Medicare Questions & Answers: New To Medicare
New To Medicare Q&A
Showing 84 questions
How do you educate clients who are completely new to Medicare?
Educating clients who are completely new to Medicare is a crucial part of my job as a Medicare agent. I approach this process step-by-step, ensuring that they feel empowered and confident in their understanding of the system. Here’s how I typically guide clients through the process:Start with the Basics: I begin by explaining the fundamentals of Medicare, including its four parts—Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Many clients are unfamiliar with these parts, so I make sure to define each one in simple terms, focusing on what it covers and how it impacts their healthcare.
Clarify Eligibility and Enrollment: I explain the general eligibility requirements for Medicare, such as age 65 or certain disabilities, and walk clients through the various enrollment periods, including the Initial Enrollment Period, Special Enrollment Periods, and General Enrollment Period. This helps them understand when they should sign up to avoid penalties.
Discuss Coverage Options: After covering the basics, I explain the different options available to them:
Original Medicare (Part A and Part B), which provides hospital and medical coverage.
Medicare Advantage (Part C), a bundled alternative offered by private insurers that includes all of the coverage from Part A and Part B, often with additional benefits like dental and vision.
Medicare Supplement (Medigap) policies, which help cover out-of-pocket costs like copayments and deductibles associated with Original Medicare.
Part D for prescription drug coverage, which is essential for clients to understand to avoid high medication costs.
Assess Their Needs: I make sure to ask about their healthcare needs and preferences. Are they looking for a plan with lower premiums? Do they have chronic conditions that require frequent medical care? Do they take prescription medications regularly?
What is the biggest mistake seniors make when enrolling in Medicare?
There are 5 key mistakes seniors make when enrolling in Medicare.1. Missing Deadlines (The Top Mistake): Failing to sign up during the 7-month window (3 months before, 65th birthday month, 3 months after) leads to a 10% premium penalty for Part B for every 12-month period delayed.
2. Assuming Automatic Enrollment: If you are not collecting Social Security at least 4 months before turning 65, you must proactively sign up, as enrollment is not automatic.
3. Misunderstanding Work Coverage: Assuming you must sign up at 65 while still working with credible employer coverage, or conversely, failing to sign up when employer coverage ends.
4. Confusing Medigap and Advantage: Failing to understand that Medicare Advantage is different from Original Medicare + Medigap, which can limit doctor choices.
5. Choosing Based Only on Premiums: Picking a plan with a $0 premium but high out-of-pocket costs, or neglecting to check if doctors/drugs are covered
I'm turning 65 next month; what are the first steps I should take regarding Medicare enrollment?
First, do you actually need to activate your Medicare at age 65? If you are continuing to work and receive full benefits from your employer, then you don't need to activate Part B of Medicare (which usually has a monthly premium) until you retire or go part-time and lose your company insurance benefits. You won't be penalized for waiting in this situation.Otherwise, if you are needing Medicare insurance benefits when you turn 65 there are a couple of things to do: Start 3 months in advance of the month you're going to need benefits to ensure that you're going to have both Part A and Part B of Medicare in place. It usually takes Social Security (SS) about 6 weeks to get your Medicare card set up and to you in time to enroll in some kind of supplementary plan.
If you are already receiving your SS benefits, then SS will automatically send you your red, white and blue Medicare card a couple of months before you turn 65. If you don't receive that card from them by 2 months in advance of the month of turning 65 call SS to get your card. You'll need your Medicare card that shows your Medicare #, your Part A (Hospital) and Part B (Medical) effective dates in order to enroll in some kind of supplementary insurance plan.
Remember, your Medicare card that shows Part A and Part B does not cover the required Part D (Prescription Drug Coverage). You'll need to get that coverage set up with an independent agent (like me) so that it goes into effect the same time as your Part A and Part B coverage.
You'll be able to choose from a Medicare Supplement (also referred to as a "Medigap" plan) and a Part D prescription drug plan, or a Medicare Advantage plan (Part C of Medicare) to help cover your medical costs that are not covered by Original Medicare (Part A & B).
Lots of choices. Lots to do.
What's the most important question I should be asking about Medicare that I probably haven't thought of yet?
The most critical question most people overlook isn’t about what Medicare costs today, but how your choices today limit your options 10 years from now: "How will my choice today affect my ability to change coverage if my health fails in the future?"Most people focus on monthly premiums and current doctors. However, the "hidden" logic of Medicare centers on Medical Underwriting. Why this question is the most important: The Medigap "One-Time" Window: When you first join Medicare, you have a six-month Medigap Open Enrollment Period. During this window, insurance companies must sell you a Supplement (Medigap) plan regardless of your health history. The Trap: If you choose a Medicare Advantage plan now because it's cheaper, and five years later you develop a chronic illness and want to switch to a Medigap plan (which has more predictable costs and no networks), you may be denied. In most states, after that initial window, insurers can use "medical underwriting" to charge you significantly more or refuse to cover you entirely based on your health. The Long-Term Impact: Approximately 80% of healthcare usage occurs after age 60. A plan that looks great while you are healthy might become a financial burden if you lose the "guaranteed issue" right to switch to a more comprehensive supplement later. Other "Missed" Questions to Consider: The Question Why It Matters: "What is my Total Out-of-Pocket (MOOP) in a 'Bad Year'?"Many focus on $0 premiums but forget that a single major surgery or hospital stay could hit a $5,000–$9,000 "Maximum Out-of-Pocket" limit."Does my plan require 'Prior Authorization' for specialists?"Original Medicare doesn't care if you see a specialist. Many Advantage plans require your primary doctor to "ok" it first, which can delay care."Are my drugs on the 'Formulary' and what tier are they?"A drug can be "covered" but placed in a Tier 4 or 5 category, costing you thousands more than if it were Tier 1 or 2."Will this plan cover me if I travel or move?"Original Medic
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
Whether a senior turning 65 should enroll in Medicare or delay it while still working depends on their job situation—specifically, their employer’s size and health plan. Here’s how it breaks down:If the employer has 20+ employees: The company’s group health plan is usually "primary" (pays first), and Medicare is "secondary." In this case, they don’t have to enroll in Medicare right away. They can stick with the work plan and delay Medicare Parts A and B without penalties, as long as the job coverage is “creditable” (meets Medicare standards). Part A (hospital coverage) is free, though, so some sign up for it as a backup since it can coordinate with the work plan. Part B (doctor visits, outpatient care) has a monthly premium, so delaying it often makes sense to avoid double costs.
If the employer has fewer than 20 employees: Medicare typically becomes primary, and the work plan secondary. Here, they should enroll in Medicare Parts A and B at 65, because the work insurance might not cover much unless Medicare kicks in first. Skipping it could mean gaps in coverage or higher out-of-pocket costs.
Other Factors: If their work plan is pricey or skimpy (high deductibles, limited drug coverage), switching to Medicare might save money or improve care, even with a big employer. They’d need to compare premiums, copays, and drug formularies. Also, if they have an HSA, signing up for Medicare stops HSA contributions—something to weigh if they’re still saving there.
How to Delay: If they skip Medicare Part B (the part that costs a monthly premium) at 65 because of a solid work plan, they will get a Special Enrollment Period (SEP) later to turn on Part B and enroll in a plan in short order at that time.
Will I be penalized if I do not enroll in Medicare when I turn 65?
If you have creditable health coverage through your (or your spouse’s) active employer, meaning it’s as good as or better than Medicare, you can delay enrolling without facing any penalties.But if you don’t have that type of coverage and skip enrolling when you first become eligible, you could end up paying late enrollment penalties that last a lifetime:
Part A: Most people get this premium-free, so there’s usually no need to worry, but if you do have to pay for Part A and you delay, there’s a 10% penalty that lasts twice as long as the time you waited to sign up.
Part B: 10% extra added to your monthly premium for every 12 months you delay.
Part D (prescription drug plan): 1% added for each month you go without creditable drug coverage.
So, the short version... if you’re turning 65 soon, make sure you know whether your current insurance counts as creditable coverage before you delay. It can save you a lot of money later!
I'm retiring next year - do I need to do anything with my Medicare?
1. Determine Your EligibilityMost people become eligible for Medicare at age 65. If you are retiring and will turn 65 next year, you should begin the enrollment process as early as three months before your 65th birthday. If you are already 65 or older, you may need to evaluate how your retirement affects your current Medicare enrollment.
2. Understand How Retirement Affects Coverage
If you’re retiring and currently have health insurance through your employer, that coverage will likely end when you stop working. You’ll need to ensure that you have Medicare Parts A (hospital insurance) and B (medical insurance) to avoid gaps in coverage. Even if you’re already enrolled in Part A, you’ll still need to sign up for Part B if it hasn't been done yet.
3. Enroll During the Special Enrollment Period (SEP)
For individuals retiring after age 65, retirement triggers a Special Enrollment Period (SEP), during which you can sign up for Medicare Part B without incurring late penalties. The SEP begins the month your employer coverage ends and lasts for eight months.
4. Consider Additional Coverage Options
Beyond Parts A and B, you may want to explore:
• Medicare Part D: Prescription drug coverage to help lower medication costs.
• Medigap: Supplemental insurance to cover costs not paid by Original Medicare, such as copayments and deductibles.
• Medicare Advantage Plans (Part C): An alternative to Original Medicare that combines Parts A and B, and often Part D, into a single plan.
5. Know Key Deadlines
Avoid gaps in coverage or penalties by knowing when to enroll:
• Initial Enrollment Period (if turning 65): Starts three months before your 65th birthday and ends three months after.
• Special Enrollment Period: Applies if you had employer-provided coverage and are retiring after age 65.
6. Contact Medicare or a Licensed Insurance Agent
Reach out to Medicare (1-800-MEDICARE) or your local Insurance Agent for personalized guidance on your specific situation.
I am on disability insurance Medicare now I will be 65 in October do I have to to sign up for Medicare again?
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.
Is it ok to meet with multiple Medicare Brokers and Agents as I start looking for help?
Yes, it is absolutely okay to meet with multiple Medicare brokers or agents as you start looking for help.As an agency owner and licensed agent myself, I actually think it is smart to compare who you are working with. Medicare is not a one-size-fits-all decision, and the person helping you should be focused on education first, not just enrollment.
Here are a few good questions to ask:
1. Do you offer the major carriers available in my ZIP code?
You want to know whether they can compare multiple options or if they are limited to only a few plans.
2. What does your enrollment process look like?
Listen for an answer that starts with education, doctor review, prescription review, plan comparison, and making sure you understand the trade-offs before enrolling.
3. Do you provide annual plan reviews?
Medicare is not a set-it-and-forget-it product. Plans, doctor networks, drug formularies, copays, and benefits can change every year. Ask them to explain exactly how they handle annual reviews and what kind of ongoing support they provide after enrollment.
The goal is to find someone who will help you understand your options, compare plans clearly, and support you beyond the initial enrollment.
Have a blessed day!
Who can help me figure out this Medicare "maze and alphabet soup" it's so confusing.
Hi, so the question is who can help me figure out this Medicare maze of alphabet soup? It's very confusing. That would be me, Nolan Popel from the Popel Insurance Group. So yes, there are a few letters we want to make sure that we're familiar with when we're going on.
Medicare Part A is for the hospital. That's what we get for working our whole life and paying taxes. The first reason we get insurance is that Medicare doesn't cover everything. They do have a big deductible this year. It's $1,676 for these one through sixty.
Medicare Part B is your outpatient medical. Medicare Part B is what you're gonna be signing up for when you first turn 65 or you're retiring from your group coverage from an employer or a spouse's employer. Part B in 2025 is going to cost you $185 a month. That's for Uncle Sam. That is for the government to pick up 80% of your outpatient medical bills, and you're paying 20%. This is a primary reason people look for insurance because they don't want to get stuck paying huge bills for 20%.
See, like Charlie is what we call the Medicare Advantage program. These are HMOs and PPOs that are subsidized by the federal government. And then we have Part D, like David. Part D is also very important. This is the term for the Medicare prescription drug program. We can get Part D in a couple of different ways. We can buy a standalone Medicare prescription drug plan, or we can get a Medicare Advantage plan that comes with Part D along with it, kind of like a package deal where you get medical and prescriptions together.
A couple more letters that I'd like to mention to you are G, like George, and N, like Nancy. These are two very popular Medicare supplement options in the United States that you can definitely look into when you get to the point of looking for insurance.
I'm turning 65 soon, when can I enroll in Medicare?
When it comes to enrolling in Medicare, there are really two paths you can take.You can enroll right when you turn 65, or you can enroll later, if you’re still working and covered under a qualifying employer plan, typically one that has 20 or more employees.
If you’re enrolling at 65, you’ll use what’s called your Initial Enrollment Period. That’s a seven-month window that starts three months before your birthday month, includes your birthday month, and continues for three months after. That window matters, because it’s how you avoid late enrollment penalties, especially for Part B. Collecting Social Security already? Then you'll be enrolled automatically.
If you’re still working and covered under a larger employer plan, you may not need to enroll right away. You can delay Part B without penalty. Then, when that coverage ends, you’d use a Special Enrollment Period to get enrolled. In this case, it's a good idea to enroll about 3 months prior to your anticipated retirement or Medicare start date.
The key there is simple, you just need to be able to show that you’ve had continuous, credible coverage the whole time. You'll have your HR or Benefits department help you fill out a Proof of Creditable Coverage form and submit that with your application for Part B.
This is one of those areas where the timing really matters, and getting it right upfront can save you a lot of headaches down the road.
What do I need to do if I didn't take Medicare at 65 and am now retiring?
If you didn’t enroll in Medicare when you turned 65 because you were still working and had employer-sponsored health coverage, you can usually enroll when you retire without a penalty.Here are the typical steps:
1. Apply for Medicare Part A and Part B
* You qualify for a Special Enrollment Period (SEP) if you had coverage through your employer (or your spouse’s employer).
* The SEP allows you to enroll in Part B without a late enrollment penalty.
2. Get proof of employer coverage
* You’ll generally need your employer to complete Medicare Form CMS-L564 (Request for Employment Information).
* You’ll also complete Form CMS-40B (Application for Enrollment in Medicare Part B).
3. Enroll promptly after retirement
* Your Special Enrollment Period lasts for 8 months after employment ends or employer coverage ends (whichever comes first).
* Don’t wait, as delaying beyond the SEP could result in penalties and coverage gaps.
4. Choose additional coverage
Once Medicare Parts A and B are active, you’ll need to decide whether to enroll in:
* A Medicare Supplement (Medigap) plan plus a Part D prescription drug plan, or
* A Medicare Advantage plan that may include drug coverage.
Important exception
If your employer had fewer than 20 employees, Medicare may have been expected to be your primary coverage at age 65. In that situation, different rules can apply, and penalties may be possible.
For personalized guidance, you can contact the Social Security Administration or visit Medicare.gov
I'm turning 65 in three months but still working with employer coverage. Do I need to sign up for Medicare right now or can I wait?
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.
What's the difference between a Medicare broker and a Medicare agent?
A Medicare agent is usually appointed with one insurance company (or sometimes just a couple).• They can only show you plans from the carrier(s) they represent
• If that company doesn’t have the best option for you, they still can’t show you others
• This isn’t necessarily bad—it just means the view is limited
Think of it like walking into a Ford dealership. You might get a great truck… but you’re only seeing Fords.
A Medicare broker is appointed with multiple insurance companies.
• They can compare plans across many carriers
• They’re not tied to pushing one specific product
• They can help you switch plans in future years if something better comes along
• The cost to you is the same as going directly to a carrier
Think of this as an independent car shopper who can show you Ford, Chevy, Toyota, Lexus—whatever actually fits your needs.
You don’t pay more to work with a broker.
Medicare plans pay the same commission whether you enroll:
• online
• through the carrier
• through an agent
• or through a broker
So the real question is:
Do you want one option—or a comparison?
My Philosophy
I believe people deserve:
• honest comparisons
• plain-language explanations
• and someone who will tell them “you’re already on the best plan” when that’s the truth
That’s why I operate as a broker.
If you ever want a second opinion—or just want to sanity-check what you already have—I’m always happy to do that. No pressure, no cost, and no sales games.
I'm turning 65 next month and the amount of Medicare mail I'm getting is overwhelming. How do I sort through all this?
Totally normal—and you’re not alone. Turning 65 triggers a marketing avalanche, and most people feel buried under it. Let’s make it manageable instead of maddening.First: know why you’re getting all that mail
When you turn 65, your name goes on a public Medicare eligibility list. Insurance companies and agents are allowed to market to you, which is why it suddenly feels nonstop.
How to sort through it without losing your mind
1. Separate education from advertising
Official Medicare info
“Medicare & You” handbook
Mail from Social Security or CMS
👉 These are worth keeping.
Everything else = ads
“You may be missing benefits”
“Extra money back”
“No cost plan”
👉 These are marketing pieces, not personalized offers.
2. Don’t call the 800 numbers on random postcards
Those usually go to:
Large call centers
Agents who can only sell one company’s plan
They don’t know your doctors, meds, or situation—and they’re paid to push their plan.
3. Focus on what actually matters
Ignore the flashy promises and ask these questions instead:
Do my doctors accept this plan?
Are my prescriptions covered and affordable?
What are the max out-of-pocket costs?
Can I see specialists easily?
Do I want Medicare Advantage or Original Medicare + supplement?
If a mailer doesn’t clearly help answer those questions, it’s not important.
4. Pick one trusted source (not 20)
Instead of reacting to every piece of mail:
Choose one knowledgeable, independent Medicare agent
Or use Medicare.gov as your baseline
Once you have a plan, the rest of the mail becomes noise.
5. You can reduce the junk
Opt out at OptOutPrescreen.com (cuts down insurance/credit offers)
Write “Refused” and return mail you don’t want
Register your number on the Do Not Call Registry
One last reassuring truth
There is no prize for choosing fast and no penalty for ignoring the mail.
You have a 7-month Initial Enrollment Period—you don’t need to decide based on fear or pressure.
Can you help me understand Maximum Out-of-Pocket (MOOP) limits in Medicare plans, from your experience as an agent?
The Maximum Out-of-Pocket (MOOP) limit is the highest amount of money you will have to pay for covered healthcare services in a Medicare Advantage plan during a given year. Once you hit this limit, the plan will pay 100% of your covered medical expenses for the rest of the year. This includes deductibles, copayments, and coinsurance, but it does not include things like premiums or non-covered services (like cosmetic surgery or out-of-network care).Let’s say someone’s Medicare Advantage plan has a $5,000 MOOP. If that person receives treatment for a chronic condition and their total out-of-pocket costs for things like doctor visits, tests, and hospital stays reach $4,800, they’ll only need to pay $200 more for the rest of the year. After that, the plan would cover all additional costs for the year, even if more treatments are needed.
The MOOP is a safety net for Medicare Advantage beneficiaries, protecting them from potentially high medical costs in any given year. It’s important to compare the MOOP limits of different plans when selecting coverage, as a higher premium plan with a lower MOOP might be better for someone with frequent healthcare needs, while a plan with a higher MOOP and lower premiums could suit someone who is generally healthy.
It’s a balancing act between premiums, MOOP, and overall healthcare needs that will vary depending on the individual!
I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
Yes — even with Original Medicare (Parts A & B), there are coverage gaps you should be aware of. Here’s the short breakdown:1. No prescription drug coverage
Part B covers some medications administered in a doctor’s office, but most prescriptions you fill at a pharmacy aren’t covered.
Solution: Add a Part D prescription drug plan.
2. No routine dental, vision, or hearing
Exams, glasses, hearing aids, and most dental work are not covered.
Some Medicare Advantage plans include limited benefits.
3. Long-term care
Medicare does not cover custodial care (assisted living, nursing home stays beyond short rehab).
Only short-term skilled nursing after hospitalization is covered.
4. Out-of-pocket costs
Deductibles, copays, and coinsurance can be significant.
Part A has hospital deductibles; Part B has a monthly premium and 20% coinsurance for most services.
Solution: Consider Medigap (Supplement) coverage.
5. Limited preventive coverage
Part B covers many preventive services, but some screenings or therapies may require extra approval or cost-sharing.
Bottom line: Original Medicare covers hospital and medical services but leaves gaps in prescriptions, dental/vision/hearing, long-term care, and out-of-pocket expenses.
I've been on disability for years and am about to turn 65. Do I automatically get Medicare because I'm on Social Security, or do I need to do something?
People who have drawn Social Security Disability (SSDI) for at least 2 years are eligible for Medicare even BEFORE turning 65. Enrollment generally occurs in the 25th month of receiving SSDI, usually providing Parts A and B automatically. To be eligible for Part A at no additional cost you must have worked full time in the USA for at least 10 years. If you have NOT drawn SSDI for at least 2 years then you can enroll in Medicare anytime in the 3 months before your 65th birthday month, and up to 3 months after. If you don't enroll in a timely manner then there could be lifetime penalties assessed to your premiums. If you're still confused that's what I'm for, I'd be happy to guide you through the process.Exceptions: The 24-month waiting period is waived for those with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
I'm still working at 67, and I don't know if I need Part B. Why is something so basic so hard to figure out?
I get it—Medicare feels like it’s written in another language! It is totally normal to find this frustrating.Here is the deal on whether you can skip Part B for now while you are still working: The "Big Company" Rule20+ Employees: If your company has 20 or more workers, your work insurance is more than likely "creditable" and will stay primary. Therefore, if you are actively working and covered by your Employer Group Health Plan (EGHP), you can safely skip Part B and won't face any late penalties. When you finally retire, you get an 8-month window to sign up.
If your employer has under 20 Employees: If it’s a small business, Medicare becomes the main boss. Your work insurance expects Medicare to pay first. You almost certainly need Part B right now, or your work plan might refuse to pay your medical bills.
The HSA Catch: If you are still putting money into a Health Savings Account (HSA), signing up for any part of Medicare locks that down. You cannot contribute to an HSA once you are on Medicare. Many people delay Part B just to keep their HSA tax perks going.
What About Part A? Since Part A (hospital care) is usually free if you've worked enough years, most people just grab it at 65. It sits in the background as a backup, unless you are trying to save into that HSA we just talked about.
To figure out your exact next move, reach out to a local Medicare Expert and your HR. Find out if your company has a "creditable" employer group health plan. If there are more than 20 employees it is most likely creditable and you can delay Part B until you retire. AND, remember if you are actively contributing to an HSA, and over 65, you need to stop contributing to the HSA 6 months before retiring and moving to Medicare to avoid an IRS penalty on your HSA contributions.
Great question... working with a local Medicare expert will ease your mind and lessen the confusion for you!
So my friend told me I should just go with the cheapest Medicare plan. That sounds too simple - what am I missing?
So the question is, my friend told me I should just go with the cheapest Medicare plan. That sounds too simple. What am I missing? I believe you're missing a couple of things. One is, if you're looking at Medicare Advantage plans, those plans typically work with networks of providers. So you want to make sure that the doctors and hospitals you see are included in the network of that plan. Or you could be in a situation where those doctors or hospitals might not be covered.
Additionally, all of the Medicare Advantage plans have different formularies and cover prescription drugs differently. So based on the prescription drugs that you happen to take, one Advantage plan might not work at all for you, while another one will, just based on those two things.
So first and foremost, if you're looking at Medicare Advantage, you really want to make sure doctors and hospitals are in-network and that it's doing the best job of covering your prescription drugs. On the other hand, if you are looking at Medicare supplement plans, or what people call Medigap, those plans are standardized. So the same plan works the same way from company to company. There's not variance in what the benefits are or how they are covered.
In that case, many times choosing the least expensive Medicare supplement plan might work best. On the prescription drug side of things, though, when you then look at prescription drug plans, again, you want to make sure that the drugs you happen to take fit in the formulary of the prescription drug plan that you're choosing. And that it's offering the best value for you.
I thought I signed up for both Part A and B when I got my Social Security, but now I'm getting bills for Part B. Did I miss something during the enrollment period?
Many people believe that when they sign up for Social Security, everything under Medicare is free. That is not exactly how it works.Medicare Part A usually does not have a monthly premium if you worked and paid Medicare taxes for at least 40 quarters, which equals 10 years. If someone worked fewer than 40 quarters, they may have a monthly premium under Part A.
Medicare Part B is different. Part B always has a monthly premium. The standard premium changes each year. For 2026, it is $202.90. Some individuals with higher incomes may pay more due to income IRMAA adjustments.
If you are receiving Social Security benefits, the Part B premium is usually deducted automatically from your monthly check. If you are not yet collecting Social Security, Medicare will send you a quarterly bill.
Receiving a bill does not necessarily mean you missed your enrollment period. It usually just means that Part B has a premium that must be paid directly.
If someone delays enrolling in Part B and does not have other creditable coverage, they face a late enrollment penalty. The penalty is 10 percent for every full 12-month period a person was eligible but not enrolled, and that penalty continues for as long as they have Part B.
If you would like, we can review your enrollment timeline together to make sure everything was processed correctly.
Educational Disclosure:
This information is provided for educational purposes only and is not a guarantee of benefits. Medicare premiums, deductibles, and penalties may change annually. Income adjustments may apply. I am not affiliated with or endorsed by the federal government or the Medicare program. For official Medicare information, please visit www.medicare.gov
or call 1-800-MEDICARE.
Janix Barbosa-Llanos, MBA, PMP, CEP, RSSA, FSN
Licensed Health Insurance Broker
Can I use a health savings account (HSA) to pay Medicare premiums after I retire?
After you retire, you can use funds from a Health Savings Account (HSA) to pay for certain Medicare premiums, offering significant tax advantages. Specifically, HSA funds can be used tax-free to cover Medicare Part B (medical insurance), Part D (prescription drug coverage), and Medicare Advantage (Part C) premiums. These withdrawals are not subject to income tax if used for these qualified medical expenses, making the HSA a powerful tool for managing healthcare costs in retirement. However, you cannot use HSA funds tax-free for Medigap (Medicare Supplement) premiums—doing so would result in a taxable distribution, and if you're under 65, a 20% penalty would also apply. One key benefit of an HSA is that once you turn 65, you can withdraw funds for any purpose without incurring the 20% penalty, though non-medical withdrawals will still be taxed as income. Additionally, while you can no longer contribute to an HSA once enrolled in Medicare, the account remains available for tax-free withdrawals on qualified medical expenses, making it an excellent long-term savings and tax planning tool.I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare?
Congrats on your upcoming retirement! Transitioning from an employer plan to Medicare can be smooth if you plan ahead. Here’s the key stuff to consider:1. Timing is critical
Your Initial Enrollment Period (IEP) for Medicare starts 3 months before your 65th birthday, includes the month of your birthday, and ends 3 months after.
Late enrollment penalties can apply if you miss your window.
Tip: If your employer coverage continues past 65 and has 20+ employees, you may qualify for a Special Enrollment Period (SEP) when you retire — no penalty.
2. Compare coverage and costs
Check what your employer plan covers vs. Medicare (doctor visits, prescriptions, hospital stays).
Look at premiums, deductibles, and out-of-pocket maximums for both Medicare and any supplemental coverage.
3. Part D for prescriptions
If your employer plan covers drugs, you may not need Part D immediately.
When you drop employer coverage, you can enroll in Part D during your SEP without penalty.
4. Consider Medigap or Medicare Advantage
Medigap (Supplement): Helps cover Part A/B out-of-pocket costs. Best for flexibility and freedom to choose doctors.
Medicare Advantage: Combines A/B + usually D, often with extra benefits like dental, vision, and hearing—but may have network restrictions.
5. Check provider networks
Make sure your doctors and preferred hospitals are in-network if you go with Medicare Advantage.
Medigap gives you freedom to see any Medicare provider.
6. Coordination of benefits
If you keep employer coverage while on Medicare, Medicare may be primary or secondary depending on your employer size.
Understanding this prevents unexpected bills.
7. Don’t rush—review all options
Compare Original Medicare + Part D + Medigap vs Medicare Advantage
Use the Medicare Plan Finder or consult a Medicare agent to find the best fit.
An agent asked me to sign a scope of appointment for before we could discuss my Medicare insurance or part D plan. What is an SOA? Is this normal? Are call centers exempt from this practice?
The Scope of Appointment (SOA) form is required to be signed 48 hours prior to any scheduled appointment where Medicare Prescription Drug (Part D) plans or Medicare Advantage (Part C) plans benefits are being discussed. The SOA lays out what will be discussed during your appointment with the agent/broker. Only plan types selected on the SOA can be discussed during your meeting. It must be signed by both the Medicare beneficiary and the Medicare agent/broker. The form is a Medicare requirement and all agents, included call center agents, are required to comply with the regulation.There are three exceptions to the 48 hour rule:
1) Walk in without prior appointment
2) Inbound call initiated by the beneficiary
3) Within 4 days of the end of a valid election period
Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?
Original Medicare will cover 80% of covered charges, leaving the beneficiary to pay the other 20%. To help with that 20% out of pocket amount, the two solutions are referred to as "Medicare Advantage" plans and "Medigap" (Medicare Supplement) plans.Advantage plans cover everything but copays or coinsurance for services used (fee-for-service model) and will typically not charge a monthly premium. Many times an Advantage plan will include Part D prescription drug (Rx) benefits at no additional premium and can even offer cheaper Rx copays than a stand-alone Rx plan. In addition, Advantage plans can include extra benefits not covered by Medicare, such as dental, vision, hearing, gym membership, and other benefits.
Medigap (Supplement) plans cover the majority, if not all, of your out of pocket medical expense, but charge a substantial monthly premium regardless of how often you use medical services. In addition, Medigap does NOT cover Rx medications, so you are required to enroll in a separate Rx drug plan which will likely also include an additional separate premium. Medigap plans do not offer additional benefits.
Typically I only recommend Medigap for someone who has a complex medical history and risks spending more on an Advantage plan's Maximum Out Of Pocket limit (MOOP) than it would cost to pay the annual premium on the Medigap supplement plan. (MOOP is a safety net with Advantage Plans that prevent you from any catastrophic expenses). Another reason would be to accommodate extenuating provider network access issues. Some people prefer Medigap over Advantage plans because they might have enough financial cushion to not factor premiums into their decision. They simply want the psychological safety of knowing everything is paid for without having to reconcile copays or medical bills.
In my view, it's easy to see why Medicare Advantage plans have become so popular. Who wouldn't want more for less?
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
Often, yes, but it depends on what type of employer coverage you are losing and whether you have (or are enrolling in) Medicare Part B.If you are losing employer/union coverage that supplements Original Medicare (including many retiree plans or COBRA): You generally have a federal Medigap “guaranteed issue” right. That means you can buy a Medigap policy without medical underwriting, and you typically must apply within 63 days of the coverage ending (or the date you are notified it is ending, depending on timing).
If you are losing active employer coverage and you are enrolling in Part B now: You may not be using “guaranteed issue,” but you typically get a 6‑month Medigap open enrollment period starting when Part B becomes effective, during which you can usually buy any Medigap plan sold in your state without underwriting.
If you are voluntarily dropping employer coverage that you could keep: You often do not get a guaranteed issue right.
Also, Medigap generally requires that you have Original Medicare (Part A and Part B), and guaranteed issue rights and plan availability can vary by state.
What's the most cost-effective way for a healthy 65-year-old to structure their Medicare coverage?
Great question! For a healthy 65-year-old looking for cost-effective Medicare coverage, the goal is balancing affordable premiums with enough protection to avoid big surprise bills.Here’s a common, cost-effective approach:
1. Original Medicare (Part A & B)
Part A is usually premium-free if you’ve worked enough
Part B has a standard monthly premium ($170.10 in 2024)
2. A High-Value Medigap Plan (Like Plan G)
Covers nearly all out-of-pocket costs except the Part B deductible
Predictable costs—usually a higher monthly premium but no surprise bills
Great for peace of mind against unexpected hospital or doctor costs
3. A Standalone Part D Prescription Drug Plan
Choose a plan with good coverage for your medications
Premiums vary, but you can shop annually for better deals
4. Skip Extras You Don’t Need Yet
Since you’re healthy, you may not need dental, vision, or hearing coverage right away
You can add these later if needed via standalone plans or Medicare Advantage
Why This Works:
You avoid high out-of-pocket costs with Medigap’s broad coverage
You keep monthly premiums manageable
You maintain freedom to see any doctor who accepts Medicare
You can tailor drug coverage to your needs and budget
Would you like help comparing Medigap and Part D plans available in your area to find the best value? Contact us.
Can you just have A and B and not enroll in anything else and still have good coverage?
That’s a great question — and it’s one a lot of people ask when they first get on Medicare.Technically, yes — you can have just Medicare Parts A and B and choose not to enroll in anything else. However, it’s usually not enough coverage for most people. Here’s why:
Part A covers hospital stays, skilled nursing care, hospice, and some home health care — but you’ll still face a large deductible per hospital stay and daily coinsurance costs if your stay is extended.
Part B covers doctor visits, outpatient care, preventive services, and medical supplies — but it only pays 80% of approved costs, leaving you responsible for the other 20% with no cap on how high those bills can go.
That means if you have a serious illness, surgery, or long hospital stay, your out-of-pocket costs could be thousands of dollars.
That’s why most people add either:
A Medigap (Supplement) plan to cover the leftover 20% and hospital costs, or
A Medicare Advantage (Part C) plan, which combines A and B and often adds prescription, dental, and vision benefits.
So while you can stay with just A and B, it’s not recommended long-term if you want full protection and predictable costs.
Would you like me to explain how much you’d typically pay out of pocket if you kept only A and B?
How can I select the right healthcare company and representative to work with?
1. How to Evaluate and Select a Healthcare CompanyWhen looking at insurance carriers, it is easy to just look at the monthly premium. However, a company's overall reliability, network size, and financial stability matter just as much. Look for the following indicators:
Network Adequacy: Ensure your preferred doctors, specialists, and local hospitals are "in-network." Out-of-network care can result in massive, unexpected out-of-pocket expenses.
Plan Variety: A strong healthcare company should offer a diverse portfolio of products (such as HMOs, PPOs, Medicare Advantage, or Medigap plans) so you can find a structure that fits your specific lifestyle and budget.
Financial Strength Ratings: Check independent rating agencies like A.M. Best, S&P, or Moody’s. Companies with high ratings (e.g., A or A+) have a proven track record of financial stability and the ability to pay out claims.
Customer Service & Claims Reputation: Look into the company's track record for processing claims efficiently and resolving customer disputes fairly. For Medicare plans, you can easily check the CMS Star Ratings (ranging from 1 to 5 stars) to see how existing members rate their quality and performance.
2. How to Choose the Right Insurance Representative
The representative you work with is your advocate. They interpret complex policy language and build a plan tailored to your life.
Captive Agents vs. Independent Brokers
First, understand the two primary types of representatives:
Captive Agents: Work exclusively for one healthcare company. They know their specific products inside and out, but they can only offer you plans from that single carrier.
Independent Brokers / Agents: Partner with multiple insurance companies. They can shop the entire market on your behalf, compare rates across competing brands, and provide an unbiased recommendation based purely on your needs.
When is the best time of the year to start looking at Medicare options?
The best time to look at your options is now, but keep these three windows on your radar:* Turning 65 (Initial Enrollment): Start researching 3–6 months before your birthday to ensure coverage begins the day you turn 65.
* Annual Enrollment (AEP): From Oct 15 – Dec 7, anyone can switch plans. I recommend reviewing your "Annual Notice of Change" in September to check for cost or doctor updates.
* Retiring after 65 (Special Enrollment): Start looking 2 months before you stop working to avoid coverage gaps.
A quick review with a licensed agent can often uncover better benefits or lower costs you didn't have last year.
Are Medicare Supplement plans the same thing as "Medicare Secondary Insurance"?
Yes, “Medicare Supplement” and “Medicare Secondary Insurance” usually mean the same thing.Both refer to insurance that pays after Medicare — helping cover costs like deductibles, copays, and coinsurance that Medicare doesn’t fully pay. The official name is Medicare Supplement Insurance (or Medigap), but a lot of people casually call it “secondary insurance” because it acts after Medicare pays first.
Quick tip: Not all “secondary insurance” is a Medigap plan — some people might have secondary coverage through a retiree plan, Medicaid, or an employer too. But if you’re buying it yourself specifically to fill Medicare’s gaps, it’s a Medicare Supplement.
Can you explain Special Needs Plans in Medicare?
A Medicare Special Needs Plan (SNP) is a specialized type of Medicare Advantage plan (Part C) that limits enrollment to individuals with specific diseases, or who are dually eligible for Medicare and Medicaid. These plans tailor their benefits, provider networks, and drug formularies to best meet the unique needs of their members.Three Primary Types of SNPs:
Dual Eligible Special Needs Plans (D-SNP): For individuals who qualify for both Medicare and Medicaid.
Chronic Condition Special Needs Plans (C-SNP): For individuals with specific, severe, or disabling chronic conditions (e.g., dementia, diabetes, end-stage renal disease).
Institutional Special Needs Plans (I-SNP): For individuals who live in a nursing home or require nursing care at home for 90 days or longer
What should I look for in a Medicare plan if I travel frequently both domestically and internationally?
If you travel domestically, Original Medicare with a Medigap policy is hard to beat because it works with any doctor or hospital in the country that accepts Medicare, giving you true nationwide access without network restrictions. Medicare Advantage plans are network based, which means if you travel outside your plan's service area you are generally only covered for emergency or urgent care, not routine services. For international travel, Original Medicare provides virtually no coverage outside the United States, so your Medigap plan becomes especially important. Plans G and N both include a foreign travel emergency benefit that covers 80 percent of emergency care costs outside the US after a small deductible, up to a lifetime maximum of $50,000. If you travel internationally often or for extended periods, a standalone travel insurance policy on top of your Medigap coverage is worth considering for added protection. The bottom line is that frequent travelers are usually best served by Original Medicare paired with a strong Medigap policy rather than a Medicare Advantage plan.
Will Medicare cover everything my current employer plan does?
Traditional Medicare will probably not cover everything your employer insurance covers. Of course that has a lot to do with the benefits offered by the employer plan. Most employer plans have dental insurance and drug insurance embedded in them. Medicare does not cover those things. However, there are so many variables that go into the decision to give up employer benefits and enroll in Medicare that it is impossible to make a decision without seeing all the options available to you. The main things to consider are: Premium, Annual Deductible, MOOP, Provider Networks, co-pays and co-insurance. In addition you need to consider if any other people are dependent on your employer benefits and what are the consequences if they no longer have them. It is best to work with a local broker who will take the time to educate you on all the options and help you make the right decision for your situation.
What if I missed my window to sign up?
There are a LOT of moving parts to this question. For the sake of simplicity I am assuming you’re saying you missed the 7 month window (3 months before your birth month, your month of birth, and 3 months after) to sign up for Medicare.You can call Social Security anytime to sign up for Part A as long you qualify for premium-free Part A (you’ve worked and paid into the system for at least 40 quarters, or 10 years).
For Part B, there’s a General Enrollment Period (GEP) from January 1st to March 31st each year, with Part B starting July 1st. If you were eligible this year, and signed up in GEP 2027, you will pay a 10% monthly penalty ($20.25 at the 2026 rate) per year you missed. It’s cumulative, so if you didn’t sign up until GEP 2028, you’d pay 20%, etc. It’s also permanent, so you pay that penalty as long as you have Part B coverage.
If you don’t qualify for premium free Part A, the same GEP applies, and the 10% penalty applies, but it only lasts for twice as long as you went without coverage. So the part A penalty is finite, the Part B penalty follows you forever.
However, if you have employer coverage or spousal coverage that can be considered creditable (VA coverage, COBRA, and ACA coverage are not creditable) then you have a different situation.
Your best bet is to talk to agent to review your situation in detail to see if any special election periods apply that can help you.
What happens if I delay Medicare Part A enrollment because I'm still on my spouse's employer plan?
If you delay Medicare Part A because you’re covered under your spouse’s active employer group health plan, you may be able to enroll later without a penalty — but it depends on the size of the employer.Here’s how it works:
• If your spouse works for a company with 20 or more employees, their employer plan usually pays first, and you can delay Part A (and Part B) without penalty.
• If the employer has fewer than 20 employees, Medicare typically becomes primary at age 65. In that case, delaying enrollment could leave you with coverage gaps and possible late penalties.
Most people qualify for premium-free Part A, so many enroll at 65 even if they keep employer coverage — but if you are contributing to an HSA, enrolling in Part A will stop you from being able to continue HSA contributions.
When your spouse retires or the employer coverage ends, you’ll qualify for a Special Enrollment Period (SEP) to sign up without penalty.
Because rules can vary depending on your situation, it’s always wise to review your specific coverage details before deciding to delay.
Can I enroll in Medicare if I've never paid into Social Security due to working overseas?
If you are a US citizen or lawful permanent resident (with 5+ years of residency) you CAN enroll in medicare, but your cost will likely be different if you’ve never paid into the system.Part A is premium free if you’ve worked for 40 quarters (10 years) and paid into the system. If you don’t meet that requirement, you can BUY part A coverage.
Part B would be handled the same as everyone else - you’ll pay the premium appropriate for your income.
Your supplemental coverage (Medicare Advantage, Medigap and/or Part D) are based on your medicare eligibility and not based on your social security contributions.
NOTE - Foreign work credits from countries with TOTALIZATION agreements with the US (ie Canada, the UK, Germany) MAY count toward the Social Security eligibility and COULD reduce or eliminate the Part A premium. Also, if you’re married to someone with US Work Credits that can make a difference, so there are a lot of variables to this situation. Social Security can help you determine what comes next.
How do you approach educating clients who are new to Medicare versus those who are considering switching plans?
The approach is a little different depending on where someone is in their Medicare journey, but the goal is always to make things clear, simple, and personalized.1. For Clients New to Medicare
Start with the basics: I explain what Medicare is, the difference between Parts A, B, C, and D.
Focus on timelines: We go over the Initial Enrollment Period, penalties to avoid, and what steps they need to take first (like enrolling in Parts A & B).
Use plain language: Instead of jargon, I break it down into real-life examples, like how a hospital stay or prescription would be covered.
Decision framework: I walk them through their two main paths—Original Medicare with a supplement + Part D versus a Medicare Advantage plan—and explain the pros and cons of each.
Cost comparison: I often make side-by-side charts showing them what the cost would be with a Medicare Supplement vs a Medicare Advantage plan so they can see the numbers clearly.
2. For Clients Considering Switching Plans
Focus on what’s changing: Instead of reviewing the entire Medicare system again, I look at their current coverage, what they like about it, and where the pain points are (costs, doctors, prescriptions, extra benefits).
Review updates: I highlight new plan options, changes in drug formularies, or network differences for the upcoming year.
Cost comparison: I often make side-by-side charts showing their current plan versus alternatives, so they can see the numbers clearly.
Reassurance: I remind them that it’s normal to re-evaluate each year during Annual Enrollment, and that my role is to make sure they’re not paying more than they need to or missing out on coverage they value.
What's the process for signing up for Medicare if I'm already on disability benefits?
If you are already receiving Social Security Disability Insurance (SSDI) benefits, the transition to Medicare is typically automatic. In most cases, you don't need to take any action to sign up. The Standard 24-Month Rule. For most individuals under age 65, Medicare coverage begins after you have received disability benefits for 24 months. Automatic Enrollment: You will be automatically enrolled in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting in your 25th month of disability benefits. Notification: You should receive a Medicare welcome package and your Medicare card in the mail approximately 3 months before your coverage is set to begin. Exceptions to the Waiting Period: Certain medical conditions allow for immediate or expedited enrollment without the 24-month wait: ALS (Lou Gehrig’s Disease): You are automatically enrolled in Medicare Parts A and B the same month your disability benefits begin. End-Stage Renal Disease (ESRD): You are eligible for Medicare regardless of age, but you usually must apply manually through Social Security rather than waiting for automatic enrollment. Key ConsiderationsPart B Premiums: While Part A is generally premium-free, Part B has a monthly premium ($185.00 for most in 2025; $202.90 in 2026). This amount is usually deducted automatically from your monthly disability check. Declining Part B: If you have other health coverage (like through a spouse's current employer), you can opt out of Part B by following the instructions in your welcome package. However, if your employer has fewer than 100 employees, Medicare is typically the primary payer, and you may need Part B to avoid coverage gaps. Additional Coverage: You will still need to decide if you want to join a Medicare Advantage Plan (Part C) or a Prescription Drug Plan (Part D), which requires separate enrollment.
What's the biggest frustration Medicare agents have when helping clients enroll?
There are several things that frustrate me as a 20+ year veteran Medicare insurance agent:1. The Medicare enrollment system can be complicated and slow but we are at the mercy of the Social Security Adminustration. I can’t make it move any faster.
2. Because the Medicare enrollment system is difficult, clients tend to procrastinate and underestimate the amount of time needed to put plans in place.
3. Clients tend to make poor choices on their own, based on insufficient education, and come to me later to fix things, but those things can’t always be fixed. My services cost my clients nothing, so they should consult with me first to make better-educated decisions and avoid expensive and often-irreversible mistakes.
4. Medicare is very political and the politicians don’t have enough education or care for how their new rules, laws and budget changes affect their constituents until after the changes are made and those changes are hurting real people.
5. Medicare insurance agents are under-appreciated by insurance companies and government officials, so we are constantly fighting for our commissions while also staying current with ever-changing licensing, certifications and continuing education requirements.
How can I tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker?
1. They ask the right questions — not just try to sell a plan.An experienced broker will take time to learn about your doctors, prescriptions, health conditions, travel habits, and budget.
An inexperienced broker usually jumps straight into showing plans without understanding your needs.
2. They can explain plans in plain English.
Experienced brokers break things down in a way that makes sense: deductibles, MOOP, networks, drug tiers, and timing rules.
If someone struggles to explain the basics clearly, that’s a sign they may not have much experience.
3. They review all your options, not just one company.
A seasoned Medicare Broker is appointed with multiple carriers and shows you side-by-side comparisons.
An inexperienced broker may only show one plan or favor one carrier because it’s the only one they know.
4. They know your local providers and networks.
Experienced brokers stay up to speed on which hospitals, specialists, and clinics are in-network in your area.
If a broker can’t answer simple provider questions, they may still be learning.
5. They provide ongoing support — not just help you enroll.
A strong broker checks in, helps with billing issues, assists with Part D changes, and is available year-round.
Inexperienced brokers often disappear after enrollment.
6. They understand Medicare rules and timing.
Experienced agents can guide you through AEP, OEP, Special Enrollment Periods, Part B penalties, and late enrollment rules.
If someone seems unsure about Medicare deadlines, that’s a red flag.
7. They don’t pressure you.
A good Medicare Broker educates.
An inexperienced one may push you toward a decision you’re not ready for.
Can you explain what "creditable coverage" means and when it applies?
Absolutely—this term causes a lot of confusion, and it means different things depending on the situation. Let’s make it clean and practical.⸻
What “Creditable Coverage” means (plain English)
Creditable coverage is health or drug coverage that Medicare considers “good enough” so you’re not penalized when you enroll later.
It mainly applies in two specific Medicare contexts:
1. Medicare Part B (medical)
2. Medicare Part D (prescription drugs)
Outside of those, the word gets misused a lot.
⸻
1. Creditable Coverage for Medicare Part B
This applies when you delay Part B.
Creditable coverage for Part B =
• Active employer group health coverage
• From current employment (yours or your spouse’s)
• Usually from an employer with 20+ employees
Why it matters
If you have this kind of coverage:
• You can delay Part B without penalty
• You qualify for a Special Enrollment Period (SEP) later
What does NOT count for Part B
❌ COBRA
❌ Retiree coverage
❌ Marketplace (ACA) plans
❌ VA coverage (for Part B purposes)
❌ Medigap or Medicare Advantage
Only current, active employer coverage counts here.
⸻
2. Creditable Coverage for Medicare Part D
This is the most common use of the term.
Creditable drug coverage means:
• Prescription coverage that is at least as good as a standard Medicare Part D plan
Examples that often count
✅ Employer or union drug plans
✅ VA prescription benefits
✅ TRICARE
✅ Some retiree plans
Each year, the plan must send a Creditable Coverage Notice telling you whether it qualifies.
Why it matters
If you go:
• 63 days or more without creditable drug coverage after Medicare eligibility,
• You can get a lifetime Part D penalty
⸻
3. What “creditable coverage” does NOT mean
This is the key misunderstanding:
🚫 Creditable coverage does NOT automatically:
• Give you Guaranteed Issue rights for Medigap
• Replace Medicare
• Mean you can enroll anytime
Do I really need help in figuring out what's best for me as for as Medicare Planning?
I’m going to say yes. Medicare isn’t just one decisionIt’s a stack of permanent and time-sensitive choices:
• Original Medicare vs Medicare Advantage
• Medigap Plan G vs Plan N (and when you’re allowed to enroll without underwriting)
• Part D drug plans that change every year
• Provider networks, prior authorizations, and out-of-pocket exposure
• Penalties that last for life if you miss something.
As an agent, I/we have to go thru annual training and certifications to assist you correctly. It’s not to say that you can’t search out the information for yourself and even get things right but I don’t know why one would if they found a good agent to work with them, and the help comes at no cost to them.
Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?
Switching to Medicare can feel like a big change, and people often wait because:1. They think they’re already covered: Still working and assume employer insurance means “I don’t need Medicare yet,” plus confusion about whether employer coverage is creditable for Part B/Part D.
2. It’s confusing/intimidating: A/B/D, Medigap vs Advantage, networks, formularies, and penalties—too many moving parts.
3. They don’t know the deadlines/penalties: Many miss the Initial Enrollment Period (IEP) and learn about penalties afterward.
4. Life gets in the way: Retirement, moving, health issues, caregiving, loss of a spouse—Medicare gets pushed down the list.
5. Bad or oversimplified advice: “Just take the free plan,” “You can enroll anytime,” or “You don’t need Part B if you’re healthy.”
6. They assume it’s quick: Social Security processing, plan selection, provider checks, and Rx research all take time.
How my office can help:
1. Start early (3–6 months before turning 65/retiring) so you’re not rushed.
2. Confirm what you actually need: doctors, prescriptions, travel habits, budget.
3. If you’re still working, verify employer coverage in writing to avoid penalties/gaps.
4. Check doctors and hospitals (especially for Medicare Advantage networks).
5. Compare prescription costs (formulary, tiers, restrictions, preferred pharmacies).
6. Explain tradeoffs in plain English: premium vs pay-as-you-go, networks/prior auth, worst-case yearly cost.
7. Help you enroll correctly and on time with a simple checklist.
8. Review annually so coverage stays a good fit as plans and medications change.
Are there disadvantages to working with a Medicare broker/agent?
Yes, while working with a Medicare broker or agent can be very helpful, there are some potential disadvantages to be aware of. Here’s a clear breakdown:⸻
✅ First, the advantages (for context):
• Expert guidance through complex options (especially if you’re new to Medicare)
• Help comparing plans side by side
• No cost to you — agents are typically paid by the insurance companies
• Can save time and reduce stress
⸻
⚠️ But here are the key disadvantages:
1. Limited Plan Access
• Many brokers are “captive agents”, meaning they only represent certain insurance companies.
• Even independent brokers may not represent all available plans, especially non-commissioned ones (some plans don’t pay brokers).
• This means you may miss out on better or cheaper plans they don’t offer.
2. Conflict of Interest
• Brokers earn commissions when you enroll in a plan.
• While many are ethical, some may steer you toward plans that earn them higher commissions — not necessarily what’s best for you.
3. Not Always Up to Date
• Some agents might not stay current on yearly plan changes or local options.
• A Medicare.gov comparison or help from a State Health Insurance Assistance Program (SHIP) counselor can sometimes be more objective.
4. Sales Pressure
• You may experience pressure to enroll quickly or choose a certain carrier.
• Some agents are more like salespeople than advisors.
I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?
No, as a green card holder with only 4 years in the US, you are not yet eligible for Medicare. To qualify for Medicare, you need to have been a lawful permanent resident (green card holder) and lived in the US continuously for 5 years.Here's a more detailed explanation:
Lawful Permanent Resident: You need to hold a green card, which grants you permanent residency in the US.
Continuous US Residence: You must have lived in the US for 5 years continuously, meaning you've maintained your primary residence in the US during that time.
Age: You need to be 65 years old or older.
In your case, you're 4 years into your US residency and haven't met the 5-year requirement. You'll need to wait until you've been a green card holder and lived in the US for 5 continuous years to be eligible for Medicare.
What happens when you're eligible:
You'll need to apply for Medicare, which can be done through the Social Security Administration or online.
You may need to pay a monthly premium for Medicare Part A (hospital insurance) if you haven't worked in the US for the required 40 quarters (10 years).
If you do have the required work history, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance).
You can also enroll in Medicare Part D (prescription drug coverage) if you have Part A and/or Part B.
I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
All parts of Medicare have some cost associated, whether it be a premium, deductibles, copays for services, or even a max out-of-pocket.Premiums are the payments you make for the coverage. Deductibles are the amount you must pay out-of-pocket before your coverage will pay anything. Copays are the amount you pay for specific services after meeting your deductible.
Medicare Part A is free once you retire if you or your spouse worked for the last 40 quarters (10 years) before you signed up, because you paid taxes while working. Medicare Part A:
* Has a deductible for each benefit period (every 60 days) for inpatient hospital stays.
* Has copays for hospital stays longer than 60 days.
* Has daily coinsurance for days 61-90 and 91-150.
Medicare Part B has a premium that comes out of your Social Security check before it is dispersed to you. If you are not receiving Social Security, you must pay the premium for Part B out-of-pocket until you start drawing your Social Security. Medicare Part B:
* Has an annual deductible.
* Does not have copays for most services.
* Has a 20% coinsurance for most services after the deductible is met.
Medicare Supplements (Medigap) provide benefits to help cover out-of-pocket costs like deductibles, coinsurance, & copays. Each Med Sup has a premium, & each one has different benefits. Medigaps:
* Help pay the 20% coinsurance for services covered by Original Medicare Part B (medical insurance).
* Many cover the Medicare Part A (hospital insurance) deductible.
* May cover additional days in the hospital after Medicare benefits are used up.
* Some may cover costs for skilled nursing facilities, hospice care, excess charges from non-participating providers, & foreign travel health care emergencies.
Medicare Advantage usually does not have premiums, but may have a deductible(s), has copays for services, & an annual max out-of-pocket.
How does losing a spouse impact my Medicare plan if I was on their employer coverage?
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.
Can my daughter work with a Medicare agent or broker on my behalf?
Yes, absolutely. In fact, many of the Medicare clients I work with have an adult child helping them through the process.Your daughter can gather information, compare options, attend appointments, ask questions, and help you evaluate plans. The only limitation is that if she is not your legal Power of Attorney (POA), she cannot enroll you in a Medicare plan on your behalf without your participation.
Once we’ve identified the best option, we’ll simply schedule a time when you’re available and complete the enrollment together. That can be done through a three-way phone call, a Zoom meeting, or an in-person appointment. Many families find this approach helpful because it allows everyone to be involved in the decision and ensures that the parent understands and agrees with the coverage being selected.
Is the cost of Medicare different for everyone?
Yes — and here’s the quick breakdown:Part A (Hospital) — Free for most people if they or their spouse worked 40+ quarters (10 years). Otherwise, up to ~$800/month.
Part B (Medical) — Standard premium is $185/month in 2025, but higher earners pay more via IRMAA surcharges (can exceed $600/month).
Part D (Drug Plan) — Varies by plan, typically $0–$100+/month depending on the plan and your drugs.
Supplement/Medigap — Varies widely by age, gender, location, and health history. Could be $80–$300+/month.
Medicare Advantage — Many plans are $0 premium, but cost-sharing (copays, deductibles) varies by plan and usage.
Bottom line: Part B is the one universal cost most people share, but income, geography, health choices, and timing all create significant variation.
What are the types of Medicare Advantage plans?
Medicare Advantage (Part C) plans are offered by private companies approved by Medicare. They combine your hospital (Part A) and medical (Part B) coverage—and most also include prescription drug coverage (Part D). There are six main types, each with different rules, costs, and flexibility:🧭 Six Types of Medicare Advantage Plans
1. HMO (Health Maintenance Organization)
You must use doctors and hospitals in the plan’s network (except in emergencies). Referrals are needed for specialists. Most plans include drug coverage.
2. PPO (Preferred Provider Organization)
You can see doctors outside the network, but it costs more. No referrals needed. Most plans include drug coverage.
3. PFFS (Private Fee-for-Service)
You can go to any provider who accepts the plan’s payment terms. Drug coverage may or may not be included. These plans are less common.
4. SNP (Special Needs Plan)
Designed for people with specific health conditions, those in care facilities, or those who qualify for both Medicare and Medicaid. Always includes drug coverage.
5. MSA (Medical Savings Account)
Combines a high-deductible plan with a savings account funded by Medicare to help pay for healthcare costs. Doesn’t include drug coverage—you’ll need a separate Part D plan.
6. HMO-POS (HMO Point of Service)
A mix of HMO and PPO. You can go outside the network for certain services, but it usually costs more.
What should people know about Medicare and its parts?
What does Medicare cover and not cover? To answer this question, we need to take a look at the two different parts of Medicare. Medicare has part A, which is your hospital coverage, and part B, which is your medical coverage. Part A, typically, people do not pay a premium for part A unless you did not work for at least 40 quarters within your lifetime. But part A is gonna cover your inpatient hospital care, some skilled nursing care, and hospice care. There is a deductible of $1,676 every time you go in the hospital. And if you're there more than 60 days, there's a co-pay of $419 per day. From date 91 to 150, it goes up to $838 per day. And then after that, you'll be paying for everything as it is not covered. For skilled nursing facility care, Medicare will cover you for the first 20 days, and then after that, $209.50 per day up to day 100. And then after day 100, you're not covered. So everything will be out of pocket. Your part B covers your doctor services, your outpatient services, including surgery and some other services and supplies that are not covered by part A. There is a premium for your part B. Most people will pay $185 per month, but it does go up based on your income. Part B has an annual deductible of $257. And then after that, 20% is what your co-insurance would be. So there are two different types of plans that you can get: Medicare Supplement and Medicare Advantage to cover the things that Medicare does not cover.
Can I backdate my Medicare enrollment if I missed my initial window due to a medical emergency?
Short answer: Usually no—but there are limited exceptions.Here’s how it works, in clear terms:
General rule
Medicare does not backdate enrollment just because you missed your Initial Enrollment Period (IEP), even due to a medical emergency. If you enroll late, coverage typically starts prospectively, not retroactively.
When you may get relief
You might qualify for help in these situations:
1. Special Enrollment Period (SEP) for “exceptional circumstances”
Medicare can grant an SEP if you can show you were incapacitated (for example, hospitalized or unable to make decisions) during your IEP.
This is handled case by case
You must provide medical documentation
CMS must agree the situation directly prevented enrollment
If approved, you can enroll without a late penalty, but coverage still usually starts the month after enrollment, not backdated.
2. Medicare Part A (hospital insurance)
If you qualify for premium-free Part A, Medicare can backdate Part A coverage up to 6 months (but never earlier than your 65th birthday).
This happens automatically once you enroll
This does not apply to Part B
3. Social Security enrollment corrections
If Social Security made an error or gave incorrect information that caused the delay, they may allow a correction. This requires proof and documentation.
What happens if you don’t qualify for an SEP?
You must wait for the General Enrollment Period (Jan 1–Mar 31)
Coverage starts July 1
Late enrollment penalties may apply (especially Part B and Part D)
Important next steps
Contact Social Security (not Medicare) to request a review
Ask specifically about an SEP due to incapacity
Gather hospital records or physician statements
Enroll as soon as you are able—waiting longer can make penalties worse
If you want, tell me:
Which part of Medicare you missed (A, B, or D)
When your Initial Enrollment Period ended
Whether you were hospitalized or incapacitated
I can help you determine the best path forward and how to expla
Why did I receive a Medicare Summary Notice, and what should I do with it?
A Medicare Summary Notice (MSN) is a statement you receive every 3 months if you have Original Medicare. It’s not a bill—it shows the medical services you received, what Medicare paid, and what you may owe. Review it carefully to make sure the information is correct, compare it with your doctor’s bills, and keep it for your records. If you notice any mistakes or charges for services you didn’t receive, report them to Medicare at 1-800-MEDICARE.
Does Medicare cover vision care?
No, Original Medicare (Parts A and B) does not cover routine vision exams, eyeglasses, or contact lenses, but it does cover certain medical eye exams and treatments for conditions like glaucoma, diabetic retinopathy, and macular degeneration. For routine vision care, you can get coverage through a Medicare Advantage (Part C) plan, which often includes exams, glasses, and contacts, or you can purchase a private vision plan to supplement your Medicare coverage.What Original Medicare covers:
Medical eye exams: Covers annual eye exams for people with diabetes to check for diabetic retinopathy and annual eye exams for those at high risk of glaucoma.
Diagnostic tests and treatments: Covers diagnostic tests and treatments for conditions like macular degeneration.
Cataract surgery: Covers the surgery to remove a cloudy lens and one pair of corrective eyeglasses or contact lenses after surgery.
What Original Medicare does not cover
Routine eye exams: For the purpose of fitting eyeglasses or contacts.
Eyeglasses and contact lenses: The cost of the frames, lenses, or contacts themselves.
How can I avoid or reduce IRMAA charges on my Medicare premiums?
Great question—IRMAA catches a lot of people off guard, especially around retirement.First, quick refresher (in plain English)
IRMAA = Income-Related Monthly Adjustment Amount
It’s an extra charge added to your Medicare Part B and Part D premiums if your income is above certain limits.
Important (and annoying) detail:
Medicare looks at your income from TWO YEARS AGO.
So in 2026, they’re usually using 2024 tax data.
How to avoid or reduce IRMAA (the practical stuff)
1. Watch your “MAGI” like a hawk
IRMAA is based on Modified Adjusted Gross Income (MAGI), not just your paycheck.
Common things that push people over the line:
Large IRA or 401(k) withdrawals
Roth conversions
Capital gains from selling property or investments
One-time bonuses or severance
Required Minimum Distributions (RMDs)
💡 Strategy: Spread income over multiple years when possible instead of taking a big hit in one year.
2. Use Roth accounts strategically
Roth IRA withdrawals do not count toward MAGI
Partial Roth conversions done before age 65 can reduce future IRMAA exposure
This is one of the most powerful long-term planning tools.
3. Time big financial moves carefully
If you can control when income hits:
Delay selling investments until a lower-income year
Spread withdrawals across December/January to straddle tax years
Avoid stacking multiple income events in the same year
Sometimes staying $1 over the limit can cost thousands in extra premiums.
4. File an IRMAA appeal if your income dropped
This is HUGE—and underused.
If your income went down due to a life-changing event, you can ask Social Security to reduce or remove IRMAA.
Qualifying events include:
Retirement or work reduction
Loss of income-producing property
Divorce or death of a spouse
Employer settlement ending
You do this using SSA Form 44.
👉 This can lower your premiums immediately, not years later.
5. Coordinate Medicare decisions with tax planning
This is where people get burned:
Medicare choices
Can you explain how Medicare works with other types of insurance like Veterans Affairs benefits or employer plans?
Medicare can work alongside other insurance, but who pays first (primary) and who pays second (secondary) depends on which type of coverage you have and why you have it.1. Employer or Union Group Health Plans
If you’re 65+ and still working (or covered by a working spouse’s plan):
Employer has 20+ employees: Employer plan pays first, Medicare pays second.
Employer has fewer than 20 employees: Medicare pays first, employer plan pays second.
Tip: Always confirm with HR whether your coverage is considered creditable for delaying Part B or Part D without penalty.
2. Retiree Coverage
Usually pays after Medicare.
You must enroll in Medicare Parts A & B for retiree coverage to work fully.
Retiree coverage may help pay Medicare’s deductibles and coinsurance, but benefits can change — especially if your former employer changes the plan.
3. Veterans Affairs (VA) Benefits
VA benefits cover care only in VA facilities.
Medicare covers care in non-VA facilities.
You can have both:
Use VA for prescriptions or specialty care.
Use Medicare for civilian doctors/hospitals.
Tip: Many vets keep Part B to avoid penalties and to have access to non-VA care.
4. TRICARE for Life (Military Retirees & Spouses)
You must have Medicare Parts A & B.
Medicare pays first for Medicare-covered services.
TRICARE pays second, often covering what Medicare doesn’t (including some drugs).
For VA or military facilities, TRICARE pays first.
5. Medicaid
Medicaid is always the payer of last resort — it pays after Medicare and any other insurance.
If you have both Medicare and Medicaid (“dual eligible”), you may qualify for a Special Needs Plan (D-SNP) that coordinates both.
6. Workers’ Compensation
Workers’ comp pays first for job-related injuries or illness.
Medicare may pay for unrelated services.
What's the difference in copays vs deductibles?
A copay is what you are going to be responsible when you utilize a medical procedure or even when you pick up your medications immediately. A deductible on the other hand is what you will pay first before the insurance company will pay. So, if you are on a plan that has a $300 deductible for medications (for all tiers) then you would pay the first $300 towards any of your medications before the plan would pick up any of the cost. Once the deductible is met then typically there is a set copayment or coinsurance that you are responsible after that point. A deductible is not to be confused with a maximum out of pocket (believe me it commonly is). The maximum out of pocket is the maximum amount you can pay within a year. Once your maximum is hit then the insurance company is to pay the copayments and coinsurance until the end of the calendar year. This resets at the end of each year.
Is it ok to work with a younger Medicare Advisor?
Yes — it’s absolutely okay to work with a younger Medicare advisor. What matters most isn’t age, but knowledge, experience, and how well they listen to your needs. A good advisor should be able to explain your options clearly, help you compare plans, and guide you through enrollment without pressure.In fact, younger advisors often bring a lot of energy, up-to-date technology skills, and a fresh approach to communication — things like virtual meetings, digital forms, and simplified explanations. The key is finding someone who’s licensed, specializes in Medicare, and takes the time to make sure you understand your coverage and feel confident in your choices.
Does everyone over the age of 65 qualify for Medicare?
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.
Are there any guidelines I should follow when filling out my Medicare application?
Guidelines for Seniors Filling Out a Medicare ApplicationFilling out a Medicare application is an important step in securing your health coverage as you age. To help make the process smoother and avoid mistakes, here are some key guidelines to follow:
1. Know when you’re eligible and what enrollment periods apply
You’re generally eligible for Medicare when you turn 65, or earlier if you have certain disabilities, end-stage renal disease (ESRD), or ALS.
The Initial Enrollment Period (IEP) is a 7-month window: 3 months before your 65th birthday, the month of your birthday, and 3 months after.
If you miss the IEP, you may have to apply during a General Enrollment Period (January 1–March 31 each year) and could face late enrollment penalties.
If you (or your spouse) are working past 65 and have employer group health coverage, you may qualify for a Special Enrollment Period to delay Medicare without penalty.
Center for Medicare Advocacy
2. Gather all required documentation ahead of time
Before you begin filling out the application, make sure you have:
Your Social Security number
Proof of citizenship or legal residency
Your date of birth
Information about your current health insurance (if any)
If applying for Part B separately, the CMS-40B form is required.
Centers for Medicare & Medicaid Services
If your employer or spouse’s employer had group health coverage, you may need to submit CMS-L564 to document when coverage ends.
Having everything ready reduces delays and mistakes.
3. Fill out the application carefully and completely
Write legibly and avoid leaving blanks
Are there any pointers or suggestions when looking over my ANOC (Annual Notice of Change)?
Yes — your ANOC (Annual Notice of Change) is one of the most important pieces of mail you’ll get from your Medicare plan each year. It explains what’s changing for the upcoming year — things like your premiums, copays, drug coverage, and extra benefits.When you look it over, take a few minutes to make sure your monthly premium and maximum out-of-pocket costs aren’t increasing too much. Also check the copays for hospital stays and specialist visits, since those can change year to year and really affect what you’ll pay if you need care. Make sure your prescriptions are still covered at the same cost, and that your doctors and preferred hospitals are still in-network. It’s also a good time to review any dental, vision, or other extra benefits to see if anything was added, removed, or reduced.
If you notice anything that could impact your coverage or costs, it’s worth scheduling a quick plan review with an agent before the Annual Enrollment Period (Oct 15–Dec 7) to make sure you’re still in the plan that fits you best.
Can I drop my employer health insurance and switch to Medicare instead?
You should talk to your benefits coordinator about when you can drop your coverage. In general, yes you can, but you will want to ensure you get the timing right. Losing employer coverage (or spousal coverage) triggers a special election period to get your Parts A & B started and get your supplemental coverage set up, but you want to so do it so you have no gaps in coverage.If you are past your 65th birthday, you’ll also want to have a loss of coverage letter handy in case medicare asks for evidence you had creditable coverage in the intervening time frame.
You’ll also want to look at cost. Medicare Part B is $202.90 per month in 2026 and depending on which route you go for your supplemental coverage you could pay additional premiums of $200 or more. If your employer coverage costs less the part B Premium at a minimum, it might make more financial sense to keep your employer coverage until you’re ready to retire.
In any case, it’s worth talking to a broker to fully understand your situation and what options are available to you.
Are x-rays, exams, or therapies done by chiropractors covered under Medicare?
No, Medicare does not cover most services performed or ordered by chiropractors, including X-rays, exams, and therapies like massage or exercise therapy. Medicare Part B only covers medically necessary manual spinal manipulation to correct a subluxation. Any other services, including any X-rays or therapies the chiropractor recommends, are generally not covered and will be your financial responsibility.
Can I use my Medicare benefits right away in January?
Yes — in most cases, your Medicare benefits begin on January 1, as long as you enrolled during the appropriate enrollment period and your plan became effective on that date.If you enrolled during:
Annual Enrollment Period (Oct 15 – Dec 7) → Your new plan starts January 1
Initial Enrollment Period → Your coverage begins based on your Medicare eligibility date
A Special Enrollment Period → Your coverage start date depends on when you enrolled
Once your plan is active, you can:
See doctors and specialists covered by your plan
Fill prescriptions under your Medicare drug coverage
Use plan benefits such as preventive care, labs, and other covered services
Important tip for January:
Always confirm that your doctor, pharmacy, and medications are still in-network for the new year, since plans can change annually.
If you’re ever unsure whether your coverage is active—or how to use it—your Medicare agent can help you verify everything so you don’t face surprises at the pharmacy or doctor’s office.
A quick review in January can help ensure your benefits are working the way they should.
How do I apply for Medicare if I qualify because of a disability?
You cannot apply for Medicare due to a disability directly; you must first be approved for SSDI through the Social Security Administration (SSA). You can submit your application online using the SSA Disability Benefits Portal.To get Medicare due to a disability before age 65, you must first qualify for and receive Social Security Disability Insurance (SSDI) for 24 months. You will then be automatically enrolled in Medicare Parts A and B starting in your 25th month.
Because you are under 65, your Medicare enrollment is usually automatic. You will receive a Welcome Packet and your official Medicare Card in the mail approximately 3 months prior to your 25th month of SSDI benefits.
For more details/guidance, go to: https://www.ssa.gov/benefits/disability/qualify.html
Is my Medicare Part B premium automatically deducted from my Social Security check?
Yes, your Medicare Part B premium is automatically deducted from your monthly Social Security check if you are enrolled in both programs. You do not need to take any action to set this up, as it happens automatically.The standard Medicare Part B premium is $202.90 per month. However, this amount can vary depending on your modified adjusted gross income and is protected by the federal "hold harmless" rule, which prevents your premium increase from being larger than your annual Social Security cost-of-living adjustment (COLA)
There are only a few instances where your premium will not be automatically deducted:
YOU ARE NOT COLLECTING SOCIAL SECURITY: If you delay claiming Social Security benefits but enroll in Medicare Part B, you will receive a bill from Medicare (typically quarterly) to pay directly.
YOUR BENEFIT IS SMALLER THAN THE PREMIUM: If your monthly Social Security check is less than your premium amount, Social Security cannot deduct it, and Medicare will bill you directly for the difference.
YOU QUALIFY FOR A MEDICARE SAVINGS PROGRAM: If your state's Medicaid program covers your Part B premiums, nothing will be deducted from your check.
What's the difference between Medicare and Medicaid?
One of the most common questions I hear is:“What’s the difference between Medicare and Medicaid?”
While the names sound similar, they are actually two very different programs.
Medicare is primarily health insurance for:
• People age 65 and older
• Certain younger individuals with disabilities
• People with End-Stage Renal Disease (ESRD) or specific qualifying conditions
Medicare is generally based on age or disability status — not income.
Medicaid, on the other hand, is a needs-based program designed to help individuals and families with limited income and resources. Medicaid rules can vary from state to state.
Here’s a simple way to think about it:
• Medicare = Age or disability-based health coverage
• Medicaid = Income and asset-based assistance program
Some people qualify for BOTH Medicare and Medicaid at the same time. These individuals are often referred to as “dual eligible” beneficiaries.
When someone qualifies for both programs, Medicaid may help pay for things like:
• Medicare premiums
• Copays and deductibles
• Additional healthcare services
• Long-term care support in some situations
This is why proper guidance matters so much. Many seniors don’t realize they may qualify for additional assistance programs that could potentially save them thousands of dollars each year.
I spend a lot of time helping seniors and families understand these programs, review their options, and connect them with resources that may help — always at no cost.
Chuck Winslow
US Marine Veteran 🇺🇸
Retirement & Legacy Planner
Contact me.
How do I find a Medicare broker in my area?
Here is a clear and easy 1‑2‑3 strategy for locating a licensed Medicare broker or agent in your area.1. Medicare Agents Hub
This national directory lists licensed, independent Medicare brokers. It’s simple for seniors to use for obtaining...
Broker profiles
States they serve
Experience and specialties
Contact information
Just visit Medicare Agents Hub, https://medicareagentshub.com/
Enter your ZIP code and browse brokers who can help you compare plan options.
2. Medicare.gov – “Find Local Help” Tool
Medicare’s official website also offers a reliable way to find licensed professionals.
Go to Medicare.gov
Type Find Local Help in the search bar
Enter your ZIP code
Select Medicare Brokers / Agents
This tool lists brokers who are registered with Medicare and meet federal standards.
3. Local Medicare Agencies in Your Community
Many seniors prefer someone nearby who can meet in person. You can search for:
“Medicare agency near me”
“Medicare insurance office”
“Medicare broker [your city]”
Local agencies may offer walk‑in support with familiar, community‑based service.
🎯
Does everyone pay the same for Medicare?
No. While most people pay the standard Medicare Part B premium, higher-income beneficiaries may pay more due to the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA is based on your income from two years prior and can increase the cost of Part B and Part D coverage.In addition, Medicare Advantage, Part D, and Medicare Supplement plan premiums vary by plan, carrier, age, location, and other factors. As a result, two people with Medicare may pay very different amounts for their overall coverage.
What does Medicare Part A cover, and is it really free?
Medicare Part A acts as your hospital insurance. It primarily covers inpatient care in hospitals, skilled nursing facilities, hospice, and some home health care. It is "premium-free" for most people (meaning $0 monthly), but you still must pay deductibles, copayments, and coinsurance when you use the services.What Does Part A Cover?
Inpatient Hospital Stays: Covers semi-private rooms, meals, nursing care, and medications administered during a hospital stay.
Skilled Nursing Facility (SNF): Covers short-term care in a specialized facility following a qualifying hospital stay of at least three days.
Hospice Care: Covers comfort care for terminally ill patients, including drugs and medical equipment.
Home Health Care: Covers part-time, medically necessary skilled care for homebound patients.
Is It Really "Free"? The Premium: It is premium-free for anyone who worked and paid Medicare taxes for at least 10 years (40 quarters). If you (or your spouse) did not meet this requirement, you can buy Part A for a monthly premium of up to $565. Out-of-Pocket Costs: Even if your premium is $0, Part A is not entirely free. You must meet a hospital deductible (e. g, $1,736 per benefit period). After meeting the deductible, hospital stays are usually covered in full for the first 60 days, but you will pay a daily coinsurance for days 61 through 90.
What is a $0 premium Medicare Advantage plan, and what's the catch?
A $0 premium Medicare Advantage plan means you do not pay an additional monthly premium to the plan beyond your Medicare Part B premium. However, “$0 premium” does not mean $0 cost — you may still have copays, coinsurance, deductibles, and other out-of-pocket expenses when you receive care.These plans also typically use provider networks and may require prior authorizations for certain services. The key is to look beyond the premium and review the plan’s Maximum Out-of-Pocket (MOOP), provider network, drug coverage, and cost-sharing structure before enrolling.
Do I need to carry my Medicare card if I have a Medicare Advantage plan?
If you have a Medicare Advantage plan, you typically do not need to carry your Medicare card with you. You will receive a card to reflect your Part C Medicare Advantage plan that will take over for original Medicare.However, it is very important that you still retain or keep your red, white and blue Medicare card in a safe place. Should you need to change your Medicare Advantage Plan or return back to Original Medicare and add a Medicare Supplement Plan / Medigap plan and Part D Prescription Drug Plan, then you will need your red, white and blue Medicare card to be able to change plans.
Only in rare situations will medical professionals ask for your Medicare card if you have a Medicare Advantage plan. For example, if you are traveling outside of your network and have an emergency situation, you may want to have a copy of the card with you for claims processing and billing purposes.
Do husband and wife each pay their own Medicare premiums, or is there a family plan option?
There is no family or joint plan option for Medicare. Medicare is strictly individual coverage, meaning a husband and wife must enroll in their own separate plans and each pay their own individual premiums.While you cannot share a plan, being married can impact your individual costs. If one spouse did not work enough quarters to qualify for premium-free hospital insurance, they can qualify based on their spouse’s work history once they turn 65. If you file taxes as Married Filing Jointly, your combined income determines whether you must pay a high-income surcharge (IRMAA) on your Part B and Part D premiums.
Aside from those factors, your premiums, deductibles, and benefits are entirely separate.
Is there a Medicare office near me where I can get help in person?
There are no dedicated Medicare offices. You can resigster for Medicare at your local Social Security office of online at www.ssa.gov. You can alo contact your local office of the State Health Insurance Program (SHIBA) which provides free counseling and will help you understand the complexity of Medicare rules and processes.Medicare also offers support through a toll-free numbner at 1-800-MEDICARE or use their live chat feature. This office will be able to assist you with general questions, penalties, checking eligibility, or submitting a complaint.
You can also use a local, indepoendent Medicare broker. Many brokers will offer an educational seminar introducing Medicare to people ready to enroll. Brokers work with multiple insurance carriers and should be able to suggest plans based on your needs.
How do I find a trustworthy Medicare agent in my area?
A good Medicare agent should focus on education first, not pressure.Look for someone who asks about your doctors, prescriptions, and budget, explains your options in plain language, and is available year‑round, not just during enrollment season.
You can check online reviews, ask friends or your pharmacy for referrals, and make sure the agent is licensed in your state and represents multiple plan options, not just one company.”
How do Medicare advisors get paid?
Medicare advisors can get paid in a couple of ways. Some agents work for a carrier or a large agency and are paid a salary with some bonus opportunities. Other agents/brokers may work on 100% commission. In this situation the only make money when they enroll someone. They are then compensated by the carrier. The department that administers Medicare (CMS) regulates these commissions and sets the rate each year. This means all the plans pay the same.Independent brokers are able to write for multiple companies and give more information about more plans. This is a benefit to the client since there is little incentive to prioritize any plan over the others.
Working with a broker does not cost the client anything. Many people think they will save money by figuring out Medicare on their own. This is false. Working with a trusted broker can save you from making some terrible mistakes that may cost you money or worse poor healthcare.
If I leave the hospital against medical advice, will Medicare still pay the bill?
Yes, Medicare will still pay for covered services even if you leave the hospital against medical advice (AMA). As long as the care you received was medically necessary and Medicare-approved, your coverage is not denied simply because you left early.However, you may still be responsible for deductibles, coinsurance, and any services not covered, just like any other hospital stay. It’s always a good idea to speak with hospital staff before leaving to understand any potential risks or costs.
Are new Medicare cards being issued for 2026?
Red, white, and blue Medicare cards are typically sent out when you first go on Medicare, and you would also typically receive a new Medicare card once you pick up Part B Medicare. Some people work beyond the age of 65 and are covered under their employer's coverage and it would likely be considered creditable coverage. If a Medicare Beneficiary picks up Part B Medical later, then a new card would be issued.Outside of this timeframe, people do not usually receive a new Medicare card except in special circumstances. From time to time, it might be identified that a Medicare Beneficiary Identification number was compromised. If this is the case, then a Medicare beneficiary would likely receive a new Medicare card along with a letter explaining why a new Medicare card was issued.
If you need a Medicare card or new Medicare card, there are multiple options to obtain one. The fastest way is online through MyMedicare.gov. You are able to see and print a copy of your Medicare card. You can request it on your Social Security account and select the option to "Replace my Medicare Card." Social Security is the gatekeeper to Medicare. You can reach them via phone, but they do have limited hours. The phone number is: 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 7 a.m.–7 p.m. You can also call Medicare at 1-800-MEDICARE and request a replacement card be mailed to you. Medicare is open around the clock and on the weekends.
Are there churches or community organizations in my area that help with Medicare questions?
Yes, in PA there are 3 main sources and organizations that offer free and unbiased Medicare counseling. These are, You Local Area Agency on Aging, PA MEDI Helpline, and Senior Community Centers. These places have counselors that are specially trained to assist with plan comparisons, enrollments and appeals.
I'm hesitant to share personal or financial information with an insurance agent. Is my information safe with you?
Insurance agents are required to follow privacy laws and protect your personal information. Only necessary information such as your ZIP code, age, preferred doctors, prescriptions, and Medicare eligibility date are needed to compare plans. Financial information should only be shared if you are choosing to enroll in a plan and that insurer requires the information. Don't hesitate to ask why a piece of information is needed, how it will be used, and who will have access to it.
Is help available in Spanish when choosing or using my Medicare plan?
Yes — absolutely, and you have a legal right to it. As your broker, I make sure all my clients know about this, whether they need it for themselves or for a family member.Official Medicare - Free, in Spanish
Medicare.gov/es - The entire Medicare website is in Spanish
1-800-MEDICARE - Say "Español" or press 2 for Spanish. They have Spanish-speaking reps 24/7.
Your Medicare & You handbook - Available in Spanish every year
You are allowed to have a family member or interpreter on the call with Medicare, HICAP, or with me. Medicare will just do a quick permission check. I also have access to a free interpreter line, so I can do a three-way call in Spanish if you need me to explain your options to a family member.
Do husband and wife each pay their own Medicare premiums, or is there a family plan option?
Medicare is individual health insurance so husbands and wives each pay their own premiums.Although there is not a family plan option and you can't share a policy, your marital status can still impact your overall costs.
1. Qualifying for Premium-Free Part A - Most people don't pay a premium for Part A (hospital insurance). If you do not have enough work history (40 credits or 10 years) to qualify for premium-free Part A on your own, you can qualify based on your spouse's history.
2. Potential Spousal Discounts - While Original Medicare (Parts A & B) does not offer discounts, some private insurance companies offer a household discount for Medicare Supplement (Medigap) policies.
3. High-Income Surcharges - If you file your taxes jointly, the government looks at your combined marital income from 2 years prior to determine your monthly Part B (medical insurance) and Part D (prescription drugs) premiums. If your combined modified adjusted gross income exceeds the established threshold, both you and your spouse pay an extra surcharge called the Income Related Monthly Adjustment Amount (IRMAA).
What is the biggest coverage gap most people don't know about with a Medicare Advantage plan?
The biggest coverage gap in Medicare Advantage plans is the costs for a hospital stay. Though there is a maximum out of pocket on what one will pay in a year, many Medicare beneficiaries are not prepared for the per day costs they would incur if they were hospitalized or the post-release care if they need additional institutional care. Having a hospital indemnity plan can help cover costs for the hospital stay; long term care coverage or tapping into the living benefits of a life insurance policy (if the policy has them) can help with post-release institutional care.Browse Other Questions & Answers
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