The Questions Nobody Warned You to Ask.

Yes. Mary receives a commission from the insurance carrier when you enroll in a plan. Importantly, this commission does not increase your premium in any way — your rate is identical whether you use an agent or enroll directly. Independent agents are compensated to help you navigate the complexity, not to steer you toward high-commission plans.

The deductible is the amount you pay out-of-pocket before insurance starts paying. A copay is a fixed dollar amount ($20, $50) you pay for a specific service after your deductible is met. Many Medicare Advantage plans have $0 deductibles but charge copays per visit.

IRMAA stands for Income-Related Monthly Adjustment Amount. If your income exceeds certain thresholds (based on your tax return from two years prior), Medicare adds a surcharge to your Part B and Part D premiums. Higher-income beneficiaries can pay significantly more. Mary can explain how IRMAA applies to your situation and how to appeal it if your income has recently dropped.

If you receive Social Security benefits, the Part B premium is automatically deducted from your check. If you are not yet collecting Social Security, CMS will send you a bill called "Medicare Easy Pay" or a quarterly premium statement. You can also set up automatic bank withdrawals through your Medicare account.

Once you enroll in any part of Medicare, you can no longer contribute to a Health Savings Account (HSA). However, you can use existing HSA funds to pay for Medicare premiums (except Medigap), deductibles, copays, and coinsurance. Stop contributing 6 months before enrolling in Medicare to avoid a tax penalty.

Your Initial Enrollment Period (IEP) is a 7-month window: 3 months before your 65th birthday month, the month you turn 65, and 3 months after. If you miss your IEP and aren't covered by employer insurance, you'll face permanent late-enrollment penalties. The Annual Enrollment Period runs Oct 15 – Dec 7 each year for plan changes.

If you or your spouse are actively working and covered by employer insurance, you may be able to delay Medicare Part B without penalty. When you eventually retire, you'll have a Special Enrollment Period (SEP) of 8 months to enroll. Critically, Medicare looks back to age 65 for continuous coverage — any gap longer than 63 days can trigger a permanent penalty.

Creditable coverage is employer-sponsored or other qualifying health insurance that is at least as good as Medicare. Having creditable coverage lets you delay Medicare enrollment without penalty. When you leave that coverage, you must notify Medicare and provide proof — this is the 8-month window that triggers your Special Enrollment Period.

If you delay Part B because you are working, Medicare looks back to the day you turned 65 to verify you had continuous coverage. Any gap in coverage longer than 63 consecutive days could trigger a permanent penalty of 10% per 12-month period without coverage. This is a common mistake Mary helps clients avoid.

No. You can change Medicare plans during any allowed enrollment period (Annual Enrollment, Open Enrollment, or a qualifying SEP) without any financial penalty from the government or insurance carriers. In fact, Mary recommends reviewing your plan every year during Annual Enrollment to ensure you're still in the most competitive option.

Not if we do our homework first. Before recommending any Medicare Advantage plan, Mary verifies that your specific primary care physician, specialists, and preferred hospital are included in that plan's network. For Medigap (Supplement) plans, you can see any doctor in the USA who accepts Medicare — no network restrictions.

No. It is illegal for anyone to sell you a Medigap policy if they know you have a Medicare Advantage plan. The two are mutually exclusive — you must choose one path or the other. Medigap supplements Original Medicare; Advantage replaces it.

Both are popular Medigap plans. Plan G is more comprehensive — it covers everything after Medicare except the Part B deductible, including Part B excess charges. Plan N has lower monthly premiums but charges a $20 copay for office visits, a $50 copay for ER visits, and does NOT cover Part B excess charges. The right choice depends on how often you visit doctors and whether your providers accept Medicare assignment.

MOOP stands for Maximum Out-of-Pocket. Every Medicare Advantage plan has an annual cap on what you'll spend on covered services. Once you reach this limit, the plan pays 100% for the rest of the year. This is a significant protection that Original Medicare alone does not provide. MOOP limits vary by plan — Mary compares them when analyzing options for you.

If you enrolled in a Medicare Advantage plan for the first time and decide within 12 months that you want to switch to Original Medicare + Medigap, you have a Trial Right. This gives you a guaranteed issue right to buy a Medigap policy — meaning the insurer cannot deny you or charge you more due to pre-existing conditions. This is a one-time protection.

Outside of guaranteed issue periods, yes — Medigap insurers in Arizona can use medical underwriting and may deny coverage or charge higher premiums based on your health history. This is why it's important to enroll during your Medigap Open Enrollment Period (the 6 months starting when you're 65+ and enrolled in Part B), when you have guaranteed issue rights and cannot be denied.

Starting in 2026, the most you will pay for covered prescription drugs in a calendar year is capped at $2,000. The "Donut Hole" (Coverage Gap) phase has been officially eliminated. This is a major benefit for anyone taking high-cost specialty medications.

The Donut Hole was a coverage gap phase where you paid a higher share of drug costs after reaching a spending threshold. Thanks to the Inflation Reduction Act, the Donut Hole is being phased out and is replaced by the new $2,000 annual out-of-pocket cap in 2026. This is great news for anyone with expensive medications.

Part D plans group drugs into tiers with different cost-sharing levels. Tier 1 typically includes low-cost generic drugs (very small copay). Tier 5 includes high-cost "specialty" drugs with the highest cost-sharing. Mary analyzes your specific medication list to find the plan where your drugs fall into the lowest possible tiers.

It depends on your plan type. If you have a Medicare Advantage plan with drug coverage (MAPD), your medical and drug benefits are on one card. If you have a Medigap (Supplement) plan, you'll need a standalone Part D plan and will have a separate drug card. Mary clarifies which setup applies to your chosen plan before enrollment.

Original Medicare (Parts A & B) does NOT cover routine dental, vision, or hearing. However, many Medicare Advantage plans bundle these benefits at no extra cost. If dental/vision/hearing coverage is important to you, Mary can find Advantage plans in your area that include them.

Yes. Under Part B, most preventive vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) — including the flu shot, COVID-19 vaccine, and shingles vaccine (Shingrix) — are now $0 copay for Medicare beneficiaries when received from a participating provider.

No. With a Medigap (Supplement) plan, you can go directly to any specialist in the USA who accepts Medicare patients — no referral, no gatekeeper, no prior authorization required. This is one of the key advantages of Medigap over Medicare Advantage HMO plans.

Medicare covers skilled nursing care for short-term recovery (up to 100 days after a qualifying hospital stay). However, it does NOT cover custodial care — long-term nursing home stays for help with daily living activities. For long-term care, you would need a Long-Term Care insurance policy or Medicaid (AHCCCS in Arizona).

No. SilverSneakers is a fitness benefit offered by many — but not all — Medicare Advantage plans. It is not included in Original Medicare or Medigap plans. If SilverSneakers access is important to you, Mary can identify Advantage plans in your area that include it.

An excess charge occurs when a doctor does not accept Medicare assignment — meaning they charge more than the Medicare-approved amount. Medicare allows providers to charge up to 15% above the approved rate. Plan G covers these excess charges; Plan N does not. In Arizona, most doctors accept Medicare assignment, but it's worth verifying for specialists.

Medigap plans are portable nationwide — you can see any doctor who accepts Medicare anywhere in the U.S. Advantage plans are ZIP-code specific — they operate within local service areas. If you move, you typically trigger a Special Enrollment Period (SEP) to pick a new Advantage plan in your new ZIP code.

Mary specializes in the Medicare side of dual-eligible coordination and provides resources and guidance to help you navigate the AHCCCS eligibility office here in Arizona. She can identify if you qualify for a D-SNP plan that coordinates both benefits — reducing your costs and simplifying your coverage.

This is rare but happens. In most cases, you must wait until the next Annual Enrollment Period (Oct 15–Dec 7) to change plans, unless the carrier or provider network undergoes a significant contractual change that qualifies as a Special Enrollment Period trigger. Mary monitors these situations for her clients and notifies you if action is needed.