Medicare and insurance questions, answered plainly

No. Meeting with me and going through your options is free. You pay the same premium whether you enroll through me or on your own, so there is no reason to sort through it by yourself.

A Medicare Advantage plan takes the place of Original Medicare. It usually includes drug coverage and extras like dental or vision, and many plans have a low or zero monthly premium, but you generally stay inside a network. A Medicare Supplement sits alongside Original Medicare. You can see any provider who accepts Medicare, anywhere in the country, and the supplement picks up most of what Medicare leaves behind. There is a monthly premium and you usually need a separate drug plan. Advantage is often cheaper month to month; a supplement is often more predictable when you use a lot of care.

If your Medicare Advantage plan already includes prescription coverage, you do not need a separate Part D plan, and enrolling in one on top can actually cause problems with your coverage. If you are on Original Medicare with a supplement, you do need a standalone Part D plan. Either way, we should check your prescriptions against the formulary each year, because drugs move between tiers and a medication that was cheap in January can be expensive by summer.

The main window is Medicare Open Enrollment, October 15 through December 7, for coverage starting January 1. If you are in a Medicare Advantage plan and want to switch or go back to Original Medicare, there is also the Medicare Advantage Open Enrollment Period from January 1 through March 31. Outside those windows, changes are limited to specific situations. If your circumstances have changed, call me and I will tell you whether you qualify for a special enrollment period.

Three things matter. First, whether you are already collecting Social Security, because that affects whether you are signed up for Part A and Part B automatically. Second, whether you have coverage through an employer, yours or your spouse's, because that decides whether Medicare should be primary. Third, what your doctors and prescriptions are, because that decides which plan type fits. Your Initial Enrollment Period runs for seven months around your 65th birthday. Call me a couple of months before it starts and we will go through it without rushing.

Open enrollment for marketplace health plans is a set window each fall. Outside of it, you can usually enroll only if you have a qualifying life event, such as losing job-based coverage, moving to a new area, getting married or divorced, having a baby, or a change in household income. If you think you qualify, call me and I will help you document it and get the application in on time.

Often yes. Depending on your household income and how many people are in your household, you may qualify for a premium tax credit that lowers your monthly payment. Some households also qualify for cost-sharing reductions that lower the deductible and copays on Silver plans. The only way to know is to run your actual numbers. It costs nothing to check, and I would rather you find out than guess.

No. Your premium is set by the insurance company and is the same whether you enroll through me or directly. I am compensated by the carrier, not by you. If you would rather enroll on your own, I will still answer your questions.

Start with what your household would have to pay if your income stopped: the mortgage or rent, everyday living costs for the years your family still needs them, and final expenses. Subtract what savings and existing coverage would handle. What is left is roughly the amount to look at. I would rather you buy the right amount of term coverage than an expensive policy you cannot keep up with.

Sometimes, and it depends on the plan. Medicare Advantage plans have networks that change every year, so the doctor who is covered in December may not be in the network in January. Supplements do not have networks, so any provider who accepts Medicare generally works. Before we change anything, I check your specific doctors and hospital against the plan, and I will tell you if switching means losing someone.

Call me. Formularies allow exceptions and prior authorizations, and there is a process for asking the plan to cover a drug that is not on the list. If your medication list has changed a lot, we should also revisit whether your current plan is still the better fit for the coming year rather than waiting for the next enrollment window.

Yes. I am licensed in Florida, New Jersey and North Carolina, so I can work with family members in different states. We can set up a call with both of you on the line, or separate calls if that is easier. Either way, the person who is enrolling needs to be part of the conversation so they know what they are signing up for.