A Medicare "annual physical" and "annual wellness visit" are not the same. The wellness visit is a no-cost, preventive appointment covered by Medicare, while a traditional physical is not.
Prepare for Medicare's 2026 Annual Enrollment Period (AEP). Learn key dates, how to prepare, and why a licensed agent can help you find the right plan for your needs.
Unpack the Medicare Part D late enrollment penalty. Learn why it happens, how it's calculated, and how to avoid this lifelong surcharge.
If you're enrolled in Medicare—or planning to be—you may have heard of something called IRMAA . No, it's not a new type of Medicare plan. It stands for Income-Related Monthly Adjustment Amount , and it can significantly impact what you pay each month for your Medicare Part B and Part D coverage. Let’s break down what IRMAA is, who it affects, and how to plan for it.
If you’re struggling to keep up with the cost of your prescription medications, the Medicare Extra Help program could be the financial relief you’ve been looking for. Also known as the Low-Income Subsidy (LIS) , Extra Help is a federal program that assists eligible Medicare beneficiaries in paying for Medicare Part D prescription drug costs . This includes help with monthly premiums, annual deductibles, and co-payments for medications. Why It Matters in 2025 In 2025, changes to Medicare are making Extra Help more valuable than ever. One major update: annual out-of-pocket costs for prescription drugs will be capped at $2,000 for everyone with Medicare drug coverage. If you qualify for Extra Help, your costs could be even lower—or nothing at all . Who Can Get Extra Help? Eligibility for Extra Help is based on your income and assets . In general, you may qualify if: Your income is below a certain level (specific thresholds vary slightly by year). Your resources (like savings and investments, not counting your home or car) fall under the program’s limits. Some people automatically qualify, such as those who: Receive full Medicaid benefits Are enrolled in a Medicare Savings Program (MSP) that pays your Medicare Part B premium Receive Supplemental Security Income (SSI) Even if you don’t automatically qualify, you can apply separately through the Social Security Administration . What Does Extra Help Cover? If approved, Extra Help may reduce or eliminate: Part D monthly premiums Annual Part D deductibles . Co-pays for covered prescription drugs. Many beneficiaries with Extra Help pay no more than a few dollars per prescription . Plus, you won’t pay the Part D late enrollment penalty if you qualify. How to Apply You can apply for Extra Help in one of several ways: Online at www.ssa.gov/extrahelp By phone at 1-800-772-1213 (TTY: 1-800-325-0778) In person at your local Social Security office If you’re unsure whether you qualify, it’s still worth applying. Many people are surprised to find they’re eligible, especially those with limited savings or fixed incomes. Need Help Navigating the Process? You don’t have to figure it out alone. Your local State Health Insurance Assistance Program (SHIP) offers free, unbiased support. You can also reach out to us... we are happy to help!
As you approach Medicare eligibility, you're likely encountering a whirlwind of information, choices, and deadlines. The complexity of Medicare—encompassing Parts A, B, C, and D, along with various supplemental plans—can be overwhelming. Making uninformed decisions or missing critical enrollment periods can lead to costly mistakes, such as unnecessary expenses or gaps in coverage. Dr. Katy Votava, a health economist and Medicare expert, emphasizes that "the big mistakes that people make in their Medicare decisions and choices can be very costly." She notes that many individuals end up with duplicative coverage or overspend on health insurance when they can least afford it. The anxiety surrounding Medicare's complexity often hinders decision-making, increasing the risk of errors. While it's tempting to navigate Medicare on your own, the intricacies of the system—such as understanding the interplay between different parts, evaluating Medicare Advantage versus Original Medicare, and considering supplemental coverage—make it a challenging endeavor. Moreover, the lack of comprehensive guidance from employers during the transition from workplace plans to Medicare leaves many unprepared. Working with a knowledgeable and trustworthy Medicare agent can alleviate this burden. An experienced agent can help you: Understand the differences between Medicare parts and what each covers. Evaluate the pros and cons of Medicare Advantage plans versus Original Medicare with supplemental coverage. Identify the most cost-effective prescription drug plans tailored to your needs. Ensure timely enrollment to avoid penalties and coverage gaps. Dr. Votava advises initiating Medicare planning by age 64 to ensure a smooth transition. Early planning allows ample time to assess options, gather necessary information, and make informed decisions without the pressure of impending deadlines. In conclusion, while Medicare offers essential health coverage for seniors, its complexity necessitates careful navigation. Partnering with a trusted Medicare agent can provide clarity, prevent costly mistakes, and offer peace of mind as you embark on this new chapter of healthcare coverage.
When you enroll in Medicare, you get access to hospital and medical insurance through Parts A and B—but many people are surprised to learn that it doesn’t cover everything. In fact, some of the most commonly needed services—like routine dental, vision, and hearing care—are not included in Original Medicare . The good news? You do have options . Whether through Medicare Advantage plans or standalone coverage, there are several ways to make sure these essential health needs don’t fall through the cracks. The Limitations of Original Medicare Original Medicare (Parts A and B) does a great job of covering hospital stays, doctor visits, and medically necessary procedures. But it does not cover most routine care for your eyes, ears, or teeth. That means these important services are entirely out-of-pocket expenses on Original Medicare: Dental cleanings, fillings, dentures, and extractions Eye exams for glasses or contacts\ Hearing tests and hearing aids There are a few exceptions to this. For example, Medicare may cover an eye exam if you have diabetes, or it might pay for eyeglasses after cataract surgery. Similarly, it could cover a dental procedure if it's necessary before a major surgery like a heart valve replacement. But as a general rule of thumb, routine care in these areas isn't covered. Medicare Advantage: An All-in-One Option If you’re looking for more complete coverage, a Medicare Advantage Plan (also known as Part C) might be a good fit. These plans are offered by private insurance companies and provide the same coverage as Original Medicare—and beyond. Most Medicare Advantage plans include benefits for: Dental care : Routine exams, x-rays, cleanings, and sometimes more complex services like crowns or dentures. Vision care : Annual eye exams, and allowances for glasses or contact lenses. Hearing care : Screenings and sometimes partial or full coverage for hearing aids. These plans often require you to use a network provider, so it's important to check which dentists, eye doctors, or audiologists are included. Costs can vary—some benefits may be included at no extra charge, while others might involve copays or set annual limits. To enroll in a Medicare Advantage plan, you must already be enrolled in both Parts A and B, and live in the plan’s service area. You can compare plans during the Annual Enrollment Period (Oct. 15–Dec. 7) or if you qualify for a Special Enrollment Period. Learn more about Medicare Advantage with this handy booklet from Medicare.gov. Standalone Coverage and Other Resources If you prefer to stick with Original Medicare or your current Medicare Advantage plan doesn’t include the coverage you want, you can fill in the gaps with other options instead: 1. Standalone Dental, Vision, and Hearing Insurance Many private insurers offer separate policies specifically for dental, vision, or hearing coverage. These plans vary in price and coverage, but typically include preventive care and a network of providers. 2. Discount Plans Discount plans are not insurance plans, but rather offer reduced rates on services for a monthly or annual fee. This might be a good fit if you just need occasional care and want to lower the out-of-pocket cost. 3. Community and Federally Funded Clinics Some Federally Qualified Health Centers (FQHCs) and local health departments offer dental and vision services at a reduced cost or on a sliding fee scale. These can be especially helpful for people on a fixed income. 4. Veterans Benefits If you’re a veteran, you may have access to dental, vision, or hearing benefits through your local VA, depending on your eligibility. Don’t Skip Out on These Services It might be tempting to put off a dental cleaning or skip an eye exam, especially if it’s not covered—but these services are vital to your overall health. Gum disease has been linked to heart disease, untreated vision problems can increase fall risk, and hearing loss has been associated with cognitive decline. Preventive care matters, and making sure you have the right coverage in place can help you stay healthier—and save money—in the long run. Final Thoughts If you’re on Medicare, dental, vision, and hearing benefits aren’t automatic—but they are available. Whether through a Medicare Advantage plan or other coverage, you can build a plan that supports your total health. Need help comparing options or understanding what’s available in your area? We’re here to help you make sense of it all.
What Is IRMAA and How Does It Affect Your Medicare Costs? If you're enrolled in Medicare—or planning to be—you may have heard of something called IRMAA. No, it's not a new type of Medicare plan. It stands for Income-Related Monthly Adjustment Amount, and it can significantly impact what you pay each month for your Medicare Part B and Part D coverage. Let’s break down what IRMAA is, who it affects, and how to plan for it. What Is IRMAA? IRMAA is an additional monthly premium charged to higher-income Medicare beneficiaries. It applies to both: Part B (Medical Insurance) — which covers things like doctor visits and outpatient care. Part D (Prescription Drug Coverage) — which helps pay for medications. While most Medicare enrollees pay a standard monthly premium, those with higher incomes pay an extra amount on top of that. This extra cost is what’s referred to as IRMAA. Who Has to Pay IRMAA? IRMAA applies if your Modified Adjusted Gross Income (MAGI) from two years ago exceeds certain thresholds. That means your 2023 tax return is used to determine your 2025 premiums . For 2025, IRMAA kicks in if your MAGI is: Over $106,000 (single filers) Over $212,000 (married couples filing jointly) If your income falls below those thresholds, you’ll only pay the standard premiums. How Much More Could You Pay? The amount of IRMAA you pay depends on your income tier. The higher your income, the higher your IRMAA surcharge. These amounts are set annually by the Social Security Administration and apply in addition to your regular Part B and Part D premiums. The 2025 IRMAA premiums can be found at Medicare.gov. It’s important to note that Part D IRMAA is paid separately —not to your plan provider, but directly to Medicare. Can You Appeal IRMAA? Yes, you can. If your income has dropped due to a life-changing event , such as: Retirement Loss of income-producing property Divorce Death of a spouse …you may be able to request a reduction or removal of your IRMAA. You’ll need to file Form SSA-44 with documentation that supports your case. If approved, your IRMAA amount will be adjusted accordingly. How Is IRMAA Paid? If you receive Social Security or Railroad Retirement benefits , IRMAA is automatically deducted from your benefit check. If you don't receive those benefits, you’ll get a bill from Medicare that can be paid online, via online banking, or by check through the mail. Why It Matters for Your Planning If you’re approaching Medicare eligibility and have higher income, IRMAA should be part of your financial planning . Your current income may qualify you for IRMAA, but if you're retiring soon, your income may drop, and you could avoid or reduce these extra costs using the appeals process. Knowing that helps you avoid surprises—and gives you time to file an appeal if needed. The Bottom Line IRMAA can come as a surprise if you’re not expecting it, but it’s manageable with a little preparation. Understanding how your income affects your Medicare premiums can help you make smarter decisions about retirement timing, tax strategies, and health plan choices. Need help? Do you have questions about how IRMAA might impact you—or need help navigating your Medicare options? We’re here to help. Contact our office for personalized guidance tailored to your income and healthcare needs.
Spring is a time for fresh starts—but it’s also a smart time to double-check your Medicare coverage. Whether you're new to Medicare or have been enrolled for years, these common mistakes can cost you money, delay your care, or leave you under-protected. Here's how to avoid them and make the most of your Medicare benefits this season. 1. Skipping Your Annual Wellness Visit Your Annual Wellness Visit is fully covered by Medicare and gives you a chance to check in with your doctor, review medications, and create a plan to stay healthy. If it’s been more than a year since your last visit, now’s the time to schedule it. Bonus Tip: Bring a list of your medications and health goals to make the visit even more valuable. 2. Forgetting to Review Your Plan Benefits Even if you didn’t switch plans during the Annual Enrollment Period last fall, your current plan may have changed in January. New copays, changes to provider networks, drug formularies, and changes to last year’s benefits can catch people off guard. Don’t wait until a bill surprises you—review your Medicare Advantage or Part D plan benefits now. 3. Assuming Medicare Covers Everything Many people are surprised to learn that Original Medicare doesn’t cover routine dental, vision, or hearing care (though some Medicare Advantage plans do). It also doesn’t cover long-term care. A Medicare Supplement plan and long-term care insurance may help fill those gaps and protect your finances. Need help comparing options? A licensed agent can walk you through what’s available in your area. 4. Missing a Special Enrollment Opportunity Spring often brings life changes—moving, retiring, losing other coverage. These events may qualify you for a Special Enrollment Period , which gives you a limited-time chance to make changes to your plan outside of the regular enrollment window. 5. Not Asking for Help When You Need It Navigating Medicare can be confusing, but you don’t have to go it alone. Agents, SHIP counselors, and Medicare.gov are all great resources. A quick phone call can often save you hours of frustration—and potentially hundreds of dollars. 🌸 The Bottom Line Spring is all about renewal—so use it as a reminder to refresh your Medicare knowledge too. Avoiding these five mistakes can help ensure you’re getting the care, coverage, and peace of mind you deserve. Need help reviewing your plan or have questions about your options? We’re here to help—just give us a call!