Cynthia Macluskie Insurance Blog

Don’t Forget International Travel Medical Insurance on Your Next Trip

Wed, 22 Apr 2026 16:00:12 GMT

How Travel Medical Insurance Can Protect Your Good Memories

International travel is an exciting experience. Whether you’re exploring a new country, visiting family overseas, or taking a long-awaited vacation, traveling abroad offers opportunities for adventure and discovery.

But one detail many travelers overlook is health insurance coverage outside the United States. Many domestic health insurance plans provide limited coverage (or no coverage at all) for medical care received overseas. That means if you become ill or injured while traveling internationally, you could be responsible for the full cost of treatment.

While no one expects a medical emergency during a trip, accidents and unexpected illnesses can happen anywhere. Without the right coverage, the resulting medical bills can be costly. Travel medical insurance is designed to help protect travelers from those unexpected risks.

Why Domestic Health Insurance May Not Be Enough

Many travelers assume their regular health insurance will follow them wherever they go. Unfortunately, that’s often not the case.

Some health plans may provide only limited international coverage, while others exclude overseas care entirely. Even if some coverage exists, travelers may still face:

High out-of-network costs
Upfront payment requirements
Limited access to English-speaking medical providers
Challenges coordinating care in unfamiliar healthcare systems

In some countries, hospitals may even require proof of insurance or payment before providing treatment. Travel medical insurance helps bridge this gap by providing coverage specifically designed for international travel.

How Travel Medical Insurance Works

Travel medical insurance provides coverage for medical expenses that occur while traveling outside your home country.

Depending on the plan, coverage may include:

Emergency medical treatment
Hospital stays
Physician visits
Urgent care services
Prescription medications
Emergency medical evacuation
Repatriation services

Many policies also include 24/7 global assistance services, which can help travelers locate nearby medical facilities, coordinate treatment, and arrange transportation if necessary.

Coverage limits and deductibles vary depending on the policy selected. Plans often allow travelers to choose from multiple coverage levels based on their destination, trip length, and personal needs.

Who Should Consider Travel Medical Insurance

Travel medical insurance can be valuable for a wide range of travelers.

Vacation Travelers

Even short trips abroad can involve risks. A medical emergency in another country could lead to thousands of dollars in unexpected expenses.

Families Traveling Internationally

When traveling with children or older relatives, having access to emergency medical support can provide valuable peace of mind.

Students Studying Abroad

Students living overseas for school may face healthcare systems that work very differently from what they are used to.

Business Travelers

Frequent international travelers may benefit from coverage that supports unexpected medical situations during work trips.

Retirees and Extended Travelers

Those taking long international trips or spending time abroad during retirement may want coverage that lasts for extended periods.

What to Look for in a Travel Medical Plan

Not all travel insurance plans are the same. When evaluating options, travelers may want to consider several key features.

Coverage limits: Policies typically offer maximum coverage amounts that range from tens of thousands to several million dollars.

Deductible options: Travelers can often choose deductibles that affect the overall cost of the policy.

Emergency evacuation coverage: This can be one of the most important features, especially when traveling to remote areas.

Pre-existing condition coverage: Some policies offer limited coverage for the acute onset of certain pre-existing conditions.

24/7 assistance services: Access to global assistance can help travelers navigate medical care in unfamiliar locations.

Peace of Mind While You Explore the World

Traveling abroad should be an exciting and memorable experience. Planning ahead for potential medical needs can help ensure that unexpected health issues don’t disrupt your trip or create financial hardship.

Travel medical insurance offers an added layer of protection so travelers can focus on enjoying their journey rather than worrying about what might go wrong.

If you’re planning an international trip, it may be worth reviewing your current health coverage and considering whether travel medical insurance could help protect you while you’re away from home.

Seven Tips for Avoiding High Medical Bills

Wed, 15 Apr 2026 16:00:00 GMT

Simple Ways to Use Your Health Plan Wisely and Avoid Unexpected Bills

When people sign up for a new health insurance plan—whether it’s an employer-sponsored plan or one purchased through the Affordable Care Act (ACA) exchange—they are often confused about when coverage starts, what services are covered, and how much they will need to share in the cost of care.

The Kaiser Family Foundation recently compiled a list of seven takeaways from stories about people who ended up paying large out-of-pocket expenses for medical care. Reviewing these tips can help health plan enrollees better understand their coverage and avoid unexpected financial surprises.

1. Most insurance coverage doesn’t start immediately

Many new plans include waiting periods, so it’s important to maintain continuous coverage until your new plan takes effect.

There are special circumstances when someone loses job-based health coverage. In that case, they may elect COBRA or purchase a plan through the ACA marketplace.

With COBRA, once payment is made, coverage applies retroactively—even for care received while someone was temporarily uninsured.
Losing employer coverage qualifies someone for an ACA Special Enrollment Period , which generally allows them to enroll in a Marketplace plan up to 60 days before or 60 days after their employer coverage ends.
If someone enrolls before their job-based coverage ends, their new plan can usually begin right away and help prevent a gap in coverage.
If someone enrolls after their job-based coverage ends, Marketplace coverage usually begins on the first day of the month after enrollment, so they could experience a short coverage gap before the new plan starts.

2. Check coverage before checking in

Some health plans include restrictions that may not be obvious at first. These restrictions can affect coverage for services such as contraception, immunizations, and cancer screenings.

Before receiving care, enrollees should contact their insurance company (or for job-based insurance, their human resources or retiree benefits office) to confirm coverage. Ask whether there are exclusions for the care you need, whether there are limits per day or per policy period, and what out-of-pocket costs you should expect.

3. “Covered” doesn’t always mean insurance will pay right away

It’s important to read the fine print about network gap exceptions, prior authorizations, and other insurance approvals. These requirements may apply only to certain doctors, services, or dates.

In addition, even if a service is covered, the insurance company may not pay for it until you have met your deductible or other cost-sharing requirements.

4. Get estimates for non-emergency procedures

Before scheduling a non-emergency procedure, patients may be able to compare prices among different providers. Request written estimates whenever possible.

If the cost seems too high, it may be possible to negotiate the price before receiving care, or find an alternate provider.

5. Location matters

The cost of care can vary significantly depending on where services are performed.

For example, if blood work is required, ask your doctor to send the order to an in-network lab. Sometimes a doctor’s office affiliated with a hospital system will automatically send samples to a hospital lab, which may result in higher charges if the lab is out of network.

6. When hospitalized, contact the billing office early

If you or a loved one is admitted to the hospital, speaking with a billing representative early in the process can help prevent confusion later. Consider asking questions such as:

Has the patient been fully admitted, or are they under observation status?
Has the care been classified as “medically necessary”?
If a transfer to another facility is recommended, is the ambulance service in-network—or can one be selected?

7. Ask for a discount

Medical charges are often higher than the rates insurers typically pay, and providers frequently expect some level of negotiation.

Patients may also be able to negotiate their own bills. In addition, uninsured or underinsured patients may qualify for self-pay discounts or financial assistance programs such as charity care.

Comparing Hospitals Near You

Wed, 08 Apr 2026 16:00:18 GMT

How to Use Medicare’s Hospital Compare Tool

How do you choose a hospital? Many people just go to the one closest to their home, but taking just a few minutes to compare ratings can help you find the best hospital in your area for your needs. Whether you’re planning for a surgery or managing a chronic condition, understanding your options can help you receive the best possible care.

Did you know Medicare offers a free online tool to help you do just that? Care Compare allows you to compare hospitals based on quality, patient experience, and performance data. We’ll walk you through how to use it and what to look for when evaluating hospitals near you.

Step 1: Run a Search on Medicare’s Care Compare Tool

Visit Medicare.gov/care-compare and enter your ZIP code and city, or allow the website to use your device location. You can search for hospitals near your address, narrow to a particular type of hospital, or search for a specific hospital by name. The tool will then run the search and create a list of hospitals to review. You can click individual results to view details, or select up to three at once and click “Compare” to see a side-by-side comparison.

Step 2: Check the Hospital Star Ratings

One of the easiest ways to evaluate a hospital is by reviewing its star ratings. Medicare assigns an Overall Hospital Star Rating to each hospital that summarizes performance across several quality categories.

These ratings are based on factors such as:

Safety of care
Mortality rates
Readmission rates
Patient experience
Timeliness and effectiveness of care

Hospitals receive a rating from 1 to 5 stars, with 5 stars indicating the highest quality performance. While star ratings shouldn’t be the only factor in your decision, they provide a quick snapshot of overall hospital quality.

Step 3: Review Patient Experience Surveys

Medicare also reports patient experience ratings based on surveys from people who have received care at the hospital, both inpatient and outpatient.

These scores measure things like:

Communication with doctors and nurses
Cleanliness and quietness of the hospital
How well discharge instructions were explained

These insights can help you understand what the hospital experience may be like from a patient’s perspective.

Step 4: Compare Performance to National Averages

Another helpful feature of the Care Compare tool is the ability to see how hospitals perform in certain areas compared to national averages. Medicare tracks performance in areas such as “Timely and effective care” or “Complications and deaths” and more. When viewing details, look for facilities that consistently perform better than national and state averages. The higher the percentage listed, the better the performance.

Step 5: Consider Your Specific Condition

Some hospitals specialize in certain treatments or conditions. For example, a hospital that treats a large number of heart attack or joint replacement patients may have more experience and stronger outcomes in those areas. If you are managing a chronic condition or a specific risk factor, look for this in the hospital’s details. Your doctor can often help you determine which hospitals are most experienced with your specific medical needs.

Step 6: Confirm Insurance and Doctor Privileges

Even if a hospital receives excellent ratings, it’s important to confirm:

The hospital accepts your insurance plan
Your doctor has privileges at that hospital

Many doctors are affiliated with specific hospitals, and may prefer to admit a patient to a particular hospital depending on medical condition or procedure. This may influence your options for treatment. Discussing this with your physician ahead of time can help you avoid surprises.

A Note About Emergencies

If you are experiencing a life-threatening emergency, always go to the closest hospital immediately. In emergency situations, getting care quickly is the most important factor.

The Bottom Line

Comparing hospitals ahead of time can help you feel more confident about where you receive care. Medicare’s Care Compare tool makes it easy to review hospital quality, patient experiences, and performance data so you can make informed health care decisions. Taking a few minutes to research hospitals today may make a big difference when you need care tomorrow.

Preparing for Spring Allergies

Wed, 01 Apr 2026 22:14:52 GMT

Simple Steps to Make Allergy Season Easier

For many people, the arrival of spring means longer days, blooming flowers, and warmer weather. But for millions of Americans, it also signals the return of seasonal allergies. Pollen from trees, grasses, and other plants can trigger uncomfortable symptoms like sneezing, congestion, itchy eyes, and fatigue.

The good news is that a little preparation can go a long way toward reducing the impact of spring allergies. Taking steps before pollen counts rise can help you manage symptoms more effectively and enjoy the season with fewer interruptions.

Start Medications Before Symptoms Begin

One of the most effective strategies for managing seasonal allergies is starting medications before symptoms become severe. Many allergy medications work best when taken consistently during allergy season rather than waiting until symptoms appear.

Common options include:

Antihistamines , which help reduce sneezing, itching, and a runny nose by blocking the body’s allergic response. Popular over-the-counter options include cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) . Some older antihistamines, like diphenhydramine (Benadryl) , can also be effective but may cause drowsiness.
Nasal corticosteroid sprays , which reduce inflammation in the nasal passages and are often considered one of the most effective treatments for seasonal allergies. Common options include fluticasone (Flonase), triamcinolone (Nasacort), and budesonide (Rhinocort) .
Decongestants , which help relieve nasal congestion by narrowing swollen blood vessels in the nasal passages. These include medications such as pseudoephedrine (Sudafed) or short-term nasal sprays like oxymetazoline (Afrin) . However, nasal decongestant sprays should typically only be used for a few days to avoid rebound congestion.

Starting treatment early can prevent symptoms from becoming overwhelming once pollen levels peak.

Before starting any new allergy medication, it’s a good idea to speak with your doctor or pharmacist to make sure it’s the right choice for your health needs.

Monitor Daily Pollen Levels

Pollen counts can vary widely from day to day depending on weather conditions. Warm, windy days tend to carry higher pollen levels, while rain can temporarily wash pollen out of the air.

Checking local pollen forecasts can help you plan your activities. On high-pollen days, you may want to limit outdoor exposure, especially in the early morning when pollen counts are often highest.

Several reliable tools make it easy to track pollen levels in your area. Some commonly used options include:

The weather app on your smartphone may seasonally include pollen counts.
Weather apps and websites , such as The Weather Channel and AccuWeather , which include daily pollen forecasts alongside standard weather reports.
Pollen.com , a site dedicated specifically to allergy forecasts and tracking seasonal allergen trends.

By keeping an eye on pollen levels and planning accordingly, you can reduce exposure and better manage allergy symptoms throughout the season.

Change Clothes and Shower After Being Outdoors

Pollen easily sticks to clothing, hair, and skin. After spending time outside, especially during peak pollen periods, it’s a good idea to change clothes and shower.

This simple routine helps remove pollen before it spreads throughout your home. Showering before bed can be especially helpful, since pollen trapped in your hair can transfer to your pillowcase and bedding, leaving you exposed to allergens all night while you sleep.

If you have pets that spend time outdoors, wiping them down when they come inside can also help limit the amount of pollen brought into your home.

Be Smart About Outdoor Activities

You don’t have to avoid the outdoors completely during allergy season, but timing can make a big difference. Pollen counts are typically highest in the early morning hours , when plants release pollen into the air and cooler temperatures help keep it circulating.

If possible, try to schedule outdoor activities for the afternoon or evening, when pollen levels may start to decline. Wearing sunglasses or a wide-brim hat can also help keep pollen away from your eyes and face.

If you enjoy yard work, consider wearing a mask to reduce pollen inhalation. Activities like mowing the lawn or gardening can stir up pollen and other allergens, so people with severe allergies may want to limit these tasks or take precautions when doing them.

Reduce Pollen Exposure at Home

While you can’t eliminate pollen completely, there are several steps you can take to reduce how much of it enters your home.

Some helpful strategies include:

Keeping windows closed during high-pollen days
Using HEPA air purifiers to capture airborne allergens
Using air conditioning with a clean filter instead of opening windows
Changing HVAC filters regularly to improve indoor air quality

These small adjustments can significantly reduce indoor pollen levels and help create a more comfortable living environment during allergy season.

Know When to Seek Medical Advice

If over-the-counter medications and lifestyle changes aren’t providing enough relief, it may be time to speak with a healthcare provider. Persistent allergy symptoms can interfere with sleep, concentration, and overall quality of life.

An allergist can help develop a personalized treatment plan and determine whether prescription medications or immunotherapy might be beneficial.

Spring allergies may be common, but they don’t have to take over the season. By preparing ahead of time, monitoring pollen levels, and taking preventive steps, you can significantly reduce symptoms and enjoy everything spring has to offer.

ACA Marketplace Plans and Tax Season

Wed, 25 Mar 2026 17:30:01 GMT

What ACA Participants Need to Know Before They File

When tax season rolls around, many people enrolled in an Affordable Care Act (ACA) Marketplace plan are surprised to learn that their health coverage and their tax return are closely connected.

If you purchased coverage through the Marketplace, here’s what you need to remember when filing taxes — and how to avoid costly mistakes.

1. You Should Receive Form 1095-A

If you had Marketplace coverage for any part of the year, you’ll receive Form 1095-A: Health Insurance Marketplace Statement .

This form includes:

The months you had coverage
The total premium for your plan
The amount of Advance Premium Tax Credit (APTC) paid on your behalf
The “benchmark” premium used to calculate your subsidy

Do not file your tax return without it. The information on this form is required to complete IRS Form 8962.

2. You Must Reconcile Your Premium Tax Credit

If you received Advance Premium Tax Credits (APTC) to lower your monthly premium, you are required to reconcile that amount when you file your federal tax return. When you received Advance Premium Tax Credits , the government estimated your subsidy based on:

Your projected annual income
Household size
Tax filing status

Because that was just an estimate, the IRS requires you to compare (reconcile) the estimated credit to what you actually qualified for based on your final income.

If your actual income was lower than estimated , you may qualify for additional premium tax credit , increasing your refund.
If your actual income was higher than estimated , you may have to repay some or all of the advance credits you received.

How Does This Reconciliation Happen?

Reconciliation happens when you file your federal tax return. If you received APTC, you will file your taxes using Form 1095-A and Form 8962 . Form 8962 is attached to your Form 1040.

Most tax software completes this automatically once you enter your 1095-A information.

3. Changes in Income Matter

Common life events that affect your subsidy and your taxes include: raises or bonuses, job loss, starting self-employment, marriage or divorce, birth or adoption of a child, and a dependent no longer qualifying.

If these changes weren’t reported to the Marketplace during the year, it can result in a tax surprise.

4. Filing Status Is Critical

Premium tax credits are generally only available if you file Married Filing Jointly (if married). Married individuals who file Married Filing Separately are typically not eligible for premium tax credits, with limited exceptions for domestic abuse or abandonment situations.

This is an important planning conversation before tax filing.

5. Self-Employed Individuals Have Special Considerations

For self-employed clients:

Marketplace premiums may be deductible as a self-employed health insurance deduction.
However, the premium deduction interacts with the premium tax credit calculation.

This can create a circular calculation that tax software usually handles — but it’s important to understand the interplay to avoid errors.

6. If You Don’t File, Future Subsidies May Be At Risk

Even individuals who are not otherwise required to file taxes must file if they received advance credits. Failure to file and reconcile premium tax credits can result in:

Loss of eligibility for advance premium tax credits in future years
Delays in coverage renewals

Final Thoughts

ACA Marketplace coverage provides valuable financial assistance, but that assistance is tied directly to your tax return.

The key takeaway: Your health insurance and your taxes are connected — and accuracy matters.

If you have questions about how income changes may affect your Marketplace subsidy, or if you anticipate life changes this year, it’s wise to review your coverage proactively rather than waiting for tax season surprises.

This article is for informational purposes only and does not constitute tax advice. Consult a qualified tax professional regarding your specific situation.

Medicare Glaucoma Screenings: Why Early Detection Matters

Wed, 18 Mar 2026 19:00:01 GMT

What You Need to Know About Protecting Your Vision

Did you know that about half of people with glaucoma don’t even know they have it?

Glaucoma is often called the “silent thief of sight” because it develops slowly and often with no noticeable symptoms in the early stages. By the time vision changes become obvious, it usually means permanent damage has already occurred.

What is glaucoma? It’s actually a group of eye diseases, not just one single disease. What they all have in common is that they damage the optic nerve, which is the vital connection between your eye and your brain. It’s often associated with increased pressure inside the eye, but it can occur even when eye pressure is normal. Left untreated, glaucoma can lead to permanent vision loss and even blindness.

Early detection and treatment are crucial to slow or prevent further vision damage. That’s why regular screenings are essential if you are at a higher risk for glaucoma based on your genetics or family history.

Why Early Detection Matters

In its early stages, glaucoma typically has no warning signs. There’s no pain or sudden changes in vision. The most common form, called open-angle glaucoma, gradually reduces peripheral (side) vision first. Because central vision remains clear for a long time, it can take quite a while to realize anything is wrong.

Other, less common types, such as angle-closure glaucoma, can develop more suddenly and may cause more obvious and acute symptoms like severe eye pain, headache, nausea, blurred vision, or seeing halos around lights. These symptoms require immediate medical attention.

The only way to know if you have glaucoma is through a comprehensive, painless eye exam that includes specific tests to check:

Eye pressure
Optic nerve health
Peripheral vision
Drainage angle of the eye

According to the National Eye Institute , regular eye exams are critical, especially as we age, because early treatment with prescription eye drops, laser therapy, or surgery can help prevent further vision loss.

Vision lost from glaucoma cannot be restored, which makes early detection essential.

Medicare Coverage for Glaucoma Screenings

Medicare Part B covers glaucoma screenings once every 12 months for people who are considered high risk (see the list below).

The screening must be performed (or supervised) by an eye doctor who is legally allowed to provide the service in your state, such as an ophthalmologist or optometrist.

If you qualify as high risk and receive your screening from a provider who accepts Medicare assignment, Medicare Part B will cover 80% of the approved amount (once your Part B deductible has been met). You would be responsible for the remaining 20% as coinsurance.

It’s important to confirm that your provider accepts Medicare assignment to help minimize out-of-pocket costs. If you have a Medicare Advantage plan, coverage rules may vary slightly, so review your plan details, or ask us to help determine what your coverage is.

Who Is at Higher Risk for Glaucoma?

While anyone can develop glaucoma, certain groups have a higher risk. Medicare considers you at high risk if at least one of the following applies:

You have diabetes
You have a family history of glaucoma
You are African American and age 50 or older
You are Hispanic and age 65 or older

Because risk increases with age, glaucoma screening becomes even more important for Medicare beneficiaries.

Protecting Your Vision Starts with a Conversation

If you fall into a high-risk category, talk with your primary care provider or eye doctor about scheduling a glaucoma screening. Your vision plays a major role in your independence, safety, and overall quality of life. When it comes to your eyesight, waiting for symptoms isn’t a safe strategy. A simple, painless screening once a year could help preserve it for years to come.

If you have questions about how your Medicare coverage works, including preventive screenings like glaucoma testing, reach out to review your benefits and make sure you’re taking full advantage of what’s available to you.

Medicare Extends Hospital-at-Home & Telehealth Coverage

Wed, 11 Mar 2026 16:00:02 GMT

What It Means for Patients

Recent federal legislation has provided multi-year extensions for two Medicare programs that expanded access to care beyond traditional clinical settings:

the Acute Hospital Care at Home Program (often called Hospital-at-Home) and Medicare telehealth flexibilities . These changes come after prior pandemic-era waivers were set to expire, and they offer more stability for patients and providers alike.

What Was Extended?

Hospital-at-Home through 2030

The Acute Hospital Care at Home Program, which allows certain hospitals to deliver inpatient-level care in a beneficiary’s home, has been extended through September 30, 2030 . This means patients who qualify can continue to receive hospital-level services—such as treatment for infections or recovery support—without being physically admitted to a facility. For many older adults or individuals with mobility challenges, this model can reduce stress, lower risk of hospital-acquired complications, and improve overall comfort during recovery.

Telehealth Flexibilities through 2027

Medicare’s expanded telehealth benefits—originally adopted during the COVID-19 public health emergency—have been extended through December 31, 2027 . These flexibilities include:

Coverage for telehealth services delivered to beneficiaries in their homes
Expanded list of provider types eligible to deliver care virtually
Continued coverage for audio-only telehealth when appropriate
Ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as telehealth distant-site providers

These extensions preserve the ability for beneficiaries to see doctors, specialists, therapists, and other providers using video or phone visits without returning to more restrictive pre-pandemic regulations.

Why These Extensions Matter

Greater Access and Convenience

For Medicare beneficiaries, especially in rural areas or with limited mobility, these extensions mean continued access to care without the need for transportation or in-person visits. Virtual visits have become a lifeline for routine check-ins, chronic condition management, mental health care, and follow-up appointments, often saving time and reducing costs.

Hospital-at-home programs bring a similar advantage for higher-acuity care. Rather than being hospitalized, eligible patients can receive equivalent treatment at home, supported by coordinated medical teams. This model has been shown to offer improvements in patient satisfaction and potentially reduce the risks associated with traditional hospital stays.

Stability After Policy Uncertainty

These extensions come after a period of uncertainty, during which telehealth and hospital-at-home waivers briefly lapsed — and then were reinstated — due to funding and appropriations negotiations in Congress. Long-term extensions give providers important certainty when planning care models and technology investments, and they give beneficiaries reassurance that these expanded care options will continue without abrupt interruptions.

Looking Ahead

Advocates on both sides of the aisle have emphasized the value of telehealth and hospital-at-home services, arguing that they should become permanent parts of the Medicare program. While the recent extensions do not yet make these flexibilities permanent law, they do represent a significant step toward longer-term integration of virtual and in-home care options into the health care system.

This blog is for informational purposes only and reflects federal health policy as of early 2026. Individual coverage can vary based on specific Medicare plans and eligibility.

IRMAA in 2026: Income Limits, Surcharges & How to Avoid Higher Medicare Premiums

Fri, 06 Mar 2026 22:19:03 GMT

What You Need to Know Before Filing

If you're on Medicare—or about to enroll—there’s a little acronym that can have a big impact on your wallet: IRMAA. Short for Income-Related Monthly Adjustment Amount, IRMAA is an additional charge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. As tax season approaches, it’s a good time to understand how IRMAA works, how it’s calculated, and what you can do to plan ahead.

What Is IRMAA?

IRMAA is not a penalty or a late fee. It’s an income-based surcharge that applies to Medicare beneficiaries who earn above a certain level. The idea is that individuals with higher incomes can afford to contribute more to the cost of their Medicare coverage.

If IRMAA applies to you, it will be added to your Part B premium (which covers doctor visits and outpatient services) and, if you have it, your Part D premium (for prescription drug coverage).

2026 IRMAA Thresholds

Your IRMAA amount is based on your modified adjusted gross income (MAGI) from two years prior—which means in 2026, the Social Security Administration (SSA) will look at your 2024 tax return. MAGI includes your adjusted gross income (AGI) plus tax-exempt interest income.

Here are the 2026 IRMAA thresholds (based on 2024 income):

For individuals, IRMAA does not apply if your 2024 modified adjusted gross income (MAGI) is $109,000 or less. IRMAA does apply if your income is above $109,000.
For married couples filing jointly, IRMAA does not apply if your 2024 MAGI is $218,000 or less. IRMAA does apply if your income is above $218,000.

The amount of IRMAA increases in tiers. The higher your MAGI, the more you may pay in additional premiums. These charges are automatically calculated and communicated by the SSA each year.

Why IRMAA Matters at Tax Time

Since IRMAA is based on your income from two years ago, your tax planning should include a forward-looking strategy—especially if you're approaching retirement or expect significant income changes.

For example, if you’re planning to retire in 2026, your 2025 income could trigger IRMAA surcharges in 2027. Even if your income drops after retirement, your Medicare premiums could remain high temporarily unless you take action. That’s why it pays to start thinking about IRMAA before you leave the workforce.

Tax Strategies to Reduce Future IRMAA Charges

Here are a few ways to plan ahead and potentially reduce your future IRMAA costs:

Time capital gains and Roth conversions wisely: Large one-time income events—like selling a property or converting a traditional IRA to a Roth—can increase your MAGI. If possible, spread these over multiple years to stay under IRMAA thresholds.
Delay Social Security: If you don’t need the income right away, delaying your Social Security benefits could reduce your MAGI during key years and help you avoid IRMAA.
Coordinate with retirement withdrawals: Work with a financial advisor to plan your distributions from tax-deferred accounts in a way that manages your taxable income.

What If You’ve Already Retired or Your Income Has Dropped?

Let’s say your income has decreased since 2024 due to retirement, the loss of a spouse, or another life event. You may request a reduction in your IRMAA amount through the SSA's reconsideration process.

This is particularly useful if your current income is much lower than what’s shown on your 2024 tax return.

How the Reconsideration Process Works

If you think your IRMAA determination is based on outdated or incorrect income information, or if you've experienced a life-changing event, you can file Form SSA-44: Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.

Qualifying life events include:

Retirement or reduction in work hours
Marriage or divorce
Death of a spouse
Loss of income-producing property
Loss of pension income
Settlement from an employer

You’ll need to provide documentation of the event and your reduced income. If approved, SSA may lower your IRMAA or remove it entirely for the current year.

To learn more or access the form, visit ssa.gov/medicare/lower-irmaa .

A Final Word on IRMAA and Planning Ahead

IRMAA is a tax-related surprise that many Medicare beneficiaries don’t expect, especially those transitioning into retirement, but it doesn’t have to catch you off guard. By understanding how IRMAA is calculated, staying below the income thresholds where possible, and knowing your appeal rights, you can keep your Medicare premiums manageable—and avoid paying more than necessary.

If you’re unsure whether IRMAA might apply to you, a retirement planner or financial advisor can help you develop a strategy to reduce future exposure. Planning ahead now can lead to meaningful savings later.

Case Study: Navigating a Cancer Scare on a High Deductible Health Plan

Wed, 25 Feb 2026 07:00:02 GMT

Follow one man's journey through a medical scare, and learn how his HDHP worked for him in real life.

Meet Marcus. He’s 52 years old and in decent health. He rarely used his insurance beyond the usual annual checks. Until one day, he suddenly needs it.

Self-Employed and in a Medical Crisis

Marcus is a 52-year-old freelance graphic designer. He’s healthy overall, exercises regularly, and only visits the doctor for annual checkups. Because he doesn't expect many medical expenses, he chose a High Deductible Health Plan (HDHP) with a lower monthly premium and a $6,000 individual deductible . His plan includes a Health Savings Account (HSA) , which he contributes to when he can.

Then something changes. He starts having pain and frequent urination. His primary care provider refers him to a urologist for further examination.

Step 1: The Specialist Visit

Cost: $280 (negotiated rate)
Plan covers: $0 until deductible is met
Marcus pays: $280 out of pocket

On an HDHP, you typically pay the full cost of most services and this is applied toward the deductible before the plan begins to share costs.

Step 2: Imaging and Lab Tests

The urologist orders a CT scan and a urine cytology test .

CT scan cost (negotiated rate): $1,300
Lab test cost: $220
Marcus pays: $1,520

Out-of-pocket total: $1,800

Step 3: Outpatient Cystoscopy Procedure

Next, Marcus undergoes a cystoscopy (a procedure using a scope to look inside the bladder).

Facility + physician cost (negotiated rate): $2,000
Marcus pays: $2,000

Out-of-pocket total: $3,800

Step 4: Biopsy and Pathology

The urologist spots a suspicious area and performs a biopsy . The sample is sent to a lab.

Biopsy procedure cost: $1,400
Pathology lab cost: $400
Marcus pays: $1,800

Out-of-pocket total: $5,600

Step 5: Prescription Medications

After the biopsy, Marcus experiences inflammation and receives a prescription for antibiotics and pain medication .

Generic antibiotic: $18
Pain medication: $10
Marcus pays (retail price, but discounted under plan): $28

Running total: $5,628

Step 6: Insurance Kicks In

Marcus goes back for a follow-up test, and $372 later, he meets his $6,000 deductible . At this point, coinsurance begins . His plan will now pays 80% of his expenses for the rest of the calendar year, and Marcus will pay 20% until he hits his $8,000 out-of-pocket annual maximum.

Running total: $6,000

Step 7: The Diagnosis

Unfortunately, Marcus’s biopsy confirms early-stage bladder cancer . Fortunately, it is caught early and is a highly treatable form of cancer. His doctors recommends surgery to remove the tumor, followed by a short course of radiation therapy to reduce the risk of recurrence.

Step 8: Treatment

As a reminder, because Marcus met his $6,000 deductible , he is in the coinsurance phase of his High Deductible Health Plan. So his plan covers 80% of eligible medical costs , and Marcus pays 20% until he reaches his annual out-of-pocket maximum of $8,000 . Here's a breakdown of the typical negotiated costs and what Marcus pays under his HDHP:

GRAND TOTAL: $8,000

Since Marcus pays another $2,000 in coinsurance, he hits his $8,000 out-of-pocket maximum . From that point on, his plan covers 100% of covered care through the end of the plan year.

Total Cost Comparison

Let’s look at the bigger picture:

Total Marcus paid out of pocket: $8,000 (maximum allowed under his plan)
Total billed amount for all care and treatment: About $33,000

A Happy (and Cautiously Optimistic) Ending

Marcus is now cancer-free , recovering well, and back to walking his dog in the mornings. He’s grateful for early detection, good doctors, and supportive friends.

He’s not thrilled to have spent an unexpected $8,000 in a year, and this puts a strain on his finances for a little while, but he understands it could have been much worse. His HDHP protected him from financial devastation — but it did require him to pay a lot up front , and quickly. He also knows he’s lucky that he had this medical crisis earlier in the year. Had it all started in November or December, his annual deductible and out-of-pocket maximum would have reset on January 1, causing him to essentially double his expenses.

Would a Different Plan Have Been Better?

It’s a fair question, and one Marcus is asking as open enrollment approaches.

A High Deductible Health Plan works well when you're healthy and rarely need care, but it can feel financially painful when something serious happens. Marcus wonders now if a lower-deductible plan with a higher monthly premium might make budgeting easier, even if the total annual cost ends up being similar.

For example:

A Gold plan or PPO with copays could have allowed him to pay smaller amounts more gradually (e.g., $50 for specialist visits, fixed amounts for tests or procedures).
Some plans also offer cancer-specific riders or critical illness coverage to provide a lump-sum payout upon diagnosis, which could have helped offset non-medical costs like time off work or travel for care.

Final Thoughts

Marcus’s story is a powerful reminder that:

Understanding how your plan works before you need it is key
Hitting your max out-of-pocket can be painful, but it beats the alternative in a worst-case-scenario
There’s no one-size-fits-all plan — the “right” plan depends on your health needs, budget, and risk tolerance

If your situation changes, your health evolves, or you're worried about what a future diagnosis could bring, it may be time to review your coverage and explore whether another plan type might offer more peace of mind.

We’re here to help talk you through your options.

Why Dental Coverage Matters If You’re Living with Diabetes

Wed, 18 Feb 2026 07:00:08 GMT

If you’re one of the millions of Americans living with diabetes, you already know how important it is to stay on top of your health. But one area that often gets overlooked in diabetes care? Your mouth.

Research shows that diabetes and oral health are deeply connected. That means taking care of your teeth and gums can have a meaningful impact on your blood sugar control, overall wellness, and even your healthcare costs.

Here’s what you need to know, and how having the right dental insurance can help you stay healthier, save money, and prevent avoidable complications.

Diabetes and Oral Health: A Two-Way Relationship

People with diabetes are more likely to develop oral health problems like:

Gum disease (periodontitis)
Dry mouth , which increases the risk of tooth decay
Mouth infections like thrush
Delayed healing after dental procedures

In fact, an estimated 1 in 5 people with diabetes also has gum disease, and research shows the connection is two-way :

High blood sugar can weaken your gums and make infections more likely
Gum inflammation can make it harder to keep your blood sugar under control

That means poor oral health doesn’t just cause tooth trouble—it can actually worsen your diabetes .

The Hidden Costs of Skipping Dental Care

Diabetes already comes with higher-than-average healthcare costs. People with diabetes spend about 2.6 times more on medical expenses than those without the condition, and dental problems only add to the burden.

Without regular cleanings and preventive care, small oral issues can turn into big, expensive ones:

Untreated gum disease may require deep cleaning, scaling, or surgery
Infections or decay may lead to tooth loss
Dental emergencies can become urgent and costly

But here’s the good news: People with diabetes who get routine dental care often spend less overall on health care. Preventive care catches problems early—and sometimes prevents them entirely.

How Dental Insurance Can Help

Dental insurance can be a smart, affordable way to stay ahead of oral health issues and make care more accessible.

With the right plan, you can:

Get regular cleanings and checkups covered (often at no extra cost)
Pay less out of pocket for things like fillings, gum treatments, and extractions
Access networks of trusted dentists who understand diabetes-related oral concerns
Spot problems early—before they become serious or impact your blood sugar

Some plans may even include extra periodontal benefits if you’ve been diagnosed with diabetes or are at higher risk for gum disease.

What to Look for in a Dental Plan

If you’re shopping for coverage, here are a few tips to keep in mind:

Look for plans that include periodontal maintenance. These are deeper cleanings and treatments that help prevent and manage gum disease.
Understand deductibles, copays, and annual maximums. Choose a plan that balances monthly premiums with your expected level of care.
Check that your current dentist is in-network, or find one who understands diabetes-related care.

Continuity of care matters, especially for managing long-term health conditions.

The Bottom Line

Managing diabetes takes a team, and your dentist is an important part of that team. When you include dental care as part of your overall health strategy, you can protect your blood sugar and in many cases reduce out-of-pocket costs over time.

If you’re living with diabetes and you’ve been putting off dental insurance, now’s the time to take a closer look.

Need help choosing a dental plan that works with your budget and supports your health goals? We’re here to guide you every step of the way.

How Medigap Extends Coverage for Hospital Care

Wed, 11 Feb 2026 07:00:07 GMT

Understand the hospital coverage gaps in Medicare and how a supplement plan can help protect your finances.

One of the most pressing concerns for older adults is the ri sing cost of hospital care. Whether it's a sudden emergency or a long recovery from illness, extended inpatient stays can lead to serious financial strain, especially when relying on Original Medicare (Part A) alone.

While Medicare provides a strong foundation of hospital benefits, its coverage has clear time and cost limits. That's where a Medigap policy (also called Medicare Supplement Insurance) can come into play. These optional plans are designed to fill the financial "gaps" in Original Medicare. One of those gaps is hospital care beyond 60 or 90 days.

Let’s walk through how Medigap works, what it covers, and why enrolling early could make a big difference.

Medicare Part A: What’s Covered — and What Isn’t

Medicare Part A helps cover inpatient hospital care, but it does so in stages , with specific limits and rising out-of-pocket costs over time:

Days 1–60

After meeting the annual Part A deductible ($1,736 in 2026), Medicare covers:

A semi-private room and meals
General nursing care
Medications and supplies used during your hospital stay
Operating room and recovery services
Care provided in specialized units (e.g., ICU, coronary care unit, etc.)
Blood (after the first 3 pints per benefit period)
Inpatient lab tests and imaging
Inpatient rehab, if part of your treatment

With no copayments during this stage, it offers the most generous coverage, but it's limited to 60 days per benefit period.

Days 61–90

You’re responsible for a daily coinsurance of $434 in 2026. That’s over $13,000 for a 30-day stay.

Days 91–150

Medicare begins using your 60 lifetime reserve days, which is a one-time pool of extra hospital days. During this stage, the daily coinsurance jumps to $868 per day in 2026. Once those 60 days are used, they’re gone forever. This reserve is not renewed.

After Day 150

Medicare no longer pays for inpatient hospital care. All costs beyond this point are your responsibility, unless you have supplemental coverage.

Where Medigap Steps In

Medigap plans are sold by private insurance companies and are designed to supplement Original Medicare , not replace it. Most Medigap policies offer additional hospital coverage that significantly reduces your financial exposure during long or repeated hospital stays.

Here’s how:

Up to 365 Extra Hospital Days

Standard Medigap plans cover 100% of hospital costs for up to 365 additional days after your Medicare and lifetime reserve days are exhausted. That’s an entire extra year of protection.

Coinsurance Coverage

Medigap plans typically pay:

The $434 daily coinsurance for days 61–90
The $868 daily coinsurance for days 91–150

This can result in tens of thousands in savings for beneficiaries during extended hospital stays.

Important Reminders

The 365 additional hospital days are a lifetime benefit and are not renewed.
Medigap only works with Original Medicare , not Medicare Advantage (Part C).
Medigap does not cover long-term care or custodial nursing home care. It only applies to inpatient hospital stays . Most Medigap plans, however, do cover skilled nursing facility care costs.

Enrolling in Medigap

Timing matters. You have a 6-month Medigap open enrollment window that starts when you’re 65 or older and enrolled in Medicare Part B. During this period:

You’re eligible for the lowest possible premium based on age and plan type, and insurance companies must sell you any plan they have available.
Your medical history and preexisting conditions cannot be used to deny coverage or determine how much you pay.

After this window, you can still apply — but insurers may charge more, require medical exams, and/or decline coverage based on health status. The only exception is if you get guaranteed issue rights through a qualifying event such as moving or losing other coverage.

Final Thoughts

Hospital stays aren’t something we typically plan on — but being prepared makes all the difference. If you rely on Original Medicare alone , your financial exposure increases significantly after just 60 days in the hospital. A Medigap plan can fill that gap, protect your finances, and provide added peace of mind.

Have questions about Medigap or when to enroll? We’re here to help you find a plan that fits your needs, your budget, and your peace of mind.

February Is American Heart Month — Show Your Heart Some Love

Wed, 04 Feb 2026 15:00:06 GMT

February isn’t just about Valentine’s Day—it’s also American Heart Month , a time dedicated to raising awareness about heart health and encouraging simple steps to protect one of your most vital organs: your heart.

Heart disease remains the leading cause of death in the United States, but the good news is that many risk factors are preventable or manageable with the right habits and healthcare support. American Heart Month is a perfect reminder to pause, reflect, and show your heart a little extra love—today and all year long.

Taking care of your heart doesn’t require drastic changes. Small, consistent actions can make a meaningful difference. Staying active with regular movement, choosing heart-healthy foods, managing stress, and getting enough sleep all contribute to better cardiovascular health. Even something as simple as a daily walk or swapping processed foods for fresh fruits and vegetables can support a stronger heart over time.

Preventive care also plays a crucial role in heart health. Routine checkups help monitor blood pressure, cholesterol levels, and other key indicators that may not show symptoms early on. Many health insurance plans cover preventive services such as annual wellness visits and cardiovascular screenings at little or no cost. These benefits are designed to help catch potential issues early, when they’re often easier to manage.

Stress is another factor that can quietly impact your heart. While life can be busy and unpredictable, finding healthy ways to unwind—such as deep breathing, light exercise, hobbies, or spending time with loved ones—can support both your mental well-being and your heart. Your heart works hard for you every day, and it deserves moments of rest, too.

This American Heart Month, consider making one small commitment to your heart—whether it’s scheduling a checkup, adding more movement to your day, or learning more about your health coverage options. And remember, you don’t have to navigate these decisions alone. A trusted insurance professional can help you understand your benefits and ensure you’re making the most of the coverage available to support your long-term health.

Your heart has been with you through every moment of your life. This February, take a little time to return the favor.

Cold & Flu Season: How to Decide When to Stay Home and When to Seek Care

Fri, 30 Jan 2026 15:45:02 GMT

Cold and flu season can bring a lot of confusion — runny noses, fevers, coughs, chills, maybe even a touch of panic if you haven’t felt well in months. For many of us, especially during the winter months, the big question becomes: “Should I rest at home and ride it out, or get help now?” The right choice depends largely on how severe your symptoms are, your personal health risks, and which care settings are the safest and most appropriate.

Here’s a helpful guide to navigating cold and flu — and making informed decisions based on symptom severity, risk factors, and insurance coverage.

Mild Illness: At-Home Care Is Often Enough

Most colds, and even many flu cases, are mild and improve on their own with time. According to the Centers for Disease Control and Prevention (CDC), most people with flu have “mild illness” and do not require medical care or antiviral drugs.

Common symptoms of cold or mild flu-like illness may include:

Runny or stuffy nose, sneezing
Sore throat or mild cough
Low-grade fever or chills (or no fever)
Mild fatigue or body aches
Mild headache

Here’s what to do if symptoms are mild:

Rest, stay home, and limit contact with others. Avoid spreading the virus.
Stay hydrated and get plenty of sleep.
Use over‑the‑counter medications (like acetaminophen or ibuprofen) to relieve fever, aches, or sore throat — as long as you don’t have underlying conditions that make these unsafe.
Consider a humidifier, sinus rinse, and warm drinks to soothe congestion or sore throat.

Because antibiotics don’t work on viruses, avoid seeking antibiotics unless a health professional diagnoses a bacterial complication (e.g., sinusitis, ear infection, pneumonia).

If after a few days you begin feeling better (less fever, improved energy) and symptoms remain mild, home care is often sufficient.

When to Consider Calling Your Primary Care Provider (PCP) or a Telehealth Provider

Certain groups — including older adults, young children, pregnant individuals, and people with chronic health conditions — are at higher risk for flu complications.If you belong to one of these groups and begin experiencing flu‑like symptoms, it’s often wise to call your doctor early. The sooner potential antiviral treatment starts, the better chance of avoiding serious complications.

You might want to call your doctor if:

You belong to a high-risk group (age 65+, chronic lung disease, heart disease, immunocompromised, etc.)
Symptoms begin to worsen after a day or two (higher fever, increasing cough, fatigue)
You’re unsure whether it’s flu, a cold, or possibly COVID-19 — as these can present similarly
You want guidance on whether antiviral treatment may help (flu antivirals work best if started early)

If your doctor is unavailable or you’d like a quicker option, telehealth or virtual-care services can be a good alternative. Many clinics offer telehealth, especially during flu season, so you can get evaluated from home and avoid potentially exposing others.

Urgent Care: A Smart Option for Moderate Symptoms

If your symptoms are more than mild but not life-threatening — or if you want to get a flu test, get antiviral prescriptions, or want symptomatic relief but don’t want to go to the hospital — an urgent care clinic is a sensible middle ground.

Urgent care is most appropriate when you experience:

Fever over 101°F that isn’t improving with medication, or lasting more than a few days
Moderate to severe body aches, persistent cough or sore throat, worsening congestion
Mild to moderate dehydration (e.g., less urination, dizziness, dark urine)
Need for flu or COVID testing, or rapid evaluation when your PCP is unavailable

Urgent care centers typically offer rapid flu testing, can prescribe antiviral medications (if appropriate), and help manage dehydration or moderate symptoms, often with shorter wait times and lower cost than a hospital ER.

When It’s Time to Go to the Emergency Room (ER)

The ER is reserved for serious or potentially life-threatening symptoms. According to experts, flu (or flu-like illness) becomes an emergency when warning signs appear.

Adults should seek immediate care if they experience:

Difficulty breathing or shortness of breath
Persistent chest or abdominal pain or pressure
Sudden dizziness, confusion, or inability to stay awake
Severe or persistent vomiting, dehydration (e.g., not urinating)

For children — especially infants — warning signs are different and may appear quickly. Seek emergency care if your child shows: trouble breathing, bluish lips or face, fast breathing, dehydration (no wet diapers or urine), persistent high fever (especially under 3 months), or lethargy / difficulty waking.If you or a loved one experiences any of these, don’t wait. Head to the ER or call 911.

Insurance & Coverage Considerations: What to Know Before You Go

Your health insurance — whether it’s under Medicare or an Affordable Care Act (ACA)/private plan — can affect where and how you seek care. Here are a few things to double‑check:

Network vs. out-of-network : If you go to urgent care or the ER, be sure the facility is in-network, or you may face higher out-of-pocket costs. If you see a provider out-of-network, expect possible increased charges.
Urgent care vs. emergency care : Often the copay for an ER visit is several times higher than an urgent care visit. If your symptoms are moderate, start with urgent care, and they will recommend you go to the ER if necessary.
Copays, deductibles, and prior authorization : For non-emergency urgent care, know your copay or deductible before walking in. For those on Medicare, urgent care and ER are typically covered, but prescription costs (for antivirals) could vary depending on your Part D or supplemental coverage.
Telehealth coverage : Many plans (both ACA and Medicare Advantage) now include telehealth visits. For mild or moderate symptoms, this can offer a convenient, lower-cost first step.
Documentation and follow-up : Keep records of your visit, any prescriptions and follow-up care, especially if you have chronic conditions. This will help your provider monitor recovery and stay on top of complications.

Final Thoughts

Cold and flu seasons can bring sniffles and coughs — and sometimes worse. It’s important to pay attention to symptoms, know what type of care you need, and understand how your insurance works.

If you’re unsure what to do, contact your primary care provider or use telehealth to be on the safe side. The sooner respiratory illness is addressed, the easier it often is to avoid complications.

And don’t forget prevention: practice good hygiene, keep current with all recommended shots for your age group, and avoid close contact when you or others are sick. For those with Medicare or ACA/private plans, today’s coverage options often include preventive services and telehealth, making it easier than ever to stay safe and healthy this season.

How to Transition to Your New ACA Health Plan in the New Year

Fri, 23 Jan 2026 13:30:00 GMT

If you recently enrolled in a new Medicare plan during the Annual Enrollment Period (AEP), your coverage likely started on January 1st. Whether you switched Medicare Advantage plans, changed Part D drug coverage, or moved between Original Medicare and a Medicare Advantage plan, it’s important to make a smooth transition.

Here are some tips to help you get started with your new plan:

1. Watch for Your New Plan Materials

You should receive a welcome packet and a new member ID card from your plan. Be sure to review these materials carefully. They’ll include important details about your coverage, provider networks, drug formularies, and how to get care.

2. Share Your New Card with Providers

Give your new Medicare Advantage or Part D card to your doctor, pharmacy, and any specialists you see. This ensures your care is billed correctly from day one.

3. Double-Check Your Coverage

Even if you already reviewed your benefits before enrolling, it’s smart to confirm:

Your doctors and pharmacies are in-network (if applicable)
Your medications are covered and fall within the plan’s formulary
You understand copays and other out-of-pocket costs

4. Prepare Your Prescriptions for the First 30 Days

If your medications or providers have changed, plan ahead to avoid any disruptions. Refill prescriptions early if possible, and call your plan’s customer service if you have any trouble getting your medications or setting up care.

5. Keep an Eye on Your Mail

You may receive additional documents throughout the year, like Explanations of Benefits (EOB) when you receive plan services, or plan updates. Don’t ignore them—these may contain information about your costs or changes to provider networks.

Have Questions or Concerns?

If something about your new plan isn’t working the way you expected, or you’re unsure about what to do next, we’re here to help you understand your coverage and explore any options you may still have.

Fall Monitors Save Lives: What You Should Know—And How Medicare Helps

Fri, 16 Jan 2026 13:15:00 GMT

Falls are one of the most serious health risks facing older adults, yet they are also one of the most preventable. Each year, millions of seniors experience a fall, and many of these incidents occur when no one else is around to help. This is where fall monitors—also known as personal emergency response systems (PERS)—can make a life-saving difference. These devices provide 24/7 monitoring and instant access to help at the push of a button or even automatically through built-in sensors. Fall monitors aren’t just helpful technology; they are powerful tools that support independence, safety, and peace of mind for older adults and their families.

Fall monitors come in several varieties, including wearable pendants, wristbands, and smart sensors placed around the home. Many modern devices use advanced fall-detection technology that can automatically alert emergency services if a fall is detected, even if the user is unable to press a button. For aging adults who want to remain in their homes longer, these monitors act as a safety net, ensuring that help is always available. This rapid response is crucial because timely medical attention dramatically improves outcomes after a fall.

Medicare plays an important role in helping seniors access fall-prevention resources, but coverage can vary. Original Medicare (Parts A and B) does not typically cover the cost of personal emergency response systems, including fall monitors. However, many Medicare Advantage (Part C) plans now include supplemental benefits that may help pay for these devices—especially plans focused on chronic care management, safety benefits, or in-home support services. Because each Medicare Advantage plan may choose whether to offer benefits beyond those covered by Medicare, it's important for beneficiaries to review their plan’s details or speak with a licensed Medicare agent to understand what is available in their area.

In addition to device coverage, Medicare offers preventive services aimed at reducing fall risk. This includes an annual wellness visit, during which a healthcare provider assesses fall risk, reviews medications, and recommends balance or mobility screenings. Medicare Part B may also cover physical therapy to improve strength and stability when medically necessary. Combining these preventive services with a fall monitor creates a strong safety strategy that can significantly reduce the chances of serious injury.

Fall monitors also provide emotional peace of mind. Many older adults fear falling more than they fear other health events, and that fear can limit activity and independence. Knowing that help is only a button-press away—or automatically detected—can restore confidence and encourage healthy, active living. Families also feel reassured knowing their loved one has reliable support around the clock, especially if they live alone or have a history of falls.

As technology continues to advance, fall monitors are becoming smarter, more affordable, and easier to use. For many seniors, they are no longer optional but essential. They offer immediate life-saving assistance, support safe aging at home, and complement Medicare’s preventive care benefits. For anyone looking to protect themselves or a loved one, exploring fall-monitor options and reviewing Medicare coverage is a meaningful step toward safer, more independent living.

Medicare Scams: Protect Your Benefits and Assets

Mon, 12 Jan 2026 21:37:38 GMT

Because of the massive scale and complexity of Medicare, this essential program is sadly a frequent target of fraud and abuse. Scammers may try to steal your personal information, bill for services never rendered, or trick you into bogus plan offers. Not only can these scams cost taxpayers millions of dollars annually, but they may also compromise your identity, coverage, and peace of mind.

That’s why awareness and vigilance are key. Knowing how scams operate and what red flags to watch for is crucial for every Medicare beneficiary and their family members. You are the first line of defense to protect yourself and the broader Medicare program from scammers.

Learn more from Medicare.gov

Common Scams and Tactics to Watch Out For

Scams targeting Medicare beneficiaries come in many forms, but several commonly recur. Here are some of the most frequent:

Fake “Medicare” Calls or Visits
Scammers often impersonate Medicare officials or agents, calling or sometimes even showing up in person. They may claim they need to “update your Medicare information,” issue a “new card,” or warn that your coverage is at risk unless you provide personal details. These communications can involve requests for your Medicare number, Social Security number, or even banking information. Legitimate Medicare or affiliated official programs will never cold‑call you for that kind of sensitive data.
Phantom Billing or False Claims
In what’s sometimes called “phantom billing,” unscrupulous providers may bill Medicare for services, tests, or equipment that were never provided. This can include duplicative billing, billing for more expensive services than were rendered (known as “upcoding”), or submitting claims for unnecessary procedures.
Free Medical Equipment or Services Offers
Scammers might contact you offering “free” medical supplies, equipment (like braces, wheelchairs, or test kits), or free tests — claiming Medicare will cover them. Their goal is often to get your Medicare or personal information upfront, then bill Medicare fraudulently, or even bill you for equipment you never requested or don’t need.
Fake Plan Offers, Cancelling Threats, or Refund Schemes
Around open enrollment periods — when many beneficiaries are shopping or switching plans — scammers may offer “exclusive” Medicare Advantage or Part D plans that promise better benefits, lower costs, or free extras. Some may even claim you’re entitled to a refund or rebate. These offers usually require giving up personal or financial information. Similarly, fraudsters may threaten that your benefits will be canceled unless you provide information or pay a “processing fee.”

Smart Habits for Medicare Beneficiaries

Staying safe from Medicare scams largely comes down to cautious behavior, record‑keeping, and verifying all suspicious contact or billing. Below are recommended best practices:

Guard Your Medicare Number Like Your Social Security Number
Never give your Medicare number or Social Security number to anyone over the phone or via email, unless you initiated the contact and are sure of the recipient’s identity.
Be Skeptical of Unsolicited Contact
If you receive an unexpected call, letter, email, or visit claiming to be from Medicare, do not provide any personal or financial information. Instead, hang up or close the communication and verify by calling Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227) .
Keep Track of Your Medical Services and Bills
Maintain a personal record of all medical visits, procedures, equipment, and services you receive. Keep receipts, statements, and calendars of dates for services — especially if you didn’t receive bills yourself. Then compare that with the official notices from Medicare.
Review Your Medicare Notices Closely
Medicare sends out a notice (often called an MSN or Explanation of Benefits) when a claim is made. Review these carefully. If you see something you don’t recognize — services you didn’t receive, providers you never visited, or equipment you didn’t order — treat it as suspicious.
Shred Old Documents and Cards
Dispose of any retired Medicare or Social Security cards securely. Old documents can still be used by fraudsters for identity theft.
Avoid High‑Pressure Offers and “Free” Promises
Offers of “free” equipment or limited-time plan deals are often scams. If it sounds too good to be true — very likely it is. Always verify through official Medicare channels.

What to Do If You Suspect Fraud or a Scam

If you suspect something isn’t right — whether you got a suspicious call, received unexpected equipment, or saw incorrect billing — take action as soon as possible. Here are the main steps:

Do not ignore it. Even small discrepancies can signal scam activity. Early detection is usually easier to resolve than problems discovered months later.
Gather documentation. Include your Medicare number, provider information (name, address), dates and descriptions of the service in question, bills, explanation-of-benefits forms, and any other supporting statements.
Report the fraud. You can:

Call 1‑800‑MEDICARE (1‑800‑633‑4227) to report suspicious calls, billing, or unauthorized claims.
Call the federal fraud hotline at 1‑800‑HHS‑TIPS (1‑800‑447‑8477) .
If you have a Medicare Advantage plan or a Part D drug plan, you can call the customer service or claims integrity line for those plans — or use the private contractor line, e.g., 1‑877‑7SAFERX (1‑877‑772‑3379) .
Contact your local Senior Medicare Patrol (SMP), which can help you investigate and report suspected fraud, and advise on next steps. See https://smpresource.org to find the phone number in your state.

Stay vigilant. Continue reviewing your Medicare statements, and consider setting up safeguards such as appointment of a trusted relative to help monitor bills if memory or health becomes a concern.

Reporting Matters For the Good of All

While preventing scams protects your personal identity and coverage, it also serves a larger purpose. Fraud, waste, and abuse in Medicare divert funds away from legitimate patient care — draining taxpayer dollars and undermining trust in the system.

Programs like the Senior Medicare Patrol rely on tips from beneficiaries to investigate suspicious activity. Over the years, SMP volunteers have helped recover millions of dollars and prevented future fraud.

By staying alert and reporting what seems wrong, you’re helping preserve Medicare’s integrity — for yourself, your peers, and future generations.

The ANOC for Medicare Advantage Enrollees: Why It’s Important

Fri, 26 Sep 2025 13:00:04 GMT

The Annual Notice of Change (ANOC) is a letter your Medicare Advantage or Part D plan sends each year to explain what’s changing in your plan for the next calendar year — usually things like:

Monthly premiums
Deductibles and copays
Prescription drug coverage
Network providers
New extra benefits (vision, dental, hearing, etc.)
Reduced or eliminated benefits

Even if you’re happy with your current plan, these changes can impact your care or costs — so it’s worth the few minutes to take a look.

When should I expect it?

Your Medicare Advantage or Part D plan must send your ANOC by September 30 each year. This gives you time to review changes before the Medicare Open Enrollment Period starts on October 15.

How do I read it?

Most ANOCs include a side-by-side comparison showing “This Year” vs. “Next Year.” Use it to quickly spot increases in your:

Monthly premium
Annual deductible
Copay or coinsurance amounts
Drug coverage tiers

Also, check to see if your doctors and pharmacies are still in-network , and whether any extra benefits have been added or removed.

We also suggest reviewing the plan’s formulary (list of covered drugs) for next year to see if your drugs will continue to be covered, and in which tier they are covered. You can see a copy of the 2026 formulary on the Medicare Plan Finder at www.medicare.gov , or the plan’s website.

What should I look for?

Ask yourself:

Are your prescriptions still covered and affordable?
Are your doctors still in the network?
Are your benefits changing, like dental, vision, or fitness perks?
Are your out-of-pocket costs going up?

If the answer to any of those is “yes,” you may want to compare plans during the Open Enrollment Period: October 15 – December 7 (in most states).

Final Tip

Even if you don’t plan to change plans, the ANOC is your early warning system . It tells you if your coverage is still a good fit before the new year begins.

You don’t have to re-enroll in your current plan— but this is your chance to shop for a different plan if your needs (or your plan) have changed.

If you would like help understanding your options, we are always here to help!

Get Ready for Medicare AEP: What You Need to Know

Mon, 22 Sep 2025 11:00:03 GMT

It’s Time to Start Thinking About Medicare AEP for 2026

As summer rolls on, now is the perfect time to start preparing for one of the most important Medicare milestones of the year: the Annual Enrollment Period (AEP) . If you're enrolled in Medicare, this is your chance to review your current coverage, make changes, and ensure your 2026 plan still fits your health and financial needs.

Here’s a quick guide to what AEP is, when it happens, and how you can get ready.

Key Medicare AEP Dates for 2025–2026

October 1, 2025:
You can begin reviewing your 2026 Medicare Advantage (Part C) and prescription drug (Part D) plan options. While you can't make changes just yet, this is when insurers release their new plan details — including costs, coverage, and provider networks.

October 15 – December 7, 2025:
The Annual Enrollment Period is officially open . During this window, you can:
Join a Medicare Advantage or Part D plan
Switch plans
Drop coverage or return to Original Medicare

January 1, 2026:
Any changes you made during AEP take effect. Be sure to review your new plan information so you understand your coverage and any out-of-pocket costs

Don’t Forget About Medigap (Medicare Supplement Plans)

If you have a Medicare Supplement (Medigap) plan, it’s important to know that AEP doesn’t apply to these policies. You can review or apply for a Medigap plan at any time during the year — though underwriting may be required outside of your initial enrollment window.

Still, this is a great time to check in on your Medigap coverage if your health or finances have changed.

How to Start Preparing Now

While you won’t be able to make plan changes until October 15, there’s plenty you can do now to make the process smoother:

Gather recent medical bills and expenses.

List your current prescriptions and dosages.

Note your preferred doctors, hospitals, and pharmacies.

Review last year’s coverage summary or annual notice of changes.

Watch for your Annual Notice of Changes (ANOC) from your health insurance carrier in late September. It outlines any changes in your coverage or costs.

Set a reminder to check back in early October for 2026 plan details.

The better prepared you are, the easier it will be to compare options and make confident, informed decisions once AEP opens.

You Don’t Have to Navigate Medicare Alone

Choosing the right Medicare coverage can feel overwhelming — but you don’t have to go it alone. Whether you're happy with your current plan or want to explore new options, a licensed Medicare agent can help you:

Understand your current plan’s changes

Compare available options in your area

Ensure your doctors and prescriptions are covered

Avoid late penalties or coverage gaps

Ready to Get Started?

While plan specifics can’t be discussed until October 1 , now’s the perfect time to start gathering information and thinking about your needs. If you have questions about Medicare AEP or want help getting organized, don’t hesitate to reach out.

Let’s make your 2026 coverage the right fit — together.

What to Do If Your Medicare Advantage Plan Denies Treatment or a Prescription

Wed, 17 Sep 2025 13:00:03 GMT

If you're enrolled in a Medicare Advantage plan and your doctor recommends a treatment or prescription, it can be frustrating — and even alarming — to learn that your plan has denied it.

Unfortunately, this scenario is becoming more common. Medicare Advantage plans are increasingly using prior authorization as a cost-control tool. While this process is designed to ensure care is medically necessary, it can also create delays, confusion, and unnecessary stress.

Here’s what you need to know — and what steps to take if your care is denied.

Why is prior authorization so common?

One of the trade-offs with Medicare Advantage plans is that, while they often have low or no monthly premiums and include extra benefits like dental, vision, and gym memberships, they also operate more like employer insurance — with provider networks and utilization management tools like prior authorization.

From 2019 through 2022, prior authorization requests increased nearly 25% to 46 million annually. In 2022, insurers denied 3.4 million requests — about 7.4% of all submitted.

Worse yet, about 1 in 10 people who were denied care never filed an appeal, meaning they may have missed out on medically necessary services they were entitled to receive.

What to do if you're denied

If your Medicare Advantage plan denies your treatment or prescription, don’t give up. There is a structured appeal process — and most denials that are appealed are eventually approved. Here's what to do:

1. Understand the denial

If your Medicare Advantage plan denies a medical service or prescription drug, they are required by law to provide you a written notice with a detailed and clear denial reason. If you do not receive a written denial notice, contact your insurer and ask for the specific reason for the denial. This could be due to coding issues, incomplete information, or not meeting plan criteria.

2. Review your plan’s coverage rules

Familiarize yourself with what your plan is supposed to cover by reviewing your plan’s Evidence of Coverage or Member Handbook, which should be available on the plan’s website. They are also required to provide you a copy at the time of your enrollment and annually thereafter. Medicare Advantage plans cannot deny coverage for services covered under Original Medicare.

3. Work with your doctor

Ask your provider to help review the denial. They may be able to correct errors, supply additional documentation, or clarify the medical necessity.

How to file an appeal

If the issue can’t be resolved quickly, you’ll need to file a formal appeal. Your appeal should include:

Your name, policy number, and the prior authorization number
The date of the original request and the proposed service date
The insurer’s reason for the denial and why you believe the request should be approved
Supporting medical records or research studies
C overage guidelines from Medicare or your plan
A signed letter from your doctor explaining the need for the service

If you feel that a delay in processing your appeal could seriously jeopardize your life or health or your ability to regain maximum function, you can request an expedited appeal.

If the appeal is still denied

For medical services and drugs covered under Medicare Part B:

If your Medicare Advantage plan denies a medical service, in whole or in part, they will automatically forward it to an independent review entity (IRE) that will review and process the second-level appeal. You will receive a written decision from the IRE.

For prescription drugs covered under Part D:

A written second-level appeal must be submitted to the IRE by you, someone you appoint to represent you, or a physician, within 65 days of the written denial notice you received (unless you can show good cause for not meeting the 65-day timeframe).

If the IRE agrees with the plan’s denial of the service or prescription drug, there are additional levels of appeal. These are described in your Evidence of Coverage and/or Member Handbook.

Preparing for Medicare AEP: Avoid These Common Mistakes

Fri, 12 Sep 2025 20:34:56 GMT

Every year, from October 15 to December 7 , Medicare beneficiaries have the opportunity to review and make changes to their Medicare coverage during the Annual Enrollment Period (AEP) . This is the time to compare plans, switch Medicare Advantage or Part D plans, or go back to Original Medicare if your needs have changed.

Unfortunately, many people rush through this process—or skip it entirely—and end up with coverage that doesn’t match their needs. Here are some common mistakes to avoid in 2025 so you can make the most of AEP and avoid unnecessary expenses or disruptions in care.

Mistake #1: Ignoring Your Annual Notice of Change (ANOC)

Your plan may look the same—but that doesn’t mean it is. Each September, your current plan will mail you an Annual Notice of Change that outlines any changes to premiums, drug formularies, provider networks, and copayments.

Why it matters: Even a small change in your prescription coverage or provider network can lead to unexpected costs or loss of access to your doctor.

Tip: Review your ANOC carefully, especially if you have regular prescriptions or see specialists.

Mistake #2: Assuming You Can ‘Set It and Forget It’

Medicare is not one-size-fits-all. Your health needs, finances, and provider preferences can shift from year to year.

Why it matters: A plan that worked for you last year might not be the best choice this year. Formularies change, premiums go up, and networks shift.

Tip: Use Medicare’s official Plan Finder at Medicare.gov/plan-compare to compare plans based on your ZIP code, medications, and preferred providers.

Mistake #3: Missing the Enrollment Window

AEP runs from October 15 through December 7 . Changes you make during this period take effect January 1, 2026 .

Why it matters: If you miss this window, your options may be limited. Unless you qualify for a Special Enrollment Period , you may have to wait until the next AEP to make changes.

Tip: Mark your calendar now and schedule time to review your options—ideally in early October to avoid last-minute stress.

Mistake #4: Not Reviewing Drug Coverage

Even if your medications haven’t changed, your Part D drug plan might have. Drug tiers, prior authorizations, and formularies are updated every year.

Why it matters: A medication you’ve taken for years could suddenly cost more—or be dropped entirely from your plan.

Tip: Make a list of your medications and dosage, then verify coverage under your current or new plan.

Mistake #5: Relying on Outdated Advice

Medicare is constantly evolving. What was true last year may no longer apply in 2025. While friends and family mean well, their advice may not reflect your personal circumstances or current Medicare rules.

Tip: Work with a licensed agent who specializes in Medicare and stays current on policy changes. Be sure they represent multiple carriers so you get objective comparisons.

Mistake #6: Forgetting to Check Your Providers

Provider networks in Medicare Advantage Plans can change annually. Just because your doctor is in-network now doesn’t guarantee they will be next year.

Tip: Confirm your preferred doctors, specialists, and hospitals are still in-network for the upcoming year before you re-enroll.

Bottom Line

The Medicare Annual Enrollment Period is your chance to fine-tune your health coverage and avoid unpleasant surprises in the year ahead. But skipping the review—or assuming nothing has changed—can cost you.

If you need help comparing plans or understanding what’s changed for 2025, we’re here to help . Reach out for a no-obligation review and get confident about your Medicare choices.

How to Prepare for ACA Open Enrollment (OEP)

Fri, 05 Sep 2025 13:00:00 GMT

How to Prepare for ACA Open Enrollment (OEP)

The Open Enrollment Period (OEP) for ACA (Affordable Care Act) health insurance runs from November 1 to January 15. This is your window to enroll in a new plan, renew your current one, or make changes to better fit your needs for 2026.

Here’s how to get ready:

1. Review Your Current Coverage

Take a moment to think about how your plan worked for you this year. Were your doctors in-network? Did your prescriptions cost more than expected? Make a list of what worked — and what didn’t.

2. Update Your Information

We will need the following:

A list of your current prescriptions (with dosage)
Names of your doctors and specialists
Preferred pharmacies

This helps us match you with the best plans available.

3. Watch for Your ANOC

If you’re currently enrolled in a plan, your carrier will send you an Annual Notice of Changes (ANOC) in late September. It outlines any changes in your coverage or costs. Don’t ignore it — these changes could affect your care in 2026.

4. Stay Alert for Scam Communications

OEP is a popular time for scammers to target consumers with misleading calls, emails, and ads. If something seems off, check with your trusted agent before responding.

5. Be Ready to Schedule Your Appointment

We’ll begin sending notices soon to schedule an appointment to review your coverage. Appointments can start after October 1. Keep an eye out for communications from us so we can help you review your options and find the best fit.

Need help or have questions?

We’re here to guide you through the process and make sure you’re confident in your 2026 coverage. Give us a call!

What You Should Know About Possible Changes to the Affordable Care Act in 2025

Fri, 29 Aug 2025 13:00:09 GMT

Lawmakers in Washington have passed the One Big Beautiful Bill Act (OBBBA) that includes significant changes to the Affordable Care Act (ACA). While the legislation is now official, many of its details are still being shaped through rulemaking, guidance, and state-level decisions. That means the real-world impact could shift as the law is rolled out. Here's a look at what the law includes so far and how it may affect individuals and families in the months ahead.

1. Changes to ACA Subsidies

One of the most notable proposals involves the expiration of enhanced premium subsidies —financial assistance that lowers the monthly cost of health insurance for many individuals and families.

These subsidies were originally expanded under pandemic-era legislation and later extended through the Inflation Reduction Act. If not renewed, they are set to end in late 2025.

According to the Congressional Budget Office (CBO), premiums could increase significantly—by up to 75% in some states .
Roughly 4.2 million people could lose their current coverage due to rising costs.

2. Adjustments to Enrollment Policies

The bill also suggests several updates to how people enroll in ACA health plans:

A shorter annual enrollment period , reducing the time available to sign up for coverage
The end of automatic re-enrollment , which currently helps about 11 million people maintain continuous coverage
Annual eligibility checks to verify income and qualification status
Revised access rules for certain lawfully present immigrants

The CBO projects these changes could result in 3.1 million more individuals becoming uninsured.

3. Proposed Medicaid Reforms

The legislation includes potential reforms to Medicaid, a key health program for low-income individuals and families. Proposed updates include:

Work requirements for some adults without disabilities
Increased cost-sharing (e.g., co-pays) for people with income above the poverty line
Stricter eligibility verification processes
A reduction in federal funding for state Medicaid programs that cover undocumented immigrants
Funding limitations on certain services, including gender-affirming care

According to CBO estimates, these Medicaid-related changes could lead to 7.8 million fewer people being enrolled in the program.

What Happens Next?

These proposals are still being debated and may change before any final legislation is enacted. While some changes are designed to reduce government spending, they could also increase the number of people without health insurance or lead to higher out-of-pocket costs for some Americans.

Timeline for Changes

The One Big Beautiful Bill Act brings a phased rollout of ACA and Medicaid changes beginning in late 2025. By the end of 2025, enhanced premium subsidies are set to expire, potentially raising costs for millions starting January 2026. In 2026, key ACA enrollment changes take effect—including a shorter sign-up window, elimination of automatic re-enrollment, and stricter income verification. Starting in 2027, Medicaid work requirements for able-bodied adults begin, alongside increased cost-sharing and tighter eligibility checks. Additional reforms will continue rolling out through the late 2020s, with the full impact—an estimated 15+ million additional uninsured—projected by 2034.

Bottom line: If you or your family rely on ACA coverage or Medicaid, it’s a good idea to stay informed and watch for updates. Policy shifts like these can impact eligibility, premiums, and benefits—so being proactive can help you plan ahead.

Stay tuned as more details unfold—and consider checking with an independent insurance agent ahead of the next open enrollment period.

Dental Insurance Options for People Over 65

Fri, 22 Aug 2025 13:00:00 GMT

Did you know that original Medicare and some Medicare Advantage plans don't cover routine dental care ? That means if you're retired and over 65, you're on your own for things like cleanings, x-rays, and crowns — unless you take action. Here’s how to fill the gap affordably.

The Dental Dilemma for Seniors

According to the CDC:

20% of adults 65+ have untreated tooth decay
68% have gum disease
Nearly 1 in 5 have lost all their teeth

Yet, about half of all seniors lack dental insurance . With aging increasing the risk for oral health problems, going without coverage can lead to serious consequences — both for your teeth and your wallet.

Your Coverage Options

1. Medicare Advantage (MA) Plans Some MA plans include dental coverage, or let you add it for an extra premium (averaging $284/year, per the Kaiser Family Foundation).

These plans may cover preventive services and some basic care
Watch for annual limits, exclusions, and network restrictions

2. Stand-alone Dental Plans You can buy private dental insurance through companies like Delta Dental, Humana, or Cigna. An independent insurance agent can help you find the right coverage for you.

On average, premiums range from $20–$80/month
Look for coverage on major services like dentures, bridges, or implants
It is possible they may have waiting periods and annual caps

3. Dental Discount Plans These are not insurance but offer access to lower rates with participating dentists. Again, an independent insurance agent can help you find the right coverage for you.

Membership fees are typically $80–$200/year
No claims or waiting periods
These can be a smart option if you need immediate care

4. Other Options

Veterans with service-connected disabilities may get VA dental care
Community health centers offer sliding-scale dental clinics
Dental schools provide supervised care at a discount

What to Watch Out For

Annual benefit caps : Many plans limit total annual payouts
Pre-existing exclusions : Some plans won’t cover pre-existing issues, like teeth that were missing before you enrolled
Waiting periods : There is sometimes a waiting period of 6–12 months for crowns, bridges, or dentures

Is It Worth It?

If you're only getting one cleaning a year, you might pay less out of pocket than the cost of premiums. But if you're managing chronic conditions, missing teeth, or want peace of mind, some coverage is better than none.

Pro tip : Consider setting aside dental funds in an HSA if you have a high-deductible Medicare Advantage plan that allows it.

Don’t wait until a toothache becomes an emergency. Need help researching options? We are here to help you choose the plan (or strategy) that works for your health, your needs, and your budget.

Sources:

What’s Changing in 2026 with HRAs and HSAs: A New Era for Employer Health Benefits

Fri, 15 Aug 2025 19:18:41 GMT

Health Reimbursement Arrangements (HRAs) have long been a flexible, tax-advantaged option for employers to support their teams’ healthcare needs. And now, with the passage of the One Big Beautiful Bill Act (OBBBA) in July 2025, Health Savings Accounts (HSAs) are seeing some of the most impactful updates in years.

While HRAs remain unchanged under the new law, HSAs are gaining new flexibility —offering expanded eligibility and enhanced coverage options that could reshape how employers structure their benefits in 2026 and beyond.

What Are HRAs?

HRAs are employer-funded arrangements that reimburse employees for qualified medical expenses and, in some cases, individual health insurance premiums. Two of the most common types are:

Individual Coverage HRA (ICHRA): Available to employers of any size, this reimburses employees for individual market health insurance premiums and other eligible expenses.
Qualified Small Employer HRA (QSEHRA): Limited to businesses with fewer than 50 full-time employees, this provides a fixed, tax-free monthly allowance to help cover medical costs or premiums.

HRAs give employers cost control and design flexibility while offering employees more choice in their healthcare options.

HRA & HSA Tax Advantages

For Employers: Contributions to HRAs and HSAs are typically tax-deductible.
For Employees: HRA reimbursements (when used correctly) and HSA contributions, earnings, and withdrawals for qualified expenses are all tax-free —making these tools highly efficient.

Why Employers Are Still Considering HRAs

Even without changes in the new legislation, HRAs remain a strong alternative to traditional group health insurance, thanks to:

Flexible Plan Design: Tailored reimbursement structures
Cost Predictability: Employers set contribution limits
Employee Choice: Workers select coverage that fits their needs

What Did Change: Key HSA Updates for 2026

While many HRA-related proposals were ultimately excluded from the final bill, the OBBBA made several meaningful updates to HSAs , effective January 1, 2026:

1. Expanded HSA Eligibility

Employees enrolled in ACA Bronze-tier or catastrophic plans will now qualify to contribute to an HSA—broadening access beyond traditional high-deductible health plans (HDHPs).

2. Telehealth Permanence

The temporary allowance for first-dollar telehealth services has been made permanent. HDHPs can now offer telehealth before the deductible without disqualifying HSA contributions .

3. Direct Primary Care (DPC) Compatibility

HSAs can now reimburse up to $150/month for individuals or $300/month for families for Direct Primary Care memberships —a popular option for preventive and low-cost care.

What Was Not Included in the Final Bill

Some widely discussed proposals did not make it into the final version of OBBBA:

No ICHRA integration with Section 125 cafeteria plans
No new HRA-specific tax credits
No dual-offering changes for ICHRA and group plans
No income-based HSA caps or fitness reimbursements

These remain on the table for future legislation, but are not part of the 2026 landscape .

Employer Action Plan for 2026

To stay ahead of the curve, employers should:

Review Benefits Strategy: Explore whether HSA-compatible plans align with workforce needs, especially given new ACA plan eligibility.
Update Plan Documents: Make necessary adjustments for telehealth, DPC coverage, and new eligibility rules.
Educate Employees: Prepare for open enrollment with clear materials outlining HSA advantages and new qualifying plans.
Coordinate with Advisors: Work with brokers and benefits partners to implement compliant and competitive plans.

Final Thoughts

The One Big Beautiful Bill makes HSAs more versatile, especially for employees enrolled in ACA plans or seeking telehealth and DPC access. While HRAs did not receive direct updates, they remain a valuable option for employers seeking flexible, budget-conscious benefit strategies.

By taking steps now, businesses can position themselves to offer more flexible plan designs heading into 2026.

What is IRMAA for Medicare recipients?

Wed, 30 Jul 2025 14:00:00 GMT

If you're enrolled in Medicare—or planning to be—you may have heard of something called IRMAA . No, it's not a new type of Medicare plan. It stands for Income-Related Monthly Adjustment Amount , and it can significantly impact what you pay each month for your Medicare Part B and Part D coverage.

Let’s break down what IRMAA is, who it affects, and how to plan for it.

What Is IRMAA?

IRMAA is an additional monthly premium charged to higher-income Medicare beneficiaries. It applies to both:

Part B (Medical Insurance) — which covers things like doctor visits and outpatient care.
Part D (Prescription Drug Coverage) — which helps pay for medications.

While most Medicare enrollees pay a standard monthly premium, those with higher incomes pay an extra amount on top of that. This extra cost is what’s referred to as IRMAA.

Who Has to Pay IRMAA?

IRMAA applies if your Modified Adjusted Gross Income (MAGI) from two years ago exceeds certain thresholds. That means your 2023 tax return is used to determine your 2025 premiums .

For 2025, IRMAA kicks in if your MAGI is:

Over $106,000 (single filers)
Over $212,000 (married couples filing jointly)

If your income falls below those thresholds, you’ll only pay the standard premiums.

How Much More Could You Pay?

The amount of IRMAA you pay depends on your income tier. The higher your income, the higher your IRMAA surcharge. These amounts are set annually by the Social Security Administration and apply in addition to your regular Part B and Part D premiums. The 2025 IRMAA premiums can be found at Medicare.gov.

It’s important to note that Part D IRMAA is paid separately —not to your plan provider, but directly to Medicare.

Can You Appeal IRMAA?

Yes, you can. If your income has dropped due to a life-changing event , such as:

Retirement
Loss of income-producing property
Divorce
Death of a spouse

…you may be able to request a reduction or removal of your IRMAA. You’ll need to file Form SSA-44 with documentation that supports your case. If approved, your IRMAA amount will be adjusted accordingly.

How Is IRMAA Paid?

If you receive Social Security or Railroad Retirement benefits , IRMAA is automatically deducted from your benefit check.
If you don't receive those benefits, you’ll get a bill from Medicare that can be paid online, via online banking, or by check through the

Why It Matters for Your Planning

If you’re approaching Medicare eligibility and have higher income, IRMAA should be part of your financial planning . Your current income may qualify you for IRMAA, but if you're retiring soon, your income may drop, and you could avoid or reduce these extra costs using the appeals process. Knowing that helps you avoid surprises—and gives you time to file an appeal if needed.

The Bottom Line

IRMAA can come as a surprise if you’re not expecting it, but it’s manageable with a little preparation. Understanding how your income affects your Medicare premiums can help you make smarter decisions about retirement timing, tax strategies, and health plan choices.

Need help?

Do you have questions about how IRMAA might impact you—or need help navigating your Medicare options? We’re here to help. Contact our office for personalized guidance tailored to your income and healthcare needs at 602-960-0017 .

Annual Physical vs. Wellness Visit: What’s the Difference for Medicare Beneficiaries?

Fri, 25 Jul 2025 13:00:01 GMT

If you're a Medicare beneficiary, you may have heard the terms "annual physical" and "annual wellness visit" used interchangeably—but here’s the thing: they're not the same . Understanding the difference can help you avoid confusion at your doctor's office and ensure you’re using your Medicare benefits wisely.

In this article, we’ll break down what each visit includes, what Medicare covers, and how you can prepare for each one to make the most of your health care experience.

The Basics: Two Very Different Appointments

Annual Physical Exam

An annual physical is a comprehensive, head-to-toe examination typically performed by your primary care provider to check your overall physical health. It’s a common practice in traditional health insurance plans and often includes:

A hands-on physical exam
Blood tests or other lab work
Screenings (like EKGs or urinalysis)
Updating vaccines
Review of ongoing medical issues
Listening to your heart, lungs, and checking reflexes

Think of the annual physical as a full body checkup , focused on identifying or treating current issues.

Annual Wellness Visit (AWV)

The Medicare Annual Wellness Visit, introduced through the Affordable Care Act, is a preventive visit that focuses more on planning and prevention than diagnosing new health conditions and/or addressing current ones. It includes:

A review of your medical and family history
Discussion of your current health providers and prescriptions
Height, weight, blood pressure, and BMI measurements
Cognitive function screening
Personalized health advice and screening schedule
Creating (or updating) your Personalized Prevention Plan

The goal of the Annual Wellness Visit is to create a roadmap for your future health , helping you stay well and independent as long as possible.

What Does Medicare Cover?

This is one of the most important distinctions for beneficiaries to understand.

Covered by Medicare (one of these per year):

Welcome to Medicare Visit:

Within the first 12 months of being enrolled in Medicare Part B, you’re eligible for a one-time “Welcome to Medicare” preventive visit—a more comprehensive introduction that also comes at no cost.

Annual Wellness Visit:

Medicare Part B covers an annual wellness visit every 12 months at no cost to you, as long as it’s been 12 months or longer since your Welcome Visit. Your provider must accept Medicare for this to be covered, and it’s important to note that it will not be covered if additional tests or services are performed during the same visit.

Not Covered by Medicare:

Annual Physical Exam:

Medicare does not cover a traditional physical exam. If you schedule this thinking it’s the same as the AWV, you may end up with unexpected out-of-pocket costs, especially if lab work or screenings are performed that aren’t preventive in nature.

Why the Confusion?

Many people grew up hearing they should get a “yearly physical,” and naturally assume that’s what Medicare offers. But Medicare takes a preventive care approach with the Annual Wellness Visit.

Because the two visits often happen in the same setting (your doctor’s office), it’s easy to mix them up—especially if your provider uses terms like “annual exam” loosely. That’s why it’s important to clarify what you’re scheduling and make sure it aligns with what Medicare covers.

When Should You Get an AWV?

You’re eligible for your first Annual Wellness Visit 12 months after your initial Welcome Visit (or after you’ve been enrolled in Medicare Part B for 12 months, if you choose to skip the Welcome Visit). After that, you can go back for an Annual Wellness Visit once every year .

Your provider may ask you to fill out a health risk assessment questionnaire, which helps them understand your lifestyle, health concerns, and risks. This allows them to build a personalized prevention plan that might include:

Recommended screenings (like mammograms, colonoscopies, etc.)
Fall prevention strategies
Cognitive assessments
Referrals for services like nutrition counseling or mental health

Tips for a Successful Wellness Visit

Want to get the most out of your AWV? Here’s how:

Bring your medical history – including hospitalizations, chronic conditions, and family history
List all your current medications – including over-the-counter supplements
Note any recent changes in your health – fatigue, mood, memory, mobility
Write down questions in advance – this is a great opportunity to talk through any concerns
Bring your completed health risk assessment if provided in advance by your provider

Does Medicare Cover More than One Visit in the Same Year?

No, Medicare Part B will only cover one of these visits per year. There are a few scenarios in which you may need to have two different visits discussed above in the same 12-month period, but in all cases, only one of them will be covered:

Annual physical + Annual Wellness Visit → Only the AWV is covered by Medicare
Annual physical + Welcome to Medicare Visit → Only the Welcome Visit is covered by Medicare
Welcome to Medicare Visit + Annual Wellness Visit → Only one of these (whichever occurs first) is covered by Medicare

If you schedule a physical in conjunction with your AWV, or if your doctor includes extra services not considered part of preventive care, you may have to pay out of pocket. To avoid surprises, ask your provider:

“Is this visit being billed as an Annual Wellness Visit under Medicare Part B?”

Bottom Line: Know Before You Go

Understanding the difference between an annual physical and a Medicare-covered wellness visit can help you:

Avoid unexpected costs
Make informed decisions
Take full advantage of your preventive benefits

Medicare is focused on prevention. The Annual Wellness Visit is your yearly opportunity to check in with your doctor, set health goals, and stay on top of screenings—all at no cost to you.

If you’re still unsure which appointment is right for you, talk to your provider—or reach out to a licensed Medicare agent who can guide you based on your plan and needs.

Need Help Understanding Your Medicare Benefits?

Our team is here to help you make sense of your coverage and get the most from your Medicare plan. We’re just a phone call away at 602-960-0017 .

Filling the Gaps: Dental, Vision, and Hearing Coverage for Medicare Beneficiaries

Mon, 21 Jul 2025 17:45:00 GMT

When you enroll in Medicare, you get access to hospital and medical insurance through Parts A and B—but many people are surprised to learn that it doesn’t cover everything. In fact, some of the most commonly needed services—like routine dental, vision, and hearing care—are not included in Original Medicare .

The good news? You do have options . Whether through Medicare Advantage plans or standalone coverage, there are several ways to make sure these essential health needs don’t fall through the cracks.

The Limitations of Original Medicare

Original Medicare (Parts A and B) does a great job of covering hospital stays, doctor visits, and medically necessary procedures. But it does not cover most routine care for your eyes, ears, or teeth. That means these important services are entirely out-of-pocket expenses on Original Medicare:

Dental cleanings, fillings, dentures, and extractions
Eye exams for glasses or contacts
Hearing tests and hearing aids

There are a few exceptions to this. For example, Medicare may cover an eye exam if you have diabetes, or it might pay for eyeglasses after cataract surgery. Similarly, it could cover a dental procedure if it's necessary before a major surgery like a heart valve replacement. But as a general rule of thumb, routine care in these areas isn't covered.

Medicare Advantage: An All-in-One Option

If you’re looking for more complete coverage, a Medicare Advantage Plan (also known as Part C) might be a good fit. These plans are offered by private insurance companies and provide the same coverage as Original Medicare—and beyond.

Most Medicare Advantage plans include benefits for:

Dental care : Routine exams, x-rays, cleanings, and sometimes more complex services like crowns or dentures.
Vision care : Annual eye exams, and allowances for glasses or contact lenses.
Hearing care : Screenings and sometimes partial or full coverage for hearing aids.

These plans often require you to use a network provider, so it's important to check which dentists, eye doctors, or audiologists are included. Costs can vary—some benefits may be included at no extra charge, while others might involve copays or set annual limits.

To enroll in a Medicare Advantage plan, you must already be enrolled in both Parts A and B, and live in the plan’s service area. You can compare plans during the Annual Enrollment Period (Oct. 15–Dec. 7) or if you qualify for a Special Enrollment Period. Learn more about Medicare Advantage with this handy booklet from Medicare.gov.

Standalone Coverage and Other Resources

If you prefer to stick with Original Medicare or your current Medicare Advantage plan doesn’t include the coverage you want, you can fill in the gaps with other options instead:

1. Standalone Dental, Vision, and Hearing Insurance

Many private insurers offer separate policies specifically for dental, vision, or hearing coverage. These plans vary in price and coverage, but typically include preventive care and a network of providers.

2. Discount Plans

Discount plans are not insurance plans, but rather offer reduced rates on services for a monthly or annual fee. This might be a good fit if you just need occasional care and want to lower the out-of-pocket cost.

3. Community and Federally Funded Clinics

Some Federally Qualified Health Centers (FQHCs) and local health departments offer dental and vision services at a reduced cost or on a sliding fee scale. These can be especially helpful for people on a fixed income.

4. Veterans Benefits

If you’re a veteran, you may have access to dental, vision, or hearing benefits through your local VA, depending on your eligibility.

Don’t Skip Out on These Services

It might be tempting to put off a dental cleaning or skip an eye exam, especially if it’s not covered—but these services are vital to your overall health. Gum disease has been linked to heart disease, untreated vision problems can increase fall risk, and hearing loss has been associated with cognitive decline.

Preventive care matters, and making sure you have the right coverage in place can help you stay healthier—and save money—in the long run.

Final Thoughts

If you’re on Medicare, dental, vision, and hearing benefits aren’t automatic—but they are available. Whether through a Medicare Advantage plan or other coverage, you can build a plan that supports your total health.

Need help comparing options or understanding what’s available in your area? We’re here to help you make sense of it all.

Stay Safe in the Summer Sun: Protecting Yourself from Heat and UV Exposure

cynthia@cmacinsurance.com (Cynthia Macluskie) — Tue, 15 Jul 2025 19:40:46 GMT

Understanding Heat-Related Illnesses

When the temperatures climb, your body has to work harder to keep itself cool. Sometimes, especially during prolonged exposure or intense activity in hot weather, your system can get overwhelmed—leading to heat-related illnesses. Two of the most common and serious types are heat exhaustion and heat stroke . While they may be easily confused, they’re very different in terms of severity. Knowing how to tell the difference—and how to respond—can make all the difference in protecting yourself and others during hot weather.

Heat Exhaustion

Heat exhaustion is the body’s early warning signal that it’s struggling to cool down. This occurs when the body loses excessive water and salt, usually through sweating.

Symptoms of heat exhaustion include:

Heavy sweating
Weakness or fatigue
Dizziness or fainting
Nausea or vomiting
Muscle cramps
Cool, moist skin

If you suspect someone you know is suffering from heat exhaustion, here’s what to do:

Move to a cooler, shaded area.
Loosen clothing and apply cool, wet cloths.
Sip water slowly.
If symptoms worsen or last longer than an hour, seek medical attention.

Heat Stroke

Heat stroke, on the other hand, is a medical emergency where the body’s temperature rises rapidly and can’t regulate itself, potentially leading to organ damage or even death.

Symptoms of heat stroke include:

High body temperature (104°F or higher)
Hot, red, dry, or damp skin
Rapid pulse
Confusion or unconsciousness
Headache ( CDC guidance )

If you or someone near you is showing these signs, here’s what to do:

Call 911 immediately.
Move the person to a cooler place.
Use cool cloths or a cool bath to lower body temperature.
Do not give the person anything to drink.( CDC Guidance )

Sun Safety: Protecting Your Skin and Eyes

According to the CDC , just a few serious sunburns can increase children's risk of skin cancer later in life. Prolonged sun exposure at any stage of life increases the risk of skin cancer and eye damage. The Centers for Disease Control and Prevention (CDC) and Mayo Clinic recommend the following precautions for yourself and your children:

Use Sunscreen: Apply a broad-spectrum sunscreen with an SPF of at least 30. Reapply every two hours, or more often if swimming or sweating. And be sure to apply liberally!
Wear Protective Clothing: Opt for lightweight, loose-fitting long-sleeved shirts and pants to stay cool and protected, and don’t forget your hat!
Seek Shade: Stay under cover, especially during peak sun hours between 10 a.m. and 4 p.m. No shade around? Bring your own by carrying a UV-blocking umbrella!
Wear Sunglasses: Protect your eyes with sunglasses that block UVA and UVB rays. Some cheaper options don’t provide true protection, so look for the UVA/UVB seal before you buy.
Avoid Tanning Beds: They emit harmful UV rays that increase skin cancer risk.

Tips for Staying Safe in the Summer Heat

Ready to head outside? Before you do, keep these final tips in mind to stay cool, safe, and sun-smart. They’ll help you avoid heat-related illness and sunburn so you can enjoy summer without the health risks.

Stay Hydrated: Drink plenty of water throughout the day. Avoid alcohol and caffeinated beverages, which can dehydrate you.
Plan Activities Wisely: Schedule outdoor activities during cooler parts of the day, such as early morning or evening.
Take Breaks: Rest in shaded or air-conditioned areas to cool down.
Monitor the UV Index: Check local UV index forecasts to determine the risk level for sun exposure.
Be Mindful of Medications: Some medications can increase sensitivity to heat and sun. Consult your healthcare provider for guidance.

Enjoying the summer sun is one of life's pleasures, but it's crucial to do so safely. By understanding the signs of heat-related illnesses and practicing sun safety, you can protect yourself and your loved ones from preventable health risks.

As summer temperatures soar across the country, staying safe in the sun and heat is more important than ever. With longer, hotter days becoming the norm—even in places that were once known for milder summers—more people are finding themselves at risk for serious heat-related illnesses and skin damage from UV exposure. Whether you're spending time gardening, enjoying family cookouts, or simply running errands in the midday sun, the risks of overheating, dehydration, and sunburn are real—and growing. Understanding how to protect yourself isn’t just about comfort; it’s about safeguarding your health. From recognizing the signs of heat exhaustion or heat stroke to practicing smart sun safety habits, a little knowledge can go a long way in helping you and your family enjoy the season while staying healthy.

5000 DDD/ALTCS Medicare members services are restored

Mon, 14 Jul 2025 23:46:26 GMT

Grateful for Our Community of Advocates

Since April 1st, a policy change disrupted payments to speech, OT, PT, home health and other providers-impacting 5,000 DDD ALTCS Medicare members.

Many of us have been actively engaged in conversations with DDD and AHCCCS, advocating for a resolution. We were genuinely concerned about a potential network collapse.

We are relieved to share that the policies causing the issue have been reversed. Providers can now resubmit claims for the payment. Our hope is that this disruption is behind us-and these vulnerable members will once again receive the care their need without further interruption.

We want to thank DDD and AHCCCS for allowing us a seat at the table. We are grateful for the providers and families who let us know what was happening.

DDD TPL Issue

Thu, 03 Jul 2025 21:16:23 GMT

Resolution To Be Announced Next Week

Many of you are aware of the recent third-party liability and billing issues affecting DDD services, including occupational therapy, speech therapy, physical therapy, home healthcare and possible other areas. Some providers have been impacted negatively and been unable to receive payment or paid significantly less than normal since April 1st, 2025.

We have been actively engaged in discussions with both DDD and AHCCCS leadership to address these concerns. The advocates involved in this negotiation are all volunteers who do not benefit from this discussion and have devoted significant hours of their time in the last few weeks to provide feedback and solutions to the system. We are not providers and simply do this because of our complex knowledge around billing, systems of care, Medicare and Medicaid.

We are grateful for families and providers who reached out to let us know of the issues facing the community. We are grateful for our relationships with DDD and AHCCCS leadership who are willing to discuss issues and receive feedback from the community.

We are pleased to share that a solution is expected to be announced next week. Our goal remains ensuring that DDD members continue to have access to the services they need, that we have a vibrant network of providers and that DDD and AHCCCS continue to act as payers of last resort. We are committed to working closely with state agencies to make sure members, providers and taxpayers are treated fairly.

Stay tuned - we'll share more details as soon as they are available.

Scammers Are Targeting Grandparents—Here’s How to Stay One Step Ahead

Wed, 02 Jul 2025 16:58:48 GMT

Imagine getting a call in the middle of the night from someone claiming to be your grandchild, panicked and in trouble. They say they’ve been in an accident or arrested —and they desperately need money. Your heart races. You’d do anything to help. That’s exactly what scammers are counting on.

The Federal Communications Commission (FCC) has recently issued a warning about a rise in what's known as the “grandparent scam” —a sneaky and heartless scheme targeting older adults with urgent, emotional phone calls meant to trick them into sending money.

What Is the Grandparent Scam?

These scams usually start with a phone call from someone pretending to be your grandchild (or another close relative). They’ll say they’re in trouble—maybe stuck in jail or in a hospital—and they need money fast for bail, legal fees, or emergency expenses.

To make things even more convincing, they may hand the phone off to someone pretending to be a lawyer or a police officer. And they’ll likely ask you not to tell anyone—saying it’s a “private” or “sensitive” situation.

That sense of urgency is key to the scam. It’s meant to bypass your instinct to double-check and make you act fast—before you have time to think it through or talk to someone else.

Why It Works—and Why It’s Dangerous

These calls often come late at night or early in the morning, when you’re more likely to be caught off guard. The scammer might not even say who they are—just “Grandma, it’s me”—and hope you fill in the blank for them. From there, they use that information to sound more convincing.

Some victims have been asked to send money via wire transfer, cryptocurrency, gift cards, or even in cash via courier—all methods that are difficult or impossible to trace or reverse. According to the FCC, scammers using this method have stolen tens of millions of dollars from seniors across the U.S.

Watch for These Warning Signs

If you or someone you love receives a call like this, here are some red flags that it could be a scam:

High pressure and urgency – You’re told to act immediately
Vague or strange details – They may not identify themselves clearly, or hope you’ll say the grandchild’s name for them
Unverifiable location or story – They say they’re in jail overseas or in a place where you can’t easily check on them
Unusual payment requests – Gift cards, Bitcoin, wire transfers, or cash deliveries
Calls at odd hours – Scammers try to catch you when you’re less alert

What To Do If You Get a Suspicious Call

If something doesn’t feel right, trust your gut. Here’s what you can do to stay safe:

Hang up and verify – Call your grandchild or their parent using a phone number you know is theirs
Talk to someone you trust – A second opinion from a friend or family member can make all the difference
Don’t rely on caller ID – Scammers often “spoof” numbers to make it look like someone you know is calling
Block the number – Use your phone’s settings to block suspicious calls
Report the scam – Contact the National Elder Fraud Hotline at 833-FRAUD-11 and file a complaint with the FCC

What If You’ve Already Sent Money?

First of all, don’t panic—and know that you’re not alone. Scammers are incredibly convincing, and even smart, cautious people have been tricked.

Here’s what to do:

Call your bank or payment service right away – They may be able to stop or reverse the transaction if it's recent
Report it – Contact the FCC, your local police, and the FBI’s Internet Crime Complaint Center at ic3.gov
Let your family know – They can help protect you and others from future attempts

Help Protect Others, Too

The more people know about this scam, the harder it becomes for criminals to succeed. Please share this information with friends, neighbors, and especially your older loved ones. A quick conversation now could prevent a heartache later.

And remember—if you ever get a call like this and aren’t sure what to do, don’t rush. Take a breath, hang up, and check in with someone you trust. Real family emergencies don’t come with secret demands or payments via gift cards.

Traveling This Summer? Make Sure Your ACA Plan Comes With You

Wed, 02 Jul 2025 16:52:56 GMT

Are you planning a getaway this season—a road trip, a family visit, or even just crossing a state border for some relaxation? Before you pack your bags, take a moment to review something just as important as your itinerary:

Your health insurance coverage.

If you're enrolled in an ACA (Affordabl e Care Act) health plan, it's essential to understand how your coverage works when you're traveling out of state. Your insurance may not extend as far as your travel plans.

Will My ACA Plan Cover Me Out of State?

It depends on your specific plan. Here’s what you need to know:

Emergency care is always covered anywhere in the United States.
Non-emergency care (such as office visits, urgent care, or specialists) may not be covered outside your plan’s home state or provider network.
Some ACA plans include national networks, while others are limited to your local area.

Before You Travel: A Quick Insurance Checklist

Take these steps to ensure you're protected during your trip:

Review your plan’s summary of benefits and network coverage

Locate nearby urgent care or emergency facilities at your destination
Ensure you have enough medication and understand refill policies
Carry your insurance ID card and provider contact information
Explore your plan’s telehealth services for remote care options

Have Questions About Your Coverage? Let’s Review Together.

If you're unsure whether your ACA plan offers the coverage you need while traveling, we're happy to help. Taking a few minutes now can help you avoid costly surprises later.

Travel Smart. Stay Covered.

No matter where you’re headed this summer, make sure your health insurance is ready to go with you. A little preparation goes a long way toward peace of mind.