What Medicare Covers and Does Not Cover in 2026
One of the biggest surprises for people new to Medicare is discovering what it does not cover. Medicare is good insurance, but it has real gaps that can lead to unexpected bills if you are not prepared. Here is a straightforward look at what is covered, what is not, and how to fill the holes.
What Medicare Part A Covers
Part A is your hospital insurance. It covers inpatient hospital stays, including a semi-private room, meals, nursing care, and medications you receive while admitted. It also covers skilled nursing facility care for up to 100 days following a qualifying hospital stay, hospice care for people who are terminally ill, and some home health care services when ordered by a doctor.
Part A has a deductible of $1,676 per benefit period in 2026. A benefit period starts when you are admitted to the hospital and ends when you have been out for 60 consecutive days. If you are admitted again after that, a new benefit period begins with a new deductible.
What Medicare Part B Covers
Part B is your medical insurance. It covers doctor visits, outpatient care, preventive services, lab tests, X-rays, MRIs, physical therapy, mental health services, durable medical equipment like wheelchairs and walkers, and ambulance services when medically necessary.
Part B also covers many preventive services at no cost to you, including annual wellness visits, flu shots, mammograms, colonoscopies, and cardiovascular screenings. These are valuable benefits that many people do not take advantage of.
Part B has a monthly premium of $185 in 2026 and an annual deductible of $257. After the deductible, you typically pay 20 percent of the Medicare-approved amount for most services.
What Medicare Does NOT Cover
This is where it gets important. Original Medicare does not cover dental care, including cleanings, fillings, extractions, and dentures. It does not cover routine vision care like eye exams for glasses or contact lenses. It does not cover hearing aids or exams for fitting hearing aids. It does not cover long-term custodial care in a nursing home or assisted living facility. It does not cover most care received outside the United States.
Medicare also does not cover cosmetic surgery, acupuncture in most cases, or most chiropractic services beyond manual spinal manipulation.
How to Fill the Gaps
There are several ways to cover what Medicare leaves out. A Medigap supplement plan covers your share of Medicare-approved costs like deductibles, copays, and coinsurance. This protects you from big bills when you need hospital care or ongoing treatment. However, supplements do not add dental, vision, or hearing coverage.
A Medicare Advantage plan replaces Original Medicare and often includes dental, vision, and hearing benefits in addition to your medical coverage. Many Advantage plans in Arizona also include gym memberships and over-the-counter allowances.
For dental and vision specifically, you can also buy standalone plans if you are on Original Medicare with a supplement. Several companies offer affordable dental and vision plans designed for seniors.
For long-term care, neither Medicare nor most Advantage plans provide meaningful coverage. Long-term care insurance is a separate product that you can purchase to protect against the cost of nursing home or assisted living care. If your income and assets are limited, Arizona’s AHCCCS Medicaid program may help cover long-term care costs.
The 20 Percent Problem
The 20 percent coinsurance on Part B services is something that catches a lot of people off guard. There is no cap on Original Medicare’s out-of-pocket costs. If you have a $100,000 surgery, your 20 percent share is $20,000. That is why most Medicare advisors recommend either a supplement plan (which covers that 20 percent) or a Medicare Advantage plan (which has an annual out-of-pocket maximum).
Going with Original Medicare alone, with no supplement and no Advantage plan, is risky for most people.
Want a Personalized Breakdown?
If you want to understand exactly what your Medicare coverage looks like and where your gaps are, I am happy to walk you through it. I will look at your current situation and show you the best ways to fill any holes in your coverage.
Call me at 480-296-5804 or request a free coverage review.…
Do I Need a Medicare Supplement? A Guide for Arizona Seniors
One of the most common questions I get from people approaching Medicare is whether they need a Medigap supplement plan. It is a fair question. Supplements have a monthly premium on top of your Part B premium, and if you are healthy, it can feel like you are paying for coverage you might not use.
But the answer depends on your situation, and getting it wrong can be costly. Here is how to think through the decision.
What Does a Medicare Supplement Cover?
Original Medicare (Parts A and B) covers a lot, but it does not cover everything. You are still responsible for deductibles, copays, coinsurance, and excess charges. A Medigap supplement plan fills in those gaps, which is why they are called “supplemental” coverage.
The most popular supplement plans in Arizona are Plan G and Plan N. Plan G covers nearly everything Original Medicare does not, including the Part A deductible, Part B coinsurance, skilled nursing facility coinsurance, and foreign travel emergency coverage. The only thing Plan G does not cover is the annual Part B deductible, which is $257 in 2026. Plan N is similar but has small copays for some office visits and emergency room visits that do not result in admission.
Who Benefits Most From a Supplement?
Supplements make the most sense for people who want predictable healthcare costs. With a supplement, you know what you are paying every month, and you rarely get surprise bills after seeing a doctor or having a procedure. Your financial exposure is minimal because the supplement covers your share of almost every Medicare-approved service.
Supplements also make sense if you travel frequently. Original Medicare works with any doctor or hospital in the country that accepts Medicare, and your supplement works right alongside it. If you spend winters in Arizona and summers somewhere else, you do not need to worry about provider networks.
People who see multiple specialists or have ongoing health conditions often prefer supplements because there are no referral requirements and no network restrictions. You can see whoever you want, whenever you want.
Who Might Not Need a Supplement?
If you are generally healthy, do not travel much, and are comfortable using a provider network, a Medicare Advantage plan might be a better fit. Advantage plans typically have lower or zero monthly premiums and include extra benefits like dental, vision, and hearing that supplements do not offer.
The tradeoff is that Advantage plans require you to use network providers and may have higher out-of-pocket costs if you need significant medical care. But for someone who rarely sees the doctor, the savings on monthly premiums can be meaningful.
The Timing Issue: Why It Matters When You Enroll
Here is something a lot of people do not realize until it is too late. When you first enroll in Medicare Part B, you have a 6-month Medigap Open Enrollment Period. During this window, insurance companies must sell you any supplement plan at the standard rate regardless of your health. No medical questions, no denial, no higher premiums for pre-existing conditions.
After that window closes, you lose those guaranteed issue rights. If you try to buy a supplement later, the insurance company can ask health questions and may charge you more or deny you coverage based on your medical history. This is one of the most important timing decisions in all of Medicare.
What Does a Supplement Cost in Arizona?
Plan G premiums in Arizona typically range from about $120 to $220 per month depending on your age, gender, zip code, and the insurance company. Plan N premiums are usually $30 to $50 less per month. These premiums increase over time, but they are predictable and budgetable.
When comparing the cost of a supplement to Medicare Advantage, remember to factor in the out-of-pocket costs you might face with Advantage if you have a hospital stay, surgery, or other major medical event. The supplement premium buys you predictability.
Not Sure What to Do?
I help Arizona seniors make this decision every week. I will look at your health situation, your doctors, your medications, and your budget, and give you an honest recommendation. Sometimes a supplement is the clear winner. Sometimes Advantage makes more sense. My job is to show you the numbers and let you decide.
Call me at 480-296-5804 or request a free consultation.…
How to Choose the Right Medicare Advantage Plan in Arizona
If you have decided that Medicare Advantage is the right path for you, the next challenge is picking the right plan. In most Arizona zip codes, there are 30 or more Medicare Advantage plans to choose from. They all look different on paper, and the details matter more than you might think.
Here is how to cut through the noise and find the plan that actually fits your life.
Step 1: Start With Your Doctors
This is the most important step. Every Medicare Advantage plan has a provider network, and if your doctors are not in that network, you will either need to switch providers or pay significantly more out of pocket. Before you look at anything else, make a list of every doctor you see regularly, including your primary care physician, any specialists, and any facilities like labs or imaging centers you use.
Then check each plan’s provider directory to confirm your doctors are in network. Do not assume that because a doctor accepted one Medicare Advantage plan, they accept them all. Networks vary widely between carriers and even between plans from the same carrier.
Step 2: Check Your Prescriptions
Most Medicare Advantage plans include Part D drug coverage, but each plan has its own formulary. That means the drugs they cover and the amount you pay for each one can be very different from plan to plan. Enter every medication you take, including the dosage and quantity, and compare what each plan would charge you annually.
Pay special attention to tier placement. If a medication you take is on Tier 4 or Tier 5 on one plan but Tier 2 on another, the savings can be substantial over the course of a year.
Step 3: Understand HMO vs. PPO
Medicare Advantage plans in Arizona come in two main types. HMO plans require you to use in-network providers and typically require referrals to see specialists. PPO plans give you more flexibility. You can see out-of-network providers, though you will pay more, and you generally do not need referrals.
If you have a specialist you see regularly who is not in many networks, a PPO might give you more peace of mind. If you are comfortable staying within a network and want lower costs, an HMO often has lower copays and out-of-pocket maximums.
Step 4: Compare Total Costs, Not Just Premiums
A zero-dollar premium is appealing, but it does not mean free healthcare. You still pay copays for doctor visits, coinsurance for procedures, and deductibles for certain services. The plan’s maximum out-of-pocket (MOOP) limit tells you the most you could pay in a year if you have significant medical needs.
Compare the full picture: monthly premium, primary care copay, specialist copay, hospital inpatient costs, and the MOOP. A plan with a small monthly premium but lower copays might save you more overall, especially if you use healthcare services frequently.
Step 5: Look at Extra Benefits
Many Medicare Advantage plans in Arizona include benefits that Original Medicare does not cover. These can include dental coverage for cleanings, fillings, and dentures, vision coverage for exams and glasses, hearing aid coverage, gym memberships through programs like SilverSneakers, over-the-counter allowances for health products, and transportation to medical appointments.
These extras can add real value, but they should not be the primary reason you choose a plan. The core medical coverage, your doctors, and your drug costs should drive the decision. The extras are a nice bonus on top.
Step 6: Check Star Ratings
Medicare rates every Advantage plan on a 1 to 5 star scale based on quality of care, customer service, and member satisfaction. Plans with 4 or more stars tend to provide better experiences. You can check star ratings on Medicare.gov or ask your local broker to include them in your comparison.
Let Me Do the Comparison for You
I compare Medicare Advantage plans for Arizona seniors every day. I will check your doctors, run your medications, and show you a side-by-side breakdown of the plans that fit your situation. It takes about 20 to 30 minutes and it costs you nothing.
Call me at 480-296-5804 or request a free plan comparison.…
Medicare vs. Medicaid in Arizona: What Is the Difference?
Medicare and Medicaid sound similar, and a lot of people mix them up. But they are two completely different programs with different eligibility rules, different benefits, and different ways of working. If you or a family member is approaching 65 or dealing with a health coverage question, understanding the difference matters.
Here is a clear breakdown of how each program works in Arizona.
What Is Medicare?
Medicare is a federal health insurance program primarily for people aged 65 and older. You can also qualify for Medicare if you are under 65 and have certain disabilities or end-stage renal disease. Medicare is not based on your income. If you or your spouse paid Medicare taxes for at least 10 years, you are eligible for premium-free Part A when you turn 65.
Medicare has four parts. Part A covers hospital stays and inpatient care. Part B covers doctor visits, outpatient services, and preventive care. Part C, also called Medicare Advantage, is an alternative way to receive your Part A and Part B benefits through a private insurance company. Part D covers prescription drugs.
What Is Medicaid?
Medicaid is a joint federal and state program that provides health coverage to people with limited income and resources. In Arizona, the Medicaid program is called AHCCCS (Arizona Health Care Cost Containment System, pronounced “access”). Eligibility is based on your income, household size, and other factors. Unlike Medicare, Medicaid can cover people of any age, including children, pregnant women, and adults with low incomes.
AHCCCS covers a wide range of services including doctor visits, hospital stays, prescriptions, behavioral health, dental care, and long-term care. Many services have little or no cost sharing for members.
Key Differences at a Glance
Medicare is based on age or disability, not income. Medicaid is based on income and financial need. Medicare is run by the federal government. Medicaid is run by each state, which is why Arizona’s program has its own name and rules. Medicare requires premiums, deductibles, and copays. Medicaid typically has very low or no out-of-pocket costs.
Medicare does not cover long-term custodial care like nursing home stays beyond a limited period. Medicaid can cover long-term care for those who qualify, which is one of the biggest practical differences between the two programs.
Can You Have Both Medicare and Medicaid?
Yes. People who qualify for both are called “dual eligible.” In Arizona, if you are 65 or older and have limited income, you may qualify for both Medicare and AHCCCS. When you have both, Medicaid can help pay your Medicare premiums, deductibles, and copays. It can also cover services that Medicare does not, like dental care and long-term care.
There are also special Medicare Advantage plans designed specifically for dual-eligible individuals, called Dual Special Needs Plans (D-SNPs). These plans coordinate your Medicare and Medicaid benefits into one plan and often include extra benefits like transportation to medical appointments.
How to Know Which Programs You Qualify For
If you are turning 65, you almost certainly qualify for Medicare regardless of your income. The question is whether you also qualify for Medicaid based on your financial situation. In Arizona, the income limits for AHCCCS vary depending on the specific program, but if your income is limited, it is worth checking.
You can apply for AHCCCS through the Arizona Health-e-Arizona Plus portal or at your local Department of Economic Security office. For Medicare, you can enroll at ssa.gov or through your local Social Security office.
Need Help Sorting It Out?
If you are not sure what you qualify for or how Medicare and Medicaid work together, I can help point you in the right direction. I specialize in Medicare plans, and I can also help you understand whether a dual-eligible plan might be right for your situation.
Call me at 480-296-5804 or request a free consultation. No cost, no pressure.
Related reading
…Medicare Open Enrollment 2026: What Arizona Seniors Need to Know
Every fall, Medicare Open Enrollment gives you a chance to review your coverage and make changes for the coming year. But a lot of people either forget about it, assume their plan is fine, or feel overwhelmed by the options. If that sounds familiar, this guide is for you.
Here is what you need to know about Medicare Open Enrollment in 2026, how it works, and what you should do to make sure you are not leaving money on the table.
When Is Medicare Open Enrollment?
For this fall, the Annual Enrollment Period runs October 15–December 7, 2026, for coverage generally effective January 1, 2027. The plan must receive your enrollment request by December 7. These dates apply in Arizona as well as other states. Source: Medicare Open Enrollment.
There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31. During this window, if you are already in a Medicare Advantage plan, you can switch to a different Advantage plan or drop Advantage and return to Original Medicare with a Part D plan.
What Can You Change During Open Enrollment?
During the Annual Enrollment Period you can switch from Original Medicare to Medicare Advantage or the other way around. You can change from one Medicare Advantage plan to another. You can join a Part D prescription drug plan, switch to a different one, or drop Part D coverage. You can also add or remove supplemental coverage depending on your situation.
AEP is not an annual guaranteed-issue window for Medigap. You may apply to change a Medigap supplement during the fall or at another time, but outside your Medigap Open Enrollment period or a qualifying protection, the insurer may use medical underwriting or decline the application. Confirm acceptance and the effective date before dropping coverage you are relying on. Source: Medicare’s Medigap enrollment guidance.
Why You Should Review Your Plan Every Year
Medicare plans change every January 1st. Insurance carriers adjust which doctors are in their networks. They change their drug formularies, moving medications to different tiers or dropping them entirely. Copays, coinsurance rates, and out-of-pocket maximums shift. A plan that saved you money last year could cost you significantly more this year.
A review does not automatically mean you need to switch. Start with the notice your current plan sends in September, then compare the changes with your doctors, prescriptions, and expected care. Use my Medicare Annual Notice of Change checklist for Arizona residents to work through the questions step by step.
What to Check During Your Annual Review
Start with your doctors. Make sure every provider you see is still in your plan’s network for the coming year. Then check your medications. Look at the plan’s formulary to confirm your prescriptions are still covered and see what tier they are on. Compare the total estimated annual cost, not just the monthly premium. A plan with a zero-dollar premium might cost you more in copays and deductibles than a plan with a small monthly premium.
Finally, think about any changes in your health over the past year. If you had a new diagnosis, started seeing a specialist, or began a new medication, your plan needs might be different.
How I Help During Open Enrollment
During a review, we discuss your doctors, prescriptions, pharmacy, budget, and coverage questions. I compare the plans I am contracted to offer; I do not represent every plan available. September is a good time to gather your current plan’s notices. Compare specific upcoming-year options when the information is available and permitted to be marketed, then confirm the details before enrolling. Keeping your current plan may be appropriate when it remains available and meets your needs.
This service is free. I am paid by the insurance companies, not by you. Learn more about how I help. The premium is the same whether you enroll through me or on your own.
Do Not Wait Until December
Every year I get calls in the first week of December from people who just realized Open Enrollment is almost over. By then, the process feels rushed and stressful. The best time to start your review is in October, right when the window opens. That gives you plenty of time to compare options and ask questions.
For help reviewing your next steps, call 480-296-5804 or learn about Medicare plan help with Andy in Mesa. We can review the options I offer and the questions to resolve before making a change. You can also compare all available options through Medicare.gov, 1-800-MEDICARE, or Arizona’s State Health Insurance Assistance Program.
Related reading
…The Complete Turning 65 Medicare Checklist for Arizona Residents
Turning 65 is a milestone, and Medicare is one of the most important decisions that comes with it. But the process can feel overwhelming if you do not know where to start. When should you sign up? What are your options? What happens if you are still working?
I have put together this step-by-step checklist to help Arizona residents navigate the transition to Medicare with confidence.
12 Months Before You Turn 65
Start learning the basics. Medicare has four parts. Part A covers hospital stays and is usually premium-free if you or your spouse paid Medicare taxes for at least 10 years. Part B covers doctor visits and outpatient care and has a monthly premium. Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurers. Part D covers prescription drugs.
Review your current health coverage. If you have employer coverage, check with your HR department about how it coordinates with Medicare. If your employer has 20 or more employees, you may be able to delay Part B without penalty. If fewer than 20 employees, Medicare becomes primary at 65.
6 Months Before You Turn 65
Decide between Original Medicare and Medicare Advantage. Original Medicare (Parts A and B) lets you see any doctor who accepts Medicare anywhere in the country. You can add a Medigap supplement to cover out-of-pocket costs and a Part D plan for prescriptions. Medicare Advantage bundles everything into one plan, often with extra benefits like dental and vision, but requires you to use a provider network.
Make a list of your doctors and medications. This is critical for choosing the right plan. You need to know which doctors you want to keep seeing and which prescriptions you take, including dosages.
Talk to a local Medicare broker. A broker can compare all available plans in your area using your specific doctors and medications. This service is free to you.
3 Months Before You Turn 65 (Your IEP Begins)
Your Initial Enrollment Period starts. This 7-month window (3 months before your birthday month, your birthday month, and 3 months after) is when you should enroll in Medicare. If you are collecting Social Security, you may be automatically enrolled in Parts A and B.
Sign up for Medicare Parts A and B. You can enroll online at ssa.gov, by phone, or at your local Social Security office. If you are delaying Part B due to employer coverage, you do not need to enroll yet but should enroll in Part A (it is free).
Choose your coverage path. Enroll in either a Medicare Advantage plan or a Medigap supplement plus Part D plan. This is where having a broker compare options for you pays off.
Your Birthday Month
Confirm your Medicare card has arrived. Your red, white, and blue Medicare card should arrive in the mail before your coverage start date. Keep it in a safe place.
Confirm your plan enrollment. Whether you chose Medicare Advantage or a supplement, verify you received confirmation from your insurance company and that your coverage start date is correct.
After Enrollment
Schedule your Welcome to Medicare preventive visit. This free visit with your doctor must be done within the first 12 months of Part B coverage. It is a great way to establish a baseline for your health.
Set a reminder to review your plan every fall. During the Annual Enrollment Period (October 15 through December 7), you can switch plans if a better option becomes available. Plans change every year, so this annual review is important.
Keep your broker’s number handy. If you have questions about a bill, a denied claim, or a change in your health, your broker can help you navigate it. That is what I am here for.
Need Help Getting Started?
If you are turning 65 in Arizona and want someone to walk you through your options step by step, I would love to help. I have been doing this for 7 years, and I work with seniors in Mesa, Gilbert, Chandler, Tempe, Scottsdale, and across the East Valley.
Call me at 480-296-5804 or request a free consultation. No pressure, no obligation, and no cost to you.
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…Understanding Medicare Part D in Arizona: How to Save on Prescription Drug Costs
Prescription drug costs are one of the biggest concerns I hear from Arizona seniors. Whether you take one medication or ten, understanding how Medicare Part D works can save you hundreds or even thousands of dollars a year.
Here is a straightforward breakdown of what Part D covers, how it works, and how to make sure you are not overpaying for your medications.
What Is Medicare Part D?
Medicare Part D is the prescription drug benefit. It is offered through private insurance companies approved by Medicare. You can get Part D coverage in two ways: as a standalone Prescription Drug Plan (PDP) that pairs with Original Medicare and a Medigap supplement, or as part of a Medicare Advantage plan that includes drug coverage (MA-PD).
Either way, every Part D plan has a formulary, which is the list of drugs the plan covers and what tier they fall into. Tiers determine how much you pay out of pocket for each medication.
How Part D Drug Tiers Work
Most Part D plans organize medications into five tiers. Tier 1 includes the cheapest generic drugs with the lowest copays. Tier 2 covers preferred generic drugs. Tier 3 is for preferred brand-name drugs. Tier 4 covers non-preferred drugs at higher costs. Tier 5, the specialty tier, includes the most expensive medications, often for complex conditions like cancer or rheumatoid arthritis.
The tier your medication falls on can vary significantly between plans. A drug that is Tier 3 on one plan might be Tier 2 on another, saving you money every time you fill your prescription.
The Part D Coverage Gap (Donut Hole)
In 2026, thanks to the Inflation Reduction Act, the out-of-pocket cap for Part D is $2,000 per year. Once you hit that amount in total out-of-pocket drug costs, you pay nothing for the rest of the year. This is a major improvement over the old donut hole structure, where costs could spiral much higher.
This $2,000 cap makes it more important than ever to choose a plan with lower copays on your specific medications, since the plan that gets you to $2,000 the slowest is the one that saves you the most.
How to Save Money on Part D in Arizona
The biggest savings come from comparing plans side by side using your actual medication list. I do this for every client. We enter each of your prescriptions, check the dosage and quantity, and then compare what each available plan in your zip code would charge you over the course of a year.
Other ways to save include asking your doctor about generic alternatives, using preferred pharmacies (many plans offer lower copays at specific pharmacy chains), and checking whether mail-order pharmacy options reduce your costs.
When Can You Change Your Part D Plan?
You can switch Part D plans during the Annual Enrollment Period from October 15 through December 7 each year. If you have a Medicare Advantage plan, you also have a chance to make changes during the Medicare Advantage Open Enrollment Period from January 1 through March 31.
Since formularies and pricing change every year, reviewing your Part D plan annually is one of the smartest things you can do. A plan that saved you money last year might not be the best option this year.
Get a Free Prescription Drug Plan Review
If you are unsure whether your current Part D plan is the best fit for your medications, I can help. I will check your prescriptions against every available plan in your area and show you exactly what each one would cost.
Call me at 480-296-5804 or request a free plan review. There is no charge and no obligation.…
5 Medicare Enrollment Mistakes That Could Cost You Thousands
Every year, thousands of Arizona seniors make avoidable mistakes during Medicare enrollment that end up costing them real money. Some of these mistakes lead to late penalties that follow you for life. Others leave you stuck in a plan that does not cover your doctors or your medications.
After 7 years of helping seniors across the East Valley navigate Medicare, I have seen every mistake in the book. Here are the five most common ones and how to avoid them.
1. Missing Your Initial Enrollment Period
Your Initial Enrollment Period (IEP) is a 7-month window around your 65th birthday: 3 months before, your birthday month, and 3 months after. If you miss this window and do not have qualifying coverage through an employer, you could face late enrollment penalties on Part B and Part D that increase your premiums permanently.
The Part B late penalty is 10 percent of the standard premium for every 12-month period you were eligible but did not enroll. That adds up fast and it never goes away.
2. Assuming Your Employer Coverage Is Enough
If you are still working at 65 and have employer coverage, you may be able to delay Medicare without penalty. But this only applies if your employer has 20 or more employees. If your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65, and delaying enrollment could leave you with coverage gaps and penalties.
Always verify your employer’s size and how their plan coordinates with Medicare before making assumptions.
3. Choosing a Plan Based on Premium Alone
A zero-dollar premium Medicare Advantage plan sounds great until you realize your cardiologist is out of network or your prescriptions are on Tier 4. The cheapest plan is rarely the best plan.
Before enrolling in any plan, check three things: Are your doctors in network? Are your medications covered at a reasonable cost? Does the plan cover the services you actually use?
4. Forgetting to Review Your Plan Every Year
Medicare plans change every January 1st. Carriers adjust their formularies, drop providers from networks, and change copay structures. A plan that was perfect last year might cost you hundreds more this year.
During the Annual Enrollment Period (October 15 through December 7), you should review your current plan and compare it to what else is available. This is something I do for all of my clients every fall.
5. Not Working With a Local Broker
Many people either go directly to Medicare.gov or call a 1-800 number they saw on TV. The problem is that these options cannot give you personalized advice. A licensed broker who knows your area can check your specific doctors, review your prescriptions, and compare every plan available in your zip code, all at no cost to you.
Brokers are paid by the insurance companies, not by you. The premium is the same whether you enroll on your own or through a broker. The only difference is you get a real person who will help you make the right choice and be there if you need help later.
Avoid the Mistakes: Get Free Help
If you are approaching 65, already on Medicare, or helping a parent with their coverage, I am happy to walk you through your options. I am based in Mesa, Arizona and I work with seniors across the East Valley every day.
Call me at 480-296-5804 or request a free plan review and I will call you back.…
Why I Recommend Medicare Advantage Plans for Most People Turning 65
If you were to ask me “What direction should I go, Medicare Advantage or Medicare Supplemental? My honest answer for most people would be Medicare Advantage and I want to explain exactly why.
I’m not saying Medicare Advantage is right for everyone. I’ve helped plenty of people in Mesa, Gilbert, and Chandler go with a Medicare Supplement plan and they’re happy. But when I look at what most people need and want at 65, Medicare Advantage plans are the answer.
First, a Quick Reminder About How Medicare Works
When you turn 65 and enroll in Medicare, you get Part A (hospital and inpatient coverage) and Part B (doctor visits and outpatient care). Together they cover about 80% of your costs. The other 20% is your responsibility. And there’s no cap on what you could owe in a bad year.
Both Medicare Advantage and Medicare Supplement exist to fill that gap. They just do it differently. Medicare Advantage changes how you receive your Medicare benefits, while Medicare Supplement works alongside Original Medicare and pays after Medicare does.
So Why Do I Usually Recommend Medicare Advantage?
1. The Monthly Cost
Most Medicare Advantage plans here in Arizona are $0 or very low monthly premium. Compare that to a Medicare Supplement plan, which typically runs $100–$200+ per month on top of your Part B premium and Part D premium. For someone on a fixed income, that difference adds up fast and for people who are generally healthy, they end up coming out ahead.
2. You Get Extra Benefits Built In
This is one of the biggest reasons people love Medicare Advantage. Most plans include dental, vision, hearing, gym memberships, Over the counter debit cards, and transportation benefits that Original Medicare and Medicare Supplement don’t cover at all. For any insurance plan having these extra benefits are a huge deal, especially because they add no extra cost.
3. Drug Coverage Is Included
Most Medicare Advantage plans include Part D prescription drug coverage. With a Medicare Supplement plan, you’d need to buy a separate standalone Part D plan which would mean another premium, another card, another plan to manage. Medicare Advantage keeps it simple.
4. There’s a Cap on What You Can Spend
Every Medicare Advantage plan has a Maximum Out-of-Pocket limit. They have a wide range but generally staying around $5,000. Once you hit that number in a given year, the plan covers 100% of your costs for the rest of the year. Original Medicare alone has no such cap. That protection matters especially if something unexpected happens.
What to Be Aware Of
I always make sure people understand the trade-offs. Medicare Advantage plans use provider networks, which means you need to check that your doctors are within the network. Some plans require referrals to see specialists, and certain procedures may need prior authorization. These aren’t deal breakers for most people, but they’re worth knowing upfront.
What I See Here in Mesa and the East Valley
Medicare Advantage plans in this area are very competitive. We have strong carrier options with $0 premiums and solid networks including Banner and Dignity Health. Most people I work with are able to keep their current doctors and pay little to nothing out of pocket month to month.
That said, “most people” does not mean everyone. My job isn’t to push any specific plan but it’s to help you figure out which one actually fits your situation. Sometimes that’s Advantage. Sometimes it’s Supplement. And I’ll tell you honestly either way.
One Thing You Should Know Before Your 65th Birthday
When you first enroll in Medicare Part B, you have a 6-month window to sign up for a Medicare Supplement plan without any medical underwriting this means you can’t be denied or charged more because of health conditions. Once that window closes, you may face underwriting if you ever want to switch.
That’s why it’s worth having this conversation before you turn 65, not after. You want to make the right call when all your options are on the table.
Ready to See What’s Available in Your Area?
I help people turning 65 compare every Medicare Advantage plan available in their zip code — at no cost to you. No pressure, no sales pitch. Just a straightforward conversation about what makes sense for your doctors, your prescriptions, and your budget.
Call me at 480-296-5804 or fill out the form and I’ll reach out at a time that works for you.
Andy Childs is a licensed Medicare broker based in Mesa, Arizona.…
When Should I Sign Up for Medicare if I’m Turning 65?
If you’re turning 65, Medicare is probably on your mind. One of the first things people ask me is when exactly do I need to sign up? The answer matters more than most people realize. Get the timing right and your coverage starts smoothly. Get it wrong and you could face penalties that follow you for life.
Let me walk you through it.
Your Initial Enrollment Period
When you turn 65, Medicare gives you a 7-month window to get your Part A and Part B started called your Initial Enrollment Period, or IEP. It works like this:
- 3 months before the month you turn 65
- The month you turn 65
- 3 months after the month you turn 65
So if your birthday is in June, your window runs from March through September. That’s your primary opportunity to get into Medicare without any issues.
My recommendation? Don’t wait until the month of your birthday. If you enroll in the 3 months before you turn 65, your coverage starts on the 1st of the month of your birthday. If you wait until your birthday month or after, your start date gets pushed back.
After You Enroll in Medicare, You Still Need to Choose a Plan
A lot of people don’t realize this. When you sign up for Medicare Parts A and B, that’s Original Medicare — and on its own it only covers about 80% of your costs. You still need to decide how you want to handle the rest.
That means choosing between a Medicare Advantage plan, a Medicare Supplement plan, and a standalone Part D plan.
This is the step most people need the most help with — and it’s what I can help you with. Once you’re enrolled in Medicare, I’ll help you compare every plan available in your area and find the one that fits your doctors, your prescriptions, and your budget.
What If I’m Still Working at 65?
This is one of the most common situations I deal with here in Mesa and the East Valley. If you or your spouse is still working at 65 and you have coverage through an employer with 20 or more employees, you can delay Medicare without any penalty. Your employer coverage counts as creditable coverage.
However — and this is important — once that employer coverage ends, you only have 8 months to enroll in Medicare before penalties kick in. That window is called a Special Enrollment Period.
If your employer has fewer than 20 employees, the rules are different and you generally need to enroll in Medicare at 65 regardless.
What Happens If You Miss the Window?
If you don’t have a valid reason for delaying and you miss your Initial Enrollment Period, here’s what happens:
Part B late enrollment penalty: Your Part B premium goes up 10% for every 12-month period you were eligible but didn’t enroll. And it stays higher permanently. Miss two years and you’re paying 20% more than everyone else EVERY month, for the rest of your life.
Part D late enrollment penalty: Similar situation with prescription drug coverage. If you go 63 or more days without creditable drug coverage, you’ll pay a penalty added to your Part D premium permanently.
These penalties are the thing I see surprise people most often. Nobody tells them until it’s too late.
Special Situations Worth Knowing
A few situations that come up regularly in my conversations with people here in Arizona:
Turning 65 but not collecting Social Security yet: You won’t be automatically enrolled in Medicare. You need to sign up yourself at ssa.gov or by calling Social Security.
Already collecting Social Security before 65: You’ll be automatically enrolled in Medicare Parts A and B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday.
COBRA coverage: COBRA does not count as creditable coverage for Medicare purposes. If you’re on COBRA and you turn 65, you still need to enroll in Medicare during your Initial Enrollment Period.
The Bottom Line
The best time to start thinking about Medicare is 3 to 4 months before your 65th birthday. That gives you enough time to understand your options, compare plans, and make a decision without rushing. The worst thing you can do is put it off and assume it’ll sort itself out.
I help people through this process every day here in Mesa, Gilbert, and Chandler. There’s no cost to work with me and no pressure — just a clear conversation about your specific situation.
Call me at 480-296-5804 or fill out the form and I’ll reach out at a time that works for you.
Andy Childs is a licensed Medicare broker based in Mesa, Arizona.