Question 1

Can I appeal Medicare IRMAA surcharges?

Accepted Answer

You may request a redetermination after life-changing events like retirement, divorce, or income loss—submit documentation to SSA. Details: /guides/medicare-irmaa-income-surcharge-buying-guide.

Question 2

What is Medicare IRMAA based on?

Accepted Answer

IRMAA uses Modified Adjusted Gross Income from your tax return two years before the premium year to add surcharges to Part B and Part D. Brackets change annually. Guide: /guides/medicare-irmaa-income-surcharge-buying-guide.

Question 3

What is Medicare prior authorization for prescriptions?

Accepted Answer

Plans may require insurer approval before covering certain drugs—especially high-cost or specialty medications. Denials can be appealed with prescriber documentation. Steps: /claims/guides/medicare-prior-authorization-claim-guide.

Question 4

How is the Medicare Part D late enrollment penalty calculated?

Accepted Answer

About 1% of the national base beneficiary premium for each month without creditable drug coverage, added to your plan premium for as long as you have Part D. Avoid gaps with timely SEP enrollment. Guide: /guides/medicare-part-d-late-enrollment-buying-guide.

Question 5

Can I delay Medicare Part B if I still work at 65?

Accepted Answer

Often yes with large-group employer coverage, but you must enroll within eight months after that coverage ends. COBRA usually does not qualify for the same delay. Steps: /guides/medicare-part-b-late-enrollment-buying-guide.

Question 6

How much is the Medicare Part B late enrollment penalty?

Accepted Answer

About 10% of the Part B premium for each full 12-month period you were eligible but not enrolled without creditable coverage. It usually lasts for life. Avoid it with timely SEP enrollment—/guides/medicare-part-b-late-enrollment-buying-guide.

Question 7

Can I have Medicare Advantage and Medigap at the same time?

Accepted Answer

Generally no—Medigap is designed to supplement Original Medicare, not Part C Advantage plans. You choose one path: Advantage (often with Part D bundled) or Original Medicare plus Medigap and usually standalone Part D. Compare in /guides/medicare-advantage-vs-medigap-buying-guide.

Question 8

How do I request a Part D formulary exception for a drug not on the list?

Accepted Answer

Ask your prescriber to submit a formulary exception request with medical necessity documentation to your Part D plan. Include failed alternatives if required. Denied exceptions can be appealed with dated denial letters. Walkthrough: /guides/medicare-part-d-formulary-guide.

Question 9

Does Medigap cover prescription drugs on the Part D formulary?

Accepted Answer

No—Medigap policies sold to new beneficiaries do not include retail drug coverage. You need a standalone Part D plan or Medicare Advantage with drug benefits. Medigap helps with Medicare cost-sharing for services, not pharmacy tiers.

Question 10

Why was my Medicare supplement claim delayed?

Accepted Answer

Delays often trace to provider billing errors, missing crossover from Medicare, or supplemental paperwork. Ask for Medicare EOB, provider claim number, and carrier trace ID.

Question 11

Does Medigap cover prescriptions?

Accepted Answer

No. Medigap supplements Original Medicare medical gaps; Part D covers prescriptions separately. Compare Part D plans annually during open enrollment.

Question 12

When is Medigap guaranteed issue enrollment available?

Accepted Answer

Many states offer guaranteed-issue windows when you are new to Medicare Part B, lose employer coverage, or leave certain Medicare Advantage plans. Dates and rules vary by state.

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Frequently asked questions

Can I appeal Medicare IRMAA surcharges?

What is Medicare IRMAA based on?

What is Medicare prior authorization for prescriptions?

How is the Medicare Part D late enrollment penalty calculated?

Can I delay Medicare Part B if I still work at 65?

How much is the Medicare Part B late enrollment penalty?

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