Michelle Sparks, Medicare Insurance Broker

Answer: That is an excellent question, and a very important one in today's telemarketing/sales world.

My personal thoughts on this...I recommend working with someone whom is Broker and Educator. A broker that works for you and is contracted with several carriers, not just a few. An educator that prides themselves on understanding your needs, the Medicare and Health industry and shares all needed information for you to feel comfortable making an informed decision. I do not believe brokers should make recommendations. I believe brokers should educate, answer all your questions fully, and then once all options have been laid out for you-- help you to enroll in your choice of plans/carriers.

You also want someone who is not just in it to write a policy.

You want someone with a proven track record of helping their clients, after they are enrolled. So, do not hesitate to ask them what customer service they provide, when/if you need assistance down the road.

Good luck! There are a lot of great Medicare Brokers out there!

Answer: As long as your wife's employer group health plan (EGHP) is "creditable", which means provides equivalent to Medicare coverage and her employer has more than 20 employees- you will not have a penalty. You should check with her HR department to confirm that their Medical and Prescription Drug coverage are "creditable". You need to have continuous coverage under her plan from the time you are age 65 until she retires. Once she retires or the EGHP ends (whichever is earlier), you have 8 months to enroll in Part B without a penalty. You will need to provide proof of your EGHP coverage at the time you apply for Part B. There is a form 564 on the CMS website (Medicare.gov) that you can access and submit.

I also recommend that you work with a local broker. They should help you with the paperwork and enrollment in Part B. This will also ensure you don't have gaps in coverage or penalties.

Answer: There is no penalty for switching back from Medicare Advantage to Original Medicare. However, there are several things you need to consider before doing so. Most important, you need to be aware that you will likely need to pass underwriting, which will consist of a medical review. In some cases, depending on the state, there are also anniversary or birthday rules, where you can switch without an underwriting requirement. Other major considerations are below:

1) Original Medicare is a 80/20 plan with no stop gap. Therefore, if you have a chronic condition or a catastrophic health event, you could be responsible for very large medical bills. I recommend that you apply for a Medigap or Medicare Supplement plan that would pick up the majority of the 20% covered costs. This however, is an additional premium on top of the Part B premium ($202.90) that you would already be paying monthly.

2) If you move to Original Medicare and a Supplement, you will also be responsible for enrolling in a stand alone Part D plan to cover your prescription drug costs. This is also another monthly premium (average premium is approximately $45 monthly).

3) Your Medicare Advantage plan also bundles dental, hearing and vision. Original Medicare and Supplements do not cover these ancillary services. If you want coverage for dental, vision or hearing, you would also need to consider a rider to your supplement, or a stand alone plan. These will run between $30-$80 monthly.

4) The timing of this change is also an important consideration. You can change to Original Medicare from a Medicare Advantage Plan during the annual enrollment period (AEP) 10/15-12/7 (change would be effective with January 1), or you can change during the Open enrollment Period (OEP) January- March (change would be effective the following month).

If this is something that you are seriously considering, I recommend that you reach out to a local Medicare broker that can walk you through each of these considerations.

Answer: That is a great question. If you qualified for a guarantee issue when you signed up for your Plan G Medicare Supplement, it will likely be covered if medically necessary.

You get a guaranteed issue Medicare Supplement (Medigap) plan during your 6-month Medigap Open Enrollment Period (starting when you turn 65 and enroll in Part B) or when specific events trigger "guaranteed issue rights". These rights allow you to buy a policy without medical underwriting (no denials for pre-existing conditions).

Examples of other triggers that may qualify you for guaranteed issue are below:

1) Losing Employer Coverage

2) Medicare Advantage (MA) plan leaves your area or is no longer available to you

3) Trial Rights to Medigap/Medicare Supplement (you joined a Medicare Advantage Plan and within the first year want to change to a Medicare Supplement)

4) Coverage ends due to circumstances beyond your control (e.g. bankruptcy etc.)

Finally, keep in mind that there are important timeframes that you need to adhere to. In most cases, you must apply for a policy 60 days before your coverage ends and no more than 63 days after it ends. If you are in your initial 6-month open enrollment, you can choose any plan, but with "guaranteed issue rights" based on loss of coverage, you are typically limited to buying plans A, B, C, D, F, G, K, or L.

I recommend reaching out to a local Medicare Broker to help you navigate these complex decisions at least 3 months in advance of needing a Medicare Medigap/Medicare Supplement Plan. In most cases, that will be when you are turning 65, retiring and leaving an employer group health plan or losing your current coverage.

Answer: Medicare brokers provide educational seminars where they are not to sell or talk about specific plan information, costs etc...

They do however offer the opportunity to schedule an appointment at a separate time, if you need more one on one education or are interested in learning more about specific plan options.

Medicare seminars can be a great way to learn about the basics of Medicare and understand the critical timelines that must be met to avoid late penalties or potential gaps in coverage.

You can also gain this information from simply reaching out to a local broker in your area that will educate you on the same information-- just without a formal presentation or meal!

Answer: Yes, a broker can help you research all available Medicare Supplement and Medicare Advantage Plans in your area to see which one may have the broadest coverage for chiropractic care.

A couple things to consider when evaluating Medicare Advantage plans for chiropractic services: 1) it’s essential to consider key factors such as coverage options—looking for plans that include not just spinal manipulation but also additional therapies—alongside costs like copayments and coinsurance to find the most affordable options; 2) additionally, ensure the plan has a wide network of chiropractors, and look for any additional benefits, like wellness programs, that can enhance your care.

Finally, researching customer satisfaction ratings and reviews can provide insights into various plans, and a broker can help you check for annual limits on visits or treatments covered.

Given all the above considerations, yes, you should definitely work with a local broker to help you find a plan that has broader chiropractic coverage tailored to your needs.

Answer: With continual changes in Carrier Plans, Formularies, and Deductibles, choosing the right Medicare Part D plan is getting more challenging each year. Below is a quick summary of the four biggest mistakes seniors make when choosing a Medicare Part D plan.

1) Not comparing plans: The biggest mistake is not comparing plans. This is critical to ensuring you are on the right plan to start out with, and each year during the annual enrollment period (AEP), because plans change annually. You must not assume that your plan will remain the same year to year. This goes for both Medicare Part D and Medicare Part C plans.

2) Not considering your prescriptions: Some plans may have a low premium, but your prescriptions may not be covered in that carriers formulary. Carriers may change their formularies each year, so this comparison should also be done during initial enrollment as well as each year during the AEP.

3) Not considering deductibles, copayments, and in network pharmacies: In 2026, several carriers added or increased their drug deductible and copays. In addition to considering these elements you should also ensure that you are using an in-network pharmacy. Not doing so could cost you several hundred dollars per prescription. All of these costs vary from carrier to carrier and many of these costs will change annually.

4) Missing enrollment periods: Missing your initial enrollment period in Medicare Part D or missing the annual enrollment period are key mistakes that seniors make. Seniors that are turning 65 or currently on a Medicare Plan, should work with a local broker at least 3 months in advance of their 65th birthday and each year during the AEP, which is October 15th-December 7th.

Answer: To be eligible for Original Medicare Part A and Part B, you must be age 65 or have been entitled to Social Security Disability insurance for 24 months (two exceptions to this: disabled due to end stage renal disease ESRD or ALS).

Part A is hospital insurance and comes with a zero dollar premium if you are insured (e.g. paid FICA tax for 10 years) for Social Security benefits. Many people sign up for Part A, even if they are continuing to work since it is a benefit they have earned and does not cost anything extra. It simply provides extra coverage.

Part B is medical insurance and in 2026 comes with a $202.90 monthly premium for most individuals (some high earners pay pay more for their Part B). If you are still working at age 65 and covered by an employer group health plan (EGHP), many people hold off on signing up for Part B, due to the cost of the premium. There is also no penalty for filing after age 65, if you are covered by an EGHP that is creditable. You should ask your Human Resources Department if your EGHP is creditable before deciding not to take Part B at age 65.

If you have not worked and paid into Social Security and are not insured for benefits, you can get Part A and Part B, but you would owe the monthly premiums for both. For Part A, the monthly premiums may range from ~$300 to over $500 monthly. For Part B, the monthly premium will be $202.90.

I also recommend working with a local Medicare expert at least 4-6 months before your 65th birthday. Additionally, if you are on Social Security Disability, reach out 4-6 months before you are eligible for Medicare. Medicare experts will be able to educate you on all your Medicare options (e.g. Original Medicare, Medicare Advantage Plans, Dental, Vision, Hearing etc...), as well as ensure that you avoid costly late enrollment penalties.

Answer: In general, Guarantee Issue is only federally mandated when you turn age 65 and in some special circumstances that may also include losing your current coverage. However, Guarantee Issue is a complex topic that requires detailed knowledge of your particular situation, age, as well as the state you reside in. I would recommend reaching out to a local expert and explain your exact situation, so they can assist in developing the best possible plan for you.

Answer: The availability of Guarantee Issue (GI) for Medicare Supplements can vary from state to state, once you are outside of your initial enrollment period (IEP). For example, some states have an anniversary rule or birthday rule that have guarantee issue beyond the initial enrollment period (e.g. 6 months beginning with the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B). Additionally, if you are outside of your IEP, you may still qualify for Guarantee Issue, if you have a qualifying event, like losing coverage from an employer group health plan. Lastly, if you are outside of your IEP, you may still qualify for a Medicare Supplement, you will just need to go through medical underwriting. My recommendation would be to contact an independent Medicare Broker to help assess all your options and best path forward.

Answer: I recommend contacting an independent Medicare Broker that can assess your individual situation. Depending on your age and eligibility for Medicaid, you may have some other enrollment options. If you do, they can help you assess the best coverage options for you. Additionally, if you don't have other enrollment options, they can help you apply for extra help and develop a plan to apply for additional insurance as soon as possible.

Answer: There are several ways to compare medicare plans for your parents. One common way to do this is to go directly to Medicare.gov and enter your zip code to compare Medicare Advantage Plans and Medicare Prescription Drug Plans. You can also go directly to various Medicare Carrier's websites to do research on individual plans, including Medicare Supplements and their estimated monthly premiums. My recommendation would be to contact a local broker who is familiar with all plans in your area so they can do the research and compare for you. It is very important to consider your parent's prescriptions and their providers if you are considering a Medicare Advantage Plan and Medicare Prescription Drug Plan to ensure that they have the most comprehensive coverage possible. An independent local broker can collect this information for you and conduct the research, then you can also double check what they are sharing via the carriers site or direct with Medicare.gov. Lastly, this information will need to be shared directly with your parents, if they are their own legal representative. Best of luck!!

Answer: You are certainly able to meet with a broker, if your parents are present. If you are the legal representative for them, you can also meet without them, as well as make decisions on their behalf.

Answer: Before you make a decision to go with an Advantage Care plan, you will want to understand the rules for switching to a Medicare Supplement Plan. Rules may vary from state to state, so you will want to work with a Medicare broker that is familiar with your state rules. Some states allow you to change plans with guarantee issue on the anniversary date of the policy, and others allow changing on your birthday month. Some do neither.

If you do not have either of those two options, and you are beyond your first 12 months on Medicare, you will more than likely need to wait until the Annual Enrollment Period (10/15-12/7) to make a change. Additionally, you will be required to go through Medical underwriting. You only have a guarantee issue for a Medicare Supplement for the first six months following your 65 birthday or from when your Part B begins. So, depending on the severity of your illness, you could be denied coverage or have an increased premium.

If you have already started with a Medicare Advantage Plan, it is a good idea to contact a local broker who can help you navigate your best options.

Answer: I conduct an intake meeting to collect information about what an individual is looking for in a health plan. I then share the basics with them on Original Medicare, Medicare Supplement Plans as well as Medicare Advantage Plans. Once I understand their health needs, I pull together comparisons for them on all to ensure they have all the information necessary to make a well informed decision. Our second meeting is to discuss any questions they may have regarding the comparisons shared. I believe strongly that all individuals should fully understand all their options- in order to make the best decision.

Answer: It is very important that you work with a local broker to assess what prescription drug plan is best for you. Especially, as you move in to 2026, as many changes are taking place with drug prices and deductibles. A Medicare expert will be able to assess your list of prescriptions and ensure you are in the best possible plan. Additionally, all carriers offer a prescription payment plan that allows individuals to spread out their prescription costs throughout the year. A local broker can assist you with this as well.

Answer: If you are enrolled in a Medigap Plan F plan, your supplement plan will cover your copay- beyond the one time annual Part B deductible of $257.00. If you have already met the one time annual Part B deductible, then you would have no copay.

Answer: If you were covered on your spouse's employer group health plan, and they lose coverage due to loss of employment, death, retirement etc... that qualifies you for a special enrollment period that begins the month the coverage ended. If you are over 65 and eligible for Medicare, you need to contact the Social Security Administration or go online at www.ssa.gov to apply for Medicare Part A or Part A and B. To avoid a penalty for filing after 65, you will need to have the employer verify coverage from age of 65 through the end date of coverage. Medicare Brokers can assist you with Original Medicare, and with a Medicare Supplement or Medicare Advantage Plan. My advice is to work with someone local that is independently contracted with all major carriers, so you are educated on all available health plans.

Answer: Please pay special attention to changes related to your maximum out of pocket, your medical and drug deductibles, as well as your prescription drug cost. There are significant changes coming with 2026 plans, so close review of your ANOC notice is critical. Additionally, reach out to a local broker so you can have them do in depth research on your providers and prescriptions cost. You don't want any surprises in January on drug costs or your doctor no longer being in network.

Answer: I would consider a PPO Medicare Advantage Plan that have good coverage for your providers and prescription drug plans. To ensure you don't have large out of pocket expenses, in the event of a chronic or catastrophic medical event, I would pair it with a Hospital Indemnity or Cancer plan that covers you up to your annual maximum out of pocket.

If you are healthy, these plans start at $45 - $55 monthly. Therefore, when paired with a zero premium Medicare Advantage Plan, you can have comprehensive coverage for an affordable cost.

Answer: When choosing between a Medicare Advantage Plan and a Medicare Supplement Plan (Medigap), there are no right or wrong answers. The best choice depends on each individual's financial and health needs.

Medicare Advantage Plans (also known as Part C) replace Original Medicare (Part A and Part B). Many of these plans offer additional benefits, such as coverage for prescription drugs, dental, vision, and hearing services. While some Medicare Advantage Plans have no extra monthly premium, individuals must continue to pay their Part B premium, which is $185 in 2025. These plans also feature a maximum out-of-pocket limit, which helps protect you from high costs if you are hospitalized or require expensive medical procedures. Most Medicare Advantage Plans are available as either PPOs (Preferred Provider Organizations) or HMOs (Health Maintenance Organizations). If you choose a Medicare Advantage Plan, you will need to use in-network providers. Be aware that there are copayments and coinsurance costs associated with these plans.

Medicare Supplements (or Medigap plans) work alongside Original Medicare (Parts A and B). Original Medicare typically covers 80% of medical expenses, while a Medicare Supplement plan covers the remaining 20%. When you choose a Medigap plan, you still need to pay your monthly Part B premium of $185 (in 2025), in addition to the monthly premium for the Medicare Supplement plan. Although the total of these premiums can add up, the only out-of-pocket expense is the one-time Part B deductible of $257 (for 2025). All other copayments and coinsurance are covered by your Medicare Supplement plan.

In summary:

- A Medicare Advantage Plan generally costs less each month, but you will incur copayments or coinsurance whenever you visit a doctor or undergo a procedure. This means you are paying for care as you receive it.

- A Medicare Supplement Plan has a higher monthly premium, but your medical expenses are known. This means you are paying for care in advance.

Answer: What does Part B cover? That is a great question. Part B is going to cover 80% of approved charges for the following services, once your annual deductible is met ($257 for 2025):

-Services from doctors and other health care providers

-Outpatient care

-Home health care

-Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

-Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Is that enough?: You will owe the other 20% with no cap on annual out-of-pocket expenses. Also, the following is a list of what Part B does NOT cover:

-Most prescription drugs (usually, Part B only covers drugs you wouldn't typically give to yourself, like those you get at a doctor's office or in a hospital outpatient setting).

Eye exams (for prescription eyeglasses)

-Massage therapy

-Routine physical exams

-Hearing aids and exams for fitting them

-Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

-Covered items or services you get from a doctor or other provider that has opted out of participating in Medicare (except in the case of an emergency or urgent need)

-Most dental care: In most cases, Original Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures.

Medicare Advantage plans cover what Part B covers, and bundle other coverage, such as prescription drug coverage and limited dental, vision, and hearing. Equally important for you to know is that Medicare Advantage Plans offer an annual Maximum Out of Pocket (MOOP), meaning once that amount is met, the carrier will cover all costs. This is one major difference between Original Medicare and a Medicare Advantage Plan.

To learn more about the differences between Original Medicare and a Medicare Advantage Plan or a Medicare Supplement Plan, reach out to an experienced local independent Medicare broker.

Answer: If you are referring to the Center for Medicare and Medicaid services (CMS), you might try using the chat feature, they are generally more responsive on the chat. If you need help navigating Original Medicare, Medicare Advantage Plans, or Medicare Supplements- I would recommend reaching out directly to a local broker via this Medicare Agents Hub. Independently licensed brokers will be able to help you navigate the complexities of Medicare, educating you so that you feel confident in your decision making .

Answer: I have spent my 35 year career with Social Security assisting individuals with Original Medicare and Social Security benefits. Now that I have retired, I love that I can continue to serve others and continue to put my expertise to good use. Healthcare decisions are an important part of retirement, sometimes as important as the financial aspects are. Getting folks off to a good start at 65, or helping them get to the best place possible if they are already on a Medicare plan, fills my current desire to continue to serve others. Not to mention, I get the opportunity to meet some really cool new people ... everyday!

Answer: There are Special Enrollment Periods (SEPs) for various circumstances (e.g. moving zip codes, ending employment/employer group health coverage etc...) that will afford you an opportunity to enroll, if you missed your Initial Enrollment Period (IEP) or the General Enrollment Period (GEP).

The IEP is a 7 month period that begins 3 months prior to your 65th birthday month, includes your birthday month, and the 3 months following. The GEP is an annual enrollment period that begins January 1st of each year and ends with March 31st. With both of these enrollment periods, coverage begins the month following the month you enroll.

To avoid potential gaps in coverage or late enrollment penalties, it is a good idea to reach out to a local broker that can help you navigate the complexities of Medicare enrollment periods.

Answer: One program that is new this year is the Medicare Prescription Payment Plan, a payment option that works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year (January–December). Anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option, and participation is voluntary.

The advantage of this program is that you will be able to spread the cost of your drugs out across the calendar year, vs. having to pay all at once up front. If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.

Another program offered by Medicare is the Extra Help program. This program is for low-income individuals. In 2025, the income limits for Medicare's Extra Help program are below:

Individuals: Monthly income of less than $1,903

Couples: Monthly income of less than $2,575

To apply, go to: https://www.ssa.gov/medicare/part-d-extra-help .

These are just a few options that may be helpful. If you have additional questions, please consider reaching out to a local expert in your area. They will be able to help with your specific situation, as well as offer other suggestions available in your state and zip code.

Answer: If you are eligible for Medicare before marriage (usually at age 65 or due to a disability), marrying does not affect your eligibility.

However, if you’re applying for programs like Extra Help for prescription drug costs or Medicaid, your household income may be considered, which includes your spouse's income. This could affect your eligibility for those programs.

If your spouse has health insurance, you may want to evaluate whether to keep your Medicare or switch to their plan, depending on the coverage options and costs. For example, they may be able to add you to their Employer Group Health Plan, if they are currently employed.

Finally, marriage can trigger a Special Enrollment Period (SEP) for Medicare, allowing you to make changes to your coverage if needed.

It's always a good idea to review your specific situation with a local broker that can advise you on all your options.

Answer: Right now is a great time to start preparing for AEP. Having a good understanding of your current plan's benefits, and conducting a review of any health changes you have had in the past year, are important first steps. Once you understand your plan, and have identified any gaps in coverage or service with your current carrier/plan, it is a good idea to reach out to a broker. A Medicare Broker will be able to educate you on all plans available to you in your zip code and do an in-depth discovery with you to ensure that you enroll in the best possible plan for your healthcare needs in 2026. Carriers can make annual changes to their plan benefits and they also change prescription drug coverage, so it is a best practice to work with a broker that will do this review for you every year at this time. Open season begins October 15th and ends December 7th. Perfect timing to discover what plan will work best for you in 2026. Reach out to a local broker soon! Thanks for reaching out... great question!

Answer: Many seniors express the regret over not enrolling in Part B when they first become eligible. Part B covers outpatient care, preventive services and some medical supplies. Some individuals also face penalties for late filing, which can also increase their penalties when they do later enroll in Part B. This is why it is important to get educated prior to your 65th birthday. Knowing what Original Medicare (Part A and Part B) cover, as well as understanding the gaps in coverage is key to making an informed decision about whether to go with a Medicare Advantage or a Medicare Supplement plan. Don't leave your healthcare to chance... call a professional Medicare Broker.

Answer: I can see how this would be very frustrating, and one of the main reasons I spend as much time as possible educating folks before they turn 65. Enrolling during your initial enrollment period for a Medigap policy ensures a guaranteed issue from all Medigap carriers.

The rules surrounding Medigap enrollment can be complex, and many people are unaware of the specific timelines and conditions that apply. The initial enrollment period for Medigap typically lasts for six months after you turn 65 and enroll in Medicare Part B. During this time, you have guaranteed issue rights, meaning insurers can't deny you coverage based on pre-existing conditions.

If you miss this window, insurers can require medical underwriting, which means they can assess your health and potentially deny coverage or charge higher premiums based on your health status.

It's always a good idea for individuals nearing 65 to educate themselves about Medicare options and timelines to avoid such situations. Reaching out to a local Broker is a great first step!

Answer: The turning age 65 market is one of the most targeted demographics right now, with baby boomers reaching the peak of the magical Medicare age- 65!

The best way to navigate the complexities of Medicare is to work with a professional licensed personal broker that is contracted with multiple carriers and has your best interest at heart. An independent broker does not work for a specific carrier, they work for you.

A personal broker will work with you to detail out your financial and health status to ensure that you select the right plan for you. They will also ensure you do things timely to avoid lifetime penalties on your premiums.

This decision is very individual, there is no cookie cutter approach. You should reach out to a local independent broker at 3-6 months before turning 65 or becoming eligible for Medicare (if disabled).

Answer: If you are already retired and collecting Social Security, you will automatically be enrolled in Medicare Part A and Part B. You will receive your Original Medicare Card in the mail 2-3 months in advance of your 65th birthday and your benefits will be effective with the first day of the month that you turn 65. If you turn 65 on the first day of the month, your Medicare benefits will be effective with the month before your 65th birthday.

Once you receive your Medicare card, you should be in contact with a broker to help you decide what additional insurance needs you have. You will need to enroll in a Part D plan (prescription drug plan) at 65. To avoid penalties, you need to enroll in a Part D plan during your initial enrollment period (IEP), which is a seven month period- beginning with the three months before you turn 65, your 65th birthday month, and the three months following.

In addition to your Part D enrollment, you will want to consider whether a Medicare Supplement or Medicare Advantage plan is best for you. Everyone's needs are individual, so it is best to speak with an independent broker that can help you navigate the complexities of Medicare- ensuring you have the best possible health coverage for your personal needs.

Answer: The Medicare "donut hole," which refers to a coverage gap in the Medicare Part D prescription drug benefit, was eliminated January 2025. This change was a result of the Inflation Reduction Act, which aims to make prescription drugs more affordable for Medicare beneficiaries.

Previously, beneficiaries faced a coverage gap (the donut hole) where they had to pay a larger share of their prescription costs after reaching a certain spending threshold.

The new rules established a maximum out-of-pocket limit of $2,000 for Medicare Part D beneficiaries. This means that once beneficiaries reach this limit in out-of-pocket costs for covered medications, they will not have to pay any additional prescription drug costs for the rest of the year.

Answer: There are many advantages when enrolled in a Medicare Advantage Plan. The biggest issue that folks need to think through before enrolling in an Advantage Plan vs. a Supplement/Medigap plan is the ability to switch if you want a plan to cover more of you medical costs.

When you turn 65, you have 6 months to enroll in a Medicare Supplement with guaranteed issue, regardless of health or pre-existing conditions.

If you elect a Medicare Advantage plan at 65, you have 12 months to switch to a Medicare Supplement and receive the same guaranteed issue. However, if you wait beyond the 12 months- you will be subject to underwriting (e.g. health exam) and risk being denied coverage.

In summary, assessing your financial and physical health when turning 65 are key critical factors to deciding whether to go with a Medicare Advantage or Medicare Supplement. There is no one right decision, these are very individual decisions that should be made with the assistance of an experienced broker that can educate you on all the details- so you are confident that you are making the best decision possible for YOU!

Answer: If you are turning 65 and still working you generally will have the option to either continue with your employer group health plan (EGHP) or switch to Original Medicare- Part A and Part B. Some EGHPs require you to take Medicare at 65- so this is something you will want to check on with your Human Resources/Benefits department.

The first step is to enroll in Original Medicare through the MySSA portal online via the Social Security website (www.ssa.gov). You can apply online for Medicare only- taking only about 20 minutes of your time.

Once you are enrolled in Part A/Part B of Medicare, my recommendation is to work with a healthcare broker who can compare your Medicare options to your EGHP and provide you with the information you need to make the best decision for you. In addition to looking at cost and coverage comparisons, they will ensure your EGHP is creditable, so that you are not at risk of a penalty for Part B or Part D.

A Medicare broker will also be ready to assist you when you do stop working and wish to enroll in a Medicare Advantage (Part C) or a Medicare Supplement (Medigap) with a stand alone Prescription Drug Plan (Part D). They will also ensure you enroll during your Special Enrollment Period to avoid penalties and ensure no gap in coverage.

Answer: For my Turning 65 clients, I start with the ABC's of Medicare so that they understand the basics of Original Medicare. I want them to understand the differences between Original Medicare, Medicare Supplements, and Medicare Advantage plans so they are confident in making good decisions. Specifically, what gaps they want to supplement with a Medicare Supplement or what benefits they want to replace with a Medicare Advantage Plan. I also spend a good bit of time educating them on what they need to know if they plan to work past 65. The average retirement age is now well beyond 66, so comparing employer group health plan benefits to Medicare is a critical step in the decision making process. I want to ensure seniors set themselves up for success down the road, which includes the best coverage for the best price- and to avoid potential late penalties.

For my clients that are considering switching plans, because I am a broker that represents all major carriers, I routinely monitor any changes in their health/financial situation against the changes that the carriers are making. Each year carriers make changes, and each year I ensure all my clients have a complete review of their current plan, so they can compare and make changes if needed- leaving them with the confidence that they know they are in the best possible plan for them.

Answer: You can always reach out to a professional broker for help in comparing Part D plans. Or, you can go directly to Medicare.gov and click on Health and Drug Plans in the upper right hand corner of the homepage. Then click on compare health and drug plans and enter your zip code. It will allow you to enter all of your prescriptions drugs and compare all available plans in your zip code. The comparison will also show what your monthly costs will be for each prescription. Don't hesitate to call for additional help!

Answer: I retired from the Social Security Administration after 35 years of service. I worked on the front lines taking claims, in mid level and executive leadership. I became a broker and social security advocate for seniors because I love sharing my knowledge with seniors so they can make good decisions that impact their health and wealth. Social Security and Medicare are complex programs that seniors need help navigating and I feel strongly that they need help as they turn 65, so they are able to make the best decision possible. I get a lot of satisfaction out of breaking down both SSA and Medicare so they are easily understood. This allows seniors to make educated and confident decisions.

Answer: Seniors! You should begin planning and getting educated on Medicare six months in advance of your 65th birthday. All seniors need to understand the difference between Medicare Advantage Plans and Medicare Supplement plans. Getting educated about Original Medicare (Part A, B and D), Medicare Advantage Plans (Part C) and Medicare Supplements will ensure each senior makes the best decision for them- this is a very individual decision that is dependent on the area you live in, and your financial and physical health. Additionally, all seniors need to know that they need to be eligible and enrolled in Original Medicare Part A and B in order to enroll in a Medicare Advantage or Medicare Supplement Plan. This needs to be completed timely through the Social Security Administration to avoid penalties on premiums or a gap in coverage. This is something that several seniors I work with are not aware of, since a growing number of seniors are working beyond their 65th birthday. Seniors working beyond 65 are generally covered by an Employer Group Health Plan and may not understand how their EGHP interacts with Medicare once they reach 65, when to enroll in Original Medicare, or what documentation to show to avoid unnecessary penalties on premiums.