If I am not happy with my current Medicare plan can I make a change after January 1?
If you are enrolled in a Medicare Advantage plan, there is another important enrollment period. It is called the Medicare Advantage Open Enrollment Period, and it runs from January 1 through March 31 each year. During this time, you are allowed to make one change if your current Medicare Advantage plan is not working for you.
You can:
- Switch to a different Medicare Advantage plan
- Drop Medicare Advantage and return to Original Medicare with a stand-alone drug plan.
Any change you make usually starts the first day of the month after the plan receives your request. This is a one-time opportunity for the year, so it is important to review options carefully rather than rushing into another decision out of frustration.
Are Medicare Advantage plans really "free," or is that just clever marketing?
The concept of “free” Medicare Advantage plans can be misleading. While some Medicare Advantage plans advertise $0 monthly premiums, it’s crucial to understand that this doesn’t mean you won’t have any healthcare costs.
Here’s a breakdown:
- $0 Premium Doesn’t Mean $0 Cost: (A $0 premium means you don’t pay a monthly fee to the private insurance company offering the Medicare Advantage plan.)
However, you’ll still have other out-of-pocket costs, such as:
- Co-payments: Fixed amounts you pay for specific services (e.g., doctor’s visits, prescriptions).
- Deductibles: The amount you pay before your plan starts covering costs.
Why Working with a local Independent Insurance Agent Can Make All the Difference with Medicare
Using a local Medicare insurance agent is beneficial to retirement and financial planning. Agents can assist individuals in selecting policies tailored to their unique needs. While various types of Medicare insurance agents exist, choosing one well-versed in policy benefits is essential. Independent Medicare brokers can offer policies from multiple insurers. This enables them to compare coverage options and find the best fit, considering the individual’s medical requirements and budget. We also have software programs that allow us to compare prescriptions costs even down to specific pharmacies within a given plan.
A question many people ask is: “If I can buy the same Medicare plan directly from an insurance company, why would I work with an agent?”
The simple answer is: You pay the same price either way, but you can meet with a local agent in-person and review your options based on your doctors and prescriptions. You also have someone you can call throughout the year with questions or concerns.
Insurance products and pricing are:
- Regulated by Medicare and State Insurance Departments
- Standardized in many ways
- Priced the same whether you enroll online, over the phone, or through an agent
There are no agent markups, no hidden fees, and no discounts for bypassing professional help. Whether you enroll directly with an insurance company or through an independent agent, your premium and benefits remain the same.
When am I eligible for Medicare?
Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) is a 7-month window that includes:
- 3 months before your 65th birthday month
- Your birthday month
- 3 months after your birthday month
First Steps to Take
1. Determine if you need to enroll now
- Automatic Enrollment: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B.
- Manual Enrollment: If you’re not receiving Social Security, you’ll need to manually enroll via the Social Security website or by calling the SS Office to set up an appointment.
- Note: If you are not taking Social Security now, you will be billed quarterly for Medicare Part B.
2. Decide on your coverage path
Choose between Original Medicare or a Medicare Advantage Plan:
- Original Medicare: Includes Part A (Hospital) + Part B (Medical).Optional additions: A Part D drug plan and a Medigap supplement (to cover costs Original Medicare doesn’t).
- Medicare Advantage (Part C): An all-in-one plan offered by private insurers. Includes Part A, Part B, usually Part D, and often extras like dental and vision.
3. Compare plans
Work with a licensed Medicare agent who can help you compare plans from multiple companies based on your doctors, prescriptions, and budget.
4. Enroll on time
Enrolling during your IEP helps you avoid:
- Late enrollment penalties (especially for Part B and Part D)
- Gaps in coverage
Can I keep my employer insurance if I am working past 65?
Yes, you can if it is creditable coverage. Please check with your Human Resource Dept. to get proof that you have creditable coverage. You may delay Medicare enrollment if you have a job that gives you creditable coverage.
Once you are ready to retire there are forms that need to be filled out by your employer proving you had credible coverage since turning 65 to avoid late enrollment penalties which we assist with.
What does Medicare Part A and B cover?
Original Medicare has 2 parts, A and B. Part A is hospital coverage. Part B covers doctors’ visits, durable medical equipment, outpatient surgeries, and part B medications. There is a monthly premium for part B, an annual deductible, and copays for services.
Part A is the hospital and Medicare Part A covers 80%.
Pat B is the 80% coverage you get for doctor services outside of the hospital
Can Medicare drop me for health reasons?
Medicare can NOT drop you because of health reasons. If you have a Medicare supplemental plan and drop the plan because you want to change to a Medicare Advantage Plan, and you are on the Medicare Advantage for more than 12 months you will be asked health questions to go back to a Medicare Supplemental plan and some people may not qualify. Or if you missed a Medicare Part B premium, Medicare will drop your Part B coverage and in turn your supplemental plan will be canceled due to a lack of Part B coverage.
How much does Medicare cost?
In 2026, most people pay a standard monthly premium of:
$202.90 for Medicare Part B, while Part A is generally $0, but Part B may cost more due to income ($284.10–$689.90 per month) and Part D also has an income surcharges ($14.50 – $91.00 per month). A $1,736 deductible applies to hospital stays (Part A).
Breakdown of 2026 Medicare Costs
- Part A (Hospital Insurance): $0 premium for most, but a $1,736 deductible per hospital benefit period.
- Part B (Medical Insurance): $202.90 standard monthly premium. Those with a higher income (IRMAA) pay up to $689.90.
- Part D (Prescription Drugs): Varies by plan, with a maximum $615 annual deductible and those with a higher income (IRMAA) pay up t0 $91.
- Late Enrollment Penalties: 10% increase in Part B premium for each 12-month period you were eligible but not enrolled and Part D is 1% × National Base Beneficiary Premium ($38.99 in 2026) × Number of uncovered months (rounded to the nearest $0.10.
- Out-of-Pocket Costs: Original Medicare generally covers 80% of costs; you pay the remaining 20% coinsurance without a supplemental plan.
Income-Related Monthly Adjustment Amounts (IRMAA) for 2026
IRMAA is calculated based on your income two years prior. If your 2024 modified adjusted gross income (MAGI) exceeded $109,000 (individual) or $218,000 (joint), your Part B premiums increase. Please reach out to us to determine your personal cost of Medicare Part B.
How can I save money on prescriptions costs?
The $2,100 (2026) out-of-pocket maximum for prescriptions in the company formulary is a significant improvement for those who rely on expensive medications. After reaching this threshold, all additional drug costs for formulary covered prescriptions will be fully covered by your Medicare Part D plan for the remainder of the year. This means that, for the first time, Medicare enrollees can predict and limit their annual prescription drug spending, offering peace of mind and financial predictability. If your prescriptions are no in the formulary, the doctor will need to file a formulary exception, or you can call the carrier’s customer service line and ask what prescriptions are equivalent so that you can have a conversation with your doctor.
Check the various discount programs to see if any of your medications are less expensive using one of these programs instead of your insurance. Good RX is one of the most popular, but there are others.
Many pharmacies also have in-house discount programs. You can check in your area if any are available.
Some expensive medications are 2 generics put together. You can ask your doctor if separating the meds would be ok. If so, individual generics are often less expensive than the combined medication.
Most of the manufacturers have programs for limited income individuals. You can check to see if you qualify for any programs through them.
There are State Resources available to help with Prescription costs. There are many generic medications that could be $0 copay in Medicare Advantage or Standalone RX plan. Brand Medications can have copays.
Do I qualify for programs that will lower my medical and prescription costs?
You may qualify for programs to lower medical and prescription costs if your income and resources are limited. Key options include the Medicare Extra Help Program for drug costs, Medicare Savings Program for premiums/copays, and state-specific Medicaid.
Key Programs and Assistance
- Extra Help (Part D Low-Income Subsidy): Helps pay for premiums and coinsurance for Medicare prescription drug coverage.
- Medicare Savings Programs (MSPs): State-run programs that help pay Medicare Part B premium. This program is a form of Medicaid where. Medicaid pays for the Medicare Premium if qualified.
- Medicaid: Provides health coverage for qualifying low-income adults, children, and people with disabilities.
- Manufacturer Assistance Programs (PAPs): Programs that offer free or low-cost drugs, often listed on Medicare.gov.
2026 Medicare Changes: A $2,100 yearly cap on out-of-pocket prescription drug costs starts in 2026, along with a Medicare Prescription Payment Plan to break down high costs.
Diabetes and Medicare: What You Need to Know About Insulin and Part D Coverage.
Medicare covers insulin and diabetes supplies primarily through Part D plans, with costs for certain insulin prescriptions capped at $35 for a one-month supply of each covered insulin product. This $35 cap applies even if you have not met your deductible. Part D covers insulin for injections/pens, while Part B covers insulin used with traditional pumps.
Key Takeaways for Medicare and Insulin:
- Insulin Costs: Under the Inflation Reduction Act, you pay no more than $35 for a one-month supply of Part D-covered insulin, with no deductible. This $35 cap applies to 1–3-month supplies ($35 per month) and for those with Extra Help.
- Part D Coverage: Part D covers most insulin (injectable/inhaled) and supplies like syringes, needles, alcohol swabs, and gauze.
- Part B Coverage: If you use an external insulin pump, the insulin and pump are covered under Medicare Part B (durable medical equipment), which means the Part B insulin would cost 20%.
- Drug List (Formulary): Coverage applies to insulin products listed on your plan’s formulary. If a specific insulin isn’t covered, you can ask for a formulary exception.
- Supplies: Part B covers diabetes testing supplies (glucometers, test strips, lancets).