FAQs

Your Initial Enrollment Period is a seven-month window: the three months before your 65th birthday month, your birthday month, and the three months after. Enrolling during the first three months ensures your coverage begins on the first day of your birthday month. Enrolling later in the window may delay when your coverage starts. This is a window worth planning for well in advance.

If you miss your Initial Enrollment Period without qualifying coverage from another source, you will generally have to wait for the General Enrollment Period, which runs from January 1 through March 31 each year, with coverage beginning July 1. You may also face permanent late enrollment penalties on your Part B and Part D premiums. These penalties do not go away. Missing this window is one of the most common and costly mistakes people make entering Medicare. We help you avoid it.

The Annual Enrollment Period runs from October 15 through December 7 each year. During this window, people already enrolled in Medicare can switch Medicare Advantage plans, switch from Medicare Advantage back to Original Medicare, join or switch Part D prescription drug plans, or drop a Part D plan. Changes take effect on January 1 of the following year. This is the window we use for annual plan reviews with our clients.

A Special Enrollment Period allows you to make changes to your Medicare coverage outside of the standard enrollment windows when certain qualifying life events occur. Examples include losing employer-based coverage, moving out of your plan’s service area, or becoming eligible for Medicaid. The specific rules and timing vary by circumstance. Contact us if you believe you may qualify for one.

No. Medigap plans are designed to work with Original Medicare only. If you are enrolled in a Medicare Advantage plan, you cannot use a Medigap policy to cover your costs. If you are considering switching from Medicare Advantage to Original Medicare and adding a Medigap plan, be aware that you may be subject to medical underwriting outside of guaranteed issue periods, which could affect your eligibility or premium.

Medigap plans are federally standardized, meaning a Plan G from one carrier covers the same benefits as a Plan G from another carrier. What differs between carriers is the monthly premium. Shopping across carriers for the same plan letter is one of the most effective ways to reduce your Medigap costs. We do this comparison for every client.

Many Medicare Advantage plans include prescription drug coverage, in which case you generally do not need a separate Part D plan. However, not all Medicare Advantage plans include drug coverage. If yours does not, you may want to consider a standalone Part D plan. We will review your specific plan and prescriptions to help you determine the right approach.

Yes. Part D plan formularies can change during the year, subject to CMS rules. If a medication you take is removed from your plan’s formulary or moved to a higher cost tier, your plan is generally required to notify you in advance. This is one reason why reviewing your Part D plan every year during the Annual Enrollment Period matters, even if your health situation has not changed. The plan you are on should always be working in your favor.

No. We are an independent agency contracted with multiple carriers. We are not tied to any single plan or company, and we are not incentivized to recommend one carrier over another. Our recommendations are based on your needs, your providers, your prescriptions, and your financial situation. We will tell you if a plan is not right for you, even if enrolling you would benefit us. That is not how we operate.

Every consultation is private, one-on-one, and conducted by phone or virtual meeting at no cost and with no obligation. We begin by understanding your situation fully, your health needs, your current providers, your medications, your plans for the months ahead, and your financial picture. We then walk you through your options clearly. If you choose to enroll, we handle the process with you. If you are not ready, we answer your questions and follow up when you are.

Not at all. We work with people at every stage of the Medicare journey. Those approaching eligibility who want to walk into this chapter with a clear plan. Those already enrolled who suspect their current coverage is not working as well as it should. Those who have been on Medicare for years and have never had anyone explain it fully. It is never too late to make sure your coverage fits the life you are living.

VA coverage is generally considered creditable for Part D purposes, meaning that if you have VA drug coverage, you typically will not face a Part D late enrollment penalty if you later decide to enroll in a standalone Part D plan. However, VA coverage does not count as creditable coverage for Part B purposes. Delaying Part B enrollment because you have VA benefits can result in permanent late enrollment penalties. This is one of the most common and costly mistakes veterans make. Contact us before making any decision to delay Part B enrollment.

In many cases, yes. The two programs can complement each other, though they do not coordinate benefits in the same way that two private insurance plans might. How they work together depends on where you receive care and what you are being treated for. We can help you understand how both programs apply to your specific situation so you are using everything available to you.

COBRA is generally not considered qualifying coverage for purposes of delaying Medicare enrollment without penalty. If you are relying on COBRA coverage after leaving employment and have not yet enrolled in Medicare, you may be in a vulnerable position. Contact us to review your specific situation before your enrollment window closes.

Self-employed individuals generally do not have access to employer-sponsored group health coverage that would qualify them to delay Medicare enrollment without penalty. If you are self-employed and approaching 65, your Initial Enrollment Period rules apply in the same way as for anyone else. Contact us well before your 65th birthday to plan accordingly.

Extra Help, also known as the Low Income Subsidy (LIS), is a federal program that helps people with limited income and resources pay for Medicare Part D prescription drug costs, including premiums, deductibles, and copayments. Eligibility is based on income and resource limits that are updated annually. Applying is free and is done through the Social Security Administration. If you qualify, the savings can be substantial.

Medicare Savings Programs (MSPs) are state-administered programs that help people with limited income pay for Medicare Part A and Part B costs, including premiums, deductibles, and coinsurance. There are four types: the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualifying Individual (QI) program, and the Qualified Disabled and Working Individuals (QDWI) program, each with different eligibility criteria and levels of assistance. Eligibility and application processes vary by state.

Contact us. We will review your situation and help you understand which programs you may qualify for and how to apply. We can also direct you to your State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling on Medicare benefits and assistance programs in your state.

Yes, in most cases. People under 65 who are enrolled in Medicare due to disability can enroll in Medicare Advantage plans, though plan availability varies by location and not all plans accept under-65 enrollees. We will help you identify what is available in your area and evaluate whether Medicare Advantage is appropriate for your situation.

Federal law does not require insurers to sell Medigap policies to people under 65. However, some states require insurers to offer at least some Medigap plans to Medicare beneficiaries under 65. State rules vary significantly. In states where Medigap is available to under-65 enrollees, premiums are often substantially higher than for those who enroll at 65. When you turn 65, you will have a guaranteed issue right to enroll in Medigap regardless of your health history. Contact us to understand what options are available in your state.

Yes. We conduct annual plan reviews with our clients ahead of the Annual Enrollment Period. Our goal is to make sure your coverage continues to reflect your current health, your providers, and your life. If a better option is available, we will tell you. If your current plan still fits, we will tell you that too.

Medicare Advantage and Part D plans are required to send enrollees an Annual Notice of Change (ANOC) before October 1 each year. This document outlines any changes to your plan’s costs, coverage, or service area taking effect on January 1. Read it carefully. If the changes affect your providers, your medications, or your out-of-pocket costs in a meaningful way, the Annual Enrollment Period is your opportunity to act. Contact us if you need help understanding what your ANOC means for you.

In most cases, no. Changes to Medicare Advantage and Part D plans are generally limited to the Annual Enrollment Period and qualifying Special Enrollment Periods. There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31 each year, during which people already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or return to Original Medicare once. Outside of these windows, your options are limited. This is why staying on top of your coverage annually matters.