Marc Gilman, Medicare Insurance Agent

Answer: Here's what nobody tells you when you're picking a plan: the premium is only one piece of the puzzle, and it's often the smallest piece if you actually use your coverage.

A lower premium usually means the plan is shifting more of the cost to when you actually see a doctor — through higher copays, coinsurance, or a bigger deductible before coverage kicks in. So it's not that you made a "wrong" choice, it's that premium alone doesn't tell you what a plan will actually cost you over a full year of visits.

The number that matters more is the total out-of-pocket maximum — the most you could pay in a worst-case year, copays and all — plus what a typical visit or prescription actually costs you under that specific plan.

A plan with a slightly higher premium sometimes ends up cheaper overall if you see doctors regularly, because it caps your exposure lower. The good news is this isn't permanent — you get a chance to re-shop every year during open enrollment. I highly recommend that you engage an independent agent like myself who will compare the whole cost picture, not just the monthly number.

Answer: The real answer depends on one specific detail: how many employees your company has.

If it's 20 or more, your employer coverage is considered primary, and you can generally delay Medicare Part B without any penalty — as long as you sign up within eight months after you eventually leave that job or the coverage ends, using what's called a Special Enrollment Period.

If your employer has fewer than 20 employees, Medicare typically becomes primary at 65 whether you're still working or not, which usually means you do need to enroll on time to avoid a gap in coverage.

One thing almost everyone should still do, regardless of employer size: sign up for Part A, since it's usually premium-free and can run alongside your employer coverage. The one exception is if you're contributing to a Health Savings Account — enrolling in any part of Medicare stops those contributions, so that's worth planning around.

Before you decide anything, check with your HR or benefits department to confirm your employer's size and whether your coverage is considered "creditable" — that one conversation determines whether waiting is actually safe for your situation, or whether it's setting you up for a penalty later.

At the same time, meet with a trusted independent Medicare agent like myself who will give you guidance about the best steps forward.

Answer: It depends, and "in the long run" is really the key phrase in that question. I could ask you how well do you predict the future?

For a lot of seniors — especially people who are generally healthy and don't see many specialists — Medicare Advantage genuinely does save money in a given year. Premiums are often low or $0, and you're getting dental, vision, and other extras bundled in that you'd otherwise pay for separately.

But that math can flip in a bad health year, because your maximum out-of-pocket cost resets every January, and that number has been climbing. The national median out-of-pocket cap on Medicare Advantage plans went from $5,400 in 2025 to $5,900 in 2026 — nearly a 10% jump in one year — and some plans allow as much as $9,250.

So the "long run" question really comes down to whether your health stays the same as it is today, and it rarely does. Someone who's healthy for five years and then has a rough sixth year with a hospital stay or a new diagnosis can end up paying more cumulatively on Medicare Advantage than they would have with a Supplement plan's steady, predictable premium the whole time.

Neither answer is universally correct — it depends on how much your health changes and how much certainty is worth to you. That's not a question you or anyone can answer, but it is one that I, or any excellent independent Medicare agent, will spend time with you to make the right decision.

Answer: Yes — and it happens every single year, whether you notice it or not.

Medicare has two separate deductibles, and CMS resets both of them annually based on a formula tied to the program's overall spending, not simple inflation, which is why the increase isn't always the same size year to year.

For 2026, the Part B deductible — the one that applies to doctor visits and outpatient care — is $283, up $26 from the year before. The Part A deductible, which applies each time you're admitted to the hospital, is $1,736 for 2026, up $60. Because Part A resets per benefit period rather than once a year, it's possible to pay it more than once in the same year if you have two separate hospital stays that aren't close together.

The part people don't expect is that these numbers move independently of your premium, and independently of each other — Part B went up more this year in dollar terms, but Part A is the bigger number overall.

If you're on Original Medicare without a Supplement, that creeping deductible is money coming straight out of your pocket every January. If you have a Supplement plan, it may be covering some or all of that increase for you, which is exactly the kind of thing worth checking each year rather than assuming your coverage looks the same as it did the year before.

Again, the best method for keeping up with all of the annual changes is to engage an independent agent like myself in order to ensure that you optimize your choice of coverage.

Answer: IRMAA is based on your income from two years ago, so the biggest lever you have is managing what shows up on that tax return before it happens, not after. That means being thoughtful about the timing of things like Roth conversions, large capital gains, or extra IRA withdrawals — spreading them out over several years instead of taking them all at once can keep you from crossing into a higher bracket.

If you're still working and charitable giving is part of your plan, a qualified charitable distribution straight from your IRA can also lower your reported income compared to withdrawing the money and donating it yourself.

The other piece people miss: IRMAA isn't locked in -- has your income has genuinely dropped since that tax return? Life events like retiring, reducing your work hours, losing a pension, or losing your spouse all qualify you to file Form SSA-44 with Social Security and get your premium reassessed using more current income instead of the two-year-old number. It's a straightforward form, but almost nobody knows it exists.

If any of that sounds like you, you want to be talking with an independent agent like myself sooner rather than later.

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: Medicare isn't one decision — it's dozens, and they don't stay decided.

Between Original Medicare, Medicare Advantage, Supplements, and Part D, you're choosing networks and drug coverage that change every year — a drug's tier shifts, a doctor leaves the network, a premium jumps. A good Medicare agent tracks all of that for you, so you're not deciphering a 40-page notice of change every fall.

And here's what people don't expect: it costs you nothing. Agents are paid by the carriers, not by you — by law, that commission never changes your premium. You pay the same whether you enroll directly or through an agent. The difference is an independent agent, like myself, compare plans across multiple carriers side by side, instead of speaking with a single carrier.

And when something goes wrong — a claim's denied, a pharmacy says you're not covered — you've got a real person who already knows your situation.

That's the value: the right plan today, and a real person - not an AI call center- on your side for as long as you're on Medicare.