Do You Need a New Medicare Plan? 4 Things to Consider

June 14, 2025

Medicare Open Enrollment is happening now! Through December 7, 2024, those currently enrolled in Medicare can change their Medicare Managed Care Plan (also known as Medicare Advantage Plans) or stand-alone prescription drug coverage. All changes are effective January 1, 2025.

How do you know if you need a new plan?
More than in previous years, the upcoming changes to Medicare Advantage Plans, Medicare Supplement (Medi-Gap) Insurance Plans, and/or Part D prescription drug coverage are likely to have a significant impact on your current coverage. For example, major insurance carriers have terminated certain plans and made changes to others.

If you have been notified in your Annual Notice of Changes (ANOC) that your plan is no longer available, you will have to find and enroll in a new one. Or it may be time to find a plan that better meets your current health and/or budget needs.

Here are 4 things to consider when exploring your options:

1. Evaluate Your Coverage and Costs.
If you are enrolled in a Medicare Advantage Plan or Medicare Supplement (Medi-Gap) Insurance Plan, it’s a good idea to review your current coverage – including costs – and determine if it provides the services you need. Take into account:

  • Whether you reached your deductible
  • How much you spent on copays
  • New services you may need next year, such as vision, dental, or hearing coverage.
  • If the plan covers where you live if you’ve moved

2. Make Sure Your Doctors are In-Network.
Ensure that your preferred doctors and pharmacy are in-network with your plan. If they are not and you continue to use them, it may cost you more.

3. Confirm Your Medications are Covered.
In 2025, all Medicare Advantage Plans, supplemental plans and stand-alone prescription drug plans will include a $2,000 annual cap on what you pay out-of-pocket for covered prescription drugs. Whether or not your medications have changed, it's more important than ever to make sure your drugs are covered. Read your ANOC carefully and note what has changed for 2025. You may also consider changing plans if your premium has increased dramatically or you switched pharmacies.

4. Speak with a Licensed Medicare Agent.
Comparing choices and finding a new plan can be challenging. A licensed Medicare professional will make sure you explore all of the options available to see if there is a plan that will save you money, provide better coverage or both. Make sure your agent has an active license in your state and that you have:

  • Cards for your current plan and effective dates
  • Home address including zip code
  • List of current medications, including dosage and frequency

December 7th is around the corner – don’t wait until the last minute!
Each New Year, we get countless calls from clients who go to the doctor or pharmacy and are told their plan is no longer valid. We cannot stress enough the importance of not waiting until January to discover your plan isn’t working.

We know how overwhelming it can be to wade through the Medicare maze and decide which coverage is best for you. With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and a clear understanding of what your choices are. And we never charge for our services. Contact Bruce today to schedule a complimentary consultation.

Medicare Prescription Drug Coverage: 3 Things to Know

June 14, 2025
Did you go to the pharmacy in January and discover your prescription medications cost more? Judging by the number of calls we received from clients over the past few weeks, you were not alone. 

Does Medicare Cover Vision, Dental, and Hearing? Here's the Breakdown

June 14, 2025
Medicare covers most major medical needs for those 65 and older. However, some services – including vision, dental and hearing – fall outside the program’s scope.

What to Do After Medicare’s Annual Enrollment Period Ends

June 14, 2025
The 2024 Medicare Annual Enrollment Period ended on December 7. If you switched from one Medicare Managed Care Plan (also known as Medicare Advantage Plan) to another or changed your stand-alone prescription drug coverage (Medicare Part D), your changes will go into effect January 1, 2025.

What to Know About Medicare Fraud

June 14, 2025
You are reviewing your latest Medicare Explanation of Benefits statement and notice you’ve been billed for a service that does not look familiar. It may simply be the result of a misunderstanding on your part about your benefits. However, it may also be fraud or abuse.

What’s the Difference Between Medicare Part A and Part B?

June 14, 2025
For people 65 an older, the Medicare federal health insurance program offers coverage to help pay for essentials like doctor visits, hospital stays and surgeries. While qualifying for Medicare coverage is a cause for celebration, many seniors find it extremely challenging to understand their options and get the coverage that’s best for them. Medicare has several “parts,” some of which may you may be automatically enrolled in when you qualify, and others that you must choose to sign up for. To begin with, it’s important to understand the difference between Medicare Part A and Part B.

Not Retiring at 65? You Still Need to Enroll in Medicare

June 14, 2025
The benefits of Medicare begin when you turn 65. But what happens if you are still working past age 65 and have no plans to retire? If your workplace offers health insurance, do you still need to get Medicare? Is there a downside if you don’t? The first step in exploring Medicare enrollment is to have a conversation with your company’s human resources department before your 65th birthday. Make sure you find out what you will need to do in terms of your health insurance coverage.

What Your Employer May Not Tell You About COBRA and Medicare

By Jessi Jennings • June 14, 2025
The Consolidated Omnibus Budget Reconciliation Act – known as COBRA – offers a way for workers and their families to maintain their employer-provided health insurance during situations such as job loss, a reduction in hours worked, transition between jobs, divorce, and other life events. COBRA is a valuable lifeline for many. But if you are nearing age 65 and plan to enroll in Medicare, there are some things you need to know before you decide to elect COBRA coverage in order to avoid gaps in coverage – and potentially costly penalties.

Medicare Prescription Drug Coverage: 3 Things to Know

June 14, 2025
As with any health insurance, Medicare changes from year to year. However, the changes in Medicare’s prescription drug coverage for 2025 seem to have created more confusion than in years past. The Inflation Reduction Act (IRA) of 2022 Signed into law in 2022, the IRA went into effect beginning January 1, 2025. There was a lot of publicity around how the law would impact Medicare prescription drug coverage, and members received information via mail and email. Here are three of the biggest changes for 2025: 1. There is a $2,000 out-of-pocket maximum. Those with Part D plans through traditional Medicare and Medicare Managed Care Plans (Medicare Advantage Plans) with prescription drug coverage won't pay more than $2,000 over the calendar year in out-of-pocket costs for their prescription medications. There is a $590 annual deductible on most plans. Once you reach the $2,000 maximum you will pay $0 for Tiers 1, 2, 3, 4, and 5 drugs as long as they are in the formulary. (If a medication is not in the formulary, your doctor can apply for an exception.) The only cost you will incur is your monthly premium. Note that the $2,000 maximum includes your deductible, copays and what your insurance pays for. The IRA also eliminated the Prescription Drugs Coverage Gap – known as the “donut hole.” 2. Plan premiums are higher. It’s not unusual for monthly premiums to increase from year to year. However, all prescription drug plans are higher for 2025 because of the IRA – and in some cases the increases are sizable. The good news is that many people will see a significant drop in expenses because of the cap on out-of-pocket costs, as well as the elimination of the coverage gap. 3. You may be paying more for medications. The IRA resulted in changes to the prescription drug tiers as well, with certain medications moving from one tier to another in the formularies. Tiers are locked in for 2025, so it’s important to work with your pharmacist to determine the most cost-effective options. When reviewing your plans for 2026, keep in mind that each insurance company can change the formularies from one plan to another. Understanding your plan is a must. We tell our Medicare clients this all the time: when you receive your “Annual Notice of Change" (ANOC) document in September, you must read it carefully! It is surprising how many people simply toss these notices in a drawer or in the trash without reading them. Your ANOC contains detailed information about any changes in coverage and costs that will be effective in the following year. And if you are unhappy with the benefits your plan is offering – or unsure about what the changes will mean for you – THAT is the time to speak with an experienced Medicare agent who can offer guidance. Why? Because the Medicare Annual Enrollment Period (AEP) begins in mid-October. Those currently enrolled in Medicare will have the opportunity to change their current Medicare Managed Care Plans (Medicare Advantage Plans) or stand-alone prescription drug coverage.  Navigating the Medicare maze can be challenging. Whether you are new to Medicare or exploring other plan options, it can be overwhelming to figure out which coverage is best for you. But you don’t have to do it on your own. With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and a clear understanding of what your choices are. And we never charge for our services. Call Bruce or Marcia at 973-628-0694 to schedule a complimentary consultation.

Medicare Basics: The A, B, C, and D of Coverage

June 14, 2025
We’ve summarized the basics of Parts A, B, C, and D to help you understand how Medicare works. Part A: Hospital Insurance Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part A is sometimes called “premium-free Part A” because the premium in $0 if you have been working for at least 40 quarters or 10 years, and paying your Medicare taxes. If you have health insurance from an employer, you only need to sign up for Medicare Part A. However, if the company you work for has less that 20 employees, you must also enroll in Part B. Part B: Medical Insurance Part B helps cover the costs of services from doctors and other health care providers, including outpatient care, home health care, durable medical equipment, and many preventive services like screenings, vaccines, and yearly wellness visits. There is a monthly premium for Part B. The amount is based on your adjusted gross income and it can change from year to year. For 2025, the minimum monthly premium is $185 each. The Part B deductible for 2025 is $250 for the calendar year. If you did not sign up for Part B and are planning to retire, you will need to provide Social Security with a form completed by your company confirming that you are no longer covered under their health plan. Part C: Medicare Managed Care Plan /Medicare Advantage Part C – also known as a Medicare Managed Care Plan or Medicare Advantage Plan – offers an alternative to Original Medicare (Parts A and B). These plans are run by private insurance companies approved by Medicare. Medicare Advantage Plans provide coverage for hospital stays and medical services. You need to be enrolled in Medicare Part A and B to purchase a plan (Medicare Advantage plans do not replace Part A and B.) Many plans offer additional benefits such as vision, hearing, dental, or wellness programs. Medicare Advantage Plans differ in their costs, benefits, and network restrictions. Some have a $0 premium, others charge up to $150 a month. We advise clients that the key consideration in purchasing a plan is ensuring that your doctors are in the network. Part D: Prescription Drug Coverage Part D helps cover the costs of prescription medications. This optional coverage is administered by private insurance companies that contract with Medicare. If you are enrolling in Original Medicare and/or a Supplement (Medi-Gap) Insurance plan, you will need to purchase a standalone Part D prescription drug plan at same time. Complete this step whether or not you are currently taking medication! Otherwise, you may have to pay a lifetime penalty should you need coverage down the road. While there are some exceptions, most Medicare Advantage plans include a prescription drug plan. We’ve explained the 2025 changes to Part D coverage in our March blog. Get the answers and the coverage you need. The Medicare landscape is constantly changing and so are your healthcare needs. Whether you are new to Medicare or exploring your plan options, working with an experienced Medicare agent can help you avoid confusion and – the frustration of not getting answers to your questions. With over 20 years of experience, we promise you an honest conversation about how Medicare works and what coverage might be best for you. We are never too busy to take your call or help resolve your issues, and we never charge for our services. Call Bruce or Marcia at 973-628-0694 to schedule a complimentary consultation.