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!

Medicare Annual Enrollment is winding down, and the December 7th deadline is fast approaching. Many beneficiaries rush to make changes without fully understanding their options, which can lead to costly mistakes. At Lehigh Valley Medicare Advisors, we want to help you avoid these pitfalls and make the most of your Medicare coverage.

Below are the five most common Medicare mistakes people make at the end of open enrollment and practical tips to avoid them.

Mistake 1 — Not Reviewing Plan Changes for 2025

Why This Happens

Insurance providers often update their premiums, deductibles, and coverage rules each year. Many people assume their plan stays the same, leading to surprises in January.

How to Avoid It

• Review the Annual Notice of Change (ANOC) sent by your plan.

• Compare your current plan to new offerings using Medicare’s Plan Finder.

• Contact a trusted advisor to see if a switch could save money or improve coverage.

Mistake 2 — Ignoring Prescription Drug Coverage

Why This Happens

Medicare Part D formularies can change yearly, meaning your medications may no longer be covered or could cost more.

How to Avoid It

• Make a list of all prescriptions and check if they’re still covered.

• Compare copays and tiers for your medications across available plans.

• Consider a plan with a better drug coverage fit if costs are increasing.

Mistake 3 — Waiting Too Long to Make Changes

Why This Happens

Procrastination is common, and some beneficiaries wait until the last minute or miss the deadline entirely, locking them into an unsuitable plan for the next year.

How to Avoid It

• Set a reminder: December 7th, 2025, is the final day to make changes.

• Start reviewing options now to avoid rushed decisions.

• Work with a Medicare advisor who can streamline the process.

Mistake 4 — Focusing Only on Premiums

Why This Happens

It’s easy to choose a plan based solely on monthly costs, but this can backfire if your deductible, copays, or network restrictions are high.

How to Avoid It

• Look at total annual costs, including premiums, copays, and coinsurance.

• Check if your preferred doctors and pharmacies are in-network.

• Consider coverage quality and benefits beyond the premium.

Mistake 5 — Overlooking Extra Benefits

Why This Happens

Many Medicare Advantage plans offer extras like dental, vision, or hearing coverage, but beneficiaries often ignore these perks.

How to Avoid It

• Review your plan for any additional benefits that can save money.

• Ask your advisor about supplemental plans if your current plan lacks these benefits.

• Evaluate if extra perks align with your health needs for the coming year.

How Lehigh Valley Medicare Advisors Can Help

Avoiding these common mistakes doesn’t have to be stressful. At Lehigh Valley Medicare Advisors, we guide you through your options, review your current coverage, and ensure you make informed decisions before the December 7th, 2025 deadline.

Contact us today to schedule a free, no-pressure consultation and protect your Medicare coverage for 2025.

How Medicare Covers Preventive Care and Why You Shouldn’t Skip It

Staying healthy is important at every age, but as we get older, preventive care becomes even more crucial. Many people don’t realize that Medicare offers a variety of preventive services at little or no cost. Taking advantage of these services can help you catch health issues early, reduce long-term medical costs, and maintain a better quality of life.

In this guide, we’ll explain what preventive care Medicare covers, why it’s essential, and how you can make the most of it.

What Is Preventive Care in Medicare?

Preventive care refers to medical services aimed at preventing illnesses or detecting health problems early, before they become more serious. Medicare recognizes that prevention is better than treatment, which is why many preventive services are covered at 100% when you use in-network providers.

Medicare Preventive Services You Should Know About

Medicare covers a wide range of preventive services. Some of the most important include:

1. Annual Wellness Visit

• A yearly check-up with your doctor to develop or update a personalized prevention plan.

• Covers health risk assessments, screenings, and counseling.

• No copay or deductible for this visit.

2. Screenings for Cancer

• Colorectal cancer: Colonoscopy, stool tests, or other screening methods.

• Breast cancer: Mammograms for women.

• Cervical and vaginal cancer: Pap tests and pelvic exams.

• Early detection can dramatically improve treatment outcomes.

3. Cardiovascular and Diabetes Screenings

• Blood pressure, cholesterol, and glucose tests.

• Prevent or manage chronic conditions before they worsen.

4. Vaccinations

• Flu shots, pneumonia vaccines, shingles vaccines, and hepatitis B vaccines are covered.

• Staying up-to-date on vaccines protects you and those around you.

5. Bone Mass Measurement

• Recommended for people at risk of osteoporosis.

• Early detection can prevent fractures and improve mobility.

Why You Shouldn’t Skip Preventive Care

Skipping preventive care can have serious consequences:

• Delayed diagnosis: Health problems like cancer or heart disease may go unnoticed until they become severe.

• Higher costs: Treating advanced conditions often costs more than prevention or early intervention.

• Lower quality of life: Managing chronic diseases early can help you stay active and independent longer.

Even if you feel healthy, preventive care ensures you’re not missing hidden health issues.

How to Make the Most of Medicare Preventive Services

1. Schedule your annual wellness visit every year.

2. Keep track of recommended screenings and vaccines based on your age and risk factors.

3. Work with a local Medicare advisor to understand what’s covered and avoid unexpected costs.

4. Ask questions about your health and prevention plan during every visit.

Lehigh Valley Medicare Advisors Can Help

Navigating Medicare can be confusing, but you don’t have to do it alone. Lehigh Valley Medicare Advisors helps you understand your benefits, schedule preventive services, and choose the right plan for your needs. Make an Appointment with One of Our Professionals Today! 

Take control of your health today—don’t skip your preventive care!

Understanding Medicare Advantage vs. Supplements: What Most People Get Wrong During AEP

When the Medicare Annual Enrollment Period (AEP) rolls around from October 15 to December 7, many people rush to compare plans—only to realize they’re confused about the biggest decision of all: Medicare Advantage vs. Medicare Supplements (Medigap).

If you’re feeling overwhelmed, you’re not alone. Every year, thousands of Medicare beneficiaries in the Lehigh Valley make the wrong choice simply because they misunderstand how these two types of coverage actually work.

This guide breaks everything down so you can make a confident, informed decision before AEP ends.

What Is Medicare Advantage?

Medicare Advantage (Part C) is an “all-in-one” alternative to Original Medicare. Private insurance companies bundle your hospital (Part A) and medical (Part B) coverage—and often include extras.

Key Features of Medicare Advantage

• Lower or $0 monthly premiums

• Co-pays and out-of-pocket costs as you go

• Includes limits on annual out-of-pocket spending

• Often includes dental, vision, hearing, OTC credits, and gym benefits

• Uses provider networks like HMO or PPO

Who Medicare Advantage Works Best For

• People who want lower monthly costs

• Those comfortable staying within a provider network

• Individuals who want extra benefits not included in Medicare Supplement plans

What Is a Medicare Supplement (Medigap)?

Medicare Supplement plans work alongside Original Medicare, paying for the gaps—like deductibles, coinsurance, and certain out-of-pocket costs.

Key Features of Medigap Plans

• Higher monthly premiums compared to Advantage

• Very low or no out-of-pocket costs when receiving care

• No provider networks—any doctor nationwide who accepts Medicare

• No extra benefits like dental or vision unless paired with separate plans

Who Medigap Works Best For

• People who travel or split time between states

• Individuals with chronic health conditions or high healthcare usage

• Anyone who wants predictable, low out-of-pocket costs

What Most People Get Wrong During AEP

The biggest confusion during AEP is thinking Medicare Advantage and Medicare Supplements can work together. They cannot be used at the same time.

Here are the top mistakes we see every year:

Mistake #1 — Thinking You Can Have Both

You must choose one or the other:

• Medicare Advantage replaces Original Medicare

• Medicare Supplement works with Original Medicare

You cannot enroll in both.

Mistake #2 — Choosing Based on Monthly Premium Only

Many people choose a Medicare Advantage plan because it has a $0 premium—but forget to look at:

• Co-pays

• Specialist costs

• Out-of-network charges

• Medication formularies

Sometimes a low monthly premium leads to a high yearly cost.

Mistake #3 — Not Checking Doctor Networks

Networks change every year. During AEP, always verify:

• Is your doctor still in-network?

• Are your specialists covered?

• Are your preferred hospitals included?

Even small network changes can affect your entire plan experience.

Mistake #4 — Assuming Supplements Are “Too Expensive”

While Medigap premiums can be higher, many people end up spending less overall because:

• Most plans cover nearly all medical costs

• There are no surprise bills

• You avoid co-pays and coinsurance

Total annual cost often matters more than monthly cost.

How to Decide Which Option Is Best for You

There is no one-size-fits-all answer, but here’s a simple breakdown:

Choose Medicare Advantage If You Want:

• Lower or $0 premiums

• Extra benefits like dental or vision

• A more “all-in-one” style plan

• Predictable out-of-pocket caps

• Local network-based care

Choose a Medicare Supplement If You Want:

• The freedom to see any Medicare-accepting doctor in the U.S.

• Very low out-of-pocket costs

• Coverage that does not change year to year

• A plan that travels with you

• Easy access to specialists without referrals

Still Unsure? Get Personalized Help Before AEP Ends

Choosing between Medicare Advantage and a Medicare Supplement is one of the most important decisions you’ll make for your health and finances. And it’s something you shouldn’t have to guess on—especially with deadlines approaching.

At Lehigh Valley Medicare Advisors, we:

• Compare plans from multiple carriers

• Review your doctors, prescriptions, and budget

• Explain the differences in simple terms

• Help you avoid common mistakes during AEP

You deserve a plan that fits your life, not just the cheapest or the one with the most ads.

Make An Appointment Today!

What Is Medicare Open Enrollment?

Each year, Medicare Open Enrollment runs from October 15 through December 7. During this period, anyone with Medicare can review their current coverage and make changes for the upcoming year.

It’s your once-a-year opportunity to ensure your plan still fits your needs—especially if your health, prescriptions, or financial situation have changed. The decisions you make now will take effect January 1, 2026.

Why Open Enrollment Matters

Medicare plans can change each year, including premiums, deductibles, prescription coverage, and provider networks. Reviewing your options during Open Enrollment helps you:

• Avoid paying for unnecessary coverage

• Make sure your preferred doctors and prescriptions are still included

• Find a plan that better fits your healthcare and budget needs

Even if you’re happy with your current plan, it’s smart to review it annually to avoid surprises in the new year.

What Changes Can You Make During Medicare Open Enrollment?

Switch Between Original Medicare and Medicare Advantage

You can move from:

• Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C)

• Medicare Advantage back to Original Medicare

Change Medicare Advantage Plans

If you’re already enrolled in a Medicare Advantage plan, you can switch to another plan that may offer better coverage, lower premiums, or different provider networks.

Review or Change Your Part D Prescription Drug Plan

Prescription drug coverage can vary widely from year to year. Reviewing your Part D plan ensures that your medications remain covered at the best cost.

Key Deadlines to Remember

• October 15: Medicare Open Enrollment begins

• December 7: Last day to make changes for 2026 coverage

• January 1, 2026: New coverage starts

Missing the December 7 deadline means you’ll likely need to wait until next year’s Open Enrollment period to make changes—unless you qualify for a Special Enrollment Period.

How to Prepare for Medicare Open Enrollment

Review Your Current Coverage

Look for any Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) letters from your current provider. These outline changes to costs, coverage, or benefits for the upcoming year.

Compare New Plan Options

Use the Medicare Plan Finder tool or speak with a trusted Medicare advisor to compare plans side-by-side. Make sure to check:

• Monthly premiums

• Deductibles and copays

• Provider networks

• Prescription drug formularies

Check for New Benefits

Many Medicare Advantage plans now include additional benefits like vision, hearing, dental, and fitness programs. Reviewing these can help you find added value and savings.

Why Work with a Medicare Advisor

Navigating Medicare on your own can be overwhelming—especially with new rules and changes each year. A licensed Medicare advisor can help you:

• Understand your coverage options

• Compare costs and benefits across plans

• Avoid penalties and coverage gaps

• Find the plan that best fits your healthcare and financial goals

Don’t Wait Until the Last Minute

The December 7 Medicare Open Enrollment deadline will arrive faster than you think. Taking time now to review your plan can help you avoid costly surprises and ensure you’re set up for a healthy, worry-free year ahead.

Meet With One of Our Advisors Today! 

Many Americans nearing age 65 ask the same question: “Is Medicare free?” While Medicare helps millions of seniors and individuals with disabilities access affordable healthcare, it isn’t completely free. Understanding what you’ll pay—and what you’ll get—is essential for budgeting your healthcare costs in retirement.

What Is Medicare?

Medicare is a federal health insurance program primarily for people age 65 and older, as well as certain younger individuals with disabilities. It’s divided into several parts, each covering different types of care—hospital stays, doctor visits, prescriptions, and more.

Is Medicare Free?

Medicare Part A: Often Free, But Not Always

Part A covers inpatient hospital care, skilled nursing, hospice, and limited home health services.

• Most people don’t pay a premium for Part A because they or their spouse paid Medicare taxes for at least 10 years (40 quarters).

• If you haven’t met that requirement, you’ll pay a monthly premium of up to $505 in 2024 (subject to change each year).

Even if your Part A premium is free, there are still out-of-pocket costs:

• Deductible: $1,632 per benefit period (2024)

• Coinsurance: $408 per day for hospital stays over 60 days

So while Part A may seem free, you could still owe money when you receive care.

Medicare Part B: Always Comes With a Premium

Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.

• The standard Part B premium in 2024 is $174.70 per month, though higher-income beneficiaries pay more.

• You’ll also pay an annual deductible ($240 in 2024), and typically 20% coinsurance for most services after meeting your deductible.

💡 Tip: You can have your Part B premium automatically deducted from your Social Security check to make payments easier.

Medicare Part C (Medicare Advantage): Costs Vary by Plan

Medicare Advantage (Part C) is an all-in-one alternative offered by private insurance companies approved by Medicare.

• You’ll still pay your Part B premium, plus any additional plan premium (some plans cost $0).

• Out-of-pocket costs depend on your plan’s copays, network rules, and maximum limits.

• Many Advantage plans include extra benefits like dental, vision, hearing, or prescription coverage.

Because pricing and benefits differ by area and provider, it’s wise to compare plans each year during Medicare’s Annual Enrollment Period (Oct 15 – Dec 7).

Medicare Part D: Prescription Drug Coverage

Part D helps cover prescription medications through private insurance companies.

• Monthly premiums vary by plan, averaging around $34 per month (2024).

• You’ll pay an annual deductible (no more than $545 in 2024), plus copays or coinsurance on medications.

💊 Note: Higher-income beneficiaries may owe an “income-related monthly adjustment amount” (IRMAA) for Part D.

Other Medicare Costs to Consider

Medigap (Medicare Supplement Insurance)

Even with Parts A and B, there are gaps—like deductibles and coinsurance. A Medigap plan can help cover those extra costs.

• Monthly premiums range from $50 to $300+, depending on your plan, age, and location.

• Medigap plans are sold by private insurers and can’t be combined with Medicare Advantage.

Late Enrollment Penalties

Failing to sign up for Medicare on time can lead to permanent penalties:

• Part B penalty: 10% added to your premium for every 12 months you delayed.

• Part D penalty: 1% added per month you went without creditable drug coverage.

These penalties last for life, so enrolling on time can save you thousands over the years.

Key Takeaway: Medicare Isn’t Free—But It’s Worth It

While Medicare offers substantial coverage and financial relief, it’s not without costs. You’ll still pay monthly premiums, deductibles, and coinsurance, depending on your plan. The good news? Medicare typically costs far less than private health insurance, especially for retirees on a fixed income.

By understanding your options and planning ahead, you can minimize your healthcare expenses and make Medicare work for your needs.

Need Help Comparing Medicare Costs?

At Lehigh Valley Medicare Advisors, we help you navigate your Medicare and retirement planning with confidence. Whether you’re looking to lower costs, compare plan options, or integrate healthcare expenses into your financial strategy—our advisors are here to help.

Contact us today to schedule a personalized Medicare and retirement review.

If you’re planning a trip — whether it’s across the country or across the globe — it’s important to understand how your Medicare coverage works when you’re away from home. Medicare offers excellent benefits for U.S. residents, but those benefits can vary depending on where you travel and what kind of plan you have.

This guide breaks down what’s covered, what’s not, and how to stay protected while traveling.

Medicare Coverage While Traveling Within the United States

When you travel within the U.S. and its territories, you can typically use your Medicare coverage without any issues.

Where You’re Covered

Medicare coverage applies anywhere in:

• All 50 states

• The District of Columbia

• Puerto Rico

• Guam

• The U.S. Virgin Islands

• American Samoa

• The Northern Mariana Islands

As long as your healthcare provider accepts Medicare, your coverage works the same as it does at home.

Original Medicare (Parts A & B)

If you have Original Medicare, you can visit any doctor or hospital that accepts Medicare nationwide — no referrals or network restrictions required.

This is especially convenient for retirees who travel frequently or live part-time in another state.

Medicare Advantage (Part C)

If you have a Medicare Advantage plan, coverage can depend on your provider network.

• HMO plans often limit coverage to in-network providers, except in emergencies.

• PPO plans usually allow out-of-network care at a higher cost.

Before you travel, check your plan’s policy for out-of-area coverage to avoid unexpected bills.

Medicare Coverage While Traveling Outside the United States

Medicare coverage outside the U.S. is very limited.
In most cases, Medicare does not pay for medical care you receive abroad, but there are a few exceptions.

Limited Exceptions

Medicare may cover care outside the U.S. only if:

1. You’re in the U.S. when a medical emergency occurs, and the nearest hospital that can treat you is in a foreign country (e.g., you’re in Canada near the border).

2. You’re traveling between Alaska and another U.S. state, and a foreign hospital is closer than the nearest U.S. hospital.

3. You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital (rare cases near the border).

Outside of these limited cases, you’ll likely pay 100% of the costs out of pocket.

How to Get Travel Medical Coverage Abroad

Since traditional Medicare rarely covers foreign travel, many retirees and travelers choose to supplement their coverage.

1. Medigap Plans

Some Medigap (Medicare Supplement) plans — specifically Plans C, D, F, G, M, and N — offer foreign travel emergency coverage.
These plans typically cover 80% of eligible emergency care costs after you meet a small deductible, for care received within the first 60 days of your trip.

2. Medicare Advantage Plans with Travel Benefits

Certain Medicare Advantage plans include worldwide emergency coverage. Always confirm the details with your insurer before leaving the country, since benefits and limits vary by plan.

3. Travel Health Insurance

Even if you have Medigap or Advantage coverage, consider purchasing travel medical insurance for added peace of mind.
These policies can cover:

• Emergency medical care

• Medical evacuation or air transport

• Trip cancellation or interruption

• Lost baggage or travel delays

Tips for Traveling with Medicare

Before you pack your bags, keep these travel tips in mind:

• Bring your Medicare card and a copy of your supplemental insurance card.

• Contact your plan provider to verify out-of-area or foreign travel coverage.

• Locate nearby hospitals in your destination before you go.

• Keep receipts and documentation if you pay for care abroad — you may be able to submit them for partial reimbursement.

• Consider additional coverage if you’re traveling internationally for an extended period.

The Bottom Line

You can confidently use Medicare while traveling within the United States, but coverage outside the U.S. is limited. To avoid unexpected expenses abroad, consider a Medigap plan, a Medicare Advantage plan with global coverage, or travel insurance that protects you wherever you go.

At Lehigh Valley Medicare Advisors, we help clients understand their healthcare and retirement options — including how Medicare fits into their long-term plans.
If you have questions about how to protect your health (and your finances) while traveling, we’re here to help.

Medicare can be confusing — especially when it comes to when and how you can make changes to your coverage. If you’ve chosen a Medicare plan and later realize it’s not the right fit, you might wonder: Can I change my Medicare plan mid-year?

The answer depends on the type of plan you have and your specific situation. Let’s break down when you can make changes, what options you have, and how to avoid costly coverage gaps.

When Can You Change Your Medicare Plan?

Generally, you can only change Medicare plans during certain times of the year — but there are a few exceptions that allow mid-year changes. Understanding these Medicare enrollment periods will help you know when you can switch.

1. Annual Enrollment Period (AEP)

• Dates: October 15 – December 7

• What you can do:

  • Switch from Original Medicare to a Medicare Advantage plan (Part C)

  • Switch from Medicare Advantage back to Original Medicare

  • Change or add a Part D prescription drug plan

Changes made during this period go into effect on January 1 of the following year.

Even though it’s not technically “mid-year,” this is the main window for making adjustments to your coverage each year.

2. Medicare Advantage Open Enrollment Period (MA OEP)

• Dates: January 1 – March 31

• Who it’s for: People already enrolled in a Medicare Advantage plan.

• What you can do:

  • Switch to another Medicare Advantage plan

  • Drop your Medicare Advantage plan and return to Original Medicare

  • Add a standalone Part D drug plan if you return to Original Medicare

This period allows a one-time plan change per year — perfect if you realize early in the year your Advantage plan isn’t what you expected.

3. Special Enrollment Periods (SEPs)

This is where mid-year plan changes become possible. You may qualify for a Special Enrollment Period if certain life events occur. SEPs let you make changes outside of the standard enrollment windows.

Common reasons you may qualify for an SEP include:

• Moving to a new address that’s outside your plan’s service area

• Losing employer or union coverage

• Qualifying for Medicaid or Extra Help

• Your plan terminates its contract with Medicare

• Significant changes to your plan’s costs or coverage

Each situation comes with its own SEP rules and time limits, usually lasting 2–3 months from the qualifying event.

What If I Want to Change My Part D (Prescription Drug) Plan?

If you only want to switch your Medicare Part D drug plan, you can do so during:

• The Annual Enrollment Period (Oct 15 – Dec 7), or

• If you qualify for a Special Enrollment Period.

For example, if you move to a new state or lose other prescription coverage, you’ll have a window to make changes mid-year.

Can I Switch from Medicare Advantage Back to Original Medicare Mid-Year?

Yes — but only during certain times:

• During MA Open Enrollment (Jan 1 – Mar 31), or

• If you qualify for a Special Enrollment Period.

When you switch back to Original Medicare, you can also enroll in a Medicare Supplement (Medigap) plan. However, keep in mind that depending on your state and situation, you might need to go through medical underwriting to be accepted for Medigap coverage.

How to Change Your Medicare Plan

If you qualify for an enrollment period and want to make a change, here’s what to do:

1. Review your current coverage – Identify what’s not working (costs, network, prescriptions, etc.).

2. Compare new plans – Use Medicare.gov’s Plan Finder or work with a licensed Medicare advisor.

3. Check for penalties or coverage gaps – Make sure your switch won’t leave you without drug coverage or duplicate benefits.

4. Enroll in your new plan – Once approved, your new plan typically starts the first of the following month.

Why Reviewing Your Medicare Plan Matters

Your healthcare needs and financial situation can change — and so can Medicare plan options. Reviewing your plan annually ensures:

• You’re not overpaying for premiums or prescriptions

• Your preferred doctors and pharmacies remain in-network

• You’re taking advantage of updated plan benefits

Final Thoughts

So, can you change your Medicare plan mid-year?
Yes — but only if you qualify for a Special Enrollment Period or are within a defined Medicare enrollment window.

If you’re unsure whether you’re eligible to make changes or which plan fits your current needs, the licensed professionals at Lehigh Valley Medicare Advisors can help you review your options, compare plans, and ensure you’re getting the coverage and value you deserve.

Make An Appointment Today!