560, Tulsa, OK 74135. Call (918) 289-2607 or schedule a conversation. Read more about our Tulsa Medicare guidance.

“We do what the big agencies cannot, we treat you like family!”

What should I bring to a Medicare appointment?

Bring your questions, current coverage details, important enrollment dates, a list of doctors and hospitals, and your prescriptions with their strength, quantity and how often you take them. Note your preferred pharmacies and your budget priorities. If you have employer or retiree coverage, bring its benefits information. You can start with questions even if you do not have every document. Bring personal documents to your appointment rather than posting them in public comments.

Medicare Advantage versus Medicare Supplement: what should I compare?

Medicare Advantage is an alternative way to receive Medicare benefits through a private plan. Medigap supplements Original Medicare by helping with certain out-of-pocket costs. Compare total costs, provider access, prescription coverage, travel needs and enrollment rights. Medigap does not include prescription drug coverage. Eligibility to buy Medigap can depend on timing and applicable protections; do not assume a later switch is guaranteed.

Official sources: Medicare coverage options and when to buy Medigap.

How do I check whether my doctors and prescriptions are covered?

Use the exact plan name and coverage year. Check the insurer’s provider directory and confirm participation with both the plan and the doctor’s office. For prescriptions, review the formulary, pharmacy network, costs and restrictions for your exact medications. A familiar insurance-company name alone does not establish that a particular plan covers your care. Sean and Cindy can help review the details.

Official sources: Medicare Plan Compare and drug plan formularies.

Where can I attend a free Medicare educational meeting near Tulsa?

Join SAG at Embassy Suites Tulsa I-44, Consulate Room, 3332 S. 79th E. Ave., Tulsa, OK 74145, on October 28, November 10, November 18 or December 1, 2026, from 2–3 p.m. Central. View meeting details or choose a date and reserve a seat. Each meeting has 30 seats; register every attendee separately. Attendance does not require enrollment.

Still have a Medicare question?

We're happy to help you understand your options. No pressure. No call center. Just a conversation with a local Oklahoma Medicare agent.

This information is for educational purposes and is not a complete description of Medicare benefits, eligibility or enrollment rules. Plan availability, benefits and eligibility requirements vary. For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE.