Medicare

If you don’t qualify for Medi-Cal or another assistance program, the standard Medicare Part B premium in 2026 is $202.90 per month. Higher-income individuals may pay more due to IRMAA (Income-Related Monthly Adjustment Amount), based on adjusted gross income from two years prior.

The maximum 2026 Part B premium, based on 2024 income, is $689.90 per month.

No, but unless you qualify for a Special Enrollment Period (SEP), you may be penalized for late enrollment.

If you’re receiving health benefits from an employer with more than 20 employees, you’ll most likely want to delay Medicare Part B because your employer coverage is generally primary. Depending on the employer contribution, however, it could still make sense to enroll in Medicare, especially if you are covered as a dependent under your spouse’s employer plan.

If your employer has fewer than 20 employees, Medicare is generally primary and your employer plan is generally secondary. Unlike a Medicare Supplement plan, employer coverage does not simply fill in Medicare's deductibles, copays, and coinsurance. In many cases, the employer plan will pay only if it would have paid more than Medicare for a covered service. Ask your employer whether they offer a reimbursement arrangement, such as an HRA for Medicare enrollees. In many situations, this can provide greater flexibility and value than remaining on your employer health plan.

Ask your employer whether they offer reimbursement arrangements or contributions for Medicare enrollees.

For more information on Medicare enrollment periods visit:
Medicare Enrollment Periods

A Medicare Advantage Plan is not a Medicare Supplement because it does not “supplement” Original Medicare Parts A & B. Medicare Advantage Prescription Drug Plans (MAPD) become your primary insurance coverage and pay providers directly through Medicare’s managed care system.

MAPD plans:

• Must cover all medically necessary services covered by Original Medicare
• Include annual maximum out-of-pocket protection
• Usually include prescription drug coverage
• Often include ancillary benefits such as dental, vision, hearing, transportation, and gym memberships

Many MAPD plans are available with low or even $0 monthly premiums due to managed care cost controls, and most are HMO-based plans.

Medicare Supplement (Medigap) plans work differently. Supplements are secondary to Original Medicare and help fill the “gaps” in Medicare coverage such as deductibles, copays, and coinsurance.

Original Medicare combined with a Supplement plan allows members the flexibility to see any provider nationwide who accepts Medicare, regardless of carrier contracting.

Depending on the plan selected, your annual out-of-pocket costs may be as little as the annual Medicare Part B deductible, which is $283 in 2026.

For more information visit:
Medicare Supplements vs Medicare Advantage Plans

Each year, CMS (Centers for Medicare & Medicaid Services) reviews and approves Medicare Part D carrier formularies (drug lists) to help ensure required drug classes and therapeutic categories are adequately covered.

Unless your carrier approves a “formulary exception,” your prescription medications must be included in your specific plan’s formulary to be covered.

Most formularies organize drugs into tiers such as:

• Tier 1 – Preferred Generic
• Tier 2 – Generic / Non-Preferred Generic
• Tier 3 – Preferred Brand
• Tier 4 – Non-Preferred Brand
• Tier 5 – Specialty Drugs
• Tier 6 – Select Care Drugs (varies by carrier)

Cost sharing is not standardized. One carrier may charge a fixed copay while another may charge a percentage coinsurance for the same tier. Carriers may also have different prior authorization or medical necessity requirements.

The good news is that the annual maximum out-of-pocket cost for covered Part D drugs is capped at $2,100 for 2026.

Beginning in 2025, all Medicare Prescription Drug Plans, including standalone PDP plans and MAPD plans, are required to offer the Medicare Prescription Payment Plan (MPPP).

This program allows members to spread out their prescription drug out-of-pocket costs throughout the calendar year rather than paying large costs upfront at the pharmacy.

This can be especially helpful if your plan has a deductible. The standard Medicare Part D deductible for 2026 is $615.

Every year, Medicare Prescription Drug Plans and Medicare Advantage Plans may change:

• Premiums
• Deductibles
• Copayments
• Coinsurance
• Formularies
• Provider networks

Your carrier is generally required to provide your Annual Notice of Change (ANOC) by September 30 each year. The ANOC gives you a side-by-side comparison of your current benefits and the upcoming year’s changes.

Call us at 818-999-3595 to review your ANOC or to obtain one if you haven’t received it.

The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7 each year.

During AEP, you may:

• Join a Medicare Advantage Plan (MAPD)
• Switch Medicare Advantage Plans
• Enroll in a Prescription Drug Plan (PDP)
• Change PDP plans
• Drop Medicare Advantage coverage and return to Original Medicare

Coverage changes become effective January 1.

There is no Medicare Supplement AEP.

For more information on enrollment periods visit:
Medicare Enrollment Periods

Yes. Many Medicare Advantage Prescription Drug Plans (MAPD) in California include ancillary benefits such as:

• Dental
• Vision
• Hearing
• Transportation
• Gym memberships
• Over-the-counter benefits

Some plans also offer Part B premium reduction (“giveback”) benefits.

For more information visit:
Medicare Advantage Plans

Certain Chronic Special Needs Plans (C-SNPs) may also offer prepaid debit card allowances for groceries or utilities for qualifying members with chronic conditions.

Learn more here:
Chronic Special Needs Plans (C-SNPs)

Many Medicare Supplement plans also include gym memberships such as SilverSneakers®, and some offer limited vision, hearing, or over-the-counter benefits.

Yes, depending on the type of Medicare plan and whether you qualify for a Special Enrollment Period (SEP).

Medicare Advantage & Prescription Drug Plans

• Annual Enrollment Period (AEP): October 15 – December 7
• Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31

During OEP, beneficiaries already enrolled in a Medicare Advantage Plan may switch plans or return to Original Medicare and enroll in a standalone PDP.

Special Enrollment Periods (SEP)

You may qualify for an SEP if:

• You have full Medi-Cal or Part D Extra Help
• You qualify for a Chronic Special Needs Plan (C-SNP)
• You are affected by a FEMA-declared disaster such as a fire, flood, or earthquake
• You lose employer coverage
• Your plan terminates or leaves your service area

Medicare Supplements

Medicare Supplement plans are available year-round but are generally subject to medical underwriting unless you qualify for guaranteed issue protections such as:

• Your 6-month Medigap Open Enrollment Period beginning when Part B becomes effective
• A Special Enrollment Period
• California’s “Birthday Rule” and similar protections available in other states
• Medicare Advantage trial rights
• Loss of employer group coverage
• Loss of Medi-Cal benefits

No, but Medicare can be complicated and mistakes can be costly.

Using our services costs the same as going directly through the insurance carrier. We help you compare plans based on:

• Budget
• Doctors and provider networks
• Prescriptions
• Benefits
• Out-of-pocket exposure

At BenefitPackages, we work as your advocate and are here to help if you encounter issues or simply need clarity regarding your Medicare options.