Angela Ellington, Medicare Insurance Agent

Answer: I would say the first step is to speak with a knowledgeable broker. Enrolling in Medicare depends on where you are currently receiving your Health Benefits, if you're able to keep them, and if you want to keep them and postpone your Medicare enrollment. If you have an employer sponsored plan, you may be able to keep it until you retire or lose your coverage for any reason. There may be good reasons to keep it based on many factors. There are also good reasons to switch over to Medicare. If you have Marketplace Coverage, you will have to enroll in Medicare if you are entitled to Premium Free Part A. If you are not collecting Social Security Retirement or Disability Benefits, you will need to enroll in Medicare Part A & Part B through SSA.gov as your first step. This step should actually be completed 3 months prior to turning 65 to ensure that you receive your Medicare Card in a timely manner to make your plan selections. If you're turning 65 and already have your Medicare card, I recommend spending some time with a broker who will give you a full education on all of your options and can explain the difference between Medicare Advantage & Medicare Supplements.

Answer: Silver Sneakers is a benefit that comes with some Medicare Advantage Plans and some Medicare Supplement plan. If your friend is enrolled in a different plan than you are, that would explain it!

Answer: It's a good idea to review your Part D coverage every year with a Licensed Broker for this reason. Formulary covered insulins are capped at $35, but it's possible that the brand that you use is no longer on your Part D formulary. The Inflation Reduction Act created a $2000 catastrophic limit in 2025, but if your drug is not on the formulary, it won't count toward the calculation, either.

Answer: The first thing that I recommend is applying for Extra Help through Social Security. If you do not qualify for that program, you may save by using GoodRx or Optum Perks which offer coupons that may be more affordable than using your Part D coverage. I have also referred some of my clients to fill certain prescription from the Canadian Med Store. Lastly, Part D has a catastrophic limit of $2000 in 2025 and they have started a payment plan that's called M3P that's spreads your copays out through the rest of the year in the event that a drug costs more than $600 to fill due to the deductible or coinsurance having a high cost up front.

Answer: There is a long list of preventive screenings that are covered by Medicare, including an annual Wellness visit.

Answer: Medicare Advantage plans already use member apps and various digital tools. I'm sure these will improve and there will be more to come in the future!

Answer: If you can qualify and afford a Medicare Supplement with Part D, you'll have the most freedom & flexibility to choose your providers, with access to any Doctor/Hospital that accepts Medicare in the entire US, with lower out of pocket responsibility than most Medicare Advantage PPO plans. Your authorizations come from Medicare, instead of an insurance company or medical group who will dictate where you can go and what will be covered. When facing a serious health issue, most people wish that they had this type of coverage if they are on Medicare Advantage and unable to purchase a Medicare Supplement plan. Medicare Advantage is not poor coverage, but there are limitations in their networks. They provide very comprehensive benefits, especially for people who prefer an HMO. Many people have adequate coverage on Medicare Advantage at a more affordable price.

Answer: This is going to vary based on needs. For the seniors who used to hit the Coverage Gap, they will see a big savings. For those who do not take any medications, there are still some affordable Part D plans on the market, but the deductibles are higher. For those who are in the Middle Class Income range and used to get their specialty drugs paid for by Manufacturer Discount programs, they are now having to pay for these drugs until they hit their $2000 Catastrophic limit, when they used to get them for free.

Answer: There are a couple of disadvantages to enrolling in Medicare Advantage. Having to wait for referrals and authorizations are the main issues that my clients run into. Another issue can be paying more to go out of network with PPOs.

Answer: If they are enrolled in Credible Employer Sponsored Coverage and are contributing to an HSA, they should not enroll in Medicare until they lose their coverage. If they are not contributing to an HSA, and if the employer group has more than 20 employees, they can enroll in Part A and postpone Part B until they lose their coverage. If the employer group is smaller than 20, they will need to enroll in Medicare A & B.

Answer: There is now a $2000 Catastrophic limit on Part D costs, so once you hit that threshold, you'll be done paying for RX copays on formulary drugs for the remainder of the year. You can also enroll in a payment plan to spread those costs over the course of the remaining months of the year to avoid paying a high deductible in one payment. You can also compare pricing at the Canadian Med Store if they offer your drug. If you have low income, you may qualify for Extra Help from Social Security.