Medicare
We take the guesswork out of Medicare so you can focus on what’s important.
Medicare Should Work for You—Not Confuse You
We’ll help you:
✔️ Understand the difference between Medicare Advantage vs. Medigap
✔️ Know the step-by-step Medicare enrollment process
✔️ Get a clear plan that fits your needs—without the stress
Medicare is supposed to provide peace of mind, but for many, it just creates stress. What’s the best plan? What does it actually cover? Is Medicare Advantage better, or should you go with a Supplement?
If you’re feeling overwhelmed, you’re not alone. And you don’t have to figure it out on your own either.
We’re here to listen to your concerns, explain your options in plain English, and help you choose the right coverage for your health, lifestyle, and budget. No high-pressure sales—just honest guidance from someone who genuinely cares about your future.
FAQ
What are the different parts of Medicare?
Medicare is divided into four parts, each covering different types of care:
Can I change my Medicare plan later?
Yes! There are specific enrollment periods when you can make changes:
How much does Medicare cost?
✔ Medicare Part A – Usually free if you (or your spouse) worked and paid Medicare taxes for at least 10 years. Otherwise, you may pay a monthly premium.
Does Medicare cover prescription drugs?
Original Medicare (Parts A & B) does NOT cover most prescription drugs.
I’m turning 65 soon—when should I enroll?
Your Medicare Initial Enrollment Period (IEP) starts three months before your 65th birthday and lasts for seven months total.
How can you help?
We know Medicare is complicated—but you don’t have to figure it out alone.
You can sign up for a Part D standalone plan, which helps cover prescription drug costs,
along with other components of Medicare, starting three months before your 65th
birthday, your birthday month, and three months after your birthday. It's important to enroll within this seven-month period because there is a permanent premium surcharge for a late enrollment (and if you don't have equivalent drug coverage from another source, such as a retiree plan). If you have a Medicare Supplement plan (also called a Medigap plan), then you also need to get a standalone Part D drug plan.
Part D Prescription Drug Plans
Yearly Open Enrollment Period
If you are already enrolled in a Part D standalone plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open enrollment period, which runs from October 15 to December 7 every year.
Improvements to Part D
In 2025, several significant updates will affect Medicare Part D enrollees, including a substantial improvement of a $2,000 out-of-pocket cap. This means that once you reach $2,000 in prescription expenses (not including the monthly plan premium), you will not have additional out-of-pocket costs for the remainder of the year. This change represents a notable reduction from previous thresholds, aimed at helping individuals manage high prescription costs throughout the year.
Part D drug benefits in 2025 are structured into three phases:
Annual deductible
If your plan has a deductible, you will pay 100% of the retail covered prescription drug costs until the annual deductible is met. The standard deductible is $590 in 2025.
Initial coverage
Once the annual deductible is met, you will pay a copay or coinsurance for covered Part D drugs. This phase ends when you have reached the annual out-of-pocket cap of $2,000 for 2025.
- Catastrophic. Once you meet the $2000 out-of-pocket cap, you will pay no cost sharing for covered Part D drugs.
Catastrophic
Once you meet the $2000 out-of-pocket cap, you will pay no cost sharing for covered Part D drugs.
Additional changes include the elimination of the “coverage gap” phase, sometimes referred to as the “donut hole,” where you were subject to a significant charge for medications. Starting in 2025, you will continue to pay consistent cost-sharing percentages in the initial phase, removing the complex transition to higher out-of-pocket costs that had occurred mid-year (the “donut hole”). The deductible is also rising slightly to $590 for many plans, although this may vary depending on individual plan details.
These updates aim to make Part D costs more predictable and manageable. The changes are part of the broader Inflation Reduction Act adjustments, which bring greater financial relief to Medicare enrollees in need of costly prescriptions.
Choosing A Plan
It pays to review your Part D coverage every year, especially if you have started taking new medications.
- Starting in 2025, insurance carriers have eliminated broker commission on many drug plans. We still offer Part D drug plans, but they tend to be ideal for people who take expensive drugs or for people who do not want a deductible.
- Given this new reality, we recommend you go to Medicare.gov, where you can find the basics about the benefit and Part D plans. Here’s a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options It also includes a helpful formulary finder that allows you to compare plans based on your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year.
Please contact us to help you understand your options!