Stephanie Floyd, Medicare Insurance Agent

Answer: Medicare Advantage plans can show a $0 premium because Medicare is basically paying the insurance company behind the scenes. Medicare sends them a set amount every month for each person on the plan, and if the plan doesn’t spend all of that on admin and benefits, they can use the leftover to drop your premium to $0 or even lower.

The amount Medicare pays changes by county, which is why some areas have tons of $0 plans and others barely have any.

And just to be clear — $0 premium does not mean $0 cost. You’ll still have copays, coinsurance, and out‑of‑pocket costs when you actually use the plan. It just means you’re not paying a monthly premium on top of that.

Answer: There are a few changes coming in 2026, and most of them are about making drug costs more predictable. The big one is the new $2,000 cap on Part D out‑of‑pocket costs — once you hit that, your plan covers the rest. You can even spread those costs out monthly with the new cost‑smoothing program, which helps avoid big surprise bills.

Medicare will also start using its negotiated drug prices for certain high‑cost medications, and Part D plans will adjust their formularies and premiums as these rules kick in. You’ll also see more GLP‑1s and new medications showing up on formularies as they get approved for conditions beyond weight loss.

Nothing dramatic or scary — just more protection, more predictability, and fewer surprise costs for people who rely on medications.

Answer: The new $2,000 cap is important because it finally puts a real limit on what you can spend on prescriptions in a year. Before this change, people on expensive medications could end up paying thousands with no ceiling at all. Now, once you hit $2,000 in out‑of‑pocket drug costs, you’re done for the year — your plan takes over from there.

A few details make this even more helpful. The cap applies to all Part D‑covered drugs, including your deductible, copays, and coinsurance. It doesn’t apply to medications billed under Part B or to drugs that aren’t on your plan’s formulary. There’s also a new “cost‑smoothing” option that lets you spread that $2,000 across monthly payments instead of paying big chunks all at once. And while many people won’t hit the cap, it’s a huge protection for anyone on high‑cost or brand‑name medications.

Another big change: Medicare can now negotiate prices for certain high‑cost drugs, which may help bring costs down even further over time.

Answer: If you missed your Medicare sign‑up window, it’s not the end of the world. A lot of people do, and there are still ways to get enrolled. What happens next really depends on whether you had other coverage at the time. If your employer plan was considered “creditable,” you can usually sign up later without any penalties. If not, Medicare gives you specific times during the year when you can jump in, and some people qualify for a Special Enrollment Period based on their situation.

The main thing is not to assume you’re stuck. Once we look at your timeline and what coverage you had, it becomes pretty clear what your next step should be — and there are ways to avoid gaps even if you missed the original window.

Answer: Medicare doesn’t cover medications that are prescribed strictly for weight loss, because federal law excludes weight‑loss drugs from Part D. But coverage is expanding in other ways. Many plans now cover certain GLP‑1 medications, including some pill forms when they’re prescribed for an approved medical condition like diabetes or cardiovascular risk, not just weight loss alone.

For medications that aren’t covered, there are now several cost‑saving options. Manufacturers have savings programs, some pharmacies offer discount pricing, and there are even government‑sponsored assistance programs depending on income and diagnosis. A good agent should help you understand what your plan covers, what it doesn’t, and what alternative programs you may qualify for so you’re not navigating it alone.

Answer: Medicare doesn’t cover general weight‑loss programs, but coverage for weight‑loss treatments is expanding. Some plans now cover certain weight‑loss medications — including some GLP‑1s — when they’re prescribed for an approved medical condition and meet the plan’s criteria. Medicare may also cover services like behavioral counseling or bariatric surgery when they’re considered medically necessary.

For medications that aren’t covered, there are now several manufacturer savings programs, discount programs, and even government‑sponsored assistance options that can make these treatments more affordable. A good agent should help you understand what your plan covers, what it doesn’t, and what alternative programs you may qualify for so you’re not navigating it alone.

Answer: Once you hit the Part D out‑of‑pocket maximum, you move into what’s called the “catastrophic coverage” phase. At that point, your costs drop dramatically. You no longer pay the usual copays or coinsurance — instead, your plan covers almost the entire cost of your medications for the rest of the year. It’s designed to protect you from very high drug expenses so you’re not stuck paying large amounts month after month.

Answer: If you’re turning 65 soon but still working and covered by your employer plan, you may not need to sign up for Medicare right away. It really depends on whether your employer coverage is considered “creditable” and how many employees your company has. Many people with large‑employer coverage can delay Part B without penalties, while those with smaller employers often need to enroll at 65.

The safest approach is to look at your employer plan, confirm whether it’s creditable, and make sure you’re not missing any deadlines. A quick review of your situation usually makes the answer clear and helps you avoid late‑enrollment penalties or gaps in coverage.

Answer: Some agents lean toward Medicare Advantage because the premiums are lower and the plans bundle a lot of benefits people often ask about. Others focus on Medigap because it offers more freedom with doctors and fewer surprises. Neither option is automatically right or wrong — it really depends on your health history, your doctors, your prescriptions, and what you want your coverage to do for you.

What matters most is that your agent takes the time to do a thorough review of your actual needs, not just the surface-level details. For example, if someone is looking ahead to the new CMS dementia care model, they need Original Medicare — not an Advantage plan — to access it. That’s the kind of nuance a good agent should catch.

You don’t need to be skeptical, but you should expect your agent to explain both paths clearly, walk you through the trade‑offs, and make sure the recommendation fits your situation, not theirs.

Answer: Your doctor is the one who decides what care you need. Their medical judgment comes first. The insurance company’s role is to decide how that care is covered under your plan — things like prior authorizations, network rules, or what portion they’ll pay. It can feel frustrating when those two don’t line up, but the medical decision itself always starts with your doctor.

Answer: A good Medicare agent gives you clarity in a system that isn’t always clear. Medicare has a lot of moving parts, and things change every year — drug lists, networks, premiums, and rules. An agent helps you understand what those changes actually mean for you, not just in theory.

Most people don’t realize how many decisions they’re expected to make on their own at 65. Having someone who can explain things in plain language, look at your doctors and prescriptions, and help you avoid surprises makes the whole process feel a lot less overwhelming. It’s really about having someone who advocates for you, year after year.

Answer: I'm sorry to hear that. A sudden increase in your Part B premium can feel confusing, especially when you’ve already been on Medicare for a few years. There are a couple of common reasons this happens:

1. Medicare looks at your income from two years ago.

If you had a higher‑income year — even temporarily — Social Security may have added an IRMAA surcharge. That alone can increase your premium by around $80–$100.

2. The standard Part B premium changes some years.

Even without IRMAA, Medicare adjusts the base premium periodically, which adds to the total.

3. You may qualify to appeal the increase.

If your income has gone down since that higher‑income year, you may be able to file an appeal to have your premium lowered.

The easiest way to know exactly what caused your increase is to look at the letter Social Security mailed you — it will list the reason.

If you want a simple breakdown of how Medicare costs work and why premiums change, I put together a free Medicare 101 guide that explains everything in plain language. Let me know if you'd like a copy.