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Medicare Enrollment: When It’s Automatic and When You Need to Sign Up

Medicare enrollment can be confusing, especially when it’s not clear whether you’ll be enrolled automatically or if you need to take the first step yourself. As either a Medicare agent or beneficiary, knowing when is Medicare enrollment automatic is critical to avoid late enrollment penalties and coverage gaps.

Here’s a breakdown of when Medicare enrollment happens automatically and when beneficiaries need to sign up on their own.

When Medicare Enrollment Is Automatic

Individuals are automatically enrolled in Medicare Part A and Part B at age 65 if:

They already receive Social Security or Railroad Retirement benefits

Individuals who collect either Social Security or Railroad Retirement Board (RRB) benefits for at least four months before their 65th birthday are automatically enrolled in:

• Medicare Part A (hospital insurance)
• Medicare Part B (medical insurance)

In most cases, These individuals receive their Medicare card about three months before their 65th birthday.

Those under 65 and have a qualifying disability

Individuals who receive Social Security Disability Insurance (SSDI) for 24 consecutive months, are automatically enrolled in Medicare once they reach the 25th month of disability benefits.

Please Note: Individuals with ALS (Lou Gehrig’s disease) receive Medicare automatically the month their disability benefits begin.

When You Need to Sign Yourself Up

Individuals must enroll themselves in Medicare if:

They’re not receiving either Social Security or RRB benefits

In many cases, people decide to delay the receipt of Social Security until after age 65 to maximize their benefit amount. Those individuals are not automatically enrolled in Medicare; they must sign themselves up during their IEP (Initial Enrollment Period).

The IEP is a 7-month window that starts 3 months before, includes the month of, and ends 3 months after the beneficiary’s 65th birthday.

Individuals who have employer coverage and delay Part B enrollment

Those still working and receive health coverage from a large employer (20+ employees) group health plan may choose to delay Part B and avoid paying the monthly premium. In that case, they must sign up later during a SEP (Special Enrollment Period). This is an 8 month window when individuals can sign up for Part B once their employer coverage ends or they stop working (whichever comes first).

Watch a YouTube video on OEP, SEPs and Late Part B enrollment

Important: COBRA and retiree coverage do not count as active employer coverage. Individuals may face penalties if they delay Medicare enrollment and rely on these plans.

What If You Miss Enrollment

If you miss your IEP and don’t qualify for an SEP, you’ll have to wait for the General Enrollment Period (GEP):

• January 1 – March 31 each year
• Coverage begins the month after you enroll
• You may owe a late enrollment penalty for Part B (and Part D if applicable)

Tips for Clients & Agents

• Mark your calendar: Your IEP starts 3 months before your 65th birthday.
• Enroll on time: Even if you’re healthy, missing the window can cost more later.
• Coordinate carefully: If still working, check with HR or your agent before delaying Medicare enrollment.
• Check coverage: Compare Original Medicare vs. Medicare Advantage (Part C) and add Part D or Medigap as needed.

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Need Help Enrolling

Whether you’re approaching 65 or advising clients, navigating enrollment can be tricky. Medicare.gov provides tools to check eligibility and apply online; agents can help guide clients through the process to avoid delays and penalties.

Knowing when Medicare enrollment is automatic and when you need to enroll yourself helps avoid costly mistakes. As an agent, walking clients through this process adds tremendous value. If you’re a beneficiary, planning ahead ensures a smooth transition into Medicare with the coverage you need.

Have questions about a specific situation? Reach out to a licensed Medicare agent who can provide personalized guidance based on your health needs and budget.

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As a Medicare agent, you’re not just helping clients find the right plan, they depend on your advice to help them navigate through all the complexities of Medicare. One important thing agents do is explaining Medicare penalties, this ensures clients avoid costly surprises.

Educating clients early using understandable terms on how to avoid these charges helps build trust and reinforces your value as a trusted advisor. Here’s a breakdown of the most important penalties clients need to understand and how to help them stay ahead of the game.

Start with the Enrollment Timeline

Some clients are unaware of the IEP (Initial Enrollment Period) and how crucial timing is. As you know, the IEP is a seven-month window:

• Three months before the month of their 65th birthday,
• The birthday month,
• And three months after their birthday month.

If they don’t enroll in Medicare Part B or Part D during this period, and they don’t qualify for an SEP (Special Enrollment Period), they could face lifelong penalties.

Encourage clients to begin planning their Medicare enrollment early; at least 3 to 6 months before turning 65. Use this time to review their current coverage and explain how Medicare will coordinate (or replace) it.

Clarify Each Type of Penalty

Clients rarely understand the specific consequences of delaying enrollment. Be sure to cover these key penalties in your consultations:

Medicare Part B Late Enrollment Penalty

• What It Is: A 10% increase in the monthly premium for every full 12-month period the client delayed enrollment without other creditable coverage.
• How Long It Lasts: For life, and CMS will add it to their Part B premium.
• Common Misunderstanding: Clients often believe they can just delay Part B if they’re healthy or not using care without knowing there is a penalty and it keeps growing.

Watch a YouTube video on OEP, SEPs an Late Part B Enrollment

Part D Late Enrollment Penalty

• What It Is: 1% of the national base premium (currently $36.78 in 2025) multiplied by the number of full uncovered months they went without creditable prescription drug coverage.
• How Long It Lasts: For life, and it’s added to their monthly Part D premium.
• Common Misunderstanding: Clients are often unaware of this penalty and if they don’t need drug coverage now, they do not have to enroll in a plan. Although, not having creditable coverage triggers the penalty anyway.

Medicare Part A Penalty

Penalty: 10% increase in the premium for twice the number of years they delayed enrollment.

Applies only to clients who do not qualify for premium-free Part A (usually those with less than 10 years of Medicare-covered work history).

Explain Employer Coverage and SEPs

This is where your expertise can be very useful.

Many clients working past 65 assume they can delay Medicare without issue. However, eligibility for an SEP (Special Enrollment Period) depends on their employment and the type of coverage they have.

Key Points:

• Employer coverage must be from active employment (not COBRA or retiree plans).
• The employer must have 20 or more employees for the coverage to delay Medicare enrollment without penalty.
• They must enroll in Medicare within 8 months of losing employer coverage to avoid penalties.

Review your client’s group health plan documents or provide them with specific questions to ask their HR department. It’s critical they confirm whether their plan is considered creditable coverage for both Part B and Part D.

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Conduct Annual Reviews

Clients’ needs, income levels, and coverage can change year to year. Use the AEP (Annual Enrollment Period) that runs Oct 15–Dec 7 to:

• Verify their current coverage.
• Check for plan changes that could increase costs.
• Remind them of potential penalties if they drop coverage without a replacement.

Document Everything and Communicate Clearly

Because it is easy for some clients to misunderstand Medicare rules, it’s essential to:

• Take notes that summarize the appointment after each consultation, some clients may want a copy for their own records.
• Track enrollment deadlines and follow up as key dates approach.
• Encourage clients to keep copies of any employer or plan letters that state their coverage is creditable.

Medicare penalties are preventable; only if your clients have the right information at the right time. As an agent, your ability to explain these rules in simple terms and guide clients through timely enrollment is a key part of your value.

By proactively addressing fees and penalties in your process, you not only protect clients financially you also strengthen your reputation as a knowledgeable and trustworthy advisor in a competitive marketplace.

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When it comes to navigating the maze of Medicare, choosing the right supplemental coverage can make a significant difference in both healthcare coverage and out-of-pocket costs. One option that remains popular is Medigap Plan N. We will outline the benefits of Medigap Plan N and highlight it’s balance of coverage and affordability. This post includes both the benefits and downsides of Medigap Plan N.

Medigap Plan N

Medigap (Medicare Supplement Insurance) helps pay for healthcare costs that Original Medicare (Part A and Part B) doesn’t cover, such as copays, coinsurance, and deductibles. Plan N is one of 10 standardized Medigap plans available in most states. It offers a good blend of coverage and cost savings, making it appealing to Medicare enrollees who want solid protection without having to pay the highest premiums.

Benefits of Medigap Plan N

Lower Monthly Premiums

In general, Plan N has lower premiums than more comprehensive plans like Plan F or Plan G. This makes it a good option for individuals who are relatively healthy and want to save on fixed monthly costs.

Plan N Covers Cost Gaps

• 100% of Part A coinsurance and hospital costs
• 100% of Part B coinsurance (with a few exceptions)
• Skilled nursing facility care coinsurance
• Part A deductible
• Emergency care during foreign travel (up to plan limits)

Nationwide Access

Like all Medigap plans, any provider that participates with Medicare will accept Plan N. Enrollees do not have to worry about provider networks or referrals. Enrollees can see any doctor or specialist who accepts Medicare.

Predictable Inpatient Costs

Because inpatient services are well covered by Plan N, beneficiaries can feel confident with their choice, if they are hospitalized or require skilled nursing care. Their costs should generally be predictable.

Downsides of Medigap Plan N

Copays for Doctor and ER Visits

While most Part B coinsurance is covered by Plan N, beneficiaries must still make some copays:

• Up to $20 for office visits
• Up to $50 for emergency room visits (waived if the patient is admitted)

These copays can add up for anyone who frequently requires the care of a doctor.

Doesn’t Cover Part B Deductible

Like all Medigap plans issued to new enrollees after January 1, 2020, Plan N does not cover the Medicare Part B deductible, which is $257 in 2025.

Excess Charges Not Covered

Plan N does not cover Part B excess charges. These are extra charges from providers who don’t accept Medicare assignment. These providers are allowed to bill up to 15% over the Medicare-approved amount. While this isn’t common, it can be a concern for those who live in or travel to areas where non-participating providers are prevalent.

Not Ideal for High Users of Care

Beneficiaries who require frequent doctor visits, lab work, or outpatient treatments may cause the recurring copays and potential for excess charges to outweigh the savings of the lower premiums. When that is the case, Plan G could be a better value despite higher monthly premiums.

Plan N can be an excellent choice for

• People in relatively good health
• Those who prefer lower monthly premiums
• Individuals who rarely see non-participating Medicare providers
• Enrollees who are comfortable paying small copays in exchange for premium savings

Plan N may not be ideal for

• People who visit the doctor frequently
• Those who live in areas where excess charges are more common
• Individuals who want the most comprehensive coverage available

Watch a video on Physicians Mutual Innovative Plan G

Medigap Plan N is a well-balanced choice for Medicare beneficiaries who want solid protection without paying top-dollar premiums. Its design provides comprehensive healthcare at an affordable rate. As always, choosing the right Medigap plan depends on health needs, budget, and lifestyle. Comparing Plan N with other options like Plan G can help beneficiaries make the most informed decision. A licensed Medicare agent can help compare plans and weigh all the options.

As a Medicare agent, mastering all the different enrollment periods is crucial to ensure smooth enrollment for your clients. It also helps you stay compliant and that is also very important. Understanding IEP vs ICEP is essential to anyone in Medicare sales. Although these two sound similar, they serve distinct purposes and apply to different parts of Medicare.

IEP (Initial Enrollment Period)

First we will go over The IEP. Most agents know that this is the first window of time when someone is eligible to enroll in Original Medicare; specifically Parts A and B.

• Who is eligible to apply: Individuals turning 65 who worked and paid Medicare taxes for a period of at least 10 years (40 quarters) or their spouse or ex-spouse. Those who are under 65 with a qualifying disability, ESRD or ALS are also eligible to enroll.
• Timing: For those who are turning 65; The IEP spans 7 months: it begins 3 months before their 65th birthday, includes their birth month and ends 3 months after the month they turn 65.
• Timing: Individuals who are under 65 and qualify due to a disability; the IEP begins 3 months before the 25th month of their disability benefit entitlement.

Example: If a client turns 65 in May, their IEP runs from February 1st to August 31st.

What beneficiaries can do during IEP

1. Enroll in Medicare Part A and/or Part B
2. Enroll in a Medicare Part D plan (if they have Part A and/or Part B)
3. If they enroll in both Part A & Part B, they may also opt for either a Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap) plan.

ICEP (Initial Coverage Election Period)

When an individual is first eligible for Medicare, the ICEP can specifically be used to enroll in a Medicare Advantage (Part C) plan.

• Who can use the ICEP: Individuals who are first enrolling in both Medicare Part A and B, and want to join a Medicare Advantage plan.
• Timing: Usually, the ICEP coincides with the IEP. However if an individual delays Part B enrollment (e.g., due to employer coverage), the ICEP does not start until they have both Part A and Part B and ends the last day of the month before their Part B coverage begins.

Example 1 (standard case): Client enrolls in A & B to begin July 1. Their ICEP runs from April 1 to June 30.

Example 2 (delayed Part B): Client took Part A at 65; delayed Part B until they retired at 67. Their ICEP begins when they enroll in Part B and ends the last day of the month before Part B becomes effective.

What beneficiaries can do during ICEP

1. Enroll in a Medicare Advantage (Part C) plan, with or without drug coverage (MAPD or MA-only).

Differences at a Glance

Why Understanding IEP vs ICEP Matters to Agents

Confusing IEP and ICEP could lead to enrollment mistakes, missed opportunities, and compliance issues. Knowing when each applies ensures:

• You recommend the right plans at the right time.
• You help clients avoid penalties for delayed Part D enrollment.
• You position yourself as a knowledgeable and trusted resource.

Watch a YouTube video on Medicare enrollment periods

Important: Always ask clients if they’ve enrolled in both Part A and B before discussing Medicare Advantage options. This small question helps determine whether they’re in their ICEP.

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As a Medicare agent, you’re always looking for ways to support your clients; especially those who have difficulty affording their medications. One of the most overlooked tools in your toolkit is the State Pharmaceutical Assistance Program (SPAP) and the Special Enrollment Period (SEP) it can trigger. This SEP can be a great opportunity for individuals with lower income levels. This post answers the question: what is an SPAP SEP and how you can use it effectively to provide clients the benefits they need and remain complaint.

What Is an SPAP

State Pharmaceutical Assistance Programs (SPAPs) are state-specific programs. Each state designs them to provide assistance to qualified residents; usually low-income seniors or people with disabilities, to pay for prescription drugs. Benefits may include help with:

• Part D premiums
• Deductibles
• Copays and coinsurance
• Coverage gaps (including the “donut hole”) Please keep in mind; the coverage gap was eliminated in 2025.

Important: Not all states offer SPAPs, and those that do have varying eligibility criteria. For example, Connecticut’s PACE, New York’s EPIC or New Jersey’s PAAD and Senior Gold, are a few of the better-known programs.

The SPAP SEP

Once a client becomes eligible for or enrolls in an SPAP, they qualify for an SEP (Special Enrollment Period). Eligible individuals can use the SEP to:

• Enroll in a Medicare Part D plan (if they haven’t yet)
• Switch from one Part D plan to another

The SPAP SEP is useful for:

• Individuals who miss their Initial Enrollment Period (IEP)
• Clients in unsuitable plans with high out-of-pocket costs
• Individuals who are newly eligible for financial help anytime during the year

Timing Rules For SPAP SEPs

• Trigger: The SEP is triggered by eligibility for or enrollment in an SPAP.
• Usage: Individuals can use this SEP only once per calendar year.
• Window: Clients have two full months after the month of SPAP enrollment/eligibility to make a change.

Example: If an individual is approved for their state’s SPAP in April, they can enroll in or switch Part D plans through June 30.

Why This SEP is Important to Agents

Some agents are unsure of how SPAPs work with Medicare timelines. Using the SPAP SEP can:

• Help your clients access more affordable drug coverage outside of AEP (the Annual Enrollment Period)
• Allows agents to proactively help clients who receive an SPAP approval notice
• Position an agent as a knowledgeable advisor who ensures clients receive the best coverage for their budget

Understanding SPAPs also gives you a competitive edge; especially when working in states that offer generous or well-known assistance programs.

Best Practices for Agents

1. Know Your State’s SPAP: Research the program(s) available in each state you are licensed in. Make sure you are aware of income limits and how the program coordinates with Part D.
2. Know the application process. Be sure you can provide assistance to clients to access the SPAP application and what they need to complete it.
3. Educate Your Clients: Many beneficiaries don’t know these programs exist. Include SPAP information in your annual reviews, especially when you have clients with low-income or high drug-costs.
4. Be aware of SEP Opportunities: If a client is approved for SPAP mid-year, this is an opportunity to review their current drug coverage and potentially move them to a plan that better suits their needs.
5. Coordinate with SHIPs: Partnering with your local State Health Insurance Assistance Program (SHIP) can help your clients apply for SPAPs and get extra help if needed.
6. Stay Compliant: Always document the SEP reason when submitting applications or plan changes, and be sure the client’s enrollment in the SPAP can be verified.

The SPAP SEP is an important but underutilized option for helping Medicare clients reduce prescription drug costs and access more suitable coverage. By understanding and using the guidelines correctly, you can serve clients better and potentially improve your retention and referral rate in the process.

Watch a YouTube video on 2025 SEP Changes for DSNP

Note: It is a good idea to bookmark your state’s SPAP website and use it as a resource when appropriate. Being the agent who knows the programs that can make a real difference in people’s lives builds long-term relationships and trust.

For many people trying to navigate Medicare, understanding how and when out-of-pocket costs apply can be overwhelming. The terminology “first dollar Medicare services” may cause confusion for some individuals. We will explain what it actually means and how they work in the context of Medicare services.

First Dollar Coverage

First dollar coverage refers to insurance benefits that begin immediately. The enrollee is not required to, pay a deductible, copay, or coinsurance before the carrier provides coverage for a medical service. This coverage literally begins from the “first dollar” of a medical bill providing the highest level of financial protection.

With Original Medicare (Parts A and B), this kind of coverage is not included by default, although it may be accessed through either supplemental plans or Medicare Advantage plans in some circumstances.

Original Medicare: No First Dollar Coverage

Medicare is divided into Part A (hospital insurance) and Part B (medical/outpatient insurance).

Original Medicare enrollees are responsible for the following out-of-pocket costs:

• Deductibles: Part A ($1,632 per benefit period in 2025); Part B ($240 annual)
• Coinsurance: 20% for most Part B services after the deductible
• Copays: Varies depending on the service or provider

Please note; although Medicare covers a significant portion of approved healthcare costs, it does not offer first dollar coverage when used on its own. Beneficiaries are responsible for cost-sharing amounts unless they purchase supplemental coverage.

First Dollar Coverage for Medicare Services

In general, there are two ways Medicare beneficiaries receive first dollar coverage:

1. Medicare Supplement (Medigap) Plans

The Medigap plans listed below cover most or all out-of-pocket costs after Original Medicare pays its share.

• Plan F: Offers true first dollar coverage. This plan covers both Part A and Part B deductibles as well as all coinsurance and copays for approved medical expenses as well as excess charges.
• Plan C: Similar to Plan F but doesn’t cover excess charges. Important: Plans F and C are not available to individuals who were eligible for Medicare after January 1, 2020.
• Plan G: Covers all approved Medicare expenses; except the Part B deductible, making this plan very close to first dollar coverage.

Beneficiaries enrolled in a Plan F shouldn’t have to pay anything out-of-pocket for Medicare covered services.

2. Some Medicare Advantage (Part C) Plans

Medicare Advantage plans are an alternative to Original Medicare. Some Medicare Advantage plans offer enrollees:

• $0 monthly premiums
• $0 copays for primary care, lab work, preventive services, or telehealth
• Reduced out-of-pocket costs through annual limits

Although technically they are not considered “first dollar” coverage, some plan benefits can effectively eliminate upfront costs for specific services, depending the plan design.

Keep in mind: Medicare Advantage plans may include networks, referrals, and prior authorization requirements.

Watch a quick YouTube video on Medicare enrollment periods

Examples of First Dollar Medicare Service

• Example 1: A Medigap Plan F enrollee visits the emergency room. The bill is fully covered; no deductible, no copay, no coinsurance. This is real first dollar coverage.
• Example 2: A Medicare Advantage plan enrollee has a $0 copay for a primary care visit. Although the plan may have a deductible for other services, this specific visit is a first dollar service.
• Example 3: A individual with Original Medicare and no supplemental coverage uses the services of a specialist. This individual must meet the Part B deductible and then pay 20% for all approved charges. In other words, this is not first dollar coverage.

Why First Dollar Coverage Matters

• Predictable healthcare costs
• Easier budgeting for individuals on fixed incomes
• Reduces the risk of surprise bills
• Encourages timely medical visits and screenings

Possible Downside

• Higher monthly premiums (especially with Medicare Supplement Plans)
• Less flexibility (if beneficiaries opt for a Medicare Advantage Plan) they must use specific provider networks.
• Limited plan availability for more recent enrollees (Medicare Supplement Plan F and Plan C enrollment restrictions).

First dollar Medicare services are about financial peace of mind. While Original Medicare doesn’t provide this level of coverage on its own, many beneficiaries learn that Medicare Supplements or Medicare Advantage plans reduce or eliminate the high price of medical care.

Beneficiaries who like predictable expenses and minimal out-of-pocket costs, may opt for a plan that offers first dollar coverage. As a licensed Medicare agent, it is important to understand your clients healthcare needs and budget to offer plan choices that provided the best benefit options.

Although there are millions of people on Medicare, many find it a confusing subject especially since there are so many different parts to it. For individuals approaching 65 or anyone who or just wants to understand more about how this insurance works, here’s a brief answer to the question; what is Original Medicare and what does it cover.

What Is Original Medicare

The federal government established Original Medicare, a federal health insurance program, in 1965. The following individuals may qualify for Medicare benefits:

• People age 65 or older
• Certain younger people with qualifying disabilities
• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There are 2 parts of Original Medicare: Part A and Part B.

Medicare Part A

Medicare Part A is sometimes referred to as hospital insurance. It provides coverage for:

• Inpatient hospital care (once the enrollee is formally admitted)
• Skilled nursing facility care (following a qualifying hospital stay)
• Home health care (limited and medically necessary services)
• Hospice care for individuals with a terminal illness

For most people, Part A is free,there is no premium payment as long as eiither the beneficiary or thier spouse worked and paid Medicare taxes for a minimum of 10 years.

Please note: Although Part A covers hospital stays, it doesn’t cover long-term care such as; nursing homes, custodial care or unlimited days in a hospital or facility. There are limits to what it pays; beneficiaires must pay a portion of their expenses (cost-sharing), such as deductibles and coinsurance and copays.

Medicare Part B

Medicare Part B is also known as medical insurance. It provides coverage for the following:

• Doctor visits and outpatient medical care
• Preventive services such as; wellness visits, flu shots and cancer screenings
• Durable medical equipment (DME) this include things like; walkers, wheelchairs, oxygen as well as some diabetes supplies and more
• Lab tests and diagnostic imaging
• Mental health services
• Some home health care

Unlike Part A, beneficiaries do pay a monthly Part B premium. Fo rmost people, this is a standard amount although higher-income beneficiaries may pay an additional cost.

Click here to learn more about Part B eligibility

Part B coverage includes an annual deductible (this amount is adjusted annually). Typically beneficiaries pay 20% coinsurance for most covered services; in other words, Medicare pays about 80% of the cost leaving enrollees responsible for the remaining 20%.

What Original Medicare Doesn’t Cover

Original Medicare provides coverage for many medical expenses; although, they do not cover everything. Some important things to know about what Medicare does not cover:

• Prescription drugs (beneficiaries must enroll in separate Part D plan)
• Routine dental, vision, and hearing care
• Long-term custodial care
• Most care received outside the U.S.

In order to fill some of these coverae gaps, many people purchase additional insurance. Some of the plans people choose are; Medicare Supplement (Medigap) plans, Stand-alone PDP (prescprion Drug) plans, Medicare Advantage (Part C) plans. Beneficiaries also may opt for ancillary coverage like dental, vision and hearing or cancer heart attack and stroke plans.

Medicare agents; learn how to sell ancillary products with Medicare – watch a quick video.

Original Medicare provides valuable health coverage for millions of Americans, but it’s important to understand what it cover and what it doesn’t. Knowing the basics helps beneficiaries make informed decisions and avoid unexpected costs.

Navigating the world of Medicare can be overwhelming, especially when it comes to choosing the right supplemental coverage. That’s why it is important to understand what Medigap standardized benefits are and how they work.

Medigap is a type of private insurance that helps beneficiaries cover the “gaps” in Original Medicare (Parts A and B). Medigap plans cover things like; deductibles, coinsurance, and copays. What many people don’t realize is that Medigap policies are standardized, meaning the benefits for each plan type are the same, no matter which insurer you choose.

What “Standardized” Means

Starting in 1992, federal law requires all Medigap policies to adhere to standardized benefit structures, designated by letters: Plans A through N. The only real difference in plans is the premium each carrier charges for the plan. Although insurance companies charge different premiums, the benefits for each plan letter must be identical no matter who the provider is. In other words, every Plan N has to provide the exact same coverage for medical expenses no matter what company offers it.

Standardization makes it easy for beneficiaries to compare plans without worrying about differences in coverage. They can simply compare cost and company ratings to find the best options.

Examples of Medigap Plan options

• Plan A: This is the most basic plan option. It provides coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance, and the first three pints of blood.
• Plan G: The most comprehensive plan available to those who turned 65 after 1-1-2020. It covers all Medicare approved expsnes with the exception of the Part B deductible.
• Plan N: Offers lower premiums than Plan G and covers a portion of the copays for doctor visits and hospital visits. The enrollee will still have a small copay for Medical services. This plan does not cover the Part B deductible or excess charges.

Some States Have Different Medigsp Standards

Although most states follow the federal standardization model, Massachusetts, Minnesota, and Wisconsin have their own versions of standardized Medigap plans. These states use their own benefit structures however, they still follow the principle of offering consistent benefits across insurers within their states.

Please Note

• Plan C and Plan F are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. These plans provided coverage for the Medicare Part B deductible, which new legislation phased out to cut back on the overuse of services.
• Beneficiaries must have both Medicare Part A and Part B to enroll in a Medigap plan. There is a premium for Medigap plans in addition ot the Part B premium.
• Medigap works with Original Medicare, beneficiaires cannot use a Medigpa plan with a Medicare Advantage (Part C) plan.

Why Standardization is Important

Standardization simplifies decision-making for Medicare beneficiaries. It eleiminates the need to decipher insurnace benefits accross multiple insurance companies; instead, the focus is on price, company reputation, and rate increase history.

Watch a quick YouTube video on Medicare Supplement Underwriting

This helps foster competition between companies based on cost and service quality instead of confusing plan designs.

Choosing a Medigap plan doesn’t have to be a guessing game. With standardized benefits, benficiaries can make apples-to-apples comparisons between insurers and choose the coverage that meets both healthcare and financial needs.

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As Medicare beneficiaries consider supplemental coverage to fill the gaps left by Original Medicare (Parts A and B), many turn to Medigap plans. Among them, The HDG (High Deductible Plan G) stands out for the comprehensive benefits it provides at a lower monthly premium, but with a catch: a high annual deductible. If your client is considering a HDG Plan, understanding the pros and cons of HDG Plans will help them make an informed decision.

What Is HDG

HDG or High Deductible Plan G provides the same benefits as standard Medigap Plan G; one of the most comprehensive Medigap options, but only after the beneficiary meets an annual deductible. Each year, CMS decided what that deductible amount will be; in 2025, the deductible is $2,800.

Once the beneficiary pays the deductible for the year, the plan pays 100% of covered Medicare expenses, just like a standard Plan G.

Pros of HDG

1. Low Monthly Premiums

The biggest selling point of the HDG plans is their affordability upfront. The premiums for HDG Plans is typically much lower than standard Plan G, in some cases, less than 1/3 of the price, making this a great option for healthy enrollees or individuals living on a fixed income who want to be prepared for unexpected health issues.

2. Full Coverage

Once the beneficiary meets the annual deductible, HDG covers:

• Part A coinsurance and hospital costs
• Part B coinsurance/copays
• Blood (first 3 pints)
• Skilled nursing facility coinsurance
• Part A hospice care coinsurance/copays
• Medicare Part A deductible
• Part B excess charges
• Foreign travel emergency care (up to plan limits)

3. Good Option for Health Individuals

Those who rarely seek medical care may not reach the annual deductible; in other words, out-of-pocket spending could stay well below the cost of a standard Plan G’s premium.

4. Standard Benefits

Just like all other Medicare Supplement plans; HDG is standardized. Therefore, after the deductible is met, the benefits are the same regardless of insurer. The only thing to compare are the premiums and service quality, not the coverage.

Cons of HDG

1. High Upfront Costs

Individuals who require frequent care (doctor visits, outpatient services, hospital stays) pay out-of-pocket until they reach the $2,800 (in 2025) deductible. For some, this could all happen early in the year, and the savings from lower premiums may not offset that.

2. Not Ideal for Some Budgets

For individuals on a tight or fixed income, facing unexpected out-of-pocket expenses could be difficult to manage before the deductible is met, even if the plan is technically cost-effective over time.

3. Premiums Aren’t Fixed

Although the premiums are much lower than standard Plan G, HDG premiums (like all Medigap plans) can still increase annually, leading to less savings over time. It may be a good idea to check the rate history of the insurer before choosing a plan.

4. Deductible Increases

Each year, CMS sets the annual deductible and it usually has a slight increase each year. This unpredictability can cause some issues with long-term budgeting when compared to standard plans.

Who May Be a Good Fit For HDG

• Healthy individuals with few healthcare needs
• Younger Medicare beneficiaries (e.g., age 65-70) not expecting major procedures
• Those comfortable with financial risk with the means to pay the deductible if necessary
• Budget-conscious individuals looking for low monthly expenses

Medicare HDG provides similar peace of mind to regular Plan G. It is just delayed until after the deductible is met. It’s a good option for those who can afford some out-of-pocket risk in exchange for lower premiums. As with all coverage options, it’s not a one-size-fits-all solution.

A licensed Medicare agent can help run the numbers and explore quotes tailored to an individual’s specific needs.

In the world of sales, one truth stays constant: people are much more likely to buy from those they know and trust. For that reason, agents who focus on local marketing are often more successful than those who sell exclusively over the phone or online. Although digital ads and lead vendors can be great tools, nothing builds long-term credibility and referrals like mastering local Medicare marketing and establishing yourself as the local Medicare expert.

So how can you, as a Medicare agent, have an impact on your local market? Take a look at some helpful tips below and grow your book of business.

Establish Yourself In The Community

Before you begin a marketing campaign in your community, make sure your branding reflects the local area. Use localized messaging in your advertising, website and even your business cards.

• Feature city or county names in your taglines (“Your Fairfield County Medicare Plan Enrollment Specialist”)
• Include popular landmarks or maps in mailers and flyers
• Mention that you work with several local plans and providers

Consider: Creating a dedicated landing page for each major city or zip code you serve. This can help improve website SEO and build credibility with local clients.

Community Involvement

People trust people they see regularly and are familiar with; especially when it comes to something as personal as healthcare. Make sure you show up where potential clients are. Here are a few suggestions:

• Volunteer at local food pantries
• Offer to help at local senior centers or events
• Sponsor a booth at community health fairs
• Provide free Medicare 101 presentations at libraries, churches, or senior centers

These events are not about a sales pitch; they’re about establishing yourself as a member of the community and a trusted, local resource.

Local Online Marketing

You don’t need a massive ad budget to be seen online. The important thing is to show up in local searches.

• Google Business Profile: Claim and optimize your listing. Add real client reviews, update your service area, and post updates.
• Facebook and Nextdoor: Participate in local discussions, share useful tips, and post your events and the services you provide.
• Local SEO: Include keywords like “Medicare agent in (City)” or “Help with Medicare plans near (ZIP code)” in your website content.

Additionally: Write blog posts about Medicare topics and include a local area in the name, such as: “Top Medicare Advantage Plans in (Your City)” or “What Seniors in (You County) Should Know About the Medicare Part B Giveback”.

Watch a Quick YouTube video on how to improve your website traffic with blogs

Build Relationships with Local Professionals

Other area professionals who serve your target audience can be excellent referral partners. Keep in mind; this relationship should work both ways:

• Independent pharmacists
• Local doctors
• Home health agencies
• Senior housing communities
• P&C Insurance agents
• Financial planners
• Social workers

Offer to co-host events, provide educational materials, or train their staff on Medicare basics or benefits. Providing free services to thier clients allows them to build trust and opens doors.

Mail or Flyers with Local Feel

Direct mail is sometimes an effective tool; especially when it feels personal. Do not end up in the waste basket:

• Use your photo (this helps you become recognizable) and a friendly message
• Reference a local community or event (“Join us at the Danbury Library Medicare Seminar!”)
• Offer a free consultation with your contact info

Be Available Year-Round

Some agents make the mistake of marketing only during AEP (Annual Enrollment Period), then disappear the rest of the year. However ther are many other opportunities to provide service to Medicare beneficiaries and grow your book:

• Offer help with SEPs (Special Enrollment Periods), or Medicaid, LIS (Extra Help).
• Follow up with clients after enrollment to ensure their questions or concerns are taken care of; provide ongoing support.
• Host workshops or Q&A sessions in a familiar location on a consistant basis.

Staying visible and providing helpful advice provides opportunities to earn referrals naturally; outside of AEP.

Final Thoughts

Local marketing isn’t about using aggressive sales tactics or decptive advertisements; it’s about connection and trust. Once an agent is established as a familiar, reliable, and helpful presence in the community, they don’t just get referrals, they build lasting relationships.

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Master your local market by showing up, serving with integrity, and positioning yourself as a reliable Medicare resource.