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Medicare Made Easy: Your Questions, Answered

Your Health

MEDICARE MADE EASY

Where can I get a complete list of the Medigap plans available in my state?

The medicare.gov website has a search tool where you can find the Medigap plans available in your ZIP code. The tool provides insurance company names and contact information along with a monthly cost estimate. You will need to contact each company directly to get a more accurate price estimate and learn how to apply. Many state departments of insurance also compile a list of available Medicare supplement plans.

I joined Medicare Advantage when I became eligible for Medicare a few months ago because my doctor was listed as a participating provider. However, the office now advises me they are not part of the plan’s network. Can I switch plans?
In most cases, a single doctor leaving a Medicare Advantage (MA) plan provider network does not trigger a special enrollment period for impacted enrollees. For 2026, however, Medicare recognized the limitations of its plan finder’s new provider directory information feature and created a temporary Special Election Period (SEP) for Incorrect Medicare Plan Finder Medicare Advantage Provider Directory Information. This SEP allows you to change your MA plan or return to original Medicare and add a drug plan if you chose and enrolled in an MA plan through the Medicare Plan Finder (MPF) based on directory information that your preferred doctor was in the plan’s provider network and you later learned the information was wrong. The SEP is limited to people who use the MPF to enroll in an MA plan between Jan. 1 and Dec. 1, 2026. You need to contact Medicare at 800-633-4227 within three months of enrollment to change plans.

I know I haven’t met my drug plan deductible, but sometimes my drugs are free, and other times, I pay full price. What gives?
It can get confusing. Your deductible is the amount you pay for covered drugs before your plan starts to pay. Those drugs are grouped in tiers. The amount you pay for a drug depends on the tier. In general, the lower the drug tier, the less you pay. Many Medicare drug plans, however, use a “split-tier” deductible, which means that the deductible applies to drugs in the higher tiers (tiers 3, 4 and 5) but not to the lower-cost generics usually found in tiers 1 and 2. Under this structure, enrollees can get many generic drugs for a small or $0 copay before any of the deductible is met, which is why you sometimes get drugs free or for a low cost before meeting your deductible. Detailed information on which drugs or tiers of drugs are subject to your plan’s deductible can be found on your drug plan website or by calling your plan directly.

I keep reading that Medicare is now negotiating drug prices. But I haven’t seen any change. When will this lower my costs?
Medicare enrollees will begin seeing the impact of Medicare’s drug price negotiation program this year. If you are currently taking one of the drugs on the negotiated and lowered price list, your out-of-pocket cost will likely be less, especially if your drug plan has you pay for a portion of the cost of the drug or coinsurance. You won’t see this type of savings if your plan charges a flat fee or copayment for the drug. Starting next year, up to 20 additional drugs will be added to the list of medications slated for price negotiations. A second benefit of the drug price negotiation program is increased access to medications, as the selected drugs must be added and remain available on all Medicare plan formularies.

Ann Kayrish has worked as a Medicare counselor with the State Health Insurance Assistance Program.

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MEDICARE HOTLINE:

800-Medicare (800-633-4227)

MEDICARE ONLINE:

medicare.gov

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