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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.

Michael T. Braden, August 28, 2024 CARING FOR AGING PARENTS Picture of Mother and Son Holding Hands with the caption "When It's Time To Care For Aging Parents" Poster HELPING LOVED ONES AND FAMILY MEMBERS WITH THEIR MEDICARE Often, as we get older, we are not fully aware of what shape our parents are in. We have been busy with our lives, and honestly, most people are not aware of the changes their parents are constantly grappling with. There comes a time when we need to care for them, in the same loving manner they cared for us growing up. Providing Care for aging parents and other family members is what this article is all about. How to care for aging parents and help them understand Medicare. There is a lot of information, and your interest and involvement mean a lot to your parents. It will also help you understand how Medicare works, which will be helpful in the future. HOW YOU CAN PROVIDE CARE FOR AGING PARENTS, AUNT, UNCLE, GRANDPARENT(S) WITH THEIR MEDICARE OPTIONS For many people , the worst part of retirement is in the beginning, starting about 3 months after they turn 64, when their mailbox begins filling up weekly with advertisements from anyone and everyone associated with Medicare and especially Medicare Advantage plans. During this time , most consumers are amazed and a little confused by the concept of Medicare, and many have no idea where to turn to start their research on the subject of Medicare. Most of our clients report that the entire process is confusing and overwhelming. For this reason, we at Braden Medicare advise everyone to call 2-3 local Medicare Brokers and get to know them. Ask questions and decide who you believe you might enjoy working with. Brokers never charge for their services and are equipped and licensed to sell both Medicare Supplement and Medicare Advantage plans. They truly are a one-stop shop for all things Medicare. Another suggestion we always make is to ask each potential client if they have a Son, Daughter, Niece, or Nephew who might assist them in their search. At some point, every Medicare Beneficiary should have a relative who understands the process and who is also familiar with the plan you choose. You may not think it is essential at the time, but having a well-versed Medicare expert who understands your plan is invaluable . They can help with research and are often the ones to inform caregivers about your plan, your doctors, and your future care wishes . HOW TO CARE FOR AGING PARENTS IF YOUR RELATIVES ALREADY HAVE A MEDICARE PLAN AND WANT TO SHARE THAT INFORMATION WITH A FAMILY MEMBER, TRY THESE STEPS TO HELP GET YOU STARTED: The first step is to determine which Medicare Plan they have. There are three ways you can do this. First, ask them to show you the Medicare card they use when they see a doctor. If it is the red, white, and blue card with their Medicare number and the start dates for Parts A & B, they have Original Medicare. If they show you a card from an insurance company with HMO or PPO designations, it is a Medicare Advantage Plan. Second, they should have a free mymedicare.gov account that provides a history of their medical care and prescriptions. It will also show which insurance they are using. If they have never set this up on the www.medicare.gov website, you can assist them in setting one up. Lastly, you can call 1-800-MEDICARE. The Medicare representative will need your parent's permission to speak with you. They should be able to answer all your questions about your parents' plan. This is important because once you set this up , you will always be able to assist your parent/relative whenever you need to speak with anyone at Medicare. And do not be nervous when calling ; Medicare has done an excellent job training its customer service agents, and they are as courteous as they are helpful. Encourage your parents/relatives to stay socially engaged with friends, neighbors, and family members. Please encourage them to participate in community activities and maintain a strong support network. The worst ailment for an aging adult is the feeling of loneliness and depression. If your relative has a Medicare Advantage plan , you may want to consider switching to a Medicare Supplement plan soon . There is less confusion and far less out-of-pocket costs with Medicare Supplement/Medigap plans. Call us if you need help understanding your options, and we can work with you to choose the best plan for your family member. Medicare Advantage health plans may change or be eliminated from year to year. Try to find an Independent Medicare Broker close to you and set up a consultation once you know which plan your relative/parents are enrolled in. Medicare Advantage Plans and Medicare Part D Prescription Drug Plans should be reviewed annually, during the Medicare Annual Enrollment Period (AEP) from October 15th to December 7th . Make a list of all of your parents' or relatives' Prescription Medications. Review them, including the frequency and strength of their medicines. Also, be sure to ask what each medication is for so you can learn more about their care . Please make a list of all their Doctors, Dentists, and Other Healthcare professionals. Email or leave your name, address, and contact information with each Doctor's office. Then, when you get a chance , call the Doctor's office and introduce yourself. They can then call your family members to verify that you are acting on their behalf as needed. Consider whether you’ll need to or be able to help your parents financially, how much, and for how long. Typically, adult children are not financially obligated to pay for their parents’ care. SPECIFIC THINGS TO FOCUS ON WHEN YOU ARE LEARNING ABOUT MEDICARE? Assess the medical needs of your aging parents or other family members and help care for them . Consider their ongoing health conditions, whether they are currently taking prescribed medications, whether they have been advised to undergo tests or screenings soon, and whether any surgical procedures have been recommended by their doctors. EVERYONE HAS 3 CHOICES TO CHOOSE FROM WHEN IT COMES TO HOW THEY WANT TO RECEIVE THEIR MEDICARE BENEFITS. ORIGINAL MEDICARE, MEDICARE ADVANTAGE, OR ORIGINAL MEDICARE WITH A MEDIGAP PLAN. DID YOU KNOW THAT MANY MEDICARE BENEFICIARIES HAVE LESSER COVERAGE THAN THEIR CHILDREN WOULD WANT THEM TO HAVE? Medicare Advantage plans are known for adding benefits not covered by Original Medicare. If they currently have a Medicare Advantage plan, obtain a copy of the Summary of Benefits so you can easily understand the benefits and how they work. This is very important because most Medicare Advantage Plans divide benefits by Quarters, so a $2,000 Dental benefit is likely $500 per quarter, with benefits not rolling over to the next quarter. WHEN YOU IN CHARGE OF CARE FOR AGING PARENTS, FOCUS YOUR EFFORTS ON UNDERSTANDING THESE ITEMS: What are the health benefits offered/included with their current plan? What can they afford? Are they struggling financially? What health concerns do they have? What health issues are anticipated? As your parents or loved ones age, will they likely require caregivers? Do they have any Life or Long-Term Care Insurance that could assist them later, if necessary? Will they have solid insurance if they have cancer, diabetes, or are hospitalized? Not all Medicare Plans are created equal, so this is another good reason to schedule a call with a local, independent Medicare Broker. Do they have proper drug coverage? The right drug plan is essential. Prescription drugs can be costly. Remember, they can change plans every year at no cost if necessary, but you can only do this at certain times of the year. Can they see any doctor who accepts Medicare (with Original Medicare Parts A & B and/or Medigap), or are they limited to in-network providers ? If they have a Medicare Advantage Plan (Medicare Part C), they must see only physicians and go to hospitals and clinics in their plan's network. Do they already have a long-term relationship with a physician, and does the physician participate in their plan? If so, this is costing them money because they are going out of the Network for care. UNDERSTANDING WHY IT IS SO IMPORTANT NOT TO MISS ANY OF THE MEDICARE DEADLINES! Medicare has specific enrollment periods that must be met. If a Medicare beneficiary misses these deadlines without qualifying for a special enrollment period and without creditable coverage, they may face permanent late enrollment penalties. Enrolling on time also allows your elderly parents access to preventive services, screenings, and vaccinations at no cost. Delaying enrollment could leave your aging parent without health insurance, exposing you to potentially high medical costs and creating further health issues. During your initial enrollment period (IEP) for Medicare, everyone is guaranteed one-time acceptance into Medicare Supplement (Medigap) policies, regardless of pre-existing conditions. If you miss this period, you might face more stringent medical underwriting requirements and could be denied coverage or charged higher premiums. Some Medicare plans, like Medicare Advantage and Medicare Part D Prescription Drug plans, have specific annual enrollment periods. If your aging parents miss these periods, they might have to wait until the next enrollment period to make changes or enroll in a different plan. CAN PEOPLE DELAY THEIR MEDICARE ENROLLMENT, OR DO THEY HAVE TO ENROLL AT AGE 65? Aging parents can often delay enrolling in Medicare without penalties in certain situations, such as having employer-sponsored health coverage while actively working. Such insurance is considered a “creditable” alternative to Medicare. WHAT DO I DO IF MY AGING PARENTS CAN NOT AFFORD MEDICARE? LOOK INTO LOW-INCOME PROGRAMS Depending on their financial situation, their parents may qualify for Medicaid, a government program that provides healthcare coverage to low-income individuals and families. Medicaid coverage and rules vary by state. MAYBE CONSIDER MEDICARE SAVINGS PROGRAMS Some states offer Medicare Savings Programs that help cover Medicare premiums, deductibles, and coinsurance for individuals with limited income. LOOK INTO COVERAGE AND PROGRAMS PROVIDED BY SOCIAL SECURITY If your parents have limited income and resources, they might qualify for SSI, a federal program that provides financial assistance to elderly and disabled individuals. You will likely need to call your local Social Security office to schedule an in-person appointment . ASSISTANCE TO HELP LOWER PRESCRIPTION DRUG COSTS Some programs offer assistance with the cost of prescription medications. Medicare’s Extra Help program helps with Part D prescription drug costs. OTHER CHARITABLE/NOT FOR PROFIT ORGANIZATIONS Many nonprofit organizations provide financial assistance, other resources, and support to seniors for healthcare expenses. WHERE IS THE BEST, SAFEST, AND MOST RELIABLE PLACE TO FIND INDEPENDENT INFORMATION ABOUT MEDICARE? 1-800-MEDICARE       This toll-free number provides assistance and information about Medicare. STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP)        Each state has a SHIP that offers free assistance to Medicare Beneficiaries. MEDICARE & YOU HANDBOOK       Medicare provides this publication, available in print and online. You can download the Medicare And You Handbook or call 1-800-Medicare and request a copy be sent to you. NON-PROFIT ORGANIZATIONS  Organizations such as AARP (American Association of Retired Persons) provide information and resources for seniors, including guidance on Medicare and other healthcare coverage. OTHER GOVERNMENTAL AGENCIES  Agencies such as the Social Security Administration can provide information on Medicare enrollment and eligibility. IF YOU ARE STILL UNSURE OF HOW TO PROCEED, WE ARE HERE TO HELP Here at Braden Medicare, we are always available to speak with anyone who has questions or needs advice regarding Medicare and other insurance issues. We are dedicated to being your friend and neighbor. We are happy to provide anyone who contacts us with free advice. Our goal is to keep as much money as possible in the pockets of our clients and their families. Medicare Supplement and Medicare Advantage carrier in the state. Our goal is to treat everyone we meet with kindness and respect. We have the hearts of teachers and the tenacity of prosecutors, and we treat everyone as we would any member of our own family. We appreciate you reading our Blog, and we look forward to assisting you with any questions you may have, now or in the future. You can reach us at mike@bradenmed-icare.com , by visiting our website at www.bradenmedicare.com , by calling us at (480) 225-1393, or by faxing Braden Medicare Insurance at (480) 422-9062.

Photograph of Tillman Braden Junior, Who Dedicated His Life and Service To The United States Of America and Is Proudly Resting AT Arlington National Cemetery ### Exciting Medicare Options for Veterans and Their Families! As the proud son of a dedicated Air Force father, who is honored to rest at Arlington National Cemetery, I want to express my heartfelt gratitude to every veteran and their families. Thank you for your unwavering commitment and the tremendous sacrifices made in the name of freedom. Your service is something many take for granted, and today, I want to highlight the wonderful health options available to you! Here’s a photo of my dad, Chief Master Sergeant Tillman Braden Junior—a true hero. Navigating Medicare can be a little daunting, but it’s crucial for veterans and their families to understand how it works alongside VA health benefits. To truly maximize the fantastic healthcare options you’ve earned, you must enroll in Medicare Part B. This is important for anyone with VA Benefits, CHAMP VA, TRICARE, or TRICARE FOR LIFE. Why is this necessary? Simply put: Medicare serves as the National Health Plan for all Americans aged 65 and older, operating as the primary payer with your VA benefits covering any costs that Medicare doesn’t. This thoughtful structuring allows for more accessible healthcare options, especially for those who may not live near a military base or VA facility. Access to local hospitals and clinics can make a huge difference in your care! Veterans have the flexibility to choose between Original Medicare (Parts A & B) and Medicare Advantage (MA) plans. If you select Original Medicare, your VA benefits provide a safety net, covering the 20% of approved Medicare expenses after the annual Medicare Part B deductible of $233 for 2022. Alternatively, if you decide to dive into a Medicare Advantage plan, they typically cover 80%, with your VA benefits taking care of the remaining 20%. Many popular Medicare Advantage providers even offer plans tailored specifically for veterans! Most of these plans operate as PPOs, giving you a wider selection of doctors and access to a nationwide network. What about prescription drug coverage? You can breathe easy! Thanks to the exceptional VA Prescription Drug Program, you won’t need to worry about selecting a plan that provides separate prescription coverage—your VA benefits are already top-notch! Now, you might be wondering which plan is truly the best fit for you. The key is to find the option that suits your unique lifestyle and family needs. For instance, if you love your gym membership, Medicare won't cover that expense, but many Medicare Advantage plans do! This means more savings and opportunities for you to stay healthy and active. Additionally, if you’re already enjoying TRICARE Dental and Vision benefits for $37 a month, many MA plans come with dental, vision, and hearing benefits built right in—potentially leading to even more savings! Of course, it’s important to be aware of some differences between Medicare Advantage plans and Original Medicare. Here are three considerations to keep in mind: 1. **Choice of Providers**: With Original Medicare, you have the freedom to visit any doctor or hospital across the country that accepts Medicare, without being limited to a specific network. 2. **Hospital Networks**: If you have your heart set on a prestigious facility like the Mayo Clinic, it’s essential to know that they do not accept Medicare Advantage plans in Arizona, which may limit your options. 3. **Billing Process**: If you opt for a Medicare Advantage PPO plan, understand that providers are required to bill both the insurance company and your VA benefits. However, this doesn’t always happen seamlessly. If your provider fails to bill both, you may need to submit your bill to Wisconsin Physicians Services for reimbursement within 30 days. For more information and guidance, I highly encourage you to explore resources on the VA website, the TRICARE For Life website, and the TRICARE website. One of the best steps you can take is to directly speak with a benefits representative from your VA plan before making any commitments. Discuss the plan you’re considering, and get clarification on how your VA benefits integrate with it. This way, you can avoid any unexpected surprises down the line! Thank you once again for your service, and I hope this information empowers you to make informed decisions about your healthcare options. Your bravery and dedication deserve nothing but the best!