By Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366
Medicare Open Enrollment is January – March. What can be changed at this time of the year is Medicare Part D Drug Plans and Medicare Advantage Plans. You can make one change from one Part C Advantage Plan to another Advantage Plan from the same company or another. You can change from one Advantage Plan to a stand-alone Part D Drug Plan, this is not advised unless you have a secondary to Original Medicare, which is a Medigap and also called a Medicare Supplement. I always do the Medicare Supplement Applications 1st to make sure that the person is approved. Medicare Supplement have medical underwriting and you may not qualify. There are certain Special Election Periods that may qualify you as a guaranteed issue. You can NOT change from one Part D drug Plan to another this time of year.
Substantial changes to Medicare Part D, standalone drug plans as well as Advantage Plans, you won’t have to pay more than $2,100 in out-of-pocket costs, which include deductibles, co-pays, and coinsurance. It is especially important to check your plans formulary as medication must be in formulary to be capped. 2026 RX deductibles will be capped at $615.00. As a reminder the cost of the plan is not as important as the cost plus your medications, that is what you look at, the total cost. It is important to know what the medication is used for to determine if it is covered by the plan. Example Wycovy may be covered but to be covered it must be used for certain heart conditions or diabetes, Medicare does not cover weight loose medications at this time.
Medicare Part C / Advantage Plans annually Medicare Advantage Plans make changes. They must all include the same features as Original Medicare but not at the same cost share. They can have a premium, Medical and or Prescription deductible, copays and coinsurance can change. Extra Value such as Vision, Dental, Over the Counter, Part B Give Back, transportation, etc. can all change or be eliminated. Medicare sets the annual in-network out of pocket maximum; in 2025 it is $9,250 and $13,900 for in-network and out-of-network services combined. However, individual insurance plans may set lower limits. These limits apply to Part A and B services only, and do not apply to Part D cost share.
The old saying if it is not broken do not fix it DOES NOT apply to Medicare Advantage Plans. Every year I see many people that have not checked/compared their current plan to what is new. I have saved so many people hundreds and in many cases thousands of dollars. You should be working with a broker that represents many insurance companies. Make sure you check them out, especially if you are going to allow someone in your house. I recommend meeting in their office. For myself we represent most insurance companies in our area and to carry all their literature with me is almost impossible. We use three large screens so that our clients can clearly see and compare the differences between the plans. The minimum information we need is all your doctors, medications: names, milligrams, and dosage. We load your current plan and then compare it to all the other companies in your area. What companies have all your doctors, the price for your medication normally makes a significant difference. Then the Extra Value, what is most important to you. We do NOT CHARGE for our review and if warranted we will change your insurance plan for you. Ethics is most important and if you are on the best plan we will tell you, plus you can see for yourself.
As a reminder it is illegal for an insurance agent to contact you unless you give them permission. There are specific forms that you should sign, such as a Scope of Appointment which outlines what you want to talk about. This form should be signed at least 48 hours prior to your meeting or if you walk into their office, prior to speaking about Medicare.
Medicare Seminar’s they are good for general information. A one-to-one appointment where you can dive into your doctors and medication is best, plus you can then compare other companies in one place.
When you turn 65 you are eligible for Medicare, once you have worked 40 quarters roughly 10 years there is no cost for Medicare Part “A”. Part A covers Hospitals, Skilled Nursing, Home Health & Hospice. Medicare Part B you can choose to take at 65 or you can hold off if you are still working and have credible coverage. If you do not have group health insurance that is considered qualified, and then you want it you would have a late enrollment penalty for each month you did not have Part B & Part D, and that penalty will last for the rest of your life. Part B covers doctors, imaging, blood work, ambulance, durable medical equipment, etc. Part D is a Medicare Drug Plan and covers medications. During your initial enrollment period it is especially important to understand your options! Medicare Supplements/Medigap Plans are NOT guaranteed issue, you may need to medically qualify. You can purchase a Medigap Plan during your 1st 6 months on Medicare Part B without medical underwriting. There are a lot of things you need to know. Again, work with an agent you can trust! Especially important: when you move you need to know your options. Can you keep the same plan? Do you need to make a change and what does that look like?
Logical Insurance Solutions is a SWFL Insurance Broker that works with most of the insurance carriers in your area, we are happy to help you through the maze. We offer Free Medicare Seminars, Personal Appointments & Virtual appointments. Please e-mail info@logicalinsurance.com to register or call 239-362-0855 for dates.
Medicare’s website is www.Medicare.gov.
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