Frequently Asked Questions About Medicare.

What is Medicare Part A?

Medicare Part A is your hospital coverage.

It helps pay for things like:

Inpatient hospital stays

Skilled nursing facility care

Hospice care

Some limited home health care

Most people qualify for Part A with no monthly premium if they’ve worked and paid Medicare taxes for at least 10 years.

But here’s what many people don’t realize…

It’s not completely free.
There are still deductibles and out-of-pocket costs depending on how long you receive care.

Also, Part A only covers hospital-related services
it does not cover doctor visits or outpatient care (that’s Medicare Part B).


Simple way to remember it:

Part A = Hospital
Not full coverage—just one piece of the puzzle.


Need help understanding how it all fits together?

At C&J Isbell Brokerage Group, we help you compare your options and make Medicare simple—so you can choose what fits your situation best.

What is Medicare Part B?

Medicare Part B is your medical coverage.

It helps pay for things like:

Doctor visits

Outpatient care

Preventive services (like screenings and wellness visits)

Lab work, X-rays, and durable medical equipment

Unlike Part A, Part B does have a monthly premium—and most people pay it.


Here’s the important part…

Part B usually covers about 80% of approved medical costs.

That means you’re responsible for the other 20%, with no cap on how high that can go.


Why that matters:

This is where many people get surprised…

Without additional coverage, that 20% can add up quickly—especially with ongoing treatments or unexpected health issues.


Simple way to remember it:

Part B = Doctor & Medical
Covers everyday healthcare—but not everything.


Need help making sense of it all?

At C&J Isbell Brokerage Group, we help you understand your options and fill in the gaps—so you’re not left guessing when it matters most.

What is Medicare Part C?

Medicare Part C, also known as Medicare Advantage, is an all-in-one alternative to Original Medicare (Part A and Part B).

These plans are offered by private insurance companies approved by Medicare.


What does it include?

Medicare Advantage plans combine:

Part A (hospital coverage)

Part B (medical coverage)

And most plans also include:

Prescription drug coverage (Part D)

Dental, vision, and hearing benefits

Fitness programs or other extra perks


Here’s the big difference…

With Medicare Advantage, you’re no longer using Original Medicare as your primary coverage.

Instead, the plan:

Has its own network of doctors and hospitals

Sets its own copays and rules

Usually includes a maximum out-of-pocket limit for the year


Why people choose it:

Lower upfront costs

Bundled coverage in one plan

Extra benefits not included in Original Medicare


But here’s the trade-off…

You may have to stay within a network

Referrals may be required

Costs can vary depending on how you use the plan


Simple way to remember it:

Part C = All-in-one alternative to Medicare


Need help deciding if it’s right for you?

At C&J Isbell Brokerage Group, we walk you through both sides—so you can choose what actually fits your doctors, your budget, and your lifestyle.

What is Medicare Part D?

Medicare Part D is your prescription drug coverage.

It helps pay for the medications you pick up at the pharmacy.


How it works:

Part D plans are offered by private insurance companies approved by Medicare.

Each plan has:

A list of covered drugs (called a formulary)

Different tiers that affect your cost

Copays or coinsurance for your prescriptions


Here’s what trips people up…

Not all plans cover the same medications the same way.

That means:

Your prescriptions might be cheaper on one plan…

And more expensive on another


Important to know:

If you don’t enroll in Part D when you’re first eligible—and don’t have other creditable drug coverage—you may face a lifetime late enrollment penalty.

Yeah… Medicare doesn’t forget 😅


Where you get Part D:

You can get prescription coverage by:

Adding a standalone Part D plan to Original Medicare

Or choosing a Medicare Advantage plan (Part C) that includes drug coverage


Simple way to remember it:

Part D = Drugs (prescriptions)


Need help choosing the right plan?

At C&J Isbell Brokerage Group, we compare plans based on your specific medications—so you’re not overpaying at the pharmacy.

What is the difference between Medicare Advantage and a Medicare Supplement plan?

The main difference comes down to how you receive your coverage and how you pay for care.


Medicare Advantage (Part C)

This is an all-in-one plan that replaces Original Medicare.

Combines Part A, Part B, and often Part D

Usually has low or $0 monthly premiums

Uses networks (HMO or PPO)

You pay copays as you go (doctor visits, hospital, etc.)

Includes a maximum out-of-pocket limit

👉 Think of it like a pay-as-you-go plan with structure


Medicare Supplement (Medigap)

This works with Original Medicare, not instead of it.

You keep Part A and Part B

No networks — see any doctor nationwide that accepts Medicare

Very low out-of-pocket costs when you receive care

You pay a higher monthly premium

Does not include drug coverage (you’ll need a Part D plan)

👉 Think of it like a predictable, low-surprise coverage plan


The real-world difference:

Medicare Advantage: Lower monthly cost, but you pay more when you use it

Medicare Supplement: Higher monthly cost, but very little cost when you use it


Which one is better?

Honestly… neither is “better.”

It depends on:

Your budget

Your doctors

How often you use healthcare

Your comfort with risk vs. predictability


Simple way to remember it:

Advantage = Lower premium, pay as you go

Supplement = Higher premium, less out-of-pocket later


Need help choosing the right fit?

At C&J Isbell Brokerage Group, we walk you through both options side-by-side—so you can make a confident decision, not a guess.

I’m turning 65 — when can I enroll in Medicare?

You can enroll during your Initial Enrollment Period (IEP).

This is a 7-month window that includes:

3 months before your 65th birthday

The month of your birthday

3 months after your birthday


Example:

If your birthday is in June:

You can enroll starting in March

Your window runs through September


Here’s the part you don’t want to mess up…

If you wait too long:

You could have delayed coverage

You may face lifetime penalties (especially for Part B and Part D)


When should you enroll?

Most people should enroll before their birthday month
(ideally 1–3 months early)

👉 This helps your coverage start on time and avoids gaps


But not everyone should enroll right away…

If you’re still working and have credible employer coverage, your timing may be different.

This is where people get tripped up—big time.


Simple way to remember it:

You’ve got a 7-month window… but earlier is better


Need help making sure you get it right?

At C&J Isbell Brokerage Group, we walk you through your timeline step-by-step—so you don’t miss deadlines or get hit with penalties.

I’m still working — do I have to go on Medicare if I have employer insurance?

Not always. It depends on your employer coverage.


You can usually delay Medicare if:

You (or your spouse) are still working

You have active employer health insurance

The employer has 20 or more employees

👉 In this case, your employer plan is typically your primary coverage, and you can delay Medicare without penalties


You may need Medicare if:

Your employer has fewer than 20 employees

Your coverage is retiree, COBRA, or not considered “creditable”

👉 In these situations, Medicare may become your primary insurance, and not enrolling could leave you with gaps—or penalties


Here’s where people get burned…

They assume:
“I’ve got insurance, so I’m fine.”

But if Medicare should have been primary and you didn’t enroll…
you could end up paying out-of-pocket for things you thought were covered


What happens when you retire?

You’ll qualify for a Special Enrollment Period (SEP):

8 months to enroll in Part B

63 days to enroll in Part D

No penalties—if you had creditable coverage


Simple way to remember it:

20+ employees → You can usually delay Medicare

Under 20 → You likely need Medicare at 65


Need help figuring out your situation?

At C&J Isbell Brokerage Group, we help you review your employer coverage and make sure you don’t make a costly mistake.

What does Medicare NOT cover?

This is one of the biggest misconceptions…

Medicare does NOT cover everything.


Here’s what Original Medicare (Part A & B) typically does NOT cover:

Most dental care (cleanings, fillings, dentures)

Vision care (eye exams for glasses, contacts)

Hearing aids and exams

Long-term care (like nursing homes or assisted living)

Most prescription drugs (without a Part D plan)


Here’s the bigger issue…

Even for the things Medicare does cover…

You’re still responsible for:

Deductibles

Copays

And 20% with no cap under Part B


Why this matters:

A lot of people think:
“I’ve got Medicare—I’m fully covered.”

But the reality is…

There can be some big gaps if you don’t have additional coverage.


Simple way to remember it:

Medicare is a foundation—not full coverage


Need help filling in the gaps?

At C&J Isbell Brokerage Group, we help you understand what’s covered, what’s not, and how to protect yourself from unexpected costs.

Frequently Asked Questions About ACA or Marketplace.

What is the ACA Marketplace?

These are plans that comply with the Affordable Care Act. They are guaranteed-issue (meaning you can’t be denied for pre-existing conditions) and cover 10 essential benefits, like maternity, mental health, and prescriptions. The biggest perk? Depending on your income, you may qualify for subsidies (premium tax credits) that significantly lower your monthly cost.

When can I enroll?

For ACA plans, the Open Enrollment Period typically runs from November 1st to January 15th. However, "Life Events" (like moving, getting married, or losing a job) allow you to enroll any time. Private plans and Healthshares often have more flexible enrollment windows.

What is a health insurance subsidy?

Think of a subsidy as a "coupon" provided by the government to lower the cost of your monthly health insurance premium. If you qualify, the government pays a portion of your bill directly to the insurance company, and you pay the remaining balance.

Who qualifies for a subsidy in 2026?

Eligibility is primarily based on your household size and your estimated income for the year.

The "Income Box": Generally, your household income must fall between 100% and 400% of the Federal Poverty Level.

The 2026 Change: From 2021 through 2025, even high earners could sometimes get a subsidy. In 2026, the "Subsidy Cliff" has returned—meaning if your income is even $1 over that 400% limit, the subsidy disappears entirely.

Are there other types of savings?

Yes! If your income is below 250% of the poverty level, you may also qualify for Cost-Sharing Reductions (CSRs). These are "extra savings" that lower your out-of-pocket costs—like your deductible, copays, and coinsurance—but they only apply if you choose a Silver-level plan.

What if my income changes during the year?

This is the most important part! Since subsidies are based on your estimated income, if you end up making more money than you told the Marketplace, you might have to pay some of that subsidy back at tax time. As your brokers, we help you estimate this accurately so there are no "surprises" in April.


Quick Summary Table for 2026

Type of Help What it Lowers Who Qualifies?

Premium Tax Credit Your Monthly BillI income between 100% – 400% FPL

Cost-Sharing Reduction Deductibles & Copays Income below 250% FPL (Silver plans only)

Does it cost more to use a broker like C&J Isbell?

No. Our services are 100% free to you. Your premium is the same whether you use us or go directly to the carrier. The difference is that with us, you get a local advocate to guide you through the maze.

Frequently Asked Questions Healthshare plan.

What is a healthshare plan?

A healthshare plan is a membership-based program where individuals and families share medical expenses with one another. It is not traditional insurance, but it can be an alternative way to manage healthcare costs.

How is a healthshare different from traditional health insurance?

Healthshare plans are not insurance and typically have fewer regulations. Instead of premiums, members contribute a monthly share, and eligible medical expenses are shared among the group.

Is a healthshare plan considered insurance?

No. Healthshare plans are not insurance and do not guarantee payment of medical bills in the same way a traditional insurance policy does.

How much does a healthshare plan cost?

Monthly costs are often lower than traditional health insurance, but they vary based on age, household size, and the program you choose.

Are pre-existing conditions covered?

Some healthshare plans have limitations or waiting periods for pre-existing conditions. It’s important to review each program carefully.

Can I go to any doctor or hospital?

Most healthshare programs allow you to choose your own providers, giving you flexibility without being tied to a strict network.

Do I have to pay upfront?

In many cases, yes. You may pay the provider directly and then submit your bill to be shared or reimbursed, depending on the plan.

How do I submit a medical bill?

Members typically submit bills through an online portal or by mail. The healthshare organization reviews the bill and determines if it’s eligible for sharing.

Are healthshare plans ACA-compliant?

No. Healthshare plans are not ACA-compliant and do not meet the requirements of traditional major medical insurance.

Who is a good fit for a healthshare plan?

Healthshare plans can be a good fit for individuals or families who are generally healthy, want lower monthly costs, and are comfortable with a non-traditional approach to healthcare.

Can I use an HSA with a healthshare plan?

In some cases, yes—especially if paired with a qualified high-deductible option. This depends on the specific setup.

Frequently Asked Questions Private Health Plans.

What is private health insurance?

Private health insurance refers to plans that are not part of the ACA Marketplace. These plans are typically offered through private carriers and may provide more flexibility in coverage options.

How is private health insurance different from ACA plans?

Private plans are not bound by all ACA regulations. This can mean lower monthly costs and more customization—but also fewer mandated benefits depending on the plan.

Who is private health insurance best for?

Private health insurance can be a good fit for individuals who are generally healthy, self-employed, or looking for more affordable alternatives outside of the Marketplace.

Can I enroll in private health insurance anytime?

Yes. Most private health plans are available year-round and are not limited to ACA open enrollment periods.

What does private health insurance cover?

Coverage varies by plan but often includes doctor visits, urgent care, hospitalization, and sometimes preventive services. Each plan has its own structure and benefits.

Are pre-existing conditions covered?

Many private plans have limitations regarding pre-existing conditions. Some may not cover them, or may include waiting periods.

Frequently Asked Questions about Dental & Vision

Are dental and vision plans included in health insurance?

In most cases, no. Dental and vision coverage are usually separate plans that can be added alongside your health insurance.

How much do dental and vision plans cost?

These plans are typically very affordable, with monthly premiums depending on the level of coverage and provider.

What do dental and vision plans typically cover?

Dental plans often cover preventive care like cleanings and exams, along with basic and major services such as fillings, crowns, and sometimes orthodontics. Vision plans usually include eye exams, glasses, and contact lenses.

Can I choose my own dentist or eye doctor?

Many plans offer large networks, and some allow out-of-network visits. It’s always best to check if your preferred provider is included.

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