Douglas Carney, Medicare Insurance Broker

Medicare in 2025: Must-Know Changes and Challenges for New and Current Enrollees

May 12, 2025

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What do you like most about being a Medicare agent?

Answer: The best part of being a Medicare Broker is the ability to provide options tailored specifically to each of my clients. This allows me to spend more time getting to know them and letting them tell me what their needs are.

What's the most frustrating misconception you have to clear up with clients about Medicare every year?

Answer: The most frustrating misconception I have to clear up with clients about Medicare every year was the Doughnut Hole (if you know, you know). Now it's how the insurance carriers can afford to offer zero-dollar monthly plans.

Should I keep original Medicare or go with an Part C, Medicare Advantage plan? What is better?

Answer: Original Medicare offers flexibility to see any provider nationwide but lacks drug coverage and an out-of-pocket cap, risking higher costs. Medicare Advantage (Part C) bundles benefits, often includes extras like dental, and caps costs (e.g., $8,850 in 2025), but limits you to networks and may require prior approvals. If you want choice, consider Original Medicare with Medigap; if you’re healthy and prefer lower premiums, Advantage might suit you. Compare plans at Medicare.gov during open enrollment (October 15–December 7, 2024).

Is it ok to meet with multiple Medicare Brokers and Agents as I start looking for help?

Answer: Absolutely. Health insurance is a relationship-based business. If you don't like the first person you talk to, or they don't have the coverage you need, there is plenty of other agents and brokers available to help take care of your needs.

I’m overwhelmed by conflicting advice on when to claim Social Security. Should I take it early at 62, wait for full retirement age, or delay until 70?

Answer: I often hear clients grapple with Social Security timing, and the best choice depends on your health, finances, and goals. Claiming at 62 gives you immediate income but reduces your monthly benefit by up to 30% for life. Great, if you need cash now or have health concerns. Waiting until full retirement age (67 for those born in 1960 or later) secures your full benefit, balancing income and longevity. Delaying until 70 boosts your benefit by 8% annually (up to 24% more), ideal if you’re healthy, can afford to wait, and want maximum lifetime payouts. Consider your savings, work status, and life expectancy: if you’re short on funds, 62 may be necessary; if you’re secure, delaying pays off.

Do I have to apply for Medicare if I am still working past 65?

Answer: The answer hinges on your situation. Suppose you’re still working and covered by an employer health plan with 20 or more employees. In that case, you can delay Medicare Part B (and Part D, if your plan includes creditable drug coverage) without penalty until you retire. However, you should enroll in Part A at 65—it’s usually premium-free and may supplement your employer plan. If your employer has fewer than 20 employees, Medicare becomes primary, so you must enroll in Parts A and B at 65 to avoid gaps or penalties (8.33%–10% premium hikes for late Part B enrollment).

I am moving to a new state in a few months. What's a good Medicare check list to make sure I am not missing anything in my new state?

Answer: I'd recommend you update your address with Social Security (1-800-772-1213 or ssa.gov) to ensure plan notices reach you. For Original Medicare, use Medicare.gov to verify that providers in your new state accept Medicare. If you’re on Medicare Advantage (Part C) or Part D, confirm your plan’s availability in the new state; if it’s not offered, you’ll get a Special Enrollment Period (SEP) to switch—call a licensed agent/broker or 1-800-MEDICARE to check. Compare new plans during open enrollment (October 15–December 7, 2025) or your SEP on Medicare.gov, reviewing costs, networks, and drug coverage. For Medigap, ensure your policy transfers or shop for a new one. Explore state-specific programs like Extra Help for low-income support.

How can I tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker?

Answer: You can tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker by their approach. Are they asking you or telling you? An experienced broker will do a needs analysis and let the client tell them what coverage works best for their needs. Then the broker will align the client with the plan best meets their needs

How could a universal healthcare debate shift Medicare's structure in the next decade?

Answer: I see the universal healthcare debate as a catalyst for positive evolution in Medicare’s structure over the next decade. Proposals like Medicare for All could expand Medicare’s framework, potentially lowering the eligibility age or covering more services like dental and vision, making healthcare more accessible for all. This might streamline costs, reduce private insurance reliance, and enhance benefits for current enrollees, such as lower out-of-pocket caps or broader provider networks. While debates spark concerns about funding or wait times, innovations in care delivery and technology could offset challenges, creating a more inclusive, efficient Medicare system.