A Complete Guide for Lehigh Valley Medicare Beneficiaries

If your Medicare premium suddenly increased and you’re wondering why, you may be affected by something called IRMAA.

Many retirees in Allentown, Bethlehem, Easton, and throughout the Lehigh Valley are surprised to learn that Medicare premiums are not the same for everyone. If your income was higher in recent years, you may pay more for Medicare Part B and Part D.

Here’s what IRMAA is, how it impacts your Medicare premiums, and how you may be able to appeal it.

What Is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount.

It’s an additional charge added to:

• Medicare Part B premiums

• Medicare Part D prescription drug plan premiums

IRMAA applies when your income exceeds certain federal thresholds.

The Social Security Administration determines whether you owe IRMAA based on your Modified Adjusted Gross Income (MAGI) from two years prior.

Example:

• Your 2026 Medicare premiums are based on your 2024 tax return.

How IRMAA Increases Your Medicare Premiums

Most people pay the standard Medicare Part B premium. However, if your income exceeds the threshold, your premium increases in tiers.

Higher income = higher monthly premium.

This adjustment can add hundreds — even thousands — of dollars per year to your Medicare costs.

Important: IRMAA is not permanent, but it does not automatically adjust when your income changes.

What Income Triggers IRMAA?

IRMAA is triggered when your income exceeds federally set limits.

Income includes:

• Wages

• Self-employment income

• Capital gains

• Rental income

• IRA withdrawals

• Required Minimum Distributions (RMDs)

• Certain tax-exempt interest

Even a one-time income spike — such as selling property or a business — can push you into a higher IRMAA bracket.

Many Lehigh Valley retirees encounter IRMAA after:

• Retiring with a pension payout

• Selling a home or investment property

• Converting a traditional IRA to a Roth IRA

• Taking large distributions from retirement accounts

Why IRMAA Often Affects Recent Retirees

Because IRMAA is based on income from two years ago, many people face this situation:

• You were working two years ago and earning a higher salary.

• You are now retired and earning significantly less.

• Medicare still uses your higher income year to calculate premiums.

The result? You may be paying a higher Medicare premium than your current income justifies.

Can You Appeal IRMAA?

Yes — and this is where many beneficiaries miss an opportunity.

If your income has decreased due to a qualifying life event, you may request a reconsideration from the Social Security Administration.

Qualifying Life Events for an IRMAA Appeal

You may qualify for an appeal if your income dropped due to:

• Retirement

• Work reduction

• Marriage

• Divorce

• Death of a spouse

• Loss of pension income

• Employer settlement payment

Retirement is one of the most common and successful reasons for appealing IRMAA.

How to Appeal IRMAA

To request a reconsideration, you must complete:

Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event)

You’ll need to provide:

• Documentation of your life-changing event

• An estimate of your current year income

• Supporting financial records

The Social Security Administration will review your request and determine whether your premiums should be adjusted.

How Long Does an IRMAA Appeal Take?

Processing times vary, but once approved:

• Your Medicare premiums may be reduced

• Overpaid amounts may be refunded

It’s important to act quickly rather than continuing to pay elevated premiums unnecessarily.

Common IRMAA Misunderstandings

Many Lehigh Valley retirees believe:

• “It’s permanent.” (It’s not.)

• “There’s nothing I can do.” (There often is.)

• “Medicare premiums are the same for everyone.” (They are income-based.)

• “Social Security automatically adjusts it when I retire.” (It does not.)

IRMAA requires proactive review.

Planning Ahead to Avoid IRMAA

Strategic retirement planning can help minimize IRMAA exposure.

Strategies may include:

• Managing Roth conversions carefully

• Spreading out large withdrawals

• Timing asset sales strategically

• Coordinating retirement income streams

Because IRMAA is income-based, even small adjustments in planning can make a difference.

Why Local Guidance Matters in the Lehigh Valley

Retirement income planning and Medicare premiums are closely connected.

Working with someone who understands:

• Pennsylvania retirement income rules

• Local retirement demographics

• Medicare enrollment timing

• How IRMAA interacts with retirement planning

can help prevent unnecessary premium increases.

Final Thoughts: Don’t Ignore a Higher Medicare Premium

If your Medicare Part B or Part D premium recently increased, IRMAA may be the reason.

The good news:

• It’s not always permanent.

• It may be appealable.

• It can often be corrected after retirement.

The key is knowing your options.

Need Help Reviewing Your Medicare Premiums?

If you live in the Lehigh Valley and have questions about IRMAA, Medicare costs, or retirement income coordination, a local Medicare review can provide clarity.

At Lehigh Valley Medicare Advisors, we help Pennsylvania retirees understand:

• Why their premiums changed

• Whether an IRMAA appeal makes sense

• How retirement income affects Medicare costs

• What steps to take next

Your retirement budget should be predictable — and Medicare shouldn’t come with surprises.

If you’d like a complimentary Medicare premium review, reach out today.

A Complete Guide for Lehigh Valley Retirees

If you’re approaching age 65 or recently enrolled, one of the most common questions is:

“What does Medicare actually cover — and what doesn’t it?”

Understanding your Medicare coverage is essential to avoid unexpected medical bills and make informed decisions about supplemental coverage. For retirees in Allentown, Bethlehem, Easton, and throughout the Lehigh Valley, knowing the gaps in Medicare can help you plan smarter.

Here’s a clear, easy-to-understand breakdown of what Medicare covers — and where it leaves you responsible.

What Medicare Covers

Medicare is divided into different parts. Each part covers specific types of care.

Medicare Part A: Hospital Coverage

Part A generally covers:

• Inpatient hospital stays

• Skilled nursing facility care (short-term, after hospitalization)

• Hospice care

• Limited home health services

Important Notes:

• Part A does not cover long-term custodial care in a nursing home.

• There is a hospital deductible per benefit period.

• Coverage for skilled nursing facilities is limited in days and requires prior hospitalization.

Most beneficiaries qualify for premium-free Part A if they worked and paid Medicare taxes for at least 10 years.

Medicare Part B: Medical Coverage

Part B covers:

• Doctor visits

• Outpatient care

• Preventive services

• Lab work and diagnostic testing

• Durable medical equipment (wheelchairs, walkers, etc.)

• Mental health services

Preventive Services Covered by Medicare:

• Annual wellness visits

• Cardiovascular screenings

• Diabetes screenings

• Mammograms

• Colonoscopies

• Flu and pneumonia vaccines

Part B typically covers 80% of approved services, leaving you responsible for 20% unless you have supplemental coverage.

Medicare Part D: Prescription Drug Coverage

Medicare Part D helps cover:

• Prescription medications

• Certain vaccines not covered under Part B

Each Part D plan has:

• A formulary (list of covered drugs)

• Pharmacy networks

• Copays or coinsurance

Drug coverage varies by plan and county, so Lehigh Valley residents may see different options depending on where they live.

Medicare Advantage (Part C)

Medicare Advantage plans bundle:

• Part A

• Part B

• Often Part D

Many plans also include:

• Dental

• Vision

• Hearing

• Fitness benefits

However, these plans are network-based (HMO or PPO), meaning you may need to use specific doctors and hospitals in the Lehigh Valley.

What Medicare Does NOT Cover

This is where many retirees are surprised.

Original Medicare does not cover:

-Routine Dental Care

• Cleanings

• Fillings

• Dentures

-Routine Vision Care

• Eye exams for glasses

• Prescription lenses

-Hearing Aids

• Hearing exams for fitting

• Hearing devices

-Long-Term Custodial Care

• Extended nursing home stays

• Assisted living facilities

-Most Cosmetic Procedures

-Routine Foot Care (with limited exceptions)

The Biggest Medicare Gap: The 20%

With Original Medicare (Parts A & B), there is no cap on out-of-pocket spending.

That means:

• You pay deductibles

• You pay 20% of outpatient services

• There is no annual maximum limit

This is why many retirees choose:

• A Medicare Supplement (Medigap) plan
  or

• A Medicare Advantage plan with an annual out-of-pocket maximum

How Lehigh Valley Residents Fill the Gaps

In Pennsylvania, retirees typically choose one of two paths:

Option 1: Medicare Supplement (Medigap)

• Works with Original Medicare

• Covers most or all of the 20%

• No network restrictions

• Higher monthly premium, lower surprise costs

Option 2: Medicare Advantage

• Lower monthly premiums

• Includes additional benefits

• Has network limitations

• Has an annual maximum out-of-pocket limit

The right choice depends on:

• Your health needs

• Your doctors

• Your prescription medications

• Your budget

Common Medicare Coverage Misunderstandings

Many Lehigh Valley retirees believe:

• Medicare covers nursing home care indefinitely (it does not)

• Dental and vision are included automatically (not under Original Medicare)

• All doctors accept all Medicare Advantage plans (networks matter)

• Medicare is completely free (there are premiums and cost-sharing)

Understanding these details early can prevent costly surprises.

Why Reviewing Your Coverage Matters

Healthcare needs change over time.

Even if you feel healthy today, reviewing your Medicare coverage annually helps ensure:

• Your prescriptions are covered affordably

• Your preferred doctors remain in-network

• Your costs align with your retirement budget

• You’re not overpaying unnecessarily

Final Thoughts: Medicare Is Strong — But It Has Gaps

Medicare provides excellent foundational coverage for hospital and medical services. However, it does not cover everything.

Understanding what Medicare covers — and what it doesn’t — allows you to make confident, informed decisions about:

• Supplement plans

• Medicare Advantage options

• Prescription coverage

• Long-term planning

Need Help Reviewing Your Medicare Coverage in the Lehigh Valley?

If you live in the Lehigh Valley and want clarity about your Medicare options, a local review can help you:

• Identify potential coverage gaps

• Compare Supplement vs. Advantage options

• Evaluate prescription drug coverage

• Align your healthcare with your retirement goals

At Lehigh Valley Medicare Advisors, we specialize in helping Pennsylvania retirees simplify Medicare with confidence.

Your retirement should feel secure — not uncertain.

If you’d like a complimentary Medicare review, schedule today.

What Lehigh Valley Residents Need to Know About Medicare Advantage Open Enrollment

If you’re wondering, “Can I change my Medicare plan in February?” — the answer is yes, in certain situations.

For many Medicare beneficiaries in the Lehigh Valley, February falls within an important window called the Medicare Advantage Open Enrollment Period. If you enrolled in a Medicare Advantage plan and are now having second thoughts, you may still have time to make a change.

Here’s what residents in Allentown, Bethlehem, Easton, and surrounding Lehigh Valley communities need to know.

What Is the Medicare Advantage Open Enrollment Period?

Each year, from January 1 through March 31, Medicare beneficiaries who are already enrolled in a Medicare Advantage plan can make one change.

This period is officially known as the Medicare Advantage Open Enrollment Period (MA OEP).

That means February is absolutely a month when changes are allowed — but only under specific rules.

Who Can Change Their Medicare Plan in February?

You can make a change in February if:

• You are currently enrolled in a Medicare Advantage plan (Part C)

• You want to switch to a different Medicare Advantage plan

• You want to return to Original Medicare (Part A & B)

You cannot use this period if you are enrolled in Original Medicare and simply want to join a Medicare Advantage plan for the first time. That opportunity happens during the Annual Enrollment Period (October 15 – December 7).

What Changes Can You Make?

During the January 1 – March 31 window, you may:

✔ Switch from one Medicare Advantage plan to another

Example: If your current plan’s network doesn’t include your preferred Lehigh Valley doctor or hospital.

✔ Drop Medicare Advantage and return to Original Medicare

You can also enroll in a standalone Part D prescription drug plan at that time.

✖ You cannot:

• Switch from Original Medicare to Medicare Advantage (unless you qualify for a Special Enrollment Period)

• Make multiple changes — you are limited to one change during this period

Why Do People Change Plans in February?

In the Lehigh Valley, we often see beneficiaries reconsider their plan after:

• Realizing their doctor is out-of-network

• Facing higher-than-expected copays

• Discovering prescription medications aren’t covered as expected

• Learning that prior authorizations are required

• Experiencing delays in specialist referrals

Many people choose a plan during the fall Annual Enrollment Period without fully knowing how it will function in real-life situations. January is often the first time they actually use the coverage — and February is when they reassess.

Important Deadlines to Remember

If you make a change during February:

• Your new coverage typically begins the first day of the month after your request is received

• The deadline to submit changes is March 31

• You only get one opportunity to make a change during this period

Waiting too long could mean staying in a plan you’re unhappy with for the rest of the year.

Special Considerations for Lehigh Valley Residents

Medicare Advantage plans are local — meaning:

• Provider networks vary by county

• Hospital participation differs between Lehigh and Northampton County

• Plan premiums and benefits are region-specific

If you receive care through major Lehigh Valley health systems, it’s important to confirm that your providers are in-network before making any switch.

What works well in one Pennsylvania county may not be the best fit in another.

What If You Have Original Medicare?

If you’re on Original Medicare (Part A & B) with a Supplement, February typically does not allow you to switch into a Medicare Advantage plan unless:

• You qualify for a Special Enrollment Period

• You recently moved

• You lost employer coverage

• You qualify for Medicaid or Extra Help

Every situation is different — which is why reviewing your eligibility matters.

Should You Change Your Medicare Plan?

Before making a change, ask yourself:

• Are my doctors in-network?

• Are my prescriptions covered affordably?

• Am I comfortable with the plan’s prior authorization requirements?

• Do the copays align with my budget?

• Does the plan include benefits I actually use (dental, vision, hearing)?

Switching plans can be helpful — but it should be strategic, not reactive.

Don’t Wait Until March

If you’re unhappy with your Medicare Advantage plan, February is one of your last opportunities to fix it before next fall.

After March 31, most beneficiaries must wait until the Annual Enrollment Period in October to make changes — unless they qualify for a Special Enrollment Period.

That’s a long time to stay in a plan that isn’t working for you.

Need Help Reviewing Your Options?

If you live in the Lehigh Valley and are unsure whether changing your Medicare plan makes sense, a local review can help clarify:

• Your current plan’s costs and network

• Available alternatives in your county

• Prescription drug coverage comparisons

• Whether returning to Original Medicare is possible

At Lehigh Valley Medicare Advisors, we help Pennsylvania retirees understand their options clearly — without pressure.

Final Takeaway

Yes — you can change your Medicare plan in February if you are enrolled in a Medicare Advantage plan.

But you only get one chance to make that change between January 1 and March 31.

If you’re questioning your coverage, now is the time to review it.

Your healthcare coverage should give you confidence — not confusion.

If you’d like a complimentary Medicare review to ensure your plan fits your needs here in the Lehigh Valley, schedule today.

Retirement is an exciting milestone — but once the celebrations settle, many new retirees realize there’s a lot to organize, especially when it comes to healthcare. Medicare can feel overwhelming at first, and the choices you make in your first few months of retirement can have long-lasting financial and medical impacts.

If you’ve recently retired (or are about to), this guide walks you through a clear, simple Medicare to-do list for your first 90 days, helping you avoid costly mistakes and feel confident about your coverage.

Let’s break it down.

Why the First 90 Days of Retirement Matter for Medicare

Your initial Medicare enrollment window is one of the most important periods in your retirement journey. During this time, you typically have access to plans and options that may not be available later without medical underwriting or penalties.

Missing deadlines or choosing coverage that doesn’t fit your needs can lead to:

• Lifetime late-enrollment penalties

• Gaps in healthcare coverage

• Unexpected out-of-pocket costs

• Limited plan choices later on

That’s why having a structured plan for your first 90 days is essential.

Days 1–30: Get Organized and Confirm Your Medicare Enrollment

Confirm You’re Enrolled in Medicare Parts A and B

If you were already receiving Social Security benefits, you may have been automatically enrolled. If not, you’ll need to actively enroll.

Start by confirming:

• Your Medicare Part A (hospital insurance) status

• Your Medicare Part B (medical insurance) status

• Your effective start dates

Keep copies of your Medicare card and enrollment confirmations in a safe place.

Review Any Employer Coverage You’re Leaving Behind

If you recently retired from a job that provided health insurance, make sure you understand:

• When your employer coverage officially ends

• Whether COBRA is available (and if it makes financial sense)

• How your previous coverage coordinates with Medicare

This step is critical to avoiding coverage gaps.

Make a List of Your Healthcare Needs

Before choosing any additional Medicare plans, take inventory of:

• Your doctors and preferred hospitals

• Prescription medications

• Ongoing or upcoming procedures

• Chronic conditions

• Travel habits

This personal healthcare snapshot will guide smarter Medicare decisions.

Days 31–60: Choose the Right Medicare Coverage

Once you’re enrolled in Parts A and B, it’s time to complete your coverage.

Decide Between Medicare Advantage or Medicare Supplement

Most retirees choose between:

• Medicare Advantage plans (often bundled with prescription drug coverage)

• Medicare Supplement plans paired with a standalone prescription drug plan

Each option has different costs, networks, and levels of flexibility. There’s no universal “best” choice — only what’s best for you.

This is where many retirees benefit from working with a licensed Medicare advisor who can compare plans side-by-side and explain everything in plain English.

Enroll in Prescription Drug Coverage

If your chosen plan doesn’t already include drug coverage, you’ll need to enroll in a separate prescription drug plan.

Skipping this step — even if you don’t currently take medications — can result in permanent penalties later.

Confirm Your Doctors Are In-Network

Before finalizing any plan, always verify that your primary care physician, specialists, and preferred hospitals accept your coverage.

This avoids unpleasant surprises at your first appointment.

Days 61–90: Final Checks and Long-Term Planning

Set Up Online Accounts and Automatic Payments

Take time to:

• Create your Medicare online account

• Set up premium payments

• Organize plan documents

• Save customer service numbers

A little organization now saves frustration later.

Schedule Preventive Appointments

Many preventive services are covered under Medicare. Use this time to book:

• Annual wellness visits

• Routine screenings

• Dental, vision, or hearing exams (depending on your plan)

Staying proactive helps protect both your health and your budget.

Revisit Your Budget

Healthcare is a major expense in retirement. Make sure your budget reflects:

• Monthly premiums

• Copays and deductibles

• Prescription costs

• Emergency reserves

Understanding your true healthcare expenses early on helps prevent financial stress down the road.

Common Medicare Mistakes New Retirees Make

Even well-prepared retirees can stumble during this transition. Some of the most common mistakes include:

• Assuming Medicare covers everything

• Missing enrollment deadlines

• Choosing plans based only on monthly premiums

• Forgetting prescription drug coverage

• Not reviewing plans annually

Working with a professional can help you avoid these pitfalls and stay confident in your choices.

Get Local, Personalized Medicare Guidance

Medicare isn’t one-size-fits-all — especially when your health, finances, and retirement goals are unique.

That’s why many retirees turn to Lehigh Valley Medicare Advisors for personalized, local guidance. A licensed advisor can help you compare plans, understand your options, and make sure everything is set up correctly — at no cost to you.

Final Thoughts

Your first 90 days of retirement set the foundation for your healthcare in the years ahead. By staying organized, meeting deadlines, and choosing coverage that truly fits your needs, you’ll protect both your health and your financial future.

If you’ve recently retired or are preparing to retire soon, now is the perfect time to review your Medicare options and create a plan that gives you peace of mind — so you can focus on enjoying this exciting new chapter. Schedule an Appointment Today!

 

If you’re approaching age 65 and still working — or covered under a spouse’s employer plan — you may be wondering whether you should enroll in Medicare or keep your employer coverage. This is one of the most common (and confusing) Medicare questions we hear.

The truth is: there is no one-size-fits-all answer. The right choice depends on your employer plan, your health needs, and your long-term costs. Making the wrong decision can lead to higher premiums, coverage gaps, or late enrollment penalties.

Here’s how to know which option may be right for you.

Understanding Your Medicare Options at Age 65

When you turn 65, you become eligible for Medicare, which includes:

• Medicare Part A (Hospital Insurance) – Often premium-free

• Medicare Part B (Medical Insurance) – Monthly premium required

• Medicare Part D (Prescription Drug Coverage) – Optional but important

• Medicare Advantage or Medicare Supplement plans – Additional coverage options

Even if you’re still working, you must actively decide whether to enroll in Medicare or delay it based on your situation.

When Employer Coverage May Make Sense

You may be able to delay Medicare enrollment without penalty if:

• You or your spouse are actively working

• You are covered by an employer plan from a company with 20 or more employees

• The employer coverage is considered creditable (especially for prescription drugs)

In this case:

• You can usually delay Part B and Part D

• You won’t face penalties when you later enroll

• You’ll qualify for a Special Enrollment Period when coverage ends

However, employer coverage isn’t always better — even if it feels familiar.

When Medicare May Be the Better Choice

In many cases, Medicare can actually provide better coverage at a lower cost.

Medicare may be the right move if:

• Your employer has fewer than 20 employees

• Your employer plan has high deductibles or premiums

• You see doctors frequently or take multiple prescriptions

• Your spouse is retiring and coverage will end soon

Medicare combined with a Supplement or Advantage plan can often reduce:

• Out-of-pocket costs

• Prescription expenses

• Unexpected medical bills

Key Factors to Compare Before Deciding

Before choosing Medicare or employer coverage, you should compare:

1. Monthly Premiums

Employer plans often appear “free” — but payroll deductions add up. Medicare costs are more transparent.

2. Deductibles & Out-of-Pocket Costs

Employer plans may have higher deductibles and coinsurance than Medicare-based plans.

3. Prescription Drug Coverage

Not all employer plans are considered creditable. This matters for avoiding Part D penalties.

4. Provider Access

Medicare offers broad provider access nationwide — helpful for retirees who travel or see specialists.

5. Future Flexibility

Enrolling at the right time protects you from lifelong late enrollment penalties.

Avoiding Costly Medicare Enrollment Mistakes

Some of the most common mistakes we see include:

• Assuming employer coverage is always better

• Delaying Medicare without confirming creditable coverage

• Missing enrollment windows

• Enrolling in Part A only when Part B is required

• Not understanding how Medicare works with employer insurance

These mistakes can result in permanent penalties or coverage delays.

How Lehigh Valley Medicare Advisors Can Help

Choosing between Medicare and employer coverage isn’t just about today — it’s about protecting your healthcare and finances for years to come.

At Lehigh Valley Medicare Advisors, we:

• Review your employer plan in detail

• Compare it side-by-side with Medicare options

• Explain penalties, timelines, and enrollment rules clearly

• Help you make a confident, informed decision — at no cost

Final Thoughts: Get Guidance Before You Decide

If you’re turning 65 or approaching retirement, don’t guess when it comes to Medicare. The right decision depends on your specific situation — and getting it wrong can be expensive.

Make an Appointment with Lehigh Valley Medicare Advisors today for a personalized Medicare vs. employer coverage review and get clarity before making your choice.

Millions of Medicare beneficiaries have come to rely on telehealth services for convenient access to doctors, specialists, and follow-up care. Since the COVID-19 pandemic, Medicare temporarily expanded telehealth coverage, allowing many services to be provided virtually from home. However, those expanded rules are set to change at the end of January.

If you or a loved one uses telehealth appointments, it’s important to understand what’s changing, what stays the same, and how to prepare before January 31, 2026.

What’s Happening With Medicare Telehealth Coverage?

Medicare’s expanded telehealth benefits were originally created as a temporary response to the pandemic. These rules removed geographic restrictions and allowed beneficiaries to receive many telehealth services from home.

Congress extended these expanded telehealth flexibilities through January 30, 2026. That means Medicare beneficiaries can continue using many telehealth services under the current rules for a short time longer. However, unless new legislation is passed, Medicare will revert to its pre-pandemic telehealth guidelines beginning January 31, 2026.

Key Telehealth Changes Starting January 31, 2026

Beginning January 31, Medicare will once again place limits on where telehealth services can be received.

Under Original Medicare, most telehealth visits will generally require the beneficiary to be physically located at an approved medical facility, such as a rural health clinic or hospital. Coverage for routine telehealth visits from home will be significantly reduced for beneficiaries living in non-rural areas.

This change may impact beneficiaries who currently rely on telehealth for routine checkups, follow-ups, and ongoing care without leaving home.

Telehealth Services That Will Still Be Covered

Even after the broader telehealth coverage ends, Medicare will continue to cover certain services via telehealth regardless of location.

Mental health and behavioral health services will still be covered through telehealth from home, no matter where the beneficiary lives. Medicare will also continue to cover telehealth for specific critical services, such as evaluation and treatment for stroke symptoms. In addition, home dialysis monitoring for patients with end-stage renal disease will remain eligible for telehealth coverage.

While telehealth will not disappear entirely, coverage will be more limited than it has been over the past several years.

Why These Changes Matter for Medicare Beneficiaries

The rollback of expanded telehealth coverage may affect how beneficiaries access care, especially those with mobility challenges, transportation issues, or busy schedules.

Some beneficiaries may need to return to in-person visits more often, which could increase travel time and out-of-pocket expenses. Others may need to adjust how they schedule appointments or coordinate care with providers who previously offered virtual visits from home.

Understanding these changes now allows beneficiaries to plan ahead and avoid surprises after January 30.

How to Prepare Before the Deadline

Medicare beneficiaries should review their current coverage and speak with their healthcare providers about how upcoming visits will be handled after January 30, 2026. Providers can explain which services will continue to be offered virtually and which will require in-person visits.

Those enrolled in Medicare Advantage plans should also review their plan benefits. Medicare Advantage plans often offer additional telehealth benefits beyond what Original Medicare covers, but coverage varies by plan and provider network.

If telehealth access is an important part of your healthcare routine, now is the time to explore whether your current plan still meets your needs.

What Could Happen Next With Telehealth Policy

Lawmakers and healthcare organizations continue to advocate for permanent telehealth expansions. While there is ongoing discussion about extending or reinstating broader telehealth coverage, no long-term solution has been finalized as of mid-January.

For now, Medicare beneficiaries should plan based on the assumption that current telehealth rules will change on January 31, 2026.

Bottom Line

Medicare telehealth coverage remains in place through January 30, 2026, allowing many beneficiaries to continue receiving care from home. After that date, most telehealth services under Original Medicare will return to more restrictive rules.

Staying informed, reviewing your Medicare coverage, and speaking with your healthcare providers now can help ensure a smooth transition and continued access to the care you need. Schedule an Appointment Here!

Choosing the right Medicare plan can feel overwhelming, but understanding your options is key to ensuring the best coverage for your healthcare needs. Many beneficiaries are torn between Original Medicare and Medicare Advantage (Part C). This guide breaks down the differences, pros and cons, and tips for selecting the plan that fits you best.

What is Original Medicare?

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). It covers most hospital stays, doctor visits, and preventive services.

Pros of Original Medicare:

• Freedom to see any doctor or specialist who accepts Medicare.

• Nationwide coverage.

• Standardized benefits—what’s covered is consistent everywhere.

Cons of Original Medicare:

• Does not cover prescription drugs (Part D is needed).

• Limited coverage for dental, vision, and hearing.

• You may face out-of-pocket costs like copayments and deductibles.

What is Medicare Advantage?

Medicare Advantage (Part C) is offered by private insurance companies and combines Parts A and B coverage—and often Part D (prescription drugs)—into one plan. Many plans also include additional benefits like dental, vision, hearing, and fitness programs.

Pros of Medicare Advantage:

• One plan may cover medical, prescription drugs, and extra benefits.

• Often includes additional perks like gym memberships or wellness programs.

• Many plans have low or $0 premiums.

Cons of Medicare Advantage:

• You may need to use a network of doctors and hospitals.

• Rules for referrals and prior authorizations can be stricter.

• Coverage can vary significantly by plan and location.

Key Factors to Consider When Choosing

When deciding between Original Medicare and Medicare Advantage, consider:

1. Your Healthcare Needs – Do you need frequent specialist visits or specific prescriptions?

2. Budget – Consider premiums, deductibles, and out-of-pocket maximums.

3. Flexibility – Do you want to see any doctor, or are you okay with a network?

4. Extra Benefits – Dental, vision, hearing, or wellness programs might influence your decision.

How a Medicare Advisor Can Help

Navigating Medicare can be confusing, but working with an advisor ensures you:

• Understand plan differences.

• Choose a plan tailored to your health and budget.

• Avoid common mistakes that could cost you money or coverage.

Final Thoughts

There’s no one-size-fits-all answer when it comes to Medicare. Whether you prefer the flexibility of Original Medicare or the added benefits of Medicare Advantage, a careful review of your needs and options is essential.

Need help choosing the right Medicare plan? Schedule an appointment today with a knowledgeable advisor who can guide you through your options.

A new year brings fresh starts—and for Medicare beneficiaries, it’s the perfect time to make sure your coverage still fits your health needs, budget, and lifestyle. Whether you’re newly enrolled or have been on Medicare for years, reviewing your plan at the beginning of the year can help you avoid surprises and feel confident moving forward.

At Lehigh Valley Medicare Advisors, we believe peace of mind starts with understanding your coverage. Here’s what to review as you begin the new year.

Why a New Year Medicare Review Matters

Even if you didn’t make changes during Open Enrollment, things can still shift from year to year. Insurance providers may update:

• Monthly premiums

• Prescription drug formularies

• Provider networks

• Copays and out-of-pocket costs

Your own needs may have changed too—new medications, doctor visits, or upcoming procedures can all impact whether your current Medicare plan is still the best fit.

Starting the year with a Medicare review helps ensure there are no gaps in coverage and no unexpected costs down the road.

Key Medicare Items to Review in the New Year

1. Your Prescription Drug Coverage

Medication costs are one of the most common Medicare concerns. Review your current prescriptions to ensure:

• Your medications are still covered

• They’re in the lowest-cost tier available

• Your preferred pharmacy is still in-network

Small changes here can make a big difference in annual costs.

2. Your Doctors and Healthcare Providers

Confirm that your primary care doctor, specialists, and preferred hospitals are still part of your plan’s network—especially if you’re enrolled in a Medicare Advantage plan.

Seeing an out-of-network provider could result in higher costs or limited coverage.

3. Your Monthly and Annual Costs

Take a look at:

• Monthly premiums

• Deductibles

• Copays and coinsurance

• Maximum out-of-pocket limits

Understanding these numbers early in the year helps you plan ahead and avoid financial stress.

4. Extra Benefits You May Be Missing

Many Medicare Advantage plans include additional benefits such as:

• Dental, vision, and hearing coverage

• Fitness or wellness programs

• Over-the-counter allowances

Make sure you’re taking full advantage of everything your plan offers.

What If You’re Unsure About Your Coverage?

You’re not alone. Medicare can feel overwhelming, especially when plans, rules, and benefits change. The good news? You don’t have to navigate it by yourself.

Working with a local Medicare advisor allows you to:

• Get personalized guidance

• Ask questions in plain language

• Review your options with no pressure

Start the Year with Confidence

The new year is a great time to feel confident, informed, and secure about your Medicare coverage. A quick review now can save you time, money, and stress later in the year.

If you live in the Lehigh Valley and have questions about your Medicare plan, Lehigh Valley Medicare Advisors is here to help. Our team is committed to making Medicare simple and ensuring you have coverage that truly works for you.

Start the new year with clarity—because confidence in your healthcare matters.

Make an Appointment Today! 

The start of a new year is the perfect time to make sure you’re getting the most out of your Medicare coverage. For Lehigh Valley residents, understanding your plan and taking proactive steps can save you money, improve access to care, and help you stay on top of your health in 2026.

Here are actionable tips to maximize your Medicare benefits in the new year.

Your Current Medicare Coverage

Check Your Plan’s Benefits and Limitations

Even if you’re happy with your current plan, it’s important to review:

• Premiums, deductibles, and copays

• Coverage for your prescription medications

• Access to your preferred doctors and hospitals

Plans can change annually, and reviewing your coverage ensures you’re not missing out on potential benefits or savings.

Confirm Provider Networks

Medicare Advantage plans may update provider networks each year. Make sure your preferred Lehigh Valley doctors and local hospitals—including Allentown, Bethlehem, and Easton—are still in-network to avoid surprise out-of-pocket costs.

Take Advantage of Preventive Services

Use Free or Low-Cost Screenings

Medicare covers a wide range of preventive services at no cost, including:

• Annual wellness visits

• Blood pressure, cholesterol, and diabetes screenings

• Vaccinations, including flu and COVID-19 boosters

Scheduling these visits early in the year can help you catch health issues before they become more serious.

Schedule Routine Check-Ups

Even if you feel healthy, regular check-ups allow your provider to track changes and recommend services covered by Medicare, helping you make the most of your benefits.

Review Your Prescription Drug Coverage

Check Your Part D Formulary

Medicare Part D and Medicare Advantage plans with drug coverage can change their formularies annually. Verify that:

• Your medications are still covered

• You understand any tier changes or prior authorizations

• Your pharmacy is in-network

Consider Mail-Order or 90-Day Supplies

Many plans offer cost savings when you order medications in 90-day supplies or use mail-order pharmacies. This can reduce trips to the pharmacy and help manage your healthcare budget.

Take Advantage of Extra Benefits

Explore Additional Plan Perks

Many Medicare Advantage plans include extra benefits such as:

• Dental, vision, or hearing coverage

• Fitness programs or gym memberships

• Telehealth services

Using these extras can improve your health and overall quality of life while staying within your plan’s coverage.

Utilize Wellness Programs

Some plans offer wellness incentives, discounts, or preventative programs. Reviewing these options can help you take advantage of services designed to support your health year-round.

Work With a Local Medicare Advisor

Personalized Guidance for Lehigh Valley Residents

Medicare rules and plan options can be complex. Working with a local Medicare advisor ensures that your review is tailored to:

• Plans available in Allentown, Bethlehem, Easton, and the surrounding Lehigh Valley area

• Your specific medications, providers, and healthcare needs

• Opportunities to save money or access additional benefits

Make the Most of Your Medicare Coverage

An advisor can guide you through plan changes, review your prescriptions, and answer questions about preventive services, giving you peace of mind as you enter the new year.

Take Action Early in the Year

The earlier you review your Medicare coverage, the more options you have to:

• Optimize benefits

• Reduce out-of-pocket costs

• Schedule preventive care and wellness services

By taking these steps, Lehigh Valley residents can maximize their Medicare benefits in 2026, stay healthy, and ensure they are getting full value from their coverage.

Schedule an Appointment Today! 

Medicare is not a “set it and forget it” program. Each year, plans, costs, and coverage rules can change—sometimes in small ways, sometimes in ways that significantly impact your healthcare and budget.

As we look ahead to 2026, Lehigh Valley residents should understand what types of Medicare changes may occur, why annual reviews matter, and how working with a local Medicare advisor can help you stay protected and informed.

Why Medicare Changes From Year to Year

Medicare plans are influenced by:

• Federal regulations

• Insurance carrier updates

• Prescription drug cost adjustments

• Changes to provider networks

Because of this, the plan that worked well for you last year may not be the best fit moving forward.

Medicare Costs May Change in 2026

Premiums, Deductibles, and Copays

Medicare premiums and out-of-pocket costs can change annually. In 2026, beneficiaries may see adjustments to:

• Medicare Part B premiums

• Deductibles and copays

• Prescription drug costs

Even small increases can add up over the course of a year, making it important to understand how your total healthcare spending may be affected.

Income-Related Adjustments

Some beneficiaries may be subject to income-related monthly adjustment amounts (IRMAA). These thresholds and calculations can change, potentially impacting higher-income retirees.

Medicare Advantage Plans Can Change Yearly

Provider Networks and Coverage Areas

Medicare Advantage plans are offered by private insurance companies and can change annually. In 2026, changes may include:

• Doctors or hospitals leaving a network

• Adjustments to service areas

• New referral or authorization requirements

This is especially important for Lehigh Valley residents who want to ensure their preferred doctors and local hospitals remain covered.

Extra Benefits May Be Updated

Many Medicare Advantage plans include additional benefits such as dental, vision, hearing, or wellness services. These benefits are not guaranteed year to year and may change in:

• Coverage limits

• Eligibility rules

• Cost-sharing

Prescription Drug Coverage May Look Different

Changes to Drug Formularies

Prescription drug plans (Part D and Medicare Advantage plans with drug coverage) can change their formularies annually. This means:

• A medication may move to a different tier

• Prior authorization rules may change

• A drug may no longer be covered

Reviewing drug coverage is one of the most important steps heading into 2026.

Pharmacy Network Changes

Your preferred pharmacy may not always remain in-network. Network changes can affect convenience and cost, especially for those managing chronic conditions.

Medicare Supplement Plans and Rate Trends

Rate Adjustments Over Time

While Medicare Supplement (Medigap) benefits are standardized, premiums are not. In 2026, some policyholders may see:

• Age-related increases

• Carrier-specific rate adjustments

Reviewing your policy can help ensure you’re still receiving competitive pricing for the coverage you need.

When a Plan Review Makes Sense

Even if you’re happy with your coverage, a periodic review can help identify:

• Potential savings

• Better-suited plan options

• Changes in your healthcare needs

Why Lehigh Valley Residents Should Review Their Medicare Coverage for 2026

Healthcare is personal—and so is Medicare. Local considerations matter, including:

• Access to Lehigh Valley doctors and hospitals

• Regional plan availability

• Local support when questions arise

Working with a local Medicare advisor allows you to receive guidance tailored to your needs, not a one-size-fits-all recommendation.

How a Local Medicare Advisor Can Help

A Medicare advisor can help you:

• Understand upcoming changes without the confusion

• Compare plans available in the Lehigh Valley

• Review costs, coverage, and provider networks

• Make informed decisions with confidence

Best of all, guidance from a licensed Medicare advisor comes with clarity—not pressure.

Preparing for Medicare in 2026

Medicare changes don’t have to be overwhelming. With the right information and support, Lehigh Valley residents can feel confident heading into 2026 knowing their coverage still meets their healthcare and financial needs.

If you haven’t reviewed your Medicare plan recently, now is a great time to start the conversation and ensure you’re prepared for the year ahead. Schedule an Appointment Today!

The holiday season is a busy time, filled with family gatherings, travel, and celebrations. For seniors and Medicare beneficiaries, it’s important to stay on top of your health and coverage to avoid unexpected medical issues or costs. Here are practical tips to help you stay healthy and make the most of your Medicare benefits during the holidays.

Plan Ahead for Your Prescriptions

Refill Early to Avoid Gaps in Medication

The holidays can disrupt pharmacy schedules, and some stores may have limited hours. Make sure you refill your prescriptions well in advance to avoid running out of essential medications.

Consider Mail-Order or Long-Term Supply

Many Medicare Part D plans offer mail-order pharmacies or 90-day supplies. Using these services can save you time and ensure you don’t miss doses during holiday travel or festivities.

Keep Up with Preventive Care

Schedule Check-Ups Before the Holidays

Routine check-ups and screenings are important for maintaining your health. If you haven’t had your annual physical, flu shot, or preventive screenings, try to schedule them before the holiday rush.

Use Your Medicare Benefits Fully

Medicare covers many preventive services at no extra cost, including vaccinations, screenings, and wellness visits. Take advantage of these benefits while you can.

Stay Safe and Avoid ER Visits

Practice Safe Travel and Holiday Activities

Winter weather and crowded holiday events can increase the risk of falls and accidents. Make sure to dress appropriately, stay active safely, and plan your travel carefully.

Know When to Seek Care

If you feel unwell, don’t wait until after the holidays to see a doctor. Knowing your options, including urgent care centers covered by Medicare, can prevent minor issues from becoming emergencies.

Review Your Medicare Plan

Check Your Coverage for the Holidays

Certain services, like urgent care, telehealth, and prescription coverage, can be essential during the holidays. Review your Medicare plan to ensure you know your benefits.

Contact Lehigh Valley Medicare Advisors for Guidance

If you’re unsure about your coverage or want to explore additional Medicare options, our team at Lehigh Valley Medicare Advisors can help. We can guide you to maximize your benefits and stay healthy all year long.

Final Thoughts

The holiday season should be about joy and connection, not stress over health or unexpected medical costs. By planning ahead, using your Medicare benefits wisely, and staying mindful of your health, you can enjoy a safer and healthier holiday season.

Make an Appointment Today! 

Missed Medicare Open Enrollment? What Lehigh Valley Residents Can Still Do Before the New Year

Medicare Open Enrollment can feel overwhelming, and many people don’t realize they need help until the deadline is right around the corner—or has already passed. If you’re a Lehigh Valley resident who is worried you missed Medicare Open Enrollment, you’re not alone.

The good news? Missing Open Enrollment doesn’t always mean you’re out of options. Depending on your situation, there may still be steps you can take before the new year begins.

Understanding Medicare Open Enrollment

What Is Medicare Open Enrollment?

Medicare Open Enrollment runs each year from October 15 through December 7. During this time, Medicare beneficiaries can:

• Switch Medicare Advantage plans

• Change prescription drug plans (Part D)

• Move from Original Medicare to Medicare Advantage (or vice versa)

Changes made during this period typically take effect on January 1.

Why People Miss the Deadline

Many Lehigh Valley residents miss Open Enrollment because:

• Medicare mail can be confusing

• They didn’t realize plans could change yearly

• Their health needs changed unexpectedly

• They assumed their current plan would stay the same

If this sounds familiar, it’s important to know what options still exist.

What Happens If You Miss Medicare Open Enrollment?

If you miss the December 7 deadline, your current Medicare coverage will generally continue into the new year. While this may be fine for some people, others may discover in January that their plan no longer meets their needs due to:

• Higher costs

• Prescription drug changes

• Provider network updates

This is why understanding your remaining options is so important.

Medicare Options That May Still Be Available

Special Enrollment Periods (SEPs)

Certain life events may qualify you for a Special Enrollment Period, allowing you to make changes outside of Open Enrollment. These events may include:

• Moving out of your plan’s service area

• Losing employer or union coverage

• Gaining eligibility for Medicaid or other assistance

• Changes in your current plan’s contract

Eligibility varies, so speaking with a Medicare advisor can help determine if an SEP applies to you.

Medicare Advantage Open Enrollment Period (January 1 – March 31)

If you’re currently enrolled in a Medicare Advantage plan, you may have another opportunity to make changes between January 1 and March 31. During this time, eligible individuals may be able to:

• Switch to a different Medicare Advantage plan

• Return to Original Medicare (with or without Part D)

This period is often overlooked but can be an important second chance for some beneficiaries.

What You Can Do Before the New Year

Review Your Current Medicare Coverage

Even if you can’t make changes immediately, reviewing your plan now can help you prepare. Take time to:

• Review your Annual Notice of Change (ANOC)

• Check prescription drug coverage and costs

• Confirm your doctors and hospitals are still in-network

Understanding what’s changing can prevent surprises in January.

Prepare for January Changes

If your plan’s costs or coverage will change in the new year, knowing ahead of time allows you to:

• Budget for new expenses

• Plan pharmacy changes if needed

• Schedule doctor visits accordingly

Preparation is key to avoiding frustration after the new year begins.

Why Lehigh Valley Residents Should Speak With a Local Medicare Advisor

Medicare rules can be complex, and options vary by location. Working with a local Medicare advisor in the Lehigh Valley means:

• Access to plans available in your area

• Guidance tailored to local doctors and hospitals

• One-on-one support from someone you can reach year-round

A conversation doesn’t mean you’re making changes—it simply helps you understand where you stand.

It’s Not Too Late to Get Help

Missing Medicare Open Enrollment can feel stressful, but it doesn’t mean you’re out of options or out of support. Many Lehigh Valley residents still have opportunities to review their coverage, prepare for upcoming changes, and explore next steps.

If you’re unsure about your Medicare plan or worried about how changes may affect you in the new year, now is the right time to ask questions and get clarity—before January arrives.

Schedule an Appointment Today!