Questions
Thirty questions people actually ask us.
Grouped by subject. Where an answer depends on your county, your plan or the current year's figures, we say so instead of printing a number that might be wrong for you.
01
Starting out
Signing up, and when.
When exactly should I sign up?
Your Initial Enrollment Period is seven months long — the three months before your birthday month, that month, and the three after. Enrolling in the early part generally means coverage begins promptly.
We would rather see you three months before than three weeks after, because some doors close when this window does.
Am I signed up automatically?
If you are already drawing Social Security when you turn 65, you are generally enrolled in Parts A and B automatically and a card arrives. If you are not drawing it, you must sign up yourself — through Social Security, not through us.
Plenty of people assume it happens on its own and it does not.
I am still working. Do I need Part B?
It depends on how many employees your employer has, and the threshold matters a great deal. With a large employer you may generally delay Part B without penalty while covered.
With a small one, Medicare may become your primary payer whether or not you have enrolled — meaning your employer plan pays second on bills Medicare would have covered. Please ask before you decide; this is the single most expensive thing to get wrong.
What is the difference between Medicare and Medicaid?
Medicare is federal and based mainly on age or disability. Medicaid is state-run and based on income and resources.
Some people qualify for both, which opens plan types and assistance not otherwise available. If money is tight, say so — it changes what we should be looking at.
Do I need to do anything if I am happy with my plan?
Most plans renew automatically, so doing nothing keeps you enrolled. But the plan itself changes each January — networks, drug lists, costs.
Doing nothing is a decision to accept next year’s version of the plan sight unseen. A fifteen-minute review each autumn is usually enough.
02
Choosing
Advantage, Supplement, and switching.
Which is better — Advantage or a Supplement?
Neither, in the abstract. They suit different people. Anyone who answers that question without asking about your doctors, your medications, your travel and your budget is selling rather than advising.
What we will say is that the choice is much easier to make at 65 than to unmake at 72.
Can I change my mind later?
Partly. You may move between Advantage plans, and back to Original Medicare, during the right windows.
What is not guaranteed is buying a Supplement afterwards — outside your initial window, in Ohio, Kentucky and Indiana an insurer may ask health questions and may decline. That asymmetry is the thing to understand before you enrol.
How do I know if my doctor takes a plan?
Check each doctor by name, not by hospital system — a practice can be in a system and out of a plan’s network.
Online directories go out of date, so we verify with the plan and we suggest you also ring the practice and ask the billing office directly. It takes ten minutes and it prevents the most common regret.
What are those television advertisements actually offering?
Usually Advantage plans, and usually described by their most attractive feature. The benefits mentioned are frequently real, and available only on certain plans, in certain counties, to people who qualify.
Nothing advertised nationally is available everywhere. If something you saw appeals to you, bring it in and we will tell you plainly whether it exists where you live.
Should I take the plan my friend has?
Only by coincidence. The right plan follows from your medication list and your doctors, and two neighbours with different prescriptions will often be best served by different plans.
It is a good starting point for a conversation and a poor basis for a decision.
03
Prescriptions
Part D, formularies and the penalty.
I take nothing. Do I really need a drug plan?
In almost every case, yes — and this is the advice most often ignored and most often regretted. Going without creditable coverage and enrolling later attaches a permanent penalty to your premium for as long as you have Part D.
A minimal plan held continuously costs far less over twenty years than the penalty does.
My medication is not on the list. What now?
Three routes: your doctor prescribes a covered alternative; you request a formulary exception with the doctor’s support; or you change plans at the next enrollment period.
If the drug is essential and nothing else works, pursue the exception — and telephone us, because the deadlines are short and easy to miss.
Why did my copay change in January?
Formularies are rewritten annually. A medication can move to a higher tier, acquire a restriction, or leave the list entirely, and your cost changes accordingly.
This is precisely why we re-run every client’s medication list each autumn rather than assuming last year’s plan still fits.
Is the pharmacy I use going to matter?
More than most people expect. Plans have preferred pharmacies where your cost is lower and standard ones where it is higher, and the same prescription can cost noticeably more two doors down.
Tell us where you actually fill things and we will factor it in.
Can I have a separate drug plan with an Advantage plan?
Generally not, and attempting it can disenroll you from your Advantage plan and return you to Original Medicare without your intending it.
Most Advantage plans include drug coverage for exactly this reason. It is a genuinely dangerous mistake and it is why we ask what you already hold before anything else.
04
Costs
Premiums, penalties and help paying.
What will Medicare cost me in total?
We will not print a figure here, because the amounts change every year and depend on your income, your county and which road you take.
What we will do on a call is add up your actual expected costs — premiums plus the deductibles and copays your own medications and doctors imply — which is the only number that means anything.
Why is my neighbour's Part B premium different from mine?
Higher-income beneficiaries pay a surcharge on Parts B and D. It is assessed from a tax return roughly two years old, which means a one-off event — selling a house, taking a lump sum — can raise your premium later.
If your income has since dropped because you retired, that decision can be appealed, and many people do not realise it.
Is there help if I cannot afford it?
Yes, and we will raise it unprompted. Extra Help reduces drug costs substantially for those under certain limits, Medicare Savings Programs can pay your Part B premium, and manufacturers run assistance schemes for particular drugs.
None of these earns us anything. Many people who qualify never apply because nobody told them.
Does a zero-premium plan really cost nothing?
No. It means the plan charges no premium of its own — you still pay your Part B premium, and you still pay copays, coinsurance and any deductible when you use care.
A zero-premium plan can be an excellent choice. It is not a free one, and any presentation that implies otherwise is misleading.
Do you charge me anything?
No. We are paid a commission by the insurance company whose plan you enrol in, and your premium is not higher for having used us — plan prices are set and are the same whether you enrol through an agent, a call centre or directly.
05
When something goes wrong
Denials, appeals and fraud.
My plan refused to cover something. Can I do anything?
Yes. You have formal appeal rights with several levels, and denials are overturned on appeal more often than people expect — the first refusal is frequently not the final answer.
The deadlines are short. Telephone us: we will not decide your appeal, but we will make sure you know how to file and by when.
Someone rang offering me a better plan. Was that you?
No. We never telephone people who have not asked us to, and rules restrict when any agent may contact you without permission.
If someone rings out of the blue, pressures you to decide immediately, or asks for your Medicare number, hang up. You can report it to 1‑800‑MEDICARE, or ring us and we will tell you whether it sounded legitimate.
Someone asked for my Medicare number over the telephone.
Treat it as fraud unless you initiated the call to a number you looked up yourself. Your Medicare number is the key to billing in your name, and the common schemes involve free braces, test kits or genetic screening.
Report it to 1‑800‑MEDICARE. If you have already given it out, ring us and we will walk you through what to watch for.
I got a bill I do not understand.
Bring it in or photograph it and email it. A great many of these turn out to be a Medicare Summary Notice, which is a statement rather than a bill, or a provider billing before the plan has processed.
Ringing us costs nothing and is faster than worrying about it.
My doctor left the network mid-year.
It happens — contracts between plans and provider groups get renegotiated. The plan must notify affected members, and depending on the circumstances there may be transition arrangements or a special window to change plans.
Ring us when the letter arrives rather than waiting for October.
06
Working with us
What we do and do not do.
Do you represent every plan available?
No, and no agency does. We represent a number of organisations offering a number of products in your area — the specific counts are stated in the footer of every page on this site.
For a complete picture of everything available to you, contact Medicare.gov, 1‑800‑MEDICARE, or your State Health Insurance Assistance Program. We say this because it is required and because it is true.
Will you pressure me to decide?
No. You leave the first appointment with written notes and no paperwork signed. Take it home, talk it over, ring us when you are ready.
If any adviser anywhere pressures you to decide on the spot, that alone is reason to end the conversation.
Can my daughter sit in?
Please bring whoever helps you make decisions — a spouse, a child, a neighbour. Appointments go better with two people listening.
If someone holds power of attorney or needs to speak on your behalf, tell us at the outset so the paperwork is right.
What happens after I enrol?
We stay your agent of record and you ring us rather than a call centre.
Each autumn we re-run your medication list against the coming year’s plans and tell you whether anything warrants changing — which most years it does not. There is no charge for any of that.
Is there somewhere I can get advice from someone who sells nothing?
Yes, and we recommend it without reservation. Every state runs a State Health Insurance Assistance Program offering free one-to-one counselling from people paid by nobody.
You can also ring 1‑800‑MEDICARE at any hour or compare plans yourself at Medicare.gov. We would rather you made a good decision somewhere than a rushed one here.
Question not answered here?
Telephone the office. There is no charge for a question and no obligation attached to the answer.