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Medicare Resources
The penalties, the programs, the gaps, and the jargon. Everything here is free to read and free to ask us about.
Avoidable mistakes
The two penalties that last forever
These are added to your premium permanently. Not for a year — permanently.
Part B late penalty
10% added for every full 12 months you could have had Part B and didn't. It never goes away, and it grows as the standard premium grows. Delay four years and you're paying 40% extra for the rest of your life.
Part D late penalty
1% of the national base premium for every month you went without creditable drug coverage. Small-sounding, but it compounds over years and follows you between plans.
How to avoid both: either enroll on time, or keep coverage that counts as creditable and get that in writing from your employer. Verbal reassurance from a benefits desk is not a defense when the bill arrives.
Higher earners
IRMAA, and how to fight it
If your income is above a set threshold, you pay a surcharge on Parts B and D. The frustrating part is the timing.
- It looks back two yearsYour 2026 surcharge is based on your 2024 tax return. Sell a house or take a large distribution, and the bill arrives two years later.
- It's a cliff, not a slopeOne dollar over a threshold moves you into the next bracket entirely. Planning around the edges is worth real money.
- You can appeal itIf your income dropped because of a life-changing event — retirement, losing a job, divorce, death of a spouse — file Form SSA-44 with Social Security.
If money is tight
Programs most people never hear about
Many people qualify for these and never apply, usually because nobody mentioned them. We check for free, whether or not you buy anything.
Extra Help
Also called the Low Income Subsidy. Cuts prescription costs dramatically for people under certain income and asset limits.
Medicare Savings Programs
State programs that can pay your Part B premium, and sometimes deductibles and coinsurance. Income limits vary by state.
Medicaid
For those who qualify, it works alongside Medicare and often opens the door to a D-SNP with very low out-of-pocket costs.
Your local SHIP
Every state has a free State Health Insurance Assistance Program offering unbiased counseling. We'll point you there if it serves you better than we can.
The gaps
What Medicare doesn't pay for
Even with a good supplement, these sit outside the system. Knowing that in advance beats finding out at the counter.
- Long-term custodial careThe biggest gap by far. Medicare covers short-term skilled nursing after a qualifying hospital stay, not ongoing help with daily living.
- Most dental, vision, and hearingRoutine cleanings, glasses, and hearing aids. Some Advantage plans include limited benefits; standalone policies are another route.
- Routine foot careUnless it's tied to a covered condition such as diabetes.
- Care outside the United StatesWith narrow exceptions. Some supplements include limited foreign travel emergency coverage.
Every fall
Five things to check before December 7
- 1. Read the notice of changeYour plan mails it in September. It lists every change coming in January.
- 2. Re-check your doctorsNetworks change every year. Confirm each one, by name, for the coming plan year.
- 3. Re-price your prescriptionsDrug lists and tiers change. Last year's cheapest plan is often not this year's.
- 4. Look at the out-of-pocket maximumNot just the premium. This is the number that matters in a bad year.
- 5. Ask whether anything in your life changedNew diagnosis, a move, a spouse retiring, a big income change. Any of these can change the right answer.
Translation
Medicare jargon, in English
Straight answers
Questions we get every day
What does this cost me?
Nothing. The advice, the comparison, the enrollment, and the years of help afterward are free. Your premium doesn't change by a penny because you used us.
Are you part of Medicare or the government?
No. We're an independent licensed agency, not connected with or endorsed by the U.S. government or the federal Medicare program. You can always go to Medicare.gov or call 1-800-MEDICARE.
Do you show me every plan that exists?
Honestly, no agency can — anyone who claims otherwise is stretching it. We show you everything we can offer where you live, including the plans we earn less on. If the right plan isn't one of ours, we'll point you to Medicare.gov.
How do you get paid, exactly?
The insurance company pays us a commission that's already built into the plan's price. It's set by the carrier and, for Advantage and drug plans, capped by Medicare. You pay the same premium either way.
Will I get sales calls afterward?
No. We don't sell, rent, or share your information. You'll hear from your advisor and no one else.
What if I have a problem with a claim later?
Call us before you call the insurance company. Sorting out billing errors and denied claims is part of what we do, for as long as you have the plan, at no charge.
Now let's apply this to you.
Your doctors, your prescriptions, your zip code. Twenty minutes on the phone and you'll know where you stand.