Samantha Jellison, Medicare Insurance Broker

Answer: That will depend mostly on your wife’s coverage through work. If it is considered credible coverage (the plan is considered as good as or better than Medicare and there are more than 20 employees) then delaying Part B should not give you a penalty at all. The best way to determine this is by contacting your wife’s employer benefits coordinator and asking directly if it is considered credible coverage. If it is, ask for a letter stating so and keep that for your records.

Now if it is not credible, my suggestion would be to not delay Part B because that penalty could be quite significant after 7 years. And you will carry that penalty for as long as you have Medicare.

Answer: Great question! So, Medicare Part B is your medical coverage. Part A is your hospital coverage and in a nutshell is your “room and board” when having a hospital stay. Anything that happens to you in the hospital, such as surgery, medication and procedures is going to fall under that Part B, your medical care. It will also cover your visits to your doctors and specialists as well as outpatient care such as infusions and chemotherapy.

Is it enough? The short answer is probably not. You see, Medicare (Original Medicare which is Part A and Part B) is only going to cover 80% of your medical costs, leaving you responsible for the other 20%. If you were to have a not so great medical year, with many trips to the doctors or multiple hospital stays, this could be quite expensive as Original Medical does not have a “cap” or a “stop loss”. Also, 20% could potentially be a great deal of money. 20% of $100 may not seem like much but 20% of $100,000 could be financially catastrophic for most!

This is why we recommend supplementing your coverage. This could be through Medicare Part C which is a Medicare Advantage Plan, or through a Medicare Supplement, also known as MediGap. This is added protection for life’s unknowns. There is no one size fits all solution, it is highly dependent on your own personal situation and needs.

Answer: It could significantly impact your options. It would be important to research providers and hospital networks nearby and which insurance carriers they accept. Depending on where you move to, your plan may or may not be available in your new county too. If this is the case, you would have a Special Election Period to enroll into a new plan so understanding your local area medical networks will be crucial to making your decision. Working with a local independent broker would be highly recommended as we understand what is available and which hospitals and doctors accept which insurance companies.

Answer: We start with a very basic, easy to follow "Medicare 101" conversation. We go over what all the Parts (A,B,C and D) are and what options are available, from Original Medicare (Parts A and B) with a Prescription Drug Plan (Part D), to Medicare Advantage Plans (Part C) to Medicare Supplements with a Prescription Drug Plan. We talk about your individual needs, such as your doctors, your prescriptions and what is important to you in a healthcare plan. We also talk about timelines and how to avoid penalties and loss of options.

The goal is to make it something that doesn't feel so intimidating, yet gives you the opportunity to feel empowered to make the right choice for your healthcare needs

Answer: For the most part yes, preventative cancer screenings are covered under your Part B (medical insurance). Your provider must accept assignment and you must meet eligibility requirements. Age, sex and risk factors do play a part in what type of screenings are available to you and how often they are available.

Answer: On a Medigap Plan K your monthly premium is going to be lower but cost-sharing and out-of-pocket costs are going to be higher. There is also no coverage for foreign travel and no protection from Excess Charges, although you will have an out-of-pocket limit.

On a Medigap Plan G, you are going to have a higher monthly premium but more extensive coverage.

Answer: It will depend on your plan, what the coverage on that plan is and how much your co-payment for the specific therapy is going to be. It will also depend on if you have a medical deductible and if your provider is in or out of network.

Answer: Each and every year, during Annual Enrollment Period. Whether you have been on your current plan for a year or 10, every Medicare Advantage plan has the opportunity to change their benefits from year to year. This also goes for formularies as well. It is important to do an annual review during this time for the upcoming year to be sure your needs will align with what your plan is offering. Your provider may have left the network, your prescriptions may no longer be covered, your deductibles or co-payments may have gone up significantly. It is better to check during this time for the upcoming year than it is to receive an unwanted surprise at the beginning of the new year. If they no longer align with what you need, this is the time to make a plan change for the upcoming year.

Answer: It depends. Are they on their Employer’s group coverage plan? Is it creditable? Is it more expensive than Medicare? There are a lot of factors to consider. Do you have a spouse under 65 that you are providing coverage for? Does is make sense financially?

This is why it’s important to work one on one with an agent/broker in order to determine what is right for you.

Answer: They can. Medicare Advantage typically offers additional benefits such as Dental, Vision and Hearing- the emphasis on these plans is Preventative Care. The better you take care of your health, the less costly it tends to be.

If you break it down, usually a Medicare Advantage plan is about $0 monthly premium, and includes your prescription drug coverage. You will still have to pay your Part B premium (in 2025 the standard premium is $185) and any copayments associated with your plan for doctors visit, procedures, medications. This is why Medicare is considered the Pay as You Go Plan. And that suits some people just fine.

With a Medicare supplement, you are responsible for your Part B premium, your Medicare supplement premium, your prescription drug plan premium and any additional policies you may require such as a Stand-alone Dental, or bundled Dental, Vision and Hearing policy (because Medicare Supplement plans do not include coverage for these). This is why a Medicare Supplement/Medigap plan is known as a Prepaid Plan.

Answer: Lack of appropriate retirement planning education. One of the foundations I have built my business on is education. Medicare 101 seminars can be really useful to people to learn how to avoid these penalties.

It is important to know that unless you have what is known as Creditable Coverage, delaying Part B and or Part D can carry lifelong penalties. Each situation is unique so it’s important to consult with a professional to understand if you have Creditable Coverage or not and have a plan in place, months before you turn 65. Sorting out your Medicare coverage is best done up to 3 months before you turn 65.

Answer: The Inflation Reduction Act went into effect at the beginning of 2025. When you are going to the pharmacy to pick up your prescriptions, you are usually paying a co-pay. Over the course of the year, all your co-payments are applied to something called TrOOP- True Out Of Pocket costs. Before 2025, your TrOOP was capped at $8000 per year, and once you reached that, you were put into what they called the “Donut Hole” which is a period of time you would be paying higher amounts toward your prescriptions before you would be transitioned to Catastrophic Coverage stage. This is where you are no longer paying anything towards your prescriptions.

With the Inflation Reduction Act, your TrOOP is now capped at $2000 per year, there is no more Donut Hole and once you’ve contributed towards your TrOOP and it’s reached $2000, you will go directly to Catastrophic Coverage.

Answer: Networks, prior authorizations and referrals.

It’s true that you have more “freedom” with a Medicare Supplement (Medigap) policy, but it will cost you. For some, that additional expense can be cumbersome.

Medicare Advantage can be a very good fit for some people. It just depends on everyone’s unique situation.

Again, that’s why it’s important to work with a professional, someone who can explain your options in-depth and discuss the pros and cons of each.

Answer: Be sure to discuss with them abe understand what is important to them regarding their plan.

Do they want to travel? Do they want to remain with their current doctors? Are their prescriptions covered on the formulary? What type of coverage is important to them? What type of budget are they working with? If they can no longer afford the costs of their healthcare, will they qualify for assistance or will the family be able to support them?

Working with a licensed agent/broker is a great way to ensure those difficult questions are asked and addressed.

Answer: It depends. There are a lot of factors to consider here, such as the State you reside in, how long you have had your current Medigap policy, and the timeline of when you plan to switch.

Unfortunately there are a lot of rules when it comes to Medicare Supplement policies. That’s why it’s important to work with a knowledgeable, trustworthy and licensed professional.

Answer: This is a great question and I am pleased to hear that you are thinking about this proactively.

Unfortunately, Medicare does not cover long-term care, such as your stay in a nursing/retirement home or having someone come to your own home daily for custodial care (bathing, dressing, feeding, ect.).

You should consider discussing a Long-Term Care policy with your agent/broker.

One thing to note is that as you age, these policies become more expensive. In many cases, people faced with the situation to enter Long-Term care may have to apply for Medicaid in order to receive any financial assistance or cover their costs. In some cases, extended family members may be able to contribute, however it can end up being a hefty financial burden.

Answer: If you are already enrolled in Part A and Part B, and you have either a Medicare Supplement with a Prescription Drug Plan (Part D) or a Medicare Advantage with Prescription Drug Plan, there is nothing more to do than to enjoy your retirement!

If you are transitioning from an Employer group insurance plan or you delayed Part B past the age of 65, there will be some additional steps you will need to take.

This is when it is best to talk to a licensed agent/broker, who can guide you on the next steps in order to make your transition to retirement that much more effortless.

Answer: That Original Medicare, Part A and Part B, is enough coverage. Remember, Original Medicare Part A is your Hospital Coverage (room and board so-to-speak). Part B is your Medical Coverage (Doctors Visits, lab services, medical treatment, immunizations, ect.).

Original Medicare Part B is only covering 80% of your bill, leaving you responsible for the additional 20%.

You really should have additional coverage to help cover the associated costs, whether that is a Medicare Supplement or a Medicare Advantage plan.

Answer: Usually, the biggest mistake I see seniors make when enrolling into Medicare is not working with a professional, such as an agent or broker. With the vast amount of choices out there, seniors should be getting a full education about their options before making any decisions.

An agent/broker is someone who can lay your options out for you, explain the differences and answer your questions… for as long as you remain their client AND at no cost to you.

When enrolling with a call center, unfortunately, there are no guarantees you will be speaking to the same person each time. If you are only speaking with one carrier, you are only learning about that carrier’s product.