Floundering In the Minutia of Medicare? We Talk with an Expert
Julie VanDyke
Are you new to Medicare? Perhaps after working for years to obtain this benefit, you’ve reached the milestone age of 65, and do not know where to begin. Or maybe you’ve been enrolled for quite some time and are among the smart cookies who realize the value of reviewing your plan each year.
Whatever stage you’re at, knowledgeable agents are available and ready to help you detangle the complex maze of Medicare. Best of all, this help is free, and the stress-relieving, impartial assistance you receive could help you save in the year ahead.
To give you a jumpstart, 50plus spoke with Medicare Consultant and Healthcare Educator Mara Woloshin of Woloshin Communications for insights on the basics and the latest developments in Medicare.
Crucial Intel for Newbies
“Many people assume that once they turn 65, they will receive their Red, White and Blue Medicare card in the mail, but Medicare doesn’t just ‘happen,’” Mara says.
“Timing is critical. You have an Initial Enrollment Period (IEP) to sign up — three months before your birthday, during your birthday month, and three months afterward. It is very important to register at least three months before your 65th birthday by calling or going to the Social Security website to ensure Medicare kicks in on time.”
The Big Cs: Changes, Concerns, Complaints and Confusion
Take heart: “Medicare is always confusing,” Mara says. “The number one complaint this year is Change. Enrollees need to carefully read and review their 2026 plans to check for changes in benefits, increased costs, or services being eliminated.”
When asked about the biggest changes in Medicare for the year ahead, Mara says, “Due to the rising cost of healthcare and other factors, there will be service area reductions in Medicare plans — not just in Oregon, but nationally. When a person receives a letter from their insurance company with this disheartening news, they are left wondering ‘now what do I do?’”
“Part D prescription drug plan rules are changing for next year as well,” Mara says. “Some of it’s good news, some not so great. And you may not find the extra Medicare advantage benefits in your plan for next year. Many plans are eliminating perks like free gym memberships, over the counter products, and grocery and utility benefits, This is a pain point for many people who relied on getting these extras from their Medicare Advantage plans.”
Alternative healthcare options are also on the chopping block for 2026, Mara says. “A lot of people want to be able to see a chiropractor, but they may sadly find out their plan won’t cover this benefit going forward. For those who value this type of coverage, it’s important to stay in touch with your agent to ensure your plan is continuing to meet your needs.”
For more on upcoming changes for 2026, see the article “2026 Changes to Medicare,” published October 2025, at www.50plusmagazine.net.
When asked what the yearly ANOC (Annual Notice of Change) sent each year to Medicare Advantage and Medicare Part D drug plan enrollees, Mara emphasizes that, “Many people overlook this vital piece of mail from their insurance companies, which outlines any upcoming changes to plans for the year ahead. People need to be really aware of what their 2026 plan will look like. If you did not receive your ANOC this year, call your insurance company and request another copy.”
If you still have concerns or questions after receiving your ANOC, it’s a great idea to meet with an agent for free, non-biased advice. Do it soon, though: the Open Enrollment Period closes Dec 7.
Changes aren’t just about plans
“While plans change from year to year, it’s equally important to consider changes in your situation. What was great for you in 2025 may not meet your health or lifestyle needs in 2026,” Mara says. “Also, if you rely on prescription medication(s), your Annual Notice of Change will not necessarily detail drugs your insurance company will not cover for next year — or any price or tier changes.”
For a benefit not many people with high drug costs know about, Mara says, “A useful option to help someone with high prescription costs is to opt into the M3P (The Medicare Prescription Payment Plan) through your Medicare health or drug plan. While this will not lower the actual price for your prescriptions, the M3P program allows people to spread their drug costs
over monthly payments.”
“Although this facet can change at any time during the year, doctors (or medical groups) you like and have a good, established relationship with, may go out of your plan’s network,” Mara says, “and your Annual Notice of Change usually won’t cover these changes, either.”
It’s All About Choices
“Everyone is different,” Mara says. “A good agent should be able to help you understand your choices in type of plan and anticipated costs. The most important message is about choice. Medicare Advantage or Medigap plans offer different choices.”
“The Centers for Medicare and Medicaid Services created the yearly Annual Enrollment Period to give beneficiaries the right to become educated about their Medicare health plans,” Mara says, “and if necessary, to choose a plan that best fits their lifestyle and health requirements. But keep in mind that not everyone needs to change their plan. For those who are seeking information, there is help.”
Cold Calls
When asked about the calls and emails many receive this time of year from people trying to sell Medicare plans, Mara offers this advice: “This time of year you might be inundated with emails and/or phone calls from salespeople who claim to know what’s best for you in terms of your Medicare coverage. They may offer you perks that are too good to be true. . . and they usually are. Cold-calling salespeople are typically most concerned about their commission; not learning about you and your needs as a unique individual or to find the best plan for you.”
Finding a Stellar Agent
When asked what constitutes a good Medicare agent, Mara says, “A good agent will provide you with information that is accurate and clear for you to make the best decision for yourself and your circumstances. They should never hard sell you or put you in a plan you don’t understand or you’re not sure will work for you.”
“A good agent takes the time to explain potential health plan choices in a way you can easily understand. Again, they verify that your doctors are in network and what your prescription co-pays are likely to be. They are knowledgeable about grants and federal and state programs that can save you money, and about current Medicare and Medicaid administrative changes.”
“A good agent communicates with you respectfully about available plans and your personal information. They return your calls in a timely manner and are available to you all year (not just during annual enrollment) to answer questions and help with medical appeals and advocacy.”
Keeping up
To keep up with all the Medicare news and changes during the year, Mara says, “sign up
for informational emails at medicare.gov.”
In as much as Medicare changes can be confusing for most, Mara concludes by saying: “Medicare CAN be flexible, if you know the system and its various deadlines. Medicare is evolving as the years go by. That is why the Annual Notice of Change is so important,
as well as seeking information and advice from a good agent.”
Julie VanDyke is a freelance writer specializing in retirement matters. She is committed to simplifying Medicare for all.