2026 Plans

Medicare Advantage plans are called Part C

Part C combines the benefits of Original Medicare A & B into one plan. When you join a Medicare Advantage plan, the insurance company now pays the claims (which is why these plans are also called Medicare Replacement plans – we replace Medicare as the claims payer).

Medicare Advantage plans usually have a network of doctors that you will use to maximize your benefits and help you control your costs.

Medicare Advantage plans also usually cover things that Original Medicare doesn’t cover – like routine vision and hearing exams, transportation for rides to your doctors, over the counter benefits – even gym memberships. You can also choose a plan that includes coverage for outpatient prescription drugs – which brings us to:

Outpatient prescription drug coverage is called Part D

Part D plans can either be included with your Medicare Advantage plan or as a stand alone plan to go with Original Medicare.

Part D plans provide coverage for your prescription drugs and are offered by insurance companies. Medicare sets the structure of the Part D plans, so the difference between Part D plans are what drugs are covered and how much you’ll pay for them.

Help with drug costs:

Social Security does have a program to assist Medicare beneficiaries that are lower-income called Extra Help or Low-Income Subsidy. Depending on your income (and somewhat on your assets), you may qualify for this program. People that qualify for Extra Help will see lower monthly premiums & generally their copays are at the Catastrophic coverage levels.

If you qualify for Medicaid, your drug costs will be even lower.

Generally you’re eligible to enroll in Medicare when you turn 65 (in fact, if you are collecting Social security benefits, you are automatically enrolled in Medicare A & B). Some people are eligible at a younger age due to a disability. If you are determined to be disabled, you will be automatically enrolled in Medicare A & B.

For simplicity, let’s look at the timelines for someone turning 65. You can start the enrollment process up to 3 months before your 65th birth month. If you are not collecting your Social Security retirement benefits, you can enroll online at www.ssa.gov or in person at your local Social Security Office.

If you are not covered under an employer plan, you will need to enroll in BOTH Medicare A & B to avoid penalties.

If you are still working and are covered under an employer plan (or you are the dependent of an ACTIVE employee), you can delay your Part B enrollment – when you retire, you can enroll in Part B with no penalties. NOTE: You should always check with Social Security to make sure you can delay your enrollment!

Yes! If you do not enroll in Medicare when you are eligible to do so, even though you receive your health care from Indian Health Services, you will still be penalized.