MediHealth Options Your Answer to Medicare

Those 65 or older AND eligible for Social Security. *Anyone at any age who has been on Social Security Disability for 24 months then Medicare begins on the 25th month. *Those with End Stage Renal Disease (ESRD) or *Those with Lou Gehrig’s Disease (ALS)

At age 65 and older, Yes you do, unless you are covered by a creditable Group or Retiree health plan. Individual health or COBRA are not considered creditable coverage. Failure to maintain creditable coverage could result in both Part B & Part D Late Enrollment Penalties.

Generally, you won’t have to pay a Part D penalty if:

• You have creditable drug coverage (coverage that’s similar in value to Part D) OR
• You qualify for Extra Help

You’ll pay an extra 1% for each month (that’s 12% a year) if you:

• Don’t join a Medicare drug plan when you first get Medicare.
• Go 63 days or more without creditable drug coverage.

You may also pay a higher premium depending on your income.

After you join a Medicare drug plan, the plan will tell you if you have to pay a penalty and what your premium will be.

Example:

If you waited 14 months after you were eligible for Medicare to join a Medicare drug plan, and you didn’t have creditable drug coverage, you’ll have to pay a 14% late enrollment penalty in addition to your monthly plan premium.

The penalty amount comes from the "national base beneficiary premium" ($36.78 in 2025).

The national base beneficiary premium changes each year, so your penalty amount may also change each year. This monthly penalty is added for as long as you have Medicare drug coverage, even if you switch plans.

Part D is prescription drug coverage. In 2006 it became law that Medicare Beneficiaries were required to maintain their own Part D coverage. Failure to Maintain creditable prescription drug plan will result in a penalty as follows: Medicare, not the plan, calculates the late enrollment penalty when a person subject to the penalty first joins a Medicare drug plan.

The Medicare Part D donut hole or coverage gap phase of coverage no longer exists as of December 31, 2024. It was the coverage phase after the initial coverage period when you owed a higher or different percentage of the cost of your drugs. Beginning January 1, 2025, there are now three phases of part D coverage: deductible phase, initial coverage period, and catastrophic coverage.

Both Medicare Supplement (Medigap) plans and Medicare Advantage Plans have their place, and the right choice depends on your specific needs and preferences.

Medicare Supplement plans are the most well-known method of enhancing Original Medicare coverage. While they tend to be more expensive, they typically cover most of the costs that Original Medicare doesn’t pay—such as deductibles, co-payments, and coinsurance. However, you’ll need to purchase a separate Prescription Drug Plan (Part D). A key advantage of Medigap is the flexibility to see any doctor or specialist nationwide, as long as they accept Medicare. 

This option is ideal for those who frequently use healthcare services or want access to providers who don’t participate in Medicare Advantage networks.

Medicare Advantage Plans (also known as Part C) are not supplements. Instead, they replace your Original Medicare (Parts A & B) and often include Part D drug coverage. These plans function more like traditional insurance, with co-pays, deductibles, and coinsurance, but they also include a maximum out-of-pocket limit for added financial protection. Many plans have low or even $0 monthly premiums and may offer nationwide coverage through broad networks. In addition, Medicare Advantage Plans often include benefits not covered by Medigap or Original Medicare, such as dental, vision, hearing, and comprehensive annual physical exams.

Ultimately, your decision should be based on how you use healthcare, your budget, and the types of providers you want access to.

Not necessarily. Without a Special Enrollment Period (SEP), you generally cannot change your Medicare plan until the Annual Enrollment Period (AEP), which runs from October 15th to December 7th each year. During AEP, you can review your options and make changes for coverage starting January 1st of the following year. If you don’t make a change by December 7th, your current plan will continue into the new year—unless you qualify for a SEP.

You may be eligible for a Special Enrollment Period under certain circumstances, including:

• Moving to a different county or state
• Gaining or losing full Medicaid coverage
• Qualifying for, receiving, or losing Extra Help (Low-Income Subsidy)
• Living in an institution such as a nursing home (you can switch monthly)

Additionally, from January 1st to March 31st, there's the Open Enrollment Period (OEP) for those already enrolled in a Medicare Advantage Plan. During OEP, you can switch to another Medicare Advantage plan or return to Original Medicare with or without drug coverage.

These are just some of the ways you may be able to change your plan before the next AEP.

My role is to serve as your trusted Medicare Plan Advisor—not to sell a particular plan. I work with multiple insurance companies and have access to many plan options. No matter which plan you choose, I have no financial incentive to steer you toward one plan over another.

My goal is to build a long-term relationship with you—ideally for as long as you’re on Medicare, which for most people is around 18 years. I take the time to understand your unique needs and conduct thorough research to present the plans that best suit your situation. It’s not uncommon for spouses to end up with different plans from different companies, simply because their needs vary.

What matters most is finding what works best for you. I’m here to guide you through Medicare at no cost—my services are always $0 cost to you.