News & Articles Category: Medicare
Still Working After 65? Here’s What to Know About Delaying Medicare
If you or your spouse have job-based insurance, you might delay Medicare — but it’s not without risk.
If you’re still working at 65 with employer insurance, you may not need Medicare right away. But delaying Medicare enrollment incorrectly can cause costly penalties or gaps.
When You Can Delay
You can delay enrolling in Medicare Part B (and sometimes Part A) if:
• You (or your spouse) are still working.
• You have active, creditable employer coverage.
• Your employer has 20+ employees.
This lets you keep employer insurance, skip Part B’s monthly premium, and sign up during an 8-month Special Enrollment Period (SEP) later. You might even enroll in Part A (often free) unless you have an HSA.
When You Shouldn’t Delay
• No job-based insurance — COBRA, retiree, and Marketplace plans don’t count.
• Employers with under 20 employees.
• If you rely on VA coverage, Medicare suggests still enrolling in Parts A & B.
If you delay Part B without proper coverage, you’ll face a 10% lifetime penalty for each year you wait. That’s why it’s critical to understand the rules if you plan to delay Part B enrollment while working, so you can avoid costly Medicare delayed enrollment penalties down the line.
HSA Users, Be Careful
Enrolling in any part of Medicare stops your ability to contribute to an HSA. If you want to keep contributing, don’t sign up for even free Part A. Stop contributions at least 6 months before enrolling to avoid IRS issues.
What to Do Next
1. Ask HR if your plan counts as creditable.
2. Get written proof.
3. Plan ahead for SEP.
4. Don’t assume you’ll be auto-enrolled — take action.
We’re Here to Help
Call us today at 1-855-890-2583 to talk with an Education Specialist about delaying Medicare Part B or to learn how to delay Medicare while working without penalties.
News & Articles Category: Medicare
Major Medicare-Medicaid Plan Changes Coming in 2026
If you’re enrolled in an MMP plan, your coverage is changing — but you won’t lose it.
The Centers for Medicare & Medicaid Services (CMS) is phasing out Medicare-Medicaid Plans (MMPs) by the end of 2025. These were pilot programs under the Medicare Medicaid Program MMP model, designed to coordinate care for people eligible for both. Now they’re being replaced to improve care quality and simplify everything for you.
What’s Changing?
Medicare MMP plan users will see that their plans are ending. These were part of a pilot to help coordinate benefits across Medicare and Medicaid. Replacing them are D-SNPs (Dual Eligible Special Needs Plans) that combine Medicare and Medicaid benefits under new structures:
• FIDE SNPs: Both programs under one organization.
• HIDE SNPs: Coordinate closely, especially for long-term and behavioral health.
Timeline & What to Expect
Most MMP plan Medicare contracts will end by December 2025. States like California, Illinois, Michigan, Ohio, and South Carolina will automatically transition many people into a D-SNP with the same insurance company. You’ll get notices from your plan or state Medicaid office. Your benefits won’t disappear — but the plan name, ID card, and extras may change.
What You Might Gain
• One card for both Medicare and Medicaid.
• Easier billing and coordination.
• Better care management and support for chronic conditions.
• Some new D-SNPs offer extras like OTC credits, dental, vision, transport, and fitness.
Why This Matters
These changes aim to improve care and cut confusion. But you still need to read your plan notices and understand your new choices before 2026. Don’t wait — understand how your Medicare Medicaid Plans MMPs will change and what it means for your coverage.
We’re Here to Help
Call us today at 1-855-890-2583 for personalized assistance!
News & Articles Category: Medicare
Understanding Your Core Medicare Coverage
Understand the foundational parts of Medicare:
Medicare Part A (Hospital Insurance): This covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Keep in mind that Part A has a deductible, and after 60 continuous days in the hospital, copays may apply.
Medicare Part B (Medical Insurance): This covers a range of outpatient medical services, including doctor visits, preventative care (like annual wellness exams), and durable medical equipment. Typically, Original Medicare (Part A and Part B combined) covers about 80% of these services.
Exploring Your Plan Options
Now, let’s explore your plan options to help cover the remaining costs:
Medicare Supplement Insurance (Medigap): Helps pay for out-of-pocket costs not covered by Original Medicare, such as the Part A deductible and Part B coinsurance (the 20% you’d typically pay).
Additional Coverage: Some Medigap plans also cover excess charges under Part B.
Monthly Premiums: These plans typically have a monthly premium.
Medicare Part D (Prescription Drug Plan): If you choose a Medigap plan, you’ll typically need to enroll separately in a Medicare Part D plan for outpatient medications.
Nationwide Freedom: Medigap plans let you see any doctor or hospital nationwide that accepts Medicare.
Medicare Advantage (MA) Plans (Part C): An “all-in-one” alternative to Original Medicare that bundles Part A, Part B, and usually Part D.
Private Insurance: Offered by private insurance companies that contract with Medicare.
Network-Based: Often limited to providers within a network (like HMO or PPO).
Premiums and Cost-Sharing: May have lower premiums but include copays and deductibles for services received throughout the year.
Extra Benefits: Often include vision, dental, hearing, and other benefits not covered by Original Medicare.
Medicare Part D: Most MA plans include drug coverage in one convenient plan.
Finding the Right Fit for You
Choosing the Medicare plan option that best suits your individual healthcare needs and budget is an important decision. Talk to a licensed agent who can guide you through each option and help you make an informed choice.
Special Enrollment Period (SEP)
Experienced a life-changing event (e.g., losing employer coverage, moving, or changes in Medicaid eligibility)? You may qualify for a SEP to enroll outside the standard windows.
We’re Here to Help
Call us today at 1-855-890-2583 for personalized assistance!
News & Articles Category: Medicare
Your Medicare Readiness Checklist:
Get Ahead 9 to 12 Months Before 65
Confirm your Medicare eligibility by contacting the Social Security Administration at 800-772-1213.
Review your current health insurance policy to understand how your coverage may change when you turn 65.
Start searching additional coverage options to help cover any costs not included in Medicare.
Fine-Tuning Your Options: 4 to 8 Months Before 65
Get familiar with the basics of Medicare: Parts A, B, C, and D.
Check with your doctor to confirm whether they accept Medicare or participate in other Medicare plans.
Explore supplemental coverage options to help with out-of-pocket medical expenses not covered by Medicare.
We’re here to help! Call 855-890-2583 to speak with an Education Specialist for expert assistance.
The Home Stretch: 1 to 3 Months Before 65
Enroll in Medicare Parts A and B. If you haven’t received your enrollment information, contact the Social Security Administration at 800-772-1213.
Planning to take early Social Security benefits? Sign up now—it may take up to three months to receive them.
Ensure your spouse and/or dependents have alternate coverage once you transition to Medicare.
Let us guide you! Call 855-890-2583 to speak with an Education Specialist about your next steps.
Happy 65th Birthday!
Haven’t received your Medicare card yet? Contact the Social Security Administration at 800-772-1213.
Provide your doctor’s office with a copy of your Medicare card and any supplemental coverage you’ve enrolled in.
News & Articles Category: Medicare
Medicare in Illinois is slightly different, plan deductibles are charged not at the beginning of the plan year, but at the beginning of each benefit period. Understanding your benefit period and when it is can help you estimate your costs in the event you need care.
Benefit Period
The benefit period is simply the way Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your period begins the day you’re admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care. This has nothing to do with the calendar year but is based on your medical needs. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15. If you need to return to the hospital before the 60 days have expired, you will still be in the same period. However, as soon as 60 days have passed with no care, if you return to the hospital, you will start a new period. While there is no limit to the number you can have or how long each can last, you must pay the inpatient hospital deductible for each.
Cost
When your benefit period begins, you are responsible for paying your Part A deductible. ($1,600 for 2023). For days 1-60 in the hospital, the coinsurance for each will be $0. For the first two months in the hospital, you are covered with no daily coinsurance. For days 61-90 of a hospital stay, coinsurance is $400 per day. For days 91 and beyond, coinsurance for each “lifetime reserve day” after day 90 is $800. With a skilled nursing facility, coinsurance is $0 for the first 20 days of each and $200.00 per day for days 21-100. To find out where you are in your benefit period, refer to your Medicare Summary Notice (MSN). This document details all health care services you received in the past 3 months.
References:
https://www.medicare.gov/glossary/b.html
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
https://blog.medicarerights.org/what-is-a-benefit-period/Â
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