Worthen Insurance Group

𝗪𝗼𝗿𝘁𝗵𝗲𝗻 𝗪𝗲𝗱𝗻𝗲𝘀𝗱𝗮𝘆: 𝗪𝗵𝗲𝗻 𝗬𝗼𝘂𝗿 𝗗𝗼𝗰𝘁𝗼𝗿 𝗟𝗲𝗮𝘃𝗲𝘀 𝗬𝗼𝘂𝗿 𝗣𝗹𝗮𝗻'𝘀 𝗡𝗲𝘁𝘄𝗼𝗿𝗸 💙

"𝗠𝘆 𝗱𝗼𝗰𝘁𝗼𝗿 𝗷𝘂𝘀𝘁 𝘁𝗼𝗹𝗱 𝗺𝗲 𝘁𝗵𝗲𝘆 𝘄𝗼𝗻'𝘁 𝗯𝗲 𝗶𝗻 𝗺𝘆 𝗽𝗹𝗮𝗻'𝘀 𝗻𝗲𝘁𝘄𝗼𝗿𝗸 𝗻𝗲𝘅𝘁 𝘆𝗲𝗮𝗿. 𝗪𝗵𝗮𝘁 𝗻𝗼𝘄?"

If you've heard this lately, you're not alone. This is one of the most common calls I get in October, and it's an unsettling one. You've built trust with your doctor, and the last thing you want is to start over with someone new because of a contract you had no say in.

Here's what's usually going on:

𝗡𝗲𝘁𝘄𝗼𝗿𝗸𝘀 𝗰𝗵𝗮𝗻𝗴𝗲 𝗳𝗿𝗼𝗺 𝘆𝗲𝗮𝗿 𝘁𝗼 𝘆𝗲𝗮𝗿. Medicare Advantage plans contract with doctors and hospitals, and those contracts get renegotiated. Sometimes a plan and a doctor's office can't come to terms, and the doctor drops out of the network for the following year. It's a business decision between them, not a reflection on you or your care.

𝗧𝗵𝗲 𝗻𝗲𝘄𝘀 𝗼𝗳𝘁𝗲𝗻 𝘀𝗵𝗼𝘄𝘀 𝘂𝗽 𝗶𝗻 𝗽𝗶𝗲𝗰𝗲𝘀. You might hear it from the doctor's front desk, a letter from the plan, or not at all until you check. Your plan's Annual Notice of Change spells out what's changing for next year, but provider details aren't always easy to find in it. That's why so many people are caught off guard.

𝗧𝗵𝗶𝗻𝗴𝘀 𝗰𝗮𝗻 𝘀𝘁𝗶𝗹𝗹 𝘀𝗵𝗶𝗳𝘁 𝗯𝗲𝗳𝗼𝗿𝗲 𝗝𝗮𝗻𝘂𝗮𝗿𝘆. Sometimes a doctor and a plan work things out late in the year. Other times a doctor stays in one of the company's plans but not another. It's worth confirming the details before you make any big moves.

𝗪𝗵𝗮𝘁 𝗱𝗼 𝗜 𝗱𝗼 𝗮𝗯𝗼𝘂𝘁 𝗶𝘁?

First, 𝗰𝗼𝗻𝗳𝗶𝗿𝗺 𝗶𝘁 𝘄𝗶𝘁𝗵 𝗯𝗼𝘁𝗵 𝘁𝗵𝗲 𝗱𝗼𝗰𝘁𝗼𝗿'𝘀 𝗼𝗳𝗳𝗶𝗰𝗲 𝗮𝗻𝗱 𝘁𝗵𝗲 𝗽𝗹𝗮𝗻. Ask the office exactly which plans they'll accept next year, and check the plan's 2027 provider directory.

Next, 𝘂𝘀𝗲 𝘁𝗵𝗲 𝗔𝗻𝗻𝘂𝗮𝗹 𝗘𝗻𝗿𝗼𝗹𝗹𝗺𝗲𝗻𝘁 𝗣𝗲𝗿𝗶𝗼𝗱. From 𝗢𝗰𝘁𝗼𝗯𝗲𝗿 𝟭𝟱 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝗗𝗲𝗰𝗲𝗺𝗯𝗲𝗿 𝟳, you can switch to a different Medicare Advantage plan your doctor accepts, or move back to Original Medicare, with your new coverage starting January 1.

If you're in the middle of treatment, ask your plan what happens to ongoing care so there are no surprises.

And if you're weighing a move to Original Medicare and want a Medicare Supplement, ask about health questions before you switch. Outside certain windows, Supplement companies can look at your health history, so it's best to know where you stand first.

𝗜𝗳 𝘁𝗵𝗶𝘀 𝗶𝘀 𝘆𝗼𝘂 𝗿𝗶𝗴𝗵𝘁 𝗻𝗼𝘄, 𝘆𝗼𝘂 𝗵𝗮𝘃𝗲 𝗼𝗽𝘁𝗶𝗼𝗻𝘀, 𝗮𝗻𝗱 𝘆𝗼𝘂 𝗵𝗮𝘃𝗲 𝘁𝗶𝗺𝗲. Missing a letter or not knowing this could happen isn't a failure on your part. It catches a lot of people off guard.

𝗛𝗮𝘃𝗲 𝗮 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻 𝗮𝗯𝗼𝘂𝘁 𝘆𝗼𝘂𝗿 𝘀𝗶𝘁𝘂𝗮𝘁𝗶𝗼𝗻? 𝗦𝗲𝗻𝗱 𝗺𝗲 𝗮 𝗺𝗲𝘀𝘀𝗮𝗴𝗲 𝗮𝗻𝘆𝘁𝗶𝗺𝗲. No pressure and no judgment, just a real conversation at no cost to you.

If you or someone you love takes an expensive prescription, here's a number worth knowing before Medicare open enrollment starts October 15.

Since 2025, Medicare drug coverage has had a yearly limit on what you pay out of pocket for covered prescriptions. This year the limit is $2,100. In 2027 it goes up to $2,400. Once your share reaches it, your covered drugs cost $0 for the rest of the calendar year. It works the same way whether you have a standalone Part D plan or a Medicare Advantage plan with drug coverage.

What counts toward the limit:
✓ Your deductible
✓ Your copays and coinsurance on drugs your plan covers
✓ Money other people pay for you, like family, friends, many charities, and Extra Help

What doesn't count:
✗ Your monthly premium
✗ Drugs your plan doesn't cover
✗ Drugs covered under Part A or Part B
✗ Discounts paid by drug makers

That second list is why the plan you pick still matters. If a drug isn't on your plan's list, what you spend on it won't count toward the limit unless the plan approves an exception. Before you settle on a 2027 plan, make sure every one of your prescriptions is covered, and check which pharmacies you can use.

The limit doesn't fix one thing: timing. If you take a high-cost drug, you could hit the whole amount in January. The Medicare Prescription Payment Plan spreads those costs into monthly bills for the rest of the year, with no fees or interest. You can sign up through your drug plan at any time. It doesn't lower what you owe overall. It just keeps one trip to the pharmacy from eating a whole month's budget.

Two costs already have their own limits:
✓ Covered insulin is capped at $35 for a month's supply, with no deductible
✓ Vaccines recommended for adults that Part D covers cost you $0

If you'd like a second set of eyes on your prescriptions before you choose a plan, give our office a call at 281-819-6619. I'm always happy to help.



This post is for educational and informational purposes only. It isn't personalized insurance, tax, legal, or financial advice. Please talk with a licensed professional about your own situation before making decisions.

If you help a parent with their bills, this list is worth ten minutes of your time.

About 9 million older adults qualify for help they never claim. NCOA's research keeps finding the same reasons: they don't know the program exists, they assume the application will be a headache, or they figure someone else needs it more.

The biggest one on the list is VA Aid and Attendance. A wartime veteran who needs help with daily care and meets the income and asset limits can get up to $34,488 a year. Surviving spouses can qualify too, at a lower amount.

The other five depend mostly on income, and some look at savings and assets too. Every program and every state sets its own limits, so the only way to know for sure is to check.

Here's the part most people miss: two of them lead to a third. If you're approved for SSI or a Medicare Savings Program, you automatically get Extra Help with prescription costs. No separate application.

A good place to start is NCOA's BenefitsCheckUp (benefitscheckup.org). It screens for all of these at once and doesn't cost a thing. Your local Area Agency on Aging can also help with the paperwork, or you can dial 2-1-1 here in Texas.

Pass this along to someone who's helping Mom or Dad. Have you ever found out about a benefit you didn't know existed?

This post is for general information only. Benefit amounts and eligibility rules change and vary by state and household, so check with each program about your own situation. Worthen Insurance Group is not connected with or endorsed by the U.S. government or the federal Medicare program.

Medicare looks like a premium decision on day one. Then the first time you get sick, it turns into a "what's this going to cost me" decision.

This is the conversation I have most with folks turning 65, so here's the plain-English version.

Both paths start with the same bill: Part B, which is $202.90 a month in 2026 for most people (more if your income is higher).

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 + 𝗣𝗹𝗮𝗻 𝗚: Plan G picks up most of what Medicare leaves behind - the $1,736 hospital deductible, the 20% you'd otherwise owe, and excess charges. The main thing you still pay is the $283 Part B deductible. The trade-off is a higher monthly premium. I used $150 to $250 a month on the chart, but that's an illustration, not a quote. It really depends on your age, your ZIP code and the insurance company.

𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗔𝗱𝘃𝗮𝗻𝘁𝗮𝗴𝗲 𝗳𝗹𝗶𝗽𝘀 𝘁𝗵𝗮𝘁. Premiums are often low, many are $0, and drug coverage is usually built in. When you need care, you pay copays as you go, up to a yearly limit. That limit can be as high as $9,250 in network, or $13,900 combined on a PPO if you go out of network.

Before you pick one, please make sure your doctors and the hospital you'd actually use are in the network. Some plans also need approval before certain services.

The one I wish everybody knew: you're guaranteed a Medigap plan with no health questions only in the 6 months after you turn 65 and enroll in Part B. Here in Texas, if you start with Advantage and want to switch to Medigap later, you'll usually have to answer health questions, and you can be turned down.

There's no right answer for everyone. It comes down to your health, your doctors, your budget and how many surprises you can live with.

So I'm curious - which one did you pick, and would you pick it again?

𝗜𝗳 𝘆𝗼𝘂'𝗿𝗲 𝘀𝗼𝗿𝘁𝗶𝗻𝗴 𝘁𝗵𝗶𝘀 𝗼𝘂𝘁 𝗳𝗼𝗿 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 𝗼𝗿 𝗮 𝗽𝗮𝗿𝗲𝗻𝘁, 𝗴𝗶𝘃𝗲 𝘂𝘀 𝗮 𝗰𝗮𝗹𝗹 𝗮𝘁 𝟮𝟴𝟭-𝟴𝟭𝟵-𝟲𝟲𝟭𝟵. 𝗪𝗲'𝗿𝗲 𝗿𝗶𝗴𝗵𝘁 𝗵𝗲𝗿𝗲 𝗶𝗻 𝗙𝗿𝗶𝗲𝗻𝗱𝘀𝘄𝗼𝗼𝗱, 𝗮𝗻𝗱 𝘁𝗮𝗹𝗸𝗶𝗻𝗴 𝗶𝘁 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝗶𝘀 𝗮𝘁 𝗻𝗼 𝗰𝗼𝘀𝘁 𝘁𝗼 𝘆𝗼𝘂.

We do not offer every plan available in your area. Currently, we represent 6 organizations which offer 62 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program.

That thick envelope from your Medicare plan this fall is your Annual Notice of Change. It lists every way your coverage changes on January 1, and this year Texans have extra reason to open it.

As of October 1, every 2027 Medicare Advantage and Part D plan can be compared on Medicare's official Plan Finder. 𝗢𝗽𝗲𝗻 𝗘𝗻𝗿𝗼𝗹𝗹𝗺𝗲𝗻𝘁, 𝘄𝗵𝗲𝗻 𝘆𝗼𝘂 𝗰𝗮𝗻 𝗮𝗰𝘁𝘂𝗮𝗹𝗹𝘆 𝘀𝘄𝗶𝘁𝗰𝗵, 𝗿𝘂𝗻𝘀 𝗢𝗰𝘁𝗼𝗯𝗲𝗿 𝟭𝟱 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝗗𝗲𝗰𝗲𝗺𝗯𝗲𝗿 𝟳. New coverage starts January 1.

Texas lost more plan choices than any other state. KFF's review of the new CMS data shows the average Texan on Medicare has 9 fewer Medicare Advantage plans with drug coverage to pick from in 2027. If your plan is one of the ones going away, you'll get a letter saying so. Don't let that one sit in the pile.

Start with your own plan's premium. The national average Medicare Advantage premium is dropping from about $14 to $12 a month, but that headline won't tell you what's happening here in Harris, Galveston, or Brazoria County. Your notice will.

Drug coverage moves, too. The highest deductible a Part D plan can charge goes from $615 to $700, and the yearly cap on what you pay for covered drugs rises from $2,100 to $2,400. Once you reach that cap, you pay nothing more for covered drugs for the rest of the year.

The changes that get less attention can cost more than the premium. A drug moved to a higher tier, a new prior approval requirement, or a doctor who leaves the network can each outweigh a few dollars a month. With fewer plans in Texas this year, networks are worth a second look.

The fastest way to check is to enter your actual prescriptions and pharmacy into the Plan Finder, then look up each of your doctors in the plan's directory.

If you have Original Medicare with a Medigap policy, the drug items on this list still apply to your standalone Part D plan.

And if your plan still fits, you don't have to do anything. It continues into 2027 unless your plan has told you it's ending.

𝗚𝗼𝘁 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻𝘀 𝗮𝗯𝗼𝘂𝘁 𝘄𝗵𝗮𝘁'𝘀 𝗶𝗻 𝘆𝗼𝘂𝗿 𝗲𝗻𝘃𝗲𝗹𝗼𝗽𝗲? 𝗪𝗲'𝗿𝗲 𝗿𝗶𝗴𝗵𝘁 𝗵𝗲𝗿𝗲 𝗶𝗻 𝗙𝗿𝗶𝗲𝗻𝗱𝘀𝘄𝗼𝗼𝗱 𝗮𝗻𝗱 𝗵𝗮𝗽𝗽𝘆 𝘁𝗼 𝗵𝗲𝗹𝗽, 𝗮𝘁 𝗻𝗼 𝗰𝗼𝘀𝘁 𝘁𝗼 𝘆𝗼𝘂. 𝟮𝟴𝟭-𝟴𝟭𝟵-𝟲𝟲𝟭𝟵

We do not offer every plan available in your area. Currently we represent 6 organizations which offer 62 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Medicare and heart health: two things a lot of folks around here are thinking about. Glad to be part of this conversation with some great fellow agents. Take a look, and send me a message if you'd like to talk it through.

Medicare generally covers heart medications under Part D, while implantable devices like pacemakers fall under Parts A and B, making sure these life-saving treatments are accessible when deemed medically necessary.

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Will Medicare pay for heart medications or implantable devices like pacemakers? This Medicare question has been answered by 23 licensed agents or brokers so far.

𝗪𝗼𝗿𝘁𝗵𝗲𝗻 𝗪𝗲𝗱𝗻𝗲𝘀𝗱𝗮𝘆: 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗠𝗮𝗱𝗲 𝗦𝗶𝗺𝗽𝗹𝗲 💙

𝗪𝗵𝗮𝘁'𝘀 𝘁𝗵𝗲 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝗰𝗲 𝗯𝗲𝘁𝘄𝗲𝗲𝗻 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗮𝗻𝗱 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗔𝗱𝘃𝗮𝗻𝘁𝗮𝗴𝗲?

If you've checked your mailbox lately, you've probably seen both of these terms about fifty times. They sound like two versions of the same thing, so it's no surprise this is one of the questions I get most. Here's the plain-English version:

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗶𝘀 𝘁𝗵𝗲 𝗴𝗼𝘃𝗲𝗿𝗻𝗺𝗲𝗻𝘁 𝗽𝗿𝗼𝗴𝗿𝗮𝗺. It's Part A (hospital insurance) and Part B (medical insurance), run by the federal government. You can generally see any doctor or hospital in the U.S. that accepts Medicare. It doesn't cover most prescriptions, so many people add a separate Part D drug plan.

𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗔𝗱𝘃𝗮𝗻𝘁𝗮𝗴𝗲 𝗶𝘀 𝗮𝗻𝗼𝘁𝗵𝗲𝗿 𝘄𝗮𝘆 𝘁𝗼 𝗴𝗲𝘁 𝘆𝗼𝘂𝗿 𝗣𝗮𝗿𝘁 𝗔 𝗮𝗻𝗱 𝗕 𝗯𝗲𝗻𝗲𝗳𝗶𝘁𝘀. 𝗜𝘁'𝘀 𝗮𝗹𝘀𝗼 𝗰𝗮𝗹𝗹𝗲𝗱 𝗣𝗮𝗿𝘁 𝗖. These plans are offered by private insurance companies that Medicare approves, and they have to follow Medicare's rules. Most include drug coverage, and many ask you to use doctors and hospitals in the plan's network.

𝗘𝗶𝘁𝗵𝗲𝗿 𝘄𝗮𝘆, 𝘆𝗼𝘂'𝗿𝗲 𝘀𝘁𝗶𝗹𝗹 𝗶𝗻 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲. You keep your Part A and Part B, and you generally still pay your Part B premium. 𝗪𝗵𝗮𝘁 𝗰𝗵𝗮𝗻𝗴𝗲𝘀 𝗶𝘀 𝗵𝗼𝘄 𝘆𝗼𝘂𝗿 𝗯𝗲𝗻𝗲𝗳𝗶𝘁𝘀 𝗮𝗿𝗲 𝗱𝗲𝗹𝗶𝘃𝗲𝗿𝗲𝗱 𝗮𝗻𝗱 𝘄𝗵𝗼 𝗵𝗮𝗻𝗱𝗹𝗲𝘀 𝘆𝗼𝘂𝗿 𝗰𝗹𝗮𝗶𝗺𝘀.

𝗦𝗼 𝘄𝗵𝗮𝘁 𝗱𝗼 𝗜 𝗱𝗼 𝘄𝗶𝘁𝗵 𝘁𝗵𝗶𝘀? Nothing yet! It's just a good foundation. 𝗞𝗻𝗼𝘄𝗶𝗻𝗴 𝘁𝗵𝗲𝗿𝗲 𝗮𝗿𝗲 𝘁𝘄𝗼 𝗽𝗮𝘁𝗵𝘀 makes the rest of that Medicare mail a lot less confusing. 𝗛𝗼𝘄 𝗶𝘁 𝗮𝗽𝗽𝗹𝗶𝗲𝘀 𝘁𝗼 𝘆𝗼𝘂𝗿 𝗼𝘄𝗻 𝘀𝗶𝘁𝘂𝗮𝘁𝗶𝗼𝗻 𝗶𝘀 𝗮 𝗼𝗻𝗲-𝗼𝗻-𝗼𝗻𝗲 𝗰𝗼𝗻𝘃𝗲𝗿𝘀𝗮𝘁𝗶𝗼𝗻, not a Facebook post.

𝗜𝗳 𝘆𝗼𝘂'𝗿𝗲 𝘁𝘂𝗿𝗻𝗶𝗻𝗴 𝟲𝟱 𝘀𝗼𝗼𝗻 𝗮𝗻𝗱 𝗵𝗲𝗮𝗿𝗶𝗻𝗴 𝘁𝗵𝗲𝘀𝗲 𝘁𝗲𝗿𝗺𝘀 𝗳𝗼𝗿 𝘁𝗵𝗲 𝗳𝗶𝗿𝘀𝘁 𝘁𝗶𝗺𝗲, 𝘆𝗼𝘂'𝗿𝗲 𝗿𝗶𝗴𝗵𝘁 𝗼𝗻 𝘀𝗰𝗵𝗲𝗱𝘂𝗹𝗲.

Tell me in the comments: are you still working, or already retired? No question is too basic around here.

𝗪𝗼𝗿𝘁𝗵𝗲𝗻 𝗪𝗲𝗱𝗻𝗲𝘀𝗱𝗮𝘆: 𝗣𝗹𝗮𝗻 𝗚 𝘃𝘀. 𝗛𝗶𝗴𝗵-𝗗𝗲𝗱𝘂𝗰𝘁𝗶𝗯𝗹𝗲 𝗣𝗹𝗮𝗻 𝗚 💙

"𝗪𝗵𝗮𝘁'𝘀 𝘁𝗵𝗲 𝗮𝗰𝘁𝘂𝗮𝗹 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝗰𝗲 𝗯𝗲𝘁𝘄𝗲𝗲𝗻 𝗣𝗹𝗮𝗻 𝗚 𝗮𝗻𝗱 𝗮 𝗛𝗶𝗴𝗵-𝗗𝗲𝗱𝘂𝗰𝘁𝗶𝗯𝗹𝗲 𝗣𝗹𝗮𝗻 𝗚?"

This one comes up a lot, and it's a good question to ask before you enroll, not after. The two plans sound almost identical on paper, and honestly, in terms of what they cover, they are. The difference is all in the math, and that math matters more than most people realize.

Here's what's usually going on:

𝗧𝗵𝗲 𝗰𝗼𝘃𝗲𝗿𝗮𝗴𝗲 𝗶𝘁𝘀𝗲𝗹𝗳 𝗶𝘀 𝘁𝗵𝗲 𝘀𝗮𝗺𝗲. Both plans pay the same benefits once they kick in - your Part A deductible and hospital coinsurance, Part B coinsurance and excess charges, skilled nursing coinsurance, hospice, blood, foreign travel emergency. Neither one covers the Part B deductible. Same benefits, full stop.

𝗧𝗵𝗲 𝗿𝗲𝗮𝗹 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝗰𝗲 𝗶𝘀 𝘁𝗶𝗺𝗶𝗻𝗴, 𝗻𝗼𝘁 𝗰𝗼𝘃𝗲𝗿𝗮𝗴𝗲. Standard Plan G starts paying as soon as you meet your Part B deductible - $283 for 2026. After that, your Medicare-covered care is close to zero out of pocket for the rest of the year. 𝗛𝗶𝗴𝗵-𝗗𝗲𝗱𝘂𝗰𝘁𝗶𝗯𝗹𝗲 𝗣𝗹𝗮𝗻 𝗚 𝘄𝗼𝗿𝗸𝘀 𝘁𝗵𝗲 𝘀𝗮𝗺𝗲 𝘄𝗮𝘆, 𝗯𝘂𝘁 𝘆𝗼𝘂 𝗽𝗮𝘆 𝗮 𝗯𝗶𝗴𝗴𝗲𝗿 𝗱𝗲𝗱𝘂𝗰𝘁𝗶𝗯𝗹𝗲 𝗳𝗶𝗿𝘀𝘁 - $𝟮,𝟵𝟬𝟬 𝗳𝗼𝗿 𝟮𝟬𝟮𝟲 - 𝗯𝗲𝗳𝗼𝗿𝗲 𝘁𝗵𝗲 𝗽𝗹𝗮𝗻 𝘀𝘁𝗮𝗿𝘁𝘀 𝗰𝗼𝘃𝗲𝗿𝗶𝗻𝗴 𝗮𝗻𝘆𝘁𝗵𝗶𝗻𝗴. Once you hit it, it behaves exactly like standard G for the rest of the year, and it resets every January 1st.

𝗜𝘁 𝗰𝗼𝗺𝗲𝘀 𝗱𝗼𝘄𝗻 𝘁𝗼 𝗽𝗿𝗲𝗺𝗶𝘂𝗺 𝘃𝗲𝗿𝘀𝘂𝘀 𝗲𝘅𝗽𝗼𝘀𝘂𝗿𝗲. High-Deductible G usually runs a fraction of what standard G costs. Something like $50 a month versus $150 a month works out to $1,200 a year in savings, weighed against a $2,900 worst case if you end up needing a lot of care. That trade-off makes a lot of sense for someone healthy who rarely goes to the doctor and has the cash on hand if the year goes sideways.

𝗜𝘁'𝘀 𝘀𝘁𝗶𝗰𝗸𝗶𝗲𝗿 𝘁𝗵𝗮𝗻 𝗽𝗲𝗼𝗽𝗹𝗲 𝗲𝘅𝗽𝗲𝗰𝘁. If you go with the high-deductible option and later decide you'd rather have standard G, switching usually means passing medical underwriting, unless you happen to be in a guaranteed issue window. It's not something to treat as a trial run.

What do I do about it?

𝗕𝗲 𝗵𝗼𝗻𝗲𝘀𝘁 𝘄𝗶𝘁𝗵 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 𝗮𝗯𝗼𝘂𝘁 𝗵𝗼𝘄 𝘆𝗼𝘂 𝗮𝗰𝘁𝘂𝗮𝗹𝗹𝘆 𝘂𝘀𝗲 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲, not how you hope to use it. If you're rarely at the doctor and have savings set aside, the lower premium can genuinely make sense. If you're in and out of the hospital most years, standard G usually comes out ahead once you factor in the premium you'd be paying on top of hitting that deductible anyway.

𝗜𝗳 𝘆𝗼𝘂'𝗿𝗲 𝘄𝗲𝗶𝗴𝗵𝗶𝗻𝗴 𝘁𝗵𝗶𝘀 𝗱𝗲𝗰𝗶𝘀𝗶𝗼𝗻 𝗿𝗶𝗴𝗵𝘁 𝗻𝗼𝘄, 𝗜'𝗱 𝗹𝗼𝘃𝗲 𝘁𝗼 𝗵𝗲𝗹𝗽 𝘆𝗼𝘂 𝗿𝘂𝗻 𝘁𝗵𝗲 𝗮𝗰𝘁𝘂𝗮𝗹 𝗻𝘂𝗺𝗯𝗲𝗿𝘀 𝗳𝗼𝗿 𝘆𝗼𝘂𝗿 𝘀𝗶𝘁𝘂𝗮𝘁𝗶𝗼𝗻. There's no wrong answer here, just the answer that fits your life and your risk tolerance.

Send me a message or give the office a call 281-819-6619, and we'll talk through it together. 💙

𝗪𝗼𝗿𝘁𝗵𝗲𝗻 𝗪𝗲𝗱𝗻𝗲𝘀𝗱𝗮𝘆: 𝗙𝗶𝗹𝗹𝗶𝗻𝗴 𝘁𝗵𝗲 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗚𝗮𝗽 💙

"𝗜 𝘁𝗵𝗼𝘂𝗴𝗵𝘁 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗰𝗼𝘃𝗲𝗿𝗲𝗱 𝗲𝘃𝗲𝗿𝘆𝘁𝗵𝗶𝗻𝗴. 𝗪𝗵𝘆 𝗮𝗺 𝗜 𝗴𝗲𝘁𝘁𝗶𝗻𝗴 𝗯𝗶𝗹𝗹𝘀?"

This one comes up more than people realize, and it's not because anyone did anything wrong. Medicare is complicated on purpose, and the parts it doesn't cover rarely get explained until you're already staring at a bill.

Here's what's usually going on:

𝗧𝗵𝗲 𝟮𝟬% 𝘄𝗶𝘁𝗵 𝗻𝗼 𝗰𝗲𝗶𝗹𝗶𝗻𝗴 𝗶𝘀 𝘁𝗵𝗲 𝗿𝗲𝗮𝗹 𝘀𝘂𝗿𝗽𝗿𝗶𝘀𝗲. Original Medicare's Part B only pays 80% of your outpatient and doctor costs. There's no cap on that other 20%, so a rough year (a hospitalization, a round of specialist visits, a cancer treatment) can add up to real money fast. Add in the Part A hospital deductible, and dental, vision, hearing, and long-term care aren't covered at all.

𝗠𝗲𝗱𝗶𝗴𝗮𝗽: 𝘆𝗼𝘂 𝗽𝗮𝘆 𝘀𝘁𝗲𝗮𝗱𝘆, 𝘀𝗼 𝘀𝘂𝗿𝗽𝗿𝗶𝘀𝗲𝘀 𝗱𝗼𝗻'𝘁 𝗰𝗼𝘀𝘁 𝘆𝗼𝘂. A Medigap policy sits on top of Original Medicare. You keep your Parts A and B exactly as they are, no networks, no referrals, and the Medigap plan picks up most of what Medicare leaves behind. You pay that premium every month whether you use it or not, but once you've hit your Part B deductible for the year, you're basically done. A heart attack or a knee replacement barely moves the number.

𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗔𝗱𝘃𝗮𝗻𝘁𝗮𝗴𝗲: 𝘆𝗼𝘂 𝗽𝗮𝘆 𝗹𝗲𝘀𝘀 𝘂𝗽 𝗳𝗿𝗼𝗻𝘁, 𝗮𝗻𝗱 𝘁𝗮𝗸𝗲 𝗼𝗻 𝗺𝗼𝗿𝗲 𝗿𝗶𝘀𝗸. A private insurer takes over your Medicare benefits, often bundling in drug coverage, dental, vision, even a gym membership, frequently for $0 premium beyond Part B. But you're working inside a network with copays, and there's an out-of-pocket max that can run into the thousands before the plan covers 100%. In a healthy year, that can save you a lot. In a hard year, it can cost you a lot.

So really, it comes down to one question: are you buying predictability, or betting on staying healthy?

𝗪𝗵𝗮𝘁 𝗱𝗼 𝗜 𝗱𝗼 𝗮𝗯𝗼𝘂𝘁 𝗶𝘁?

𝗟𝗼𝗼𝗸 𝗮𝘁 𝘆𝗼𝘂𝗿 𝗼𝘄𝗻 𝗵𝗲𝗮𝗹𝘁𝗵 𝗵𝗶𝘀𝘁𝗼𝗿𝘆 𝗵𝗼𝗻𝗲𝘀𝘁𝗹𝘆, not just your health today. 𝗧𝗵𝗶𝗻𝗸 𝗮𝗯𝗼𝘂𝘁 𝗵𝗼𝘄 𝗺𝘂𝗰𝗵 𝗺𝗼𝗻𝘁𝗵𝗹𝘆 𝗽𝗿𝗲𝗺𝗶𝘂𝗺 𝘆𝗼𝘂 𝗰𝗮𝗻 𝗰𝗼𝗺𝗳𝗼𝗿𝘁𝗮𝗯𝗹𝘆 𝗰𝗮𝗿𝗿𝘆. And if you travel or split time between states, know that 𝗠𝗲𝗱𝗶𝗴𝗮𝗽 𝗳𝗼𝗹𝗹𝗼𝘄𝘀 𝘆𝗼𝘂 𝗮𝗻𝘆𝘄𝗵𝗲𝗿𝗲 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗶𝘀 𝗮𝗰𝗰𝗲𝗽𝘁𝗲𝗱, 𝘄𝗵𝗶𝗹𝗲 𝗺𝗼𝘀𝘁 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗔𝗱𝘃𝗮𝗻𝘁𝗮𝗴𝗲 𝗽𝗹𝗮𝗻𝘀 𝗱𝗼𝗻'𝘁 𝗼𝘂𝘁𝘀𝗶𝗱𝗲 𝗼𝗳 𝗲𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝗶𝗲𝘀.

𝗜𝗳 𝘆𝗼𝘂'𝗿𝗲 𝘁𝗵𝗲 𝘁𝘆𝗽𝗲 𝘄𝗵𝗼 𝗹𝗶𝗸𝗲𝘀 𝗸𝗻𝗼𝘄𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝘄𝗼𝗿𝘀𝘁-𝗰𝗮𝘀𝗲 𝗻𝘂𝗺𝗯𝗲𝗿 𝗮𝗵𝗲𝗮𝗱 𝗼𝗳 𝘁𝗶𝗺𝗲, 𝘁𝗵𝗮𝘁'𝘀 𝘄𝗼𝗿𝘁𝗵 𝗻𝗮𝗺𝗶𝗻𝗴 𝗼𝘂𝘁 𝗹𝗼𝘂𝗱. There's no wrong answer here, just the one that fits your life.

𝗜𝗳 𝘆𝗼𝘂 𝘄𝗮𝗻𝘁 𝘁𝗼 𝘄𝗮𝗹𝗸 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝘄𝗵𝗮𝘁 𝘆𝗼𝘂𝗿 𝗼𝘄𝗻 𝗴𝗮𝗽 𝗮𝗰𝘁𝘂𝗮𝗹𝗹𝘆 𝗹𝗼𝗼𝗸𝘀 𝗹𝗶𝗸𝗲, 𝗜'𝗺 𝗮𝗹𝘄𝗮𝘆𝘀 𝗵𝗮𝗽𝗽𝘆 𝘁𝗼 𝘁𝗮𝗹𝗸 𝗶𝘁 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝘄𝗶𝘁𝗵 𝘆𝗼𝘂. No pressure, no pitch, 𝑵𝑶 𝑪𝑶𝑺𝑻, just a conversation.

𝗪𝗼𝗿𝘁𝗵𝗲𝗻 𝗪𝗲𝗱𝗻𝗲𝘀𝗱𝗮𝘆: 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐌𝐚𝐝𝐞 𝐒𝐢𝐦𝐩𝐥𝐞 💙

𝗧𝗿𝘂𝗲 𝗼𝗿 𝗳𝗮𝗹𝘀𝗲: 𝗶𝗳 𝘆𝗼𝘂 𝗱𝗼𝗻'𝘁 𝗱𝗼 𝗮𝗻𝘆𝘁𝗵𝗶𝗻𝗴 𝗱𝘂𝗿𝗶𝗻𝗴 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲'𝘀 𝗔𝗻𝗻𝘂𝗮𝗹 𝗘𝗻𝗿𝗼𝗹𝗹𝗺𝗲𝗻𝘁 𝗣𝗲𝗿𝗶𝗼𝗱, 𝘆𝗼𝘂𝗿 𝗰𝗼𝘃𝗲𝗿𝗮𝗴𝗲 𝗷𝘂𝘀𝘁 𝗮𝘂𝘁𝗼𝗺𝗮𝘁𝗶𝗰𝗮𝗹𝗹𝘆 𝘀𝘁𝗮𝘆𝘀 𝘁𝗵𝗲 𝘀𝗮𝗺𝗲 𝗻𝗲𝘅𝘁 𝘆𝗲𝗮𝗿?

Drop your guess in the comments 👇

Here's the honest answer: it's false - and it trips up more people than you'd think.

Technically, if you do nothing, your current plan usually does continue into the new year. But "𝘀𝘁𝗮𝘆𝗶𝗻𝗴 𝘁𝗵𝗲 𝘀𝗮𝗺𝗲" 𝗮𝗻𝗱 "𝘀𝘁𝗮𝘆𝗶𝗻𝗴 𝘁𝗵𝗲 𝗯𝗲𝘀𝘁 𝗳𝗶𝘁" 𝗮𝗿𝗲 𝘁𝘄𝗼 𝘃𝗲𝗿𝘆 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝘁𝗵𝗶𝗻𝗴𝘀. Every year, plans can change their costs, covered drugs, and provider networks - even if the plan name stays the same. 𝗦𝗼 𝘁𝗵𝗲 𝗽𝗹𝗮𝗻 𝘁𝗵𝗮𝘁 𝘄𝗼𝗿𝗸𝗲𝗱 𝗴𝗿𝗲𝗮𝘁 𝗳𝗼𝗿 𝘆𝗼𝘂 𝘁𝗵𝗶𝘀 𝘆𝗲𝗮𝗿 𝗺𝗶𝗴𝗵𝘁 𝗹𝗼𝗼𝗸 𝗽𝗿𝗲𝘁𝘁𝘆 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗶𝗻 𝗝𝗮𝗻𝘂𝗮𝗿𝘆.

That's exactly why 𝗔𝗻𝗻𝘂𝗮𝗹 𝗘𝗻𝗿𝗼𝗹𝗹𝗺𝗲𝗻𝘁 𝗣𝗲𝗿𝗶𝗼𝗱 (October 15 - December 7) exists: 𝗶𝘁'𝘀 𝘆𝗼𝘂𝗿 𝘆𝗲𝗮𝗿𝗹𝘆 𝘄𝗶𝗻𝗱𝗼𝘄 𝘁𝗼 𝗺𝗮𝗸𝗲 𝘀𝘂𝗿𝗲 𝘆𝗼𝘂𝗿 𝗰𝗼𝘃𝗲𝗿𝗮𝗴𝗲 𝘀𝘁𝗶𝗹𝗹 𝗳𝗶𝘁𝘀 𝘆𝗼𝘂𝗿 𝗻𝗲𝗲𝗱𝘀, 𝘆𝗼𝘂𝗿 𝗯𝘂𝗱𝗴𝗲𝘁, 𝗮𝗻𝗱 𝘆𝗼𝘂𝗿 𝗱𝗼𝗰𝘁𝗼𝗿𝘀 - 𝘄𝗵𝗲𝘁𝗵𝗲𝗿 𝘁𝗵𝗮𝘁 𝗺𝗲𝗮𝗻𝘀 𝗺𝗮𝗸𝗶𝗻𝗴 𝗮 𝗰𝗵𝗮𝗻𝗴𝗲 𝗼𝗿 𝘀𝗶𝗺𝗽𝗹𝘆 𝗰𝗼𝗻𝗳𝗶𝗿𝗺𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝗰𝘂𝗿𝗿𝗲𝗻𝘁 𝗽𝗹𝗮𝗻 𝗶𝘀 𝘀𝘁𝗶𝗹𝗹 𝘁𝗵𝗲 𝗿𝗶𝗴𝗵𝘁 𝗼𝗻𝗲.

If you've never had someone walk through your options with you, that's what I'm here for - 𝗮𝘁 𝗻𝗼 𝗰𝗼𝘀𝘁 𝘁𝗼 𝘆𝗼𝘂. 😊

Drop a comment or send me a message if you want to chat!