Elizabeth Henderson, Medicare Insurance Broker

Answer: Yes you are eligible for a Special Enrollment Period if you lose your employer coverage. The Special Enrollment Period for Parts A and/or B are for 8 months and starts the month after Employment stops or coverage stops, whichever comes first. You have 63 days from that time to enroll in either Part D or a Medicare Advantage plan with prescription drug coverage in order to avoid penalties.

**Please note that COBRA does not count as creditable coverage, as it is not considered employer coverage. That said, there is not an SEP if you have COBRA and it ends.

Answer: As of 2026, there is no longer a 'donut hole'. That ended in 2025. There is an annual maximum out of pocket of $2100 and, once you reach that, you are in the 'catastrophic' phase where your prescription drugs copays are $0 for the rest of the year.

Answer: This is a loaded question because every market is different. I would need to know your state before answering this question plus also what you're looking for in a plan. There are some that offer preventative coverage (most, if not all but this one, don't) and not only diagnostic coverage. Some offer exercise programs, similar to Medicare Advantage plans, in addition to other perks (but many people just like having that option and never use them).

If, on the other hand, you are talking about which actual PLAN within Medigap is the best value, that is a different answer. That, again, depends on what you're looking for. You may have a lot of money and would rather have a higher deductible plan. Those are only offered on Plan G and Plan F (no longer available to newly qualified Medigare recipients unless they were born or were on disability prior to 1/1/2020). Most of what we see in the industry is that people want to be on plan G or N. Plan G is the #1 most popular plan because it covers everything except the Part B deductible. Plan N is the #2 most popular plan as a lower cost alternative because it covers everything except Part B deductible and Part B Excess charges. Some markets do not have these plans (like MN and WI, for example). The plans have different names but brokers know the equivalents and I know in Minnesota they the equivalent is better than Plan G if you configure the moving parts correctly.

Answer: Assuming they are not on Medicaid and are somewhat healthy, there are a couple of questions that you should ask first;

>Will they be traveling (i.e. do they need to be able to see a doctor in other states at any given time) or will they be sedentary in their local area?

>Do they like certainty in their healthcare costs or do are they OK with the under 65 type plans with co-insurance, copays, and deductibles?

Answers to both of these questions will determine if your parents should be in a Medigap plan or Medicare Advantage plan. Medigap plans are mostly the same in that they cover all doctors who accept Medicare throughout the USA and have some coverage outside of the USA. Medicare Advantage plans are particular to doctors nearby (not good for people who travel and want coverage outside of their area even in the same state) because doctors choose if they take the particular plan or not and most doctors are out of network.

There's a lot of information regarding these plans so it's best to talk with a broker since healthcare is the biggest expense in senior years, ESPECIALLY as people age and are in their "No Go" years.

Answer: The worst medicare-related decision someone can make is to choose a plan based on cost, or lack therof. The reason is because it may be more costly in the end and it may not incorporate your doctors.

Answer: This depends on the state, however, what I think you're asking is how to have a guaranteed issue policy when a prior insurer ceases to exist and what to do it they don't notify you to still have those rights.

Guaranteed Issue policies can be issued 60 days prior to and up to 63 days of your current policy ceasing to exist. Outside of that, you usually cannot backdate a Medicare Supplement policy but you can file a complaint with your State Department of Insurance. Keep records of everything because you will be asked for them. Make sure to enroll in another plan as soon as possible though so you minimize the potential of getting denied.

Answer: The answer to this question is entirely up to your specific needs. Medicare Advantage (aka Part C) is a "Pay Later" type of plan, very similar to under 65 plans with a deductoble, copays and co-insurance. The plans tend to have low premiums to offset the higher deductibles, copays, and co-insurance. They also restrict your care to a network near you. This is good if you don't plan on traveling and think you won't get sick anytime soon. Also, this plan can either cover prescription drugs or not. It is also the only plan that combines with Medicaid.

Medigap plans, on the other hand, tend to have higher premiums and are known as "Pay Now" plans. They have different plans, but Plan G covers all costs except for the Part B deductible, which is $283 in 2026. This type of plan allows you to see any doctor across the nation who takes Medicare, so this is good for those who travel out of their local network area. This plan does not cover prescription medication, so you will need to purchase a separate Part D plan. Part D plans range in price but should be determined based on your medication coverage needs.

Both types of plans can include extra perks such as gym memberships, dental, vision, and hearing. You will find a few more perks with Medicare Advantage plans, however, such as transportation allowance to doctor appointments and money back to pay for Part B premiums.

**Note: You still have to pay Part B premiums regardless of which plan you purchase... Medicare Advantage Plan or Medigap Plan.

Answer: One of the reasons people are leaving Medicare Advantage plans is because as they age, their health deteriorates and Original Medicare can cost less than Medicare Advantage plans. Also, the networks limit who a patient can see for care. Medicare Advantage plans (the HMO and EPO plans) also require referrals. Medicare Advantage plans also require prior authorization before getting surgeries, etc., which lengthens the process for getting care. Lastly, some plans have chosen to exit the market so people are forced to either choose another plan or go back to Original Medicare. Overall, the concensus is that people are exiting due to dissatisfaction.

Answer: This is a loaded question. I have heard that what people regret in some cases is that they didn't know about Medicare Advantage plans and were told about only Medigap plans, when they would have preferred to have been in a Medicare Advantage plan had they known about them. Some of us are licensed for both. I can speak to both so I will. The alternate regret I have heard is that people enrolled in a Medicare Advantage plan and didn't realize they couldn't switch to a Medigap plan later without underwriting (the 'trap'). It ultimately comes down to what you need and want in a healthcare plan. Consider what you want to do in your elder years and in your 'no go' years... where will you be? Your agent should have discussions with you about these things because it will shape which type of plan is right for you.

Answer: Typically Plan K has lower premiums than Plan G but it is so at a greater cost later. If you don't mind higher out of pocket costs later, Plan K may work for you. The differences lie in the following costs: Part B (co-insurance and co-pays), pints of blood, hospice care coinsurance, skilled nursing facility coinsurance, Part A deductible, Part B Excess Charges, and Foreign Travel Emergency cost.

Answer: You will want to do your own research for what you think your own needs will be. There are materials out there that can teach you about the varying different types of plans and we Medicare Agents are here for you also. Our job is to listen to you and find the best fit for what you, and only you, want/need.

Answer: If you sign up for a Medicare Advantage plan and become seriously ill later, you won't be able to change to a Medigap (Medicare Supplement) plan. The reason this matters is that Medigap plans tend to be a bit more reliable for cost, but are higher per month from the beginning than Medicare Advantage plans. Medicare Advantage plans are riddled with co-pays, co-insurance, and a deductible... as well as a Maximum out-of-pocket amount. After 12 months of committing to a Medicare Advantage plan, you will need to go through underwriting to get into a Medigap plan, which is why it is considered a 'trap'. I have to say that some people are fine with Medicare Advantage plans nonetheless :)

Answer: Medicare Part D is meant to help lower the cost of prescription drugs using Medicare negotiated rates. It protects patients from the high cost of medication.

Answer: While there aren't discounts persay, with Medicare Advantage plans there are other "give-backs" in some cases to effectively offset some of the cost of Part B. You can also earn money back from some of the insurance companies for doing preventative measures, such as going to the gym, getting preventative tests done, etc..

Also, some Medicare Supplement plans give household discounts, whereas Medicare Advantage plans don't.

Answer: This is a trick question for Medicare Agents... haha! The Plans are not truly ever "free". If you are paying a $0 premium, then you are probably paying higher copays, deductibles, and co-insurance. You are still also paying for Part B, which is affected by IRMAA.

Answer: Medicare Advantage (Plan C) plan - C-SNP, Chronic Special Needs Plans are the best equipped to help with chronic kidney disease. You will receive a care team to help you through this as they were designed for this.

Answer: Review your Evidence of Coverage (EOC) document you received from either the insurance company and/or your Medicare Agent. You also want to make sure each year that your doctor/clinic/hospital accepts your insurance. A Medicare Agent can help you with this.

Answer: With a new diagnosis, the best time of year to change a medicare plan is either right away (if it's a Qualifying Life Event, such as cancer) or during Open Enrollment Period (between January 1 - March 31) if you are already in a Medicare Advantage plan and would like to change Medicare Advantage plans. If you are in a Medigap plan and are within the first 6 months of having it when you get a diagnosis, you can change Medigap plans during that time without having to go through underwriting. Beyond that time, however, you will likely have to go through underwriting and your preexisting condition won't allow you to qualify.

Answer: Plan B (original medicare) covers all but 20% of COPD treatment and Plan D (Prescription) covers oxygen therapy. Another way this can be covered is via a Medicare Advantage plan (Plan C) with a C-SNP, a Chronic Special Needs Plan, which is geared toward helping with specialized cases such as these. The patient receives a care team to help with this and, oftentimes, more financial help to cover COPD.

Answer: The biggest impact on how healthcare engages digitally with patients will probably come in the form of increased telehealth options to save on cost. If this is the case, it would be a positive impact for all of us.

Answer: There are many people who are used to just choosing their own health insurance online or from their employer, however, there is so much more to know with Medicare. There is timing to be aware of and also income strategies to be aware of in order to minimize costs. Also, medicare agents help you understand the difference between plans and, if they work with enough insurance companies, they will be able to guide you to which one will work best for you in your specific market given what you want and need.

Answer: There are what's called C-SNPs, which stands for Chronic Special Needs Plans. These are the ones that cater the best to chronic pain management as you are offered a care team to help you work with and through the pain/arthritis. Not every market has C-SNPs, however.