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Michael T. Braden, July 11, 2024, Medicare Advantage ARE ALL MEDICARE ADVANTAGE PLANS BAD Medicare Advantage plans are not for everyone. But are they terrible? When you enroll in coverage, several factors should be considered, including costs, availability, and the plan's network. Braden Medicare's Poster Of The Disadvantages Of Medicare Advantage Plans Many seniors turn to Medicare Advantage plans as an alternative to traditional Medicare, as healthcare costs continue to rise nationwide. However, despite the promises of these plans, they often entail drawbacks that are frequently overlooked . Medicare Advantage plans may include additional benefits such as prescription drug coverage, vision, dental, hearing aids, and possibly a free gym membership . Yet, people often complain about or criticize these plans. So, what are the disadvantages of Medicare Advantage? WHY ARE MEDICARE ADVANTAGE PLANS BAD? Misinformation and a lack of understanding can lead to Medicare Advantage nightmares. We are here to help clarify the issue. Medicare Advantage plans are not bad in every situation. However, they are certainly not a good fit for everyone. You should only enroll in Medicare Advantage coverage if it is the best fit for your unique situation. Below, we clarify why these seemingly too-good-to-be-true plans have a less-than-stellar reputation and answer the much-anticipated question of why Medicare Advantage plans are evil. WHY DOCTORS DON'T LIKE MEDICARE ADVANTAGE It is no secret that some physicians have expressed concerns about Medicare Advantage plans . If you ask your doctor how they feel about Medicare Advantage plans, the answer may surprise you. There are several reasons physicians do not favor Medicare Advantage Plans. These include: Strict network of providers The financial structure of the plans Prior authorization is typically required for services. If you are on the fence about enrolling in a Medicare Advantage plan, it is essential to weigh the pros and cons from your physician’s perspective. However, not all physicians share this view; some may encourage Medicare Advantage plans if they believe it is in their patients' best interests . THEY USUALLY HAVE STRICT PROVIDER NETWORKS Physicians may have a variety of reasons for disfavoring Medicare Advantage plans. One reason is that these plans often have smaller networks of doctors and hospitals than traditional Medicare, which can limit the number of available providers. This can be frustrating for doctors who want to provide the best possible care for their patients by offering referrals, but are constrained by the limitations of the plan. When a Medicare Advantage plan offers a limited network, receiving a referral to the best specialist may be more difficult than anticipated. HOW MA/MAPD PLANS ARE DESIGNED The average physician is not a fan of Medicare Advantage because these plans shift patients’ financial risk to physicians . The Medicare Advantage plan carrier will pay your doctor a set amount of money upfront based on a diagnosis. So, the only way the physician will make a profit is if they stay under budget. This encourages doctors to provide cost-effective care that may create pressure to prioritize cost over care. The complex billing and reimbursement process for Medicare Advantage plans is also a common source of frustration for physicians . In addition to needing to stay under budget when providing care, Medicare Advantage plans often have different payment structures and rates than traditional Medicare, which can make it difficult for doctors to understand how they will be paid for their services. DEALING WITH PRIOR AUTHORIZATIONS Another reason doctors may not favor Medicare Advantage plans is that they often require prior authorization for specific treatments or procedures. This means that doctors must get approval from the insurance company before they can perform specific tests, procedures, or treatments. Obtaining prior authorization can be time-consuming and delay the delivery of care, which can be frustrating for both the physician and the patient. THE GOOD, THE BAD, AND THE UGLY OF MEDICARE ADVANTAGE PLANS Not all aspects of Medicare Advantage plans are bad. If the benefits match your needs both medically and financially, there can be some drawbacks to Medicare Advantage plans. SOME POSITIVE THINGS ABOUT MEDICARE ADVANTAGE PLANS ARE Additional benefits: Medicare Advantage Plans often offer extra benefits that Original Medicare does not cover, such as dental, vision, and hearing care. Some plans may also include fitness and wellness programs, transportation, and other services. Lower costs: Medicare Advantage Plans may offer lower out-of-pocket costs than Original Medicare and impose annual limits on out-of-pocket expenses, which can help individuals budget for healthcare expenses. Prescription drug coverage: Many Medicare Advantage Plans also include prescription drug coverage, which can be more affordable than purchasing a separate Part D plan. Overall, if the benefits are best for you, Medicare Advantage Plans may not be entirely bad. However, it is essential to understand the overall costs associated with your plan, your benefits, and the network restrictions you must comply with when receiving care. DISADVANTAGES OF MEDICARE ADVANTAGE PLANS There are several reasons beneficiaries may perceive Medicare Advantage plans unfavorably . Some policyholders may identify disadvantages, whereas others may be satisfied with their Medicare Advantage coverage. Based on who you ask, the answer to this question varies. Overall, the most common complaint we hear about Medicare Advantage plans concerns their restrictive provider networks and high out-of-pocket costs. Even without a low or zero-dollar monthly premium, most beneficiaries spend more out-of-pocket on a Medicare Advantage plan than they would through a Medicare Supplement plan. THE BIGGEST DISADVANTAGES OF MEDICARE ADVANTAGE PLANS Coverage does not travel with you. The small network of doctors High out-of-pocket costs Plan benefits change annually The constant need for referrals and approvals You should carefully consider your priorities before enrolling in a Medicare Advantage plan. By doing so, you can make an informed decision about your healthcare and ensure you receive the best possible care. MA/MAPD (MEDICARE ADVANTAGE PLANS) DO NOT TRAVEL WITH YOU Another disadvantage of Medicare Advantage plans is that coverage does not travel with you, which can be particularly problematic for seniors who enjoy traveling or who spend part of the year in a different location. When you enroll in a Medicare Advantage plan, you are typically limited to a specific geographic area. If you travel outside this area, you may be covered only for emergency care . SMALL PHYSICIANS NETWORKS Provider networks are another significant disadvantage of Medicare Advantage plans, not only for the doctors but also for you as an enrollee. Medicare Advantage plans often have narrow provider networks, which can limit access to care. In some cases, you may have to travel long distances to see a provider within your network who can care for your needs. This can be especially difficult for individuals with mobility impairments or who rely on public transportation. Moreover, even when you can find a provider within your network, the quality of care may not be optimal. Medicare Advantage plans are known for incentivizing providers to offer lower-cost care, which can result in lower-quality care or limited treatment options. HIGH OUT-OF-POCKET COSTS One of the primary reasons why Medicare Advantage plans are problematic for some is their high costs. While these plans may offer lower premiums than traditional Medicare, they often entail additional fees that can quickly accumulate . For example, many Medicare Advantage plans can have high deductibles, which means you must pay a certain amount out-of-pocket before their coverage kicks in. In addition, these plans may also have higher copayments and coinsurance for certain services, such as hospital stays or outpatient procedures. Additionally, you may be subject to paying higher costs if you receive care from a provider who is out of your plan’s network. ANNUAL PLAN BENEFIT CHANGES & ENROLLING EVERY YEAR Annual changes to Medicare Advantage plan benefits can create uncertainty, limit access to needed care, and increase out-of-pocket costs for policyholders if not properly reviewed. When you enroll in a Medicare Advantage plan, you agree to a set of benefits and costs for a specific period of time. However, insurance companies may make changes to the plan each year, such as to the cost-sharing structure, the drugs covered, or the in-network providers . These changes can make it difficult for patients to adjust to new requirements, find alternative treatments, and access needed care. If a plan increases copays or deductibles, it may be more difficult for patients to afford needed care or adhere to their treatment plans. Therefore, patients should review the details of their plan annually and consider alternatives if the changes are not favorable to their health needs or budget. MOST HMO PLANS REQUIRE REFERRALS TO SEE A SPECIALIST Medicare Advantage plans often require you to obtain referrals from your primary care physician before seeing a specialist or receiving certain medical services. This can be a frustrating and time-consuming process, as you must complete this additional step before you can receive the care you need. In some cases, you may also need to obtain prior authorization from your insurance company before receiving certain medical services or treatments. This can result in delays or denials of care, which can be especially problematic for patients with severe or urgent health needs. NO MEDICARE ADVANTAGE PLAN IS FREE A big misconception about Medicare Advantage plans is that they are free. However, this is far from the truth. When you enroll in a Medicare Advantage plan, you are still responsible for paying the Medicare Part B premium and cost-sharing. So, unfortunately, while you may have a zero-dollar premium plan, there is no such thing as a free Medicare plan. The main reason why Medicare Advantage carriers can offer low to zero-dollar monthly premium plans is that Medicare pays the private companies providing the plans to take on your health risk. However, not all Medicare Advantage plans have low premiums . Medicare Advantage carriers make their plans look attractive to entice beneficiaries to enroll. Then, Medicare pays the carrier a fixed monthly amount to provide coverage to each enrolled beneficiary. WHAT MOST AGENTS AND MEDICARE ADVANTAGE COMPANIES DO NOT WANT YOU TO KNOW Medicare Advantage plans often offer extra benefits that you won’t find with Original Medicare or a Medicare Supplement plan. These benefits include dental, vision, and hearing care , prescription drug coverage, gym memberships, and more. However, these additional benefits can cause issues when paying for the services. Often, beneficiaries face disappointment when they pay more than they budgeted for when utilizing the additional benefits. Although their Medicare Advantage plan provides coverage, they are almost always faced with high out-of-pocket expenses and a low maximum benefit . Plus, once you exceed a certain amount of coverage for most additional benefits, you are responsible for 100% of your costs. And if that was not bad enough, no one tells you that the additional benefits are divided into four quarters, so your $1,000 Dental Allowance is only $250 per quarter. Very few plans roll over unused amounts to the next quarter. No one tells you that you must pay $295- $400 per day for the first seven days if you are admitted to the hospital. There are very few rehabilitation facilities in the network.NetworkCare Advantage members are required to pay out-of-pocket for a facility that is preferred or the closest to them. However, Medicare Advantage plans may be appropriate in certain situations. If you are on a limited budget and cannot afford the monthly premiums for a Medicare Supplement plan, then a Medicare Advantage plan with sufficient coverage for your health needs is a good deal. IS ENROLLING IN A MEDICARE ADVANTAGE PLAN A SOUND INVESTMENT? Medicare Advantage plans are undoubtedly worth the zero-dollar premium. However, it is your choice to determine whether the coverage is appropriate for you and your budget. The value of a Medicare Advantage plan depends on your location, healthcare needs, budget, and preferences. For some, a Medicare Advantage plan may be a sound financial investment. If you do not regularly attend doctors’ appointments and are in excellent health, you could end up getting more out of the plan than you put in. However, if a health concern eventually arises, this is when the investment could flop. Medicare Advantage plans are good until they are no longer suitable for you. IF I ENROLL IN A MEDICARE ADVANTAGE PLAN NOW, I CAN ENROLL IN A MEDICARE SUPPLEMENT PLAN LATER, RIGHT? If you enroll in a Medicare Advantage plan now, you may be able to cancel your Medicare Advantage plan and enroll in a Medicare Supplement (Medigap) plan  in the future. To do so, you will have to wait until the Annual Enrollment Period , a Special Enrollment Period , or the Medicare Advantage Open Enrollment Period  to make changes. It is essential to note that most beneficiaries will receive only one Medicare Supplement Open Enrollment Period in their lifetime. This is your only opportunity to enroll in a Medigap plan without answering health questions. In addition to answering health questions, you may already have a circumstance that could deny you acceptance for a Medicare Supplement Plan. Some of these items are having had stents implanted, having a Defibrillator, being diagnosed or taking COPD Medication, receiving care from a Pain Clinic, Having been diagnosed with Chronic Arthritis or SPinal Stenosis, taking more than 50 Units of Insulin daily, having ESRD, Having had surgery in the last 2-3 years, having more than two overnight stays in a hospital in the past year. There are many more , and each carrier has its own Underwriting Guidelines. Still, here at Braden Medicare, we advise anyone who may want a Medicare Supplement plan later to start with one. We have seen too many bad things happen to good people. BRADEN MEDICARE INSURANCE POSTER OF A BIRD IN THE HAND IS WORTH TWO IN THE BUSH If you miss this one-time opportunity to enroll, you will have to answer health questions should you wish to enroll in a Medicare Supplement plan in the future. This means the carrier may deny your application based on pre-existing conditions. Thus, it’s essential to understand which coverage is best for you and enroll in that coverage the first time. WILL YOU PAY MORE WITH A MEDICARE ADVANTAGE PLAN OR A MEDIGAP PLAN? Although many people are initially put off by the higher monthly premiums of Medicare Supplement plans, your out-of-pocket costs each year could be higher on a premium-free Medicare Advantage plan. When you compare your total costs on each plan, you may be surprised at how much you will spend out-of-pocket on copayments, coinsurances, and deductibles. Typically, your MOOP (Maximum-Out-Of-Pocket) amount is the most you can spend, and most Medicare Advantage plans have MOOP amounts well over 5K per year. With a Medicare Supplement plan, you have a low Annual Part B Deductible of $257 (In 2025) + the cost of your premiums. For most people, this is between $1,500 - $3,000 per year. There is value in having predictable expenses, rather than paying out-of-pocket for services, as you must with Medicare Advantage plans. Remember that your actual spending will depend on which Medicare Supplement plan you choose and the amount of care you receive throughout the year. Those who visit the doctor only once annually may spend less under a Medicare Advantage plan. However, if a significant health concern arises, you will always pay less with a Medicare Supplement plan. Lastly , an important point to remember is that every Medicare Advantage plan has a 20% Copayment for all chemotherapy and Radiation Treatments, which can add up quickly. These services are covered under Original Medicare and a Medicare Supplement Plan C, F, G, or N . IS HAVING A MEDICARE ADVANTAGE plan right FOR YOU? Understanding whether a Medicare Advantage plan is right for you can depend on several factors. Most importantly, you’ll need to be sure that the plan you choose to enroll in meets your needs, both medically and financially. With all the downsides, why are they pushing Medicare Advantage plans so often? This may be because a Medicare Advantage plan could be your best option. To ensure a Medicare Advantage plan is right for you, you will need to: Evaluate your healthcare needs:  Look at your current healthcare needs and consider any potential changes in the future. Make a list of your prescription drugs, doctor visits, and any other healthcare services you anticipate needing in the coming year. Compare plan options:  Use the Medicare Plan Finder tool to compare the costs and benefits of different Medicare Advantage plans available in your area. Look at the premiums, deductibles, copayments, and coverage limitations. Consider your budget:  Evaluate your budget and determine how much you can afford to spend on healthcare costs each month. Remember that Medicare Advantage plans often have different fees for different services, so it’s essential to consider all the potential costs. Review plan networks:  Ensure that the plan you are considering includes your current doctors, hospitals, and other healthcare providers in its network. Understand plan benefits:  Review the additional benefits that the Medicare Advantage plan offers, such as dental, vision, or hearing services, as well as wellness programs, gym memberships, and other perks. Speak with a licensed Medicare agent:  Consult with a Medicare expert to help you understand your options and make an informed decision. Ultimately, the decision to enroll in a Medicare Advantage plan depends on your unique healthcare needs and budget. By taking the time to research and compare different plans, you can find the one that is best for you. By following these steps, you will be able to determine if a Medicare Advantage plan is right for you. We encourage all of our clients to invite their children, Nieces, Nephews, Cousins, or Grandchildren to be part of the decision-making process. After all, they will only want the best for you, and more importantly, they might be taking care of you and acting on your behalf later, so it just makes good sense to involve them early on. HOW DO MEDICARE ADVANTAGE PLANS MAKE MONEY? Medicare pays carriers that offer Medicare Advantage plans through a bidding process. The carriers submit their bids based on per-enrollee costs for medical services covered by Original Medicare . Suppose the bid exceeds the benchmark amount. In that case, the enrollee will pay the difference as monthly premiums ; thus, some Advantage plans have a zero-dollar premium, whereas others have a monthly premium. But the most significant way they make money is from the Government. Medicare pays Medicare Advantage companies $12K per year for each Medicare beneficiary enrolled in one of their plans, for assuming the risks associated with your care. This is where most of the money comes from for all of their commercials and advertising. Medicare Advantage plans have always been notorious for running out the clock in the 4th quarter. What do I mean by that? You have to sign up for a new Medicare Advantage plan every year, so if your Medicare Advantage Insurance carrier wants to, they can have you get 2nd, 3rd, and 4th opinions for anything they want, to delay paying out for a procedure, knowing that you will have a new plan beginning January 1st. AT THE END OF THE DAY, ARE MY PLANS GOOD OR BAD Depending on your situation, a Medicare Advantage plan may not be the best option for you. However, different circumstances warrant different plan types. Ultimately, it is crucial to know what to expect from these plans – regarding price and coverage – and become educated on which options are affordable to you and provide the coverage you need. When determining if a Medicare Advantage plan is bad or good for you, you should thoroughly compare all plans available to you. Then, you can choose which plan best fits your needs and which ultimately fits your budget. This is the best way to determine which plan type is best for you. Remember, everyone’s situation is different, so what works best for you may not work best for your spouse or neighbor. What is the Biggest Downside to Medicare Advantage Plans? One of the most common complaints we hear about Medicare Advantage plans is the lack of flexibility and high out-of-pocket costs for services. Although these plans often offer low monthly premiums, they are usually accompanied by high deductibles and out-of-pocket expenses. In some cases, you may be better off paying a higher premium to have lower overall costs in the end. However, cost is not the only downside to Medicare Advantage plans. The lack of network availability in some areas is another significant downside to Medicare Advantage plans. For some, the importance of seeing whichever doctor you prefer is a deal breaker. However, if you enroll in a Medicare Advantage plan, you may not be able to have this option. In Arizona, the Mayo Clinic, Mayo Hospital, and Barrow Neurological Institute do not accept Medicare Advantage plans but do accept Original Medicare. This is true for most teaching hospitals nationwide. IF YOU ARE HELL BENT ON HAVING A MEDICARE ADVANTAGE PLAN, DO YOUR RESEARCH...... The worst Medicare Advantage plan for you is one that is not suitable for your needs and budget. If you enroll in a plan that is not right for you, you could be stuck with subpar coverage, high costs, and doctors that you do not prefer. If you decide that a Medicare Advantage plan is best for you, it is essential to still research which Medicare Advantage plan is best for you. Not all Medicare Advantage plans offer the same benefits. Thus, understanding your plan is key to a prosperous future with your healthcare plan. WRAPPING THINGS UP We always recommend that every Medicare Beneficiary work with a Licensed, Independent Medicare Broker. It costs you nothing but can save you the most time, and Brokers inherently know more than you will learn; they do this for a living. They have access to more plans, and choice does equate to value. As an example, you might think you are just going to get a Humana Medicare Advantage plan, fine, your choice, but if you call Humana, they can only recommend Humana plans ; they cannot recommend any other company's plans. You may think you are saving money, but you are actually costing yourself by not working with an expert. If you are considering enrolling in a Medicare Advantage plan but are hesitant, we are here to help you make an informed decision. The key to obtaining the best coverage for you is researching plans in your area and becoming educated on your options. Whether you believe a Medicare Advantage plan is right for you or wish to explore Medicare Supplement plans, we are available online, by telephone, email, or text. Our only goal is to provide a service and to do our level best to ensure that each of our clients finds the right plan that meets their needs and those of their families. There is no one-size-fits-all plan for Medicare. However, with over 40 carriers, we know we can offer you more choices from more companies than any other agent or broker. It's another reason why we say that we treat clients like friends, and we always treat friends as members of our family. Braden Medicare Insurance Business Card For Michael Braden

Michael T. Braden August 31, 2025 MEDICARE NEWS THE MEDICARE ANNUAL ENROLLMENT PERIOD IS FAST APPROACHING. ARE YOU READY? It's Almost Time For The Medicare Annual Enrollment Period. The Medicare Annual Enrollment period runs from October 15 through December 7th. The Medicare AEP (Annual Enrollment Period) runs from October 15th through December 7th every year. During AEP, about 48 million Medicare Beneficiaries will make at least one change to their Healthcare portfolio for the 2026 Plan Year. The Medicare Annual Enrollment Period (AEP) occurs each fall. During the AEP, Medicare beneficiaries can change their current Medicare Advantage Plan, change their Stand-Alone Medicare Part D Prescription Drug Plan, leave Medicare Advantage and return to Original Medicare, or leave Original Medicare and choose a Medicare Advantage plan for the coming year. All changes made during the AEP will begin on January 1st, 2026. Medicare Annual Enrollment is an opportunity to review your current coverage and assess your needs. Furthermore, for those who missed their chance to enroll in Medicare Part D when first eligible, this is the only time to enroll each year. Reviewing your needs at least once a year is always a good idea, and the Fall Enrollment Period is an ideal opportunity. Below, we review the AEP enrollment period, including its timing, operation, and how to utilize it effectively.   THE MEDICARE AEP DEFINED   During the Annual Enrollment Period, you can change your Medicare Part C and Part D plans for the upcoming year. Subsequently, it could also affect your Medicare Supplement plan if you choose to enroll in a Medicare Advantage plan. The Medicare Annual Enrollment Period happens each fall and allows you to ensure you are enrolled in the right coverage year after year. The way in which you are covered for your healthcare expenses is essential for several reasons. There are different options for different people, and considering you can’t have both a Medicare Advantage plan and a Medicare Supplement (Medigap) plan simultaneously, it’s essential to know your options. If you have a Medicare Supplement Plan, there is nothing to do during the Annual Enrollment Period. Medigap/Medicare Supplement plans automatically renew each month you own your policy. You can check rates and change your Medigap plan at any time during the year. You will most likely need to answer Health questions, and your application will be subject to the Underwriting process with your Insurance partner. However, for 7 out of 10 people, the process is straightforward.   IS THE ANNUAL ENROLLMENT PERIOD FOR MEDICARE THE SAME EACH YEAR?   The Medicare Annual Enrollment Period, also known as the Fall Enrollment Period or Open Enrollment Period, occurs annually from October 15 to December 7. During these AEP dates, you can make changes to your Medicare elections for the upcoming year during this enrollment period. This annual Medicare enrollment period is an opportunity to review and update your Medicare elections to better fit your lifestyle, healthcare needs, and budget. If you are unhappy with changes you made in the past or with your current plan, the Medicare Fall Open Enrollment Period is the time to address them for the following year.   COMPARING THE ANNUAL ENROLLMENT PERIOD TO THE MEDICARE ADVANTAGE OPEN ENROLLMENT PERIOD   AEP stands for Medicare Annual Enrollment Period,  and OEP stands for Medicare Open Enrollment Period . Depending on the context, OEP can refer to many other Medicare enrollment windows . The difference between Medicare AEP and OEP is that there are multiple Open Enrollment Periods available through Medicare. Depending on your coverage type, you can make adjustments. For example: If you’re talking about the AEP, then you can make changes to your current Medicare Advantage or Part D plan. Those referring to the Medicare Advantage Open Enrollment Period can only make changes if they’re already enrolled in a Medicare Advantage plan. If you’re referring to your Medicare Supplement Open Enrollment Period , then you can enroll in a Medicare Supplement plan (Medigap) without having to answer any health questions. It’s essential to note that you can enroll in a Medicare Supplement plan at any time during the year. The only difference is that if you do it outside your open enrollment window, you’ll have to answer Medicare Supplement underwriting questions . The number of changes you can make during an OEP depends on which Open Enrollment Period you’re referring to: If you’re making changes to your Advantage or Part D plan during the AEP, you can make as many changes as you want. The last change you make will take effect on January 1st of the following year. If you’re referring to your Medigap OEP, you can also make as many changes as you want. However, the plan you choose last is the one you will be enrolled in and is effective on the 1st of the following month, or as soon as your Part B is active. Additional changes within the 6-month window become effective on the 1st of the following month. If you’re talking about the Medicare Advantage Open Enrollment Period, you can only make one change during this enrollment window. Choose wisely the first time. Medicare enrollment windows can be confusing, but help from a licensed insurance agent can make the process easier. WHAT IS THE BEST WAY TO COMPARE PRESCRIPTION DRUG PLANS   Approximately 23 million Americans are enrolled in a Medicare Part D drug plan. Thus, it is essential to review and compare Medicare Part D prescription drug plans  annually during the Medicare Annual Enrollment period, as plans undergo annual changes. As Medicare Advantage plans , Medicare Part D coverage also does not stay consistent year after year, and it is crucial to review your plan changes. This way, you can compare other policy options and double-check that you have the right coverage for your needs. Common reasons you may want to switch drug plans are: Changes in premium Changes in the drug formulary Change in preferred pharmacy Any of the above changes could significantly affect how you use your Medicare Part D plan. This means that a plan better suited to your needs may be available. However, you may not be aware of these changes unless you review and compare your plan. The Medicare AEP dates are the perfect time to do this. Each year, the company that manages your Medicare Part D plan must send you an Annual Notice of Change document in September. This document outlines any changes to your current policy that will take effect next year. Reading and understanding these changes is necessary, as they directly affect your coverage. Prescription drug prices have been increasing at an average annual rate of 31.6%. Some medications can experience extreme inflation and have been known to increase by over 500% within a year. This is obviously a significant concern for anyone taking prescription medications, and the exact reason you’ll need to use your Annual Enrollment Period to ensure you are covered. However, to combat this extreme price increase, Medicare has implemented the prescription drug rebate rule , which penalizes companies with significant cost increases for their medications.   WHAT IS THE BEST WAY TO COMPARE DIFFERENT MEDICARE PLANS DURING THE ANNUAL ENROLLMENT PERIOD   Like Medicare Part D , your Medicare Advantage plan will see changes in networks, coverage, and out-of-pocket costs yearly. Between October 15 and December 7 each year, you can enroll in a Medicare Advantage plan  for the new year. Your plan will change annually, so it is wise to keep it up to date. The best way to understand your plan changes is by reviewing the Annual Notice of Change . However, another plan may be more suitable for your needs, so you and your agent should review all available plans to ensure you get the right coverage moving forward.   IS IT POSSIBLE TO SWITCH BACK TO ORIGINAL MEDICARE DURING AEP?   The Medicare Annual Enrollment Period is not the time for you to enroll in Medicare Part A  or Medicare Part B  (Original Medicare). To be eligible for the Annual Enrollment Period, you must already be enrolled in Original Medicare. If you are new to Medicare and need to enroll in Part A or B, you must do so during your Initial Enrollment Period  or General Enrollment Period . If you already have Original Medicare and want to purchase a Medicare Supplement plan, you can still enroll. However, you will face medical underwriting and may be denied coverage if you do not have a guaranteed issue right.   WHAT CHANGES CAN SOMEONE MAKE DURING THIS AEP?   During the Medicare Annual Enrollment Period, you can: Switch from Medicare Advantage to Original Medicare Enroll in a Medicare Advantage plan. Change from one Medicare Advantage plan to another. Enroll in a Medicare Part D plan. Change from one Medicare Part D plan to another Disenroll from a Medicare Part D plan If you plan to switch from a Medicare Advantage plan to Original Medicare and wish to enroll in a Medicare Supplement plan, you can do so during this time. You can also pick up a Medicare Part D Prescription Drug Plan to replace your coverage through your MAPD  once you switch to Original Medicare. But remember that you must pass the Medicare Supplement underwriting eligibility questions  to enroll in a Medicare Supplement plan. Therefore, it is crucial to work with an agent to enroll in the right policy tailored to your healthcare needs, thereby avoiding a lapse in coverage. HOW DO I SWITCH OVER TO HAVING A MEDIGAP PLAN (MEDICARE Supplement PLAN) DURING AEP?   You can enroll in a Medicare Supplement plan  at any time. However, you cannot have Medicare Advantage and Medicare Supplement coverage at the same time. Therefore, you must have a valid disenrollment period for your Medicare Advantage plan before picking up Medigap coverage. Fortunately, the Annual Enrollment Period is a valid disenrollment period for Medicare Advantage. When you switch to a Medicare Supplement plan, you must undergo medical underwriting. A carrier can deny issuing you a Medicare Supplement policy based on your pre-existing conditions. If you believe you may not qualify for a Medigap plan, having a Medicare Advantage plan in mind is essential to avoid a lapse in coverage. Often, licensed agents can help you find a plan with a carrier that will accept your pre-existing condition. However, that is not always the case with more severe health conditions.   ANY CHANGES YOU MAKE DURING THE ANNUAL ENROLLMENT PERIOD WILL TAKE EFFECT ON JANUARY 1, 2026   If you make changes to your Medicare coverage  during the Annual Enrollment Period, these changes will go into effect on January 1 of the following year. During the Fall Open Enrollment Period, you can make as many changes as you wish. However, the most recent change will be honored. For example, if you switch from a Humana Medicare Advantage plan to an Aetna Medicare Advantage plan during the Fall Open Enrollment Period for Medicare, and later decide to change to a Cigna Medicare Advantage plan, the Cigna plan will take effect on January 1.   IF I CHANGE MY PLAN DURING THE AEP AND I END UP NOT LIKING THE NEW PLAN, WHAT CAN I DO? Suppose you enroll in a Medicare Advantage plan during the Annual Enrollment Period. In that case, you will have the chance to change your plan during the Medicare Advantage Open Enrollment Period. This is a separate period from January 1 to March 31, independent of AEP Medicare. During this time, you can either switch back to Original Medicare or enroll in a new Medicare Advantage plan. If you switched from a Medicare Supplement plan to a Medicare Advantage plan for the first time, you would have a trial right for 12 months that allows you to switch back to your Medicare Supplement plan. Because the changes you make during the Fall Open Enrollment Period don’t take effect until January 1 and will affect your healthcare for the entire year, getting them correct is imperative. You can still change your Medicare Advantage coverage, but especially for Part D coverage, you’ll need to get it right, as you’ll have to wait until the fall to make changes.   YOU DO NOT HAVE TO CHANGE COVERAGE, BUT YOU SHOULD COMPARE PLANS TO MAKE SURE YOU HAVE ALL OF THE BENEFITS YOU NEED   You should consider changing your coverage during the Annual Enrollment Period because plans change annually, and a new option may fit your needs better than your current plan. The only way to know is by reviewing your options each year. Some changes that occur to Medicare Advantage and Medicare Part D plans include: Premium Increases Changes To Provider Networks Prescription Drug Formulary changes Changes In Benefits Changes With Prescription Drug Pharmacy Networks To avoid surprises, conduct due diligence by reviewing your plan and those in your area during the Fall Enrollment Period.   PREPARING FOR THE AEP (ANNUAL ENROLLMENT PERIOD)   It is crucial to have a plan when approaching the Annual Enrollment Period. It is never too early to prepare. If you wait too long, contacting an agent may become difficult, and you may miss your opportunity to change plans. To have a successful Annual Enrollment Period, you should follow these steps to get the most out of the Medicare open enrollment dates and your healthcare coverage next year. Braden Medicare Insurance' Let's Chat About Your AEP Choices' Poster   DOUBLE CHECK TO ENSURE YOU ARE ELIGIBLE TO MAKE CHANGES   If you are newly eligible for Medicare or have delayed coverage for any reason and do not yet have Medicare Part A and B, this is NOT your enrollment period. You will not be eligible to make changes during the Fall Open Enrollment Period unless you are within your Initial Enrollment period or are eligible for a Special Enrollment Period . In this case, you must wait until the General Enrollment Period. However, remember that if you delayed Medicare Part D coverage for any reason and didn’t have creditable coverage, but wish to enroll, this is also your opportunity. You’ll be eligible to sign up for a Part D plan during the Medicare Annual Enrollment Period, but you’ll have to pay a penalty on top of your premium.   YOU NEED TO DECIDE IF YOU ARE HAPPY WITH YOUR CURRENT PLAN AND COVERAGE   When deciding on your coverage during the Medicare Annual Enrollment Period, you must take a deeper look at your current coverage and determine if there are any changes you would like to make. If you can find a plan with these changes, it may be the right decision to enroll. However, no changes are necessary if your current plan is still working for you.   YOU MUST MAKE YOUR CHANGES FOR THE 2026 PLAN YEAR BEFORE DECEMBER 7, 2025   The most critical step in the process is connecting with a licensed insurance agent who specializes in the plans you want to enroll in. Often, an agent may be able to help you find plans that you were not aware of, help you save money, or recommend plans that are right for your needs. You can also save time in comparing coverages and premiums. Everyone has different needs and variables, including location. Therefore, it can be challenging to identify the right plan without some guidance. Working with an agent is crucial to ensuring you receive the coverage you need at the lowest possible price in a fraction of the time.   HOW DO I FIND OUT IF MY PLAN OR BENEFITS ARE CHANGING FOR NEXT YEAR?   Understanding whether or not you’ll experience changes in your coverage is critical for AEP Medicare. You can work with a licensed agent to understand your options and changes to your coverage, but if you have Medicare Advantage or Part D, you will be notified in advance. Braden Medicare Insurance ANOC (Annual Notice Of Change) letter Poster. In September, you should receive a letter from your Medicare Advantage or Medicare Part D carrier that includes the Annual Notice of Change. The Annual Notice of Change will inform you if your premium, copays, pharmacy networks, or drug formulary changes in the upcoming year. After reviewing the document, you may decide to stay with your current plan or seek a new policy that better suits your needs. Even if your current plan does not make significant changes, reviewing other options during the Fall Enrollment Period helps ensure you are still receiving the right coverage for your needs.   WRAPPING THINGS UP   Whether you are a seasoned veteran of the Annual Enrollment Period or this is your first time going through it, Medicare need not be confusing or overwhelming. If you do not already have a Medicare Broker, please get in touch with Braden Medicare Insurance. We offer a free, no-obligation plan review for Medicare Advantage, Medicare Part D Prescription Drug, and Medicare Supplement/Medigap plans at any time of year. Please complete an online request form, call, email, or text us at your convenience. We will get back with you as soon as possible. Braden Medicare Insurance Business Card For Michael Braden

Michael T. Braden August 30, 2025 MEDICARE 101 MAKING SENSE OUT OF MEDICARE OR MAKING MEDICARE MAKE SENSE Medicare can be confusing, and it is challenging to assemble all the pieces. We wrote this to help you better understand Medicare concisely and transparently.                           HOW DO WE MAKE SENSE OF MEDICARE? LET'S START WITH WHAT IS MEDICARE Picture of Braden Medicare Insurance's Medicare Poster With A Woman Medicare Beneficiary Meeting With A Medicare Broker   Medicare consists of four parts. Medicare Part A,  Part B, Part C, and Part D              MEDICARE PART A - Pays for Inpatient Hospitalization, Hospice, and Skilled Nursing                                       Care. MEDICARE PART B - Pays for outpatient doctor visits, Lab Tests, Screenings, and                                        Durable Medical Equipment (DME).  MEDICARE PART C - Is referred to as Medicare Advantage  MEDICARE PART D - Prescription Drug Coverage             ORIGINAL MEDICARE   Original Medicare includes Medicare Part A and Medicare Part B. ORIGINAL MEDICARE - Is basically an 80/20 Health Plan where the Government (Medicare) pays 80% of all of your covered Medical Expenses, and you are responsible for the other 20%.  With Original Medicare, there are no Networks, so you can see any Doctor and use any Hospital in the United States that accepts Medicare (about 94% of all doctors accept Medicare).             MEDICARE PART C (MEDICARE ADVANTAGE) Takes the place of Original Medicare, but instead of working with the   Government, you work with Private Insurance companies.  Instead of it being an 80/20 Plan like Medicare, you will have a lot of Co-Insurance and Copays. There are Co-Pays for Hospitalizations, Physical Therapy, Doctor Visits, MRIs, Lab Work, Referrals, Prescriptions, etc. Some of these private insurance companies will offer additional ancillary benefits as a way of enticing people to join their plan.  They may say they offer free things like Dental, Vision, Hearing, Rides to your doctor appointments, and even Free meals, but PLEASE read the fine print. Every Medicare Advantage plan is different.  Some have stronger ancillary plans, and others have stronger health-related plans.  Every Medicare Advantage plan has an MOOP (Maximum Out-of-Pocket) limit that ranges from $2,800 to $12,000 per year.  This means that you can spend $2,800-$12,000 annually out of your own pocket.                 Often, they define Free Dental Coverage as an Annual Benefit Amount, then divide that amount by 4 and provide a limit for each quarter: 1 or 2 cleanings and x-rays per year. The dollar amount by 4, and then you have a Quarterly benefit. Instead of $1,000 in Dental Benefits, the benefit is $250 per quarter.                   Free Vision may include an Eye Exam and a credit of $100-$250 towards glasses each year, but you usually need to see an Optometrist in their network. Most Medicare Advantage plans include a free Gym Membership.                                                   MEDICARE PART D Prescription Drug Coverage.  These are plans offered by individual private insurance companies that provide various plans to Medicare beneficiaries. These plans require a monthly premium to be paid to the plan in exchange for having  access to their pharmacy networks, their Formularies (Drug Lists), and their pricing  structure.  There are NO Part D plans that include the cost of your medications.                 Some Medicare Advantage Plans include Part D Prescription Drug coverage.  But, here again, there are NO  Medicare Advantage (MAPD) plans that include the cost of your medications. They only pay your premium for access to the plan.  However, you must use the plan's network, its pharmacy, and its formulary.                 STAND-ALONE PART D DRUG PLANS This refers to any Part D Drug Plan that is not included in a Medicare Advantage Plan. For example, if you have Original Medicare or Original Medicare with a Medicare Supplement  or a Medigap Plan.                 PART D DRUG TIERS All Prescription Drug plans are divided into six tiers.  And each individual The company sets the price and structure of what is included in each Tier based on its formulary.                   PART D DRUG FORMULARY It is a formal list of Drugs and Medications available on a particular Medicare Part D Drug Plan.  Every plan sets its own formulary. Formularies are not the same.  And even though Medicare states that at least two drugs must be available in each class of medications, a particular plan may not have your exact medicines. So, finding the right plan is essential.                 PART D LATE ENROLLMENT PENALTY Every person who joins Medicare should enroll in a Medicare Part D Prescription Drug Plan as soon as they sign up for Medicare Part B. If you do not sign up within the approved timeframe (within 63 Days Of Your Part B Effective Date), you will incur a penalty that will be added to your monthly Part D premium every month in the future. The penalty is approximately 38 cents per month for each month you were without Creditable Part D Drug Coverage. This amount is added to your monthly plan premiums by your Insurance company. Now, while you may think 38 cents per month is a small price to pay, remember that the penalty stays with you for the rest of your life.                 PART D PREMIUM COSTS In Arizona, Part D Premiums can cost between $0 and $98.00 per month.  And just because a plan is more expensive, it does not mean it is the best one for you.  Most people with little or no Medications can easily get by with a $0 Premium Part D Drug plan, while someone with several Brand-Name medications may be better suited for a higher-priced plan. PART D PREFERRED PHARMACY Every drug plan specifies a list of "Preferred " pharmacies in its network. This is very important.  You can only get the lowest price on your prescriptions if you fill them at their "Preferred" pharmacy. Medication prices can increase rapidly; be cautious.                 MEDICARE SUPPLEMENT PLANS & MEDIGAP PLANS ARE THE SAME THING                 MEDICARE SUPPLEMENTS They are used in conjunction with Original Medicare.  These Medicare Supplement, or Medigap, plans are designed to fill the gaps that Original Medicare leaves behind. So, depending on which plan you choose, you could have all of the 20% that you are responsible for with Original Medicare paid for by your Medicare Supplement plan, and you will owe nothing. There are no networks with Medicare Supplement plans; you can see any Doctor in the US that accepts Medicare!                 MOST POPULAR MEDICARE SUPPLEMENT PLANS There are 11  Medicare Supplement plans. All of the plans are identified by a corresponding letter. And they are the same plans nationwide. A Plan N in Iowa is the same as a Plan N in Florida. The most popular Medicare Supplement plans in the US are Plan F, Plan G, and Plan N. Braden Medicare Insurance Services Medicare Supplement Plan Comparison Chart                 MEDICARE SUPPLEMENT PLAN COSTS With 11 different choices, Medicare Supplement plan premiums can vary from $50 - $500 a month, depending on your age, location, and other factors. Plan G has been the most popular Medigap/Medicare Supplement plan in America since 2020. Plan G is the most comprehensive Medigap plan available, and the average monthly cost for a new Medicare beneficiary is $120-$140. And, with this plan, you will most likely never receive a bill for any services, because Medicare pays 80% And Your Medicare Supplement Plan will pay the other 20%. The supplement will pay the other 20%, plus your Part A Deductible of $1,676.                 LOOK AT YOUR MEDICARE SUPPLEMENT PREMIUM AS YOUR MOOP COST If you choose a Medicare Plan G, you will never receive a bill, so your maximum out-of-pocket costs (your MOOP) are your premium.  If your premium is $140 per month, that is $1.680 all'anno.  You should have peace of mind knowing you will not have any out-of-pocket costs over that amount, except for the Annual $257 Part B Deductible.                 WHAT MEDICARE COVERS Anything that is deemed to be medically necessary  as stated by any provider who accepts Medicare's Assignment. (Medicare Assignment refers to Medicare's Fee Schedule).   Note: This information applies to Original Medicare; for those with a Medicare Advantage plan or Medicare Part C, what is and is not covered is determined by your plan's discretion .                 WHAT MEDICARE DOES NOT PAY FOR Medicare (Original or Traditional Medicare) does not cover Routine Eye Exams, Eyeglasses, or Contact Lenses. However, Medicare will cover cataract surgery and injections for certain other eye diseases and conditions, such as macular degeneration and Glaucoma. Medicare will pay for certain ear surgeries if they are deemed medically necessary. Think of it like this: Ophthalmologists are covered, Optometrists are not covered. Medicare does not cover Routine Dental Care. They will address TMJ and specific dental issues resulting from an accident. But, if you choose Original Medicare with or without a Medicare Supplement or Medigap plan, you will need to purchase a Separate Dental plan, or pay for your dental out-of-pocket. Medicare does not cover Routine Hearing Exams or Hearing Aids. If you are a Veteran, your VA benefits are excellent for Hearing. Note: Because Medicare does not cover routine dental, vision, or hearing care, many Medicare beneficiaries turn to DVH Policies. DVH covers Dental/Vision/Hearing at rates that are more affordable than Dental Insurance itself. Medicare does not cover plastic surgery or Botox injections. There is a limited number of Chiropractic and Acupuncture treatments allowed each year.                                 WHAT IS THE GUARANTEED ISSUE PERIOD FOR MEDICARE During your IEP (Initial Enrollment Period), which runs from 3 months before your birth month when you turn 65, through 3 months after your birth month.   During this period (IEP), you are guaranteed to purchase any Medicare Supplement Plan, regardless of Medical History, as long as you do not have end-stage renal Disease or ALS (Lou Gehrig's Disease). Braden Medicare Insurance's Medicare Initial Enrollment Period Poster Anyone 65 and older who's enrolled in both Medicare Part A and Part B can be accepted into Original Medicare, or into any Medicare Advantage Plan at any time, as long as they do not have Lou Gehrig's Disease (ALS) or End Stage Renal Disease.                 After your IEP, Anyone can apply for a Medicare Supplement Plan; however, they will be subject to Underwriting approval and must answer a few Medical Questions.                 Many people think they can start with a Medicare Advantage Plan and switch to a              Medicare Supplement Plan later, which may be proper; however, it is not guaranteed past the Guaranteed Issue Period.                 BREAKING DOWN THE COSTS OF MEDICARE                 MEDICARE PART A Most people qualify through their work experience (Having worked for a minimum of 40 Quarters) or their spouse.  All of the Taxes taken out for Medicare pay for your Medicare Part A premiums. So, most people pay $0 for their Part A coverage. For those who do not qualify for Medicare Part A, the premium for Part A in 2025 is a whopping $518 per month.                 Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. Approximately 99% of Medicare beneficiaries do not pay a Part A premium because they have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration.  The Medicare Part A inpatient hospital deductible that beneficiaries pay upon hospital admission will be $1,676 in 2025, an increase of $44 from $1,632 in 2024. Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2025, beneficiaries must pay a coinsurance amount of $419 per day for the 61 st through 90 th day of a hospitalization ($408 in 2024) in a benefit period and $838 per day for lifetime reserve days ($816 in 2024). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $209.50 in 2025 ($204.00 in 2024).  Note:   Most of these Part A Deductibles are paid if you have a Medicare Supplement Plan. Braden Medicare Insurance's Medicare Part A Chart for 2025                    MEDICARE PART B There are two costs associated with Medicare Part B. The first of these is the Monthly Premium for Medicare Part B, which is $185.00 per month in 2025. EVERYONE must pay this amount, whether you choose a Medicare Advantage plan, Original Medicare, or Original Medicare with a Medigap/Medicare Supplement policy. The second Part B Deductible is the Annual Part B deductible, to which everyone with Original Medicare is subject. Essentially, for your first $257 of Part B services, you will pay out of pocket. Then, after the deductible is met each Calendar year, Medicare will cover 80% of all Part B charges. If you choose a Medicare Supplemental Plan F, Plan C, Plan G, or Plan N, your Supplemental insurer will pay the additional 20% for you.                 Your total Medicare Part B costs are $185.00 per month for 2025. That is a total of $2,220 for your Part B Premiums, plus the Annual Medicare Part B Deductible of $257 ($206.41 Per Month average for all Part B expenses).                 Braden Medicare Insurance's Medicare Part B Chart for 2025 MEDICARE PART C This depends on whether a monthly premium is associated with a particular Part C (Medicare Advantage) plan. Everyone with a Medicare Advantage plan must pay the $185.00 Monthly Premium to the Government, plus any additional plan premiums that may be associated with the Medicare Advantage Plan they choose. Each Medicare Advantage plan will have an MOOP. Moop stands for Maximum-Out-Of-Pocket Expense. Each Medicare Advantage Beneficiary is responsible for paying their MOOP through a combination of copayments and coinsurance. Once the MOOP has been satisfied, your plan will cover all costs for the remainder of the Calendar Year.                 MEDICARE SUPPLEMENT COSTS If you bolster Original Medicare by purchasing a Medigap or Medicare Supplement policy, your costs will vary, depending on which lettered plan you choose. We have found that a reasonable average amount to use for a single individual in Arizona is $140 per month ($1,680 annually). If you are single, and $130 per month, if you are married. You will typically be asked to pay your Medicare Supplement Premiums via EFT debits from your bank account each month. There are options to pay your bill quarterly, semi-annually, or annually.         MEDICARE PART D If you have a Medicare Advantage plan, your Part D coverage is included. So you will have no additional Part D costs to budget for, except for the costs of your Prescription Medications.      If you have chosen a Stand-Alone Medicare Part D Prescription Drug plan that works alongside Original Medicare, you will pay between $0 and $98 per month. IF you do not take any medications or if your medications are Generic or preferred generic medications, you should be fine with one of the $0 Premium Part D plans that should be available in your State. If you use brand-name medications, you will most likely be looking at a Part D plan that carries a Monthly Premium of $24-$98. It just depends on your medications. We compare your Drug list against each plan and then present the three lowest-cost options, taking both premiums and medication costs into account. WRAPPING THINGS UP All of us at Braden Medicare Insurance hope you found this article helpful, especially for those of you turning 65 in the following year. Our greatest passion is genuinely helping our friends and neighbors find the best possible Medicare plans based on their own wants, needs, and desires, at the lowest price. We can do this because of our unparalleled carrier list, our in-depth industry knowledge, and our extensive experience, not just as a Medicare Broker, but as a Certified Medicare Planner. Please feel free to call, Text, Email, or request a call from our website at www.bradenmedicare.com Braden Medicare Insurance's Business Card For Michael Braden

How Medicare Works with Your FEHB (Federal Employee Health Benefits) Many individuals working for Governmental Agencies or Departments have Federal Employee Health Benefits (FEHB). This article explains how Medicare interacts with FEHB plans and what federal employees should know about aligning their benefits with Medicare. Braden Medicare Insurance Poster About Federal Employee Health Benefit Plans and Medicare If you are one of the thousands of Federal Employees covered by FEHB and become eligible for Medicare, you likely have questions. You may wonder which coverage to choose or if you can have both. Below, we review all possible scenarios for the FEHB and Medicare enrollees on FEHB and Medicare. This ensures you have a clear understanding of how the two coverage types work together. Federal Employee Health Benefits Explained Did you know that the Federal Employees Health Benefits Program (FEHB) is the most extensive employer group health plan in the world? FEHB covers federal workers, retirees, and their families. Through FEHB, federal employees can choose from a variety of health insurance plans. Those who enroll in a health insurance plan through the FEHB program receive a government contribution to their plan costs. Additionally, coverage can continue into retirement. What Happens When You Become Eligible for Medicare? When you become eligible for Medicare while covered by FEHB, it's essential to understand your options. Let's take a deeper dive into your FEHB options to ensure you have a clear understanding of your Medicare and Federal Employee Health Benefits options. How Federal Employee Benefits Work with Medicare Like Medicare, FEHB includes coverage for inpatient and outpatient services. Retired, former, and active federal employees eligible for both FEHB and Medicare often wonder if they can have both types of coverage simultaneously. The short answer is yes. Enrolling in Medicare when you turn 65 will not cause you to lose or be disenrolled from your FEHB plan. Considerations for Enrolling in Medicare with FEHB Depending on your individual needs, it may make sense to: Keep your FEHB plan and opt out of Medicare coverage. Maintain your FEHB plan and only enroll in Medicare Part A. Keep your FEHB plan and enroll in both Medicare Part A and Medicare Part B. Pause your FEHB coverage, enroll in Medicare, and then select a Medicare Advantage plan. Cancel your FEHB and enroll in Original Medicare with a Medicare Supplement plan. Although most people eligible for Medicare and FEHB won’t need a Medicare Supplement or Medicare Part D plan , FEHB can be pricey. Many FEHB beneficiaries ask if there’s a way to lower their out-of-pocket costs. How Does Medicare Coordinate Benefits with FEHB Beneficiaries? For those enrolled in FEHB and planning to enroll in Medicare, it's essential to understand that Medicare will pay secondary to FEHB while you or your spouse is still employed. While the coverage may look similar, most FEHB beneficiaries find that Medicare offers better coverage for Durable Medical Equipment (DME), Home Health Care, and prosthetics. You will have 30 days before your Medicare eligibility date to change your current FEHB plan. This enrollment opportunity is available only once, allowing you to switch to any currently available plan. If you plan to retire, consider switching to a lower-cost plan or one that waives some out-of-pocket costs when Medicare is the primary payer. Once you retire, Medicare will become your primary payer, and your FEHB plan will become the secondary payer. Your FEHB plan premium will not change when Medicare becomes your primary payer. During retirement, you can still change your FEHB plan during the annual Federal Benefits Open Season. How FEHB Fits with Medicare Part A Individuals enrolled in a plan through the FEHB Program can benefit from enrolling in Medicare Part A as soon as they become eligible. If you or your spouse have paid Medicare taxes for 40 or more quarters, you will be eligible for Medicare Part A with a $0 premium. We recommend that everyone eligible for premium-free Medicare Part A enroll in the coverage, even if they are still working and have an FEHB plan. While you are working, your Medicare Part A will pay secondary to your FEHB plan and may help cover some costs that your FEHB plan doesn’t cover. For example, some Federal Employee Health Benefits plans may not cover or only partially cover home health care. If you need home health care services and your plan doesn’t cover them, the services would be billed to Medicare, and Medicare Part A would cover eligible services. Medicare Part B Works with FEHB If you are enrolled in a Federal Employee Health Benefits plan and are wondering whether to enroll in Medicare Part B, consider the following. For Medicare Part B outpatient coverage, you’ll need to pay a monthly premium, regardless of how many quarters you paid Medicare taxes. Additionally, you’ll still have to pay the monthly premium for your FEHB plan. As a result, some individuals delay enrolling in Medicare Part B until retirement. Medicare Views FEHB as Creditable Coverage If you (or your spouse, if you’re covered under their FEHB plan) are still employed, Medicare considers your FEHB plan as creditable coverage. This means FEHB beneficiaries are not subject to the Medicare Part B Late Enrollment Penalty if they delay their Medicare Enrollment until retirement. However, if you (or your spouse, if you’re covered under their FEHB plan) are retired, your FEHB coverage will no longer be viewed as creditable. You must enroll in Medicare Part B within 8 months of your employment ending; otherwise, you could face a penalty if you sign up for Part B later. When deciding whether to pick up Medicare Part B, calculate what you’d pay in Medicare Part B premiums for the year. Higher-income earners pay higher premiums . Then estimate your copayments for FEHB outpatient services. If you find that you would pay more in premiums, you’ll save money by delaying Medicare Part B. However, if your copays on FEHB in an average year are higher than your potential Medicare Part B premiums, you should consider enrolling in Medicare Part B. Remember, if you enroll in Medicare Part A and Part B while you’re still working, Medicare will be your secondary coverage. At the same time, FEHB acts as your primary insurance. You may also consider enrolling in Medicare Part B alongside your FEHB plan to enhance your coverage. For example, your FEHB plan may have limited coverage for prosthetic devices, durable medical equipment, and some medical supplies, which are generally covered by Medicare Part B. FEHB and Prescription Medications When you have FEHB, it is generally unnecessary to enroll in Medicare Part D, as all FEHB plans include prescription drug coverage comparable to Medicare Part D. You may still enroll in a Medicare Part D plan while keeping your FEHB coverage when you retire. In this case, your Medicare Part D will pay first. You can contact your Part D plan provider to confirm how they will coordinate coverage with your FEHB plan. Federal Employee Health Benefit coverage for prescription drugs is considered creditable drug coverage. If you decide to enroll in a Medicare Part D plan later, you will not incur a late enrollment penalty. However, if you lose or terminate your Federal Employee Health Benefits, you must enroll in a qualifying Medicare Part D Prescription Drug plan within two months after your coverage ends to avoid a penalty. Choosing a Medicare Plan if You Have FEHB Medigap Policies and FEHB As an FEHB member, you are under no obligation to enroll in a Medigap Plan or to purchase a Medicare Supplement policy. Your FEHB plan will coordinate benefits with Medicare to provide comprehensive coverage. If you decide to get a Medicare Supplement plan (Medigap) in addition to Medicare Part A and Medicare Part B, you will need to terminate your FEHB. If you prefer to terminate your FEHB benefits and enroll in a Medicare Supplement plan, you must also enroll in a Stand-Alone Medicare Part D Prescription Drug plan. Regardless of whether you plan to suspend or terminate your current FEHB plan, it’s advisable to reach out to the U.S. Office of Personnel Management or your retirement office. FEHB and Medicare Advantage (Medicare Part C) If you have a FEHB plan with Original Medicare and decide to enroll in a Medicare Advantage plan, you’ll first need to pause or suspend your FEHB coverage. Suspending FEHB is not the same as canceling. When you suspend your FEHB coverage, you will no longer be responsible for paying your FEHB plan premium. You may choose to re-enroll in the FEHB program later if you drop your Medicare Advantage plan. If you decide to return to your FEHB plan, you can do so during the Federal Health Open Season. Your Medicare Advantage plan will become your primary payer. Remember, you need both Medicare Part A and Medicare Part B to enroll in a Medicare Advantage plan. Since FEHB plans include drug coverage, ensure your Medicare Advantage plan also provides drug coverage so you don’t end up without medication coverage. As an FEHB Beneficiary, What Happens After You Retire? One qualification for your benefits is the consequences/verification that you had FEHB coverage for at least five consecutive years before retiring. Though it’s never mandatory to take Medicare, there are considerations to make if you have FEHB coverage and are retiring. While you (or your spouse) are actively employed, your Federal Employee Health Benefits are considered creditable coverage by Medicare. This means you can delay your Medicare Part B without incurring a Part B late enrollment penalty. However, once you or your spouse retires, your FEHB coverage will no longer be considered creditable. You will be granted a Special Enrollment Period that allows you up to 63 days to enroll in Medicare Part B. If you choose to enroll in Medicare Part B after this Special Enrollment Period ends, your monthly premium could be higher due to the late enrollment penalty. As mentioned above, you are not required to enroll in Medicare, but if you do, it is recommended that you do so as soon as you become eligible. As long as you keep FEHB, whether you’re retired or still working, your prescription drug coverage is sufficient. You’ll avoid the late enrollment penalty for Medicare Part D. Retirement Plans for Federal Employee Health Benefits Beneficiaries There are over 200 FEHB plans to choose from when electing coverage. The most utilized FEHB plan carriers include Blue Cross Blue Shield, Aetna, and GEHA. When selecting a FEHB plan in retirement, keep the following in mind: If you have Medicare and are retired, consider an FEHB plan with lower costs. You can change your plan annually during the Open Season (November 15th to December 31st). Some FEHB plans provide coverage for services Medicare doesn’t cover, such as dental. Some FEHB plans waive deductibles, copayments, and coinsurance when Medicare is your primary payer. Letter Carriers Insurance and Medicare The Mail Handlers Benefit Plan (MHBP) has served federal and postal employees for over 50 years. Aetna administers the MHBP, which offers plan options including Self Only, Self Plus One, and Self and Family – similar to the FEHB. MHBP will coordinate your benefits with Medicare once you enroll. Just like FEHB, your MHBP will be your primary coverage while still employed, and Medicare will be secondary. Once you retire, Medicare will become the primary insurance, and your Mail Handlers Benefit Plan will pay secondary. Your MHBP will provide creditable prescription drug coverage and will help cover many of the out-of-pocket costs left behind by Medicare (when Medicare is your primary coverage). Wrapping Things Up Whether you are enrolled in the FEHB plan as an employee or as the spouse of an employee, it’s crucial to request a meeting with your local plan Administrator. You have participated in the FEHB for a long time, and it makes sense to request a meeting so they can fully explain all your options regarding Medicare, including Medicare Eligibility, Enrollment, and Retirement. Your plan Administrator will also explain the differences between pausing or suspending any of your benefits and the repercussions of terminating your FEHB plan.

Michael T. Braden September 8, 2025 MEDICARE 101 RWB Understanding health coverage options can be overwhelming, especially when it comes to Medicare. This federal program provides essential health insurance to millions of Americans, primarily those aged 65 and older, as well as specific individuals with disabilities younger than 65. Knowing what Medicare covers, the benefits it offers, and the choices available can help you make informed decisions about your healthcare. UNPACKING MEDICARE: COVERAGE, BENEFITS, AND YOUR OPTIONS EXPLORING MEDICARE HEALTH COVERAGE: WHAT YOU NEED TO KNOW ABOUT UNPACKING MEDICARE Medicare is divided into different parts, each designed to cover specific healthcare services. Here’s a breakdown of the main components: Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health care. Part C (Medicare Advantage): An alternative to Original Medicare (Parts A and B) offered by private companies. These plans often include additional benefits, such as vision, dental, and prescription drug coverage. Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications. Each part has its own costs, including premiums, deductibles, and copayments. For example, Part A is usually premium-free if you or your spouse paid Medicare taxes while working. Part B requires a monthly premium that varies with income. Choosing the right combination depends on your health needs, budget, and preferences. Many people opt for Original Medicare (Parts A and B) and add a Part D plan for drug coverage. Others prefer Medicare Advantage plans for more comprehensive benefits. Hospital entrance representing Medicare Part A coverage HOW TO MAXIMIZE YOUR MEDICARE HEALTH COVERAGE BENEFITS Medicare offers several benefits that can significantly reduce your healthcare expenses. Here are some key advantages and tips to get the most out of your coverage: Preventive Services: Medicare covers many preventive services at no additional cost, including flu shots, cancer screenings, and annual wellness visits. Taking advantage of these can help detect health issues early. Access to a Wide Network of Providers: Original Medicare allows you to see any doctor or specialist who accepts Medicare. Medicare Advantage plans may have network restrictions, but often include extra perks. Prescription Drug Savings: Part D plans help reduce the cost of medications, which can be a significant expense for many older adults. Financial Protection: Medicare limits your out-of-pocket costs, protecting you from catastrophic medical bills. To maximize benefits, review your plan annually during the open enrollment period. Compare costs, coverage, and provider networks to ensure your plan continues to meet your needs. Also, consider supplemental Medigap policies to cover gaps in Original Medicare, such as copayments and deductibles. Prescription medications representing Medicare Part D coverage SIX THINGS NOT COVERED BY ORIGINAL MEDICARE While Medicare provides broad coverage, there are essential services and items it does not cover. Being aware of these can help you plan for additional insurance or out-of-pocket expenses: Long-Term Care: Medicare does not cover custodial care in nursing homes or assisted living facilities if that is the only care you need. Most Dental Care: Routine dental exams, cleanings, fillings, dentures, and other dental services are generally not covered. Eye Exams and Glasses: Medicare does not cover routine eye exams for glasses or contact lenses, though it may cover some eye care related to diseases. Hearing Aids: Hearing exams and hearing aids are not covered under Original Medicare. Cosmetic Surgery: Procedures done for cosmetic reasons are excluded unless medically necessary. Routine Foot Care: Basic foot care, like nail trimming and treatment of corns or calluses, is not covered. Knowing these exclusions can help you decide if you need additional coverage, such as dental or vision insurance, or a Medicare Advantage plan that includes these benefits. Dental clinic waiting area illustrating services not covered by Medicare. HOW TO CHOOSE THE BEST MEDICARE HEALTH PLAN FOR YOU Selecting the best Medicare plan involves evaluating your health needs, budget, and lifestyle to determine the most suitable option. Here are some steps to guide your decision: Assess Your Healthcare Needs: Consider your current health status, medications, and preferred healthcare providers or facilities. Compare Plan Options: Look at Original Medicare versus Medicare Advantage plans. Check what each plan covers, its costs, and the provider networks it offers. Check Prescription Drug Coverage: If you take medications regularly, review Part D plans for formulary coverage and costs. Consider Supplemental Insurance: Medigap policies can help cover out-of-pocket expenses not paid by Original Medicare. Review Annual Changes: Plans can change benefits and costs yearly, so review your options during open enrollment. Using online tools and consulting with licensed Medicare advisors can simplify this process. They can help you understand plan details and find options tailored to your needs. ENROLLMENT TIPS AND AVOIDING MEDICARE PENALTIES Enrolling in Medicare at the right time is crucial to avoid late enrollment penalties and coverage gaps. Here are some essential enrollment tips: Initial Enrollment Period: Begins three months before you turn 65 and lasts for seven months. Enroll during this time to avoid penalties. Special Enrollment Periods: Available if you have other coverage through your employer or experience certain life events. General Enrollment Period: From January 1 to March 31 each year, if you missed your initial enrollment. Avoid Late Enrollment Penalties: Delaying enrollment without qualifying for a special period can result in higher premiums. Ensure you enroll in the parts of Medicare that best fit your situation. If you have employer coverage, coordinate with your benefits administrator to understand how Medicare works with your current insurance. Understanding your options and the details of Medicare health coverage empowers you to make choices that protect your health and finances. Take the time to explore plans, ask questions, and stay informed to get the most from your Medicare benefits.

MIchael T. Braden September 5, 2025 Medicare 101 MAXIMIZE BENEFITS DURING THE MEDICARE ANNUAL ENROLLMENT PERIOD Navigating Medicare can be complex, especially when it comes to understanding the critical deadlines. Missing these deadlines can result in the loss of valuable coverage or higher costs. This guide will help you understand the key Medicare enrollment deadlines and how to maximize their benefits. By planning and knowing your options, you can maximize your benefits and avoid unnecessary stress. Photo of two hands holding a Red Heart, from Braden Medicare Insurance, with the caption "How To Maximize Your Medicare Benefits". UNDERSTANDING MEDICARE ENROLLMENT DEADLINES Medicare enrollment deadlines are specific periods when you can sign up for or make changes to your Medicare coverage. These deadlines are crucial because they determine when you can enroll in Medicare Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Here are the main enrollment periods to keep in mind: Initial Enrollment Period (IEP): This is a 7-month window that begins 3 months before your birthday month, includes your birthday month, and ends 3 months after your birthday month. General Enrollment Period (GEP): If you miss your IEP, you can enroll between January 1 and March 31 each year, but coverage starts July 1. Special Enrollment Period (SEP): Certain life events, like losing other health coverage, allow you to enroll outside the usual periods. Open Enrollment Period (OEP): From January 1 to March 31, you can make changes to your Medicare Advantage or prescription drug plans. Knowing these deadlines helps you avoid penalties and ensures you have the required coverage. Braden Medicare Insurance's Medicare Enrollment Periods Poster KEY MEDICARE ENROLLMENT DEADLINES YOU SHOULD KNOW Failure to meet Medicare enrollment deadlines can result in late enrollment penalties or coverage gaps. Here are the most important deadlines to remember: Initial Enrollment Period (IEP): This is your first chance to sign up for Medicare. If you enroll during this period, your coverage starts the month you turn 65 or the following month if you enroll later in the period. General Enrollment Period (GEP): If you miss your IEP and don’t qualify for a Special Enrollment Period, you must wait for the GEP from January 1 to March 31. Coverage begins July 1, and you may pay a late enrollment penalty. Special Enrollment Period (SEP): If you have health coverage through an employer or union, you can delay Medicare without penalty. When that coverage ends, you have an 8-month SEP to enroll. Annual Enrollment Period (AEP): From October 15 to December 7, you can join, switch, or drop Medicare Advantage and Part D plans. Changes take effect January 1. Medicare Advantage Open Enrollment Period (OEP): From January 1 to March 31, if you’re already in a Medicare Advantage plan, you can switch plans or return to Original Medicare. To stay on top of these deadlines, mark your calendar and set reminders well in advance. Braden Medicare Poster Of The Medicare Annual Enrollment Period From October 15th through December 7th Every Year DOES MEDICARE HAVE AN ANNUAL ENROLLMENT PERIOD? Yes, Medicare has an annual enrollment period (AEP) . This period runs from October 15 to December 7 each year. During this time, beneficiaries can: Enroll in a Medicare Advantage plan. Switch from Original Medicare to a Medicare Advantage plan or vice versa. Change Medicare Advantage plans Enroll in or change a Medicare Part D prescription drug plan. Drop Medicare prescription drug coverage entirely. The AEP is the most critical time to review your current coverage and make adjustments based on your health needs and budget. For example, if your current Part D plan no longer covers your medications or has increased premiums, the AEP is your chance to switch to a better plan. It’s essential to act during this period, as missing it may require waiting until the following year to make changes, unless you qualify for a Special Enrollment Period. Braden Medicare Insurance's How To Prepare For Medicare's AEP Poster HOW TO PREPARE FOR THE MEDICARE ANNUAL ENROLLMENT PERIOD Preparation is key to maximizing your benefits during the Medicare Annual Enrollment Period. Here are some practical steps to get ready: Review Your Current Coverage: Look at your current Medicare plan details, including premiums, deductibles, copayments, and covered services. Identify any gaps or changes in your health needs. Compare Plans: Use online tools or consult with a Medicare expert to compare available Medicare Advantage and Part D plans in your area. Pay attention to formularies (drug lists), provider networks, and costs. Gather Your Information: Have your Medicare card, list of medications, and any recent medical bills or statements handy. This will help you accurately compare plans. Check for Changes: Insurance companies may modify their plan benefits, premiums, or provider networks annually. Review any notices you receive from your current plan. Ask Questions: If you’re unsure about your options, consider contacting a licensed Medicare counselor or utilizing resources such as the official Medicare website. Mark Important Dates: Set reminders for the start and end of the enrollment period to ensure you don't miss deadlines. By following these steps, you can make informed decisions that best suit your health and financial situation. TIPS TO MAXIMIZE YOUR MEDICARE BENEFITS Maximizing your Medicare benefits means getting the most coverage for your money and ensuring your health needs are met. Here are some actionable tips: Take Advantage of Preventive Services: Medicare covers many preventive services at no cost, such as flu shots, cancer screenings, and wellness visits. Schedule these regularly. Consider Medicare Advantage Plans: These plans often include additional benefits, such as dental, vision, hearing, and fitness programs. Compare these benefits against Original Medicare. Review Prescription Drug Coverage: Make sure your medications are covered under your Part D plan. If not, consider switching plans during the enrollment period. Use In-Network Providers: To save money, use doctors and hospitals that are in your plan’s network. Watch for Late Enrollment Penalties: Enroll on time to avoid paying higher premiums later. Stay Informed: Medicare rules and plans can change yearly. Stay updated by reading official communications and consulting experts. By actively managing your Medicare coverage, you can reduce out-of-pocket costs and improve your access to care. WHERE CAN YOU GET MORE HELP AND INFORMATION Navigating Medicare enrollment deadlines and options can be overwhelming. Fortunately, there are many resources available to help you: Official Medicare Website: Visit Medicare.gov for detailed information and plan comparison tools. Licensed Medicare Counselors: Certified counselors can provide personalized advice at no cost. Local Social Security Office: For enrollment assistance and questions about eligibility. Trusted Medicare Advisors: Professionals who specialize in Medicare can help you understand your options and enroll correctly. Remember, the Medicare Annual Enrollment Period is your opportunity to make essential changes. Don’t wait until the last minute to seek help or make decisions. Picture With An Alarm Clock Reminding People Not To Miss Their Medicare Enrollment Deadline STAYING AHEAD OF MEDICARE ENROLLMENT DEADLINES Planning is the best way to avoid missing Medicare enrollment deadlines. Here are some final recommendations: Set Calendar Alerts: Use your phone or computer to set reminders for key dates. Review Your Coverage Annually: Even if you’re satisfied with your plan, review it annually during the enrollment period. Keep Documentation Organized: Store your Medicare card, plan documents, and notes in a single location. Ask for Help Early: Don’t wait until the last week of enrollment to get assistance. By staying proactive, you can ensure continuous coverage and maximize your Medicare benefits. Taking control of your Medicare enrollment deadlines empowers you to make informed choices that protect your health and finances. Utilize the available resources and plan to maximize your benefits each year.

Michael T. Braden, August 30, 2025 MEDICARE 101 NAVIGATING MEDICARE: WHAT YOU NEED TO KNOW Understanding Medicare can feel overwhelming. With various plans, coverage options, and rules, it is essential to understand what Medicare entails. This post will help you navigate Medicare effectively and understand the options available to you or your loved ones, ensuring that your healthcare needs are met without stress. Braden Medicare Insurance's Poster About 5 Tips For Navigating Medicare In Retirement MEDICARE COVERAGE GUIDE NAVIGATING MEDICARE: WHAT YOU NEED TO KNOW ABOUT YOUR MEDICARE COVERAGE Medicare is a federal health insurance program for individuals aged 65 and older, as well as specific individuals with disabilities younger than 65. It is divided into different parts that cover specific services. Here’s a breakdown of those parts: Part A (Hospital Insurance): This coverage includes inpatient hospital stays, skilled nursing facilities, hospice care, and certain home health services. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. Part B (Medical Insurance): Part B covers outpatient services, doctor visits, preventive care, and some home health services. There is a monthly premium for Part B, which can vary based on your income. Part C (Medicare Advantage): Part C is a type of health plan offered by private companies that includes both Part A and Part B coverage, often with additional benefits like vision and dental care. These plans may have different costs and rules. Part D (Prescription Drug Coverage): This part helps cover the cost of prescription medications. You can enroll in a standalone Part D plan or a Medicare Advantage plan that includes drug coverage. Each of these parts has distinct rules, costs, and benefits, making it essential to understand how they interact. Braden Medicare Insurance's Poster Showing Items That Are Typically Not Covered By Medicare WHAT TYPES OF SERVICES ARE COVERED BY MEDICARE NAVIGATING MEDICARE: WHAT YOU NEED TO KNOW ABOUT WHAT SERVICES ARE COVERED BY MEDICARE Knowing what services are covered under Medicare can help you plan for healthcare expenses. Here are the essential services commonly covered: Inpatient Hospital Stays: Medicare Part A covers semi-private rooms, meals, general nursing, and other hospital services and supplies. Outpatient Services: Medicare Part B covers doctor visits, emergency room care, outpatient surgery, and certain preventive services, including vaccines and screenings. Preventive Services: Part B services include screenings for diabetes, cancer, and heart disease, as well as vaccines, enabling early detection of health issues. By understanding what is covered, you can avoid unexpected medical bills and make informed decisions about your healthcare options. Braden Medicare Insurance Poster Featuring Medications Taken By Medicare Beneficiaries Every Day IS MEDICARE FREE WHEN YOU TURN 65? Many people wonder about the costs associated with Medicare after reaching 65. The short answer is: no, Medicare is not entirely free of charge. Here’s a breakdown of expected expenses: Part A Costs: Most people do not pay a premium for Part A because they have paid Medicare taxes throughout their working years. However, some may be required to pay a premium if they do not qualify based on their work history. Part B Costs: Part B requires a monthly premium of approximately $170.10 in 2022, which may vary based on income. High-income earners may pay a higher premium known as the Income-Related Monthly Adjustment Amount (IRMAA). Out-of-Pocket Costs: Even with Medicare coverage, there can be out-of-pocket expenses, such as co-pays, deductibles, and uncovered services. It is crucial to review these costs when planning your budget. By understanding the costs involved, you can make better financial decisions regarding your healthcare. MEDICARE ENROLLMENT PERIODS: WHAT YOU NEED TO KNOW Knowing when to enroll in Medicare is crucial. There are specific enrollment periods, and missing them can result in penalties. Here’s a breakdown: Initial Enrollment Period: You can first enroll in Medicare three months before you turn 65, the month of your birthday, and three months after. It is essential to register during this window to avoid late enrollment penalties. General Enrollment Period: If you miss the Initial Enrollment Period, you can enroll in Medicare from January 1 to March 31 each year, but coverage will not begin until July 1. Special Enrollment Period: If you have delayed enrollment because you were still working and had employer coverage, you may qualify for a Special Enrollment Period. This period allows you to sign up without penalty. Understanding these enrollment periods can help you make timely decisions about your healthcare coverage and avoid unnecessary costs. CHOOSING THE RIGHT MEDICARE PLAN FOR YOU Selecting the right Medicare plan requires careful consideration and planning. Here are the steps to help you make this decision: Assess Your Needs: Identify the specific healthcare services you will require. Do you require frequent doctor visits or specialized care? Understanding your health care needs will guide you towards the right plan. Compare Plans: If you are considering a Medicare Advantage plan, compare it with Original Medicare. Evaluate the additional benefits, costs, and networks offered. Consider Your Budget: Account for premiums, deductibles, copayments, and prescription drug costs. Ensure you select a plan that fits within your financial means. Seek Assistance: If you are confused about the options, do not hesitate to seek help from professionals who can assist you with Medicare-related questions. You can find resources or speak with someone who has firsthand experience. By taking the time to explore your options, you can make an informed decision that best suits your healthcare needs. HOW TO MAKE THE MOST OUT OF YOUR MEDICARE COVERAGE Once you have enrolled in Medicare, it is essential to actively manage your coverage. Here are a few tips: Stay Informed: Regularly check for changes in your plan or coverage options. Medicare updates rules, so staying informed is key. Review Your Health Costs: At least once a year, review your medical expenses and healthcare utilization to ensure you're getting the most value for your money. This will help you determine if you need to change plans during the Open Enrollment Period. Utilize Preventive Services: Take advantage of preventive care that Medicare offers. These services can help maintain health and prevent future serious health issues. Understanding and managing your Medicare coverage will help ensure you receive the necessary healthcare services while minimizing out-of-pocket expenses. WRAPPING THINGS UP Navigating Medicare can be daunting, but with the correct information and resources, you can make informed decisions about your healthcare. From understanding different parts to assessing your coverage options, being proactive is key. Make sure to explore Medicare resources to find the additional support you may need. With every decision you make, you pave the way toward a healthier future. Take the time to understand your Medicare options and thrive in your health management. Your journey toward understanding Medicare starts today!

Michael T. Braden August 27, 2025 MEDICARE 101 WHY UNDERSTANDING MEDICARE IS GOOD FOR EVERYONE Navigating healthcare options can be overwhelming, particularly when it comes to understanding government programs that support your medical needs. One such program is Medicare, a federal health insurance program primarily for people aged 65 and older, as well as specific younger individuals with disabilities. Understanding the benefits available through Medicare can empower you to make informed decisions about your healthcare coverage and expenses. WHAT ARE THE KEY BENEFITS OF MEDICARE, AND WHY IS UNDERSTANDING MEDICARE GOOD FOR EVERYONE Medicare offers a variety of benefits that cover many healthcare services and supplies. These benefits are divided into different parts, each serving a specific purpose: Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health care. Part C (Medicare Advantage Plans): An alternative to Original Medicare that bundles Part A, Part B, and usually Part D (prescription drug coverage) into one plan, often with extra benefits. Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications. Each part has its own costs, coverage rules, and enrollment periods. For example, Part A is usually premium-free if you or your spouse paid Medicare taxes while working. Part B requires a monthly premium that varies with income. Understanding these parts helps you choose the right coverage for your needs. For instance, if you require frequent hospital visits, Part A is essential. If you take multiple medications, enrolling in Part D can save you money. Hospital care is a significant component of Medicare Part A benefits. Braden Medicare Insurance Poster: The ABCs of Medicare. Understanding the Basics Of Medicare Is Important For Every Medicare Beneficiary. SEE HOW MEDICARE CAN SAVE YOU MONEY One of the most significant advantages of Medicare is the financial protection it offers against high medical costs. Here are some ways Medicare benefits can help you save: Lower Out-of-Pocket Costs: Medicare covers a significant portion of your medical bills, reducing what you pay out of pocket. Preventive Services at No Cost: Many preventive services, such as influenza vaccinations, screenings, and annual wellness visits, are covered without copayments. Prescription Drug Savings: Part D plans negotiate prices with pharmacies, often resulting in lower medication costs. Caps on Spending: Some Medicare Advantage plans include out-of-pocket maximums, protecting you from excessive expenses. For example, if you need surgery, Medicare Part A typically covers most hospital charges, and Part B covers doctor fees. Without Medicare, these costs could be financially devastating. To maximize your savings, review your healthcare needs annually and adjust your coverage during open enrollment periods. Consider supplemental plans, such as Medigap, to cover gaps in Original Medicare. Prescription medication bottles arranged on a pharmacy shelf Prescription drug coverage helps reduce the cost of medications. IF I DO NOT LIKE YOUR MEDICARE ADVANTAGE PLAN, CAN YOU SWITCH BACK TO ORIGINAL MEDICARE? Yes, you can switch from a Medicare Advantage plan back to Original Medicare, but there are specific rules and timeframes to consider. When You Can Switch: The Medicare Advantage Open Enrollment Period (January 1 - March 31) allows you to leave your Medicare Advantage plan and return to Original Medicare. How to Switch: Contact the Social Security Administration or use the Medicare website to make changes. Adding Drug Coverage: If you switch back to Original Medicare, you can enroll in a standalone Part D plan for prescription drugs. Considerations: Be aware of potential changes in costs and coverage. Original Medicare does not include certain benefits that Medicare Advantage plans may offer, such as dental and vision coverage. For example, if you find that your Medicare Advantage plan has limited provider networks or higher copays, switching back to Original Medicare might give you more flexibility in choosing doctors. Always review your options carefully and consult with a licensed Medicare advisor to ensure the switch aligns with your healthcare needs. Reviewing your Medicare plan options helps you make informed decisions. Poster showing a Medicare Beneficiary speaking To His Medicare Advantage Plan on the phone. Remember, If You do not like your Medicare Advantage plan, you can change back over to Original/Traditional Medicare during the Medicare Advantage Open Enrollment Period (OEP) CHOOSING THE RIGHT MEDICARE PLAN FOR YOU Selecting the best Medicare plan depends on your health needs, budget, and preferences. Here are some practical tips: Assess Your Health Needs: Consider your current health status, medications, and preferred doctors. Compare Costs: Review premiums, deductibles, copayments, and out-of-pocket maximums. Check Provider Networks: Ensure your doctors and hospitals accept the plan. Review Extra Benefits: Some plans offer vision, dental, hearing, or wellness programs. Use Online Tools: The Medicare Plan Finder tool can help compare plans in your area. Seek Professional Advice: Licensed agents or counselors can provide personalized guidance. For example, if you have chronic conditions that require specialist care, a plan with a broad network and low specialist copays may be the best option. Remember, you can change your plan during specific enrollment periods, so stay informed about deadlines. UNDERSTANDING THE MEDICARE ENROLLMENT PERIODS IS THE KEY TO AVOIDING MEDICARE PENALTIES Enrolling in Medicare at the right time is crucial to avoid late enrollment penalties and ensure continuous coverage. Initial Enrollment Period (IEP): Starts three months before you turn 65 and lasts for seven months. General Enrollment Period (GEP): January 1 - March 31 each year for those who missed the IEP. Special Enrollment Periods (SEP): For qualifying life events like moving or losing other coverage. Medicare Advantage Open Enrollment: January 1 - March 31 for switching plans. Failure to meet enrollment deadlines can result in higher life insurance premiums. For example, if you delay enrolling in Part B without having other credible coverage, you may pay a late enrollment penalty. To avoid penalties, mark your calendar with important dates and review your coverage annually. Understanding the full scope of medicare benefits can significantly improve your healthcare experience and financial security. By knowing your options, costs, and enrollment rules, you can choose the coverage that best fits your needs and enjoy peace of mind as you age.

Michael T. Braden July 14, 2025 MEDICARE PART D CHOOSING THE RIGHT MEDICARE PART D PRESCRIPTION DRUG PLAN An Elderly Medicare Beneficiary is Consulting With Her Doctor and asking how she can find the best Medicare Part D Drug Plan. Choosing a new Medicare Part D Prescription Drug plan can be overwhelming, especially when considering its crucial role in managing healthcare costs. In 2023, Medicare beneficiaries will have access to a variety of prescription drug plans to help cover medication costs, but the options can be confusing. With the correct information, you can choose a plan that fits your specific health needs and budget. HELPING YOU TO UNDERSTAND MEDICARE PDP PLANS Prescription drug plans help cover the costs of medications not included in original Medicare. They are offered by private insurance companies that contract with the Medicare program. These plans may come with various premiums, deductibles, and copayments. It's essential to understand how these different components work to select the most beneficial plan. Premium : This is the monthly fee you pay to maintain your plan and can vary significantly by plan. Deductible : This is the amount you must pay out-of-pocket before your plan starts to cover your prescriptions. Copay/Coinsurance : After you meet your deductible, you may still be responsible for a portion of the prescription cost, either as a flat fee (copay) or a percentage of the total (coinsurance). Choosing a plan isn’t as simple as selecting the one with the lowest premium; it requires assessing your individual needs and medication costs to determine the best option for you. IMPORTANT POINTS TO CONSIDER WHEN YOU ARE LOOKING FOR A NEW MEDICARE PART D PRESCRIPTION DRUG PLAN When selecting a Medicare Part D plan, consider the following factors to ensure it meets your requirements: MEDICATION COVERAGE/FORMULARIES Before enrolling in a plan, review the formulary, the list of covered medications. Ensure the medicines you currently take—or may need in the future—are included. For example, plans may differ on coverage for specific brands versus generics. PHARMACY NETWORKS Most Part D plans have a network of preferred pharmacies where you can save on drug costs. Ensure the plan you choose includes pharmacies that are convenient for you. Using an out-of-network pharmacy can lead to higher out-of-pocket costs. COSTS Look beyond the premium. Calculate your expected annual costs, which include premiums, deductibles, copayments, and any other out-of-pocket expenses. You can use the plan finder tool on Medicare's website to get an estimate based on your specific medications. Braden Medicare Insurance Poster: Pharmacy Image. Reminding Beneficiaries That They Will Only Get The Lowest Price For Their Prescription Medications When They Use Their Plan's Preferred Pharmacies. WHAT ARE MEDICARE PART D STAR RATINGS Medicare rates Part D plans using a five-star rating system, with five being the highest. Consider the star ratings when comparing plans, as they reflect the quality of service and member satisfaction. HOW MANY DIFFERENT TYPES OF MEDICARE PART D PLANS ARE THERE? There are two primary types of Medicare Part D plans available: Standalone Prescription Drug Plans (PDPs) : These plans cover only medications and are typically added to a Medicare Advantage plan. PDPs can be a good option if you want to keep your original Medicare benefits and need drug coverage. Medicare Advantage Plans with Drug Coverage (MA-PDs) : These plans combine Medicare Part A and Part B benefits with prescription drug coverage. If you choose this route, you generally must use providers within the plan's network, except in emergencies. When choosing between these options, consider the benefits you need and whether you prefer a separate prescription drug plan or an all-in-one package. MEDICARE PART D ENROLLMENT PERIODS Timing is crucial when enrolling in a Medicare Part D plan. Understanding the enrollment periods can help you avoid late penalties and ensure you have coverage when you need it. Initial Enrollment Period (IEP) : This is a seven-month period surrounding your 65th birthday, during which you can enroll in a Part D plan without incurring penalties. Annual Enrollment Period (AEP) : This happens from October 15 to December 7 each year, allowing you to enroll in or switch your Part D plans. Special Enrollment Period (SEP) : Certain life events, such as moving or losing other health coverage, can allow you to enroll or change plans outside of the regular periods. Failing to act during these periods can lead to coverage delays and unnecessary out-of-pocket expenses. Braden Medicare Insurance: What Is The Medicare Part D Penalty Poster? HOW TO GET THE MOST FROM YOUR MEDICARE PART D PRESCRIPTION DRUG PLAN After you've chosen a Medicare Part D plan, here are some recommendations to use your benefits effectively: Stay Connected with Your Healthcare Provider : Regularly communicate with your doctor about your medications and any changes to your health. This ensures they’re prescribing the most effective drugs at the best prices. Utilize Preventive Services : Some Part D plans offer additional benefits for preventive drugs, such as those for cholesterol or hypertension. Take advantage of these to maintain your health. Review Annually : Your needs may change, and so may the plans available to you. Review your coverage options annually during AEP to ensure you still have the best plan for your needs. Use the Medicare Plan Finder : Regularly check the Medicare Plan Finder online for updates. This tool provides updated information on available plans and their associated costs, enabling you to make informed decisions. WRAPPING THINGS UP Choosing the right Medicare Part D plan is pivotal to your healthcare strategy. By understanding the components, evaluating your options, and staying informed, you can select a plan that not only meets your medical needs but also minimizes your costs. Don't hesitate to seek help from Medicare experts if you're unsure; getting personalized advice can deconstruct the complexities of the system and lead you to more confident decisions. By taking the time to evaluate your options yearly, you can ensure your prescription drug coverage remains optimal for your changing health needs.

Michael T. Braden October 11, 2025 MEDICARE 101 MEDICARE SUPPLEMENT vs MEDICARE ADVANTAGE , which option is better? This has been an ongoing battle for decades and will continue for the foreseeable future. It is one of the most common and confusing decisions people face when enrolling in Medicare. We hope that by reading this guide and sharing it with friends or family members, you will better understand the differences between Medicare Advantage Plans (Medicare Part C) and Medicare Supplement (Medigap) plans, including costs, coverage, provider access, enrollment rules, and long-term flexibility. Whether you’re deciding for the first time or reconsidering your current coverage, we hope this article helps you determine which Medicare plan is best for your healthcare needs, travel habits, and budget, without the jargon or sales pressure. MEDICARE DOES NOT COVER EVERYTHING Items that Original Medicare does not cover The first shock for many people upon retirement is learning that Medicare does not cover everything. For example, Original Medicare Medicare (Medicare Part A & Medicare Part B) does not provide Coverage for Routine Dental, Vision, or hearing visits or examinations. These are just a few of the reasons that Medicare Advantage plans were established. Because Medicare Advantage plans are offered by private, for-profit insurance companies, these companies are not subject to Medicare rules. The Government pays these private insurance companies $ 12,000 per year for each of their Medicare Beneficiaries. This additional income funds the extra coverage and, unfortunately, the Medicare Advantage commercials we see on TV and hear on the radio. Here are some of the significant differences between Medicare Supplement plans and Medicare Advantage: Medicare Advantage plans typically offer lower premiums and additional benefits, but often impose significant network restrictions. In contrast, Medigap plans cover more out-of-pocket expenses, and are accepted by any provider who already accepts Medicare- no network necessary. Understanding enrollment periods, plan limitations, and costs is essential for making informed decisions about whether to choose a Medicare Advantage plan (Medicare Part C) or a Medicare Supplement plan. Typically, Medicare Advantage offers no coverage outside of the County you live in, except for Urgent Care or using a Hospital Emergency Room. Typically, people are interested in the fact that most Medicare Advantage Plans have $0 or very low monthly premiums. However, your costs quickly add up due to the number of copayments and coinsurance you are responsible for. Any of you who can remember the old Midas commercials from the 80s might recall the tagline: "You can pay me now, or pay me later." Well, Medicare Supplement Plans are similar to the pay ahead of time, you have a consistent monthly payment, and you are covered for pretty much everything else, and your only expense will be an annual Medicare Part B deductible, which is $288 for 2026. Medicare Advantage Plans have little or no premiums, but they nickel and dime you for everything else. Including the need to receive a referral from your PCP before seeing a specialist, $300 per day for Hospital Stays, $250 and up for MRI or CT Scans, etc. They can also delay or deny services and require you to obtain 2nd, 3rd, and even 4th opinions in some cases. Original Medicare covers most services you would see an Ophthalmologist for; however, it does not cover expenses at an Optometrist's office. MEDICARE HAS 4 PARTS Colorful Blocks Showing The Four Parts That Make Up Medicare WHAT IS MEDICARE ADVANTAGE? Medicare Advantage, also referred to as Part C, is an alternative to traditional Medicare. Private insurers provide Advantage Plan coverage. These plans cover the same essential dynamics as Parts A and B of Original Medicare and may also include additional services, yet lack the coverage flexibility that Original Medicare offers. Advantage plans often offer additional benefits, such as vision, dental, and hearing coverage. Many Advantage plans also include prescription drug coverage, and some even include telehealth services. DIFFERENT TYPES OF MEDICARE ADVANTAGE PLANS Advantage plans are primarily categorized as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). HMOs generally require you to use a specific network of doctors and hospitals, and typically require referrals to see specialists. PPOs offer slightly more flexibility, allowing you to see out-of-network providers, but at a higher cost. Most Medicare Advantage plans operate under an HMO or PPO structure. Some plans cover a portion of out-of-network care, while others strictly cover only in-network services. WHAT ARE THE COSTS AND PREMIUMS FOR MEDICARE ADVANTAGE Advantage plans are known for their lower premiums compared to Medigap plans, with many offering no-cost premiums. However, that comparison is not relevant because an Advantage plan competes only with Original Medicare without a supplement. The benefits are not equal to Medicare plus a supplement. In 2025, the average monthly premium for these plans is approximately $17, with a substantial number of plans having no premium. However, it’s essential to consider other notable expenses, such as copayments, the monthly Part B premium, and out-of-network service costs. The federal government requires these plans to limit the out-of-pocket maximum, with current caps set at $9,350 for in-network services. This cap helps protect beneficiaries from high medical costs, though additional fees may still arise. WHAT IS MEDIGAP? Medigap plans, also referred to as Medicare Supplement plans , fill coverage gaps in Original Medicare (Parts A and B). A Medigap policy helps cover expenses that you would otherwise need to pay out of pocket, such as copayments, coinsurance, and deductibles. There are several plan choices available, offering a variety of coverage options. For more details, see the Medicare Supplement Plans Comparison Chart . One significant advantage of Medigap plans is that the policies are automatically renewed each year -as long as premiums continue to remain paid- which ensures continuous coverage regardless of your current health status.     COMPARING MEDICARE SUPPLEMENT PLANS Braden Medicare Insurance' 2026 Medicare Supplement Plan Comparison Chart These plans cover various deductibles, copayments, and coinsurance under Original Medicare. Some plans, such as Plan F, even cover costs not included in Medicare, such as the Part A deductible and overseas care. MEDICARE SUPPLEMENT COSTS DEPEND ON THE MEDICARE SUPPLEMENT PLAN YOU CHOOSE Medigap premiums vary significantly, based on the insurance company you choose, your location, and age. These plans often involve minimal additional costs, even for frequent medical care, making them a predictable option for budgeting. Missing the Initial Enrollment Period may result in higher premium costs or denial of coverage due to medical underwriting. COMPARING MEDICARE SUPPLEMENTS AND MEDICARE ADVANTAGE Choosing between Advantage and Medigap plans involves comparing their benefits and costs: A Medicare Advantage Plan replaces Medicare Part A, Part B, and often Part D. The Advantage plan is best compared to Original Medicare without a supplement. Unlike a Medicare supplement, an Advantage plan does not increase your benefits relative to Original Medicare. A Medigap Plan increases the benefit of Original Medicare by paying all or some of the copays and deductible in Medicare Part A and Part B. Medigap allows access to any doctor who already accepts Original Medicare, providing greater provider-network flexibility compared with Advantage plans, most of which require care within the plan’s network. Medicare Advantage plans often include additional benefits, such as vision and dental care, that Original Medicare does not cover. Even with these extra benefits, premiums for Advantage plans are typically lower than Medigap premiums; several plans have a $0 premium. Many Medicare Advantage plans also include prescription drug coverage. WILL YOUR PLAN TRAVEL WITH YOU? Patients with Medicare Advantage plans (Medicare Part C) may face limitations on provider choice due to the plans’ network restrictions. Coverage for Advantage Plans, while still regulated by Medicare, is provided through private companies that contract with specific in-network hospitals and physicians. Most Medicare Advantage plans restrict you to in-network medical providers, which can be significant if you have preferred doctors outside the network or need to see a specialist. If you want to stay with a specific doctor or hospital while enrolling in Medicare, ask whether they participate in any Advantage plans or accept Original Medicare . Advantage plans may be less suitable for Medicare beneficiaries who travel frequently, due to network restrictions. Medigap plans, however, typically allow members to access any Medicare-accepting provider nationwide. For those who travel abroad, combining Original Medicare with a Medigap plan that covers overseas emergency care can provide assurance and comprehensive coverage wherever they go. DIFFERENCES IN COVERAGE WITH MEDICARE ADVANTAGE AND MEDIGAP PLANS Medigap and Medicare Advantage plans differ in coverage and benefits: Medigap does not include coverage for prescription medications; a separate Part D plan is required for drug coverage. Advantage plans often include additional benefits, such as dental, vision, and hearing coverage, and some also include gym memberships. Plans K and L have out-of-pocket limits that can help manage beneficiaries' costs. Understanding out-of-pocket maximums is crucial, as they can significantly affect overall healthcare expenses. Using online comparison tools and resources can help evaluate the differences in coverage and costs among Medicare insurance plans, including prescription drugs. CHOOSING THE RIGHT PLAN FROM THE START When deciding between Medicare Advantage and a supplement, it’s crucial to assess your personal health, lifestyle, and financial needs. Consider your preferred method of healthcare and frequency of medical care. If you have specific health conditions or require frequent medical services, this will undoubtedly influence your choice. Certified Medicare advisors can provide tailored recommendations based on individual health needs and financial circumstances. They can clarify the complexities of Medicare options and help ensure that you make an informed decision. SPECIAL NEEDS PLANS AND CHRONIC SPECIAL NEEDS PLANS Medicare Advantage Special Needs Plans are designed for individuals with significant healthcare needs and are available to Advantage enrollees with specific chronic conditions, offering tailored care and services. Ignoring potential future healthcare needs can lead to selecting a plan that may not provide adequate coverage in the future. Planning for future medical needs, such as chronic conditions or poor health, is essential for making an informed decision regarding Medicare coverage. BUDGETS ARE DIFFERENT FOR EVERYONE To determine overall expenses for both plans, consider the following: Calculate all costs associated with each plan, including copayments and deductibles. Account for variations in Medigap plan premiums by age. Consider location-based differences in pricing. 2026 BRADEN MEDICARE INSURANCE' Monthly Medicare Cost Estimate Worksheet Failing to understand how out-of-pocket costs  accumulate can impact decision-making regarding plan selection. Evaluating both cost and coverage options , including prescription drug needs, is crucial when selecting between Medicare Advantage and Medigap. HSA ACCOUNTS If you have a Health Savings Account (HSA), it’s essential to understand how HSAs interact with Medicare , especially regarding rules like when to stop contributions and when to sign up for Medicare coverage. KNOWING THE CORRECT ENROLLMENT PERIODS IS IMPORTANT Understanding Medicare enrollment periods is crucial for making changes to your coverage without incurring penalties. Advantage plans typically offer three enrollment options: the Initial Enrollment Period , Annual Election Period (October 15 to December 7), and Medicare Advantage Open Enrollment (January 1 to March 31). INITIAL ENROLLMENT PERIOD (IEP) Braden Medicare Insurance's Initial Enrollment Period (IEP) Poster You should enroll in Medicare Parts A and B during a specific seven-month ‘Initial Enrollment’ time window, which starts three months before you turn 65, includes that birthday month, and continues for the three consecutive months after. This period is crucial because it guarantees the right to coverage, meaning insurance companies cannot deny coverage or charge higher premiums based on health conditions. The best time to purchase a Medigap/supplement plan is during the six months immediately following enrollment in Medicare Part B, typically when you turn 65. During this “Initial Enrollment Period,” the 6-month/180-day timeframe after starting Part B, insurance companies must allow you to choose a supplement plan without consideration of your health status, which is why this is the most preferred time to acquire your medigap plan. If you’re receiving Social Security benefits, you’ll be automatically enrolled in Medicare when you become eligible. Those not yet receiving these benefits can enroll online or at their local Social Security Administration office. For information on prescription drug coverage, review how to enroll in Medicare Part D . MEDICARE ANNUAL ELECTION PERIOD (AEP) During the Annual Election Period from October 15 to December 7, Medicare beneficiaries can add or switch their Medicare Part D coverage. This period also allows beneficiaries to transition from Medigap to an Advantage plan. Annual reviews during the Annual Election Period ensure your coverage continues to meet your healthcare needs. Premiums, coverage options, and healthcare needs can change from year to year, making these reviews critical. OTHER SPECIAL ENROLLMENT PERIODS (SEP) Medicare allows special enrollment periods for individuals who experience specific life changes, such as moving out of their plan’s service area or ending employer-sponsored health coverage. If you lose your employer health insurance, you can enroll in Medicare during a special eight-month enrollment period. Make sure to consult a Medicare expert to explain these time frames so that you can make the best decision at the right time for you. Special enrollment periods provide flexibility for those who experience unexpected changes in their health insurance coverage, ensuring they can maintain their benefits without penalties. AVOIDING COMMON MEDICARE MISTAKES Confusing Medicare Advantage and Medigap coverage. Thinking that Advantage and Medigap plans provide identical coverage is also a standard error. It is essential to understand the differences between these plans to make the right choice. Overlooking the loss of guaranteed-issue rights. Switching from Medigap to Advantage may cause you to lose certain guaranteed-issue rights for Medigap coverage later. Being aware of this is essential to avoid unexpected issues. Not thoroughly researching plan benefits. Failing to fully study and understand what each plan offers before switching can lead to surprises, which you’d prefer to minimize when it comes to your health care. Ignoring out-of-pocket cost limits, many overlook the differences in out-of-pocket limits between Medicare Advantage and Medigap plans. These limits significantly impact overall healthcare expenses and budgeting. Neglecting to consider future healthcare needs. Not planning for future medical care can be problematic, mainly because once a supplemental policy is canceled, regaining coverage may be difficult. Anticipating future health needs is crucial for making informed decisions. CAN YOU SWITCH BACK AND FORTH BETWEEN PLANS Switching between Medicare Advantage and Medigap  requires returning to Original Medicare  first. Understand the specific steps and considerations for changing plans  to avoid any coverage gaps. Many individuals consider switching from a Medicare Advantage plan to Medigap for more choice in specialists and less hassle involving prior authorizations. Conversely, switching from Medigap to a Medicare Advantage option requires careful consideration of the potential loss of specific Medigap benefits. SWITCHING FROM MEDICARE ADVANTAGE TO A MEDICARE SUPPLEMENT PLAN To switch from a Medicare Advantage plan to Medigap, you must make this coverage change during the Annual Election Period. When switching back to Original Medicare, you will need to enroll in a Medicare Part D plan at the same time. In some states, individuals are offered guaranteed-issue Medigap plans year-round without medical underwriting. However, if you have a pre-existing condition when applying for Medigap coverage after switching plans, insurers may deny coverage or offer it at a higher premium. When considering changes to Medicare coverage, it is imperative to seek knowledgeable advice and guidance from a qualified Medicare expert. They will be able to help you navigate all necessary steps within specified time frames, providing invaluable assurance during the process. SWITCHING FROM MEDICARE SUPPLEMENT TO A MEDICARE ADVANTAGE PLAN Check if your Medigap policy has any specific contract requirements regarding switching. You may lose specific Medigap benefits when switching to a Medicare Advantage plan. Understanding these implications is crucial to making an informed decision that aligns with your healthcare needs and financial situation. Key Tips for Making the Best Choice Research and Compare Plans: Thoroughly research all available Medicare options , including Medicare Advantage and Medigap plans , to understand their coverage, costs, and provider networks. Consider your health needs, budget, lifestyle, and any existing insurance coverage to make an informed decision about which plan best suits you. Consult with Experts: Seek guidance from Medicare specialists or licensed insurance advisors who can provide personalized recommendations tailored to your unique healthcare requirements and financial situation. Consulting with experts can help clarify potentially complex options as you enroll in Medicare and ensure that you choose the best plan for your needs. Review Annual Changes: Regularly review your Medicare Advantage or Medicare Supplement plans during the annual open enrollment period to ensure they continue to meet your evolving health needs. You can also use resources such as Medicare.gov to research and compare plans and make adjustments as necessary. WRAPPING THINGS UP Choosing between Medicare Advantage and a Medicare Supplement (Medigap) plan is a significant decision that can affect your healthcare and finances. While Medicare Advantage plans offer lower premiums and additional benefits, such as vision and dental care, they come with network restrictions. In contrast, Medigap plans provide greater flexibility in choosing medical providers and cover more out-of-pocket costs. Ultimately, the best choice depends on your health needs, budget, and lifestyle. By conducting thorough research, consulting experts, and reviewing your plan annually, you can ensure that you select the plan that best meets your needs. Make an informed decision today to secure a healthier and more financially stable future.

Michael T. Braden December 27, 2026 ONLINE FILING CABINET Picture of Wooden Filing Cabinets Used For The Braden Medicare Insurance Virtual Filing Cabinet Page at www.bradenmedicare.com BRADEN MEDICARE INSURANCE'S READY TO PRINT PDF FILES FOR RELEVANT MEDICARE FORMS AND ARTICLES Here at Braden Medicare Insurance, we have included the most commonly used and requested forms from our clients. However, if you are looking for a specific item or form and do not see it here, call us at (480) 225-1393 or email me at mike@bradenmedicare.com , and we will do our best to send it to you asap. 2026 MEDICARE & YOU BOOKLET MEDICARE FORM 40B https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/CMS%20Medicare%20Part%20B%20Form%2040B.pdf?ver=1711212459718 MEDICARE FORM L564 https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/CMS-L564%20-%209-23.pdf?ver=1711212459718 MEDICARE PART A ENROLLMENT FORM https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/Medicare%20Part%20A%20Application%20CMS-18-F-5%20(508)Ju.pdf?ver=1711212459718 MEDICARE PART A BENEFITS CHART Copy Of The Braden Medicare Insurance 2026 Medicare Part A Benefits Form MEDICARE PART B BENEFITS CHART Copy Of The 2026 Medicare Part B Benefits Form BRADEN MEDICARE INSURANCE MEDICARE ENROLLMENT GUIDE https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/Braden%20Medicare%20Insurance%20Medicare%20Enrollment%20.pdf?ver=1711212459718 CMS ENROLLING IN MEDICARE PART A AND PART B BOOKLET https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/11036-Enrolling-Medicare-Part-A-Part-B%20Booklet.pdf?ver=1711212459718 CMS MEDICARE REIMBURSEMENT FORM https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/CMS-1490S%20Patient%20Reimbursement%20Form.pdf?ver=1711212459718 2026 IRMAA CHART Photo Of The 2026 Medicare 2026 IRMAA Chart For High Wage Earners BRADEN MEDICARE' AVOIDING THE TOP 7 MEDICARE MISTAKES https://img1.wsimg.com/blobby/go/15d4ea89-9de4-4408-bf91-59aaf980bdc6/downloads/Top%207%20Medicare%20Mistakes.pdf?ver=1711212459717 PATIENT INFORMATION SHEET (EDITABLE WITH MICROSOFT EXCEL) https://bradenmedicare-my.sharepoint.com/:x:/r/personal/mike_bradenmedicare_com/_layouts/15/Doc.aspx?sourcedoc=%7BA7886977-5C98-483C-9AAB-841BD800EECE%7D&file=PATIENT%20INFORMATION%20SHEET%20(JOHN%20DOE).xlsx&wdLOR=c63A88B72-E5F4-49FD-ADAE-4A299407C4EB&fromShare=true&action=default&mobileredirect=true BRADEN MEDICARE' 2026 MONTHLY MEDICARE COST WORKSHEET Photo Of Braden Medicare Insurance's 2026 Medicare Monthly Cost Estimate Worksheet

Michael T Braden August 28, 2024 FILING A MEDICARE CLAIM Picture depicting a doctor pointing out Step-By-Step instructions for How To File A Medicare Claim HOW TO FILE A MEDICARE CLAIM You may never need to file a Medicare Claim, but if you do, we want to provide you with step-by-step instructions on how to file a Medicare Claim in the event you ever need it. Medicare reimbursement may be necessary if you pay a claim out-of-pocket and should receive coverage through Medicare. While it is not common to need Medicare reimbursement, you still may find yourself in this situation. In this article, we discuss how to file a Medicare claim. In most cases, your doctor or hospital will handle the Medicare billing process for you. But in a few situations, you may have to pay for your care upfront and file a claim to ask Medicare to reimburse you. The claims process is simple, but you will need an itemized receipt from your provider to proceed with Medicare reimbursement. WHAT DOES MEDICARE REIMBURSEMENT MEAN? If you receive your Healthcare Benefits from Original/Traditional Medicare, your doctors typically bill Medicare for any care you obtain. Medicare will then pay its portion directly to your doctor. Then, your doctor will only charge you for any outstanding copay, deductible, or coinsurance. If you have a Medicare Supplement (Medigap) plan, your Medigap plan will cover its portion of your bill after Medicare pays its portion. In a few cases, your physician might request that you pay the total cost of your care upfront or by bill. These situations include cases where your doctor does not participate in Medicare or where Medicare does not cover the service you receive. The doctor's office can assist you in filing a claim, but they are not required to do so. If your doctor does not bill Medicare directly, you can file a claim asking Medicare to reimburse you for out-of-pocket costs. NOTE: Even if your doctor does not accept Medicare, you should keep them as your doctor if you prefer them. But, you could also suggest that it's okay if they assist you in speeding up the process by helping you to file your reimbursement request from their office electronically. Most doctors who do not accept Medicare Assignment can legally add 15% to the Maximum amount Medicare would pay for any specified service. And, if you have a Medicare Supplement Plan F or Plan G, your plan will pay the Excess Charge for you. WHAT DOES THE MEDICARE REIMBURSEMENT PROCESS LOOK LIKE? Original, or Traditional Medicare (Part A and Part B), allows you to see any doctor you choose. However, not all providers handle billing in the same way. Medicare assignment lists the rates Medicare will pay for covered healthcare services. If your provider participates in Medicare assignment, you will know your exact costs before coverage begins. Most doctors are participating providers who accept Medicare Assignment. They have agreed to accept Medicare’s rates as full payment for their services and will only bill you for the remaining deductible or coinsurance if necessary. If you see a participating doctor, they handle Medicare billing, and you do not have to file any claim forms. However, some doctors don’t bill Medicare directly, so it is wise to speak with your doctor about their billing practices before receiving treatment. In this case, if you want Medicare to pay for your care, you must submit a reimbursement request form. WILL MEDICARE REIMBURSE ME IF I SEE A DOCTOR WHO DOES NOT ACCEPT MEDICARE ASSIGNMENTS? A doctor who accepts Medicare patients but has not agreed to accept Medicare’s Assignment (Their Fee Schedule) is permitted to charge you what is referred to as a Medicare Part B Excess Charge. This extra charge can range from 0-15%, and most often amounts to an additional 15%. So if your Doctor Visit would generally cost $300 under Medicare rates, your doctor can add 15%, or in this example, add $45, so your $300 Office Visit is now $345. Medicare will reimburse you for 80% of the $300, which is $240, and you will be responsible for the remaining $60 for your Medigap/Medicare Supplement plan, provided you have one. And, if you do have a Plan G or Plan F Medicare Supplement, they will send a reimbursement request to your Medicare Supplement company for the additional (15% Charge) The extra fee is known as an excess charge. Non-participating doctors may bill Medicare directly. Alternatively, they may ask you to pay upfront and seek reimbursement from Medicare yourself if you qualify. The best way to avoid these surprise charges is to verify that any doctor you see accepts Medicare. REIMBURSEMENT FOR MEDICARE PART A (IN-PATIENT HOSPITAL CHARGES) Medicare Part A is the Part of Medicare that pertains to care you receive as an inpatient at a Hospital, Skilled Nursing Facility (SNF), Hospice Care, and Home Healthcare. Typically, your doctors will bill Medicare directly. In this case, you may need to pay a deductible or a coinsurance amount. However, you may occasionally receive an unexpected bill from a doctor involved in your inpatient treatment. If this ever happens to you, the easiest thing to do is to call Medicare at 1-800-MEDICARE. They will be glad to help you and provide all the information and steps to submit your claim. NOTE: We often cringe at the suggestion that you need to call a 1-800 Number for Customer Service. However, I have personally never experienced this when calling 1-800-MEDICARE. They do an excellent job of training their Agents and Staff, and they are genuinely there to assist you. They are patient and caring, and there is no need to be irrational or curt when contacting them. And remember, if you are smiling while you are talking on the phone, you accomplish a lot more than you ever could with a sour look on your face. REIMBURSEMENT UNDER MEDICARE PART B (OUTPATIENT SERVICES) Doctor visits, durable medical equipment, and outpatient care fall under Medicare Part B . When scheduling doctor appointments, always ask whether the doctor accepts Medicare assignment; this helps you avoid having to seek reimbursement. Be aware that some doctors have opted out of Medicare altogether, and Medicare will not pay for any portion of their services. Thus, ensuring your physician accepts Medicare before receiving services is essential. If this happens, contact the doctor to confirm whether they accept Medicare assignments and when they plan to submit the claim to Medicare—Using Form 1490S. https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms1490s-english.pdf   If they do not intend to submit the claim themselves on your behalf, request an itemized receipt so you can file a request for reimbursement. WHAT IF YOU ARE COVERED UNDER MEDICARE ADVANTAGE (MEDICARE PART C)? If you have a Medicare Advantage plan , you will never need to ask for reimbursement from Medicare. Medicare pays Medicare Advantage companies to process their claims independently. Although you may need to ask your carrier to reimburse you for something, you will never need to contact Medicare for reimbursement. You gave up your Medicare rights to receive coverage once you agreed to join a Medicare Advantage plan. You may ask Medicare about pretty much anything else, but your plan has the final say on payments and reimbursements. Your doctor can only charge you for your deductible, copayment, or coinsurance. Unless you go out of your "Network". If you see a physician out-of-network, there is a reasonable chance that you'll be responsible for up to 100% of the costs for an out-of-network provider. Coverage for out-of-network doctors depends on your Medicare Advantage plan, and each plan is unique and has its own rules. Many Medicare Advantage HMO plans do not cover non-emergency out-of-network care. But a Medicare Advantage PPO plan could provide you with some out-of-network coverage. REIMBURSEMENTS FOR MEDICARE PART D Medicare Part D is prescription drug coverage that Medicare Beneficiaries receive from private insurance companies. These companies set their own policies and availability for which drugs they offer and the cost of those medications. As a general rule, pharmacies handle the insurance process, and you (The Medicare Beneficiary) will have to pay a Co-Insurance or Co-Pay amount for any medications you receive. Contact your prescription drug plan if the pharmacist tells you a drug is not covered or if the cost is higher than anticipated. Or contact the Agent/Broker who sold you your policy and request their assistance. If you do not know who it was, and you need help, please feel free to contact us at www.bradenmedicare.com , send us a contact request, or give us a call at (480) 225-1393 anytime. WHERE CAN YOU FIND THE CORRECT FORM 1940S TO SUBMIT? Medicare Part D Reimbursement Form that you must fill out and return to Medicare. You can use this link to access and print or save the form, which is available in English and Spanish  on the Medicare website. SUBMITTING A BILL TO MEDICARE FOR REIMBURSEMENT OF WHAT YOU PAID FOR OUT-OF-POCKET To receive reimbursement, you must send a completed claim form and an itemized bill supporting your claim. It includes detailed instructions for submitting your request. You can fill it out on your computer and print it out, or print it first and fill it out by hand. The form asks for information about you, your claim, and other health insurance you may have. HERE IS WHAT MEDICARE REQUIRES TO HAVE ON ANY BILL SUBMITTED FOR REIMBURSEMENT: DATE (When was the service provided/Appointment Date). WHERE DID THE SERVICE TAKE PLACE (Address of the doctor's Office/Clinic, Hospital). COST (How much were you charged for the service(s) you received?) DEFINITION (Lists a description/reason for your visit, illness, injury, check-up, annual visit, etc.) SUPPLIES (List any/all of the supplies and/or medications used for the procedure). NAME, ADDRESS, AND TELEPHONE NUMBER (Of The Healthcare Professional you saw). DOCTORS ID (List the National Provider Network Number (NPN) of the Doctor or Supplier you went to). Send the CMS Form 1490s, along with any other documentation, to the correct address for your state. (A list of addresses is included in the link to the CMS Form 1490s.) FINDING DOCTORS WHO ACCEPT MEDICARE To find a doctor that accepts Medicare, a person can visit the Medicare Physician Compare  site and search by location, and by entering either: Type in the Last Name of the Healthcare Professional you are considering. Enter the Group Name or the Name Of The Practice, such as "Sunshine Family Healthcare". Enter Their Specialty or PCP (Primary Care Provider) if they are not a " Specialist. " Enter your Medical Condition. The search results will then list every Doctor in your location who accepts Medicare within the field you specified. QUESTIONS SPECIFIC TO MEDICARE REIMBURSEMENT HOW LONG IS THE PROCESS TO RECEIVE A REIMBURSEMENT FROM MEDICARE? It usually will take Medicare about Sixty (60) days to process a reimbursement claim. Most people filing a claim have already paid their Doctor's bill out-of-pocket, but if you have not done this, please reach out to the doctor's office, let them know you are submitting a claim, and that the process may take two months to resolve. Any doctor can submit a claim on your behalf, and if they refuse, citing that it takes too much of their time, don't worry about how long it takes. You might also consider interviewing other doctors who accept Medicare or will submit a claim on your behalf. HOW LONG WILL THE DOCTOR HAVE TO WAIT TO GET PAID IF YOU HAVE NOT PAID THEM YET? Once your service is approved, Medicare claims to providers take about 30 days to process. The provider usually gets direct payment from Medicare. Otherwise, if you have already paid your doctor, Medicare will send a check directly to you. WHAT THE HECK IS A MEDICARE FEE SCHEDULE? The Medicare Fee Schedule is the amount Medicare will pay for each procedure and service, for Doctors, Hospitals, Ambulances, Transportation, etc., as listed in its Medicare database. So if an Office Visit fee is $300, that is the maximum amount any Doctor who accepts Medicare can charge for an Office Visit. If you see a Doctor who has not agreed to the Medicare Fee Schedule (AKA Medicare Assignment), they can charge you an amount up to 15% more than Medicare. However, if you have purchased a Medigap or Medicare Supplement Plan G or Plan F policy, your Supplemental Insurance Company will pay his additional fee for you. WRAPPING THINGS UP Did you know there are over 1 Million Licensed Doctors in the United States?. The majority of doctors who do not accept Medicare are Pediatricians, Psychologists, and Psychiatrists. All told, nearly 94.7% of all physicians accept Medicare in the United States of America. We love to hear from Clients and Non-Clients alike. If you would like to reach us, please email us directly at mike@bradenmedicare.com or call us anytime at (480) 225-1393.