Plain English. No jargon.
No sales pitch.

Part A covers hospital stays. Part B covers doctor visits and outpatient care. Together those two are called Original Medicare. Part C is Medicare Advantage — a private plan that bundles A and B (and usually D) into one package, often with extras like dental or vision. Part D is prescription drug coverage. If you stay on Original Medicare, you'd add a separate Part D plan. Most people pick either: Original Medicare + Medigap + Part D, OR a Medicare Advantage plan that includes drugs.

Most people become eligible the month they turn 65. If you've worked enough quarters (or your spouse has), you pay $0 for Part A. Part B has a standard monthly premium — $174.70 in 2024 for most people. You can also become eligible before 65 through disability (after 24 months on SSDI), ALS, or end-stage renal disease.

Depends on your employer's plan. If your employer has 20+ employees and you have credible coverage through them, you can delay Part B without penalty until you retire (you'd then have an 8-month Special Enrollment Period). Most people do enroll in Part A at 65 because it's usually free. Always sit down with someone before assuming — penalties for missing Part B enrollment are permanent.

No — they're different products and you can only have one or the other. Medigap (also called Medicare Supplement) sits on top of Original Medicare and pays the gaps Medicare doesn't (deductibles, copays, coinsurance). Medicare Advantage REPLACES Original Medicare with a private all-in-one plan. Medigap usually has a higher premium but lower out-of-pocket. Advantage usually has a lower premium but defined networks and copays.

Your IEP is a 7-month window: 3 months before your 65th birthday month, the month itself, and 3 months after. If you sign up in the 3 months BEFORE your birthday month, coverage starts the first of your birthday month. If you sign up later in the window, coverage starts up to 3 months after enrollment. Best practice: start the conversation 6 months out so you're never under pressure.

AEP runs October 15 to December 7 every year. During AEP, you can switch Medicare Advantage plans, join or drop a Part D plan, or move between Original Medicare and Advantage. Coverage changes take effect January 1. This is when you should review whether your current plan still fits — formularies change, networks change, premiums change.

January 1 to March 31. If you're already on Medicare Advantage and the plan you picked during AEP isn't working out, you get ONE chance to switch to a different MA plan or go back to Original Medicare (and pick up a Part D plan if needed). This window isn't for people on Original Medicare — it's a do-over for MA enrollees only.

Life events that let you sign up or switch outside the normal windows. Common SEPs: moving out of your plan's service area, losing employer coverage, qualifying for Extra Help/LIS, your plan leaving Medicare, or getting a new chronic condition diagnosis (for some plans). Most SEPs give you 2 months to act. If you think one applies to you, call before you wait.

Yes — and it's permanent. The Part B penalty is 10% of the standard premium for every 12-month period you could have had Part B but didn't. The Part D penalty is 1% of the national base premium for every month you went without creditable drug coverage. Both are added to your monthly premium for the rest of your life. This is the single biggest reason to talk to someone BEFORE your IEP closes.

Part A: $0 for most people (if you worked 10+ years). Part B: $174.70/month standard premium, higher if your income is above $103K single / $206K married (IRMAA). Part D plans range $0–$70+ depending on the plan and your drugs. Medicare Advantage plans can be $0/month premium (many in Tennessee are). Medigap plans typically run $120–$250+/month depending on plan letter and your age.

IRMAA stands for Income-Related Monthly Adjustment Amount. If your modified adjusted gross income from 2 years ago was above $103K (single) or $206K (married filing jointly), you pay a higher Part B premium AND a higher Part D premium. There are five income tiers. If a one-time event drove your income up (selling a house, retiring), you can request a reconsideration — I can help walk you through Form SSA-44.

The coverage gap. Once you and your plan have spent a combined ~$5,030 on covered drugs in a year (2024), you enter the donut hole and pay 25% of drug costs until you hit ~$8,000 in out-of-pocket, then catastrophic coverage kicks in and your costs drop dramatically. The Inflation Reduction Act is reshaping this — starting 2025, Part D out-of-pocket is capped at $2,000/year. Big change.

Yes — Extra Help (also called LIS, Low-Income Subsidy). If your income is below ~$23K single / ~$31K married and your assets are modest, you may pay $0 in Part D premiums, no deductible, and just $4–$11 per prescription. Many people who qualify don't know they do. Call me — we can run the application together.

First — call me. Don't pay the bill yet. We'll request the Explanation of Benefits and the denial reason, look at whether it was a coding error, a network issue, or a coverage exclusion. Most denials have an appeal path. You typically have 60–120 days to file an appeal depending on plan type. I handle the paperwork; you tell me what happened.

Usually only during AEP (Oct 15–Dec 7) or the MA OEP (Jan 1–Mar 31). Outside those, you'd need a Special Enrollment Period — moving, losing other coverage, etc. If you're miserable in your current plan and no SEP applies, I'll tell you straight: we plan ahead for AEP and make it count. We don't switch into a worse situation just to feel like we did something.

Yes, during AEP or the MA OEP. But here's the catch: if you want to add a Medigap policy on top of Original Medicare, you'll usually be subject to medical underwriting — meaning the Medigap carrier can deny you for health reasons or charge you more. Your one guaranteed-issue window for Medigap is during your 6-month Initial Enrollment Period at 65. After that, it depends on state rules and your situation. Don't make this move without a plan.

This happens. Two paths: 1) Find a comparable doctor still in network — I can pull the directory and we'll review. 2) If the doctor is critical (oncologist, specialist), check if you have a Special Enrollment Period option. Some plans also allow continuity-of-care exceptions for ongoing treatment. Don't wait — call me when you get the letter, not three months later.

30 minutes, no pressure. I ask about your situation — when you're 65, who your doctors are, what medications you take, what your concerns are, what you've heard. I don't ask for your Social Security number, your bank info, or anything sensitive. The first call is about understanding what you need.

Your zip code. A list of your prescriptions (names and dosages). The names of your primary care doctor and any specialists. Your Medicare card if you have one. That's it. No tax returns, no bank statements, no SSN — not for our first conversation.

Your call. I do kitchen-table meetings across East Tennessee, video calls on Microsoft Teams, or phone calls — whichever you prefer. Most enrollment paperwork can be done remotely. For Medicare Advantage and Part D, CMS requires me to have a specific Scope of Appointment signed before we discuss plans, but that's just a one-page form.

I'm still your guy. When your card arrives, I'll call to walk through it. When a bill shows up you don't understand, you call me — not the 800 number. When AEP rolls around each fall, I check in to see if anything's changed. Doctor changes, new prescriptions, new diagnoses — I want to know. The relationship doesn't end at enrollment.

Call me. Bring them on the line. We can set up a 3-way call or a Teams meeting where you're both on. I always want the senior themselves involved in the decision when possible — but I understand the realities of caregiving. If they have a Power of Attorney for healthcare or finances, bring that. We can also set you up as an authorized representative on the file so I can talk to you directly going forward.

Not strictly — Medicare lets you be designated as an 'authorized representative' with a simple form (CMS-1696). That lets you talk to Medicare and to plans on their behalf. A Power of Attorney is broader and gives more authority for healthcare and finances. If your parent is still able to consent, the simple form is faster. If they're not, the POA matters. We'll work with what you have.

I'm currently licensed in Tennessee. I'm adding reciprocal licenses in additional Southeastern states. If your parent is in a state I'm not licensed in, call anyway — I'll either be able to help directly or refer you to someone I trust in their state. I don't pass families off lightly.