If your plan is terminating on December 31, you still have options! Members of terminating Medicare Advantage plans will have guaranteed issue rights, giving them an important opportunity to choose new coverage, such as being able to enroll in any other Medicare Advantage plan available in their service area or to enroll in certain Medicare Supplement plans without medical underwriting. This is a rare opportunity and may be especially valuable for anyone who has considered switching to a Medicare Supplement plan but cannot pass underwriting in a normal situation to do so. Members of terminating Medicare Advantage and Prescription Drug Plans will also receive a Special Enrollment Period, extending their opportunity to select new coverage beyond December 7 through February 28. However, we strongly recommend enrolling in new coverage before December 31 to help avoid a gap in coverage. Ask one of our licensed agents or attend a Medicare Supplement Seminar to learn more about your options.

If you plan to enroll in a Humana Medicare Advantage plan for 2027, please be aware that, at this time, Western Montana Clinic is not accepting Humana Medicare Advantage patients, including both new and existing patients. Western Montana Clinic is considered out of network and is currently not billing Humana for out-of-network services or allowing patients to self-pay for care. They are, however, continuing to accept patients with Medicare Supplement plans. If you choose a Humana Medicare Advantage plan, you will need to establish care with a different provider, such as Greater Good Health for primary care or Forefront Dermatology for dermatology services. If Western Montana Clinic changes its policy and begins allowing out-of-network services, we will notify all clients by email. Please speak with one of our licensed agents if you have questions or would like help finding new participating in-network providers who are accepting new patients.

There will be significant changes to prescription drug coverage across Medicare plans in 2027, including changes to drug costs, tiers, deductibles, formularies, and pharmacy coverage. We encourage you to review your medications every year, and our goal is to help you find the most cost-effective option available. When reviewing your plan, we may also compare non-insurance resources such as GoodRx, TrumpRx, Mark Cuban Cost Plus Drugs, and Canadian MedStore, as well as programs like Extra Help, also known as the Low-Income Subsidy (LIS), for those who may qualify. For 2027, the standard Medicare Part D deductible is $700, with a $2,400 annual out-of-pocket limit for covered Part D medications. Feel free to explore these resources, contact our office, or speak with your pharmacist if you have questions about lowering your prescription costs.

We can only review your coverage based on the medications and information available to us at the time, and no one can predict whether you may need a new medication later in the year. If that happens, you still have options. We will first check whether you qualify for a Special Enrollment Period that may allow you to change plans, as well as explore discount resources mentioned in the previous question. If changing plans is not an option, you may be able to request a formulary exception, where your doctor asks the plan to make an exception and cover your medication. The plan may require covered alternatives to be tried first, but your doctor can provide medical documentation explaining why the requested medication is necessary.

Medicare Advantage and Medicare Supplement (Medigap) plans both help with Medicare costs, but they work very differently. Medicare Advantage replaces Original Medicare as your primary coverage and may include copays, deductibles, provider networks, prescription drug coverage, and extra benefits like dental, vision, hearing, and fitness programs. These plans are designed just like a group health plan or an individual plan on/off the Marketplace. A Medicare Supplement plan works alongside Original Medicare and helps pay some of the costs Medicare leaves behind. These plans generally have higher monthly premiums, fewer extra benefits, and require a separate Part D prescription drug plan. Want to learn more? Join us for one of our Medicare Supplement Seminars during AEP.

Medicare does not technically “require” you to have prescription drug coverage. However, if you go 63 days or more without Part D or other creditable drug coverage, you may have to pay a Late Enrollment Penalty when you enroll later. This penalty is usually added to your monthly Part D premium and can continue for as long as you have Medicare drug coverage. Because of this, we generally recommend keeping creditable prescription coverage even if you do not currently take many medications. As Diane always says, you are required to have drug coverage to avoid this penalty, but you aren't required to the use it! Even if you don't take prescription medications, it important to have creditable coverage in place to avoid this penalty down the road.

If your plan is no longer working for you or you miss an enrollment period, there may still be options. Medicare offers many different Special Enrollment Periods (SEPs) throughout the year based on specific situations and life changes. This is one of the benefits of working with an agent: we are trained to review the many SEPs available, determine whether you qualify, and help you find coverage that better fits your needs.

Hellman Insurance Agency is an independent brokerage, which means we can compare plans from multiple insurance companies instead of representing just one carrier. We are contracted with all Medicare Advantage and Prescription Drug Plans available in Montana, along with many leading Medicare Supplement companies. Our licensed agents complete extensive certifications, continuing education, and Medicare-specific training each week throughout the year. SHIP counselors are not licensed insurance agents and serve primarily as Medicare educators and counselors. Calling an insurance company directly limits you to that carrier’s products. Working with an independent licensed agent allows us to compare multiple companies, explain your options, and help you find coverage that best fits your individual needs.