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!

When it comes to Medicare, one of the most common questions people ask is: Should I choose Original Medicare or Medicare Advantage? At Lehigh Valley Medicare Advisors, we help you compare your options so you can make the best decision for your health and budget. In this guide, we’ll break down what Medicare Advantage is, how it works, and what Lehigh Valley residents should know before enrolling.

What Is Medicare Advantage?

Medicare Advantage (also known as Medicare Part C) is an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare, and they combine the benefits of:

• Part A (Hospital Insurance)

• Part B (Medical Insurance)

• Often Part D (Prescription Drug Coverage)

• Additional perks like vision, dental, hearing, and fitness benefits

Medicare Advantage vs. Original Medicare

Key Differences

• Network Restrictions: Medicare Advantage plans typically require you to use doctors and hospitals within the plan’s network.

• Extra Benefits: Unlike Original Medicare, Advantage plans often cover services like dental, vision, and wellness programs.

• Out-of-Pocket Maximums: Medicare Advantage sets a yearly cap on how much you’ll spend, which Original Medicare does not.

Which Is Right for You?

Choosing between Medicare Advantage and Original Medicare depends on your healthcare needs, preferred providers, and budget. Our advisors in the Lehigh Valley can walk you through side-by-side comparisons.

Why Lehigh Valley Residents Choose Medicare Advantage

Healthcare needs in the Lehigh Valley are unique, and so are the Medicare Advantage options available here. Local residents often choose these plans for:

• Access to local provider networks in the Lehigh Valley region

• All-in-one coverage that bundles hospital, medical, and drug coverage

• Extra benefits like hearing aids or dental coverage that Original Medicare doesn’t provide

How to Enroll in a Medicare Advantage Plan

Key Enrollment Periods

• Initial Enrollment Period (IEP): When you first become eligible for Medicare

• Annual Enrollment Period (AEP): October 15 – December 7 each year

• Medicare Advantage Open Enrollment: January 1 – March 31

Getting Expert Help

Medicare rules can feel overwhelming. That’s why working with a local team like Lehigh Valley Medicare Advisors can make the process simple. We’ll help you compare plans, explain the fine print, and ensure you avoid costly mistakes.

Talk to a Lehigh Valley Medicare Advisor Today

Medicare Advantage plans can offer great benefits — but only if you choose the right one for your needs. At Lehigh Valley Medicare Advisors, we specialize in helping residents throughout the region find coverage that fits their lifestyle, healthcare needs, and budget.

👉 Call us today or schedule a consultation to review your Medicare Advantage options.

Navigating Medicare can be complicated, and even small mistakes can lead to higher costs, gaps in coverage, or penalties. Understanding the most common pitfalls and how to avoid them can save you money and ensure you get the healthcare coverage you need.

Mistake 1: Missing Your Initial Enrollment Period (IEP) 

Your Initial Enrollment Period begins 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after.

How to Avoid It 

• Mark your calendar early and enroll as soon as possible.

• If you’re still working and have employer coverage, make sure you understand your Special Enrollment Period options to avoid penalties.

Mistake 2: Not Understanding Medicare Parts 

Medicare has multiple parts: Part A (hospital), Part B (medical), Part C (Medicare Advantage), and Part D (prescription drugs). Many people assume enrolling in Part A is enough.

How to Avoid It 

• Learn which parts you need based on your health, medications, and doctor network.

• Consider a Medicare Advantage plan if you want bundled coverage or Medigap if you want supplemental coverage.

Mistake 3: Delaying Enrollment in Part B or Part D (H2)

Failing to enroll in Part B or Part D on time can lead to lifetime late enrollment penalties.

How to Avoid It 

• Check if you qualify for a Special Enrollment Period (SEP) if you’re still working at 65.

• Keep documentation of your employer coverage to prove creditable coverage.

Mistake 4: Choosing a Plan Without Comparing Costs (H2)

Medicare premiums, deductibles, and copays vary between plans and regions. Choosing the wrong plan can result in unnecessary out-of-pocket costs.

How to Avoid It 

• Use the Medicare Plan Finder tool to compare costs and benefits.

• Review your plan annually during the Open Enrollment Period (Oct 15 – Dec 7) to make adjustments.

Mistake 5: Ignoring Prescription Drug Coverage 

Many people assume their Medicare Advantage plan or employer coverage fully covers all prescriptions. Skipping Part D can result in a late enrollment penalty if you ever drop coverage.

How to Avoid It 

• Check if your medications are on the plan’s formulary before enrolling.

• Consider a standalone Part D plan if you have specific prescription needs.

Mistake 6: Not Checking Provider Networks (H2)

Some Medicare Advantage plans have restricted networks, meaning your preferred doctors or hospitals may not be covered.

How to Avoid It 

• Verify your primary care doctor and specialists are in-network before enrolling.

• If you travel frequently, consider plans with broader networks or nationwide coverage.

Geo-Specific Note on Medicare 

Medicare is federal, but some states have programs that affect coverage:

• Pennsylvania: Medicare Savings Programs can help pay premiums if income is limited.

• California: Medi-Cal works alongside Medicare to reduce out-of-pocket costs.

Check your state health insurance assistance program (SHIP) for local resources.

Final Thoughts 

Avoiding common Medicare mistakes ensures you get the coverage you need without paying unnecessary penalties or out-of-pocket costs. Start early, compare plans carefully, and review your coverage annually.

With a little planning, you can navigate Medicare confidently and focus on your health, not your insurance.

Need Help With Your Medicare? Make an appointment today! 

For many Americans turning 65, one of the biggest questions is whether they need to sign up for Medicare right away—especially if they still have health insurance through their employer. Understanding the rules can save you money, prevent late enrollment penalties, and ensure you don’t have a gap in coverage.

Is Medicare Mandatory at Age 65?

Medicare is not mandatory. However, whether you should sign up at 65 depends on your personal situation. If you don’t enroll when you’re first eligible, you could face permanent late penalties—unless you qualify for a Special Enrollment Period (SEP).

Can I Delay Medicare If I Have Employer Coverage?

Yes, you may be able to delay enrolling in Medicare if you’re still covered by an employer’s health plan. The key factors include the size of your employer and whether your coverage is considered creditable by Medicare standards.

Large Employer Coverage (20+ Employees)

• If your employer has 20 or more employees, you can usually keep your employer’s health insurance and delay Medicare enrollment without penalty.

• Medicare becomes “secondary” insurance, meaning your employer plan pays first.

• Once you retire or lose that coverage, you’ll get a Special Enrollment Period to sign up for Medicare without penalty.

Small Employer Coverage (Fewer Than 20 Employees)

• If your employer has fewer than 20 employees, Medicare usually becomes the primary payer once you turn 65.

• In this case, you should sign up for Medicare Part A and Part B when you’re first eligible to avoid gaps in coverage.

• Not enrolling could leave you with unpaid medical bills, since your employer plan may only cover what Medicare doesn’t.

What About Medicare Part A?

Why Most People Sign Up for Part A at 65

• Part A (hospital insurance) is usually premium-free if you or your spouse paid Medicare taxes while working.

• Since it doesn’t cost most people anything, many choose to enroll at 65 even if they still have employer coverage.

When You Might Delay Part A

• If you’re contributing to a Health Savings Account (HSA), you may want to delay Part A enrollment.

• Once you sign up for Medicare, you can no longer contribute to an HSA.

Penalties for Delaying Medicare Incorrectly

Failing to enroll in Medicare on time can result in permanent penalties:

Part B Penalty

• Your monthly premium increases by 10% for every 12-month period you were eligible but didn’t sign up.

• This penalty lasts as long as you have Part B.

Part D Penalty

• If you go 63 or more days without creditable prescription drug coverage, you’ll face a late enrollment penalty when you sign up for Part D.

Key Takeaways

• Medicare is not mandatory, but delaying enrollment without the right coverage can be costly.

• If your employer has 20+ employees, you can delay Medicare and avoid penalties.

• If your employer has fewer than 20 employees, you generally need to enroll at 65.

• Always review your employer’s coverage to confirm if it’s creditable before deciding to delay Medicare.

Final Thoughts

The decision to delay Medicare depends on your job, your health coverage, and your retirement timeline. If you’re nearing 65, talk to your HR department and review your benefits carefully. Making the right choice now ensures you avoid penalties and have seamless coverage when you need it most.

Need Help With Medicare? Make An Appointment Today!

Enrolling in Medicare is an important milestone as you approach retirement age. But what if you miss your enrollment window? Unfortunately, delaying Medicare enrollment can result in costly lifetime penalties and gaps in health coverage. In this article, we’ll cover what happens if you don’t sign up on time, the penalties you might face, and how to avoid them.

Understanding Medicare Enrollment Periods

Before exploring the consequences, it’s important to understand when you’re supposed to sign up.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is a 7-month window:

• Begins 3 months before the month you turn 65

• Includes your birthday month

• Ends 3 months after your birthday month

Missing this window can lead to late fees and coverage delays.

Special Enrollment Period (SEP)

You may qualify for a Special Enrollment Period if you have credible coverage through an employer (your own or your spouse’s). Once that coverage ends, you have 8 months to sign up for Medicare without penalty.

General Enrollment Period (GEP)

If you miss both your Initial and Special Enrollment Periods, you’ll need to wait for the General Enrollment Period, which runs January 1 to March 31 each year. Coverage begins July 1—and penalties may apply.

Penalties for Not Signing Up on Time

Delaying Medicare doesn’t just affect when your coverage starts—it can also increase your monthly premiums for life.

Part A Penalty

• Most people don’t pay a premium for Part A (hospital insurance).

• If you do need to pay (because you don’t have enough work credits), your premium may go up 10% for twice the number of years you delayed enrollment.

Part B Penalty

• Part B (medical insurance) has a standard monthly premium.

• If you miss enrollment, your premium increases by 10% for every 12-month period you were eligible but didn’t sign up.

• This penalty is permanent—you’ll pay it as long as you have Medicare.

Part D Penalty

• Part D (prescription drug coverage) penalties apply if you go 63 days or more without drug coverage.

• The penalty is 1% of the national base premium multiplied by the number of months you delayed.

• Like Part B, this penalty is lifetime.

Coverage Delays if You Miss Enrollment

Even beyond penalties, missing your enrollment period means you could be without health insurance for months. For example, if you miss your Initial Enrollment Period and apply during the General Enrollment Period in January, your coverage won’t start until July 1—leaving a dangerous gap.

How to Avoid Medicare Late Penalties

Fortunately, you can avoid these issues with proper planning.

Mark Your Calendar Early

Know your Initial Enrollment Period and set reminders months in advance.

Confirm Employer Coverage

If you’re still working at 65, make sure your employer coverage counts as credible coverage so you won’t face penalties when you eventually switch.

Seek Professional Guidance

Medicare can be complicated. Working with a licensed Medicare advisor or using official resources like Medicare.gov can help ensure you enroll correctly and on time.

Final Thoughts

Missing your Medicare enrollment deadline can be costly. Late penalties for Parts A, B, and D can follow you for life, and coverage gaps could leave you without protection when you need it most. By understanding enrollment periods and planning ahead, you can avoid unnecessary fees and make the transition to Medicare smooth and stress-free.

Need Help With Medicare? Make An Appointment Today!

One of the most common questions people ask as they approach age 65 is: “Do I need to retire to qualify for Medicare?” The answer is no. Medicare eligibility is based on age or certain health conditions—not on whether you’re retired. Let’s break down how it works, especially if you’re planning to keep working past 65.

Medicare Eligibility Basics

Age-Based Medicare Eligibility

• Most people qualify for Medicare at age 65.

• Retirement is not required to start Medicare coverage.

Medicare for People Under 65

• Individuals may qualify earlier due to certain disabilities.

• Conditions like End-Stage Renal Disease (ESRD) or ALS can also make someone eligible before 65.

Do You Have to Be Retired to Get Medicare?

Medicare and Social Security Retirement Benefits

Medicare and Social Security are often linked in people’s minds, but they are separate programs. You don’t have to begin Social Security retirement benefits to enroll in Medicare.

Working Past Age 65

• Many people continue working after turning 65.

• You can enroll in Medicare even if you remain employed.

• Since Medicare Part A (hospital insurance) is usually premium-free, many workers sign up while keeping their employer health coverage.

Medicare Enrollment When You’re Still Working

Employer Coverage vs. Medicare

• If you have health insurance through your employer (or your spouse’s employer), you may be able to delay Medicare Part B (medical insurance) without penalty.

• The key is whether your employer coverage is considered “creditable coverage.”

Avoiding Medicare Late Enrollment Penalties

• If you don’t have creditable coverage and delay enrollment, you could face permanent penalties.

• It’s important to review your options carefully before deciding whether to delay Medicare.

Key Takeaways

• You do not need to retire to qualify for Medicare.

• Eligibility typically begins at 65, regardless of employment status.

• Employer coverage may influence whether you should enroll right away.

• Delaying Medicare without creditable coverage can lead to penalties.

Bottom Line:

Medicare eligibility is based on age or qualifying health conditions—not retirement. Whether you’re still working or fully retired, understanding how Medicare coordinates with your health coverage can save you money and help you avoid penalties.

Have Questions Regarding Medicare? 

Make an appointment with one of our professionals today. 

Introduction

• Navigating Medicare can be overwhelming.

• Common question: What is Medigap and do I need it?

• This guide explains what Medigap is, how it works, and who it’s for.

What Is Medigap?

Definition

• Medigap = Medicare Supplement Insurance

• Private insurance that helps pay for costs not covered by Original Medicare (Parts A & B)

Costs Covered by Medigap

• Copayments

• Coinsurance

• Deductibles

Purpose of Medigap

• Reduces out-of-pocket costs

• Provides predictable healthcare expenses

How Does Medigap Work?

Coordination with Medicare

• Medicare pays its share of approved healthcare costs.

• Medigap pays its share based on plan coverage.

Important Notes

• Only works with Original Medicare (not Medicare Advantage).

• Must be enrolled in Medicare Part A & B.

• Policies sold by private companies but standardized federally.

What Do Medigap Plans Cover?

Standardized Plans

• Labeled A, B, C, D, F, G, K, L, M, N

• Each plan offers different levels of coverage

Typical Coverage Includes

• Part A coinsurance & hospital costs

• Part B coinsurance or copayments

• Blood (first 3 pints)

• Part A hospice care coinsurance/copayment

• Skilled nursing facility coinsurance

• Part A &/or Part B deductibles (depending on plan)

• Emergency care abroad

Availability Notes

• Not all plans available in every state

• Some plans (e.g., Plan F) only available to those eligible before 2020

What Medigap Doesn’t Cover

• Prescription drugs (need Part D)

• Long-term care

• Dental, vision, hearing

• Private-duty nursing

When Should You Enroll in Medigap?

Open Enrollment Period

• Six months starting the month you’re 65 and enrolled in Part B

Benefits of Enrolling Early

• Guaranteed acceptance regardless of pre-existing conditions

• Avoids medical underwriting later

Medigap vs. Medicare Advantage

Key Differences

• Medigap supplements Original Medicare

• Medicare Advantage replaces Original Medicare, often including extra benefits

Important Note

• Cannot have Medigap and Medicare Advantage at the same time

• Consider which option aligns best with budget and healthcare needs

Is Medigap Right for You?

Ideal Candidates

• Want predictable healthcare costs

• Travel frequently (some plans cover international care)

• Prefer flexibility in choosing doctors/hospitals

Alternatives

• Medicare Advantage if you want vision, dental, or prescription coverage bundled

Final Thoughts

• Medigap reduces surprise medical bills and ensures manageable healthcare costs

• Compare options carefully

• Consult a trusted advisor to select the best plan

Need Help With Medicare?

Make an appointment with one of our professionals!

Overview of 2025 Medicare Costs

• Brief introduction to Medicare cost changes in 2025
• Why knowing premiums and deductibles matters for retirees in the Lehigh Valley

Medicare Part B Costs for 2025

Standard Monthly Premium

• 2025 premium amount: \$185/month
• Comparison to 2024’s \$174.70/month premium
• What this increase means for most beneficiaries

Part B Deductible

• 2025 deductible amount: \$257/year
• How the deductible works and when you pay it

Coinsurance and Out-of-Pocket Costs

• 20% coinsurance rule
• Examples of common Part B services

 Medicare Part A Costs for 2025

Premium-Free Part A

• Who qualifies for \$0 monthly premium
• Work history requirements

Premiums for Those Without Enough Work Credits

• Full premium: \$518/month (fewer than 30 quarters of coverage)
• Reduced premium: \$285/month (30–39 quarters of coverage)

Other Factors That May Affect Your Medicare Premium

Higher Income Premium Adjustments (IRMAA)

• Income thresholds and how they impact Part B and Part D premiums
• 2025 IRMAA surcharge ranges

Late Enrollment Penalties

• How penalties are calculated
• Strategies to avoid these costs

Medicare Advantage (Part C) Costs in 2025

• Average premium trends (slight decrease for 2025)
• Why costs vary by plan and location

Medicare Prescription Drug Plan (Part D) Costs in 2025

• Variation by plan and income level
• How to compare plans in the Lehigh Valley for best value

How Lehigh Valley Medicare Advisors Can Help You Save

• Personalized plan comparisons
• Guidance on avoiding penalties and excess costs
• Annual plan review for cost efficiency

Final Thoughts

• Summary of key 2025 Medicare cost changes
• Encouragement to review coverage before annual enrollment

Get Personalized Medicare Guidance Today

Ready to see how these 2025 Medicare changes affect you?

Contact Lehigh Valley Medicare Advisors for a free, no-obligation consultation.

We’ll help you:

• Compare plans side-by-side
• Identify ways to lower your out-of-pocket costs
• Avoid costly penalties
  📞 Call us today at 610-973-5334 or register for a obligation Free Consultation.