Jason Rubin Insurance Services LLC

Choosing a Medicare plan can feel overwhelming. Beneficiaries must decide between Original Medicare and Medicare Advantage, evaluate prescription drug coverage, compare provider networks, and understand out-of-pocket costs. A licensed Medicare broker helps simplify this process by explaining how the different parts of Medicare work and presenting plan options available in a specific area. Brokers are certified to represent plans regulated by the Centers for Medicare & Medicaid Services, ensuring they follow federal guidelines when educating and enrolling clients. One major advantage of working with a broker is access to multiple insurance carriers. Instead of calling several companies individually, a broker can compare benefits, premiums, provider networks, drug formularies, and out-of-pocket maximums side by side. This broader view helps individuals make informed decisions based on their doctors, medications, travel habits, and budget. Brokers can also explain important enrollment periods, help avoid late enrollment penalties, and assist with applications to ensure paperwork is completed correctly. Beyond enrollment, many brokers provide ongoing service throughout the year. If a client’s medications change, a doctor leaves a network, or annual plan changes occur during the Medicare Annual Enrollment Period, a broker can review options and recommend adjustments if needed. Because broker compensation is typically paid by the insurance company and does not increase the plan’s premium, beneficiaries often gain professional guidance at no additional cost. Working with a knowledgeable broker can provide clarity, confidence, and long-term support when navigating Medicare decisions.

**Do You Need Medicare Parts A and B If You Have Employer Coverage?** If you are age 65 or older and still covered under an employer group health plan—either through your own active employment or your spouse’s—you may not need to enroll in Medicare Parts A and B right away. Whether you should enroll depends largely on the size of the employer. If the employer has 20 or more employees, the group health plan typically pays primary and Medicare pays secondary, allowing you to delay Part B without penalty. Enrollment decisions are coordinated through the Social Security Administration, which administers Medicare enrollment rules and Special Enrollment Periods. Many individuals choose to enroll in premium-free Part A at age 65 because it usually does not cost anything if you have sufficient work history. However, those contributing to a Health Savings Account (HSA) should be cautious, since enrolling in any part of Medicare generally makes you ineligible to continue HSA contributions. Part B, which has a monthly premium, is often delayed if you have creditable employer coverage. If the employer has fewer than 20 employees, Medicare typically becomes primary at age 65, and delaying Part B could result in coverage gaps and potential late enrollment penalties. When employment or employer coverage ends, you qualify for a Special Enrollment Period to enroll in Part B without penalty. This period generally lasts eight months from the date employment or group coverage ends, whichever comes first. Making the right decision requires reviewing how your employer coverage coordinates with Medicare, the cost of Part B premiums, and your overall healthcare needs. Evaluating these factors carefully helps ensure continuous coverage and avoids unexpected penalties later.

A Medicare Supplement plan, also known as Medigap, is private insurance designed to help cover the out-of-pocket costs left behind by Original Medicare. While Medicare Part A and Part B cover a large portion of hospital and medical expenses, beneficiaries are still responsible for deductibles, copayments, and coinsurance. Medicare Supplement plans help pay some or most of those remaining costs, providing greater financial predictability. These plans are standardized and regulated under federal guidelines overseen by the Centers for Medicare & Medicaid Services, meaning the benefits for each plan letter are the same regardless of the insurance company offering it. Medicare Supplement plans are identified by letters, such as Plan G, Plan N, and others, with each letter offering a different level of coverage. For example, some plans cover nearly all Medicare-approved out-of-pocket costs, while others require modest copayments in exchange for lower premiums. Unlike Medicare Advantage plans, Medigap policies do not use provider networks—beneficiaries may see any doctor or hospital nationwide that accepts Medicare. However, Medicare Supplement plans do not include prescription drug coverage, so beneficiaries typically enroll separately in a standalone Medicare Part D plan if they need medication coverage. Enrollment timing is especially important with Medicare Supplement plans. The best time to enroll is during the six-month Medigap Open Enrollment Period that begins when a person is age 65 or older and enrolled in Medicare Part B. During this window, applicants generally cannot be denied coverage or charged higher premiums due to health conditions. After this period, medical underwriting may apply in most states. Understanding how Medicare Supplement plans work allows beneficiaries to decide whether predictable out-of-pocket costs and nationwide provider flexibility align with their healthcare and financial goals.

Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. Instead of receiving coverage directly from the federal government under Original Medicare (Part A and Part B), beneficiaries enroll in a Medicare Advantage plan offered by a private carrier that contracts with the Centers for Medicare & Medicaid Services. These plans are required to provide at least the same level of coverage as Original Medicare but often include additional benefits such as dental, vision, hearing, and fitness programs. Most Medicare Advantage plans operate as managed care plans, such as HMOs or PPOs, meaning members may need to use a network of doctors and hospitals and may require referrals for specialist care. Many plans also include prescription drug coverage (Part D), bundling medical and drug benefits into one plan with a single member ID card. Unlike Original Medicare, which has no annual out-of-pocket maximum for medical services, Medicare Advantage plans must include a yearly maximum limit on out-of-pocket costs for Part A and Part B services, providing an added layer of financial protection. While Medicare Advantage plans can offer lower monthly premiums and extra benefits, they may also have different provider networks, prior authorization requirements, and cost-sharing structures compared to Original Medicare. Plan availability and benefits vary by county, so individuals should carefully compare options during their enrollment period. Understanding how Medicare Advantage works helps beneficiaries decide whether a bundled, managed care approach or the flexibility of Original Medicare better fits their healthcare needs and budget.

Enrolling in Medicare begins with understanding eligibility and timing. Most individuals qualify for Medicare at age 65, while some may qualify earlier due to disability or certain medical conditions. Enrollment in Medicare Parts A and B is handled through the Social Security Administration, not directly through Medicare itself. Individuals who are already receiving Social Security retirement benefits at least four months before turning 65 are typically enrolled automatically in Part A (hospital insurance) and Part B (medical insurance), and their Medicare card is mailed to them before their coverage begins. For those not automatically enrolled, there are several ways to sign up. Individuals can apply online at SSA.gov, call the Social Security Administration, or schedule an appointment at a local Social Security office. The Initial Enrollment Period lasts seven months—beginning three months before the month of a person’s 65th birthday, including their birthday month, and ending three months after. Those who continue working and have employer coverage may qualify for a Special Enrollment Period once employment or group health coverage ends, allowing them to enroll without penalty if they act within the required timeframe. After enrolling in Parts A and B, individuals can choose how they want to receive their Medicare coverage. They may stay with Original Medicare and consider adding a Medicare Supplement plan and a standalone Part D prescription drug plan, or they may enroll in a Medicare Advantage plan offered by private insurance companies. Because enrollment timing affects coverage start dates and potential late enrollment penalties, reviewing options carefully and enrolling during the appropriate window helps ensure continuous coverage and long-term cost protection.

Most people first become eligible to enroll in Medicare Parts A and B when they turn age 65. The Initial Enrollment Period (IEP) begins three months before the month of your 65th birthday, includes your birthday month, and continues for three months after, giving you a seven-month window to enroll. Medicare Part A covers hospital insurance, while Medicare Part B covers outpatient and physician services. Enrollment is handled through the Social Security Administration, and individuals already receiving Social Security retirement benefits are typically enrolled in Part A and Part B automatically. If someone does not enroll during their Initial Enrollment Period, other enrollment opportunities may apply. Individuals who continue working past age 65 and are covered under an employer group health plan may qualify for a Special Enrollment Period (SEP) once employment or employer coverage ends. This SEP generally allows enrollment in Part B without penalty if action is taken within eight months of losing employer coverage. Those who miss both their Initial Enrollment Period and a Special Enrollment Period may have to wait for the General Enrollment Period, which runs annually from January 1 through March 31, with coverage beginning later in the year and possible late enrollment penalties. Medicare eligibility can also begin before age 65 for individuals who qualify due to disability or certain medical conditions. People who have received Social Security Disability Insurance (SSDI) benefits for 24 months are automatically enrolled in Medicare. Additionally, individuals diagnosed with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease) may qualify earlier. Because enrollment timing affects coverage start dates and potential lifelong penalties, understanding when and how to enroll in Medicare Parts A and B is essential for avoiding gaps in coverage and unnecessary costs.

Medicare’s Income-Related Monthly Adjustment Amount (IRMAA) continues to affect higher-income beneficiaries in 2026. IRMAA is an additional premium surcharge added to standard Medicare Part B (medical insurance) and Part D (prescription drug) premiums for individuals whose income exceeds certain thresholds. The Social Security Administration determines whether a beneficiary owes IRMAA based on their Modified Adjusted Gross Income (MAGI) reported on their federal tax return from two years prior. For 2026 premiums, Medicare looks at income reported on 2024 tax returns. Income thresholds are adjusted periodically, but IRMAA generally applies to individuals with income above specified limits for single filers and married couples filing jointly. The surcharge increases in tiers, meaning the higher the income, the larger the additional monthly premium. IRMAA applies separately to Part B and Part D coverage, and even beneficiaries enrolled in a Medicare Advantage plan with prescription drug coverage must pay the Part D IRMAA amount directly to Medicare if their income exceeds the threshold. For higher-income retirees, IRMAA can significantly increase total annual healthcare costs. Beneficiaries whose income has decreased due to certain life-changing events—such as retirement, divorce, death of a spouse, or loss of income-producing property—may request a reconsideration. By filing Form SSA-44 with the Social Security Administration, individuals can ask Medicare to base their premiums on more current income information. Because IRMAA is based on income from two years earlier, proactive tax and retirement income planning remains essential to help manage potential premium surcharges in 2026 and beyond. Here is a clear, professional 3-paragraph article you can use for 2026: Medicare’s Income-Related Monthly Adjustment Amount (IRMAA) continues to affect higher-income beneficiaries in 2026. IRMAA is an additional premium surcharge added to standard Medicare Part B (medical insurance) and Part D (prescription drug) premiums for individuals whose income exceeds certain thresholds. The Social Security Administration determines whether a beneficiary owes IRMAA based on their Modified Adjusted Gross Income (MAGI) reported on their federal tax return from two years prior. For 2026 premiums, Medicare looks at income reported on 2024 tax returns. Income thresholds are adjusted periodically, but IRMAA generally applies to individuals with income above specified limits for single filers and married couples filing jointly. The surcharge increases in tiers, meaning the higher the income, the larger the additional monthly premium. IRMAA applies separately to Part B and Part D coverage, and even beneficiaries enrolled in a Medicare Advantage plan with prescription drug coverage must pay the Part D IRMAA amount directly to Medicare if their income exceeds the threshold. For higher-income retirees, IRMAA can significantly increase total annual healthcare costs. Beneficiaries whose income has decreased due to certain life-changing events—such as retirement, divorce, death of a spouse, or loss of income-producing property—may request a reconsideration. By filing Form SSA-44 with the Social Security Administration, individuals can ask Medicare to base their premiums on more current income information. Because IRMAA is based on income from two years earlier, proactive tax and retirement income planning remains essential to help manage potential premium surcharges in 2026 and beyond.

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Jason Rubin Insurance Services LLC is a premier Health Insurance Agency based in Woodland Hills, CA, offering Medicare insurance products for the past 15 years.