Christopher Horan, Medicare Insurance Agent

Answer: Yes, you can switch from your SCAN Medicare Advantage plan back to Original Medicare during the upcoming Annual Enrollment Period running from October 15 to December 7.

During this fall open enrollment window, anyone enrolled in a Medicare Advantage plan has the right to drop it and return to Original Medicare (Parts A and B), with the change taking effect on January 1. Turning 66 does not restrict you from using this standard annual window.

Answer: Confirmed changes for 2027 Medicare prescription drug coverage include an increase in the maximum out-of-pocket spending limit to $2,400 (up from $2,100 in 2026) and a rise in the maximum annual deductible ceiling to $700 (up from $615).

The Centers for Medicare & Medicaid Services (CMS) and federal rules have finalized several major cost parameters taking effect on January 1, 2027

Answer: Yes, you can absolutely use the work-stoppage life-changing event to have your 2028 IRMAA based on your lower 2027 income.

Because Medicare has a standard two-year look-back period, your 2026 income normally dictates your 2028 premiums. Since your retirement in August 2026 constitutes an official "Work Stoppage," you can legally request that the Social Security Administration (SSA) bypass the 2026 tax year and look ahead to your lower 2027 numbers instead.

Answer: No, the fall Medicare Open Enrollment Period does not let you switch Medigap plans without answering health questions.

The annual fall enrollment window (running from October 15 to December 7) applies strictly to Medicare Advantage (Part C) and Medicare Prescription Drug plans (Part D). It does not provide a yearly, guaranteed-issue window to change or sign up for a Medicare Supplement Insurance (Medigap) policy

Answer: Yes, Medicare covers PCSK9 inhibitors like Repatha and Praluent, but coverage is provided through private Medicare Part D prescription drug plans or Medicare Advantage plans with drug coverage (MAPDs) rather than Original Medicare Part B.

Approximately 90% to 95% of Medicare prescription plans include at least one PCSK9 inhibitor on their formulary, but getting approval and managing the costs requires navigating a few specific rules

Answer: These cards are private insurance perks, not a government-issued benefit from Original Medicare.

• What they are worth: Typically between $25 and $200 per month [$25–$200/mo] loaded onto a prepaid debit card to buy approved healthy foods (like produce, dairy, and meats). Unused funds usually expire at the end of each month.

• How to get one: You must enroll in a specific Medicare Advantage plan that offers this supplemental benefit.

• The Catch: These grocery allowances are heavily restricted. Regulations require you to have a documented chronic illness (like diabetes or heart failure) or be dually eligible for both Medicare and Medicaid (enrolled in a D-SNP) to qualify. You cannot get them through self-attestation alone.

Answer: No, the Medicare Prescription Payment Plan does not lower your drug costs or save you money.

Instead, it is a free, voluntary program that changes when you pay by spreading your out-of-pocket Medicare Part D prescription costs into predictable monthly bills across the calendar year (January to December) rather than forcing you to pay the full amount upfront at the pharmacy counter

Answer: If your employer has 20 or more global employees for at least 20 calendar weeks out of the year, their Group Health Plan pays first (primary), and Medicare pays second. This means an employee turning 65 at a seemingly "small" U.S. office can safely delay Medicare Part B without penalty because the company's global footprint pushes them into "large group" rules

Answer: Under Original Medicare, Part B pays 80% of the Medicare-approved amount for doctor visits, outpatient care, and medical equipment after you meet your annual deductible, leaving you responsible for the remaining 20% with no out-of-pocket maximum. Part A (hospital care) works differently, covering 100% of the first 60 days of an inpatient stay after you pay the inpatient deductible, but requiring steep daily coinsurance for longer stays

Who Covers the Rest of the Bills?

• You (Out-of-Pocket): If you rely solely on Original Medicare without extra coverage, you pay the 20% Part B coinsurance and any extended Part A hospital fees out of your own pocket, as there is no annual limit on your spending.

• Medigap (Medicare Supplement Insurance): Private insurance policies you buy separately to cover the 20% coinsurance, deductibles, and gaps left by Original Medicare.

• Medicare Advantage (Part C): Private bundled plans that replace Original Medicare and include an annual out-of-pocket spending limit to protect you from catastrophic costs.

• Medicaid: If you have limited income and assets, joint state-federal programs can cover your remaining copayments, coinsurance, and premiums

Answer: If the Plan Was Discontinued or Non-Renewed by the Insurer

• Return to Original Medicare: If you take no action, you are automatically enrolled in Original Medicare (Parts A and B). You will need to add a stand-alone Part D plan for prescription drug coverage.

• Enroll in a New Medicare Advantage Plan: A plan termination triggers a Special Enrollment Period (SEP). If it ended at year's end, this window runs from December 8 through the last day of February.

• Add a Massachusetts Medigap Policy: Massachusetts features continuous open enrollment for Medicare Supplement (Medigap) plans. You can switch to a Medigap policy from Original Medicare without waiting for a specific annual window.

If the Plan Lapsed Due to Non-Payment

• Contact the Insurer Immediately: Call Blue Cross Blue Shield of Massachusetts right away. Ask if they allow reinstatement for "good cause" if you can show an emergency or unexpected situation prevented timely payment.

• Pay Past-Due Balances: If you are within the grace period (typically up to two months), paying the overdue premium restores your active status.

• Wait for an Enrollment Window: If your disenrollment is final and good cause is denied, you generally must wait for the next Annual Enrollment Period running from October 15 to December 7

Answer: Key Benefits of Working with an Agent

• Zero cost for their services: Insurance companies pay agents a commission. You never pay extra to use an agent, and plan prices are identical whether you sign up alone or with help.

• Local network knowledge: Agents know which local doctors, clinics, and hospitals accept specific insurance networks in your community.

• Time-saving comparisons: They review dozens of private insurance options, drug lists, and copay structures to narrow down the best choices for you.

• Unbiased, multi-carrier choices: Independent agents represent many different insurance companies, meaning they can show you options from various providers rather than pushing just one brand.

• Ongoing, year-round support: They remain your advocate after you enroll, helping you fix billing errors, understand changing benefits, or re-evaluate your coverage during future enrollment windows.

Answer: You qualify for a Medicare Special Enrollment Period (SEP) if you experience specific life transitions, such as losing job-based health insurance, relocating to a new area, or losing Medicaid eligibility. These windows allow you to enroll or change plans outside normal enrollment periods without facing late-enrollment penalties.

Some states have "birthday" rules for Medicare Supplement plans, but state specific.