Search Results

Michael T Braden April 16, 2026 MEDICARE 101 WHAT IS A MEDICARE SUMMARY NOTICE If you have been receiving Medicare Benefits for at least 6 months, you should have already received your first Medicare Summary Notice. Most people who open their MSN (Medicare Summary Notice) for the first time have many questions about what the most important things to review in the Summary are. We've been helping Medicare Beneficiaries for the past 11 years, and we thought we should write this article to help everyone better understand their Medicare Summary Notice. The Medicare Summary Notice is sent to you every four months, and it arrives in your mailbox. Your MSN is a Statement; it is not a bill. The MSN is a summary of all your claims for that period. Your Medicare Summary Notice describes how any/all of your Medicare claims were processed. In the Notes for Claims Section, Medicare provides you with an explanation of which/what services were approved, denied, and how much was paid towards your deductible for the current Calendar Year. There are times when Medicare informs you that a claim was denied. If that happens, don’t panic; it is usually a minor issue with how the doctor's office, clinic, or hospital coded your claim. Everything should be resolved easily by speaking directly to your provider's office and asking them to please correct the error and resubmit the claim. Depending on what they tell you, you can decide to file an appeal with Medicare by calling 1-800-MEDICARE. A Medicare Beneficiary Reading Up On Her Medicare Beneficiary Notice Statement YOUR SUMMARY IS NOT A BILL. PLEASE DO NOT WRITE A CHECK TO ANYONE The most important thing to understand about your Medicare Summary Notice is that it is a statement, not an invoice/bill. Your Medicare Summary Notice is merely a recap and breakdown of how all of your Medicare claims were processed during a given time period. Your MSN shows you what services were billed, whether or not Medicare approved these services, if a claim was denied, how much Medicare paid, and the balance of what you may be responsible for. This amount could be much lower if you have a Medigap or Medicare Supplement policy. The keyword there is may. Each MSN does not consider a Medicare Supplement (Medigap) plan or other secondary insurance, so your actual responsibility could be much lower. WHAT YOU WILL KNOW AFTER READING THIS NOTICE Your Medicare Summary Notice provides a detailed accounting of any medical services or supplies billed to Medicare under your MBI (Medicare Number). It indicates whether the listed service or item was approved or denied. If approved, you can see how much Medicare paid toward it. The notice also shows the maximum amount you may be responsible for paying, assuming you have no other coverage. If you have a Medicare Supplement or a Medigap policy, a pension, or another form of secondary insurance, those plans may cover some or all of what Medicare didn’t pay. This is why you must review the full EOB (Explanation of Benefits) from all of your polices/coverages. WHAT IS YOUR DEDUCTIBLE STATUS AND WHY IS IT IMPORTANT On the first page of each Medicare Summary Notice, there is a section about your Deductible Status. This shows you how close you are to meeting your Annual Medicare Part B Deductible, which is $283 for the 2026 plan year. This total often includes deductible amounts from the specific claims listed on the following pages. One thing that catches people off guard is that Medicare chooses which claims count toward your deductible and how much, even though your healthcare providers are the ones who bill you for those deductible amounts. Claims are processed in the order Medicare receives them, not the order you received care, so there can be a delay. Because Medicare cannot control when providers submit their bills, it is possible that, in some cases, a bill appears on a prior MSN. Medicare leaves it up to each provider to either collect for any unmet deductibles at the time of the appointment or let Medicare bill you. For example, in Arizona, most providers do not collect the deductible, whereas in Florida, almost every provider collects it at the time of your visit. This is a good time to remind you that knowing whether or when you meet your deductible is great, but it is the beneficiary's (you/your) responsibility to pay it. Medicare tracks when you’ve met your annual deductible; you are responsible for paying the providers who bill you for those amounts. You can use and refer to the Medicare Summary Notice to confirm which providers you may owe money to and why. NOTES SECTION OF THE MEDICARE SUMMARY NOTICE Please remember to read and pay close attention to the NOTES FOR CLAIMS ABOVE located at the bottom of each page of your MSN. Many people gloss over the bottom of a page, but please promise me you will not overlook this section. For every service that is listed on your Medicare Summary Notice, you will see a letter next to it. This letter corresponds to specific notes that detail more information about each claim. They can tell you how much has been applied to your deductible and whether services were formally approved, denied, or under review. It is good to know that any service is/was denied. WHAT TO DO IF A SERVICE WAS DENIED FOR ANY REASON It is never fun to see a service has been denied by your insurance. But in the event you ever see the word denied on your Medicare Summary Notice, you’re not automatically stuck with a bill. But it does mean you should take a closer look to understand why and decide whether you believe this is correct or not, and whether you want to appeal the decision. Sometimes, providers catch billing errors or coding issues and resubmit claims behind the scenes without you ever knowing there was a problem. If you receive a denial, your first step should be to contact your healthcare provider. Ask whether they’re aware of the denial and if they plan to make corrections or resubmit the claim. If you get a bill, don’t panic. Request a written, itemized bill to understand the exact charges. WHY READ YOUR MSN Your MSN is only as useful as it is accurate. This is why we encourage each of our clients to take some time to review their MSN in detail. You should check that the services billed match what you remember receiving, and that you didn’t overpay your provider for any services that Medicare has already approved and paid for. Mistakes can happen with billing and coding, so a quick double-check now can save you time, money, and frustration down the road. WHAT IS THE DEADLINE TO APPEAL A DETERMINATION MADE BY MEDICARE? In most cases, providers resolve these issues on their own. However, if the issue persists and you do receive a bill, consider whether the situation warrants an appeal. If you want to submit an appeal, your Medicare Summary Notice includes the information and instructions you’ll need. Keep in mind there is a deadline. Generally, you have 120 days from the date of your MSN to file one, so don’t wait until the last minute. MEDICARE FRAUD IS EVERYWHERE Unfortunately, Medicare fraud is not only real but also a problem, and it seems to be getting more widespread. If you ever notice unfamiliar providers on your Summary Notice, or if you are billed for services that you never received, report them to Medicare immediately by calling 1-800-MEDICARE. Medicare Customer Service Specialists are great at identifying fraudulent charges, and they work quickly and efficiently to get them removed from your account. If you didn’t receive MSN services or if you have charges that seem questionable, report them to Medicare right away. False or Fraudulent billing affects everyone, you and CMS (Centers for Medicare and Medicaid Services). Staying engaged and aware protects your benefits and serves a big role in keeping the Medicare System working for everyone who relies on Medicare. HOW DO YOU PREFER RECEIVING YOUR MSN As of January 1, 2026, Medicare will only mail an MSN every six months. If you want access to your MSN more frequently, consider signing up for electronic MSNs through your Medicare account. Going digital provides quicker access to your notices, making it easier to track your claims over time. Additionally, you’ll always have your records available when you need them, without having to dig through stacks of paper. PUTTING YOUR MSN TO WORK FOR YOU We recommend viewing your Medicare Summary Notices as just another tool in your Medicare toolbelt. The more comfortable you are with all of the Medicare information you receive, the better builder you will become. This statement allows you to stay informed about your healthcare, catch billing errors, monitor your out-of-pocket costs, and ensure you’re getting the coverage you’re paying for. Once you understand how to read them, these once-intimidating pages become a valuable resource for managing your health and finances. So, the next time your Medicare Summary Notice arrives, keep cool. Remember: it’s for your information. Look it over and compare it with your other insurance statements. If something doesn’t look right, don’t hesitate to ask. You have the right to verify and to understand every charge. WRAPPING THINGS UP I hope you enjoyed learning more about the Medicare Summary Notice and feel more confident in your understanding of its purpose. Nothing is perfect, but the more you understand how to read and understand your MSN, the more you will be able to help your friends and neighbors. If you have any questions about your MSN or anything else about Medicare, please reach out to us. We are always happy to assist anyone in need. You can reach me via email at mike@bradenmedicare.com, on our website at www.bradenmedicare.com, or by telephone or text at (480) 225-1393.

Braden Medicare Insurance's 2027 Medicare AEP Checklist Page 1 of 4 Braden Medicare Insurance's 2027 Medicare AEP Checklist Page 2 of 4 Braden Medicare Insurance's 2027 Medicare AEP Checklist Page 3 of 4 Braden Medicare Insurance's 2027 Medicare AEP Checklist Page 3 of 4 MONTHLY MEDICARE COST WORKSHEET

Breaking Down Medicare So It Makes Sense and Is Easy to Understand Welcome to Medicare! I hope this article is fun, handy, and informative. As you can imagine, since Medicare is a government program, there is a lot to digest. In this article, we've tried to cover Medicare from A-Z in a very condensed but effective manner. Please feel free to contact me directly if you have any questions or want more details on anything. You can email me at [mike@bradenmedicare.com I have been an independent, licensed Medicare Broker and Certified Medicare Planner for the past 11 years. Every day, I am honored to speak to people who need help understanding Medicare and where to start the process. I often compare learning about Medicare to cleaning and organizing your garage. You have to know what you have so you can feel more confident about anything else you may need. Ten Things Everyone Needs to Know About Medicare Right Off the Bat Medicare is the National Health Insurance Program for all adults 65 and over, and others with full-time disabilities. Medicare is NOT FREE. Most folks will never pay for Medicare Part A, which covers hospitalization. We paid for Medicare Part A through our Medicare and Social Security taxes during our working careers. Medicare is not a health care provider; it’s a federal program. You’re responsible for making your own choices about how you want to receive your Medicare benefits. You can enroll in Original Medicare or Medicare Part C, also known as Medicare Advantage. Each person has their own Medicare policy. There are no policies for couples. Even if you are married, you are entitled to have your policy under your name, with your own Medicare ID number, similar to your Social Security number. Once you turn 65, you have three options for healthcare: Stay with your employer's healthcare until you retire, as long as your employer has more than 20 employees. If your employer has less than 20 employees, you must join Medicare. You can enroll in an ACA/Obamacare plan, but they are often not cost-effective. Medicare has many options and a full range of solutions to choose from. We will cover those options later in this article. Medicare has strict rules and penalties if you miss certain enrollment dates. This could cause you to pay more for coverage for the rest of your life, so please be aware of these dates to avoid being caught off-guard. The first date is your Initial Enrollment Period (IEP). The second deadline is once you are enrolled in Medicare Part B; you must enroll in a Medicare Part D Prescription Drug Plan within 63 days of your Medicare Part B effective date. You are not legally obligated to enroll in Medicare, though most people do. Everyone enrolls in Medicare through the Social Security Administration. Most people think they need to contact Medicare, which is true once you have your Medicare card. However, until you have your Medicare card, you need to apply for Medicare either using the Social Security website at www.ssa.gov or by calling your local SSA office to apply over the phone or in person by appointment. If you are currently receiving Social Security benefits, you will be automatically enrolled in Medicare when you turn 65. There’s nothing for you to do, and you will receive your Medicare ID card in the mail. If you get stuck along the way, please reach out to me at mike@bradenmedicare.com, and I will be happy to help you. Medicare always starts on the first day of the month in which you turn 65. If your birthday is on the 1st, then your Medicare will start on the 1st of the month preceding your birth month. 10. Some individuals determined by the IRS as “high wage earners” may need to pay a Medicare Part B and/or a Medicare Part D surcharge. Please refer to the IRMAA (Income-Related Monthly Adjustment Amount) chart below. When to Sign Up for Medicare Everyone approaching age 65 needs to become familiar with your IEP or Initial Enrollment Period. As the chart above shows, your IEP begins three months before your birth month and extends three months beyond your birth month. During your IEP, you can enroll in Medicare. If you choose to receive your Medicare benefits through Original/Traditional Medicare, you can enroll in a Medicare Supplement or Medigap Plan without having to answer any medical questions. Your acceptance is guaranteed for any Medigap plan you choose. THIS IS A HUGE BENEFIT that needs to be considered by everyone. If you or your spouse are still working but your employer has less than 20 employees, you MUST enroll in Medicare at age 65. If your employer has more than 20 employees, you can enroll in Medicare or stay on your employer’s plan. If you stay on your employer's plan, you will have eight months to enroll in Medicare without a penalty once you decide to retire. If you are opting to stay on your employer's plan, please look closely at your deductible. If you have a deductible of $4,000 or more, it probably makes more sense to enroll in Medicare. The annual Medicare Part B deductible is just $283. Many companies will reimburse their employees for their Medicare costs in exchange for opting out of their Group Health plan. This saves both you and your employer money. I recommend that everyone request a meeting with your Benefits Administrator or HR department three to six months before you turn 65 so you can understand all of your options. Employers pay $650 - $800 per month for each employee's healthcare costs. Original Medicare, with a Medigap Plan G and a Medicare Prescription Drug plan, is around $350, with a $240 deductible! What If You Already Receive Health Benefits From the Government? If you are a military retiree or spouse of a veteran insured with Tricare or Tricare For Life, you will need to enroll in Medicare. Why? Once you turn 65, Medicare becomes the primary payer. You must enroll in Medicare Part B to continue receiving all of your Tricare, Tricare for Life, or Champ VA benefits. Once you are enrolled in Medicare, Tricare and Champ VA become your secondary payer. If you are a current or former federal employee insured under FEHB (Federal Employee Health Benefits), it’s a bit more complicated. FEHB beneficiaries are NOT required to enroll in Medicare at age 65, but those who qualify are encouraged to enroll in both Medicare and FEHB to help fill in the coverage gaps that are not covered by FEHB alone. If you are not sure what to do, please contact your FEHB benefits administrator or visit the FEHB plan information on their website at www.opm.gov. Medicare Has 4 Parts Three Options for Receiving Your Medicare Coverage Option 1: Original Medicare Medicare in its purest form is known as Original Medicare. It comprises Medicare Part A (In-Patient & Hospitalization Costs and Services) and Medicare Part B (all of your Outpatient costs and services such as doctors, office visits, labs, diagnostics, screenings, procedures, and durable medical equipment). Original Medicare is a straightforward 80/20 health plan where Medicare pays 80% of all Medicare-approved (medically necessary) procedures, and you are responsible for your 20%. There is no deductible (aside from the annual $283.00 Part B deductible), no minimums, and no maximums. Plus, there is a $1,736 Part A deductible if you’re admitted to a hospital. With Original Medicare, you can see any doctor and use any physician anywhere in the United States who accepts Medicare. When a doctor or hospital agrees to use Medicare’s service fee schedule, they agree to accept Medicare. This is also known as Medicare Assignment. Nearly 94% of all doctors in the US accept Medicare. The main group of doctors who do not accept Medicare are psychiatrists, psychologists, pediatricians, and homeopathic and naturopathic doctors because there are no networks. Option 2: Original Medicare with a Medicare Supplement or Medigap Plan A Medicare Supplement can pay for all of your 20% share of healthcare, depending on which Medicare Supplement Plan you choose. Plan G is the most popular and has the best value. In most states, a Medigap Plan G costs between $150-$200 per month, depending on where you live. This is still an 80/20 plan, but aside from your premium, you would only have to pay the annual Part B deductible of $283.00 out of pocket. Everything else, including the Part A deductible, will be paid by Medicare and your Medicare Supplement plan. Altogether, the best estimate for the best coverage with no hidden costs would be around $320 per month. This includes absolutely everything, with no deductibles (aside from the $283 annual Part B deductible), no co-pays, and no co-insurance. You can see any doctor or receive services at any hospital in the United States. With a Medicare Supplement Plan G, your maximum annual out-of-pocket expense will be your Medicare Supplement/Medigap plan premium and the annual Part B deductible of $283. About 6 out of 10 people choose this plan, 3 out of 10 choose Medicare Supplement Plan N, and 1 out of 10 choose another Medicare Supplement plan. Option 3: Medicare Advantage A Medicare Advantage plan, often referred to as Medicare Part C, is offered by a private for-profit Medicare insurance company. These companies receive money from Medicare to take on the risks for your care (approximately $12,000 annually). Medicare Advantage plans are managed by private, for-profit healthcare insurers, and you are at their mercy when it comes to following their rules for care, service, prior authorizations, networks, etc. You will either choose an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization) plan. An HMO plan typically includes a Part D Prescription Drug Plan, but you will have to see their network of doctors and hospitals. This means you have little or no coverage outside of the county you live in, except for going to a hospital emergency room or an urgent care facility. A Medicare Advantage PPO plan will have more options for doctors outside of the plan's network. However, some Medicare Advantage plans do not include any Part D benefits; the majority of these plans are designed for veterans who can use their VA prescription drug benefits. The majority of MA (Medicare Advantage) HMO plans have a $0 premium. However, you will be responsible for any/all coinsurance and co-pays stated in your plan. These include doctor visits, referrals to see a specialist, and co-pays for MRIs, CT scans, and other imaging, which typically cost $300-$400. If you are hospitalized, you can expect to pay $300-$400 per night for up to seven nights. A MA/PPO plan will range from $0 to $100 depending on where you live. There is an annual maximum that varies by plan; the national average for MOOP (Maximum Out-Of-Pocket) in 2026 is $5,700 in-network and up to $17,000 a year if you go out of network. Once you meet the MOOP amounts for a given year, your plan pays 100% of the charges for the remainder of that calendar year. This means that if you run into bad luck, you could pay out-of-pocket up to the amount of your maximum out-of-pocket expense every year. Everyone who chooses Medicare Advantage must pick a new plan each year during the Medicare Annual Enrollment Period (AEP), which starts on October 15th and runs through December 7th each year. They can keep their current plan if it is still available, or they can choose a new plan that will start on January 1st. Medicare Advantage plans offer many extra benefits that Original Medicare cannot offer, such as routine dental, routine vision, routine hearing benefits, and gym memberships. However, these benefits are less and less each year. They are typically divided into four quarters. So, a $1,000 dental benefit is usually only $250 per quarter, and you do not get to roll over what you do not use. Additionally, when it comes to dental, things like root canals, implants, dentures, crowns, and bridges are not included. Anyone considering a MA plan needs to review the full Summary of Benefits (SOB) and their Evidence of Coverage (EOC) for all of the fine print and details of any plan they might be considering. A Bit of Advice on How to Choose the Right Medicare Plan for You Health insurance is important, and after age 65, it becomes critical. It’s also a very personal decision. If you are single, involve your children in the discussions and ask them for their opinions. After all, chances are they will need to understand what sort of coverage you have at some point in the future. Please do not listen to your neighbor, your friends on Facebook, or the woman who does your nails or hair. For the love of Pete, do not blindly do what anyone suggests when it comes to your healthcare. I always recommend that everyone researches things on their own, and then call 2-3 local independent Medicare brokers. Interview them, see if you “click” with them, and then work with the one you feel best about. Medicare brokers will never charge you a dime. Here Are a Few Great Questions to Ask the Brokers You Interview Ask them how long they have been a broker. Ask them how many insurance companies they represent. Clarify to ensure that they offer Medicare Supplements/Medigap plans, Medicare Advantage Plans, and Medicare Part C/Medicare Advantage plans. Ask them for their website address. If they are a reputable broker, they will have a full-fledged website, not just a “landing page.” Their email address should be a part of their website. See my business card below. My website is www.bradenmedicare.com, and my email address is mike@bradenmedicare.com. Ask them if they are a member of the Better Business Bureau and if so, what their rating is. Ask them how many clients they have. Ask them how they can provide service to you for the rest of your life. 10. Ask them why they decided to become a Medicare broker in the first place. The answer they give you will tell you a lot about them. Medicare Part D Prescription Drug Plans Part D (D for Drugs) is a part of Medicare that is optional. However, it will cost you if you do not enroll in Part D when you first can. The Medicare Part D Late Enrollment Penalty costs about $0.37 a month, but this penalty is forever; it never goes away. So, let's say you have no prescriptions and decide not to enroll in a Part D Prescription Drug Plan for three years. Your penalty would be $0.37 x 36 or $13.32 per month. This means you will have to pay an additional $13.32 in premium each month in addition to your regular Part D premium forever! This is why most Medicare beneficiaries choose the lowest-cost plan from the beginning, as it just makes the most financial sense. It is helpful to have a list of any/all prescription medications you may be taking, including the dosage and the quantity (1x or 2 times daily). We will use that list along with your most preferred pharmacy when we compare Medicare Part D Prescription Drug Plans. Make sure you include your favorite pharmacy to use, whether it is Costco, Rite-Aid, Walgreens, CVS, Walmart, or most grocery stores with a pharmacy. Amazon Pharmacy may also be used. You can also receive 90-day supplies using your plan's mail-order pharmacy! Part D Plans can be changed every year. I recommend doing a Part D review at least every other year. Anytime you change plans, you will choose your new plan during the Annual Enrollment Period (AEP) from October 15th through December 7th. If you choose a new plan, your new plan will begin on January 1st. The average cost of a Medicare Part D PDP (Medicare Prescription Drug Plan) depends on the plan you choose and the medications you are prescribed. The lowest-cost plan is ideal for no medications or for someone with 1-3 generic prescriptions. The plans range from $0 - $169 per month. Many retirees have no medications, so they enroll in the lowest Medicare Part D plan available in their area to avoid the Medicare Part D penalty. They can change plans each year if their prescriptions change. The rule is that you need to enroll in a Medicare Part D Prescription Drug Plan within 63 days of your Medicare Part B effective date. 5 Things That Original Medicare Does Not Cover A Few Other Things That Are Typically Not Covered by Medicare Naturopathic doctors and homeopathic doctors are not covered. Most psychiatrists and psychologists do not accept Medicare assignments. Medicare does not cover Botox injections. Caregivers are not covered under Medicare. Grab bars are typically not covered under Medicare but may be covered under your long-term care policy. Gym Memberships Most Medicare Advantage plans include gym memberships, but most Medigap plans do not. Some Medicare Supplement Plans offered by AARP/UHC, ANTHEM, BCBS, HUMANA, and WELLPOINT can include gym memberships. Other Medigap plans from ALLSTATE, CIGNA, and MUTUAL OF OMAHA offer gym memberships for around $35 per month. Where Medicare Advantage Plans Are Not Accepted In Arizona, Barrow Neurological Center, The Mayo Clinic, and Mayo Hospital accept Original Medicare. They also accept Medicare Supplement and Medigap plans. But they DO NOT ACCEPT Medicare Advantage plans. Many cancer treatment centers and hospitals only accept a few Medicare Advantage plans. Typically, there are not enough good skilled nursing facilities in most Medicare Advantage networks. Most non-Medicare Advantage skilled nursing facilities (rehabilitation and post-surgery rehabilitation) do not accept Medicare Advantage plans. Reasons to Like Original Medicare More Than Medicare Advantage Plans You can see any doctor anywhere in the US that accepts Medicare. You can go to any hospital in America for services. Perfect if you have homes in different states. If you like to be in control of your healthcare and not someone else. If you like having predictable costs. Peace of mind knowing everything is covered except for the $283 each year for the Part B deductible. You do not want your kids to have a hard time helping you or understanding your healthcare. If you itemize your deductions, all of your premiums and costs are tax-deductible! Virtually no co-pays or co-insurance if you have a Medigap plan. Once you pick Original Medicare and your Medicare Supplement, you are done. You can always compare premiums for your Medigap plan, but you never have to choose a new plan unless you want to change your Medicare Part D Prescription Drug plan. But with Medicare Advantage plans, you have to choose a new plan every year. Reasons to Like Medicare Advantage Plans Over Original Medicare Low or $0 premiums, but higher and never-ending co-pays and co-insurance until you meet your MOOP. More ancillary benefits than Original Medicare. You do not mind working with networks. You like having a primary care doctor. Some plans have Medicare Part B give-backs. Some plans offer allowances for pet supplies, food, and OTC supplies, but these are all limited amounts. Free meals typically refer to meals for 1-2 weeks at home after an extended hospital stay. Some plans offer transportation to doctor appointments for a preset number of one-way rides to doctor appointments. Medicare Part D Covers Vaccines Medicare and Medicare Advantage plans cover the following vaccinations for FREE, as long as you go to any “preferred pharmacy” for your Part D Prescription Plan. Influenza (Flu Shot) RSV Shingrix (Shingles) Covid Boosters Hepatitis B Pneumonia Medicare Part B covers Prolia and Evenity. Medicare Advantage plans charge a 20% co-insurance for all cancer treatments, including chemotherapy and radiation. With Original Medicare, cancer treatments are covered 100% if you have Original Medicare and a Medicare Supplement Plan A, C, D, F, G, M, or N. Preventative Screenings That Are Covered by Medicare Wrapping Things Up Thank you for reading this article, "Breaking Down Medicare So It Makes Sense." I hope you found this blog helpful, informative, and an easy-to-follow read that left you much more confident in what Medicare is and what your options are for enrolling in a Medicare plan that fits your unique needs. If you still have questions or would like any additional information or just have a few questions, please feel free to contact me directly anytime. It will be my pleasure to assist you in any way I can.

Michael T. Braden April 29, 2026 MEDICARE ENROLLMENT Picture of Braden Medicare Insurance's Medicare Enrollment Checklist YOUR MEDICARE ENROLLMENT CHECKLIST If you miss a deadline by a few weeks, you could face a permanent penalty on your monthly medicare premiums. Making assumptions without checking can force you to choose a new doctor(s). Not reading the fine print may mean you lack coverage outside your county, but worst of all, if you do not fully understand your options when you turn 65, your decisions can cause financial distress and a catastrophe that some may never recover from. But all of these issues can easily be avoided if you know the right steps to take and follow the outline in this article. The good news is that this process becomes manageable when you follow a clear sequence of steps. Our goal for everyone reading this article is to have a clearer, better understanding of the Medicare Enrollment Process, and the knowledge and confidence to set you and your family up for success, knowing your healthcare choices are in place for the next 20-25 years. Or the Medicare Enrollment Checklist will guide you through the Medicare Maze step by step, and make sure that you completely understand each of your decisions. Picture Of Braden Medicare Insurance's Medicare Initial Enrollment Period (IEP) Poster Everyone has a 7-month Initial Enrollment Period that starts 3 months before the month when you turn 65. This is the first major thing you need to remember and to get right, in order to avoid potential Medicare Part B and Medicare Part D penalties that could follow you for the rest of your life. The next big decision is to choose the best healthcare plan for you and your family. You can choose to: Enroll in Original Medicare. Choose to enroll in Original Medicare and add a Medicare Supplement (Medigap) policy for additional protection. Choose to enroll in a Medicare Advantage Plan (MA plans are often referred to as Medicare Part C or All-In-One plans). Choosing between Original Medicare and Medicare Advantage is the biggest decision you will make, and it deserves to be taken seriously. I have seen far too many bad things happen to good people, and I do not want to see them happen to you. Healthcare decisions should be made based on your doctors, all of your medications being covered, where you can be seen and treated for your current and future medical needs, what is best for you and your family, and having a full understanding of premiums, budgets, co-pays, and co-insurance. Included in your IEP (Initial Enrollment Period) is the Medicare Supplement Open Enrollment Period. This is a one-time only opportunity for you to join any Medicare Supplement/Medigap plan of your choosing, without having to divulge any health history, and you will have guaranteed acceptance, and insurance companies cannot deny your enrollment, regardless of your health history. Once your Medicare Supplement/Medigap Open Enrollment Period closes, that protection disappears forever. LET'S TAKE A QUICK GLANCE AT THE STEPS YOU WILL BE TAKING Step 1: Identify your Initial Enrollment Period (IEP), the 7-month window tied to your birthday. Step 2: Choose your coverage path, Original Medicare or Medicare Advantage. Step 3: Add prescription drug coverage (Part D) to avoid late penalties. Step 4: Decide whether Medigap makes sense for you, and enroll during your protected window. Step 5: Coordinate with any employer coverage or COBRA you currently have. Step 6: Understand IRMAA surcharges and check for savings programs. Step 7: Schedule an annual review every fall during the Annual Enrollment Period (AEP). FAMILIARIZE YOURSELF WITH THE FOUR PARTS OF MEDICARE Photo Of Braden Medicare Insurance's ABCs Of Medicare Poster Highlighting the Four Parts Of Medicare #1 UNDERSTANDING YOUR IEP (INITIAL ENROLLMENT PERIOD) Your Initial Enrollment Period (IEP) is the 7-month window around your 65th birthday when you can first enroll in Medicare Part A and Part B without penalty. Your Medicare Initial Enrollment Period spans 7 months total: the 3 months before your birthday month, your actual birthday month, and the 3 months after. That’s your primary window to sign up for Part A and Part B without facing penalties. If you’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you’ll be enrolled in Part A and Part B automatically. Your red, white, and blue Medicare card will arrive in the mail before your coverage starts. If you’re not yet receiving Social Security benefits, you’ll need to enroll actively through Social Security. Timing matters even within the IEP. If you enroll during the first 3 months, coverage typically starts on the first day of your birthday month. If you enroll in months 4 through 7, your coverage start date is delayed. For someone who wants seamless coverage from day one, enrolling early in that window is the smarter move. IF YOU MISS YOUR IEP WINDOW, THERE CAN BE CONSEQUENCES Part B Late Enrollment Penalty: 10% added to your premium for every 12 months without coverage, permanently. For 2026, the Standard Part B Premium is $202.90 per month. Everyone who enrolls in Medicare is charged this monthly premium, regardless of whether you choose a Medicare Advantage plan or Original Medicare. The Part B late enrollment penalty adds 10% to your premium for every 12-month period you went without coverage, and that surcharge stays with you permanently. The 2026 standard Part B premium is $202.90 per month, so even a one-year delay adds roughly $20 per month for life. #2 THOUGHTFULLY EVALUATE YOUR COVERAGE NEEDS AND COMPARE ALL OPTIONS AVAILABLE TO YOU Everyone must choose between Original Medicare (Parts A and B, often supplemented by Part D and most often by adding a Medicare Supplement Plan) or a Medicare Advantage Plan (Part C), which bundles benefits and is offered by private insurers. Once you know your enrollment window, the next decision is foundational: do you want Original Medicare or a Medicare Advantage plan? Both paths have genuine advantages. The right answer depends on your situation, not on which plan has the flashiest TV commercial. Original Medicare gives you broad access. You can see any doctor or specialist who accepts Medicare, anywhere in the country, without a referral. Medicare Advantage plans (Part C) often come with $0 premiums and extra perks like dental or vision coverage. But be careful to read the fine print because the majority of these "Extra Benefits" are broken down by Quarter (Instead of $1,000 in Dental Benefits, you get $250 Per Quarter). And most unused amounts are not rolled over. Additionally, oftentimes, major items are not covered at all. A few more things related to Medicare Advantage plans: Typically, you are only covered for services in the County you live in. If you are outside your county of residence, you can receive covered Emergency treatment only in a hospital, emergency room, or urgent care facility. The National Average for the Maximum Out-of-Pocket (MOOP) Expense you can pay is $5,600 in 2026. HMO plans require you to see your chosen PCP to get a referral to a specialist. Most Medicare Advantage plans require you to use a specific network of providers and may require prior authorizations for certain services. So if you want Medicare Advantage, and you want to keep your current doctors, you need to verify that they are associated with any Medicare Advantage plan you are considering. Most Medicare Advantage HMO Plans have a $0 Premium. However, you still pay your monthly Part B Premium of $202.90 each month, and you are responsible for all Co-Pays and Co-Insurance stated by your plan in their Evidence of Coverage rules. An MRI or CT Scan averages $400, and Hospital Stays require a per-day co-pay of $350-$450 on average. Most Hospitals accept Medicare Advantage, but be warned that most teaching Hospitals (Mayo Clinic, Barrow Neurological Center, Johns Hopkins, Cedars-Sinai, and many other prestigious hospitals) do not accept any Medicare Advantage plans. MEDICARE PART A Medicare Part A covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice care, and some home health services. Most people qualify for premium-free Part A because they (or their spouse) worked and paid Medicare taxes for at least 40 quarters, roughly 10 years. The Part A Deductible in 2026 is $1,736 per benefit period. That applies each time you’re admitted to a hospital, not once per year, an important distinction that catches many new beneficiaries off guard. A benefit period ends once you have been discharged and have not returned to the hospital for a period of 60 days. MEDICARE PART B Part B covers outpatient services: doctor visits, lab work, preventive screenings, mental health services, durable medical equipment, and some home health care. The Medicare Part B Annual Deductible for 2026 is just $283. That is how much you have to pay out-of-pocket before Medicare and your Medicare Supplement plan start to pay for your covered Expenses. Original Medicare Pays 80% of all covered costs once you have met your deductible for the year, and most of the popular Medicare Supplement/Medigap plans pay the other 20%. If you’re already collecting Social Security, your Part B premium is automatically deducted from your monthly benefit. It is very important that you are crystal clear regarding how deductibles, copays, and coinsurance work, so you have an accurate understanding of your total Healthcare Costs, not just your premiums. If you’re already collecting Social Security, your Part B premium is automatically deducted from your monthly benefit. Understanding how deductibles, copays, and coinsurance layer together helps you estimate your true annual costs, not just your premium. Understanding Medicare Part C (Medicare Advantage Plans) Medicare Advantage plans bundle Parts A, B, and usually D into a single plan offered by a private insurer. Many include vision, dental, and hearing benefits that Original Medicare doesn’t cover. In 2026, the maximum out-of-pocket cap for Medicare Advantage plans is $9,250 for In-Network Expenses, which provides a ceiling on your annual exposure. #3 MEDICARE PART D PRESCRIPTION DRUG COVERAGE) Be sure to enroll in a Medicare Part D prescription drug plan when you’re first eligible to avoid permanent late enrollment penalties, even if you don’t currently take many medications. The rule is you must enroll in a plan within 63 days of your Medicare Part B Effective Date. (Most markets have at least one $0 premium Part D plan in each market. Even if you don’t take many prescriptions right now, enrolling in a Part D plan when you’re first eligible is a smart move. Skipping it and signing up later triggers a late enrollment penalty, calculated as 1% of the national base beneficiary premium for each month you went without creditable coverage. That penalty also stays for life. The 2026 average Part D premium is around $34.50 per month, and the maximum deductible is $615. Plans vary widely in what drugs they cover and at what tier, so checking each plan’s formulary against your specific medications is essential before choosing. In 2026, once your out-of-pocket drug costs reach $2,100, you enter the catastrophic phase, and your cost-sharing drops significantly. This change, made permanent in recent years, provides meaningful protection for people with high-cost medications. If your income is limited, the Extra Help program (also called the Low-Income Subsidy) can dramatically reduce your Part D costs. The 2026 Extra Help Income Limit (Individual) is $24,180. #4 EVALUATE YOUR MEDICARE SUPPLEMENT/MEDIGAP INSURANCE COVERAGE OPTIONS Medicare Supplement Plans and Medigap Plans are the same thing. Medigap plans (Medicare Supplement Insurance) help cover out-of-pocket costs such as deductibles, copayments, and coinsurance that Original Medicare doesn’t cover. Original Medicare is an 80/20 Healthcare plan, where Medicare covers 80% of all covered and approved services, leaving you to pay the remaining 20%. And since there are no annual maximums with Medicare, if you get hit with a serious health issue, that 20% can be a BIG number. Heck, 20% for a Hip Replacement is about $8,000 now. This is where your Medigap or Medicare Supplement plan comes in and often pays your 20% share (Plan F, Plan G, and Plan N, HDF, HDG), depending on which Medicare Supplement plan you choose. The most critical window is your 6-month Medigap Open Enrollment Period. It begins the month you turn 65 and are enrolled in Part B. During this window, insurers must sell you any plan they offer at standard rates, regardless of your health history. Pre-existing conditions cannot be used against you. Plan G is currently the most popular choice; it covers virtually everything except the Part B deductible ($283 in 2026), providing broad protection with predictable costs. Plan N offers lower premiums in exchange for small copays on some office visits and a potential exposure to Part B excess charges. Plan F is the most comprehensive, covering even the Part B deductible, but it’s only available to those who were eligible for Medicare before January 1, 2020. When comparing these plans, remember that the benefits are standardized by federal law; a Plan G from one insurer covers the same things as a Plan G from another. The only difference is the premium. Comparing prices is straightforward once you know which plan letter fits your needs. #5 UNDERSTANDING YOUR CURRENT EMPLOYER GROUP HEALTH PLAN, COBRA, AND SEPs (SPECIAL ENROLLMENT PERIODS) You may be able to delay Medicare enrollment without penalty if you have active employer coverage, but COBRA and retiree benefits do not qualify as creditable alternatives to Medicare. Photo of Braden Medicare Insurance's Special Election Periods For Medicare Poster. If you choose to work past 65, or are covered through a spouse’s employer plan? You may have more flexibility than you think. Federal rules allow you to delay Part B enrollment without penalty if you have active coverage through a current employer with 20 or more employees. The keyword is “active” retiree health coverage, and COBRA does not count as a creditable alternative to Medicare. When your employer coverage ends, you receive a Special Enrollment Period (SEP), generally 8 months to sign up for Part A and Part B without a late penalty. However, you typically have only 63 days to enroll in a standalone Part D plan or Medigap without complications. COBRA is a common source of confusion. The majority of new Medicare Beneficiaries assume COBRA protects them from Medicare late penalties. It does not. If you’re eligible for Medicare and choose COBRA instead, Medicare becomes primary when you eventually enroll, and the months you spent on COBRA after becoming Medicare-eligible may still count against you for penalty purposes. Getting clarity on this before making a COBRA decision can prevent costly mistakes. #6 UNDERSTANDING IRMAAA Beyond standard premiums, you may face higher costs due to Income-Related Monthly Adjustment Amounts (IRMAA) if your income is above certain thresholds, or you might qualify for Medicare Savings Programs if your income is limited. The $202.90 Part B premium is the standard rate, but not everyone pays it. If your income from two years ago exceeded certain thresholds, you’ll owe an Income-Related Monthly Adjustment Amount, known as IRMAA. For 2026, IRMAA is based on your 2024 tax return. Phot Of Braden Medicare Insurance's 2026 IRMAA Brackets Poster Individual filers with income above $109,000 enter the first IRMAA tier. At the highest income level (over $500,000 for individuals), the total Part B premium is $689.90 per month. Part D also carries IRMAA surcharges ranging from $14.50 to $91. If your income has dropped significantly since that look-back year, due to retirement, the death of a spouse, or other life changes, you can appeal IRMAA using IRS Form SSA-44. The Social Security Administration can use more recent income data to recalculate your surcharge. On the other end of the spectrum, Medicare Savings Programs help lower-income beneficiaries with premiums, deductibles, and cost-sharing. These programs are administered at the state level and have their own income and resource limits. If you think you might qualify, contacting your state Medicaid office is the right place to start. #7 YOUR ANNUAL REVIEW DURING MEDICARE ANNUAL ENROLLMENT PERIOD Your first enrollment is a major milestone, but Medicare isn’t a set-it-and-forget-it decision. Plans change their premiums, formularies, and networks every year. A plan that worked well this year may cost more or cover fewer of your drugs next October. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this window, you can switch Medicare Advantage plans, move from Medicare Advantage back to Original Medicare, or change your Part D drug plan. Changes take effect January 1. Review your Medicare coverage annually during the Annual Enrollment Period (AEP) from October 15 to December 7 to ensure your plan still meets your needs and budget for the upcoming year. Each fall, your plan sends an Annual Notice of Change letter. Read it carefully before AEP opens. If your drug costs have increased, your doctor left the network, or your premium jumped, that’s your signal to shop for alternatives. Even a 30-minute comparison during AEP can save meaningful money over the course of the year. Your health needs also evolve. A plan that was right at 65 may not be right at 70 or 75. Building in an annual review, ideally with a licensed Medicare agent who can compare options in your area, keeps your coverage aligned with your actual life. Photo Of Braden Medicare Insurance's Frequently Asked Questions Poster About The Medicare Enrollment Guide FREQUENTLY ASKED QUESTIONS ABOUT THIS ENROLLING IN MEDICARE CHECKLIST What is the most important deadline to remember when turning 65 for Medicare? Your Initial Enrollment Period, the 7-month window surrounding your 65th birthday, is the most critical deadline. Missing it can result in permanent late enrollment penalties on your Part B and Part D premiums, and those surcharges follow you for the rest of your coverage. Can I delay enrolling in Medicare if I have employer health coverage? Yes, but only if you have active coverage through a current employer with at least 20 employees. Retiree coverage and COBRA do not qualify as creditable alternatives, so relying on either of those to delay Medicare can expose you to penalties when you eventually enroll. What happens if I miss my Initial Enrollment Period for Medicare Part B? You’ll face a late enrollment penalty of 10% added to your Part B premium for every 12-month period you went without coverage. With the 2026 standard Part B premium at $202.90 per month, even a one-year gap adds a permanent surcharge. You’d also need to wait for the General Enrollment Period (January 1 – March 31) to sign up, with coverage starting July 1. How do I choose between Original Medicare and a Medicare Advantage Plan? Start by listing your current doctors and prescriptions, then check whether they’re covered under each option. Original Medicare offers broader nationwide provider access, while Medicare Advantage often offers lower upfront costs and additional benefits within a defined network. Your health status, travel habits, and financial situation should all factor into that comparison. What is IRMAA, and how does it affect my Medicare premiums? IRMAA is an income-based surcharge added to your Part B and Part D premiums. It’s calculated using your tax return from two years prior, in 2026, which means your 2024 income. Individual filers earning more than $109,000 pay higher premiums, with Part B surcharges up to $689.90 per month in the highest income bracket. When can I change my Medicare plan after my initial enrollment? The primary window is the Annual Enrollment Period (October 15 – December 7), where you can switch Medicare Advantage or Part D plans for the following year. Certain life events, such as moving, losing employer coverage, or qualifying for Medicaid, can also trigger a Special Enrollment Period outside AEP. WRAPPING THINGS UP We hope you found this article helpful and informative regarding how you can successfully navigate the Medicare Enrollment process. Working through this Medicare enrollment checklist before your 65th birthday puts you ahead of the curve, sets you up for success, and puts you in control of all of the critical decisions you will soon be making. Perhaps the most important thing to remember is that the deadlines discussed in this article are real, and the penalties are permanent. Acting within your Initial Enrollment Period, locking in your Medigap rights while you still have guaranteed issue protection, and enrolling in Part D before any late-penalty clock starts, those three actions alone protect you from the most common and costly mistakes new beneficiaries make. Every situation is a little different. If you’re still working, married to someone with employer coverage, or coordinating with VA benefits, your path through this checklist has nuances that a general guide can only partially address. We always think the best thing anyone approaching 65 can do is work with a local, experienced, independent Medicare Broker. Speaking with a licensed Medicare broker who can review 2026 Medicare costs and compare plans available in your zip code provides personalized clarity that no article can fully replace. If you are not sure where to look or how to proceed, please feel free to reach out to me via email at mike@bradenmsi.com or call me directly on my cell at (480) 225-1393. Use this checklist as your starting point. Then take the next step toward coverage that actually fits your life, your lifestyle, and please include a Son, Daughter, Niece, or Nephew to assist you.

Michael T. Braden May 14, 2026 MEDIGAP PREMIUMS COPING WITH THE FACT YOUR MEDIGAP PREMIUMS ARE INCREASING; WHAT CAN YOU DO? In today’s article, we are going to pull back the curtain and take a look at the recent alarming trend of Medigap premium increases over the past few years, and especially what has happened so far in 2026. We will explain the insurance company’s logic and examine the options you have to address these increased costs. I honestly believe that a good portion of the increases is driven by the current state of the economy and the “Greed Factor” among some insurers. But there is also some truth to the claim that companies are paying out more in claims due to the huge increase in Baby Boomers enrolling in Medicare over the past decade. Photo Of Braden Medicare Insurance's Medigap Rate Increases In 2026 Poster MEDICARE SUPPLEMENT PLAN G AND PLAN F PREMIUMS CONTINUE TO RISE SHARPLY IN 2026. Over 12 million Americans carry Medigap policies to help cover the gaps that Original Medicare leaves behind, such as deductibles, coinsurance, and Medicare cost-sharing. For years, annual premium increases were modest. That has changed. In early 2026 rate filings, Medigap Plan G premiums rose between 12% and 26% across many states. Some increases were even steeper. INA has filed increases as high as 45% in certain markets, and that is their 2nd increase in 2026. Last year, BCBSAZ, M of O, and AARP/UHC had the highest increases of all carriers in Arizona. The average monthly Plan G premium was around $164 in 2023, meaning these surges translate to real, meaningful dollars out of your pocket each month. This article explains why premiums are climbing so sharply, what your options look like, and the concrete steps you can take to protect your coverage and your budget. WHY HAVE MEDICARE SUPPLEMENT/MEDIGAP PREMIUMS RISEN SO DRAMATICALLY THE PAST 2-3 YEARS? The short answer is that insurers are paying out more in claims, and those costs are being passed on to policyholders. But several specific factors are converging to make 2026 particularly sharp. First, the Medigap population is aging. People who enrolled in Plan G years ago are now in their mid-to-late 70s and using significantly more healthcare services. Claims volume is rising, and insurers must adjust premiums to remain actuarially sound. Second, healthcare labor costs surged in the post-pandemic years and have not fully retreated. Hospital stays, specialist visits, and outpatient procedures all cost more today than they did in 2021 or 2022. Third, and this is a factor many beneficiaries don’t hear about, some enrollees are switching from Medicare Advantage back to Medigap. These are often sicker individuals who found MA’s network restrictions and prior authorization requirements limiting. When they move back to Medigap, they bring higher claims with them. Major insurers, including UnitedHealthcare, Aetna, Humana, Blue Cross Blue Shield, Cigna, and Mutual of Omaha, are relying on actuarial firms such as Telos Actuarial to justify these filings. Historically, annual Medigap Plan G increases have ranged from 3% to 6%. MEDIGAP RATE INCREASES ARE HAPPENING COAST TO COAST, WITH THE NORTHEAST, EAST, AND WEST COASTS SEEING THE LARGEST INCREASES Rate filings reviewed through early 2026 show Plan G increases clustering between 12% and 26%, though the range varies considerably by state and carrier. Some states with more aggressive regulatory oversight, like New York and Massachusetts, have seen smaller approved increases, while states with lighter-touch review processes have seen larger jumps pass through. Illinois, Alaska, and Ohio stand out in the data as states where multiple carriers filed double-digit increases. State insurance commissioners play a critical gatekeeping role here: they review insurer filings, can request justification, and in some cases reject or modify proposed rates. Plan G isn’t the only plan seeing pressure. Plan N premiums have also risen, though generally at a slower rate. High-Deductible Plan G remains a notably lower-cost option; premiums can run $40 to $70 per month in many markets, but it comes with a deductible of approximately $3,000 before coverage kicks in fully. Plan F, once the most popular Medigap option, is no longer available to beneficiaries who became eligible for Medicare after January 1, 2020. Those already enrolled can keep it, but new enrollees must choose from the remaining plan types. LET'S TAKE A LOOK AT YOUR OPTIONS TO COUNTERACT THE PREMIUM INCREASES YOU HAVE NO CONTROL OVER First, let's remember that the purpose of any insurance is to find someone who will take on the lion's share of your risks. In this case, your healthcare costs. You are charged a premium to keep yourself and your loved ones from catastrophic loss. With retirement, there is perhaps no bigger potential for loss than healthcare costs. You do have options, but perhaps the best option is to agree to share more of the risks with your insurance partner in exchange for lower premiums or fewer benefits. YOU HAVE OPTIONS TO REDUCE YOUR PREMIUMS BY LOOKING AT PLAN N, PLAN G, AND THE HDG (HIGH-DEDUCTIBLE PLAN G) When your Plan G premium jumps significantly, it’s worth understanding exactly what alternatives exist. Here is a structured look at the three most commonly considered options: COVERAGE PLAN G PLAN N HDG (High-Deductible Plan G) Estimated Monthly Premium (2026) $160–$250+ $110–$175 $40–$70 Part B Deductible Covered No No No (after deductible met) Doctor Visit Copays None Up to $20 copay None (after deductible) ER Copay None Up to $50 copay None (after deductible) Annual Deductible None None $2,950 (The $283 Part B Deductible Is Included) Part B Excess Charges Covered Yes No Yes (after deductible) Plan N is gaining traction among beneficiaries who regularly see doctors but want meaningful premium relief. The small copays are manageable for most, and the monthly savings compared to Plan G can be $50 to $80 or more. High-Deductible Plan G works best for beneficiaries who are relatively healthy and want a financial backstop for major events rather than routine coverage. Assessing which plan fits your situation means honestly evaluating how often you use care and how much financial risk you can absorb in a given year. You can explore strategies to reduce supplement costs as part of that review. HOW CMS AND YOUR STATES INSURANCE DEPARTMENTS CAN HELP YOU WITH OVERSIGHT: The Centers for Medicare & Medicaid Services (CMS) sets federal standards for what each Medigap plan letter must cover. This means a Plan G sold in Texas covers the same benefits as one sold in Oregon. What CMS does not control is the premium insurers charge for those standardized plans. That responsibility falls to state insurance commissioners. Each state has its own rate approval process. In states with prior approval requirements, insurers must submit actuarial justification before any increase takes effect. In states with file-and-use rules, an increase can take effect before formal approval, with review occurring afterward. A persistent underlying issue is that Traditional Medicare has no out-of-pocket maximum. Without Medigap, a beneficiary undergoing a prolonged hospital stay could incur tens of thousands of dollars in out-of-pocket costs. This structural gap in Original Medicare makes Medigap essential for many people, but it also means demand remains inelastic, giving insurers less pricing pressure from the market. Legislators, including Sen. Ron Wyden, have proposed federal out-of-pocket caps for Traditional Medicare, which could reduce the need for Medigap and potentially moderate premiums over the long term. Still, no such legislation has been enacted as of mid-2026. LOOK INTO WHETHER OR NOT YOUR STATE HAS ADOPTED A MEDICARE BIRTHDAY RULE Your ability to switch Medigap plans depends heavily on timing and where you live. Outside your Initial Enrollment Period, insurers can generally use medical underwriting, meaning they can charge more or decline coverage based on your health history. That’s a significant barrier for many beneficiaries with chronic conditions. However, several states offer important protection. The “Medicare Birthday Rule,” available in many states including California, Colorado, Washington, Oregon, Idaho, New Mexico, Ohio, Kentucky, Maryland, Illinois, Virginia, New York, Connecticut, Massachusetts, Maine and Nevada, allows Medicare beneficiaries to switch to a comparable or lesser plan around your birthday each year without underwriting. This is extremely valuable as we age. For those of you who have homes in two states, it makes sense to make the state that has a “Birthday Rule in place your primary residence. Yes, your premiums may be a little higher, but the security of being able to switch plans every year without the need to pass Medicare Underwriting is potentially worth its weight in gold. Even if you cannot switch today, comparing plans annually builds your understanding of the market. You’ll know what comparable coverage costs elsewhere, and you’ll be positioned to act quickly during any future guaranteed issue window. Independent Medicare Brokers who represent multiple carriers are particularly valuable here; they can run side-by-side comparisons across insurers and flag rate increase histories that aren’t obvious from a single quote. AS YOU AGE, YOU MIGHT CONSIDER A MEDICARE ADVANTAGE PLAN Medicare Advantage is often the first alternative that comes to mind when Medigap premiums feel unsustainable. MA plans typically have lower monthly premiums, many $0-premium options still exist in 2026, and they include an annual out-of-pocket maximum, which Traditional Medicare lacks. The trade-offs are real, though. MA plans operate within provider networks, meaning your current doctors may not be covered. Prior authorization requirements can delay or complicate access to specialty care. If you enroll in Medicare Advantage and later want to return to a Medigap plan, you’ll typically face medical underwriting in most states. A health condition you developed while on MA could make it difficult or even impossible to qualify for Plan G coverage at a standard rate. That asymmetry- easy to leave Medigap, hard to come back- is a factor worth weighing carefully before making the switch. You can review how switching from MA to Medigap works before making any decisions. I am a firm believer that giving up control of your own healthcare to a corporation, in this case an Insurance company, is not prudent. And with the high MOOP (Maximum Out-of-Pocket) limits, there is a strong argument for keeping Original Medicare and adding a High-Deductible Plan G (HDG) rather than switching to a Medicare Advantage plan (Medicare Part C). FREQUENTLY ASKED QUESTIONS REGARDING MEDICARE SUPPLEMENT/MEDIGAP PREMIUM INCREASES HOW MUCH WILL MY PLAN G PREMIUM INCREASE IN 2026? There is no way to guarantee where your premiums will be at the end of 2026. Medigap Plan G premiums have been increasing 10%-45% in many states. Some individual carriers have had multiple increases already in 2026, with a handful of insurers increasing their Plan G premiums by over 30%. It is important to remember that the actual increase you face depends on your carrier, your state, and your age-rating method. WHY IS MY PREMIUM PRICE SKYROCKETING OVER THE PAST TWO YEARS? Your Medigap Plan G premium is likely to increase due to several converging factors. These include higher claims from an aging Medigap population, increased healthcare and labor costs, and a wave of sicker beneficiaries switching back from Medicare Advantage. Insurers are adjusting rates to keep plans financially viable based on actuarial projections. AM I ALLOWED TO SWITCH PLANS OR FIND A DIFFERENT INSURANCE COMPANY TO PARTNER WITH? Yes, you can switch Medigap plans, but your ability to do so without medical underwriting is limited. You can switch without medical underwriting during your Initial Enrollment Period or if your state offers guaranteed-issue rights, such as the Birthday Rule. Outside those windows, most states allow insurers to apply medical underwriting, which can limit your options if you have preexisting conditions. WHERE CAN I GET FAIR AND UNBIASED OPTIONS TO UNDERSTAND MY MEDICARE OPTIONS BETTER? You can get unbiased help with your Medigap options from several reliable sources. Contact your State Health Insurance Assistance Program (SHIP) for free, non-sales counseling. You can also work with an independent Medicare broker, like Braden Medicare Insurance Services; we represent multiple carriers and can compare rates and plan structures across your available options. WRAPPING THINGS UP The sheer rate of Medicare Supplement (Medigap) premium increases has been alarming over the past 24 months. Plan F AND Plan G have had the highest percentage of increases, while Plan N and the High-Deductible Plan F and High-Deductible Plan G have remained virtually unchanged. The 12% to 40% Medigap Plan G premium increases hitting beneficiaries in 2026 represent a real financial challenge, one that rewards preparation over passivity. Reviewing your current plan, understanding your state’s switching rules, and comparing alternatives like Plan N or High-Deductible Plan G are all steps worth taking now, not at renewal time. Free resources like SHIP counselors and independent brokers exist precisely to help you sort through these decisions without pressure. Your coverage choices directly shape your healthcare stability, and understanding those choices is the most important thing you can do this year. As always, if you want to discuss your options and you're not sure who to call, please feel free to reach out to me anytime. You can reach me via email atm mike@bradenmedicare.com; call or text me at (480) 225-1393; and submit an inquiry on our website at www.bradenmedicare.com 24 hours a day.

Michael T. Braden May 7, 2026 Medicare 101 Photo of Braden Medicare Insurances' Medicare Supplement Underwriting Poster MEDICARE SUPPLEMENT UNDERWRITING GUIDELINES · If you can truthfully answer ‘No’ to all or most of the underwriting questions you encounter on a Medicare Supplement application, you should have a good chance of passing the underwriting process, depending on the carrier, as some carriers have more stringent rules than others do. · Chronic conditions like immune disorders, having been diagnosed or prescribed COPD medications or medications usually used in the treatment of Congestive Heart Failure, Atrial Fibrillation, having an implanted Defibrillator, and other major heart disorders often result in your new Medicare Supplement Application being denied. Some carriers can decline you if you use Insulin to control Diabetes. However, minor conditions like Asthma or Hypertension are usually not an issue. · Some states have special underwriting rules that offer additional enrollment periods for residents to apply for Medigap plans without underwriting, including California, Illinois, New York, Washington, Maryland, Kentucky, Idaho, Oregon, Utah, Virginia, and New Mexico. There are currently 21 States that have some form of Birthday or Anniversary Rules for Medicare Supplement Enrollments. Most of the time, after your initial Enrollment for a Medicare Supplement or Medigap plan, Medical Underwriting is usually required when you want to switch carriers or change to a different “lettered” Medicare Supplement plan. Perhaps you’ve been on your Medigap plan for a while, and the rate has gone up a few times. Maybe you originally signed up for Plan F, and now you are interested in switching to Medicare Supplement Plan G, which has lower monthly premiums and historically lower premium increases than your current Plan F. One of the most important decisions one can make once they turn 65 is their one chance to enroll in any Medicare Supplement plan of their choosing with Guaranteed Issue Rights, and they do not have to answer any Medical Questions. However, once that Initial Enrollment Period or Medicare Supplement Open Enrollment Period has passed, there is no guarantee you will be approved for a Medicare Supplement plan in most states. You’ll need to answer health questions and pass underwriting to get approved for a plan. This can create some anxiety about getting through Medigap underwriting. Fortunately, hundreds of thousands of people pass underwriting to change plans each year. Let’s take a closer look at situations that are likely to lead to approval, and which circumstances might cause an Underwriter to deny your application. We hope that the more you understand the Medicare Supplement Underwriting Process, the better you will understand the Medigap underwriting process. STATES WITH ADDITIONAL MEDICARE SUPPLEMENT OPEN ENROLLMENT OPPORTUNITIES Photo Of Braden Medicare Insurances' Medicare Supplement Birthday Rule Poster In California, Oregon, and Maryland, you can change your Medigap policy during your birthday month with no Medigap underwriting. You must have an existing policy in place to qualify. Have your agent run quotes for the same plan or a lower one to see if lower rates are available. If so, completing the application is short and easy because there are no health questions. Missouri residents have an anniversary rule. You can change Medigap carriers, while keeping the same level of coverage, during the months surrounding your Medigap anniversary. For example, you can switch from one Plan G to another without underwriting, but not from Plan G to a Plan N. The anniversary rule window generally starts 30 days before your anniversary and ends 30 days after. Delaware Medigap enrollees can change to another plan of equal or lesser coverage 30 days before and up to 30 days after their birthday. Illinois Medigap enrollees ages 65 to 75 have 45 days after their birthday to change their Medigap policy without medical underwriting. They can only purchase a Medigap policy with equal or lesser coverage from their current Medigap carrier. Idaho has a birthday rule that allows Medigap enrollees to switch to a different Medigap plan of equal or lesser coverage. This window starts on their birthday and ends 63 days afterward. Indiana residents have a “guaranteed issue” period to change to the same lettered Medigap plan with a different carrier, without underwriting. This window begins one month before their birthday and ends one month after the enrollee’s birthday. Louisiana Medigap enrollees who are at least 65 years old can change to another Medigap policy with no health questions asked around their birthday each year. They have 63 days after their birthday to make this change. Nevada Medigap enrollees can change their Medigap plan to a different plan with equal or lesser coverage without underwriting on their birthday. This window starts on the 1st of their birthday month and lasts for 60 days. Oklahoma has a birthday rule that allows Medigap enrollees to switch to another Medigap plan with equal or lower value. Enrollees will have a 60-day window that starts on their birthday. Kentucky residents have a birthday rule that allows Medigap enrollees to change to the same plan with a different carrier. Enrollees can use this guaranteed issue right within 60 days of their birthday. Rhode Island Medigap enrollees who have been covered by a Medicare Supplement or Medicare Advantage plan (with no gap longer than 90 days) beginning from their Medicare Supplement Open Enrollment Period, will have a 30-day window starting on their birthday to switch to any available Medicare supplement plan without medical underwriting. Utah Medigap enrollees can change their Medigap plan to one of equal or lesser coverage with their current insurance carrier. Effective May 7, 2025, this window starts on their birthday and ends 60 days after each year. Virginia has a birthday rule that allows Medigap enrollees to switch to a different insurance carrier offering the same coverage within 60 days of their birthday month without underwriting. Wyoming has a birthday rule that allows people with a Medigap plan to switch to a different policy with similar or lesser benefits. Effective June 4, 2025, this window starts on the beneficiary’s birthday and lasts for 63 days. West Virginia Medigap enrollees who have had the same Medigap policy for at least 2 years can change their Medigap policy with no health questions asked. Effective June 11, 2026, West Virginia residents have a 60-day window beginning on the first day of their birthday month to purchase a plan of equal or lesser coverage from their current insurance company or an affiliated company, unless no comparable plan is available. New Mexico has a birthday rule that allows its residents to change their Medigap policy to one of equal or lesser value with no health questions asked. Effective January 1, 2027, have a 60-day window beginning on the first day of their birthday month. Connecticut, Maine*, Massachusetts*, New York, Vermont (some carriers), and Washington** have Medigap Open Enrollment year-round. However, each of these states has specific rules with its year-round Open Enrollment. *In Maine, you must have never had a lapse of Medigap coverage lasting longer than 90 days to access the year-round Open Enrollment benefit. Also, you can only switch to a plan with the same or fewer benefits. *In Washington, if you have a Plan A, you can only switch to another Plan A without underwriting. However, if you have any other Medigap plan, you can switch to any other Medigap plan without underwriting. *In Massachusetts, some carriers offer continuous year-round Open Enrollment. However, there is also a guaranteed issue window between February 1st and March 31st during which you can change policies with no health questions asked. ANSWERING QUESTIONS ON A NEW MEDICARE SUPPLEMENT APPLICATION Now that we’ve covered Guarantee Issues, let’s dive deeper into just how the insurance companies use the Underwriting process. Each insurance company has its own Medigap application. That application will include at least one page of health questions. There will be questions about certain conditions that you have ever had, and others that ask about a recent period of time. It’s common to see questions about the last one to three years of your health history. Generally, you’ll need to answer NO to some or all of the health questions as indicated in the application. Answering yes to a question results in an automatic decline with most carriers. You are not eligible for the coverage and do not need to even submit the application. There may be limited exceptions with a few carriers, depending on your state laws, so it’s always good to ask your agent about any possibilities. That may sound harsh, but even though it is a fair description, we have found that about 7 out of 10 applicants can safely pass the Medicare Supplement Underwriting Process. As you read through the following sections, I’ll give you some sample questions from actual Medigap carrier applications. QUESTIONS FROM MEDICARE SUPPLEMENT APPLICATIONS When you are looking for a Medicare supplement plan, our team can help identify which carriers are the best fit for you. They’ll know which carriers have underwriting questions that may be more lenient than others for certain health conditions. Nearly all applications will ask for information about ongoing conditions. For example: In the past 3 years, have you been diagnosed with, received any treatment, or been prescribed any medications for the following conditions: · Internal Cancer · Heart Conditions · Atrial Fibrillation · Stroke or Transient Ischemic Attack · Stent · Chronic Obstructive Pulmonary Disease · Diabetes · Osteoporosis · Rheumatoid or other chronic disabling arthritis Now that you have a feel for the type of questions, let’s look at how various health conditions or procedures could affect you. MINOR HEALTH CONDITIONS THAT USUALLY ARE APPROVED BY MOST CARRIERS The first thing you’ll notice is that the health questions don’t concern minor things like seasonal allergies or the flu. Likewise, they don’t really care if you had two colds last year or a urinary tract infection. Certain injuries are a non-issue as well, as long as you are fully healed and done with treatment. Additionally, conditions like high blood pressure and high cholesterol are not an issue as long as they are not occurring alongside another more serious condition. Minor arthritis is not a problem, but as you’ll see below, a more serious form of rheumatoid arthritis would cause a decline. Your Body Mass Index (BMI) is usually less of a factor on Medigap plans than on other types of insurance, like life insurance. Carrying a few extra pounds is not a problem as long as you are not morbidly obese. Every carrier will have underwriting guidelines about this, so your agent can check your height/weight against the company’s guidelines to make sure you don’t apply if your BMI will cause a decline. But I should mention that, although it generally will not result in you being denied coverage, you could be moved to a Standard I or Standard II rate instead of a Preferred Rate. IF YOU HAVE SCHEDULED SURGERIES OR RECOMMENDED PROCEDURES, TAKE CARE OF THOSE BEFORE APPLYING FOR A NEW MEDICARE SUPPLEMENT/MEDIGAP PLAN Now we’ll begin to move into potentially declinable situations, and expensive pending procedures top the list. No insurance carrier wants to cover you just before a costly diagnostic test or major surgery. Remember that since Medicare Supplement Insurance Carriers are responsible for paying for 20% of Surgical Costs/Procedures, these insurance carriers have a vested interest in making sure you take care of any outstanding procedure and/or surgeries completed with your current insurer, before they will want to accept the risks that have already been identified, before applying with them. This is the case even if your pending surgery is for something non-life-threatening, such as endometriosis or having your appendix removed. You will need to complete the surgery and any follow-up visits or therapy before a new carrier will consider you. Some carriers may also ask for a window of time to clear after a major surgery, such as a knee replacement. Since hardware problems can occur, they may ask you to wait a year or two before submitting your application. Requirements vary, though. Be sure to ask your agent about which carriers’ questions offer you the best chance. IF YOU HAVE HAD RECENT MAJOR CARE OR SURGERY, YOU SHOULD WAIT BEFORE APPLYING Medigap carriers also ask questions about recent major care. If you are receiving home health care or have been hospitalized 2 or more times in the last 2 years, it is common for the carrier to decline you right on the application. Likewise, if you are a resident in a nursing home, you may not be eligible. Since people rarely go from assisted living or nursing homes back to living on their own, your current coverage may be the coverage you need to stick with for the rest of your life. Many people also ask us about cancer. When it comes to a major life illness, such as cancer, carriers usually want at least 2 years cancer-free and in remission before considering you. If you have had recent surgery or are still being treated, you’ll need to wait a few years before you apply. There is at least one major carrier that will consider people with cancer or other serious conditions, but will charge you a significantly higher rate for the coverage. Sometimes we find that your current carrier is cheaper than switching to a carrier that is “rated up” for a major health condition. IF YOU HAVE DOCUMENTED CHRONIC OR UNTREATABLE CONDITIONS OR MALLADIES, YOU NEED TO KEEP YOUR CURRENT POLICY Some illnesses are treatable but incurable. If you have a serious illness that will require treatment forever, you’ll find that the questions on most Medigap applications will exclude you. Common examples would be dementia, chronic lung disorders, immune disorders such as RA, MS, Lupus, or AIDS, and nervous system disorders such as Parkinson’s. Osteoporosis with fractures will also be problematic. The insurance company knows these conditions will require lifetime expensive care. Major heart disorders might also prevent you from changing insurance carriers. Arterial and vascular diseases, history of heart attack and/or strokes, stents, pacemakers, and congestive heart failure are some examples. Many carriers decline due to rhythm defects or valve problems. Kidney failure and/or organ transplants can cause a decline in most circumstances. BORDERLINE CONDITIONS ARE NOT GUARANTEED TO BE APPROVED Some conditions are what we call borderline. How a carrier asks and phrases the related question on their application may determine whether you can pass Medigap underwriting. Diabetes is considered a borderline condition. If you only take oral meds or less than 50 units of insulin, you might get approved. With diabetes, carriers look at relative conditions. For example, if you have diabetes and high blood pressure with cholesterol or neuropathy, it is much harder to get approved than if you have diabetes without any related conditions. This is one condition where I always advise you to talk to an agent. Individual Medigap underwriting guidelines for this condition vary widely. Your agent will know where you’ll have the best chance. Another example would be mental health conditions. Generally, seeing a therapist or taking a mild antidepressant is not an issue. However, more chronic mental disorders can cause declines. CAN YOU BE DECLINED BASED ON MY PRESCRIPTION MEDICATIONS Medicare Supplement insurance carriers have access to national records regarding your prescription history. On your application, you must agree to allow the carrier access to these records. When the carrier pulls the report, they will check whether any prescriptions in your record indicate a declinable condition. For example, if you take a blood thinner, the insurance company wants to know why. They’ll look closely at what other medications you take that could indicate significant health problems. It’s important to be honest. Try hard to remember all the meds you’ve taken recently. Think back over your medication history. If your doctor once prescribed a medication for lupus, but you didn’t mention lupus on your application, that’s a red flag. You may not consider yourself to be “taking that medicine,” but it still exists in your record. It is safer to assume they will ask about it. THERE IS A LIST OF DECLINABLE MEDICATIONS Carriers also have a list of auto-decline medications. These are medications that treat major or chronic illnesses. By taking these meds, you indicate a health condition that might be costly for the carrier to treat. Sometimes a certain mix of medications is problematic. If you take diabetes meds along with high blood pressure and cholesterol meds, you may be denied. Carriers will look at your history with those meds and see how recently your dosages have changed. Frequent or recent changes can work against you. One set of medications that can sneak up on you is pain medications. If you took a short-term round of hydrocodone while recovering from surgery, this usually won’t be a problem. However, if you have been taking it regularly, then that indicates an underlying and potentially costly problem. The Medicare Supplement carriers don’t usually like to take a chance on this. Similar problematic pain meds include fentanyl, morphine, oxycodone, and OxyContin. PERTAINING TO MEDICAL RECORDS Something we’ve noticed over the years is that many people don’t always know what’s in their medical records. Think carefully about this. If your doctor has told you that you are pre-diabetic, ask him what is written in your file. Did your doctor sugar-coat that health condition in his conversation with you? Perhaps he told you that you were pre-diabetic, but what matters is what he wrote in the file. If your chart says diabetes, that is what the carrier will include in its assessment. If you are unsure, ask your doctor before you apply. Also, if a doctor prescribes medication that you have no intention of filling, tell him that at the appointment and ask him not to prescribe it. Once it is prescribed, it’s in your medical record. SUBMITTING YOUR MEDICARE SUPPLEMENT REPLACEMENT APPLICATION Once your agent has identified which insurance company you’ll apply for, she can usually take that application from you over the phone or by emailing you a printable application. You’ll complete the application, and your agent will check that you have answered NO to all questions that require a NO. Switching Medigap plans can take time, so I recommend applying for a future effective date 2–3 weeks out. This gives the new insurance company plenty of time to complete underwriting and give you an answer before the coverage takes effect. Your agent forwards your application to the Medigap underwriting department. An underwriter will call you. Phone interviews are an important part of the insurance company’s decision process. Underwriters will usually have questions related to your medical records and prescriptions you’ve taken. Occasionally, they may ask you to provide medical records if your doctor’s office is unwilling to forward them, but this is relatively rare. Don’t volunteer any more information than what the underwriter asks you. Sometimes, we see someone get declined for information that they voluntarily offered that was not an answer to a question asked by the underwriter. Use yes and no answers to questions whenever possible. NEVER CANCEL YOUR CURRENT POLICY UNTIL YOUR NEW POLICY HAS BEEN FORMALLY APPROVED Don’t cancel your current coverage until your agent notifies you of your approval. Here at Boomer Benefits, we watch the pending applications daily and notify our clients immediately. Once you receive that call, you will always need to contact your old carrier to cancel that coverage. Your insurance agent cannot cancel prior coverage for you. That rule exists to protect you. So never, ever assume that your agent is canceling your old coverage for you. Many people have contacted us over the years for help who had actually enrolled in MORE than one supplement plan from different agents before they found us. There is NEVER any reason to have double Medigap coverage. WHAT HAPPENS IF YOUR APPLICATION IS DENIED? So if you apply and get denied, is that the end of the world? Does it mean that everyone else will deny you, too? Not necessarily. Our team has had great success with evaluating reasons for denial and examining other carriers to see where else you might have a chance. If there are no other carriers that are likely to accept you, we’ll tell you. Then you can decide whether to keep your current coverage or explore other options, such as Medicare Advantage. It’s worth noting that the fall open enrollment period for Medicare Part D Prescription Drug plans does not apply to Medigap plans. That period is NOT when you can apply to a new Medigap carrier and skip the health questions. If you can’t pass the underwriting because of health conditions, you will have a choice to make. You can keep your existing policy or consider the Medicare Advantage plan, which has no health questions. WRAPPING THINGS UP Going through Medigap underwriting can be a scary time. With Braden Medicare Insurance, you don’t have to go it alone. We’ll choose the carrier where you have the best chance. We don’t want to waste your time. If we believe you can’t pass Medigap underwriting questions right now, we’ll be the first to tell you. Sometimes waiting a few months can make a difference. The worst thing is getting declined and being unsure whether you have any other options. Working with us means you’ve got someone to advise you of your options. REMEMBER · There is no penalty or repercussion for applying for a Medigap plan and being denied due to underwriting. So, it doesn’t hurt to try. · Some carriers may be more lenient with their underwriting process, so it doesn’t hurt to try with another carrier if one denies you.

Michael T. Braden May 7, 2026 MEDICARE NEWS Photo Of Braden Medicare Insurance's Poster Of Medicare's New GLP-1 Program Medicare is launching a new short-term program called the GLP-1 Bridge, providing Part D enrollees access beginning July 1, 2026. This article explains who qualifies, what drugs are covered, and how to get started. WHO IS ELIGIBLE FOR GLP-1 DRUGS UNDER MEDICARE’S NEW BRIDGE PROGRAM? For years, people covered by Medicare had little to no access to prescription medications approved specifically for weight management. That changed May 6, 2026, in a major announcement sure to have dramatic implications for seniors & the pharmaceutical industry when the Centers for Medicare & Medicaid Services (CMS) announced the details of the Medicare GLP-1 Bridge — a short-term demonstration program designed to give eligible Medicare Part D enrollees access to certain GLP-1 weight-loss drugs beginning July 1, 2026. WHAT IS THE MEDICARE GLP-1 BRIDGE PROGRAM? The Medicare GLP-1 Bridge is a federal demonstration program administered by CMS. It will run from July 1, 2026, through December 31, 2027, and operates separately from the standard Medicare Part D drug benefit. As a result, the program has its own prior authorization process, claims system, and payment structure. CMS is using Humana — which already administers the federal Limited Income Newly Eligible Transition (LI NET) program — as the central processor. Humana will handle prior authorizations, process pharmacy claims, and pay pharmacies directly for drugs dispensed under the Bridge. Importantly, your Part D plan does not need to opt in to this program. If you meet the eligibility criteria, you can access the covered GLP-1 drugs through this program regardless of which Part D plan you are enrolled in. The program is available in all 50 states and U.S. territories. WHO CAN PARTICIPATE IN THE BRIDGE PROGRAM? Eligibility for the GLP-1 Bridge comes down to two sets of requirements: your plan enrollment type and your clinical profile. ENROLLMENT REQUIREMENTS FOR THE BRIDGE PROGRAM To qualify, you must be enrolled in one of the following Medicare drug coverage plans: · A standalone Medicare Part D Prescription Drug Plan (PDP) · A Medicare Advantage plan with prescription drug coverage (MA-PD), including HMOs, HMO Point-of-Service plans, and Local or Regional PPO plans. · People enrolled in Special Needs Plans (SNPs) and dually eligible individuals (those enrolled in both Medicare and Medicaid) who are in an eligible plan type are also able to participate. However, not all plan types are included. According to CMS's official guidance on the Medicare GLP-1 Bridge, people enrolled in private fee-for-service plans, PACE organizations, section 1876 cost contract plans, section 1833 health care prepayment plans, fallback plans, religious fraternal benefit plans, and employer or union group waiver plans (EGWPs) are generally not eligible — unless they are also enrolled in a standalone PDP. ELIGIBILITY CRITERIA Beyond plan enrollment, you must also meet specific medical criteria that your provider will attest to when submitting a prior authorization request on your behalf. The drug must be prescribed to reduce excess body weight and maintain weight reduction, in combination with lifestyle modification — including structured nutrition and physical activity — consistent with the applicable FDA-approved label. THERE ARE THREE OPTIONS/PATHWAYS FOR THE MEDICARE GLP-1 BRIDGE PROGRAM Option/Pathway 1 — BMI of 35 or higher: You are at least 18 years old and have a BMI of 35 or above when you began GLP-1 therapy. No additional diagnosis is required. Option/Pathway 2 — BMI of 30 or higher, with a qualifying condition: You are at least 18 years old, have a BMI of 30 or above when you began therapy, and have been diagnosed with one of the following: · Heart failure with preserved ejection fraction · Uncontrolled hypertension (systolic blood pressure above 140 mm Hg or diastolic above 90 mm Hg, despite taking two antihypertensive medications) · Chronic kidney disease, stage 3 or higher Option/Pathway 3 — BMI of 27 or higher, with a qualifying condition: You are at least 18 years old, have a BMI of 27 or above when you began therapy, and have been diagnosed with one of the following · Pre-diabetes (as defined by American Diabetes Association guidelines) · A previous heart attack (myocardial infarction) · A previous stroke · Symptomatic peripheral artery disease One important note: the clinical criteria are assessed at the time you first started GLP-1 therapy — not necessarily at the time the prior authorization request is submitted. This matters for people who began a GLP-1 medication before enrolling in Medicare or before the Bridge program launched. For example, if someone started therapy in 2024 with a BMI of 37 but has since lost weight and now has a BMI of 34, their provider can still attest that they met the BMI ≥35 criterion at the time therapy was initiated. WHICH MEDICATIONS ARE AVAILABLE FOR THE MEDICARE GLP-1 BRIDGE PROGRAM? As of the program's April 2026 update, three medications are covered under the Medicare GLP-1 Bridge for weight management: Foundayo (all formulations) Wegovy (injection and tablet formulations) Zepbound (Kwik Pen formulation only — the single-dose vial and single-dose pen are not included) These drugs are covered specifically for weight reduction and maintenance. If a GLP-1 medication is prescribed for a different use — such as Zepbound for obstructive sleep apnea, or Wegovy to reduce the risk of major cardiovascular events — that prescription would be handled through the standard Part D benefit, not the Bridge program. The list of covered drugs and their specific National Drug Codes (NDCs) may be updated over the course of the program. CMS has stated it will notify providers and pharmacies of any changes. HOW MUCH DOES THIS GLP-1 BRIDGE PLAN COST? The out-of-pocket cost for beneficiaries participating in the Medicare GLP-1 Bridge is a flat $50 copay per monthly supply, regardless of which phase of the Part D benefit you are in. This is a key distinction from standard Part D drug coverage, where your cost-sharing can change depending on whether you are in the deductible, initial coverage, or catastrophic phase. It is also worth knowing that the $50 copay and the cost of the drug itself do not count toward your Part D plan's true out-of-pocket (TrOOP) calculation. Similarly, low-income cost-sharing subsidies (also called Extra Help) do not apply to the Bridge program copay. Participating drug manufacturers have agreed to supply eligible GLP-1 drugs at a net price of $245 per monthly supply. Pharmacies are reimbursed at the wholesale acquisition cost, minus the copay, plus a dispensing fee. Coupons and discount programs cannot be applied to Medicare GLP-1 Bridge claims. HOW CAN YOU ACCESS THIS BRIDGE PROGRAM? The process begins with your medical provider/doctor. To get coverage through the Medicare GLP-1 Bridge, your provider must: Submit a prior authorization request to the central processor (Humana, acting on behalf of CMS), attesting that you meet the clinical criteria described above. Prescribe one of the covered GLP-1 drugs. Providers do not need to be enrolled in Medicare to write the prescription or submit the prior authorization. Still, they must not appear on Medicare's Preclusion List — a list of providers who are barred from participating in Medicare programs. Once the prior authorization is approved, you can fill your prescription at a participating pharmacy. Pharmacies do not need to opt in to the program; they automatically participate. Claims are submitted electronically through a specific Bank Identification Number (BIN) and Processor Control Number (PCN) established by CMS for the Bridge program. CMS has indicated it will release detailed guidance on prior authorization processes and pharmacy claims procedures ahead of the July 1, 2026, launch. MISCONCEPTIONS AND MYTHS REGARDING THIS NEW GLP-1 BRIDGE PROGRAM Understanding any new government program isn't always as well-defined and straightforward as we would like. Here are some of the most common misunderstandings about the Medicare GLP-1 Bridge — and the facts that clear them up. Myth 1 Any Medicare beneficiary can get GLP-1 drugs through this program. Not quite. You must be enrolled in an eligible type of Part D plan and meet specific clinical criteria related to your BMI and health history. People in certain plan types — like PACE organizations, private fee-for-service plans, or employer group waiver plans — generally do not qualify. Myth 2 If your BMI is lower than it was when you started treatment, you no longer qualify. This is not correct. Eligibility is based on your BMI and health status at the time you first began GLP-1 therapy, not your BMI today. Someone who has lost weight since starting treatment may still qualify if they met the criteria at the time therapy was initiated. Myth 3 Your Part D plan needs to approve or cover the drug under the Bridge program. Your Part D plan does not need to take any special action for you to access the Bridge. The program operates separately from standard Part D coverage. If your plan receives a prior authorization request for a GLP-1 drug for weight management, CMS strongly encourages the plan to redirect the provider to the central processor — but the Bridge program functions independently. Myth 4 Your GLP-1 drug costs under the Bridge program count toward your Part D out-of-pocket maximum. They do not. Spending through the Bridge program is not counted toward your TrOOP total under your Part D plan. This also means that Extra Help (low-income subsidy) benefits do not reduce your Bridge copay. Myth 5 Only people who start GLP-1 therapy after July 1, 2026, can participate. People who were already taking a covered GLP-1 drug before the program launched — including those who began treatment before enrolling in Medicare — may still be eligible, as long as they met the clinical criteria when they first started therapy. WHAT TO DO NEXT If you think you or a family member might qualify for coverage through the Medicare GLP-1 Bridge, here are practical steps to take: Confirm your plan type. Check whether you are enrolled in a standalone PDP, an MA-PD plan (HMO or PPO), or a Special Needs Plan. If you are unsure, call the number on the back of your Medicare ID card or log in to Medicare.gov. 1. Talk with your doctor or prescriber. Ask whether a covered GLP-1 medication is appropriate for you and whether you meet the clinical criteria — particularly in terms of BMI at the time you first began (or would begin) therapy, and any qualifying diagnoses. 2. Ask your provider to submit a prior authorization. The prior authorization must go through the Bridge program's central processor, not your Part D plan. Your provider will need to attest that you meet the clinical criteria. 3. Clarify your BMI history. If you have already been taking a GLP-1 drug, make sure your provider has access to your medical records from when therapy was first initiated, since eligibility is based on that point in time. 4. Understand the cost structure. Plan for a $50 copay per monthly fill. Know that this expense does not count toward your Part D deductible, coverage gap, or true out- of-pocket total. 5. Check for program updates. CMS has indicated it will release additional guidance in Spring 2026. Keep an eye on CMS's dedicated GLP-1 Bridge page for the latest information on prior authorization processes and participating drugs. 6. Seek independent Medicare counseling if needed. Your State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling. Find your local SHIP at shiphelp.org. FAQ’S ABOUT THE MEDICARE GLP-1 BRIDGE PROGRAM WILL THE MEDICATIONS BE AVAILABLE NATIONWIDE? Yes. The program is available in all 50 states and U.S. territories, and it is open to eligible beneficiaries regardless of which state they live in. CAN I ACCESS THIS PROGRAM IF I HAVE MEDICARE PART C? Yes, if you are enrolled in an MA-PD plan — which is a Medicare Advantage plan that includes prescription drug coverage through an HMO, HMO Point-of-Service, or PPO arrangement — you may be eligible. However, if your Medicare Advantage plan does not include drug coverage, or if you are enrolled in a private fee-for-service plan, you would not qualify unless you also have a standalone PDP. IS IT OKAY IF I HAVE NEVER USED PRESCRIPTION MEDICATION FOR WEIGHT LOSS IN THE PAST? The CMS clinical criteria published for the Medicare GLP-1 Bridge do not require that you have tried and failed other weight-loss treatments before becoming eligible. The criteria focus on your BMI at the time of GLP-1 therapy initiation and whether you have any of the listed qualifying health conditions. WHAT HAPPENS IF THESE MEDICATIONS ARE NOT IN MY DRUG PLAN’S FORMULARY? The Bridge program operates independently of your Part D plan's formulary. Even if a covered GLP-1 drug is not on your plan's formulary, you can still access it through the Bridge if you meet the eligibility criteria. WHAT IF MEDICARE SETS A NEW PRICE FOR ANY OF THESE THREE MEDICATIONS? CMS has confirmed that the negotiated Maximum Fair Price (MFP) for Wegovy — which is part of the Medicare Drug Price Negotiation Program — does not take effect until January 1, 2027. For the 2026 portion of the Bridge program, the negotiated price and the Bridge program operate independently. CMS has stated that more information about how these two programs will interact in 2027 is forthcoming, per the Medicare GLP-1 Bridge FAQ. IS IT OKAY TO USE MANUFACTURERS COUPONS OR A DISCOUNT CARD TO REDUCE THE $50 COPAY? No. Coupons, manufacturer discount programs, and similar tools cannot be applied to claims submitted through the Medicare GLP-1 Bridge. DOES MY DOCTOR HAVE TO ACCEPT MEDICARE TO PRESCRIBE MY MEDICATIONS THROUGH THE BRIDGE? Yes. Consistent with how Medicare Part D generally works, a provider does not need to be enrolled in Medicare to write a prescription or submit a prior authorization request under the Bridge program. The only restriction is that the provider must not appear on Medicare's Preclusion List, which bars certain providers from participating in Medicare programs. WRAPPING THINGS UP We all hope you found this article about the new Medicare GLP-1 Bridge Program as informative and exciting as we did. There are currently no other updates at the time of this article's publication. But please stay tuned, and we will be sure to add any further updates as they become available.

Michael T. Braden May 6, 2026 MEDICARE 101 HOW BRADEN MEDICARE INSURANCE ASSISTS YOU IN SOLVING THESE 7 MEDICARE POST-ENROLLMENT COMPLAINTS Medicare is the National Health Insurance for Americans 65 and older, and for some with an approved disability designation from the Social Security Administration. With well over 70 million people enrolled in Medicare. As you can imagine, some beneficiaries have Medicare complaints that are difficult to resolve on their own. Whenever this happens, Braden Medicare is right by your side. We will work with you, using our knowledge and expertise, to resolve any Medicare issues quickly and efficiently. Picture Of Braden Medicare Insurance's 7 Common Medicare Post-Enrollment Complaints Poster MY DOCTOR'S OFFICE IS ASKING ME TO PAY MY PART B DEDUCTIBLE, EVEN THOUGH I'VE ALREADY PAID IT. Oftentimes, doctor offices aren’t as well-versed in Medicare as you would expect. They know that Medicare Part B has an annual deductible that patients must pay out of pocket. However, it’s common for an office to ask you to pay the deductible the same day as your appointment. Then the following week, you receive a bill from your doctor’s office that says you still owe your Part B deductible. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: This happened because Medicare had no way of knowing you already paid your deductible to the doctor. The doctor’s office must submit your claim to Medicare first. When billed this way, Medicare will process the claim without recording that you have met your deductible. Another way this happens is that you pay your deductible to the doctor, but another provider, often a lab facility, bills Medicare first. Medicare processes the claim for the other provider minus the deductible, and then that provider bills you for the deductible. You must ask your doctor to refund the deductible to you since Medicare applied it to a different claim. When our clients contact us about an unexpected bill, we contact the doctor first to understand why. After determining the issue, we will work with Medicare and the doctor’s office to resolve it. We do this by requesting that the doctor’s office reimburse the client in full for the Part B deductible ($283 in 2026). The client then uses that money to pay the deductible to the correct provider. Medicare and the doctor’s office to correct it. We do this by requesting that the doctor’s office reimburse the client for the $283 (2026 Part B deductible). The client then uses that money to pay the deductible to the correct provider. WE RECOMMEND THAT YOU ASK ALL OF YOUR DOCTORS TO BILL MEDICARE FIRST, TO REMOVE ANY CONFUSION AND THE POTENTIAL FOR PAYING YOUR DEDUCTIBLE TWICE. I HAD TO PAY A HIGHER PREMIUM FOR PART B AND PART D, BUT I DO NOT MAKE THAT MUCH ANYMORE Medicare sets your Part B and Part D monthly premiums based on your tax return from two years prior. As of 2026, if you made more than $109,000 annually two years before, you would pay a higher premium for Part B and Part D, also known as an IRMAA (Income-Related Monthly Adjustment Amount) charge. However, when Medicare beneficiaries retire, they’re usually making less than what their prior tax forms indicate. This higher premium can be frustrating for beneficiaries. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: We walk our clients through the IRMAA appeal process, which involves submitting an SSA-44 form to request reconsideration. The Social Security office reviews the form along with related documentation and decides whether to reduce the premium. Many of our clients have successfully lowered their Medicare premiums this way. MAKE SURE YOU ALWAYS HAVE COPIES OF YOUR PAST TWO FEDERAL TAX RETURNS 7 ANY W-2’S IN CASE YOU NEED TO REQUEST A HEARING FROM SOCIAL SECURITY TO REMOVE YOUR IRMAA SUR-CHARGES I GOT HIT WITH UNEXPECTED CHARGES FROM MY MEDICARE ADVANTAGE INSURANCE PLAN When enrolled in Medicare Advantage, you’ll pay for copays and coinsurance for services as you go along. For example, your doctor’s copay might be $40, but then they send you down the hall for bloodwork, so you get hit with another copay from the lab. This makes out-of-pocket expenses under Medicare Advantage plans hard to predict and often causes them to exceed your original budget. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: Sometimes, when you enroll on your own without fully understanding how Advantage plans work, you may find that you’re spending more money out-of-pocket for your Advantage plan than you had anticipated. The reality is, one visit can cost you multiple copays and/or coinsurance if you have more than one provider billing Medicare. We assist our clients by comparing other Medicare Advantage plans in your area to see if we can lower your costs and reduce your exposure. We can also look at other types of plans, such as Medigap plans, that could significantly reduce your out-of-pocket spending and eliminate doctor copays. REFER TO YOUR PLANS SUMMARY OF BENEFITS (SOB) TO KNOW EXACTLY WHAT YOU ARE RESPONSIBLE FOR MY PART D CO-PAY IS HIGHER THAN IT IS SUPPOSED TO BE You get to the pharmacy to pick up a prescription, and the pharmacist informs you that you owe more than you expected. Sometimes the price the pharmacy charges is right, other times it’s wrong. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: We will contact your insurer and investigate whether you’re supposed to pay that price. Often, we confer with the drug plan company for an explanation. One reason the price may be higher than you expected is that the medication is a higher-tier drug. Typically, the higher the tier, the higher the cost, as confirmed by your plan’s drug formulary. If this is the case, there are a couple of ways to resolve the issue. We can help you call your doctor to submit a tier reduction request to your plan’s carrier. Alternatively, you can ask your doctor to prescribe a similar drug in a lower tier. ASK YOUR DOCTOR WHAT GENERIC OPTIONS ARE AVAILABLE & MAKE SURE HE KNOWS WHAT YOUR PART D PLAN IS MEDICARE IS NOT PAYING FOR MY DME (DURABLE MEDICARE EQUIPMENT) Our Braden Medicare Insurance clients, especially our newest clients, may not realize they need to use a Medicare-approved supplier to receive coverage for durable medical equipment (DME), such as glucose monitors, CPAP supplies, and more. Medicare will only cover DME (Durable Medical Equipment) if you use a supplier approved by them. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: The way we solve this issue often depends on the type of Medicare plan a client has. For instance, with a Medicare Advantage plan, we’d contact the carrier to find a contracted supplier approved by the plan. If our client has a Medigap plan, our team will help find a Medicare-contracted supplier and guide the client through the process of obtaining their supplies. MAKE SURE YOU ONLY RECEIVE MEDICARE EQUIPMENT FROM A MEDICARE APPROVED SUPPLIER WHY IS MY MEDICARE SUPPLEMENT/MEDIGAP PLAN NOT COVERING CHARGES THAT MEDICARE DENIED? Many beneficiaries think that Medigap plans cover all services and procedures Medicare doesn’t, but that isn’t true. Medigap plans only pay for deductibles, copays, and coinsurance on claims that Medicare has approved first. Unfortunately, if Medicare doesn’t cover a service, the Medigap plan cannot make any payment on the claim either. If Medicare doesn’t cover the service, the supplement is not allowed to make any payment on the claim either. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: In this situation, our team makes sure the claim was billed correctly to Medicare. If it was, and still is, denied, we find out why. Then we educate you so that you don’t run into this problem again. We can give you a refresher on services Medicare doesn’t cover, such as routine foot care or cosmetic procedures. If the claim was billed incorrectly, which happens often, we work on your behalf to resolve this issue by contacting Medicare and your doctor’s office to ensure that the claim is resubmitted correctly. MEDICARE SUPPLEMENTS ONLY COVER MEDICARE APPROVED SERVICES I SURVIVED THE MEDICARE ENROLLMENT PROCESS, BUT I DON'T KNOW WHY MEDICARE IS NOT PAYING MY DOCTOR'S BILLS People who delayed Medicare past age 65 or recently left employer coverage often run into this problem. They visit the doctor for a checkup and present their Medicare card, thinking that Medicare is now their primary coverage. This usually happens because Medicare’s records still show the old employer insurance as the primary payer. If the employer fails to notify Medicare that you are no longer employed there, Medicare will reject the claim because it believes the group insurance plan is still the secondary payer. HOW WE WORK WITH YOU TO RESOLVE THIS ISSUE: We will offer to resolve this issue by placing a conference call with the client and Medicare to ensure their systems reflect that Medicare is, in fact, primary. Then we will contact the doctor’s office to have them resubmit the claim so Medicare can pay its share. MAKE SURE MEDICARE IS YOUR PRIMARY INSURANCE WRAPPING THINGS UP At the end of the day, Medicare is not perfect. And they are not exempt from Medicare Billing Issues. As beneficiaries have these dicare complaints, it is all the more important to have an advocate like Boomer Benefits on your side. MOST PROBLEMS HAVE EASY ANSWERS WHEN YOU KNOW WHO TO TALK TO AND WHERE TO LOOK Thank you for reading this article about avoiding the 7 Most Common Medicare Post-Enrollment Mistakes. If you have any questions about this article or need help with anything related to Medicare and are not sure who to call, please feel free to email me directly at mike@bradenmedicare.com, 24/7 on our website at www.bradenmedicare.com, or simply give me a call at 480-225-1393.

Michael T. Braden March 24, 2026 MEDICARE ADVANTAGE WHY MEDICARE ADVANTAGE PLANS ARE BAD Picture of Braden Medicare Insurance's Poster: Why Some People Refer To Medicare Advantage as Medicare Dis-Advantage. WHY PEOPLE REFER TO MEDICARE ADVANTAGE PLANS AS “MEDICARE DISADVANTAGE” Picture of Braden Medicare Insurance's Poster For Medicare DIS-ADVANTAGE Plans Almost one in three Medicare Advantage members experienced at least one prior authorization denial in 2024, according to CMS data, and millions more discovered mid-year that their preferred doctor or hospital had left their plan’s network. These situations are more common than many enrollees expect, and understanding them before you choose a plan can make a real difference. Medicare Advantage (MA) plans are private insurance alternatives to Original Medicare, bundling hospital, medical, and often drug coverage into a single plan. Their appeal is understandable; many advertise $0 premiums, dental and vision benefits, and gym memberships. Enrollment has grown steadily, with MA now covering roughly half of all Medicare beneficiaries as of 2026. But popularity doesn’t equal suitability. This article takes a clear-eyed look at why Medicare Advantage plans are bad for many seniors, particularly due to restricted provider networks, prior-authorization barriers, out-of-pocket costs, and year-to-year instability. Understanding these disadvantages before you enroll or re-evaluate your current plan can protect both your health and your finances. Medicare Advantage plans can be frustrating due to their restricted networks, frequent prior-authorization denials, high cost-sharing, and annual benefit changes that disrupt continuity of care. THE MOST COMMON ISSUES FOR THOSE WHO CHOOSE MEDICARE ADVANTAGE PLANS Most people like the extra benefits, but these benefits are a far cry from what was offered 3-4 years ago. It was common to find $3,000 of Dental Coverage; now it is hard to find anything over $1,000. Most Medicare beneficiaries are not told the truth by Medicare Advantage Agents. For example, nearly all of the “Extra Benefit” coverage is divided by 4, so $1,000 is just $250 per quarter. And to add insult to injury, most plans do not allow you to roll over unused amounts. Captured Agents (Agents who only work for one company) are not allowed to mention any plans that they are not contracted to sell. So, most people never hear about any other plans from them. Medicare Advantage plans have strict Networks of Providers and Facilities that you must use. More and more Medicare Advantage members have had to put up with Denials for care and the need for prior authorizations. Medicare Advantage plans restrict which doctors and hospitals you can use, which can limit access to specialists and disrupt ongoing care relationships. Prior authorization requirements frequently delay or deny medically necessary treatments, creating barriers between you and the care your doctor recommends. The 2026 maximum out-of-pocket limit for MA plans is $9,250, a potentially significant financial exposure that many enrollees don’t anticipate when selecting a “$0 premium” plan. BIGGEST GRIPES THAT SENIORS HAVE WITH MEDICARE ADVANTAGE PLANS Medicare Advantage plans are not inherently bad products. But they come with structural limitations that can create serious problems, especially for seniors managing chronic conditions or complex health needs. Five issues consistently surface as the most impactful. Restrictive Provider Networks: Many plans limit you to a specific group of doctors and hospitals, potentially restricting your choice of care. Prior Authorization Delays and Denials: Plans often require approval for services, which can delay or deny medically necessary treatments. High Out-of-Pocket Costs: Despite low or $0 premiums, you may face significant copayments, coinsurance, and deductibles that add up. Annual Plan Benefit Changes: Benefits, networks, and drug formularies can change every year, creating instability and uncertainty. Referral Requirements: Many plans require a referral from a primary care physician before you can see a specialist, which slows access to care. These aren’t abstract policy concerns. They show up as denied claims, delayed surgeries, unexpected bills, and phone calls with insurance representatives when you should be focused on recovery. In 2026, these disadvantages remain just as relevant as they were when MA plans first became widely adopted. Understanding each issue clearly helps you make a coverage decision based on reality, not marketing materials. 1. NETWORK, PROVIDER, AND GEOPGRAPHICAL LIMITATIONS Medicare Advantage plans operate as HMOs or PPOs, which means your care is tied to a specific network of contracted doctors, hospitals, and specialists. Step outside that network, intentionally or in an emergency, and you may face dramatically higher costs or no coverage at all. This can result in you being responsible for much higher costs for those Medicare beneficiaries who travel frequently, split time between two states, or live in rural areas where the network may include only a handful of providers. If your cardiologist or oncologist isn’t in the plan’s network, you either pay out-of-pocket or find a new doctor. States like rural Montana, Wyoming, and parts of the South have seen ongoing complaints about thin MA networks, which make it genuinely difficult to access specialists. Even in suburban areas, a mid-year network change can leave you scrambling to find a new primary care physician. You can learn more about navigating Medicare Advantage networks before committing to a plan. 2. AUTHORIZATIONS, 2nd, 3rd and 4th OPINIONS, ADDITIONAL REASONS FOR DENAIAL OF CARE Prior authorization is the process by which an MA plan must approve certain services, tests, or treatments before they’re covered. In theory, it controls costs. In practice, it can stand between you and the care your doctor has already determined you need. A 2024 CMS audit found that Medicare Advantage plans denied millions of prior authorization requests that would have been approved under Original Medicare, often using clinical criteria stricter than CMS standards permit. Beneficiaries can appeal, but appeals take time, and time matters when you’re waiting for a cancer scan, a cardiac procedure, or a post-surgical rehabilitation placement. The administrative burden on physicians is also substantial. Medical offices routinely spend hours each week on authorization paperwork, pulling staff away from direct patient care. For seniors, this translates into measurable delays that can affect diagnosis and treatment timelines. 3. CO-PAYMENTS AND OUT-OF-POCKET COSTS HAVE GOTTEN MUCH HIGHER The “$0 premium” label on many MA plans captures attention, but it tells only part of the story. While you may pay nothing monthly beyond your Part B premium (currently $202.90 in 2026), you’ll still face copayments, coinsurance, and potentially separate deductibles every time you use care. A hospital stay, a specialist visit, or a course of chemotherapy can trigger cost-sharing that adds up quickly. The 2026 maximum out-of-pocket limit for MA plans is $9,250. That’s the ceiling, meaning your actual exposure could reach that amount in a single plan year if you experience a serious illness or injury. By contrast, someone with Original Medicare plus a comprehensive Medigap plan like Plan G would face a predictable annual deductible (currently $283 for Part B in 2026) with most other costs covered by their supplement. For someone with significant health needs, financial comparison often favors Medigap despite its monthly premium. 4. HAVING TO REVIEW DOCTORS, PLANS, AND CHANGES IN BENEFITS EVERY YEAR. Medicare Advantage plans can change almost everything about themselves each year, including their premiums, cost-sharing, drug formularies, provider networks, and covered benefits. What worked well for you in 2025 may look very different in 2026. Each fall, enrollees receive an Annual Notice of Change (ANOC) document outlining upcoming changes. Many people don’t read it carefully, or don’t realize a specific drug has been dropped from the formulary or a beloved specialist has left the network until they’re already mid-treatment. This annual instability creates a real burden for seniors managing long-term conditions. Continuity of care, seeing the same doctors, staying on the same medications, following through on multi-year treatment plans, can be disrupted every January 1st. Review your Annual Notice of Change letter every fall without exception. 5. THE HEADACHES OF NEEDING PERMISSION TO SEE A SPECIALIST HMO-based Medicare Advantage plans typically require you to choose a primary care physician (PCP) who must then provide a referral before you can see a specialist. This “gatekeeper” structure is designed to coordinate care, but in reality, it often slows down access to the specialists you actually need. Under Original Medicare, you can generally see any Medicare-accepting specialist directly, no referral required. That freedom disappears under most HMO plans. If your PCP is booked up for three weeks, your specialist appointment is delayed by at least that long. Consider a scenario: a senior notices a new symptom that warrants a neurology consultation. Under Original Medicare, they call the neurologist directly. Under an HMO, they wait for a PCP appointment, then for the referral to be processed, and then for the specialist appointment. For certain conditions, those extra weeks matter enormously. DOCTORS DO NOT LIKE THE WAY MEDICARE ADVANTAGE PLANS MANAGE THEIR CARE, AND BROWBEAT THEM ABOUT THEIR FEES Patient frustration with MA plans is well-documented. Less discussed, but equally important, is the frustration among physicians and medical staff who must operate within the system’s constraints every day. Surveys of practicing physicians consistently show dissatisfaction with Medicare Advantage’s administrative requirements. Prior authorizations, complex billing rules, and restrictions on specialist referrals don’t just affect patients; they affect a doctor’s ability to practice medicine the way they were trained to. Some practices have stopped accepting certain MA plans entirely, citing payment delays and administrative overhead that make participation financially unsustainable. This further shrinks the effective network for enrollees. WHAT HAPPENS WHEN PRIOR AUTHORIZATIONS GET IN THE WAY OF CRITICAL HEALTH DECISIONS When a physician orders a test or procedure, they’ve made a clinical judgment based on your symptoms, history, and medical evidence. Prior authorization inserts an insurer’s review process into that judgment, sometimes overriding it with a denial from a reviewer who has never examined you. Medical offices in large health systems report dedicating multiple full-time staff members exclusively to prior authorization work. Independent practices, which often serve rural and underserved populations, frequently lack the resources to absorb this burden. The downstream effects are real: delayed imaging, postponed procedures, and patients who abandon recommended care after navigating multiple denial cycles. These aren’t billing inconveniences; they’re clinical outcomes shaped by administrative processes. LESS CARE FOR THOSE WHO NEED IT THE MOST DUE TO THE WAY MEDICARE ADVANTAGE PLANS ARE STRUCTURED Understanding why MA plans are structured the way they are requires understanding how they’re paid. CMS pays each Medicare Advantage insurer a fixed monthly amount per enrollee, called a capitation payment, adjusted based on the enrollee’s health status through a process known as risk adjustment. The risk adjustment model means insurers receive more money for sicker enrollees. This creates an incentive to thoroughly document diagnoses (a practice known as “upcoding” when taken to extremes) while simultaneously restricting services to keep actual costs below the capitation amount. The profit margin lives in that gap. Critics argue this model fundamentally misaligns insurer incentives with patient care. The plan earns more when your conditions are documented as complex, but also profits when your care is limited. This financial structure explains many of the prior authorization denials and network restrictions that frustrate both patients and physicians. MEDICARE INSTITUTED THEIR STAR-RATINGS SYSTEM FOR MEDICARE ADVANTAGE PLANS Not all Medicare Advantage plans perform equally. CMS evaluates each plan annually using a Star Ratings System, scoring plans on a scale of 1 to 5 stars across dozens of quality measures. These measures include things like how well plans manage chronic conditions, how members rate their experience, how often care is delayed, and how the plan handles complaints and appeals. A 5-star plan represents consistently high performance. A 2-star or 3-star plan indicates documented problems with member experience and the quality of care. Picture of Braden Medicare Insurances Poster of Medicare Star Ratings. Before enrolling in any MA plan, check its star rating on Medicare. gov. A plan with low ratings isn’t just underperforming on paper; those ratings reflect real patterns of member dissatisfaction, denied care, and poor service that other enrollees have already experienced. You can also explore why Medicare Star Ratings matter when comparing your options. NOTE: Before the Annual Enrollment Period closes each year, pull up your plan’s Star Rating and read your ANOC document side by side. Look specifically for any changes to your drug formulary, provider network, or specialist copayments; these three areas account for most unpleasant surprises that hit in January. If anything has changed that affects your current doctors or medications, that’s your signal to compare alternatives during open enrollment rather than waiting until a problem forces your hand. CMS IS RESPONSIBLE FOR OVERSEEING HOW MEDICARE ADVANTAGE PLANS OPERATE CMS serves as the primary regulator of Medicare Advantage plans, setting standards that plans must meet to participate in the program and conducting audits to monitor compliance. In recent years, CMS has taken a notably sharper stance on MA plan behavior. In 2024 and 2025, CMS audit reports documented widespread inappropriate denials of medically necessary care across multiple major MA carriers. CMS also tightened prior authorization rules, requiring plans to respond to certain authorization requests within defined timeframes and to use only CMS-approved clinical criteria when making decisions. Consumer complaint data collected by CMS consistently show that MA plans generate higher complaint volumes than Original Medicare across categories such as coverage denials, billing disputes, and network access problems. These aren’t random outliers; they represent structural issues that regulatory oversight continues to work to address, with mixed success. Understanding your Medicare rights and protections is an important part of navigating any MA plan. COMPARING ORIGINAL MEDICARE WITH MEDICARE ADVANTAGE (MEDICARE PART C) For many seniors, particularly those with ongoing health conditions or those who value predictability, Original Medicare combined with a Medicare Supplement (Medigap) plan offers meaningful advantages over Medicare Advantage. Original Medicare gives you access to any provider in the country who accepts Medicare, with no network restrictions and no referral requirements. Add a Medigap plan like Plan G, and most of your cost-sharing is covered, leaving you with highly predictable annual expenses. The tradeoff is a monthly Medigap premium, but for someone who uses their coverage regularly, that premium often costs less than the cumulative copayments and coinsurance of an MA plan. The key question isn’t which structure is universally better; it’s which structure fits your specific health needs, preferred doctors, and financial situation. HOW AND WHEN YOU CAN CHANGE/SWITCH PLANS The Annual Enrollment Period (AEP) runs October 15 through December 7 each year and allows you to switch between MA plans or return to Original Medicare. The Medicare Advantage Open Enrollment Period (MA OEP) runs January 1 through March 31 and allows one switch per year for current MA enrollees. Switching from Medicare Advantage back to Original Medicare is straightforward. The complication arises when you want to add Medigap coverage. Outside your initial Medigap Open Enrollment Period, which begins when you first enroll in Part B at age 65, insurers can require medical underwriting and deny coverage based on pre-existing conditions in most states. This makes the decision to choose MA at 65 potentially irreversible for people who later develop health conditions and want to switch to Medigap. Working with an independent insurance agent who represents multiple carriers can help you think through these long-term implications before making your initial enrollment choice. Learn more about switching from Medicare Advantage to Medicare Supplement if you’re currently in an MA plan and considering a change. PUTTING IN TIME TO RESEARCH AND UNDERSTANDING IF MEDICARE ADVANTAGE IS THE RIGHT OPTION FOR YOU This article focused on the real disadvantages of Medicare Advantage, and those disadvantages are significant. But context matters. MA plans may still be a reasonable fit for some people, particularly those in good health, living in areas with networks, and working within a tight monthly budget. The extra benefits that MA plans often include, such as dental, vision, hearing, and gym memberships, offer genuine value to people who would otherwise pay out of pocket for those services. Plans from major carriers like Humana, UnitedHealthcare, and Aetna vary considerably in quality by region, and some perform well on Star Ratings year after year. No one should ever join a Medicare Advantage plan based solely on a Gym Membership. The most important questions to ask before enrolling in any MA plan are: Are my current doctors and specialists in-network? Are my current prescriptions on the formulary at an acceptable tier? What is the prior plan’s list for services I’m likely to need? What is the maximum out-of-pocket limit, and could I absorb that cost in a bad year? What is the plan’s Star Rating, and how has it trended over recent years? We strongly believe that no one should enroll in a Medicare plan, of any type, without reviewing a licensed, independent agent who can compare actual options in your zip code. Independent agents work across multiple carriers and aren’t incentivized to steer you toward any single product. PRIORITIZE YOUR HEALTH MORE THAN ONE YEAR AT A TIME Medicare Advantage plans are heavily marketed, widely enrolled, and, for some people, genuinely useful. But the disadvantages are real, documented, and consequential. Restricted networks, prior-authorization barriers, out-of-pocket costs up to $9,250, and annual benefit instability can create serious problems, especially when your health needs are complex or unpredictable. The most important thing you can do before choosing any Medicare plan is to look beyond the premium. Read both the Summary of Benefits (SOB) and the Evidence of Coverage (EOC) for each Medicare Advantage plan you may be considering. We also recommend checking the Medicare Star Rating for each plan you are interested in. Verify that your doctors are in-network, and that all of your prescription medications are covered. Each plan must include at least two medications in each category of Medications, but it does not always cover your exact medication, especially if it is a brand name. Understand what prior authorization requirements apply to services you’re likely to need. And think about what your situation might look like five years from now, not just this January. Choosing between Medicare Advantage and Original Medicare is a decision that deserves real attention and personalized guidance. Speak with a licensed, independent Medicare agent, not a captive representative for a single carrier, who can walk you through the actual options available in your area and help you choose coverage that fits both your health and your budget. MEDICARE ADVANTAGE FAQ’S Photo of Braden Medicare Insurance's FAQ Poster. WHAT DO MEDICARE ADVANTAGE MEMBER COMPLAIN ABOUT THE MOST? The most common complaints center on restrictive provider networks, frequent prior authorization denials for medically necessary care, high out-of-pocket costs, and annual changes to benefits and drug formularies. These issues often surface most acutely for enrollees managing serious or chronic health conditions. And believe it or not, since every Medicare Advantage plan is only good for one year, the highest amount of delays often happens in the last quarter of the year, as many companies believe that if they run out the clock, you may choose a different plan or a different carrier for the next year, and at the end of the day, they save money. It is sad, but this is a proven fact. WHY DOCTORS, NURSES, AND HOSPITAL STAFF DISLIKE MEDICARE PART C (MEDICARE ADVANTAGE)? Physicians frequently cite the heavy administrative burden of prior authorizations, payment delays, and restrictions on their ability to refer patients to specialists. Many doctors feel these requirements interfere directly with clinical decision-making and the quality of care they can deliver. In fact, the majority of healthcare professionals who decide to leave a Medicare Advantage plan do so because they feel the company focuses on the bottom line rather than the health and welfare of their patients. CAN YOU GO BACK TO ORIGINAL MEDICARE AND DROP YOUR MEDICARE ADVANTAGE PLAN? Yes, but the timing is critical. Returning to Original Medicare during the Annual Enrollment Period is straightforward, but adding a Medigap plan outside your initial open enrollment period typically requires passing medical underwriting. If you’ve developed health conditions since you first enrolled, you could be denied Medigap coverage or charged significantly higher premiums in most states. This is another reason to really focus on choosing the right plan during your IEP (Initial Enrollment Period). WHY DO PEOPLE THINK MEDICARE ADVANTAGE PLANS ARE FREE? No, Medicare Advantage Plans are not free. Everyone who enrolls in Medicare must pay their Medicare Part B Monthly Premium of $202.90. A $0 premium means you pay no additional monthly fee beyond your Part B premium, but you’re still responsible for all co-payments, coinsurance, and deductibles every time you use covered services. In a year of serious illness, those costs can add up to well into the thousands. Every Medicare Advantage plan has an MOOP (Maximum Out-Of-Pocket) amount. If you reach that amount for either In-Network or Out-Of-Network services, your carrier will pay for everything for the remainder of the calendar year. The National average for MOOP in 2026 is $5,700 across all Medicare Advantage plans. HOW COMPLYING WITH PRIOR AUTHORIZATION REQUESTS CAN HURT YOUR CARE? Prior authorizations can easily delay or deny access to medically necessary tests, treatments, or specialist visits, sometimes for weeks. These delays aren’t administrative inconveniences; for conditions requiring timely intervention, they can directly affect health outcomes. AM I COVERED IF I LEAVE THE COUNTY I LIVE IN? Most MA plans cover only emergency or urgent care outside their defined service area. Routine care, specialist visits, and scheduled procedures are typically not covered when you’re traveling or spending extended time in a different location, a significant limitation for seniors who travel frequently or maintain residences in multiple states. Typically, the only options you have if you are out of your Service Area (Your Service Area is generally the County you reside in) are either at an Urgent Care Facility or in a Hospital Emergency Room. But if you are admitted to the hospital, you will have to pay those costs out of pocket. WRAPPING THINGS UP We hope this article was informative and helpful in your search for the best Medicare option for you and your family. Everyone is different, with different wants, needs, and desires for their Healthcare; this is especially important when enrolling in Medicare. This is why it is extremely important to start with the plan you want, not just for the here and now, but for all your tomorrows. If you have any questions about Medicare and would like to speak with an independent Medicare Broker who is also a Certified Medicare Planner (CMP), please feel free to reach out to me anytime. You can reach me at mike@bradenmedicare.com, via our website at www.bradenmedicare.com, or by text or phone using (480) 225-1393.

Michael T. Braden April 2, 2026 MEDIGAP PREMIUMS WHY HAVE THERE BEEN SO MANY PREMIUM INCREASES THE PAST 2-3 YEARS? Picture Of Braden Medicare Insurance's 2026 Medicare Premiums Poster If you’ve been enrolled in a  Medigap plan  for a while, you probably noticed Premium increases were not just higher, they were noticeably outside the normal range most people had come to expect. Our goal with this article is to try and bring some clarity and honesty to why Medicare Supplement and Medigap Premiums have been increasing at not just an elevated rate the past few years, but I think we could safely say at an Alarming Rate! I have been an Independent Medicare Broker and certified Medicare Planner for more than a decade. Prior to 2024, I could confidently say that  Medigap rate  increases have historically been fairly predictable. In most years, premiums tended to rise somewhere in the 3% to 7% range. It wasn’t ideal, but it was manageable. You could plan on those increases and although not liking it, these increases typically do not break the bank. #1 WAY TO SAVE MONEY WITH MEDICARE IS TO WORK WITH AN INDEPENDENT, LICENSED, MEDICARE BROKER IN YOUR AREA Brokers work with Medicare clients daily. They are your Ace In the Hold for all things relating to Medicare. a Picture Of Braden Medicare Insurance's Why Working With An Independent, Licensed Medicare Broker Makes The Most Sense. MEDIGAP RATE INCREASES ARE OCCURING NATIONWIDE Across many states and carriers, beneficiaries began seeing larger-than-normal rate increases, sometimes well into the double digits. For individuals living on a fixed income, these increases don't just stand out, they demand our attention and we need to all have a better grasp of the 5-W's, as it pertains to Medicare Supplement and Medigap premiums. (Who, What, When, Where, Why) WHO Medicare Insurance Carriers, Medigap Insurance Companies, Hospital's and All Healthcare Companies have seen a large increase in bills for Doctors and Hospital Services that have been ignored and gone unpaid. The vast majority of these recent trends seem to mirror the large increases in individuals entering the US unlawfully. Other contributing factors include Loss Ratios, and the under-estimating the true costs of Healthcare with the lingering inflation we have all been experiencing. In researching this, I also found that more Medicare Beneficiaries are using Medicare in the first five years, than at anytime, going back to 1967. It also raised many questions about whether something had fundamentally changed in the Medicare Supplement/Medigap market. AS of March 1, 2026 nearly 14 million people have a Medicare Supplement Policy in the United States, and of those over 95% own a Plan N, Plan G or Plan F policy. So price increases are being felt far and wide across America. So the real question is not easy to answer, we will all find out together, whether or not these premium increases were a temporary adjustment, or is it something we need to constantly be planning for moving forward. WHAT Over the past 30 Months, the highest Premium Increases for Medigap/Medicare Supplement Plans in Arizona have come from: MUTUAL OF OMAHA AARP/UHC BCBSAZ HUMANA AETNA USAA PHYSICIANS MUTUAL This same percentage of increases have been seen across the US. Floridians have seen 15-25% increases, and they were already 50% higher than Arizona for example. Some companies almost seemed to delight in demanding 25-40% premium increase nationwide. WHEN We started seeing issues with large double-digit Medigap premiums at the end of 2023, and it has not stopped. We literally do not know how long this trend will continue, and whether or not it is similar to the housing market collapse of 2008, or something more sinister. Time will tell. WHERE Oftentimes we can see price increases simply based on geography, however; in this instance, there is nothing we can point a finger out as being geographically driven. Even though this article is focused on Medicare Supplement premiums, there has also been a huge change in the Medicare Advantage Market the past two years. Below are just a few things that have also caused alarm with other Seniors who chose Medicare Advantage plans. Most States Have 30% or Medicare Part D Plans available than there were in 2024. Medicare Advantage Plan Annual Maximum Out-Of-Pocket expenses have jumped 2-3K the past two years alone. Many Medicare Advantage Companies Cut 20% of their plans, and removed commissions from their plans. There are now only a handful of Medicare Part D Drug Plans that pay commissions to Agents. Insurance Companies have greatly reduced the levels of Dental, Vision, and other Supplemental Benefits, while the cost for Hospital Stays continues to go up year after year. Companies have increase their insistence that any procedure be submitted for Prior Authorization before it can be performed. Note: Most Medicare Beneficiaries have no clue that Medicare (CMS) pays each Medicare Advantage Company $12,000 per year, for every person enrolled in a Medicare Advantage plan every year. Yet people want too act like Chicken Little if Medicare ever considers reducing their payments. WHY We have already listed a variety of things that impact where companies set their premiums: Healthcare Costs Increase year after year, Doctors, Nurses, Hospitals and Insurance company's all cry that they are poor and need more money. Margins on Prescription Medications are shrinking. While demand for expensive drugs is at an all-time high. People are living longer However, one item that has grown very quickly, I believe has had a lasting impact, but; none of the so-called experts have not figured it out. That is, the explosion of states with Medicare Birthday Rules. This is great for Beneficiaries and Agents, but it cuts into the profits of Insurance companies who have lost a lot of the control of who they offer policies to. This lessens their profit margins because it increases their risk pool. And they have compensated by increasing premiums across the board. Inflation, whether it is all real, or partially manufactured as the over-riding excuse for mismanagement. The fact it Inflation has and will continue to be a large factor as it pertains to costs and containing costs for anything and everything. We just need to trust and hope that once there is some sort of normalcy again, then it will also result in lower costs in many areas of the economy. ITS WHAT MOST PEOPLE NEVER SEE OR HEAR ABOUT THAT HAS THE HIGHEST IMPACT ON TEH COST OF PREMIUMS Behind the scenes, there’s a level of competition in the Medigap market that most beneficiaries never hear about. Every day, roughly 11,000 Americans turn 65 and become  eligible for Medicare . That steady wave of new enrollees has made the Medicare market one of the fastest-growing segments in health insurance. Naturally, insurance companies want a piece of that growth. To compete, many carriers use a strategy that looks great on the surface. They enter a market with very aggressive pricing, often coming in lower than established competitors to attract new policyholders quickly. And it works. Lower premiums get attention. Agents quote those plans more often. Enrollment grows. But here’s the part most consumers don’t see. When a company prices aggressively, they’re making assumptions about future claims. If those assumptions are even slightly off, meaning members use more healthcare than expected, the company has to adjust. And the only way to do that is through rate increases. So what you often get is a cycle: A carrier enters the market with very competitive rates Enrollment grows quickly Claims come in higher than projected Premiums increase to correct the pricing This doesn’t happen with every company, every year, but it’s common. This was especially true in 2024, 2025, and so far in 2026. From a consumer standpoint, it can feel frustrating. A plan that looked like a great deal at enrollment may experience larger adjustments a few years later. WHAT AGRESSIVE PRICING LOOKS LIKE You can see this pricing strategy play out when new carriers enter the Medigap market and try to gain traction quickly. In several recent cases, newer or expanding companies launched plans with premiums well below those of established carriers like UnitedHealthcare,  Aetna , Cigna,  Mutual of Omaha , and Blue Cross Blue Shield affiliates. On paper, these plans looked like obvious winners. Lower premiums for the same standardized coverage will naturally attract attention from both consumers and agents. One example was  ACE  (Chubb). They entered the Medigap space with pricing that was noticeably lower than that of many competitors. As expected, that pricing led to rapid enrollment growth. But not long after, the company decided to pause new Medigap applications while it evaluated how its claims experience was developing in that block of business. That kind of move usually signals that actual healthcare use is higher than originally projected. Over the past three years CHUBB has changed their name three times, and now operate under the Name Insurance Company Of North America. They have taken a 7% increase the past three years, and we will not know until July what they are going to do this year. EDUCATE YOURSELF TO UNDERSTAND WHAT THE MOST COMMON NEXT STEPS ARE FOR MEDICARE SUPPLEMENT CARRIERS. When a company uses a low-ball technique early on, and once their claims begin to catch up, they often need to adjust premiums more aggressively later to bring things back in line. For beneficiaries, that can mean a plan that started out as one of the lowest-cost options may experience larger-than-average rate increases in future years. This is exactly why it’s important to look beyond just the initial premium. In the Medigap world, how a company prices over time can matter just as much as how it prices today. HEALTHCARE COSTS CONTINUE TO RISE ACROSS THE BOARD It’s important to understand that Medigap rate increases are not happening in a vacuum. They’re part of a much larger trend. Healthcare costs are going up across the board, and those increases eventually show up in insurance premiums, including Medicare Supplement plans. You can see this clearly by looking at other parts of the healthcare market. In the Affordable Care Act (ACA) marketplace, insurers proposed average premium increases of around 7% for 2025 in many regions. That’s fairly consistent with what we’ve seen in recent years, and it reflects the same underlying pressure, higher utilization, and rising medical costs. Employer-sponsored health insurance tells a similar story, but on a larger scale. Today, the average cost of a family health plan is approaching $27,000 per year, with employees contributing roughly $6,800 to $7,000 annually out of pocket. Employers are also projecting another 6.5% increase in healthcare costs for 2026, which would be one of the largest jumps in over a decade. Those numbers matter because they show this isn’t just a Medicare issue. It’s happening everywhere. We’re also seeing pressure in the  Medicare Advantage  market. Several insurers have pulled back or exited certain markets after experiencing higher-than-expected claims. In some cases, those losses have been significant enough to force major strategic changes. Nationwide, an estimated 1.4 million Medicare Advantage enrollees were impacted by plan exits heading into 2025. When you step back and look at the full picture, the pattern becomes clear. Rising healthcare costs are putting pressure on every segment of the system, from employer plans to ACA coverage to Medicare Advantage. Medigap is no exception. That’s why the larger-than-normal premium increases in 2024 and 2025 shouldn’t be viewed as an isolated event. They’re part of a broader shift in healthcare costs that is working its way through the entire insurance landscape. WHAT THIS MEANS FOR YOU, THE POLICY OLDER When rising healthcare costs combine with aggressive market competition and increased utilization, the unusually large Medigap adjustments seen in 2024 and 2025 start to make more sense. But understanding  why  it happened doesn’t solve the real issue most people are facing. The most common question we hear is simple: “My premium went up. What should I do now?” Let’s walk through the most important things to consider before making a decision. WE DO NOT ADVISE ANYONE TO RUSH INTO A MEDICARE ADVANTAGE PLAN When premiums jump, it’s natural to look at alternatives.  Medicare Advantage plans  often advertise low or even $0 monthly premiums, which can be appealing after a rate increase.  But it’s important to look at the full picture . Medicare Advantage plans typically come with: Higher potential out-of-pocket costs Provider networks that may limit which doctors you can see Prior authorization requirements for certain services Benefits that can change from year to year By contrast, Medigap plans work with  Original Medicare  and allow you to: See any doctor in the U.S. who accepts Medicare Avoid network restrictions Maintain consistent coverage year after year That stability is a big reason many retirees choose Medigap in the first place. Before leaving Medigap entirely, it’s usually worth exploring other options within the program. Plans like Plan N or High Deductible Plan G can often reduce your premium while keeping the flexibility that Medigap provides. In most cases, Medicare Advantage should be viewed as a last resort option, not your first option after a rate increase. CHANGING YOUR MEDICARE SUPPLEMENT/MEDIGAP PLAN One of the biggest misconceptions is that you can only change coverage during the  Annual Election Period (AEP )  (October 15 to December 7). That’s true for Medicare Advantage and Part D plans, but it does not apply to Medigap. In most states, you can apply to change your Medigap plan at any time of year. This flexibility creates opportunities to shop for better pricing, especially after a significant rate increase. MEDICAL UNDERWRITING REQUIRED FOR NEW POLICIES AND POLICY CHANGES Here’s the part many people don’t realize. In most states, switching Medigap plans requires medical underwriting. This means the new insurance company will review your health history before approving your application. Depending on your health, that can result in: Approval at standard rates Approval at higher than standard rates Or a denial of coverage Because of this, not everyone will be able to switch plans easily. STATES THAT HAVE ADOPTED BIRTHDAY RULES FOR MEDICARE Some states offer additional consumer protections that make switching much easier. These are commonly known as Medigap birthday rules: CA, OR, NV, ID, UT, WY, IN, KY, IL, OK, MD, DE, LA, VA If you live in one of these states, you typically have a 30- to 60-day window around your birthday each year to switch Medigap plans  without medical underwriting . IN MOST CASES THE BIRTHDAY RULE ALLOWS A MEDICARE SUPPLEMENT/MEDIGAP BENEFICIARY TO MOVE:  From one carrier’s Plan G to another Plan G Or from a more comprehensive plan to a less comprehensive one (for example, Plan G to Plan N) This is a powerful advantage. It lets you shop for lower premiums without worrying about being declined for health conditions. STATES WITH OTHER CONSUMER PROTECTIONS Some states go even further than birthday-rule protections and offer broader flexibility for changing Medigap plans, making it easier to adjust your coverage. For example, in Connecticut and New York, the rules are the most flexible in the country. Medigap plans are available on a guaranteed-issue basis year-round, which means: You can apply at any time You cannot be denied coverage Your premium cannot be increased due to health conditions This gives beneficiaries the ability to shop for better pricing whenever they want, without worrying about underwriting. Other states, like Massachusetts, Maine, Missouri, and Washington, offer structured opportunities to switch plans: Annual switching windows (Massachusetts) Anniversary rules (Missouri) Expanded protections that allow certain plan changes without underwriting (Washington) The details vary by state, but the goal is the same. These rules are designed to give beneficiaries more flexibility to move to lower-cost plans if premiums rise. WHY IS THIS IMPORTANT? On the surface, if you reside in one of these states, you have a distinct advantage. Instead of being tied to your current insurance plan due to health conditions, you can regularly review the market and modify your coverage. While this flexibility is advantageous, it also means that insurance companies are modifying their rates to account for the increased risk of adding members without inquiring about their health conditions.   As a result, individuals in these states are experiencing larger annual rate increases than in states without these carve-outs. For everyone else, switching may still be possible, but it often depends on passing medical underwriting. That’s why understanding your state’s rules is one of the most important steps when deciding what to do after a Medigap rate increase. HERE IS HOW THESE STATE RULES WORK FOR YOU In these states, Medigap enrollment is centered around a one-time window known as your  Medigap Open Enrollment Period . This period lasts for six months and begins when you are: Age 65 or older Enrolled in Medicare  Part B During this time, you have the strongest protections available, including: Enroll in any Medigap plan offered in your state Avoid medical underwriting entirely Cannot be denied coverage Cannot be charged more due to health conditions This is typically the best time to enroll in a Medicare Supplement plan. AFTER YOUR AEP/OPEN ENROLLMENT PERIOD IS OVER Once that six-month window ends, the rules change. If you want to switch Medigap plans later, you will usually need to go through medical underwriting. This means the insurance company can: Review your health history Ask medical questions Approve or deny your application Because of this, beneficiaries in these states are often more limited when trying to change plans later, especially if their health has changed. HERE IS WHY THIS IS IMPORTANT If you live in one of these states, your initial enrollment decision carries more weight. While you can still shop and apply for a lower premium later, approval is not guaranteed. That’s why many beneficiaries choose to: Work with an experienced agent upfront Compare multiple carriers during their Open Enrollment Period Consider not just price, but also long-term rate stability In years like 2024 and 2025, when rate increases were higher than normal, these rules are even more important. They explain why some people can easily switch plans to save money, while others may need to stay with their current coverage. OTHER LOW COST MEDICARE SUPPLEMENT/MEDIGAP PLANS WORTHY OF CONSIDERATION When premiums increase, many beneficiaries start looking for ways to lower their monthly costs without giving up the core benefits of Medigap. Two plans consistently come up in that conversation:  Plan N  and  High Deductible Plan G . Both options allow you to stay on Original Medicare, keep nationwide doctor access, and still reduce your premium. IS PLAN N MORE POPULAR NOW THAN IN THE PAST? Medicare Supplement Plan N has gained in popularity in recent years, especially as the Medicare Supplement   Plan G premiums  continued to increase. The reason is simple. It offers coverage very similar to  Plan G , but at a lower monthly cost. Although premiums for Plan N vary from State to State, Plan N premiums are consistently $30-$50 lower than the premiums for Plan G. However, there is a tradeoff. You can see in the Chart Below, all of the benefits for Plan N compared to Plan G. Remember, ALL Medicare Supplement plans are standardized, meaning that the benefits for each lettered plan are exactly the same in all 50 states. Photo Of Braden Medicare Insurance's 2026 Medicare Supplement Comparison Poster. WHAT IS THE TRADE-OFF WITH PLAN N? With Medicare Supplement/Medigap  Plan N , you are responsible for absorbing some cost-sharing that is covered under Plan G: Up to a $20 copay for doctor visits. Some Doctors do not charge anything, Some Charge $5 - $20, it just depends on what code their office uses. You can always contact your providers and ask them what they charge. $50 copay for Hospital Emergency room visits, if you are not admitted to the hospital. No coverage for Part B excess charges. If there are any Excess Charges, you can avoid these by simply making sure that you only see Healthcare Professionals who accept Medicare. In practice, these costs are often relatively minor, especially for people who don’t visit the doctor frequently. PLAN N IS A GOOD OPTION FOR MEDICARE BENEFICIARIES WHO: In generally good health Those who want to lower their monthly premium Beneficiaries who are comfortable with occasional, predictable copays For many, the math is straightforward. Even with a few copays during the year, the premium savings can still come out ahead. WHY THIS IS IMPORTANT TO UNDERSTAND YOUR OPTIONS As Plan G premiums have increased, more beneficiaries are taking a second look at Plan N, with factors including: Lower premium than Plan G Strong protection compared to Medicare Advantage Minimal changes to how you access care That balance is exactly why Plan N has become one of the fastest-growing Medigap plan since 2022. ANYONE WITH A MEDICARE SUPPLEMENT PLAN F NEEDS TO STRONGLY ENTERTAIN THE OPTION OF SWITCHING OVER TO A MEDICARE SUPPLEMENT/MEDIGAP PLAN G Referring to the Medicare Supplement Plan Comparison Chart, note that the only difference between PLan G and Plan F is the fact that PLan F automatically pays the Annual Medicare Part B Deductible ($283.00 in 2026) for you. And with Plan G, you pay that first $283 yourself. The problem is not with the coverage, but once you are past 70, Plan F typically costs more than $100 more per month in premiums when compared to Plan G. So while not having to pay for anything out of pocket is great, it is nullified when you pay more than $30 per month more in higher premiums. HIGH DEDUCTIBLE PLAN G (HDG) MIGHT BE WORTHY OF CONSIDERATION FOR SOME PEOPLE We believe a High Deductible Plan G is best suited for those who are financially secure but savvy Medicare Beneficiaries and for those considering a Medicare Advantage Plan. Typically a HDG plan premium is 1/3 the cost of a regular Plan G. Medicare pays 80% of all costs after you reach the Annual Part B Deducible threshold of $283. Your Supplement Insurance will not kick in and pay their 20% share until you have had a total of $2,950 in Out-Of-Pocket costs for the Calendar Year. Once you reach that, your HDG works like a regular Plan G for the remainder of the Calendar Year. The average Maximum Out-Of-Pocket Expense for a Medicare Advantage HMO Plan nationwide is over $5,500 in 2026. And, you can add on $2,000 more for a Medicare Advantage PPO Plan. Most Medicare Advantage Plans only cover you in your network, and your network is the county that you live in. The only coverage outside of the county you live in is at any Urgent Care Facility or in a Hospital Facility Emergency Room. This makes it risky for those who like to travel or have multiple homes in different states. Most people do not have serious health issues that require a Hospital stay, in back to back years. Or, even every three years. This is where the HDG plan can make the most sense. WRAPPING THINGS UP Medigap rate increases in 2024 and 2025 caught a lot of people off guard, but when you step back, the reasons are clear. Rising healthcare costs, aggressive pricing strategies from insurers, new and expanding state guaranteed issue enrollment rules, and higher claims across the board all played a role. If your premium increases, it doesn’t automatically mean you need to leave Medigap or make drastic changes. In many cases, the better approach is to: Review your current plan Compare pricing with other carriers Consider alternatives like Plan N or High Deductible Plan G Understand your state’s rules around switching Make sure you are getting the deepest discount possible: There are two types of discounts for Medicare Supplement policies. The Roommate Discount is typically given if you live with anyone age 60 and older at the same address. And, the Household/Multi-Insured Discount pertains to a Married/Partnered couple who have the same Medicare Supplement plan with the same carrier. Medicare Supplement plans remain among the most stable and flexible forms of coverage available. You can see any doctor that accepts Medicare, avoid network restrictions, and keep consistent coverage year after year. One additional bit of information we feel compelled to mention to anyone considering an AARP/UHC Medicare Supplement plan. First, UHC is a great company, financially strong, but they are one of only two or three companies who use a Declining Discount Scale to their Medicare Supplement policies. Meaning that Year on, you get an 11% Discount, then in year two it drops to 9% and then it drops 1% per year over the next 8 years. This is extremely important because you can find yourself upside down quickly, in a market where Double-Digit increases in premiums have become the rule and not the exception. Picture of Michael Braden's Business Card

Michael T. Braden March 4, 2026 MEDICARE SUPPLEMENT PLANS If you’ve started shopping for a Medigap/Medicare Supplement plan, you may have noticed something confusing. A Plan G from one company can have a very different price tag than the same plan from another. This is because while the government standardizes the benefits of every Plan G, it does not have the authority to standardize the pricing. This is actually excellent for every Medicare beneficiary. It means you have the power to shop around and find the best deal. Photo of Braden Medicare Insurances' Medigap Plan G Poster BREAKING DOWN MEDICARE SUPPLEMENT/MEDIGAP PLAN G The key is to compare the Medicare Supplement Plan G costs  from different insurance carriers. In this article, we’ll walk you through exactly how to do that, what to look for besides the price, and how to ensure you’re not overpaying for your coverage. We will show you recent increases from all carriers you are considering, and their Financial Ratings. (AM Best/Moody's/S&P), Market Share, etc. Get organized, simplify your budget with predictable costs, and forget about needing a Rainy Day fund for Health Emergencies. Your Medicare Supplement/Medigap Plan G  will cover nearly all your Medicare-approved expenses after you meet the annual Part B deductible (which is only $283 in 2026)—giving you a clear picture of your yearly healthcare spending. Since every Plan G offers the same government-standardized benefits, the only difference between insurance companies is the monthly premium. Comparing quotes is the key to finding the most affordable rate. Enroll on time to guarantee your coverage: Your six-month Medigap Open Enrollment Period (Initial Enrollment Period) is the most important time to sign up. During this window, you have the right to buy any Plan G policy without answering health questions or risking denial. MEDICARE SUPPLEMENT PLAN G AND MEDIGAP PLAN G ARE THE SAME THING If you’ve started looking into your Medicare options, you’ve likely heard about Plan G. So, what is it exactly? Think of Medicare Supplement Plan G, also called Medigap Plan G, as a partner to your Original Medicare (Part A and Part B). Its main job is to help pay for some of the healthcare costs that Original Medicare doesn’t cover, like deductibles and coinsurance. These “gaps” in coverage can lead to unpredictable out-of-pocket expenses. A Medigap plan like Plan G is designed to fill most of those gaps, giving you a clearer picture of your annual healthcare spending. It’s one of the most popular Medicare Supplement plans  available because it offers very comprehensive coverage, making it a dependable choice for many retirees who want to minimize surprise medical bills. By pairing it with Original Medicare, you create a powerful combination for your health coverage. Picture Of Braden Medicare Insurance's 2026 Medicare Supplement Side-By-Side Comparison Chart Poster WHAT IS COVERED UNDER MEDICARE SUPPLEMENT PLAN G Plan G is known for its comprehensive medical coverage, which significantly simplifies your healthcare costs . Once you’ve paid the annual Medicare Part B deductible, Plan G covers nearly all of your remaining out-of-pocket costs for Medicare-approved services. This means it pays for your Part A deductible, hospital coinsurance, and the 20% coinsurance for doctor visits and other outpatient services. The only high-cost Plan G does not cover is the annual Part B deductible . You are responsible for paying this amount each year before your Plan G coverage kicks in for Part B services. A unique benefit of Plan G is that it also covers Part B “excess charges.” These are additional fees, up to 15% above the Medicare-approved amount, that some doctors may charge. With Plan G, you don’t have to worry about paying these extra costs out of your own pocket. HOW PLAN G FITS WITH ORIGINAL MEDICARE When you have Plan G, you use it alongside your Original Medicare. Original Medicare acts as your primary insurance, and Plan G works as your secondary coverage, picking up the costs that Medicare leaves behind. This partnership gives you incredible freedom and flexibility. With a Medigap policy like Plan G, you can see any doctor or visit any hospital in the United States that accepts Medicare. There are no restrictive networks to worry about. This setup is designed to make your healthcare costs more predictable. Original Medicare has deductibles, copayments, and coinsurance that can add up quickly, especially if you need frequent medical care. Plan G steps in to cover most of these expenses, so after you meet your Part B deductible, you can have peace of mind knowing your major medical bills are taken care of. IS A MEDICARE SUPPLEMENT PLAN G EXPENSIVE? One of the first questions people ask about Plan G is, “How Much Does That One Cost?” The answer isn’t a single number, because your monthly premium can vary quite a bit. Think of it like car insurance, where your rate depends on your driving record and the car you drive. With Plan G, factors like your age, where you live, and the insurance company you choose all play a big role in determining your final price. It’s not a one-size-fits-all situation, which can feel confusing at first, but breaking it down makes it much more manageable. The price you pay is personalized to reflect your specific circumstances. This is actually a good thing, because it means you aren’t paying a flat rate that might be higher than what’s fair for you. Instead, your premium is tailored to you. While several elements come into play, your age and location are two of the most significant drivers of your monthly cost. Getting a handle on how these work will give you a much clearer idea of what to expect when you start looking at quotes. Let’s explore how each of these factors can affect your Plan G premium so you can feel confident as you compare your options. WHERE YOU LIVE DETERMINES WHAT YOUR PREMIUM AMOUNT WILL BE Where you live has a huge impact on your Plan G premium. Costs can differ dramatically not just from state to state, but even between different zip codes in the same city. For instance, a 65-year-old non-smoker in Dallas might find a plan for around $99 a month. That same person could see rates over $700 in New York City. On a statewide level, New York has the highest average monthly cost  at over $400, while Minnesota has the lowest at about $123. This variation is why you can’t rely on national averages; you need a quote specific to your area to understand your actual Medicare Supplement Plan G  costs. What Determines Your Plan G Premium? When you start looking at Plan G, you’ll quickly notice that there isn’t one single price tag. The monthly premium you pay is personal to you and depends on a few key factors. Insurance companies look at this information to determine how much to charge for your policy. Understanding these factors will help you see why one person’s quote might look very different from another’s and empower you to find the best rate for your situation. Let’s walk through exactly what goes into that final number. YOUR AGE It’s probably no surprise that your age plays a big role in what you’ll pay for a Plan G policy. Generally, the younger you are when you first enroll, the lower your monthly premium will be. Insurance carriers see age as a primary risk factor, so they often structure their pricing accordingly. The actual cost of Plan G  can change quite a bit based on your age when you apply. This is one of the strongest arguments for signing up for a Medigap plan during your Open Enrollment Period, which is the six-month window that starts when you’re 65 and enrolled in Part B. TOBACCO USE If you use tobacco, you can expect to pay a higher premium for your Plan G policy. Insurance companies view smoking and other tobacco use as a major health risk, which translates to higher anticipated medical costs. As a result, most carriers will charge a higher rate for tobacco users, sometimes as much as 10% to 20% more than non-users. When you apply for a policy, you will be asked about your tobacco use. It’s important to be honest, as providing false information can lead to your policy being canceled down the road. WHO YOU CHOOSE TO PARTNER WITH MATTERS & DON'T PAY FOR ANYTHING YOU DO NOT USE This is a big one. While Medicare standardizes the benefits for every Plan G policy, the insurance companies that sell them do not have standardized pricing. This means you can get the same coverage from Company A for a very different price than Company B. The basic benefits for each lettered plan are the same, no matter which insurance company sells it . This is great news for you because it means you can shop around and compare prices for the identical plan. Never assume the first quote you get is the best one available. Taking the time to compare options from different carriers is one of the best ways to save money. PLAN G OUT-OF-POCKET COSTS One of the biggest reasons people choose Medicare Supplement Plan G is for its predictability. When you’re managing a budget in retirement, the last thing you want is a surprise medical bill. Plan G helps smooth out your healthcare expenses, so you know almost exactly what to expect. Aside from your monthly premium, your out-of-pocket costs for services covered by Medicare are incredibly straightforward and limited. The plan is designed to give you a clear picture of your annual medical spending, which is a huge relief for many people. SIMPLE AND STRAIGHTFORWARD BILLING You are responsible for one annual deductible for your outpatient care. ($283 For the 2026 Medicare Plan Year), Once you’ve paid that amount for the year, Plan G steps in to cover the remaining costs for Medicare-approved services. This includes bills that can add up quickly, such as coinsurance for doctor visits, specialist appointments, and hospital stays. This comprehensive coverage provides incredible peace of mind. You can go to your appointments knowing you won’t be hit with an unexpected 20% added to the bill. It allows you to focus on your health, not on complicated medical statements and confusing percentages. YOUR ANNUAL MEDICARE PART B DEDUCTIBLE With Plan G, your main out-of-pocket cost for the year is the annual Part B deductible. Think of it as the one yearly expense you need to cover for your doctor visits and other outpatient medical services. You pay for these services yourself until you’ve reached the deductible amount. After that, your Plan G benefits take over for all Medicare-approved services for the rest of the year. Medicare sets this deductible and can change it slightly each year. Because the amount is updated annually, it’s always a good idea to check the official figure. You can find the current Part B deductible  on Medicare’s website to see what you’d be responsible for. ONCE YOU MEET THE ANNUAL PART B DEDUCTIBLE Once you’ve met your annual Part B deductible, your wallet can take a rest. Plan G is designed to cover the gaps in Original Medicare, and it does so thoroughly. For all Medicare-approved services, you will have no copayments or coinsurance. This means Plan G pays the 20% Part B coinsurance for doctor visits, outpatient therapy, and durable medical equipment. It also covers your Part A hospital deductible and coinsurance. Crucially, Plan G also covers Part B excess charges. These are additional fees that some doctors are legally allowed to charge in addition to the Medicare-approved amount. Without this coverage, you would be responsible for paying them. With Plan G, you’re protected from these extra costs. PLAN G VS PLAN F For years, Plan F was considered the top-tier Medigap plan because it covered everything, leaving you with virtually no out-of-pocket costs for Medicare-approved services. However, for people new to Medicare on or after January 1, 2020, Plan F is no longer available. This is where Plan G steps in as the most comprehensive option for new enrollees. It’s nearly identical to Plan F, with one simple difference: you are responsible for paying the annual Medicare Part B deductible. Once you’ve paid that amount for the year, Plan G’s coverage kicks in to cover the rest of your costs, just like Plan F would have. PLAN N VS PLAN G If you’re comfortable with a few more out-of-pocket costs in exchange for a lower monthly premium, Plan N is another popular option to consider. With Plan N, you are still responsible for the annual Part B deductible, just like with Plan G. However, you may also have copayments for certain services, such as up to $20 for some doctor’s office visits and up to $50 for emergency room visits that don’t result in a hospital admission. Additionally, Plan N does not cover Part B excess charges, which are extra fees some doctors can charge. Plan G covers these charges, offering a bit more protection from unpredictable costs. DON'T GET HUNG UP ON THE PREMIUMS, YOU ARE INVESTING IN YOUR HEALTH FOR YOU AND YOUR FAMILY It’s tempting to choose a plan based on the lowest monthly premium, but it’s important to look at the bigger picture. While a comprehensive plan like Plan G may have a higher monthly cost, it often provides substantial savings by limiting what you’ll pay when you actually receive medical care. Think of the premium as an investment in predictability. Paying a bit more each month can give you valuable peace of mind, knowing you’re protected from large, unexpected bills for hospital stays or frequent doctor visits. It’s all about finding the right balance between what you pay monthly and what you could potentially pay for services throughout the year. MEDICARE MYTHS When you’re looking into Plan G, you’ll likely come across a lot of information, and some of it can be misleading. Believing common myths about costs can lead you down the wrong path, potentially costing you more in the long run. Let’s clear up a few common misconceptions so you can decide with confidence. MEDICARE MYTH 1: ALL PLAN G OPTIONS ARE THE SAME PRICE BECAUSE ALL PLAN G POLICIES ARE STANDARDIZED This is one of the biggest points of confusion. While the government standardizes Medicare Supplement plans, the pricing is not. This means that a Plan G from one insurance company offers the same medical benefits as a Plan G from another. However, the monthly premium you pay can vary significantly between companies. One insurer might charge $150 per month while another charges $200 for the identical plan. This is why it’s so important to compare quotes from different carriers instead of just picking the first one you see. You could be overpaying for the same Medigap policy benefits . MEDICARE MYTH 2: ONCE YOU CHOOSE A MEDICARE SUPPLEMENT, YOUR PREMIUMS WILL NEVER INCREASE It would be nice if your premium stayed the same forever, but that’s rarely the case. Your initial rate is just a starting point. Insurance companies can, and almost always do, raise premiums over time. These increases occur for several reasons, including inflation and rising healthcare costs. Some policies also have rates that go up as you get older. A plan that seems like a bargain today could become much more expensive down the road. When choosing a plan, it’s wise to consider the company’s history of rate increases, not just the initial price. A stable company with predictable, modest increases is often a better long-term value and helps you avoid common mistakes . MEDICARE MYTH 3: PLAN G COVERS EVERYTHING Plan G provides fantastic coverage for the gaps in Original Medicare, but it doesn’t cover everything. A common and potentially costly myth is that Medigap is a complete, all-in-one insurance solution. Plan G is designed specifically to work with Medicare Parts A and B, covering your deductibles, coinsurance, and copayments. However, it does not include coverage for prescription drugs. For that, you’ll need a separate Medicare Part D plan. It also typically doesn’t cover routine dental, vision, or hearing services. Understanding these limitations helps you plan for your total healthcare strategy  and avoid surprise bills. WHEN SHOULD YOU ENROLL IN A MEDICARE SUPPLEMENT PLAN G? When it comes to signing up for a Medicare Supplement plan, timing is everything. Unlike some other parts of Medicare, there’s a specific, one-time window that gives you the most power and protection as a consumer. Missing this window can have a big impact on your options and what you pay for coverage down the road. Let’s walk through why this period is so important and what happens if you decide to wait. TAKE ADVANTAGE OF YOUR IEP AND OEP The absolute best time to buy Plan G is during your Medigap Open Enrollment Period. Think of this as your golden ticket. This six-month window starts on the first day of the month you are both 65 or older and enrolled in Medicare Part B. During this protected time, an insurance company cannot turn you down for any Medigap plan it sells, including Plan G. It doesn’t matter what health conditions you have; they must offer you a policy. This is your one chance to get coverage with guaranteed issue rights , meaning no medical questions asked. YOUR HEALTH IN THE FUTURE MAY CHANGE, SO MAKE YOUR FIRST CHOICE OF MEDICARE PLANS COUNT If you miss your Open Enrollment Period and decide to apply for Plan G later, the rules change completely. Insurance companies are no longer required to sell you a policy. Instead, you’ll likely have to go through medical underwriting. This is a process where the insurer reviews your entire health history, including pre-existing conditions and prescriptions. Based on this review, they can legally charge you a higher premium or even deny your application for coverage altogether. In It’s a common and costly myth that you can pick up a Medigap plan whenever you want. Taking action during your initial enrollment window is the surest way to secure the plan you want at the best possible price. OPTIONS TO COMPARE PLAN G OFFERINGS IN YOUR AREA Here’s the single most important thing to know when you start shopping: every Plan G offers the same basic benefits, no matter which insurance company sells it. This is because the government standardizes Medigap plans . A Plan G from one company covers the same Medicare gaps as a Plan G from any other company. This is great news for you, because it means you can shop around and compare prices  for the identical plan. The monthly premium is the main difference you’ll see between carriers. So, your goal is to find the company that offers the most competitive price for Plan G in your area, along with a reputation for good customer service. PRICE COMPARISON TOOLS FOR MEDIGAP PREMIUMS Did You Know That You Can Actually Start A Search Using Your Own Computer: The official Medicare website has a tool that lets you find and compare Medigap policies available in your area. This is a great starting point for getting a general idea of the price range you can expect. You can also visit the websites of individual insurance companies to get quotes. However, keep in mind that the most accurate way to understand your Medigap costs  is to get a personalized quote directly from the company. Online estimators are helpful, but a direct quote will be based on your specific details, giving you a real number to work with for your budget. YOUR BE ST CHOICE IS TO WORK WITH A LOCAL MEDICARE BROKER Photo of Braden Medicare Insurances" Why Working With An Independent Licensed Medicare Broker Makes The Most Sense Poster If you’d rather not spend your time gathering quotes yourself, working with an independent insurance agent is a fantastic option. A licensed Medicare Broker can do all the heavy lifting for you. They can pull quotes from multiple carriers at once and present you with the best options for your health needs and budget. This approach not only saves you time but also gives you peace of mind by having an expert guide you through the process, ensuring you understand your choices and feel confident in your final decision. FREQUENTLY ASKED QUESTIONS REGARDING PLAN G Does Plan G  cover my prescription drugs? No, it does not. Medicare Supplement plans, including Plan G, are designed to work with Original Medicare (Part A and Part B) to cover your hospital and medical costs. They do not include coverage for prescription medications. To get help paying for your prescriptions, you will need to enroll in a separate Medicare Part D plan. If all Plan G policies have the same benefits, why are the prices so different? This is a great question. While the government standardizes the medical benefits for every Plan G policy, it does not regulate the price. Each insurance company sets its own monthly premium for the same coverage. This is why you can find identical plans at very different price points, making it one of the most important steps: comparing quotes from several carriers . What happens if I wait to enroll in Plan G after my initial enrollment period? Waiting can make it much harder and more expensive to get a plan. During your one-time, six-month Open Enrollment Period, insurance companies cannot use your health history to deny you coverage or charge you more. If you apply later, you will likely have to answer health questions. An insurer could then charge you a higher rate or even refuse to sell you a policy based on your medical history. Besides my monthly premium, what will I actually have to pay for my healthcare with Plan G? Your out-of-pocket costs are very predictable with Plan G. Your only major responsibility for Medicare-covered services is the annual Part B deductible. You pay for your outpatient care until you meet that amount for the year. After that, Plan G covers your approved costs, like hospital deductibles and coinsurance, at 100%. WHAT HAPPENED TO PLAN F? A change in federal law made Plan F unavailable to anyone who became eligible for Medicare on or after January 1, 2020. For this group of new enrollees, Plan G is now the most comprehensive option available. It works almost identically to Plan F; the only difference is that you are responsible for paying the annual Part B deductible yourself, instead of the Plan automatically paying it for you. Did you know that , on average, Plan F Annual Premiums range from $300 to $600 More than Plan G? WRAPPING THINGS UP When I first started out as a Medicare Broker over 10 years ago, Plan F was hands down the best, most comprehensive Medicare Supplement plan available, and it was considered fairly affordable. However, times have changed, other Medicare Supplement plans are plentiful, and for quality and value, Plan G is now a much better value than Plan F. Most Plan F premiums are, on average, $500-$1,200 higher than Plan G per year. And, not only that, but when there are increases, Plan F is typically 2-3% higher than increases with Plan G. Since the only difference is the fact that the grandfathered Plan F plans automatically pay the Annual Medicare Part B deductible for you (The Part B Deductible is just $283 for 2026), and you pay the Part B Deductible with a Plan G. There is no good reason to keep putting up with the sizeable premiums for Plan F. They are both the best and most comprehensive Medigap plans available. But Plan G is the winner for best overall value among all Medicare Supplement/Medigap plans. My Mother-In-Law is now 92, and she still has a Plan F, because at her age, it did not make sense to upset the Apple Cart. But for anyone in their 60s and 70s changing to a Plan G now, it will save you not just per year, but for the rest of your life. If you have any questions about how to compare and contrast Plan G and Plan F, or about Medicare in general, please feel free to email, call, or text me anytime. We are always here to serve others, and we never charge a penny for our time or for our expertise. Picture Of Braden Medicare Insurance's Poster of Michael Braden's Business Card.

Michael T. Braden January 25, 2026 MEDICARE 101 WHAT IS YOUR BENEFIT VERIFICATION LETTER? In today's article, we are introducing and explaining what A Benefit Authorization Letter is, how and where to get a copy of your Benefit Verification Letter, and what to do with it once you have it. A photo of Braden Medicare Insurance's Online Benefit Verification Letter Poster ABOUT YOUR SOCIAL SECURITY BENEFIT VERIFICATION LETTER Medicare is much more confusing than it needs to be, but the government certainly is not as helpful as it could be. After all, they never teach us about Medicare, we are usually left to ask a friend or relative, or roll up our sleeves and figure it out on our own. Up until you receive your Medicare Card and you are formally enrolled in Medicare, you actually enroll in Medicare through Social Security. Because the SSA (Social Security Administration) has access to all of your work history, they are the ones who can vouch/verify that you are qualified and entitled to Medicare Benefits. Then, once you have your Red, White & Blue Medicare Card, you can set up an account on the Medicare website at www.medicare.gov One of the most confusing things is having a clear understanding that to receive your Medicare card, you need to do one of two things: If you have already enrolled and/or you are already receiving Social Security Benefits, you will automatically be enrolled in both Medicare Part A (Hospitalization) and Medicare Part B (Outpatient Services). If you are not enrolled in Social Security, you need to enroll in Medicare. The best and fastest way to do this is to visit the Social Security Website at www.ssa.gov and follow the links to Enroll in Medicare Only. On the Social Security Website, you can enroll in Medicare Part A, Medicare Part B or both; Part A and Part B. YOU COMPLETED YOUR ENROLLMENT ONLINE, BUT YOU HAVE NOT YET RECEIVED YOUR MEDICARE CARD If you completed your Medicare enrollment online but have not yet received your Medicare Card, it's okay. The main thing is you will need the information from your Medicare Card to enroll in the Medicare plan of your choosing, but there are some steps you can take to get that information while you are waiting for your card to arrive. If you’ve recently enrolled in Medicare but haven’t received your Medicare card yet, do not panic; you actually do not have to wait for your Medicare card to arrive by mail. You can request/access your Benefit Verification Letter from your Account on the Social Security Administration's website quickly and easily. Your Benefit Verification Letter from the Social Security Administration (SSA) contains all the information you need, including your Medicare number and coverage start dates. The best part is that you can get it online right now through your “My Social Security” account at SSA.gov , and follow the instructions to receive a copy of your Benefit Verification Letter (BVL). SO WHAT IS A BENEFIT VERIFICATION LETTER AND WHY YOU MIGHT NEED ONE A Benefit Verification Letter from the Social Security Office is often referred to as a Proof Of Income letter. It is an official document from the Social Security Administration that confirms your Medicare enrollment status. For Medicare beneficiaries, this letter serves as immediate proof of coverage and includes all the essential information you need to move forward with your healthcare planning. Until you receive your actual Medicare Card, you can use the Benefit Verification Letter to complete the rest of your enrollment into the Medicare plan of your choice.  The BVL displays your Medicare ID Number, and both your Medicare Part A and Medicare Part B Effective Dates.  If you are enrolled in Social Security and are receiving Social Security Benefits, your BVL also shows your monthly benefit amount and any Medicare premium deductions taken from those benefits. Your Benefit Verification Letter (BVL) is accepted by insurance companies, healthcare providers, and Medicare Advantage or Medicare Supplement carriers as proof that you have completed your Medicare enrollment.  FOLLOW THESE STEPS TO ACCESS YOUR BVL 1. CREATING A NEW ACCOUNT, or LOG IN TO YOUR EXISTING "MY SOCIAL SECURITY" ACCOUNT. Go to the Social Security website by entering www.ssa.gov into your web browser. Once you are connected, look for and click on the blue  “Sign in or create an account”  button. This button is located near the top of the Social Security website's landing page. If you’re creating a new account, you’ll verify your identity through Login.gov or ID.me using your Social Security number, driver’s license or state ID, and either your telephone number or your email address.  2. FINDING AND ACCESSING YOUR BVL Once you’re logged in, look for “Replacement Documents” on your dashboard and click “Get a Benefit Verification Letter.” You’ll see your letter on screen immediately, showing your Medicare number and coverage dates.  3. DOWNLOAD AND SAVE YOUR BVL Click “Download” or “Print” to save a PDF copy to either your Laptop, Desktop, Tablet, or Smartphone. Many people save copies in multiple places for easy access whenever they need to provide proof of Medicare enrollment.  IF YOU GET STUCK DURING THIS PROCESS If you can’t find your benefit verification letter, make sure you’re logged in to your personal My Social Security account, not just browsing the SSA website. If the information looks incorrect, you can contact Social Security at 1-800-772-1213. You can also request a letter by phone if you prefer not to use the online system, and it will be mailed within 10-14 business days.  ONCE YOU HAVE YOUR BENEFIT VERIFICATION LETTER Now that you have a copy of your BVL, it will act as a fully legal substitute for your physical Medicare Card until you receive yours in the mail. You can present your BVL to your Medicare Agent/Broker, and they can complete your enrollment in the Medicare Plan option that best meets your needs. Your BVL will work for Medicare Supplement Plans, Medigap Plans, Medicare Advantage Plans, and Medicare Part D Prescription Drug Plans.  ENROLLING IN A MEDICARE SUPPLEMENT PLAN/MEDIGAP PLAN  Medicare Supplement plans work alongside Original Medicare to help cover remaining out-of-pocket costs. With your letter, you can confidently contact insurance agents, request quotes online, and compare multiple carriers to find the Medigap plan that best fits your healthcare needs and budget.   Once you have your Medicare number and coverage effective dates, you can provide this information to ensure your Medigap coverage coordinates properly with Original Medicare.  ENROLLING IN A MEDICARE ADVANTAGE PLAN (MEDICARE PART C)  If you’re considering Medicare Advantage  instead, your SSA Benefit Verification Letter serves as proof of your Medicare eligibility.   Contrary to Medicare Supplement plans, you must have your Medicare ID number to apply for an Advantage plan. Medicare Advantage plans bundle your Part A hospital coverage and Part B medical coverage into one comprehensive plan, often including additional  benefits like prescription drug coverage, dental, vision, and hearing services.  ENROLLING IN A STAND-ALONE MEDICARE PART D PRESCRIPTION DRUG PLAN  Having your BVL allows you to enroll in a standalone Part D prescription drug plan if you’re staying with Original Medicare. Since many medications can be expensive without coverage, having your Medicare information readily available helps you compare and enroll in a Part D plan to ensure prescription coverage and, perhaps more importantly, to make sure you avoid any potential Medicare Part D Late-Enrollment Penalties.  WRAPPING THINGS UP I hope you feel like an expert in Social Security Online Benefit Verification Letters now. The next part of your Medicare enrollment will be for you to determine which Medicare Health Plan option is the best choice for you, your lifestyle, and your family. Your options are: Original Medicare Parts A and B. Original Medicare and adding a Medicare Supplement or Medigap Plan to fill in the gaps to protect you financially from unforeseen medical expenses. Medicare Part C (Medicare Advantage Plans, which are often referred to as All-In-One plans). We recommend that every Medicare beneficiary work with an independent Medicare Broker. Medicare brokers are experts in the field of Medicare; they never charge for their experience or their time, and they will be there working with you for years to come. If you already have a broker to work with, congratulations. If you are unsure how to find an independent broker near you, feel free to reach out to us at Braden Medicare. We will teach you where to find a broker near you and how to interview them to see if you think they are a good fit for you. Picture of Braden Medicare Insurance's Copy Of Michael Braden's Business Card Braden Medicare Insurance is based in Chandler, Arizona, and we serve clients throughout Arizona, as well as CA, CO, FL, IN, IA, MI, NM, NV, OH, OR, PA, TX, and WI.