top of page
ASK THE MEDICARE GUYS

Group & Employer Benefits

Question?
Description
Sign up during your Initial Enrollment Period — the 7-month window around your 65th birthday. If you have employer coverage, you may be able to delay without penalty. Talk to us before deciding.
Medicare Advantage replaces Original Medicare. Medicare Supplement works alongside it to cover out-of-pocket costs. They cannot be used together. The right choice depends on your doctors, health needs, and budget.
Only if you’re already receiving Social Security benefits. Otherwise, you must actively enroll at ssa.gov or by calling 1-800-MEDICARE.
Part A is free for most people. Part B has a $202.90/month standard premium in 2026. Medicare Advantage and Part D plans vary — some have $0 premiums.
The standard Medicare Part B premium is $202.90 per month in 2026. The annual Part B deductible is $283 in 2026. After meeting your deductible, Medicare covers 80% of most covered services — leaving you responsible for the remaining 20% unless you have a Medigap plan. If your income exceeds a certain threshold, you may pay more through a surcharge known as IRMAA (see below).
Medicare uses your income from the two years before to determine your Part B premium. This is called IRMAA — Income-Related Monthly Adjustment Amount. For example, your 2026 premium is based on your 2024 tax return. Higher earners pay more, which surprises many people who recently retired after a high-income year. If your income has since decreased, you may be able to request a reduction. Our agents can help you understand what to expect.
Original Medicare does not cover routine dental, vision, hearing aids, or long-term care. Some Medicare Advantage plans include these benefits. We can help you find coverage that fills the gaps.
Original Medicare does not cover dentures or most routine dental care. Some Medicare Advantage plans include dental benefits that may cover dentures. We can help you find a plan with the dental coverage you need.
With Original Medicare, yes — any doctor that accepts Medicare. With Medicare Advantage, you’ll need to check that your doctor is in the plan’s network.
Plan G is one of the most comprehensive Medigap plans available. It covers nearly all out-of-pocket Medicare costs except the Part B deductible ($283 in 2026).
$1,736 per benefit period for inpatient hospital care in 2026.
It begins when you’re admitted to a hospital or skilled nursing facility and ends after 60 consecutive days without inpatient care. There’s no limit to how many benefit periods you can have.
No. Medigap only works with Original Medicare. If you’re in Medicare Advantage, Medigap provides no benefit. It is actually illegal to be sold both simultaneously.
October 15 – December 7 each year. The window to switch, add, or drop Medicare Advantage or Part D plans. Changes take effect January 1.
Not during your Medigap Open Enrollment Period — the 6 months after you turn 65 and enroll in Part B. After that, medical underwriting may apply and you could be denied or charged more based on health conditions.
If you delayed enrollment without a qualifying Special Enrollment Period, you can sign up during the General Enrollment Period (January 1 – March 31). Late penalties may apply. Contact us and we’ll help you understand your options and next steps.
Switching from Medicare Advantage to a Medigap plan is possible but can be complex. Outside of your initial enrollment period, insurance companies may require medical underwriting and can deny coverage based on health conditions. There are some exceptions — speak with one of our agents to find out if you qualify.
The list of prescription drugs covered by a Part D or Medicare Advantage plan, organized into cost tiers. Formularies can change annually — always review your plan during AEP.
No. This is why many people choose Medicare Advantage (which requires an out-of-pocket maximum by law — $9,350 in 2026) or a Medigap plan to limit their exposure.
The Inflation Reduction Act caps out-of-pocket prescription drug costs at $2,000 in 2026. After reaching that amount, you pay $0 for covered Part D drugs for the rest of the year.
HMO plans require you to use a network and get referrals to see specialists. PPO plans offer more flexibility to see out-of-network providers, typically at a higher cost.
Yes — during the Annual Enrollment Period (Oct 15 – Dec 7). Switching Medigap plans outside of open enrollment may require medical underwriting.
You may face a coverage gap and permanent late enrollment penalties on your Part B and/or Part D premiums. Talk to a licensed agent as soon as possible if you’ve missed your window.
Original Medicare does not. Some Medicare Advantage plans do. Standalone dental and vision plans are also available. We can help you find the right fit.
Original Medicare does not. Some Medicare Advantage plans include hearing benefits. Let us help you find a plan that covers what you need.
Original Medicare (Parts A and B) cannot be taken away as long as you pay your premiums. However, Medicare Advantage and Part D plans can change or leave your area each year. Always review your plan annually during AEP to make sure your coverage still meets your needs.
A window to enroll or change coverage outside of standard enrollment periods due to a qualifying life event — like losing employer coverage or moving out of your plan’s service area.
A federal program (also called Low Income Subsidy) that helps people with limited income pay for prescription drug costs. It can significantly reduce premiums and copays. Visit ssa.gov to apply.
Yes. People who qualify for both are called ‘dual eligible.’ Special plans exist to coordinate benefits between the two programs. Our agents can help you understand your options.
State programs that help pay Medicare premiums, deductibles, and coinsurance for people with limited income. Contact your State Medical Assistance office or ask us for guidance.
Health or drug insurance that meets Medicare’s minimum standards. If you have creditable coverage through an employer, you can delay Medicare enrollment without penalty. You should receive an annual notice from your insurer confirming this.
Online at ssa.gov, by calling 1-800-MEDICARE (1-800-633-4227), or at your local Social Security office. A licensed Medicare broker can help you navigate the process at no cost.
No single plan covers 100% of costs. However, pairing Original Medicare with a Plan G Medigap policy and Part D comes close for most people. Our agents can walk you through the best combination for your situation.
We are licensed, independent Medicare brokers contracted with multiple carriers. We compare your options, explain the differences, and help you enroll — all at no cost to you. Schedule a free consultation today.
bottom of page