Medicare 101 – The Basics

What is Medicare:  Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare is divided into four parts A, B, C & D.

Click here to learn more about the different parts.

Who is eligible?

You are eligible for Medicare if:

  • You are 65 or older
  • You are under 65 and have certain disabilities
  • You have End-Stage Renal Disease, which is permanent kidney failure that requires dialysis or a kidney transplant

What does Medicare cost?

Part A is free and Part B can be too if you qualify.  In most cases, you’ll automatically get Part A and Part B starting the first day of the month you turn 65 if you are already getting Social Security benefits.

If you don’t get Social Security benefits and you are 65 or older, you’ll have to sign up for Part A and Part B.  To sign up, call Social Security at (800) 772-1213.

To find out more about qualifications, click here.

What does Medicare cover: 

There are four parts to Medicare. They are:

Medicare Part A is Hospital Insurance and it:

  • Helps cover inpatient care in hospitals (room cost, hospital meals and supplies), including critical access hospitals, and skilled nursing facilities.  It does not cover custodial or long-term care.
  • Helps cover hospice care and some home health care You must meet certain conditions to get these benefits.
  • There is a $1,288 deductible for Part A, but once met, days 1-60 of hospitalization are covered 100%. After 60 days, you must pay a daily amount set by Medicare.  You can read more about the 2016 costs here.

Medicare Part B is Medical Insurance and it:

  • Helps cover doctors’ services, hospital outpatient care, and home health care.
  • Helps cover tests, shots and some preventive services to maintain your health and to keep certain illnesses from getting worse (flu shots, PAP tests).
  • There is monthly premium of $121.80, and a $166 annual deductible. Once the deductible is met, Part B generally pays 80 percent of the Medicare-approved amount for covered services, which means you pay 20 percent.

Part A and Part B together are commonly referred to as “Original Medicare”. Original Medicare is offered by the government, and again, in most cases you’ll automatically get Part A and Part B starting the first day of the month you turn 65 if you are already getting Social Security benefits.

Medicare Part C is Medicare Advantage Plans

Instead of getting Medicare Part A and Part B, you have a choice and you can purchase a Medicare Advantage Plan (also called “Part C”).  Medicare Advantage Plans are health plans run by Medicare-approved private insurance companies, and have different rules and costs, but offer at least the same benefits of Medicare Part A and Part B, and in some cases, offer more benefits such as a prescription drug plan.

Why would someone opt to buy a Medicare Advantage Plan over getting Medicare Part A & Part B?

When it comes to Medicare the decision is yours however, you may want to get a Medicare Advantage Plan instead of Original Medicare if:

  • You take prescription drugs. With a few exceptions, most prescriptions aren’t covered in Original Medicare. Many Medicare Advantage Plans include prescription drug coverage.
  • You want a cap on your out-of-pocket health spending. Original Medicare has no out-of-pocket maximum. You keep paying a portion of the cost of services as you use them. Medicare Advantage plans, by law, have an out-of-pocket maximum of no more than $6,700 per year. Once you hit that limit, the plan pays for all covered expenses.
  • You want an alternative to the 20-percent coinsurance charged by Original Medicare for most services. Medicare Advantage plans structure costs differently and may offer a lower (or higher) coinsurance, or may charge copays instead – which are fixed costs you pay for services. A trade-off could be a higher monthly premium.
  • You want coverage for vision and dental. Original Medicare doesn’t cover these services. Certain Medicare Advantage plans do.
  • To find Medicare Advantage plans in your area, click here.

Medicare Part D is Prescription Drug Coverage

There are two ways to get prescription drug coverage through Medicare – either as an add on known as Medicare Part D to your Original Medicare Plan (Part A and Part B), or as part of your Medicare Advantage Plan (Part C). There are several different Part D plans offered, and they vary in cost and medications covered. Also note that Medicare Part D is provided by private insurance companies that have contracts with the government, unlike Medicare Part A and Part B, which is provided directly by the government.

Each Medicare Prescription Drug Plan has its own list of covered drugs. Many Medicare drug plans classify drugs by tiers and each tier has a different cost associated with it. Before you choose a Prescription Drug plan, it’s best to look at the plan’s list of drugs to see if your medication(s) is covered, and how much it will cost.

To find out more about Part D coverage, click here.

What is Medicare Supplement Insurance (also known as Medigap)?

A Medicare Supplement Insurance (Medigap) policy is sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, such as copayments and deductibles.  Medicare Supplement policies fill in the gap between what Original Medicare covers and what it doesn’t. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. A Medicare Advantage Plan is a way to get Medicare benefits. A Medigap plan simply supplements your existing Original Medicare coverage.  Medigap plans differ in price and coverage.

How can I find out more about Medicare and have my questions answered?

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Money-Saving Tips for Part D Drug Plans

Prescription drugs can take a big bite out of your budget.  Medicare prescription drug plans may offer cost-saving benefits that you may not be aware of.  It’s wise to talk to your agent or broker about how your plan works and how you can maximize the savings.  Knowing some of these insider tips could save you a lot of money.   Read on…

How to Get Discounts on Medicare Prescription Drugs

  • Prescription Drug Discount Program – Your Medicare Part D or Medicare Advantage plan might offer a prescription drug discount program. This could be a separate program from your plan benefits or it might be included in your membership.  Check your plan information or call your plan’s customer service number to find out more.
  • Pharmacy Discount Programs – Some pharmacies offer discount programs to regular customers.  Talk to your pharmacist and ask if they have a program you might qualify for.  Talk with your Part D or Medicare Advantage plan about how a pharmacy discount card might work with your plan benefits.
  • Prescription Discount Cards – Prescription discount cards are available through some companies and organizations. You can check online or ask your pharmacist for prescription discount cards that may be available to you. You may want to check with your Medicare Part D or Medicare Advantage plan to learn how a discount card might work with your plan benefits.
  • Pharmaceutical Assistance Programs – Many drug companies have programs that offer discounts on the brand-name drugs they make.  You can learn about programs by calling the company that makes your drug.  You may also visit’s PAP page and look up your drug to see if there are programs available.  Many doctor’s offices have staff members who can help patients find these programs so ask your doctor for help.

How to Save Money with Your Medicare Drug Plan

  • Pick a Network Pharmacy – Your Medicare prescription drug plans may have a pharmacy network.  This is a group of pharmacies that offer extra savings and discounts to plan members.  Your plan might also have a special arrangement with certain “preferred” pharmacies that could mean additional savings.  Check your plan materials or call a plan representative for information about network pharmacies.  Some plans offer $0 co-pays on generic drugs at these “preferred” pharmacies so it worth asking!
  • Follow the Formulary – Your Medicare prescription drug plan probably has a formulary that lists the drugs it will cover.  Drugs on your plan’s formulary list cost you less than drugs not on the list.  Many formularies have tiers which divide drugs into groups based mostly on cost.  Usually, the lower the tier, the lower your co-pay may be.  You might be able to switch from a high-tier drug to one on a lower tier to help lower your costs.  Ask your doctor if this is an option for you.
  • Request an Exception – Your Medicare prescription drug plan can make exceptions so it sometimes pays to ask.   They can change your drug from a higher tier to a lower tier to help with your costs.   Check with your Medicare Part D or Medicare Advantage plan to learn how to request an exception.
  • Give Generics a Chance – Generic drugs are the same as brand-name drugs in safety, strength, quality and how they work.  They usually cost less, too!   The lower cost of generic drugs could help you avoid the Medicare Part D coverage gap or pay less when you’re in it.  Ask your doctor if this is an option for you.
  • Give Mail-Order a Try – Many Medicare Advantage and Medicare Part D plans offer a mail-order pharmacy service. Co-pays may be much lower than getting refills at the pharmacy. You may save even more by ordering a 90-day supply of your drugs at one time.

Review Your Medicare Drug Plan Each Year

  • Annual Open Enrollment Period – Each year both Part D Prescription Drug Plans and Medicare Advantage Plans change.  Sometimes they remove or add drugs from the formulary or move a drug from one tier to another – changing your cost at the pharmacy.  The Annual Open Enrollment Period runs from October 15th to December 7th Medicare allows you an opportunity to review other plans that are available to make sure each year you have the best coverage possible.   This is where the expertise of an insurance agent like myself  can be really beneficial.  You can call me and I’ll check all your medications against the plans available and tell you which ones will save you the most.   To do this yourself you can use the planfinder tool on or for the same cost (zero!) you can call me and I’ll help you.  🙂

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Medicare Enrollment – Timing

How to Correctly Plan Your Enrollment

Most people getting close to retirement know that Medicare coverage starts when you turn 65.  But that’s not the whole story. If you want to enroll in Medicare without hassles and costly penalties, you need to know exactly when to sign up for the program you want. There are different enrollment periods, so it’s trickier than you might think.

   …it’s trickier than you might think.

Not everyone needs to sign up at age 65. You may still be covered by your employer’s health care plan, for example, or if you are eligible for Medicare due to a disability, you can actually sign up earlier.

Initial Enrollment Window

Medicare has established a seven-month Initial Enrollment Period, which includes the three months before you turn 65, your birthday month, and the three months afterward. This window applies to all forms of Medicare—Part A (hospital), Part B (doctor and outpatient), Part C (Medicare Advantage), and Part D (prescription drugs).

Medicare Supplement (Medigap) Enrollment

There is a separate six-month open enrollment period for Medicare Supplement policies (also called Medigap), which begins when you’ve turned 65 and are enrolled in Part B. During this period, insurers must sell you any Medigap policy they offer, and they can’t charge you more because of your age or health condition. This guaranteed enrollment period may be crucial because if you miss this window and try to buy a Medigap policy later, insurers may not be obligated to sell you a policy and may be able to charge you more money.

General Enrollment

If you missed enrolling in Part A or B during the Initial Enrollment Period, there is also a General Enrollment Period from January 1 through March 31 each year. Waiting until this period could, however, trigger lifetime premium surcharges for late Part B enrollment, which can end up costing you thousands of dollars more. Also your coverage won’t begin until July!
Part D drug coverage may not be something you need when you first retire.  But if you don’t sign up for it when you are first eligible, and later decide you want it, you will face potentially premium penalties (surcharges).  For example, if you missed enrolling during your initial enrollment period and then bought a policy, a premium surcharge would later take effect if you were without Part D coverage for 63 days.  And this surcharge is added to your premium for the rest of the time you have a Part D plan.

Special Enrollment Periods

There are lots of special conditions that can expand your penalty-free options for when you sign up for Medicare. And there also are what’s called Special Enrollment Periods for people who’ve moved, lost their employer group coverage or face other special circumstances. These special periods may have enrollment windows that differ in length from the standard ones.

If you’re turning 65 and still working click here to learn more.

Would you like my help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Low Cost Insulin Alternatives

Medicare Part B covers some diabetes supplies, including:

  • Blood sugar (glucose) test strips
  • Blood sugar testing monitors
  • Insulin
  • Lancet devices and lancets
  • Glucose control solutions  
  • Therapeutic shoes or inserts

Note:  You may need to use specific suppliers for some types of diabetic testing supplies.

If you’re diabetic then you know how expensive it can be. 

While Medicare provides testing supplies to monitor your blood glucose levels at no cost the drugs to treat diabetes are covered under Part D so there is a cost associated with these medications.   Insulin and the syringes to administer self-injections are very expensive and often times can contribute to you entering the “donut hole” which means these drugs get even more expensive.


If you find yourself unable to afford your insulin or syringes or if you do not have Medicare yet here are some tips on how to get what you need.

Blood Glucose Test Strips

If you don’t have insurance or Medicare, test strips are obscenely expensive and the cost seems to be getting worse every month. Still, used properly they can be the most powerful tool you have in the battle to avoid high blood sugar levels and the damage that can cause.

The ReliOn brand meters and strips sold at Walmart are much cheaper than the name brand strips. Currently you can get a box of 50 test strips for about $9.00. (

Type 2 Diabetes Drugs

With most pharmacies and supermarkets selling generic drugs for $4 per prescription, you can afford these effective diabetes drugs.

The most prescribed drug for people with Type 2 diabetes is Metformin. Plain Metformin and Metformin ER, the extended release form that is easier on the stomach, are both available as generics. Some generic brands appear to be stronger than others, so if you aren’t happy with the results you are getting with one brand, ask the pharmacist to try another, or if that isn’t a possibility, switch your prescription to another pharmacy that dispenses a different generic brand. The pharmacist will tell you which brand they dispense if you ask.


Analog insulins which most doctors prescribe are very expensive. The ones I see prescribed most often are Lantus, Levemir, Humalog, and Novolog. Fortunately there are other insulins that are much cheaper which you may be able to use instead. These cheap insulins are sold at Walmart under the ReliOn brand name.  Currently a vial of ReliOn Novolin is $24.88. (

The pharmacy at Walmart also has a 100 count box of syringes for $12.58. ( as well as a 50 count box of Pen Needles for $9.00 (


CAUTION:  Always consult with your doctor before switching medications.

Ken Inchausti, director of media relations, communications and public affairs for Novo Nordisk, Inc., which is the maker of Novolog warns, “There are going to be some distinctions,” he says. “… You can have variations in terms of, one NPH is constructed this way, one NPH is constructed another way.”

Most doctors recommend any time you are switching medications in any situation, it requires delicate and close monitoring and care to make sure you will have a consistent outcome. Always consult with your doctor before switching medications.

The patient information sheet for Humulin states in bold capital letters: “Any change in insulin should be made cautiously and only under medical supervision. Changes in strength, manufacturer, type (e.g., regular, NPH, analog), species or method of manufacture may result in the need for a change in dosage.”  Likewise, printed on the Novolin box is the warning: “Any change in insulin should be made cautiously and only under medical supervision.”  The same warning appears on the website for ReliOn.

What if the cheap insulin is not for you?

If these cheaper insulins are not an option for you for whatever reason, ask your doctor to file the paperwork to get insulin via one of the hardship programs that help people who are insulin dependent. If he cannot or will not, call the largest regional hospital in your area and ask to speak to a social worker about how to sign up for one of these programs.

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or go to the CONTACT page of this site to send an email message to me.  

Call me today and I will explain all your options and help you understand those options so you can get the coverage you need for the most affordable price.

Call me today at (207) 370-0143 or toll free at (866) 976-9038.


When and How to Enroll in Medicare

It’s always best to start early because the rules and deadlines for Medicare enrollment can be confusing. Here’s what you need to know…
Firstly, Medicare has two parts: Part A, which is your hospital coverage and has no monthly premium for most people, and Part B which is your Medical coverage (doctor’s visits and other medical services).  Part B costs $104.90 per month for most enrollees in 2015.

When to Enroll in Medicare

Everyone is eligible for Medicare at age 65, even if your full Social Security retirement age is 66 or later.
You can enroll any time during the Initial Enrollment Period (IEP), which is a seven-month period which starts three months before your 65th birth month, includes the month of your birth and three months after. It is a good idea to enroll when you are first eligible (three months before your birth month) to make sure your coverage starts when you turn 65.
If you miss this seven-month sign-up period, you will have to wait until the next “General Enrollment” which starts each year on January 1st and runs through March 31.  Your Medicare benefits will begin the following July 1st. You also might incur a 10% penalty for each year you wait beyond your initial enrollment period, which will increase to your monthly Part B premium by the penalty amount.

Still Working and Have Employer Insurance?

If you are eligible for Medicare and still working then you may have an exception to the penalty. If you have group health insurance coverage through your employer or your spouse’s employer, and the company has 20 or more employees, you have a “special enrollment period” in which you can sign up. This means that you can delay enrolling in Medicare Part B, and are not subject to the 10 percent late-enrollment penalty as long as you sign up for within eight months of losing that coverage.  This would generally happen when either you or your spouse eventually retire.

Part D Drug Coverage

Original Medicare does not cover prescription medications, so if you don’t have creditable drug coverage from an employer or union, you’ll need to buy a Part D drug plan from a private insurance company during your initial enrollment if you want coverage. Some health plans include drug coverage and some do not.  You will want to compare each of your options carefully because drug prices and co-pays can vary between different companies.  If you don’t enroll in a Part D prescription drug plan when you are eligible you’ll also have a penalty.  This is 1 percent of the average national premium ($33.13 in 2015) for every month you don’t have coverage and will also be added to your monthly premium at the time you enroll in a plan.   So, even if you do not take any medications it is wise to consider the plans available weigh the costs of the plan with the eventual penalty you may incur.

Medicare Supplements

When you enroll in Medicare it is also a good idea to get a Medigap (Medicare supplemental) policy within six months after enrolling in Part B to help pay for things that aren’t covered by Medicare, such as co-payments, co-insurance and deductibles. 

“All-In-One” Plans

Instead of getting original Medicare, plus a stand-alone Part D drug plan and a Medigap policy, you could sign up for a Medicare Advantage plan that covers everything in one plan. These plans, which are also sold by insurance companies, are generally available through HMOs and PPOs and often have cheaper monthly premiums, but their deductibles and co-pays are usually higher which makes them better suited for healthier retirees.

How to Enroll

If you’re already receiving your Social Security benefits before 65, you will automatically be enrolled in Part A and Part B, and you’ll receive your Medicare card about three months before your 65th birthday. It will include instructions to return it if you have group health coverage through an employer that qualifies you for late enrollment without a penalty.  If you’re not receiving Social Security, you’ll need to enroll either online at, over the phone by calling Social Security Administration 800-772-1213 or through your local Social Security office.

Help is Available!

Finding a trusted source for help can be frustrating, with all the “noise” generated from mailers, TV ads and radio spots. My name is Todd Reagin, a Licensed Insurance Agent specializing in Medicare plans for residents of Maine and New Hampshire. I actually qualify as a Broker because I’m independent, and I represent the top Medicare insurance plans in Maine and New Hampshire.  
If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or go to the CONTACT ME page of this site to send an email message to me.  

Best Part: It Will Cost You NOTHING!

The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans when we meet.  Everyone needs help because there are so many different plans to choose from and I want to help.  I have found great joy in being able to offer my services to people who want my help.
Book an appointment with Maine Medicare Options using SetMore

Call me today and I will explain all your options and help you understand your options so you can choose the coverage you need for a price you can afford.

Call me today at (207) 370-0143 

or toll free at (866) 976-9038.  

Call right now. I’m waiting! 🙂



Turning 65 and still working?

Should I apply for Medicare even though I have insurance at work?

Yes.  If you’re not retiring and you are continuing to work then you may want to consider enrolling in Medicare Part A and delaying Part B until you retire and leave your employer sponsored health insurance plan.  Even if you’re not receiving Social Security benefits at age 65, you’re still eligible for full Medicare benefits. This includes the Part A (hospitalization), as well as Part B (doctors’ visits and outpatient care) and Part D (prescription drugs); you pay a premium for each.  But if you are not collecting social security benefits then it’s up to you to contact Social Security to sign up for Medicare only.  You must do this within your “initial enrollment period.” This period starts three months BEFORE the month you turn 65, includes the month you turn 65 and continues three months AFTER that — a seven-month period.

Do you have an HSA?

If you enroll in Medicare Part A and/or B you can no longer contribute to your Health Savings Account (HSA). Whether you should delay enrollment in Medicare so you can continue contributing to your HSA depends on your circumstances. Carefully weigh the savings of enrolling in Medicare against the advantages of continuing to save money in a tax-free HSA.

You don’t have to enroll in all parts of Medicare.

Only the parts you need.

In a situation where you are still working at age 65 and have health insurance through your employer you don’t have to enroll in all parts of Medicare until you retire. If you have creditable insurance coverage through an employer plan, you can apply for Part A only. Part A might help pay for some of the costs not covered by your group plan such as your deductible if you go into the hospital for a surgery or if you need to stay in a skilled nursing facility.  And as long as you have group coverage, you won’t be penalized for delaying Part B or Part D (Medicare Prescription Drug Coverage). When your employment or group coverage ends, you then have eight months in which to sign up for Part B and enroll in a Medicare Supplement or a Medicare Advantage plan.  This is where I come in!   There are a lot of different plans available and finding a plan that covers your doctors and your specific medications at the best price is what I do best.  I’ve helped hundreds of people find the right plan and saved THOUSANDS in the process.
Your decision to enroll in Medicare Part B if you are still working is really a cost/value decision. The standard monthly premium for Part B is $121.80 in 2016. Where as Part A in most cases has no monthly premium.  So your decision to enroll in Part B while you’re still working might depend on how much money you’re making and what your current costs are with your employer health insurance plan.  You also need to consider what you’re getting. If you work for a company with 20 or more employees, your group health plan is still the primary payer of your medical bills, making your Medicare benefits of limited value. However, if your company has fewer than 20 employees, Medicare would be the primary payer and your company’s plan the secondary payer. In this case, it’s best to talk to your employee benefits administrator to see how Medicare would work with your insurance.  The Part B coverage may well be worth the monthly premium.

What if I retire and then go back to work?

It’s not unheard of for insurance needs to change as people move in and out of the work force. So what happens if you retire, enroll in Part B and then find yourself back at work with employer coverage once again?
 In this situation, you can drop Part B while working and re-enroll at any time while you have group coverage or during the eight months after your employer coverage ends, without risk of penalty or higher premiums.


For now, I suggest you mark the dates of your initial enrollment period on your calendar.

Then when the time comes, call the Social Security Administration at 800-772-1213 to sign up for Medicare Part A and/or Part B.  You can also go to for more information.
No matter how long you choose to work, there’s no reason not to take advantage of the benefits you’ve earned.  Keep in mind, this information is no substitute for an individualized consultation. You can Contact Me to schedule an appointment and we can sit down and talk about your individual needs and answer any of your questions. There is no cost or obligation to talk or meet with me.  I would be glad to talk to you and answer questions about your options.  You can reach me toll free at (866) 976-9038 or CLICK HERE if you would prefer e-mail.  I am looking forward to answering your questions and helping you get the coverage that you need.

-Todd 🙂


Missed the deadline? You have options!

Did you Miss the December 7th Medicare Annual Open Enrollment Deadline?

Don’t worry, you still have options!

Special Enrollment Periods (or SEPs) allow you to change to another Medicare Part D Prescription Drug or Medicare Part C Advantage plan outside of the annual Open Enrollment Period (from October 15th to December 7th).  SEPs are only granted for specific reasons (such as when you move outside of your plan’s service area, qualify for low income assistance in your state or a plethora of other reasons)

One Special Enrollment Period that is available is the 5-star SEP.

If a plan is available in your area, you can use the 5-star Special Enrollment Period for a once-a-year opportunity to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating.  The 5-star SEP is available to you at any time during the plan year.  So, if you discover that your plan has changed significantly in January, you are not stuck with it until next year.  You can change plans today.

Who is eligible for this SEP?

  • Beneficiaries currently enrolled any MA, MAPD or PDP plan (including those that already have a 5-star rating)
  • Beneficiaries who are enrolled in Original Medicare and meet the eligibility requirements for Medicare Advantage
Effective dates for enrollments made under the 5-star SEP will be the first of the month following the month the enrollment request is received.  Once you enroll in a 5-star plan using this SEP, the individual’s SEP ends for that plan year and the individual will be limited to making changes only during other applicable election periods.  To summarize, the 5-star rating SEP can only be used one time during the plan year. 
For more information you can visit the official Medicare website at

Please call today while your questions are fresh in your mind.  There will never be any cost to you for my assistance or for a friendly, no-obligation chat.


You can reach me toll free at (866) 976-9038 or

CLICK HERE if you would prefer e-mail.  I am looking forward to helping you move to a better plan to get the coverage that you need.

Will your Drugs cost more in 2015?

If you’re currently enrolled in Medicare, what you do or don’t do over the next few weeks could determine whether you can get the best, most affordable coverage next year.  Hear’s why:

Medicare Part D prescription plans frequently change premiums, drug formularies, deductibles and co-payment amounts for specific drugs from year to year.  Medicare Advantage plans often make similar changes; plus doctors, hospitals and pharmacies may drop out of their preferred provider networks.

Thus, by simply choosing the same options for 2015 without investigating alternatives, you could wind up paying hundreds or thousands of dollars more for similar healthcare services.

Medicare’s annual election period ends Dec. 7. 

For most people, this is the best — and sometimes only — opportunity to make coverage changes. (Exceptions are made for people who qualify for special enrollment periods.)

If you already have traditional Medicare Parts A and B and a Medigap plan, you don’t need to make any changes; however, if you also have a Part D plan, you must either accept your current plan’s changes or choose another plan.

When choosing next year’s Part D plan:

  • Carefully review your plan’s “Annual Notice of Change” for any changes to premiums, deductibles, co-payments, covered drugs, participating pharmacies, etc.
  • Notice whether they’ve changed co-payments or co-insurance for your medications or possibly dropped some altogether.  (Yes, this does happen!) Ask your doctor whether comparable, covered drugs will work; otherwise you could pay much more next year.
  • Even if your plan hasn’t changed substantially, it’s still wise to sit down with someone like myself who can help you compare all available plans.  Each year I am trained and tested on the new plans by each of the insurance companies and I have the experience and knowledge to help you make the best choice.

IMPORTANT NOTE:  The lowest monthly premium may not be your best bet — sometimes plans with higher monthly premiums have a lower overall cost due to their more favorable deductible, co-payment and coinsurance amounts.  Also each company negotiates individual drug prices so a drug that costs $400 per month with one company may put you in the Coverage gap sooner than one that only costs $80 with another company.  This is an important piece of your plan review.

Medicare Advantage plans are HMO or PPO type Managed care plans.  They are alternatives to Traditional Medicare Parts A and B with a Medigap Supplement. Most cover drugs and some include extra benefits like vision and dental coverage or reimbursement for gym memberships.  They usually have lower deductibles and co-payments but require you to use the plan’s provider network.

If your Part C, Medicare Advantage plan includes drug coverage you should also carefully review the “Annual Notice of Change” from your plan for any changes that could cost you more money in 2015.

Bottom line: Reviewing your Medicare options each year is complicated and time-consuming.  But if you don’t and your plans change significantly, it could cost you a bundle next year.  

Call Todd today for a no-cost plan review, toll free: (866) 976-9038


When do I enroll in Medicare?

When you're approaching age 65, it's important to thoroughly research the benefits and costs of each different Medicare insurance plan in your area.  But it's even more important to make sure you enroll at the right time.

Missing an enrollment date could cost you higher premiums down the line or it could cost you coverage entirely. 

If you are already receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare you won't have to worry about your enrollment date, since the government automatically enrolls you in both Part A and Part B at age 65. (Three months prior to your 65th birthday, your Medicare card will arrive in the mail.) Your only concern of timing would be if you declined Medicare Part B (and missed the initial enrollment window). If you do decline Part B, you will pay higher Part B premiums if you enroll later on. For each year that you don't enroll your premium will be 10 percent higher, unless you're insured by an employer-sponsored health insurance through either you or your spouse. 

If you are not receiving Social Security or Railroad Retirement Benefits when you become eligible for Medicare you won't be automatically enrolled in Original Medicare. Instead, you'll be able to enroll during one of three enrollment periods.

  • Initial Enrollment Period – a seven-month window of time that begins three months prior to the month of your 65th birthday. The date your Part B coverage starts depends upon how early in the IEP you enroll. If you wait until the last four months of the IEP, the start date of your coverage will be later.

  • General Enrollment Period – January 1 to March 31 of each year. Your coverage will begin on July 1 of the year you enroll.

  • Special Enrollment Period – You can wait to enroll in Part B and not incur a premium hike if you had coverage through your job or your spouse's job at the time you became eligible for Medicare. While you're still covered, you can enroll in Medicare at any time – and for another eight months after you lose your group coverage or you (or your spouse) stop working.

For more information about signing up in Parts A and B you can contact your local Social Security office or call 1-800-772-1213. If you would like to know more or talk about your options and what plans are available for you, call me at (207) 370-0143. There is never any cost or obligation to discuss your options.

Once you have enrolled in Parts A & B you may need to enroll in a Medicare Part D prescription drug plan – even if you do not take any medications!


With Medicare's prescription drug coverage, your first opportunity to enroll is when you're first eligible for Medicare (during the seven-month period beginning three months before your 65th birthday).  It's important to note that if you don't enroll during the seven-month period when you're first eligible, you may pay a late-enrollment penalty that will raise your Part D premium when you do decide to purchase coverage. 

During the Open Enrollment Period mentioned above, you can also enroll in a Medicare Part D plan, switch to another Part D plan or leave Part D entirely. Again, pay close attention to the dates as they affect your options.

  • Between October 15 and December 7 – You can join a Part D plan, switch between Part D plans or drop your Part D coverage.

  • Between January 1 and February 14 – You can leave Original Medicare for an Advantage plan that offers prescription drug coverage. You can not switch from one Part D plan to another.

There is still much more you should know but these are some important dates to keep in mind.  For more information about late enrollment penalties or to ask some specific questions you can call me anytime toll free at (866) 976-9038 or use my Contact Me form on this website to email me. 🙂


6 Reasons To Change Your Medicare Plan.

6 Reasons To Change Your Medicare Plan.


1. Has your health situation changed? 

Perhaps you have developed a health condition in the previous 12 months that requires a new prescription drug or ongoing visits to a specialist. It’s important to know whether the plan you have, or decide to purchase, covers these health needs.

2. Have you changed doctors?

Physicians may retire or relocate, and medical facilities may change their terms. A number of developments could lead your plans to no longer include the doctors you see or the medical center you visit. If your doctor is important to you, this is a good reason to study your options and possibly switch Medicare plans.

3. Has your coverage changed? 

Plans can alter the drugs, procedures and conditions they cover. For example, your prescription drug Part D plan may no longer cover the prescription drugs you need to purchase in the coming year, or put restrictions on how and where you purchase them. Questions about prescription drug costs are one of the top concerns I encounter.  This is especially critical for those who fall into the prescription drug donut hole.  The donut hole is the gap of coverage in which the individual pays a greater percentage of the drug cost.

4. Have your plan premiums, co-pays or deductibles increased? 

Price changes occur year to year, so examine the prices you have been paying and what you can expect to pay in the coming year. There may be alternative plans with lower costs available in your area that an experienced Agent like myself can help you review.

5. Have you moved or are you planning to move? 

It’s important to consider your Medicare plans when moving because you may leave the plan’s service area and be disenrolled or have new options available to you.

6. Has your current plan changed dramatically or will it no longer be available next year? 

In these instances, beneficiaries should take the time to talk with an agent to review their options. Sometimes plans are eliminated because the provider offers a similar plan, but it’s still important to compare that coverage to what you actually need in the coming year.

The Bottom Line.

It is always a good idea to call your agent and have a brief conversation to discuss how your current plan is meeting your needs.   If you are happy with your current plan and all your doctors and medications are covered by the plan that’s great.  But if a new doctor you want to see does not accept your plan or the plan will not pay for those visits or if you are prescribed a new medication that is not covered then you should most certainly check to see if there is another plan available that will give you the coverage you need.  Maine has a lot of Medicare Supplement and Medicare Advantage plans available to choose from.  I talk to every one of my clients each year to review any plan changes and to make sure they are receiving the coverage they need.
Each year, Medicare open enrollment brings with it changes that can affect you. The limited enrollment timeframe of just 54 days – Oct. 15 to Dec. 7 – gives all Medicare beneficiaries the opportunity to change their Medicare plans for the coming year to better match their needs and potentially save on health care costs. This includes anyone using original Medicare, Medicare Advantage or Part D prescription drug plans.
In the fall, Medicare participants receive their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their current Medicare Advantage and Part D providers. It’s important you read this information.  Take time to review your current health care needs, and then compare this to the plan’s coverage for the coming year.   Reviewing your Medicare plan options earlier rather than later will put you in a better position to make changes during the annual enrollment window.
I hope you found this information helpful.
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