Frequently Asked Questions

You are eligible for Medicare at age 65. Your Initial Enrollment Period begins 3 months before your 65th birthday and ends 3 months after. Signing up late can result in permanent premium penalties so it is important to act on time. Contact us early and we will walk you through every step.

For 2026, the Centers for Medicare & Medicaid Services (CMS) has set the standard monthly Medicare Part B premium at $202.90. This is an increase of $17.90 from the 2025 premium of $185.00. Most beneficiaries will pay this standard amount, though it can be higher for high-income earners or lower for some current enrollees due to "hold harmless" statutory protections. 2026 Medicare Part B Costs at a Glance Income-Related Adjustments (IRMAA) If your modified adjusted gross income (MAGI) from your 2024 tax return was above a certain threshold, you will pay the standard premium plus an extra surcharge. In addition to your original Medicare A and B, you will have the option to add a traditional Medicare Supplement plan with a stand-alone Part D drug plan, or add a Part C Medicare Advantage plan with prescription drug coverage.

Medicare Advantage (Part C) replaces Original Medicare and bundles your coverage into one plan — often including dental, vision, and prescription drugs. Medicare Supplement (Medigap) works alongside Original Medicare to cover the gaps like copays, coinsurance, and deductibles. Both have pros and cons depending on your health needs and budget.

Since Original Medicare (Parts A & B) has no "out-of-pocket maximum," most people choose one of two "safety nets": • Option 1: The "Buffet" Model (Medigap + Part D) You keep Original Medicare as your primary insurance and buy a Medicare Supplement (Medigap) plan to pay the 20% Medicare doesn't cover. You also buy a standalone Part D drug plan. • Option 2: The "All-in-One" Model (Medicare Advantage / Part C) You opt out of the government-run system and join a private plan. These plans bundle A, B, and usually D (drugs) together, often including "extras" like dental and vision.

• Choose Medigap Plan G if: You want a fixed monthly budget, you travel frequently (it works nationwide), or you have a chronic condition that requires many specialist visits. • Choose Medicare Advantage if: You are currently healthy, you prefer a low monthly premium, and you value "extra" perks like dental, vision, and gym memberships (which Plan G does not cover).

Both options create a ceiling on your spending, but the "ceiling" is structured differently:

• Medigap: You can see any doctor in the USA who accepts Medicare. No networks, no referrals, and no "prior authorizations" for most treatments. • Advantage: You are usually restricted to a local network (HMO or PPO). You may need a "hall pass" (referral) to see a specialist, and the insurance company must often approve surgeries or MRIs before they happen.

While the low premium is tempting, it can be harder to "switch back" to Medigap later. In most states, if you start with Advantage and try to move to Medigap after a year, the Medigap company can look at your health history and deny you coverage or charge you significantly more.

The Inflation Reduction Act has fully kicked in. For both options, the most you will pay for your prescriptions at the pharmacy in 2026 is $2,100. This is a huge win for those on expensive specialty medications (like those for cancer or RA) who previously paid $5,000–$10,000+ per year.

In 2026, Plan G is designed to cover every single gap in Original Medicare, with only one exception: the Part B annual deductible. • Hospital (Part A): It pays your $1,736 deductible and all coinsurance. If you are in the hospital, your bill is $0. • Medical (Part B): It pays the 20% "leftover" bill for doctors, surgeries, and labs. • Excess Charges: It covers "Part B Excess Charges" (when a doctor charges more than the Medicare-approved amount), which other plans like Plan N do not cover.

While Plan N is cheaper, Plan G offers "billing peace of mind." With Plan G, you never have to pull out your wallet at a doctor's office. There are no copays and no surprise "excess charge" bills. You pay your monthly premium, pay your one-time $283 deductible, and you are done for the year.

Original Medicare does not cover routine dental or vision care. However many Medicare Advantage plans include dental and vision benefits. We can help you find a plan that covers the services you use most.

A Medicare Special Enrollment Period allows you to make changes to your Medicare coverage outside of the Annual Election Period. Common qualifying events include losing employer coverage, moving to a new area, or qualifying for Extra Help. Contact us to find out if you qualify.