Tamara Borowiec :: Medicare One-on-One

10/23/2025

🎯 Medicare Open Enrollment is Here! 🎯
From October 15 - December 7, it’s your opportunity to review your Medicare coverage and make sure it still meets your health and financial needs.

💡 What You Can Do During Open Enrollment:
👉 Change your Medicare Advantage Plan (Part C)

Switch to a different Medicare Advantage Plan that may offer lower costs, better benefits, or a larger provider network.

Move from a Medicare Advantage Plan with drug coverage to one without, or vice versa.

👉 Change your Medicare Drug Plan (Part D)

Join, drop, or switch your Part D prescription drug plan if you have Original Medicare.

Compare plans to find one that covers your medications at the best price.

👉 Change How You Get Coverage

Switch from Original Medicare to a Medicare Advantage Plan that combines hospital, medical, and sometimes drug coverage.

Go from a Medicare Advantage Plan back to Original Medicare if you prefer to choose your own providers or add a Medigap policy.

💬 Reviewing your coverage each year helps you make sure you’re not overpaying and that your doctors, hospitals, and prescriptions are still covered!

📅 Enrollment Period: October 15 – December 7
🗓️ Changes Take Effect: January 1

📞 Have questions or need guidance? Reach out today to get one-on-one help understanding your Medicare choices.

Licensed Sales Agent :: Independent Medicare Insurance Advisor :: Chicago & NW Suburbs

10/06/2025

📅 Medicare Annual Enrollment is Coming!
October 15 – December 7

Now’s the time to review your Medicare coverage and make sure it still fits your healthcare needs and budget. Plans can change - and so can your health - so a quick check-in could make a big difference.

Here’s why a review is important:

1️⃣ Plan Changes: Your current plan may have updates to costs, coverage, or its network of doctors and hospitals. Make sure it still works for you.
2️⃣ Health Needs Change: New medications, treatments, or diagnoses might require different coverage than before.
3️⃣ Potential Savings: You may find a plan with better benefits at a lower cost - more coverage doesn’t always mean higher premiums!
4️⃣ Prescription Drug Coverage: Drug lists (formularies) can change. Double-check that your medications are still covered affordably.

Ask yourself these key questions:

🤔 What's changing in my current plan for next year?
📋 Are my preferred doctors and hospitals still in-network?
💊 Are my medications still covered - and at what cost?
💵 Is there a plan with similar benefits that costs less?
✨ Are there new perks or programs available with other plans?

📞 Need help? You don’t have to figure this out alone.
Call me at 773.882.0823 and let’s review your options together.

09/12/2025

Medicare can be confusing at first glance, but it’s incredibly important to understand - especially if you’re approaching age 65, helping a family member navigate their options, or just planning ahead. Here’s a detailed breakdown of the different parts of Medicare, what they cover, and what costs you can expect.

🏥 ORIGINAL MEDICARE: Part A – Hospital Insurance

Part A helps cover medically necessary care in:
✅ Hospitals.
✅ Skilled nursing facilities (short-term).
✅ Hospice for terminally ill patients.
✅ Some home healthcare services.

Cost (2025):
✅ Free if you or your spouse paid into Social Security for at least 10 years.
✅ There is a $1,676 deductible per hospital stay, per benefit period.
✅ A benefit period begins when you're admitted and ends after 60 days without inpatient care.
✅ If your hospital stay extends beyond 60 days, you’ll pay daily copayments.
✅ There is no annual cap on your out-of-pocket costs under Part A.

👨‍⚕️ ORIGINAL MEDICARE: Part B – Medical Insurance

Part B covers:
✅ Doctor visits and outpatient care.
✅ Preventive services (like screenings and lab work).
✅ Some home health services.
✅ Doctor services while hospitalized.

Cost (2025):
✅The standard monthly premium is $185.
✅ There is a $257 annual deductible.
✅ After meeting your deductible, Medicare covers 80% of approved medical costs.
✅ You are responsible for the remaining 20%, along with most prescription drug, dental, and vision costs.
✅ Higher-income individuals may pay more due to an Income-Related Monthly Adjustment Amount (IRMAA).
✅ Like Part A, Part B does not have an annual out-of-pocket maximum.

💊 Part D – Prescription Drug Plans (PDPs)

Part D helps pay for prescription medications and is offered through private insurance companies.

Key Points:
✅ You’ll pay a monthly premium (amount varies by plan).
✅ Some plans have a deductible, and premiums can change yearly.
✅ If you go 63 days or more without drug coverage after you're first eligible, you may face a lifetime late enrollment penalty.
✅ Like Part B, higher-income individuals may pay additional premiums.

🌀 Part C – Medicare Advantage Plans

Medicare Advantage (Part C) is an alternative to Original Medicare. These plans are offered by private insurers and provide the same coverage as Parts A and B, and often Part D as well.

What they offer:
✅ All-in-one coverage, often with extras like dental, vision, hearing, and fitness benefits.
✅ Out-of-pocket maximum for medical expenses each year, which Original Medicare does not offer.
✅ Premiums and coverage vary by plan and provider.
✅ Plans may have network restrictions (e.g., HMOs or PPOs), so it’s important to review plan details carefully.

➕ MEDICARE SUPPLEMENT INSURANCE (Medigap)

Medigap plans help cover the “gaps” in Original Medicare (like deductibles, coinsurance, and copayments).

Things to know:
✅ Offered by private insurance companies.
✅ Monthly premiums are required in addition to your Part B premium.
✅ Medigap does not cover prescription drugs, dental, vision, or long-term care.
✅ Plans are standardized but vary in what they pay and how much they cost.

Choosing the right Medicare coverage depends on your health needs, financial situation, and whether you prefer to manage your care through a single plan (like Medicare Advantage) or keep Original Medicare and add a Supplement and Drug Plan.

Each option comes with trade-offs in terms of flexibility, cost, and coverage. It’s worth reviewing your choices carefully or speaking with a licensed Medicare advisor if you need help comparing plans.

Source: cms.gov

02/20/2025

There are several programs designed to assist individuals with limited resources in covering their Medicare premiums and cost-sharing expenses.

Medicare savings programs can help with the monthly Part B premium and any Part A premium you may have. In some cases, these programs may also cover deductibles, coinsurance, or copayments. To find out if you qualify, contact your State Health Insurance Assistance Program (SHIP). Please note that these programs are not available in Puerto Rico or the U.S. Virgin Islands, though Medicaid - a joint federal-state or federal-territory program - may offer assistance to those with low incomes.

Extra Help is a federal program that assists with the costs of Medicare Part D prescription drug coverage. To check your eligibility and apply, visit the Social Security Administration's website or call 800-772-1213. You can also visit Medicare's page (medicare.gov) for more information on drug cost assistance.

Additionally, some states offer pharmaceutical assistance programs to help eligible individuals pay for prescriptions. Use Medicare's (medicare.gov) online tool or contact your State Health Insurance Assistance Program to find out if your state offers such a program.

Source: aarp.org

02/12/2025

Whether you’re choosing a stand-alone Part D plan or a Medicare Advantage plan for your prescriptions, it’s important to understand the rules, the drugs covered, and your costs. 💊

Ensure your plan includes all the medications you need. Every Part D plan has a formulary, a list of covered drugs. If your medication isn’t on the list, you may need to request an exception, pay out-of-pocket, or file an appeal. Some prescriptions may also require prior authorization from your insurer for coverage.

Beyond comparing premiums, make sure to understand the cost of your prescriptions under each plan. Part D plans offer various cost-sharing structures. For example, you might pay a $10 copay for some drugs but a $35 copay for others, or you may be responsible for 20% of the medication’s cost. Use the medicare.gov Medicare Plan Finder 🔍 to compare drug coverage across plans in your area and check if there are preferred pharmacies where you can save on copayments.

Remember, premiums and coverage can change annually. During the open enrollment period (Oct. 15 to Dec. 7), you have the opportunity to switch Part D plans for coverage starting Jan. 1.

Source: aarp.org

02/11/2025

Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

In 2025, the Medicare Part A premium is $0 for most beneficiaries with qualifying work history, and the standard Part B premium is $185 per month (high earners pay more).

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital is $1,676 for each benefit period, and the annual Part B deductible is $257 per year.

The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2025, beneficiaries must pay a coinsurance amount of $419 per day for the 61st through 90th day of a hospitalization in a benefit period, and $838 per day for lifetime reserve days.

The Part B coinsurance is 20% of the Medicare-approved amount.

For more information, please visit cms.gov

01/28/2025

A Medigap policy helps cover some of the out-of-pocket expenses that Medicare doesn’t pay for, like your Part A hospital deductible or the 20% coinsurance under Part B. These policies are sold by private companies and are named by letters, such as Plan G.

While the federal government ensures that the benefits of each Medigap plan type are standardized, the premiums can differ. Multiple insurance companies may offer the same lettered plan in your area.

If you purchase a Medigap policy within six months of enrolling in Part B at age 65 or older, insurance companies cannot deny you coverage or charge higher premiums due to health issues. However, if you attempt to buy a policy outside of this period, insurers in most states might refuse to sell you one or raise your premiums based on preexisting conditions.

Since some states have their own regulations for Medigap policies, if you missed your enrollment window, it’s a good idea to contact your State Health Insurance Assistance Program (SHIP) to learn about specific rules in your state.

Source: aarp.org

11/04/2024

While Medicare covers a significant portion of medical expenses for its beneficiaries, it's important to be prepared for some out-of-pocket costs. If you have Original Medicare, you can consider getting supplemental Medigap coverage and a separate Part D drug plan to help manage these expenses. Here’s a breakdown:

✅PREMIUMS ::
Each part of Medicare may have its own monthly premium. Most people do not pay a premium for Part A, which covers hospital services. However, whether you opt for Original Medicare or a Medicare Advantage plan, you'll need to pay the Part B premium, which is $174.70 per month for most individuals in 2024. If you choose a Medicare Advantage or Part D plan, additional monthly premiums may apply depending on your selection.

✅ DEDUCTIBLES ::
Before Medicare begins to cover your costs, you may have to meet certain deductibles. In 2024, the Part A deductible is $1,632 per benefit period (not annually), while the Part B deductible is $240 for the year. A Part A benefit period starts when you're admitted as an inpatient to a hospital or skilled nursing facility and lasts until you've been out of care for 60 days. This could result in multiple Part A benefit periods within a year, each requiring its own deductible. Many Part D plans also have their own deductibles.

✅ COPAYMENTS ::
This is a fixed fee you pay each time you receive medical services. For example, with Original Medicare and no supplemental coverage, you may have to pay $408 per day for hospital stays lasting 61 to 90 days during each benefit period in 2024. Part D plans also have copayments that vary based on the type of medication.

✅ COINSURANCE ::
This refers to a percentage of the cost you need to pay for medical visits or services. With Original Medicare, you're typically responsible for 20% of the doctor and outpatient charges covered under Part B. Some high-cost medications in Part D plans may also require you to pay a percentage of the total cost.

Source: aarp.org

10/25/2024

Add these important Medicare dates to your calendar:

✅ October 1, 2024: Start reviewing and comparing your current Medicare health or drug coverage with options available for 2025. You might be able to save money or gain additional benefits.

✅ October 15 – December 7, 2024: This is the Open Enrollment Period. You can update your Medicare coverage for 2025 if desired. You may join, switch, or drop a Medicare Advantage Plan or Medicare drug plan, or return to Original Medicare during this time.

✅ January 1, 2025: New coverage takes effect if you made changes during Open Enrollment. Any cost or benefit updates to your existing plan will also begin on this date if you chose to keep your coverage.

✅ January 1 – March 31, 2025: If enrolled in a Medicare Advantage Plan, you have the option to switch to another Advantage Plan or to Original Medicare (with a separate drug plan) once during this period. Any changes made will start on the first day of the month after your request is received.

Questions? I'm here to help 📱773.882.0823

To learn more, please visit: medicare.gov

10/25/2024

✅ Out-of-pocket limit on drug costs ::

In 2025, your annual out-of-pocket expenses for medications will be limited to $2,000. Once you reach this cap—considering both your out-of-pocket spending and certain contributions from others, including Medicare’s Extra Help program—you won’t need to pay any copayments or coinsurance for covered Part D drugs for the remainder of the calendar year.

✅ Medicare Prescription Payment Plan ::

Starting in 2025, this new payment option will work alongside your current drug coverage to help you manage your out-of-pocket costs by spreading them throughout the calendar year (January–December). While this option can assist with budgeting, it does not reduce your overall drug costs.

If you choose this payment option, you'll continue to pay your plan premium (if applicable), and instead of paying the pharmacy directly, you’ll receive a monthly bill from your health or drug plan for your prescription medications. All plans offer this option, and participation is voluntary with no associated costs.

For more information and to see if this payment option is right for you, contact your plan or visit Medicare.gov/prescription-payment-plan.

Questions? Let's connect 📱773.882.0823

10/18/2024

Each Medicare Advantage plan has specific rules regarding provider networks. Most are categorized as either HMOs, which usually require referrals to see specialists and depend on primary care physicians to manage patient care, or PPOs, which feature networks of contracted doctors, hospitals, and medical facilities. In both cases, your costs are generally lower when you use in-network providers.

If you choose to enroll in a Medicare Advantage plan, check whether your preferred doctors and hospitals are in your network. For any questions, reach out to the plan for details. If your providers are out of network, find out what, if anything, the plan will cover for their services.

Ensure that the plan continues to cover your doctors each year. You can switch to a different Medicare Advantage plan during the open enrollment period from October 15 to December 7, with coverage starting January 1. Additionally, there's a Medicare Advantage open enrollment period from January 1 to March 31 each year, during which any changes will take effect on the first of the following month.

Source: aarp.org

10/08/2024

Original Medicare doesn’t cover self-administered prescription medications, but you can purchase a Part D policy for drug coverage. The enrollment rules for Part D differ from those for Parts A and B, and many Medicare Advantage plans include prescription coverage.

You can enroll in Part D when you first qualify for Medicare, but it’s not mandatory if you have other drug coverage deemed as good as or better than Part D. This may come from an employer plan, retiree benefits, Tricare, or other sources.

Each September, you should receive a letter from your employer or insurer confirming whether your drug coverage meets the government’s standard for “creditable coverage.” If you lose this coverage, you’ll have a two-month special enrollment period to sign up for Part D without a penalty. Keep this letter as proof of your comparable coverage.

If you go 63 days or more without comparable drug coverage, you may incur a late enrollment penalty, which is 1% of the national base beneficiary premium for each month you delayed enrollment. This penalty generally applies for as long as you have Part D. However, if you qualify for the Extra Help program, which assists low-income individuals with Medicare costs, you won’t face the penalty.

Source: aarp.org