If you continue working past age 65 and your employer has fewer than 20 employees, you must enroll in Medicare. Otherwise, your employer-sponsored insurance may deny your claims.

If your employer has 20 or more employees and provides coverage considered "creditable," you may choose to postpone enrolling in Medicare. You can then enroll whenever you decide to retire.

Upon retirement, your employer will complete a form verifying you had continuous creditable coverage after turning 65. You'll submit this form to the Social Security office to ensure you aren't charged any late-enrollment penalties.

In case you are worried about this advice, please reference this article on the Medicare.gov website. - https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65

Once you enroll in Medicare Part A and/or Part B, you are no longer eligible to make contributions to a Health Savings Account (HSA). Many individuals turning 65 opt to retain their employer-sponsored coverage and enroll in Medicare Part A—since it typically carries no premium—while delaying Part B. While this approach is generally acceptable, enrolling even in just Part A means you must stop contributing to your HSA. To remain eligible to contribute to your HSA, you must delay enrollment in both Part A and Part B entirely. However, caution is needed—when enrolling in Medicare after age 65, Social Security often backdates Part A enrollment by up to six months. If you've contributed to your HSA during that retroactive period, it could lead to tax complications.

Medicare costs vary depending on the specific coverage you choose and your income level.

Medicare Part A (Hospital Coverage): Most individuals qualify for premium-free Part A if they (or their spouse) have paid Medicare payroll taxes for at least 10 years (40 quarters). If not, Part A premiums can be as high as $518 per month in 2025.

Medicare Part B (Medical Coverage): The standard monthly premium for Part B in 2025 is $185. Higher-income individuals pay an additional premium known as the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA is determined by your Modified Adjusted Gross Income from two years prior (your 2023 tax return affects your 2025 premiums). The higher your income, the greater the IRMAA surcharge you'll pay above the standard premium.

Medicare Part D (Prescription Drug Coverage): Monthly premiums vary widely by the insurance provider and chosen plan. Like Part B, high-income earners also pay an IRMAA surcharge on Part D premiums, based on income from two years earlier.

Medicare Advantage (Part C): These plans typically bundle medical and prescription drug coverage and often include additional benefits. Monthly premiums vary significantly by location, plan provider, and benefits. Many plans feature low or even $0 monthly premiums.

Medicare Supplement (Medigap) Plans: Supplement premiums vary widely depending on the insurance company, the chosen plan type, your age, gender, tobacco use, and geographic location. Generally, monthly premiums range anywhere from approximately $100 to over $300 per month. Supplements help cover the costs that Original Medicare doesn't pay (like deductibles, coinsurance, and copayments), potentially reducing your out-of-pocket expenses significantly.

It's essential to review your income level and chosen coverage carefully to determine your exact Medicare costs and budget accordingly.

It depends on the type of Medicare coverage you select:

Original Medicare (Parts A & B): Original Medicare does not have an annual out-of-pocket maximum. Therefore, there's no limit on how much you might pay in medical expenses each year. To mitigate this risk, many people opt for a Medicare Supplement (Medigap) plan, which helps limit or cover these costs.

Medicare Advantage (Part C): Medicare Advantage plans are legally required to set an annual Maximum Out-of-Pocket (MOOP). For 2025, the highest allowable MOOP for in-network medical services is $9,350, although many plans offer significantly lower limits. After reaching this limit, the plan covers 100% of covered medical costs for the remainder of the year.

Medicare Part D (Prescription Drug Coverage): Beginning in 2025, Medicare Part D plans will have a newly established annual out-of-pocket maximum of $2,000 for prescription drug expenses. Once you reach this limit, you won't pay anything further for covered prescription medications for the remainder of that calendar year.

It's important to note that many Medicare Advantage (Part C) plans also include prescription drug coverage (Part D). In these cases, each portion (medical and prescription drugs) has its own separate maximum out-of-pocket limit. For example, in a Medicare Advantage plan that includes prescription coverage, it's possible you could reach both limits independently. The combined maximum amount you could pay out-of-pocket for medical and prescription expenses in a calendar year could total up to $11,350 in 2025 (the $9,350 medical maximum plus the $2,000 drug maximum allowed under combined Medicare Advantage plans).

Note: The combined maximum limit ($11,350) mentioned here includes the Part D maximum ($2,000) specifically allowed for Medicare Advantage plans (Part C with Part D), which slightly differs from the $2,000 Part D standalone limit.

Carefully reviewing these limits can help ensure your Medicare coverage adequately protects you financially, matching both your budget and healthcare needs.

Yes, Medicare fully covers pre-existing conditions. Original Medicare (Parts A and B) does not exclude coverage or impose waiting periods based on your health history or pre-existing medical conditions.

Additionally:

Medicare Advantage (Part C): Plans must also accept you regardless of pre-existing conditions, and you cannot be denied coverage or charged more because of them.

Medicare Supplement (Medigap): If you apply during your Medigap Open Enrollment Period (which starts the month you're 65 or older and enrolled in Medicare Part B and lasts for 6 months), you cannot be denied coverage or charged higher premiums due to pre-existing conditions. If you apply after this enrollment period, insurers might consider your health status and could apply waiting periods or higher premiums based on pre-existing conditions.

In short, Medicare provides comprehensive protection and coverage for your healthcare needs, regardless of your medical history.

No, you cannot have both a Medicare Advantage (Part C) plan and a Medigap (Medicare Supplement) plan at the same time.

Medicare Advantage plans are all-in-one alternatives to Original Medicare, often including hospital, medical, and sometimes prescription drug coverage. These plans are administered by private insurance companies and come with their own provider networks, copays, and out-of-pocket limits.

Medigap plans, on the other hand, are designed to work only with Original Medicare (Parts A & B)—not with Medicare Advantage. They help cover some or all of the out-of-pocket costs like deductibles, coinsurance, and copayments that Original Medicare doesn’t pay.

If you’re currently enrolled in a Medicare Advantage plan and decide to return to Original Medicare, you can apply for a Medigap (Medicare Supplement) plan. However, it’s important to understand that you may be subject to medical underwriting unless you qualify for a guaranteed issue right or are within a Medigap Open Enrollment Period.

This means that, depending on your health at the time of application, the insurance company may deny coverage, impose waiting periods, or charge higher premiums. Before making the switch, it's wise to research your eligibility and speak with a licensed agent to ensure the transition to a Medigap plan is possible in your situation.

When you move across state lines, you’ll usually need to choose a new Medicare plan since most coverage is state-specific. Some Medicare Supplement plans can move with you, but it’s always a good idea to check with your agent or insurance company to be sure. Medicare generally gives you a 60-day window to enroll in a new plan after your move, so it’s important to act quickly to avoid losing options.

The easiest way is to work with a licensed insurance broker. We understand the differences between plans and can quickly narrow down which options fit your doctors, prescriptions, and budget. With more than 50 plans to sort through, doing it on your own can feel overwhelming. Best of all, our services are completely free to you, and you’ll never pay more for a plan by working with a broker than if you enrolled directly.

Original Medicare (Parts A and B) does not cover most routine dental care, vision exams, eyeglasses, or hearing aids. It mainly covers medical services—like hospital stays, doctor visits, and preventive screenings.

If you want coverage for dental, vision, or hearing, there are two main options:

- Medicare Advantage (Part C) plans: Many of these include extra benefits such as dental cleanings, eye exams, glasses, and hearing aids. The level of coverage varies by plan.

- Standalone insurance plans: You can also purchase separate dental, vision, or hearing policies to fill these gaps.

So, while Medicare by itself doesn’t provide these benefits, you do have ways to add them on.

Yes, but when you can switch depends on the type of plan you have. Medicare has specific enrollment periods each year when changes are allowed. For example, during the Annual Enrollment Period (Oct. 15–Dec. 7), you can switch Medicare Advantage or Part D drug plans. Special Enrollment Periods may also apply if you move, lose other coverage, or experience certain life changes.

For Medigap (Medicare Supplement) plans in Idaho and some other states, you also get a special “Birthday Rule” each year. During the 63 days following your birthday, you can switch to another plan of equal or lesser benefits without medical underwriting.

In some other states, you would have to pass a health underwriting process to be able to switch supplement plans.

Yes, there can be penalties if you delay enrolling in Medicare when you’re first eligible—unless you qualify for special exceptions. For example:

-Part B (medical insurance): If you don’t sign up when you’re first eligible and don’t have other creditable coverage (like employer insurance), you may pay a late enrollment penalty that increases your monthly premium for life.

-Part D (prescription drug coverage): If you go without creditable drug coverage for more than 63 days after your initial eligibility, you’ll likely pay a permanent penalty added to your premium.

-Medigap (supplements): If you wait beyond your initial 6-month Medigap window, you may have to go through medical underwriting and could be denied coverage or charged more.

The good news is, if you still have employer-sponsored health coverage, you may be able to delay without penalty. It’s best to talk with an agent to make sure you don’t miss a deadline.

Most people become eligible for Medicare at age 65. Your Initial Enrollment Period begins three months before your 65th birthday month and lasts until three months after, giving you a 7-month window to sign up.

Some people qualify earlier if they have a disability, end-stage renal disease (ESRD), or ALS.

If you’re already collecting Social Security benefits when you turn 65, you’ll usually be enrolled in Medicare automatically. You should get your red, white, and blue Medicare card in the mail a few months before your 65th birthday.

-Part A (hospital coverage): You’ll be enrolled automatically. Most people don’t pay a premium for Part A.

-Part B (medical coverage): You’ll also be enrolled automatically, and the monthly premium will be deducted from your Social Security check. If you don’t want Part B, you can decline it, but be careful, because dropping it could mean penalties later unless you have other qualifying coverage.

The opposite is true, if you are NOT taking Social Security, you WON'T be automatically enrolled in Medicare, and in that case, you would want to call our agency to help walk you through that process.

If you don’t sign up for Medicare during your Initial Enrollment Period (the 7 months around your 65th birthday), you still have opportunities to enroll:

-General Enrollment Period (GEP): Runs every year from January 1 to March 31. Your coverage will start the month after you sign up. However, if you didn’t have other qualifying coverage, you may face a late enrollment penalty.

-Special Enrollment Period (SEP): If you had creditable coverage, like through an employer or union, you may be able to delay Medicare without penalty. When that coverage ends, you’ll have an 8-month window to enroll in Part B.

Missing your Initial Enrollment doesn’t mean you’re out of luck, but it can affect both your costs and your options. It’s important to review your situation right away so you don’t get stuck with permanent penalties or gaps in coverage.

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If your employer coverage is not considered creditable, you may face penalties or gaps in coverage if you delay enrolling in Medicare when you're first eligible.

Creditable coverage means your current insurance is expected to pay, on average, at least as much as Medicare would pay for similar coverage.

If your coverage is not creditable:

- You may need to enroll in Medicare when you first become eligible to avoid late enrollment penalties.

- Delaying Part B or Part D enrollment could result in permanent penalties that increase your monthly premiums.

- You could also experience a gap in coverage if your employer plan doesn't coordinate well with Medicare.

Most employers provide an annual notice indicating whether their coverage is creditable. If you're unsure, contact your employer's benefits department or speak with a Medicare professional before making any decisions.

Every situation is different, especially for those who continue working past age 65, so it's important to review your options before delaying Medicare enrollment.

Generally, no. Medicare does not cover long-term custodial care or the cost of living in an assisted living facility.

Medicare is designed to cover medical care, not ongoing assistance with daily activities such as bathing, dressing, eating, or supervision.

Medicare may cover:

- Short-term skilled nursing facility care following a qualifying hospital stay

- Home health services when medically necessary

- Doctor visits, hospital care, and other covered medical services

Medicare typically does not cover:

- Assisted living facility costs

- Nursing home care when only custodial care is needed

- Help with activities of daily living on a long-term basis

Because long-term care expenses can be significant, many people explore options such as long-term care insurance, hybrid life insurance policies with long-term care benefits, personal savings, or Medicaid planning.

If long-term care is a concern, it's best to start planning far before care is needed, as options become more limited with age and health changes.

Yes, but there are important rules to understand.

Once you enroll in any part of Medicare (Part A, Part B, or Part C/Medicare Advantage), you are no longer eligible to make new contributions to an HSA. However, the money already in your HSA remains yours and can continue to be used.

You can use HSA funds tax-free to pay for many qualified medical expenses, including:

- Medicare Part B premiums

- Medicare Part D prescription drug premiums

- Medicare Advantage (Part C) premiums

- Deductibles, copays, and coinsurance

- Dental, vision, and hearing expenses

HSA funds generally cannot be used tax-free to pay for Medigap (Medicare Supplement) premiums.

If you're approaching Medicare eligibility and are still contributing to an HSA, it's important to stop contributions before your Medicare coverage begins to avoid potential tax penalties. Consult a tax professional for guidance specific to your situation.

IRMAA stands for Income-Related Monthly Adjustment Amount. It's an additional charge that some Medicare beneficiaries pay on top of their normal Part B and Part D premiums if their income exceeds certain limits.

The Social Security Administration typically looks at your tax return from two years ago to determine whether IRMAA applies. For example, your 2026 Medicare premiums are generally based on your 2024 tax return.

Will it affect me?

If your income is below the IRS income thresholds, IRMAA will not apply.

If your income is above the thresholds, you'll pay a higher monthly premium for Medicare Part B and Part D.

Common events that can trigger IRMAA include large IRA withdrawals, Roth conversions, capital gains, selling a business, or unusually high investment income.

Good news: If your income has dropped due to a qualifying life event (such as retirement, marriage, divorce, or the death of a spouse), you can request that Social Security reconsider the IRMAA determination.