Nancy Courser, Medicare Insurance Agent

Answer: Yes, you can drop your employer health insurance (assuming you have no dependents on the plan including your spouse) if you're turning 65 and you've determined that moving to Medicare Part A & B with supplemental insurance makes the most sense while you continue to work (active employee). It's called a qualifying event when you are first eligible at age 65. Doesn't matter what time of the year you turn 65; you shouldn't have to wait for the employer's Open Enrollment.

Answer: Many Advantage plans have a zero premium. You still pay the Medicare Part B premium to Social Security. It is anticipated in 2027 that there will be some plans that move from a $0/month premium to a $$ amount.

Answer: You should review your plan changes during the Annual Election Period in the fall which runs 10/15 - 12/07 for a January 1st start date. You can then ascertain if a specific therapy is covered and what the potential co-pay/so-insurance might be.

Answer: Medicare Part B is the medical services portion of your Medicare. You're not in the hospital - that's Part A - but receiving outpatient care, preventative services, ambulance transportation, and durable medical equipment. Most people pay for their Part B in the form of a monthly premium. Then they pay a deductible (annual) and Medicare pays 80% and you pay 20% of the Medicare covered service. There are certain drugs that also are covered by Part B - generally these are infusions - medications that are not self-administered.

Answer: Word of mouth, ask family friends, google Medicare Agents in your area, attend seminars to learn more about Medicare and request a consultation from the agent (no cost to you).

Answer: Yes, a primary care physician will be assigned if you have Medicare Advantage plan HMO or HMO-POS plan. You can always change providers with the plan anytime throughout the year.

Answer: There are several ways to make changes during open enrollment which is also referred to as the Annual Election Period. This takes place in the fall (10/15 - 12/07) for a January 1st effective date. You can contact an agent/broker for assistance, call the plan provider, or even go to Medicare.gov and change your Part C/D (Advantage Plan) or Part D (Prescription Drug Plan)

Answer: A disadvantage of the Medicare Advantage plan is that you work with a network versus the ability to chose any doctor that participates with Medicare if you stay with Original Medicare - Part A & B. A Medicare Advantage (Part C) plan network is a contracted group of doctors, hospitals, pharmacies, and specialists that a private insurance company has arranged for its members to use for covered services. Staying in-network usually ensures lower out-of-pocket costs, while using out-of-network providers may cost more or not be covered at all. Bottom line: freedom to chose.

Answer: Unexpected call from person(s) claiming to represent Medicare and then asking for personal information: Social Security, Medicare ID#, etc. Threats that include loss of benefits. Offers of free services or items: walkers, debit cards, food, etc. Often pressure tactics are used.

Answer: Yes, Breztri is a covered Part D prescription drug medication. Generally a Tier 3 and would have a co-pay and potentially subject to the annual deductible. It might require a prior authorization.

Answer: If you are comfortable with technology you can use the Medicare.gov website to input your medications along with information about your zip code and pharmacy. It will do a preliminary analysis for you and differentiate by tier the various medications - some generic (generally Tier 1 & 2) and brand/specialty drugs (Tier 3 and above). It will show you the overall cost of the plan based on the remaining months of the year - it will include the monthly premium, annual deductible, and co-pays/co-insurance. Compare the overall costs to your plan choices. There are fewer Part D plans to chose from in 2026. This website does a good job of breaking down the monthly costs to arrive at an estimated cost for the year (or the months remaining). I also recommend using coupons available such as GoodRX, SingleCare etc. and the Canadian Med store as possible alternatives. Always, ask your pharmacist to check for coupon availability which might lower your costs. You can call the Canadian Med store has very competitive prices as well for expensive drugs - like Eliquis, other diabetes medications, etc. Two other options: Log into your Medicare.gov account and it too has a list of your medications, current Part D provider, and can help you determine the best plan during the Annual Election Period. Otherwise, call the broker/agent that sold you your Medicare Supplement (Medigap) and inquire about having that person do the analysis for you. They should be helping you.

Answer: Once you reach the Maximum Out of Pocket threshold, you will not have any co-pays or co-insurance for the balance of the year as long as the services are covered by Medicare and are medically necessary. The $ 3,000 does NOT include Part D medications (co-pays, co-pays, etc.) If you have a monthly premium, you are still responsible for paying the monthly premium through the rest of the year.

Answer: Not educating themselves on their supplemental plan options. Medicare is confusing and not understanding Part A & B and how the "gaps" would be covered is essential. Also, understanding what is covered by Medicare and what is not. Not only is Medicare not free it does not cover everything (i.e. dental, vision, hearing).

Answer: Generally, you cannot drop a Medicare Advantage plan mid-year unless you have a Special Election Period (i.e. moved to a different state). If you have a Special Election Period, most likely you would have to medically qualify for the Medigap and having a serious illness would probably end up in a decline. Every insurance carrier has a list of declinable conditions and medications.

Answer: Your insurance company sends the Annual Notice of Change document prior to the Annual Election Period which started 10/1/2025 for a 1/1/2026 effective date. They try to send notices prior to 10/1 - sometimes they are late. It will detail the plan changes - comparing the old premium to the new one, changes in co-pays or co-insurance for specific tiers, etc.

Answer: Alot emotion is involved by both the caregiver and the person receiving care. They are losing their independence, and the family becomes much more involved with their everyday care. The roles get reversed. Important that the caregiver get support from other family members - we have divided the responsibilities among my brothers and sisters - one handles financial, one handles medical, etc.

Answer: No, you do not need to re-enroll again in Medicare. You will retain the same Part A and Part B and Medicare ID #. You are granted a special enrollment (assuming you have Part A & B today) to enroll in a different Medicare Advantage plan or join a Medigap & Part D prescription drug plan. New plans - if chosen will be effective 10/1/2025. If you decide to stay with the same supplemental plans, they will automatically continue - no action needed on your part.

Answer: Many people are enticed by the low premiums for the Advantage plan and additional benefits like fitness, dental, vision, over-the-counter, etc. They view their health in today's terms not in future terms when potentially health changes occur. So, it's about the cost and coverage. People also think that they can enroll in a Medigap down the road but find out that guarantee issue rights are not available and cannot medically qualify. They forget that after the initial enrollment, the insurance company requires the applications to go through medical underwriting. Not everyone qualifies and pre-existing do count in the overall evaluation.

Answer: Some seniors end up paying lifelong penalties for not enrolling in either Part B or D during either their Initial Enrollment Period or Special Enrollment Period. It's very important to understand the enrollment periods and when they apply. Miss an enrollment period and potentially a penalty will be assessed by Medicare unless there is a valid reason/explanation.

Answer: A huge misconception is having to enroll in Medicare Part A & B when you are first eligible at age 65. Certainly does apply to some individuals but many people think they MUST do something even if they are still working and for an employer with more than 20 employees. Fear of a penalty is huge.

Answer: I enjoy helping people navigate the crazy world of Medicare. First, helping them understand the basics: Part A, B, C, D and then explaining how to fill in the gaps with supplemental insurance products. Making sure they understand that I'm in it for the long run and available to answer questions year round. It's easy for me to relate because I am now Medicare eligible myself!