David Wynne, Medicare Insurance Broker

Answer: The new 2025 Medicare Part D out-of-pocket cap is a major change that will help many seniors better manage prescription drug expenses. Starting in 2025, Medicare beneficiaries will have a $2,000 annual cap on out-of-pocket costs for covered Part D medications. Once that limit is reached, they will not pay additional copays or coinsurance for covered prescriptions for the remainder of the year. This is especially beneficial for individuals taking expensive medications or managing chronic conditions. In 2026, the cap is expected to adjust slightly to approximately $2,100 due to inflation, and additional Medicare drug pricing reforms are expected to continue into 2027 as Medicare expands negotiated pricing and other cost-saving measures.

Even with these improvements, Medicare drug plans can still vary significantly in premiums, formularies, pharmacy networks, and medication coverage. Choosing the wrong plan can still lead to unnecessary costs or coverage issues. That is why working with an experienced local insurance broker is so important. A broker, such as Live Well Benefit Advisors of SC, can compare plans from multiple carriers, review medications individually, and help seniors select coverage that best fits both their healthcare needs and budget.

Answer: In the Medicare Part D catastrophic coverage phase, once you reach the out-of-pocket cap, you now pay $0 for covered prescription drugs for the rest of the year (a change made under the Inflation Reduction Act), whereas previously you paid a small coinsurance.

Answer: Many people choose Original Medicare (Parts A and B) so they can keep their doctors and avoid network restrictions. However, what often surprises new beneficiaries is that Original Medicare typically only covers about 80% of approved medical costs, leaving you responsible for the remaining 20% with no annual out-of-pocket maximum. That means outpatient procedures, tests, and specialist visits can quickly lead to unexpected bills if you don’t also have a Medicare Supplement (Medigap) plan to help cover those gaps. In contrast, Medicare Advantage plans (Part C) often bundle medical and prescription coverage together, include copays instead of percentage coinsurance, and have a yearly out-of-pocket limit—but they usually require you to use a provider network. If you’re feeling overwhelmed by medical bills, it doesn’t necessarily mean you made the wrong choice; it may simply mean your current coverage isn’t fully optimized for your healthcare needs. At Live Well Benefit Advisors, we help retirees compare Original Medicare, Medicare Supplement plans, and Medicare Advantage options so they can find coverage that protects both their doctors and their budget.

Answer: In 2025, the Inflation Reduction Act makes Medicare Part D more affordable and predictable. The biggest change is a $2,000 annual cap on out-of-pocket prescription costs, meaning beneficiaries pay nothing once they reach that limit. It also removes enrollee cost-sharing in the catastrophic phase and introduces the Medicare Prescription Payment Plan, allowing people to spread drug costs over the year. Overall, these changes reduce financial strain and help stabilize premiums.

Answer: Medicare Advantage (Part C) plans may offer extra chiropractic benefits beyond what Original Medicare covers, but it varies by plan. Some Advantage plans include limited coverage for chiropractic therapy or additional visits, while others do not. You must check each plan’s summary of benefits to know for sure.

Medicare covers spinal adjustments only — not X-rays, exams, or therapies from chiropractors.

Answer: At Live Well Benefit Advisors, we recommend reviewing your Annual Notice of Change with your Medicare agent. The ANOC shows any changes to your plan, like costs, coverage, or network updates, that will take effect next year. Reviewing it helps ensure your doctors and prescriptions are still covered and lets you compare your plan to other options that might save money or offer better benefits. At Live Well Benefit Advisors, we conduct annual reviews and mid-year check-ins with all of our clients to make sure their coverage continues to meet their needs and to prevent any surprises throughout the year.

Answer: Medicare Advantage plans, offered by private insurance companies approved by Medicare, can provide $0 monthly premiums because Medicare pays insurers a fixed amount per enrollee to cover all Medicare-covered services. Insurers also manage costs through preventive care, care coordination, and selective provider networks. Optional benefits like dental, vision, and hearing, along with strategic plan design, help insurers generate revenue while keeping premiums low. Offering $0 premiums is a way to attract members while still providing comprehensive coverage. At Live Well Benefit Advisors, we help seniors understand these plans and choose the best option to maximize benefits without unexpected costs.

Answer: If you’re considering switching to a Medicare Advantage (Part C) plan in South Carolina, it helps to know when you can make changes and who can help you through the process.

The most important window is the Annual Election Period, which runs October 15 – December 7 each year. During that time, you can enroll into a Medicare Advantage plan, switch from one plan to another, or return to Original Medicare. Coverage typically begins on January 1. If you’re already on a Medicare Advantage plan, there’s also a Medicare Advantage Open Enrollment Period from January 1 – March 31, when you can make one change: either switch Advantage plans or drop back to Original Medicare. Special Enrollment Periods (SEPs) apply if you’ve had a qualifying life event like moving, losing employer coverage, or changes to your eligibility.

For those of you in South Carolina, Live Well Benefit Advisors is an excellent resource. Based in Charleston (virtual appointments available) and operating across South Carolina, we specialize in helping with Medicare, health insurance, life insurance, annuities, and Social Security planning.

Our approach is highly personalized — they take time to understand your unique needs, budget, provider preferences, and prescription drug requirements before recommending plans. By comparing premiums, out‑of‑pocket costs, doctors in‑network, and extra benefits (vision, dental, hearing, etc.), they aim to help you find a plan that fits both your health and financial goals.

Answer: Yes — losing employer or union-based health coverage does indeed qualify you for a Medicare Special Enrollment Period (SEP). Specifically, if you delay enrolling in Original Medicare (Parts A and/or B) because you were covered by current employment-based group health insurance, you have an eight‑month SEP to sign up once that coverage ends or your employment ends—whichever comes first

However, for enrolling in or changing a Medicare Advantage (Part C) plan or a stand-alone Part D prescription drug plan, you have only a two‑month SEP that begins immediately after the month your employer coverage ends

Answer: Choosing the best Medicare Advantage Prescription Drug (MAPD) plan in South Carolina for 2025 depends on your specific needs, but some top options include Aetna and Devoted Health, both earning 4.5-star ratings. Aetna offers multiple PPO plans with additional benefits, including dental and vision coverage, while Devoted Health is recognized for its excellent customer service and low out-of-pocket costs.

UnitedHealthcare also offers a 5-star special needs plan for individuals in nursing homes or those with certain chronic conditions.

Other solid choices include Humana, Blue Cross Blue Shield of South Carolina, Clover Health, and Cigna, which offer 4-star plans with some $0-premium options.

Because picking the right plan can be confusing, working with a local agent like Live Well Benefit Advisors can be a big help. We can guide you through the process, ensure your doctors and prescriptions are covered, and help you choose the plan that fits your needs and budget.

You can also use the Medicare Plan Finder tool on Medicare.gov for more details, but having a local expert makes it easier and ensures you make the best choice.

Answer: If you're on Medicare Supplement Plan N, your MRI is likely covered. First, you’ll need to pay the yearly Part B deductible, which is $257 in 2025. After that, Medicare pays 80% of the cost, and Plan N usually covers the other 20%. You might still have a small copay up to $20 if it was done at a doctor’s office, or up to $50 if it was in the ER and you weren’t admitted. If the provider doesn’t accept Medicare assignment, you could be billed a bit more, but that’s rare. In most cases, your cost will be low once the deductible is paid

Answer: When comparing Medicare Supplement Plan G and Plan N, you’ll find they are very similar. Both plans help cover gaps in Medicare, including hospital costs, skilled nursing, hospice care, and other important benefits. The key difference is in how they handle doctor visits and out-of-pocket costs.

Plan G provides the most comprehensive coverage. After you pay your Medicare Part B deductible, Plan G covers everything else with no extra bills—just your monthly premium.

Plan N offers a lower monthly premium, which can save you money, but it comes with small copays: up to $20 for a doctor visit and up to $50 for an ER visit (if you’re not admitted). Plan N also does not cover Medicare Part B excess charges, which are additional fees a provider may charge above Medicare’s approved rate.

The good news is that for most retirees, excess charges aren’t something to worry about. The majority of doctors accept Medicare “assignment,” which means they agree to Medicare’s approved rates and cannot bill you extra. Since excess charges only apply when you see a provider who doesn’t accept assignment—and that’s becoming increasingly rare—most people will never encounter them.

So which plan is right for you? If you prefer predictable costs and the peace of mind of knowing all your doctor visits are fully covered, Medicare Supplement Plan G is the safer choice. If you’re generally healthy, don’t go to the doctor often, and want to save money on premiums, Medicare Supplement Plan N can be a smart option.

At Live Well Benefit Advisors Licensed in SC& NC, we help you compare Medicare Supplement plans so you can choose the coverage that fits both your health needs and your budget.

Answer: If you are already retired and collecting Social Security when you turn 65, you will be automatically enrolled in Medicare. Part A, which covers hospital insurance, will begin with no monthly premium if you worked and paid Medicare taxes for at least 10 years. You will also be enrolled in Part B, which covers medical insurance, and the standard monthly premium will be deducted directly from your Social Security check (the amount in 2025 is about $185.00, though higher-income individuals may pay more). About three months before your 65th birthday, you will receive your red, white, and blue Medicare card showing the effective dates for both Part A and Part B. At that point, you’ll need to decide whether to stay with Original Medicare (Parts A and B) and add a Medicare Supplement (Medigap) plan plus a Part D prescription drug plan, or choose a Medicare Advantage plan (Part C), which often combines hospital, medical, and drug coverage in one. If you do nothing, you’ll simply be covered under Original Medicare Parts A and B beginning the month you turn 65.

Answer: To avoid potential life time penalties you would need Part D for prescription drugs, Part A covers hospital stays, and Part B covers things like doctor visits and outpatient care. For some people, especially if you're pretty healthy and don't take a lot of medications, that might feel like enough. But it’s important to know that Original Medicare doesn’t cover everything — it won’t pay for prescriptions, dental, vision, hearing aids, or long-term care. Plus, there’s no limit on how much you could end up paying out-of-pocket, and you’d be responsible for deductibles and 20% of most medical costs under Part B. That’s why a lot of people choose to add a drug plan (Part D), a Medigap policy to help with extra costs, or go with a Medicare Advantage plan that bundles everything together.

Answer: It is important to understand that not all events are the same — and Medicare has clear rules about the differences.

Educational events are strictly designed to inform and educate attendees about Medicare — such as how Original Medicare works, what’s covered, and updates to the program. These sessions are prohibited from promoting specific plans or collecting personal information for enrollment. In other words, no sales or sign-ups can happen during an educational event. The goal is to help people better understand their options without any pressure to buy or enroll.

Marketing events, on the other hand, are designed to promote or sell specific Medicare Advantage or Part D plans. Licensed agents may discuss plan details, distribute brochures, and even assist with enrollment. These events must follow Medicare’s marketing rules, including not using misleading language or implying that they represent Medicare itself.

So, are Medicare seminars disguised sales pitches? Some are, and some aren’t — it depends on the type of event. If it’s promoted as an educational seminar, no sales activity is allowed. If it’s a marketing event, you can expect plan-specific discussions and the option to enroll. Always check the invitation or event description to see which type it is, and you’ll know what to expect.

Answer: If you're trying to find local dentists that accept Medicare, it's important to first understand the type of Medicare coverage you have. Original Medicare (Part A and B) generally does not include dental benefits, but many Medicare Advantage plans (Part C) do offer coverage for routine dental services such as exams, cleanings, x-rays, and even more comprehensive care like fillings, crowns, or dentures. To locate a Medicare dentist near you, start by visiting your insurance company’s website and using their provider search tool. You can also call the member services number on your Medicare Advantage card to request a list of in-network dentists in your area.

Another helpful step is to search online using terms like “Medicare Advantage dentists near me” or “dentists that accept [Your Plan Name] in [Your City or ZIP Code].” Be sure to confirm directly with any dental office to ensure they accept your specific Medicare plan, as provider networks can vary.

At Live Well Benefit Advisors, based in the Charleston and Summerville, SC area, we specialize in helping retirees and Medicare beneficiaries understand their options, including plans that offer strong dental coverage. If you're unsure what your current plan includes—or want to explore Medicare Advantage plans with dental benefits— our team can help you compare options, find local in-network dentists, and make the most of your Medicare benefits. Contact us to learn more or schedule a free consultation.

Answer: When your husband passes away, you do not receive both your full Social Security benefit and his full benefit at the same time. Social Security only pays one benefit per person, and you would generally receive the higher of the two, not both.

Answer: Since you’re planning to delay Social Security until age 70 but are turning 65 soon, it’s important to understand that you will not be automatically enrolled in Medicare. Automatic enrollment only happens if you're already receiving Social Security benefits before age 65. Because you're delaying those benefits, you'll need to actively sign up for Medicare yourself during your Initial Enrollment Period (IEP), which is a 7-month window that starts three months before the month you turn 65, includes your birth month, and continues for three months after.

At age 65, most people choose to enroll in Medicare Part A, which covers hospital insurance and is usually premium-free if you or your spouse worked at least 10 years. Enrolling in Part A generally makes sense even if you're delaying Social Security. However, Part B—which covers outpatient medical services—has a monthly premium, and whether you should enroll depends on your current health insurance situation. If you have health insurance through your or your spouse’s active employment, and the employer has 20 or more employees, you may be able to delay enrolling in Part B without penalty. But if your coverage is from a smaller employer or you don’t have creditable coverage, it’s important to enroll in Part B during your IEP to avoid late enrollment penalties and gaps in coverage.

Delaying enrollment in Medicare without proper coverage can result in permanent penalties and delayed access to care, so it's critical not to wait until age 70 to make these decisions. If you'd like, I can help you evaluate your current coverage and walk you through the steps for enrolling at the right time.

Answer: After you retire, you can use funds from a Health Savings Account (HSA) to pay for certain Medicare premiums, offering significant tax advantages. Specifically, HSA funds can be used tax-free to cover Medicare Part B (medical insurance), Part D (prescription drug coverage), and Medicare Advantage (Part C) premiums. These withdrawals are not subject to income tax if used for these qualified medical expenses, making the HSA a powerful tool for managing healthcare costs in retirement. However, you cannot use HSA funds tax-free for Medigap (Medicare Supplement) premiums—doing so would result in a taxable distribution, and if you're under 65, a 20% penalty would also apply. One key benefit of an HSA is that once you turn 65, you can withdraw funds for any purpose without incurring the 20% penalty, though non-medical withdrawals will still be taxed as income. Additionally, while you can no longer contribute to an HSA once enrolled in Medicare, the account remains available for tax-free withdrawals on qualified medical expenses, making it an excellent long-term savings and tax planning tool.

Answer: If you're new to Medicare, I’m here to make the process simple and stress-free. I’ll walk you through the basics like what Medicare covers, where the gaps are, and the difference between options like Medigap and Medicare Advantage. My goal is to give you clear, honest information so you can confidently choose the plan option that fits your personal health needs and budget.

Answer: Original Medicare (Parts A & B) does not cover hearing aids or routine hearing exams, so you would typically pay out of pocket, or purchase a plan separately. Some Medicare Advantage (Part C) plans do offer hearing benefits, including coverage for hearing aids and fittings — coverage varies by plan. A bill is in Congress that may expand Medicare to include hearing aids starting in 2026, but it has not passed yet.

Answer: The Maximum Out-of-Pocket (MOOP) limit is the most you’ll have to pay in a calendar year for covered services under a Medicare Advantage plan. Once you reach this limit, your plan covers 100% of the costs for the rest of the year. MOOP includes your deductibles, copayments, and coinsurance for medical services covered by your plan. It does not include your monthly premiums, prescription drug costs or services not covered by Medicare.

From an agent’s perspective, I always advise clients to compare MOOP limits when reviewing plan options. Lower MOOPs can offer peace of mind, especially for those with chronic conditions. Also, some plans like PPOs, have separate in-network and out-of-network MOOPs, so it’s important to understand how that applies to your situation.

Answer: The Medicare Advantage 5-Star Special Enrollment Period (SEP) lets you switch to a 5-star Medicare Advantage or Part D drug plan once per year, anytime between December 8 and November 30. This is different from the Annual Enrollment Period (AEP) in the fall and the Open Enrollment Period (OEP) in early spring, because it allows you to change plans mid-year—but only if a 5-star plan is available in your area.

Answer: You chose Medigap for the flexibility it offers, especially while traveling, and that was a smart move if seeing doctors nationwide without network restrictions is important to you. But if the premiums are starting to feel like too much, it may be time to review your plan.

It may be time to shop your Medigap plan — to see if there’s a more cost-effective option that still fits your lifestyle and health needs. Rates can vary significantly between insurance companies for the exact same coverage, so there may be room to save without sacrificing benefits.

Answer: Medicare Part B covers things like doctor visits, outpatient care, lab work, and preventive services. It’s a big help—but it’s not enough on its own.

It doesn’t cover prescriptions, dental, vision, hearing, or long-term care. Plus, you’ll still have to pay monthly premiums, a deductible, and 20% of most bills.

That’s why it’s smart to talk to a local Medicare expert like me. As a top-rated Medicare Agent with HUB, I can help you understand your options and fill the gaps with the right plan for your needs. Let’s make sure you’re fully covered!

Answer: Original Medicare (Parts A and B) covers many basic health services but leaves several important gaps. There’s no annual out-of-pocket maximum, so you could end up paying a lot if you need extensive care. You’re also responsible for deductibles and 20% coinsurance on most services.

It doesn’t cover routine dental, vision, or hearing care, and it excludes most outpatient prescription drugs unless you add a separate Part D plan. Long-term care and medical services outside the U.S. are also not covered.

To help with these gaps, many people choose a Medigap policy or a Medicare Advantage (Part C) plan, which can include extra benefits and limit your out-of-pocket costs.

By working with a Licensed Local agent like myself, we can talk through the options that are available so you can make an informed decision.

Answer: Original Medicare (Part A and B) does not cover routine dental or vision care like cleanings, fillings, eye exams, or glasses. If you prefer to stay on Original Medicare, you can buy standalone dental and vision insurance from private companies. Some people also choose discount plans, which offer reduced rates for services but are not insurance. Alternatively, some people choose a Medicare Advantage (Part C) plan, which often includes dental and vision benefits. These plans are offered by private insurers. To understand what is right for you, speaking with a local licensed agent will help you get the right information to make a informed decision.

Answer: The most over looked question when asking about Medicare and many people don’t realize that, if your income is above certain limits, you’ll have to pay more for Medicare Part B and Part D. This is called IRMAA (Income-Related Monthly Adjustment Amount). It can catch people off guard, especially if you sell a home, take money from retirement accounts, or have a high income in retirement. Planning ahead can help you avoid paying more than you need to!

Answer: Understanding your medicare plan is important. There is a lot of information out there including some bad opinions. Thats why working with a local agent is important. Having an educated and licensed agent guide you and provide solutions for your specific needs, is the best way to get the right recommendations.

Answer: Enrolling in Medicare for the first time can be a daunting task. For seniors, taking the time to fully understand what options are available should be a priority ahead of your Initial Enrollment period. Working with a licensed professional that is local, is a great way to solid guidance. At Living Well Benefit Advisors, our goal is to educate the client and let them decide what plan will work best for their personal needs.