Marc Gilman, Medicare Insurance Agent

Answer: How long after I apply for Medicare parts and why I received my Medicare card? If you're confused about enrolling in Medicare, your agent is always ready to assist you. You will automatically receive your Medicare card in the mail three months before your 65th birthday if you are already receiving Social Security benefits. If you do not currently receive Social Security benefits, you need to enroll in Medicare. You can call your Social Security office or visit if they're still taking in-person appointments, or much faster, you can apply for Medicare online. However, many seniors do get duped by a fake lookalike Social Security or Medicare websites. If you're nervous about doing it yourself, please ask us, your son or daughter, spouse, or trusted friend, or give me a call, your local agent. If you're confident with your online skills and you want to self-enroll online, you need a login.gov account. Please be careful and go to the official website as shown over my shoulder: https://login.gov/Create-Account. Once you have enrolled, you will receive your card in 2 to 4 weeks.

Answer: If you are turning 65 and still working, should you enroll in Medicare or wait? If you are still working and you have employer health coverage through a company with 20 or more employees, you can delay your Medicare enrollment without penalty. Under 20 employees, you cannot. You must sign up for Medicare Part A and Part B if you have the company with health care coverage. If you have more than 20 employees, you will need to sign up for Medicare Part A. Your Medicare Part A enrollment does not occur automatically if you are not receiving Social Security benefits.

If you are considering Medicare coverage, we will evaluate your out-of-pocket costs as they may be lower with employer coverage. Keep in mind that Medicare premiums may be higher if you enroll while you are working because your income may exceed a level where you incur a surcharge known as an income-related monthly adjustment amount, or IRMAA.

Once you stop working, you have an eight-month special election period, or SEP. The sign-up for Medicare Part B without penalties is available during this time. However, you only have a two-month special enrollment period, or QEP, for signing up for a Medicare Part C, Medicare Advantage, or Medicare Part D drug coverage.

If you retain your employer's health insurance, it is the primary coverage, meaning that it pays first. Medicare will be the secondary payer. If you have a health savings account at work, be aware that enrolling in Medicare may affect your ability to contribute to your HSA.

In this situation, I strongly advise you to consult with a Medicare agent in order to make the best decision based on your individual circumstances. Thank you.

Answer: Why do doctors not like Medicare Advantage plans? Many doctors dislike Medicare Advantage plans because they may have lower reimbursement rates and more paperwork to complete. For example, prior authorization requirements and provider networks may constrain their ability to provide referrals or services. Likewise, hospitals and health systems have cited delayed reimbursements, cumbersome prior authorization requirements, and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.

However, all of those same features allow Medicare Advantage plans to offer $0 monthly premiums, maximum out-of-pocket costs, and extra benefits like dental, vision, and hearing.

Answer: Does IRMAA go away automatically if my income drops? Or do I need to report it to Social Security?

No, I need to report a change in my income to Social Security. Yes, your IRMAA, or income-related monthly adjusted amount, is a surcharge on your Medicare Part A and Part D premiums for individuals or couples whose modified adjusted gross income from two years prior exceeds certain thresholds. For 2026, that’s $109,000 for individuals and $218,000 for joint filers.

It is calculated on a sliding scale, meaning higher income results in higher premiums. If your income has decreased, you should consider filing an appeal to have your IRMAA premiums reconsidered. You will need the appropriate documentation verifying the changes in your personal finances.

If you need assistance with any of the above, as IRMAA rules can be confusing, please contact me.

Answer: How do I budget for Medicare costs if I expect my health to decline in the next decade? Luckily, most of us start out healthy at age 65. Inevitably, we will all experience an unexpected medical event at some point and an overall decline in health. No matter how hard we fight it, I strongly advise everyone to have a plan. Your plan should include a spouse, family member, or trusted friend as your medical power of attorney.

Our choices for Medicare coverage are important, but either a Medicare Advantage or a Medicare supplement plan may be the right choice for you. It really depends on your situation and your budget. You always want to protect yourself financially from potential catastrophic medical expenses. You can do that easily by adding a hospital indemnity and critical illness plans to your coverage.

Seventy percent of us will need some form of long-term care in our lives. Medicare does not cover long-term care, which can be a significant expense. Planning for potential assisted living or nursing home costs is crucial. If you had the benefit of a health savings account (HSA) while you were working, those funds can be used for qualified medical expenses. The best strategy requires planning early and enlisting the best advisers.

Answer: Yes, but the availability of Medicare Advantage plans and their provider network coverage will vary. You are advised to engage a Medicare Agent who will review plans for network restrictions and ensure that your key providers are In-Network.

The bottom line is that beneficiaries in rural areas have fewer choices and smaller plan networks. While most rural areas have access to a Medicare Advantage plan, it is critical for you to understand the specific plan's network and provider participation before enrolling.

Answer: Our question today is: what is one Medicare trend that you believe is having a positive impact on Medicare affordability, and how is it making a difference? Medicare Part D drug coverage has a maximum out-of-pocket for 2026 of $2,100. That is a slight increase of $100, or 5%, from 2025. Once you reach this maximum amount out of pocket, you have no further copayments or coinsurance for the remainder of the year.

Newly introduced in 2025 was the Medicare Prescription Payment Plan. Instead of paying for prescriptions in full at the pharmacy, a beneficiary may choose to receive a monthly bill from their drug plan. This allows individuals to spread their total prescription costs evenly across the year, making budgeting easier. The MPP is available to anyone with a Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage.

The MPP greatly helps those beneficiaries who face high drug costs, particularly at the beginning of the year. The MPP has no additional fees, and participation in the MPP is free. There are no hidden costs associated with spreading out payments.

Answer: If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Medicare. Your enrollment will include both Medicare Part A (hospitalization) and Part B (medical insurance).

Answer: If you are enrolled in Medicare due to receiving Social Security Disability Income, you do not need to sign up for Medicare again. Your Medicare coverage will continue without interruption. Your eligibility reason will change from disability to age. The change in eligibility occurs automatically.

Answer: I encourage everyone to enroll through the services of a good Medicare Agent. Your Medicare Agent knows your healthcare situation and will work with you if your needs change.

Medicare Agents receive training throughout the year from CMS (the Medicare government agency) and our insurance carrier partners. Finalized Medicare plans for the next year are approved and released per a fixed schedule determined by CMS.

Medicare Agents receive training on new plans before their official release to the public. You will receive an Annual Notice of Change (ANOC) from your current healthcare plan provider in late September or early October. Since not everyone reads their ANOC, your Medicare Agent will make you aware of important items and guide your selection of the best coverage for the new year.

Answer: If you are still working when you turn 65, you may only have signed up for Medicare Part A, hospitalization. About 99% of us get Medicare Part A for free. You do not pay for Part A if you or your spouse worked for at least 10 years (or 40 quarters).

If you didn't need Part B due to an employer provided health plan or other coverage, then you would have delayed your enrollment. However, once you enroll i Part B you will pay a monthly premium. For 2026, most of us pay a Part B premium of $202.90. If your income exceeds a certain threshold, you will pay a surcharge referred to as an Income-Related Monthly Adjustment Amount (IRMAA).

Answer: Yes, but typically only Medicare Advantage plans which are classified as Special Needs Plans (SNPs). These plans may either be a Chronic SNP (C-SNP) or a Dual Eligible SNP (D-SNP). Eligibility is based on the verification of a Chronic Condition and enrolled in Medicaid. The benefit may only be used at approved retailers and is limited to healthy foods. Contrary to the TV advertisement, the benefit is typically from $25 to $200 per month.

Answer: Medicare, as other healthcare plans also do, distinguish between visits to your primary care provider versus specialists. Medicare incentivizes visits to your primary care provider by having zero or very low copays. Specialists have a higher copay which varies between plans. Additionally, most Medicare Advantage plans require a prior authorization before you see a specialist which may need to be within the plan's network.

Answer: The simple answer is yes, but Medicare Part B will only pay a percentage of one type of chiropractic treatment. And, Medicare has specific requirements for getting the treatment and payment approved.

Spinal manipulation is the only type of treatment Medicare Part B will cover. A spinal manipulation involves a controlled thrust to the spine using the hands or a device. The goal is to correct bones in your spine that are out of position, called spinal subluxation. Results may include reduced pain, lower inflammation and restored function.

Medicare Advantage plans differ individually in their coverage. If you want chiropractic coverage, then I will select a Medicare Advantage plan that provides that benefit. I will need to review your specific chiropractic services in advance.

Answer: Yes, I always welcome a son, daughter, interested family member or even a caring friend to be involved with my customer's health plan selection, When we get sick, we always want to have someone who has copies of our Medicare and Health Plan cards If they are familiar with our healthcare needs, that is even better.

Answer: Medicare offers Special Election Periods or SEPs. We will review your situation. Almost always, we can find an eligible SEP to use.

Answer: It is highly dependent on my customer's preference and their current health status. If you have significant medical conditions or a large number of prescriptions, it is highly beneficial for us to meet in person.

Even if we do not meet in person for our first meeting, i always try to meet all of my customers based as our mutual schedules permit.

I am very proficient at solving problems for my customers without their in-person involvement or even thier time. This week, I solved a challenging drug coverage issue for a customer. She needed access to a very important Chrohn's disease prescription. The drug is a non-formulary Tier 4 injectable drug. It required me to visit the local specialty pharmacy twice, three calls with the insurance carrier, and an extra call to the carrier's specialty pharmacy. The end result was a filled prescription at her plan's copay rate of $250 versus the initial payment request of $2,132 by the local pharmacy.

Answer: An experienced Medicare Agent is trained to first review all of your healthcare requirements - your preferred medical facilities and provider relationships, prescriptions, medical conditions, and what specific extract benefits would be of value to you. Only then will we evaluate all available healthcare options for you including drug coverage.