Categories Health insurance

Why Work With a Medicare Broker?

Why work with a Medicare broker?

Why Work With a Medicare Broker?

Choosing a Medicare plan can feel overwhelming. Between Original Medicare, Medicare Advantage, Part D prescription plans, and Medicare Supplements (Medigap), there’s a lot to sort through — and the wrong choice can end up costing you more in the long run.

That’s where working with a licensed Medicare broker comes in. A broker is your personal guide to understanding your options and making confident, informed decisions.

Unbiased Guidance — Focused on You

Unlike agents who only work with one insurance company, Medicare brokers represent multiple carriers. That means they’re not trying to push a specific plan — they’re focused on finding the best fit for your needs and budget.

Whether you’re looking for lower copays, more prescription drug coverage, or access to specific doctors, a broker helps match you with the right plan for your unique situation.

No Cost to You

One of the biggest myths about Medicare brokers is that you have to pay for their services. In reality, working with a broker costs you nothing. Brokers are compensated by insurance companies, not by you — and your premiums are the same whether you enroll directly or through a broker.

That means you get free expert help without any added cost.

Personal Help, Not Call Center Confusion

When you call a big insurance company, you’re often just a number in a queue. But when you work with a local broker like Patricia Saint Louis, RN, you get one-on-one support from someone who takes the time to get to know you.

Patricia combines her professional background as a Registered Nurse with years of experience in health insurance to help clients understand their benefits, avoid costly mistakes, and get the care they deserve.

Support Beyond Enrollment

A good broker doesn’t disappear after you choose a plan. Patricia is here to help you year-round — whether it’s reviewing your coverage annually, solving billing issues, or answering questions as your health needs change.

Medicare Is Complicated — You Don’t Have to Figure It Out Alone

From enrollment windows to plan networks and drug formularies, Medicare is full of fine print. A broker helps you understand the details so you can feel confident in your choices — and avoid common pitfalls like late enrollment penalties or surprise out-of-pocket costs.


📍 Ready to Get Expert Help with Medicare?

If you’re approaching 65, losing employer coverage, or just need a second look at your current plan, Patricia Saint Louis, RN is here to help — right here in your local community.

Visit: 216 N 3rd St, Suite B, Leesburg, FL 34748
Call: 352-260-0202

No pressure. No confusion. Just personalized Medicare guidance you can trust.

Categories Health insurance

2025 Medicare Part D Changes due to the Inflation Reduction Act

Medicare Part D changes in 2025

Big Changes to Medicare Part D in 2025: What You Need to Know

Starting in 2025, the Inflation Reduction Act introduces major changes to Medicare Part D that are designed to make prescription drugs more affordable and easier to manage for beneficiaries. One of the most significant updates is a $2,000 annual cap on out-of-pocket drug costs, which will also eliminate the infamous “donut hole” (coverage gap).

Here’s what’s changing — and how it may affect you:


Key Changes Coming to Medicare Part D in 2025

💵 $2,000 Out-of-Pocket Maximum

Medicare Part D enrollees will not spend more than $2,000 per year on covered prescription medications. This cap includes all deductibles, copayments, and coinsurance.

🚫 Goodbye Donut Hole

The coverage gap — where beneficiaries used to pay a higher share of drug costs after reaching a certain spending limit — will be completely eliminated in 2025.

🔄 New 3-Phase Coverage Structure

The old four-phase model is being simplified. Beginning in 2025, Medicare Part D will have three distinct phases:

  1. Deductible Phase – You pay 100% of drug costs until your deductible is met (standard deductible is $590 in 2025).

  2. Initial Coverage Phase – After meeting your deductible, you and your plan share the cost of covered drugs.

  3. Catastrophic Phase – Once your out-of-pocket costs reach $2,000, you enter this phase, and your drug costs drop significantly.

🏥 Plan Responsibility & Government Support

Plans will now bear more of the cost during the catastrophic phase, with additional support from federal subsidies. This reduces the financial burden on beneficiaries.

💊 Manufacturer Discounts

Drug manufacturers will now be required to offer discounts during the initial coverage phase, helping to lower overall drug prices even further.

📅 Monthly Payment Option (MPPP)

Medicare will introduce the Medicare Prescription Payment Plan (MPPP), allowing enrollees to spread their out-of-pocket drug expenses over monthly payments, offering better budget flexibility.

💉 Vaccine Coverage Still Free

As of early 2023, out-of-pocket costs for ACIP-recommended and travel vaccines have already been eliminated for those with Part D — and that benefit continues into 2025.


How These Changes May Affect You

  • Lower Out-of-Pocket Drug Costs: The $2,000 cap and new discount structure should reduce total yearly spending for many beneficiaries.

  • ⚠️ Possible Premium or Deductible Increases: Some plans may adjust premiums or deductibles in response to the new cost-sharing structure.

  • Simplified Coverage Model: The updated three-phase design makes it easier to understand how your medication costs are calculated and when you’ll hit your yearly cap.


These 2025 updates aim to make Medicare Part D more affordable, predictable, and easier to navigate. If you’re unsure how these changes may impact your specific plan or medications, working with a licensed Medicare broker like Patricia Saint Louis, RN can help you make the most of your coverage.

📍 Visit Patricia at: 216 N 3rd St, Suite B, Leesburg, FL 34748
📞 Call: 352-260-0202

Categories Health insurance

Ten Common Medicare Mistakes to Avoid

 

Navigating Medicare can be overwhelming, especially if you’re unfamiliar with its many rules, deadlines, and plan options. Failing to understand key aspects of Medicare can result in financial penalties, gaps in coverage, or being stuck with a plan that doesn’t fit your needs. Here are ten of the most common Medicare mistakes people make—and how you can avoid them.

  1. Not Enrolling on Time During the Seven-Month Birthday Window-Turning 65

One of the biggest and most costly Medicare mistakes is missing your initial enrollment period. This period spans a total of seven months—three months before the month you turn 65, the month of your 65th birthday, and three months after. Failing to enroll in Medicare Part A and/or Part B during this window can result in significant and permanent late enrollment penalties. These penalties are added to your monthly premiums and remain for the rest of your life, making it essential to sign up on time, even if you don’t need all the benefits right away. You can, however, delay Medicare if you are covered under an Employer’s Health Insurance plan or your spouse’s Employer’s Health Insurance plan as long as the employer has 20 or more employees.

  1. Not Enrolling in Part B After Becoming Unemployed

If you delay enrolling in Medicare Part B because you’re still working and have employer-provided health coverage, that’s fine, as long as the employer has 20 or more employees. However, once your employment (or your spouse’s) ends, you have a limited window to sign up for Part B—specifically, within eight months of losing group health coverage. Missing this special enrollment period can lead to late penalties and a delay in coverage. Even if COBRA is offered, it does not count as creditable coverage for Medicare.

  1. Not Enrolling in a Drug Plan (Part D)

Even if you’re not currently taking prescription medications, enrolling in Medicare Part D is highly recommended. This optional plan provides drug coverage and can prevent substantial out-of-pocket costs in the future. If you delay enrolling in Part D and don’t have other creditable drug coverage, you’ll be penalized with a higher premium when you finally do enroll. The longer you wait, the higher the penalty—so it’s best to enroll when you first become eligible, even if you choose the most basic plan.

  1. Not Enrolling in a Supplement or Advantage Plan

Original Medicare (Parts A and B) covers only about 80% of your medical expenses. That remaining 20% can be a major financial burden, especially if you have ongoing health needs or experience a medical emergency. To fill in these gaps, many people opt for a Medicare Supplement Plan (Medigap) or a Medicare Advantage Plan (Part C). While supplement plans help cover out-of-pocket costs like deductibles and coinsurance, Advantage plans often include additional benefits like dental, vision, hearing, and even gym memberships. Failing to enroll in either can leave you exposed to high medical bills.

What Are the Medicare Deductibles for 2025?

If you’re enrolled in Medicare, it’s important to understand what your out-of-pocket costs may look like in 2025 — starting with your deductibles.

Medicare Part B Deductible (Medical Insurance)

For 2025, the Part B deductible is $257, up from $240 in 2024 — a $17 increase.
This deductible must be met before Medicare begins paying its share for covered services. Once you’ve paid the deductible, Medicare typically covers 80% of approved costs, and you’re responsible for the remaining 20%.
Part B covers services such as:

  • Doctor visits

  • Outpatient care

  • Home health services

  • Durable medical equipment (like walkers, oxygen equipment, and diabetic supplies)

Medicare Part A Deductible (Hospital Insurance)

The Part A deductible in 2025 is $1,676, an increase of $44 from the 2024 amount of $1,632.
This deductible applies when you are admitted to the hospital and is charged per benefit period, not annually. A benefit period begins when you’re admitted and ends once you’ve been out of the hospital or a skilled nursing facility for 60 consecutive days. This means you could pay the Part A deductible more than once in a year if you have multiple hospitalizations.

Your Part A deductible covers the first 60 days of inpatient care in each benefit period. If your hospital stay extends beyond 60 days, coinsurance charges will begin to apply starting on day 61. Days 61-90 are $419 per day, Days 91+ are $838 per day.

  1. Not Being Aware of Your Benefits

Many people don’t take full advantage of the benefits included in their Medicare plans. Whether it’s preventive services, wellness visits, telehealth options, or discounts on health-related services, your plan may offer more than you realize. Carefully reviewing your plan each year—and asking your broker to explain any confusing terms—can help you get the most value from your coverage.

  1. Not Checking Your Insurance’s Drug List (Formulary)

Medicare Part D plans have a formulary—a list of covered medications. These formularies vary by plan and are subject to change annually. If you don’t check that your prescriptions are included in your plan’s current formulary, you could end up paying more or losing coverage for a medication you need. Always review your plan’s drug list during the Annual Enrollment Period (Oct. 15 – Dec. 7) to ensure it still meets your medication needs.

  1. Not Checking What Doctors Are In-Network

Medicare Advantage plans have networks of doctors, hospitals, and healthcare providers. If you fail to confirm that your preferred doctor or hospital is in-network before enrolling, you may face higher costs or be unable to see your provider at all. To avoid surprises, always confirm your providers are in-network before signing up for a plan and check each year to make sure that hasn’t changed.

  1. Doing an Automatic Renewal Without Reviewing Changes

While automatic renewal may sound convenient, it can lead to serious issues if you don’t review your plan annually. Medicare plans can change their costs, coverage, provider networks, and drug formularies every year. By simply letting your plan renew without checking for updates, you might miss out on better coverage or lower premiums. Reviewing your options during the Annual Enrollment Period gives you the chance to make changes that better fit your evolving health needs.

  1. Not Considering Your Individual Needs Compared to Your Spouse

It’s common for couples to assume they should enroll in the same Medicare plan, but this can be a costly mistake. Everyone’s health needs, preferred doctors, medications, and budget differ. One spouse might need extensive prescription coverage, while the other may prioritize access to specific specialists. Medicare Advantage plans are highly individual, and you’ll get better results by choosing a plan based on your own health needs and preferences, not your partner’s.

  1. Not Working with a No Cost, Licensed Medicare Broker

Medicare is complicated, and trying to navigate it alone can lead to costly and avoidable mistakes. That’s why it’s wise to work with a licensed Medicare broker. Brokers help you compare plans, understand your options, and enroll in the plan that’s best suited for you. And the best part? Their services are completely free to you. Patricia Saint Louis, RN is a licensed Medicare broker, providing expert guidance and personalized support. She is licensed in multiple states, including Florida, Georgia, Michigan, North Carolina, Ohio, Pennsylvania, Texas, Tennessee, New Jersey, Virginia, Louisiana, Maryland, and Washington state.

Conclusion

Avoiding these ten Medicare mistakes can save you money, time, and stress. By planning ahead, staying informed, and getting professional help when needed, you’ll set yourself up for long-term healthcare success. Medicare doesn’t have to be overwhelming—with the right guidance, it can be a powerful tool to protect your health and finances.

 

Categories Health insurance

Overview of Medicare for 2024

overview of Medicare

Understanding Medicare, is crucial as you approach retirement age or need to manage your healthcare options. With the right choices, you can gain access to high-quality, affordable healthcare. But when you make a mistake in your selections, you could wind up unable to access or afford the best care for your needs.

Here’s a detailed look at the different Medicare Plans to help you decide what’s necessary and how it all fits together. We’ll also explore the differences between Medicare Supplement and Medicare Advantage plans to help you make the best decision for your healthcare needs.

What is Medicare Insurance?

Medicare is a federal health insurance program primarily for people aged 65 and older, but it also covers certain younger people with disabilities and individuals with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Originating in 1965, Medicare was designed to address the lack of health insurance coverage for the nation’s elderly. Today, it continues to provide financial security and health benefits to millions of Americans.

In the United States, Medicare helps cover hospital stays, doctor visits, prescription drugs, and other healthcare needs. The program is divided into several parts, each covering different aspects of healthcare. Understanding these parts is essential to choosing the right coverage for your situation.

Decoding the Parts of Medicare Coverage

Medicare consists of four main parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Each part provides specific benefits that cater to the healthcare needs of insured individuals. Knowing what each part covers can help you better manage your healthcare costs and needs.

Find out more about what Medicare covers at the official website, or contact me to schedule an appointment. I’m here to help with your Medicare questions.

Medicare: Part A

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice, lab tests, surgery, and home health care. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.

Medicare: Part B

Medicare Part B covers outpatient care, doctor visits, preventive services, and medical supplies. It is a standard monthly premium that most people pay, which can vary based on your income. In 2024, the standard Part B premium is projected to remain relatively stable compared to previous years.

Medicare: Part C (Medicare Advantage)

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans provide all Part A and Part B benefits and often include additional benefits like dental, vision, and hearing. Many also include prescription drug coverage. Medicare Advantage plans vary in cost and benefits.

Medicare: Part D

Medicare Part D provides prescription drug coverage. These plans are also offered by Medicare-approved private companies. Part D can help lower the cost of prescription drugs and protect against higher costs in the future. Premiums and the specifics of what is covered can vary from one plan to another.

Learn more: What’s Medicare for All?

Medicare Supplement Coverage

 

Medicare Supplement Insurance, also known as Medigap, is additional health insurance you can buy from a private company to pay health care costs not covered by Original Medicare, such as copayments, deductibles, and health care if you travel outside the U.S. Medigap policies do not work with Medicare Advantage Plans. Understanding the variety of available Medigap plans and the coverage they offer can be crucial.

Medicare Supplement plans help fill the gaps in your Original Medicare coverage. These policies are standardized, meaning that each plan of the same letter offers the same basic benefits, no matter which insurance company sells it. However, the cost of these policies can vary depending on the provider and the extent of coverage.

Finding the Best Medicare Coverage

Choosing the best Medicare coverage, involves comparing Medicare Advantage and Medicare Supplement plans based on your individual health needs and financial situation. It’s advisable to consult with a  Medicare expert who can provide personalized advice and help you navigate the complexities of Medicare. Local agents like myself have insights into the plans that are most popular and beneficial in the your area, and can assist you in finding a plan that fits your needs and budget.

Whether you’re new to Medicare or looking to switch plans, understanding the specifics of Medicare, will help ensure that you make an informed decision. With the right plan, you can enjoy your retirement with peace of mind, knowing that your health care needs are covered.