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Medicare Part D Coverage phases 2026

With significant changes enacted under the Inflation Reduction Act (IRA), Medicare Part D prescription drug coverage is now simpler and more predictable. Beginning in 2025, beneficiaries no longer experience a “donut hole,” and starting in 2026, cost thresholds slightly increase to keep pace with inflation. This blog explains the Medicare Part D Coverage Phases for 2026.

Part D Coverage: Three Straightforward Phases

1. Deductible Phase

• In 2026, CMS will implement a maximum standard deductible of $615 (increased from $590 in 2025). Beneficiaries pay 100% of drug costs out of pocket until they meet the deductible. Keep in mind, plan providers have the option to offer a lower or zero deductible.

2. Initial Coverage Phase

• Once the beneficiary meets the deductible, they enter the initial coverage phase.
• In this phase beneficiaries may pay up to 25% coinsurance on covered drugs. Pleas note; most drug plans do not charge coinsurance for tier 1 or even tier 2 drugs.
• Beneficiaries continue to pay coinsurance until their total out‑of‑pocket spending reaches $2,100 in 2026 (previously $2,000 in 2025).
• There is no Initial Coverage Limit (ICL) separate from your out‑of‑pocket threshold, so no “gap” in coverage.

3. Catastrophic Phase

• Once the beneficiary has spent $2,100 out of pocket on formulary (covered) drugs, they enter the catastrophic phase.
• In this phase, beneficiary coinsurance drops to $0; they have no further cost-sharing on covered Part D drugs for the rest of the year.

Watch a YouTube video on the Part D drug cap

What Happened to the Donut Hole

• The coverage gap (“donut hole”) was officially eliminated starting January 1, 2025.
• Instead of transitioning from initial coverage to a gap, enrollees transition directly into catastrophic coverage once they reach the annual out-of-pocket cap ($2,000 in 2025; $2,100 in 2026).
• This means no more confusing coinsurance changes mid‑year; just a smooth journey through three phases.

Why No “Donut Hole”

Before 2025, Part D had four somewhat confusing cost-share phases:

• Deductible → Initial Coverage → Coverage Gap (“donut hole”) → Catastrophic Coverage.

Thanks to the Inflation Reduction Act:

• The donut hole was discontinued, coinsurance standardized at 25%, and a hard cap on TrOOP at $2,000 in 2025.
• In other words: Simplified coverage and predictability was put in place.

2026 Standard Benefit Summary

TrOOP stands for out of pocket. The TrOOP includes: deductible, copays and coinsurance. However the TrOOP does not include; plan premiums or drugs not covered under Part D of your plan.

Summary for Medicare Prescription Coverage 2026

• The year begins with beneficiaries paying up to $615 out of pocket toward their deductible.
• After that, they pay 25% of covered drug costs until their total out-of-pocket spending hits $2,100.
• Once they hit the cap, they move into catastrophic coverage and pay zero out-of-pocket for covered drugs for the rest of the year.
• As of 2025, the donut hole is gone, ensuring a smooth and straightforward benefit structure.
• Beneficiaries can consider enrolling in the Medicare Prescription Payment Plan if it helps spread out drug costs.

Medicare agents:

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2026 brings continued relief and clarity for Medicare Part D enrollees; no donut hole, no complicated phases, just predictable costs and peace of mind.

How To Save On Prescription Drugs – Helping Medicare Clients

Prescription drug costs can be a major concern for Medicare beneficiaries, especially those on a fixed income. As a Medicare agent, helping your clients learn how to save on prescription drugs not only builds trust; it can also make a real difference in their overall healthcare experience.

Here are several effective strategies you can use to help your clients save on their prescriptions:

Review Medicare Part D Plans Annually

Encourage clients to compare Part D plans every year, especially during the Annual Enrollment Period (AEP). Drug formularies, pharmacy networks, and premiums can change annually, which may impact out-of-pocket costs.

Use Medicare’s Plan Finder tool or your quoting software to:

• Check if current medications are still covered
• Compare plan premiums, deductibles, and copays
• Identify preferred pharmacy networks for added savings

Look Into Medicare Advantage Plans with Drug Coverage

Some Medicare Advantage (MAPD) plans include prescription drug benefits that may offer lower costs than standalone Part D plans. Make sure to evaluate:

• Formulary tier placement for their medications
• Coverage phases (deductible, initial coverage, catastrophic)
• Extra benefits like mail-order options or pharmacy discount programs

Apply for Extra Help (LIS)

Let eligible clients know about Medicare’s Extra Help program, also known as Low-Income Subsidy (LIS). It helps cover:

• Part D premiums
• Deductibles
• Coinsurance

Each year, income and asset limits are updated. Help clients check eligibility and apply through Social Security or their state Medicaid office.

Check for State Pharmaceutical Assistance Programs (SPAPs)

Many states offer SPAPs that provide financial help with prescription drugs for low- to moderate-income seniors. These programs vary by state, so check what’s available locally and guide clients through the application process if applicable.

Request Generic and Therapeutic Alternatives

Encourage clients to:

• Ask their doctor if a generic version is available
• Discuss therapeutic alternatives that might work just as well at a lower cost
• Use formulary tools to find covered equivalents in lower tiers

This can result in significant monthly savings without sacrificing effectiveness.

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Use Preferred or Mail-Order Pharmacies

This one should be obvious, but some beneficiaries do not understand the possible savings. Help clients find pharmacies within their plan’s preferred network, where they’ll often get the lowest copays. In many cases, 90-day mail-order supplies are also more affordable and convenient for maintenance medications.

Explore Prescription Discount Programs

While they can’t be used in conjunction with Medicare, some clients may benefit from discount cards (like Glic, GoodRx or SingleCare) when paying cash. These may be helpful for:

• Medications not covered by their plan
• When the discount price is lower than their copay

Important: Remind clients that purchases using discount cards don’t count toward their Part D deductible or out-of-pocket threshold.

Consider Safe International Pharmacy Options

For some clients, especially those with high-cost brand-name prescriptions, licensed international pharmacies can provide considerable savings.

One popular and reputable option is The Canadian MedStore, which connects U.S. consumers with licensed international pharmacies in Canada and other Tier 1 countries. Key benefits include:

• Substantial savings on brand-name medications
• Licensed pharmacy partners
• Reliable customer service and refill support

Please note: Agents should advise clients to check with their doctors before switching sources and confirm that any international pharmacy is legitimate and properly licensed.

Watch a YouTube video with details on the Canadian Medstore

Saving on prescriptions doesn’t have to be complicated, sometimes all it takes is having the right resources. As an agent, you can guide clients toward cost-effective, safe solutions that help them stay healthy and financially stable.

Stay updated on the latest agent events and information

Whether it’s comparing plans, applying for Extra Help, or exploring alternative resources, your support can make a meaningful difference.

Understanding the Medicare SHIP Program

When navigating the complexities of Medicare, having expert, unbiased help can make all the difference. That’s where the State Health Insurance Assistance Program (SHIP) comes in. SHIP provides free, personalized counseling and assistance to Medicare beneficiaries and their families. Whether you’re enrolling for the first time or reviewing coverage options, Understanding the Medicare SHIP Program can be a valuable resource.

What Is SHIP

SHIP stands for State Health Insurance Assistance Program. Funded by the federal government and administered at the state level, SHIP offers free, objective, and confidential help to people with Medicare.

Each state has its own SHIP, staffed by trained counselors who are not affiliated with insurance companies. Their goal is to help Medicare beneficiaries make informed decisions based on individual needs; not sales goals.

Medicare beneficiaries may use SHIP in conjunction with their Medicare agent to access additional support with Medicare issues such as:

What Services Does SHIP Provide

• Understanding Original Medicare (Parts A and B)
• Comparing Medicare Advantage (Part C) and Part D drug plans
• Reviewing Medigap (supplemental insurance) options
• Explaining Medicare Savings Programs and Extra Help
• Appealing Medicare denials and billing errors
• Transitioning from employer insurance to Medicare
• Understanding coverage for long-term care

SHIP can provide guidance tailored to each specific situation.

Who Can Use SHIP

SHIP services are available to:

• Current Medicare beneficiaries
• People turning 65 soon or new to Medicare
• Caregivers or family members assisting someone with Medicare
• Individuals under 65 who qualify for Medicare due to a disability

There is no cost for SHIP counseling, and there is no pressure to choose a specific plan.

Need help getting diabetic supplies; watch a quick YouTube video to access assistance

How to Find SHIP Help

To contact your local SHIP office, visit www.shiphelp.org and use the locator tool. You can also call 1-877-839-2675 to be directed to your state’s SHIP.

Appointments may be available by phone, in-person, or virtually; depending on location and preference.

Why SHIP Matters

For beneficiaries who do not have a trusted Medicare agent; Medicare can be overwhelming when you’re trying to choose the right plan for your needs or help a loved one through the process. SHIP counselors offer unbiased, trusted advice. They exist solely to help Medicare beneficiaries make informed choices and avoid costly mistakes.

If you are a Medicare agent looking for a supportive upline; click for Crowe contracting

Stay up-to-date on the latest agent events and information.

Those unsure about Medicare coverage, billing, or eligibility; or just need someone to walk through the options; SHIP is an excellent place to start.

Get a Head Start on AEP: Prep Now for a Successful Enrollment Season

The Annual Enrollment Period (AEP) is one of the busiest and most profitable times of the year for Medicare agents. Between October 15th and December 7th, the demand for knowledgeable, trusted advisors skyrockets. But here’s the truth: agents who wait until the fall to prepare are already behind. It is best to get a head start on AEP before everything piles up.

The most successful Medicare agents treat the months leading up to AEP as preparation time. By getting a head start now, you’ll not only reduce stress but also position yourself to grow your book of business and serve clients more effectively when the rush begins.

Here are some steps you can take right now to set yourself up for your best AEP yet:

Complete Certifications and Training

Staying current with your certifications is critical. Most carriers require agents to complete either AHIP or NABIP certification and plan-specific training before they can begin selling Medicare Advantage or PDP plans during AEP.

• AHIP and NABIP typically launch in June, so mark your calendar.
• Many carriers offer a discount if you complete AHIP through their portal; take advantage of that!
• Start your carrier certifications as soon as possible so they do not pile up (they can be time consuming). This helps you minimize stress as it gets closer to the October deadline.

By getting these done early, you’ll be compliant, confident, and ready to hit the ground running.

Stay Updated on Industry Changes & Training Opportunities

The Medicare landscape is constantly evolving; plan changes, regulatory updates, compliance rules, and new technology are all part of the mix. That’s why staying informed isn’t just helpful; it’s essential.

Take time now to:

• Subscribe to carrier newsletters and CMS updates.
• Attend webinars, workshops, or local training events.
• Engage in forums or networking groups with other Medicare agents.

The more informed you are, the more value you bring to your clients—and the more confident you’ll feel going into AEP.

Click here to view the latest agent events and information.

Prepare and Update Your Marketing Materials

Your marketing materials are your first impression; make sure they’re working for you, not against you.

Before AEP begins, audit and refresh all your materials:

• Brochures
• Flyers
• Business cards
• Educational handouts
• Giveaways or branded items (under $15 for compliance!)

Make sure everything reflects your current branding, includes up-to-date contact information, and is tailored to your audience.

If you’re planning to promote yourself through social media, email, or your website, remember:

• Include all required disclaimers (especially for Medicare Advantage or PDP).
• Double-check whether your materials require HPMS filing and approval.
• For peace of mind, consider working with your compliance department to review and file your materials properly.

Watch a YouTube Video of the CMS proposed changes for CY2026

When in doubt; ask. Staying compliant now saves headaches later.

Test Lead Sources Before the Rush

Not all leads are created equal; the best time to figure out what works is before the pressure of AEP hits.

Now is the perfect time to test and evaluate:

• Digital leads (Google ads, Facebook campaigns)
• Direct mail campaigns
• Community referrals
• Educational events
• Grassroots marketing (partnering with local businesses or pharmacies)

Track metrics like cost per lead, contact rate, appointment set rate, and ultimately, conversion to sale.

Give yourself time to test, and refine your lead strategy so when AEP begins, you’re not guessing, you’re scaling.

Make a Marketing Plan

Don’t wait until October to promote yourself; start building awareness now. Consider:

• Planning grassroots marketing like community events or educational seminars.
• Designing print materials (postcards, flyers, business cards).
• Lining up email campaigns or social media content to build visibility.

Make sure your Permission to Contact (PTC) processes are compliant and ready to go.

Update Tools and Technology

Evaluate whether your current tools are working efficiently:

• Is your CRM user-friendly and up to date?
• Are your quoting tools and enrollment platforms ready?
• Do you need to upgrade your laptop, printer, or internet connection?

Watch a YouTube video on Connecture & Sunfire quoting and enrollment tools

A little tech prep now can save you major headaches later.

Check that your systems are:

• Updated and running smoothly
• Synced across devices
• Easy for both you and your clients to use

Key tools to have ready:

• Online quoting tools – for fast and accurate plan comparisons
• E-app platforms – for secure and paperless enrollment
• Video conferencing tools – for remote appointments
• Electronic scope of appointment (SOA) tools – for compliance

Also, make sure your email, calendar, and CRM are integrated so nothing slips through the cracks.

Learn about Pinnacle’s BOSS agent portal & CRM for agents

By mastering your tech tools before AEP, you’ll boost efficiency, reduce errors, and deliver a smoother experience to every client; earning trust and more referrals.

If you are ready to join the team at Crowe,; click here for online contracting

Take Care of Yourself

Don’t forget: you’re your biggest asset. AEP is a marathon, not a sprint. Use this pre-season time to get into a good routine; physically, mentally, and professionally so you can show up at your best every day during the rush.

Medicare Savings Program: What It Is, How It Works, and Who Qualifies

Healthcare costs can be overwhelming, especially for people living on a fixed income. That’s where Medicare Savings Programs (MSPs) come in. If you are either new to Medicare or a new agent, you might ask; what is the Medicare savings Program. This program is designed to help individuals who meet specific income requirements with Medicare-related costs such as; premiums, deductibles, and coinsurance.

Let’s break down what these programs are, how they work, and who qualifies.

What Is the Medicare Savings Program

The Medicare Savings Program (MSP) is a set of federally funded, state-run programs that help eligible individuals pay for some or all of their Medicare Part A and/or Part B costs. This includes:

• Monthly premiums
• Annual deductibles
• Copays or coinsurance amounts

There are four main types of MSPs, each with slightly different income and asset limits and benefits.

The Four Types of Medicare Savings Programs

1. Qualified Medicare Beneficiary (QMB) Program
   • Pays for Medicare Part A & Part B premiums
   • Also covers deductibles, coinsurance, and copayments
   • Very limited income and asset limits apply
2. Specified Low-Income Medicare Beneficiary (SLMB) Program
   • Helps pay for Part B premiums only
   • Slightly higher income limits than QMB
3. Qualifying Individual (QI) Program
   • Also helps with Part B premiums
   • Available on a first-come, first-served basis
   • You must reapply each year
4. Qualified Disabled and Working Individuals (QDWI) Program
   • Pays for Part A premiums
   • For people under 65 who lost their premium-free Part A due to returning to work

How the Program Works

If you qualify for any of the Medicare Savings Programs:

• Your state pays your Medicare premiums directly to Medicare.
• In the case of QMB, providers are prohibited from billing for services covered by Medicare (except for a small copay in some cases).
• Enrollment in an MSP automatically qualifies you for Extra Help, a program that reduces prescription drug costs under Medicare Part D.

Who Qualifies for a Medicare Savings Program

Eligibility is based on monthly income and assets. The exact limits vary slightly by state, but general federal guidelines for 2025 are:

1. QMB (Qualified Medicare Beneficiary)

• Income: Below $1,325/month (individual), $1,783/month (married couple)
• Resources: Below $9,660 (individual), $14,470 (couple)

2. SLMB (Specified Low-Income Medicare Beneficiary)

• Income: $1,585/month (individual), $2,135/month (couple)
• Resources: Same as QMB

3. QI (Qualifying Individual)

• Income: $1,781/month (individual), $2,400/month (couple)
• Resources: Same as QMB

4. QDWI (Qualified Disabled and Working Individual)

• Income: Up to $5,302/month (individual), $7,135/month (couple)
• Resources: $4,000 (individual), $6,000 (couple)

Note: These limits are approximate and may vary slightly by state and year. Some states do not count all income or resources when determining eligibility.

Another way to save is by using the Canadian Medstore for some non-formulary or higher cost medications. Click here to watch a video on this program.

How to Apply

You must apply through your state Medicaid office, even though the program is funded by the federal government. You can apply at any time during the year; there’s no annual enrollment window for MSPs.

When applying, you’ll typically need to provide:

• Proof of income (such as pay stubs or Social Security statements)
• Bank statements
• Medicare card
• Identification documents

Individuals living on Medicare with a limited income shouldn’t overlook the Medicare Savings Programs. These programs can save hundreds or even thousands of dollars annually, making it easier to access needed care without worrying about the financial burden.

Those who might be close to the income or asset limits should still apply. Some states have flexible guidelines or exclude certain resources from their calculations.

Medicare agents; stay updated on the latest events and information, click here.

If you are an agent who is ready to join the team at Crowe; click here for contracting

A licensed Medicare agent or your local State Health Insurance Assistance Program (SHIP) can provide guidance with the process.

Understanding Medicare Part B Coverage

Both Medicare Part B (medical insurance) and Part A (hospital insurance), make up Original Medicare and play a vital role in healthcare for millions of Americans. Because Part B provides essential coverage for outpatient care, doctor visits, preventive services, and more; understanding Medicare Part B coverage is essential.

What’s Covered by Medicare Part B

Part B helps pay for a range of services and supplies, including but not limited to:

• Doctor’s visits (primary care and specialists)
• Wellness and preventive visits
• Urgent care services
• Laboratory tests (e.g., blood work, urinalysis)
• Diagnostic imaging (X‑rays, scans)
• Emergency ambulance transportation
• Mental health services (outpatient therapy, counseling)
• Durable medical equipment/DME (e.g., wheelchairs, oxygen tanks)
• Rehabilitative services (physical, occupational, speech therapy)
• Preventive services (e.g., flu shots, pap smears, cancer screenings)

Beneficiaries may receive these services in doctors’ offices, hospitals, clinics, and other outpatient facilities.

Medicare Part B Costs (2025 Rates)

Premium

• Standard monthly premium: $185.00 in 2025; up from $174.70 in 2024.
• Beneficiaries who receive Social Security payments have this amount automatically deducted from their Social Security checks. Those who opt not to take Social Security payments receive a quarterly bill for $555.00.

High-income earners pay higher premiums under IRMAA (Income‑Related Monthly Adjustment Amounts), with surcharges ranging from an additional $74 to $443.90, depending on tax filing status and income level.

Deductible & Coinsurance

• Annual deductible: $257 for 2025, this amount is up from $240 in 2024
• Coinsurance: Once the beneficiary meets the deductible, they pay 20% of the Medicare-approved cost for most services after Medicare pays it’s share (80%).

Late Enrollment Penalty

Those who don’t sign up for Part B when first eligible (and don’t qualify for a Special Enrollment Period), incur a 10% penalty for each full 12 months they were eligible but didn’t enroll. This penalty is added to the monthly premium and lasts for as long as they have Part B.

Watch a YouTube video on OEP, Special Elections & Late Part B Enrollments

How to Enroll

You can sign up for Medicare Part B online via the Social Security Administration, by phone at 1-800-772-1213 (TTY: 1-800-325-0778), or in person at your local Social Security office.
Ready to sign up for Part B? Click here to enroll now.

We’re Here to Help

Medicare agents can be a valuable source of information and guidance. There is no fee for the appointment. Whether you’re new to Medicare or looking to optimize your coverage, licensed agents are ready to assist.

Agents: if you are ready to join the team at Crowe; click here for contract.

Get all the latest agent news and event information; click here!

Keeping up with annual updates, such as; Part B premiums and deductible as well as nay plan changes, can help you budget effectively and avoid surprises.

What Medicare Doesn’t Cover: Avoid Costly Surprises

When you think about Medicare, it’s easy to assume it covers everything you might need as you age, but that’s far not quite the truth. While Medicare provides important and often lifesaving benefits, there are several healthcare services and items that Original Medicare (Parts A and B) simply doesn’t pay for. If you’re not aware of these gaps, you could face unexpected bills. Let’s take a closer look at what Medicare doesn’t cover and how you can protect yourself from high out-of-pocket costs.

Long-Term Care (Custodial Care)

One of the biggest misconceptions about Medicare is that it covers long-term care. In reality, Medicare does not cover custodial care, which includes help with daily activities like bathing, dressing, or eating; if it’s the only care you need.
Medicare may cover short stays in a skilled nursing facility after a hospital stay, but not ongoing assistance in a nursing home or at home.

How to plan: Look into long-term care insurance or other alternatives, such as life insurance with long-term care riders or setting aside personal savings.

Most Dental Care

Original Medicare doesn’t cover routine dental cleanings, fillings, extractions, root canals, dentures, or implants.
It will only cover dental procedures if they’re medically necessary as part of another covered procedure; like jaw surgery in a hospital.

Your options: Some Medicare Advantage (Part C) plans include limited dental coverage. Standalone dental plans are also available.

Vision Care

Medicare doesn’t cover routine eye exams for glasses or contact lenses. It also won’t pay for eyeglasses or lenses unless you’ve had cataract surgery.

Exceptions: Medicare does cover exams for certain conditions like glaucoma, diabetic retinopathy, or macular degeneration.

Your options: Many Medicare Advantage plans offer some vision benefits and like dental plans there are stand alone options as well as dental & vision packages.

Hearing Aids and Exams for Fitting Them

Hearing loss is common with age, but Medicare won’t cover hearing aids or the exams needed to fit them.
This can be a big financial hit, with hearing aids often costing thousands of dollars per pair.

Your options: Check Medicare Advantage plans or look for a stand alone plan, discount programs and clinics offering more affordable devices.

Routine Foot Care

Unless you have a qualifying condition like diabetes, Original Medicare doesn’t cover routine foot care like callus removal, nail trimming, or orthotics.

Your options: Some Medicare Advantage plans may cover podiatry services.

Over-the-Counter Medications and Most Prescription Drugs

Medicare Parts A and B don’t cover most prescription drugs or any over-the-counter medications. For that, you’ll need to enroll in a Medicare Part D plan (Prescription Drug Plan) or choose a Medicare Advantage plan that includes drug coverage.

Important: Even with drug coverage, some expensive medications may not be on your plan’s formulary; always check!

Foreign Travel Emergency Care

Generally, Medicare doesn’t cover healthcare you receive outside the U.S., except in very limited circumstances.

Your options: Some Medigap plans (like Plan G or Plan N) include limited foreign travel emergency benefits. You can also buy standalone travel insurance.

Cosmetic Surgery

Medicare doesn’t cover cosmetic procedures unless they’re needed due to accidental injury or to improve function from a deformity or illness (e.g., breast reconstruction after a mastectomy).

Acupuncture (Beyond Limited Use)

Medicare only covers acupuncture for chronic lower back pain, and only under specific guidelines. Other types of acupuncture, or treatment for other conditions, aren’t covered.

Agents, are you ready to join the team at Crowe; click here for contracting

How to Fill the Gaps

To protect yourself from unexpected expenses, consider:

• Medigap (Medicare Supplement Insurance): Helps pay for deductibles, copays, and coinsurance.
• Medicare Advantage (Part C): May include extra benefits like dental, vision, hearing, and wellness.
• Prescription Drug Plan (Part D): Adds drug coverage to Original Medicare.
• Dental, Vision, and Hearing Insurance: Available as standalone policies.

Agents: Watch a quick YouTube video on why and how to sell ancillary with Medicare

Stay updated on agent events and information – click here.

Medicare is an important program, but it’s not all-inclusive. Being proactive and understanding what it doesn’t cover can help you make smarter choices and avoid surprise bills. Talk to a licensed Medicare agent to help assess your needs and explore coverage options that close the gaps.

Common Medicare Enrollment Mistakes (and How to Avoid Them)

Enrolling in Medicare is one of the most important steps many of us take when we transition into retirement or experience a qualifying medical condition. But with multiple parts, deadlines, and plan types, it’s easy to make costly mistakes that could lead to penalties, gaps in coverage, or higher out-of-pocket expenses. We have listed some common Medicare Enrollment mistakes below with the hope that your clients can avoid them.

Missing the Initial Enrollment Period (IEP)

The Mistake: Waiting too long to enroll in Medicare Parts A and B can lead to late enrollment penalties, some of which are permanent.

How to Avoid It:
You’re eligible to enroll during a 7-month window:

• Starts 3 months before your 65th birthday month
• Includes your birthday month
• Ends 3 months after

If you’re not working or don’t have credible employer coverage, enroll during your IEP to avoid penalties.

Not Enrolling in Part B on Time

The Mistake: Some people mistakenly delay enrolling in Medicare Part B (medical insurance), thinking they don’t need it — even when they don’t have other credible coverage.

The Penalty: A 10% increase in premiums for every 12-month period you were eligible but didn’t enroll. This penalty lasts as long as the beneficiary has Part B coverage (for life).

How to Avoid It:
If you’re not actively working and don’t have employer-sponsored coverage, you should enroll in Part B when you’re first eligible. COBRA, retiree coverage, and the Marketplace do not count as credible coverage for Part B delays.

Not Enrolling in Part D (Drug Coverage)

The Mistake: Delaying enrollment in a Part D drug plan, thinking you don’t need one because you don’t take medications.

The Penalty: A permanent late enrollment penalty added to your Part D premium.

How to Avoid It:
Even if you don’t take prescriptions now, it’s wise to enroll in a low-cost Part D plan when you’re first eligible. You’ll avoid penalties and have coverage in place when you need it.

Watch a YouTube Video on Medicare Enrollment Periods

Assuming Medicare Covers Everything

The Mistake: Many people think Medicare is free and will cover 100% of their healthcare needs. Unfortunately, that’s not the case.

How to Avoid It:
Learn what Medicare does and doesn’t cover. For example:

• Part A covers hospital care but has a deductible
• Part B covers doctor visits and outpatient care, but only 80% after the deductible
• Medicare doesn’t cover routine dental, vision, hearing aids, or long-term care

Supplemental plans or Medicare Advantage can help fill these gaps.

Not Comparing Plan Options Annually

The Mistake: Sticking with the same plan year after year without reviewing changes.

How to Avoid It:
Use the AEP (Annual Enrollment Period) that runs from Oct 15 – Dec 7 to review:

• Premium changes
• Drug formularies
• Doctor networks
• Copays and out-of-pocket maximums

Plans change annually, and so do your health needs. An annual review ensures you’re in the most cost-effective and appropriate plan.

Relying on Friends or Online Info Without Expert Help

The Mistake: Taking advice from well-meaning friends or reading generic info online without speaking to a licensed agent.

How to Avoid It:
Medicare is personal. Plans vary by location, health needs, income, and prescription use. A licensed Medicare agent can help you compare plans and avoid costly oversights.

Are you an agent looking to join the team at Crowe, click here for online contract

Making the wrong choice with Medicare can cost hundreds, even thousands, over time. Whether you’re helping someone new to Medicare or reviewing your own plan, the smartest thing you can do is work with a licensed Medicare agent who understands the rules, timelines, and local options.

Agents stay up-to-date on events and information

Medicare for People Under 65: What Benefits and Plans Are Available

When most people think of Medicare, they think of individuals turning 65. But Medicare also covers millions of Americans under age 65 who qualify due to disability or specific medical conditions. Because understanding benefits and plan options is essential to getting the best possible care, we will discuss Medicare for people under 65.

Who Qualifies for Medicare Under Age 65

You may be eligible for Medicare before turning 65 if:

• You’ve been receiving Social Security Disability Insurance (SSDI) for 24 months (consecutive or non-consecutive).
• You have Amyotrophic Lateral Sclerosis (ALS); you automatically get Medicare the same month your SSDI benefits begin.
• You have End-Stage Renal Disease (ESRD); you may qualify for Medicare without waiting 24 months, depending on your treatment and transplant status.

What Medicare Benefits Do You Get

Medicare coverage for those under 65 generally includes:

• Part A (Hospital Insurance): Covers inpatient care, skilled nursing facility care, hospice, and some home health care. Usually premium-free if you worked 40 quarters (or qualify through a spouse).
• Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and durable medical equipment. You pay a monthly premium (standard amount is $174.70/month in 2025, though income can affect this).
• Part D (Prescription Drug Coverage): You can enroll in a standalone drug plan or get drug coverage through a Medicare Advantage plan.

Medicare Advantage (Part C) Plans for People Under 65

Private insurance companies offer Medicare Advantage plans. These plans must cover everything Original Medicare covers and often more, like dental, vision, hearing, gym memberships, and over-the-counter allowances.

Important notes:

• Not every state or county offers Medicare Advantage plans for beneficiaries under 65.
• You must be enrolled in both Part A and Part B to join a Medicare Advantage plan.
• Availability can depend on your ZIP code and health condition.

Some Advantage plans are designed for people with chronic conditions (C-SNPs), which could be a great fit for those with a qualifying illness.

Watch a YouTube video on Chronic Condition MAPD Plans

Medicare Supplement (Medigap) Plans for Individuals Under 65

Medicare Supplement plans (also called Medigap) help pay out-of-pocket costs like deductibles, copays, and coinsurance. They work with Original Medicare (not with Advantage plans).

Here’s the catch:

• Federal law does not require insurance companies to sell Medigap plans to people under 65. But many states do require it.
• If your state allows it, premiums may be higher than for people 65 and older.
• You may not be offered the full range of plans (A–N), and plan availability is very limited and varies widely by state.

Important: Even if you’re under 65 now, you’ll get another Medigap Open Enrollment Period when you turn 65; at that point, you can enroll in any plan with guaranteed issue rights and generally at lower rates.

Prescription Drug Coverage for Under-65 Beneficiaries

If you’re on Original Medicare, you’ll need a standalone Part D plan to cover your medications. These plans vary by region and formulary, so it’s important to review which plan best fits your prescriptions and pharmacy preferences.

If you choose a Medicare Advantage plan with prescription coverage, you don’t need to enroll in a separate Part D plan.

Don’t skip drug coverage! If you delay enrolling in Part D when first eligible and don’t have other credible coverage, you may face a late enrollment penalty later.

Getting Help with Costs: Extra Help & Medicaid

If you’re under 65 and have limited income or resources, you may qualify for:

• Medicare Savings Programs (help pay for Part A and B premiums and other costs)
• Extra Help with prescription drug costs
• State Medicaid programs, which can provide additional services and cost coverage

Medicare for people under 65 can be complex, but it’s also a lifeline. Plan options may differ from those turning 65, especially when it comes to Medigap and Medicare Advantage availability. It’s essential to:

• Review your state-specific rules
• Check if you’re eligible for Extra Help or Medicaid
• Compare Medicare Advantage vs. Original Medicare + Medigap carefully

Remember; coverage options may improve (and become more affordable) when you reach age 65, so be sure to reassess at that time.

Agents; if you are ready to join the Crowe team; click here for online contract.

Need help understanding your Medicare options under 65? Contact a licensed Medicare agent who can walk you through what’s available in your area and help you make the most of your benefit.

Get the latest agent information and up coming events; click here.

Digital Marketing for Medicare Agents: Expand Your Reach Online

The Medicare market is competitive, and while traditional methods like grassroots marketing and referrals still work, today’s successful agents know that digital marketing is key to long-term growth. Whether you’re just getting started or looking to refine your strategy, here are some essential tips for digital marketing for Medicare agents.

Build a Professional Website

Your website is your digital storefront. It should be clean, easy to navigate, and mobile-friendly. Be sure to include:

• A simple explanation of what you do
• Your contact information
• An appointment scheduler or contact form
• Educational content (like blogs or videos)
• Compliance disclaimers (required by CMS)

Tip: Add an FAQ section to answer common Medicare questions; it boosts SEO and builds trust.

Learn about the free website design assistance we offer to our agents.

Start a Blog

Blogging helps you:

• Educate prospects and clients
• Rank higher on Google
• Position yourself as a local Medicare expert

Make your posts easy to read, and include a call to action like “Schedule a Free Medicare Review Today.”

Watch a YouTube video on how to create a successful blog

Use Email Marketing

Email is a low-cost way to:

• Keep in touch with leads and clients
• Share reminders about enrollment periods
• Deliver newsletters or tips

Segment your list (e.g., by age, status, or interest), and personalize your emails with tools like Mailchimp, Constant Contact, or SendGrid.

Always follow CMS guidelines; no marketing AEP-related products before October 1st!

Get Active on Social Media

Platforms like Facebook and LinkedIn are great for reaching seniors and their caregivers. Post regularly and mix up your content:

• Educational posts and videos
• Reminders for enrollment periods
• Client testimonials (with permission)
• “Medicare Tip of the Week”

Join local Facebook groups and community pages; just be careful not to promote directly in restricted groups. Focus on being helpful not on selling.

Use Video to Explain Complex Topics

Short videos are powerful tools. You can create:

• “Explainer” videos for Medicare Parts A, B, C, and D
• Plan comparison walkthroughs
• “Ask Me Anything” Q&A sessions

Use YouTube, Instagram Reels, or Facebook Live. Keep it down to a few minutes and include captions for accessibility.

Set Up a Google Business Profile

A Google Business Profile (formerly Google My Business) helps locals find you when they search “Medicare agent near me.”

Make sure to:

• Keep your hours and contact info updated
• Add photos of your office or events
• Ask clients to leave reviews (and respond professionally)

Join the team at Crowe; click here for online contracting

Use CRM and Automation Tools

Managing follow-ups is critical. A Customer Relationship Management (CRM) system like Blitz, AgencyBloc or our new addition: the all -in-one agent portal, BOSS (learn more about BOSS) these tolls help:

• Track leads and clients
• Automate birthday or policy renewal reminders
• Manage email campaigns
• Track downline production (for agencies) These last 3 are available with BOSS!
• Book of business reports
• Track your sales

Automation saves time while keeping your outreach personal and consistent.

Track Your Results

Use tools like Google Analytics, Meta Ads Manager, and your email platform to see what’s working and what’s not.

Track:

• Website traffic and page views
• Email open and click rates
• Facebook post engagement
• Number of appointments or contacts per campaign

This data will help you fine-tune your digital marketing strategy over time.

You don’t need to master every digital channel at once. Start small; maybe by building your website and writing one blog post per month. As you get more comfortable, expand into social media or email marketing.

Stay updated on agent events and information

Being present and professional online helps build credibility, reach more prospects, and stay top-of-mind with current clients. With the right tools and strategy, digital marketing can become one of your most powerful Medicare sales tools.