Question 1

How do you get paid?

Accepted Answer

Fred gets paid directly by the insurance carriers when you enroll in a plan through Lakes Health Insurance. Calling the carrier directly to enroll will not save you any money on your monthly premium — and you'll be stuck calling an 800# when you need help.

Question 2

Can you help me review my plans each year?

Accepted Answer

Yes! Fred will email you Medicare information throughout the year. As the Annual Election Period each fall approaches, he'll reach out to see if you're interested in reviewing your plan.

Question 3

Part D – What does the 2026 $2,100 cap really mean?

Accepted Answer

In 2026, there will be a cap of $2,100 on co-pays you could spend out of pocket for Part D medications. That $2,100 does not include your premium or deductible. It applies to Part D (pharmacy) medications — not Part B medications like chemotherapy or IV drugs administered in a healthcare setting.

Question 4

Does the $2,100 cap apply to chemotherapy or Part B medications?

Accepted Answer

No. Part D medications are prescriptions your doctor calls into a pharmacy — these fall under the $2,100 cap if they're in the formulary. Part B medications — chemotherapies, IV drugs, or injectables administered in a healthcare setting — do NOT fall under the cap.

Question 5

What is IRMAA?

Accepted Answer

IRMAA stands for Income Related Monthly Adjustment Amount. If your Modified Adjusted Gross Income (MAGI) is above certain thresholds, you pay a surcharge on top of your standard Part B and Part D premiums. It's based on your federal tax returns using a two-year look-back period.

Question 6

Can I appeal my IRMAA?

Accepted Answer

Yes. If you had a life-changing event (retirement, divorce, death of spouse, loss of income) that reduced your income, you can appeal your IRMAA using Form SSA-44.

Question 7

Should I take COBRA or Medicare when I leave my job?

Accepted Answer

In most cases, you should enroll in Medicare first and use COBRA as a secondary supplement — not as a replacement for Medicare. For Part B purposes, COBRA is not considered coverage based on current employment, so it does not give you a Special Enrollment Period to delay Part B. Delaying Part B while on COBRA can result in a permanent late enrollment penalty. For Part D, the question is separate: ask your COBRA plan administrator whether the prescription drug coverage is creditable — meaning it is expected to pay at least as much as standard Medicare drug coverage on average.

Question 8

Can I have both COBRA and Medicare at the same time?

Accepted Answer

Yes, but Medicare is primary and COBRA is secondary when you are Medicare-eligible. COBRA may help cover costs Medicare does not pay, such as deductibles and coinsurance. However, you are still paying full COBRA premiums out of pocket — it is worth comparing that cost against a Medicare Supplement or Medicare Advantage plan.

Question 9

What happens if I delay Medicare Part B to stay on COBRA?

Accepted Answer

This is one of the most costly mistakes people make. COBRA is not considered employer group health coverage for Medicare Special Enrollment Period purposes. If you delay Part B enrollment past your Initial Enrollment Period while on COBRA, you may face a permanent 10% penalty on your Part B premium for every 12-month period you were without Part B.

Question 10

How long does COBRA last, and what should I do when it ends?

Accepted Answer

COBRA typically lasts up to 18 months (sometimes 29 or 36 months in certain circumstances). When COBRA ends, you should already be enrolled in Medicare. If you are not yet enrolled, contact Fred immediately — you may qualify for a Special Enrollment Period depending on your situation.

Question 11

Is COBRA considered creditable coverage for Medicare Part D?

Accepted Answer

The answer depends on the specific COBRA plan — you cannot assume based on the fact that it is COBRA coverage. CMS requires plan administrators to notify Medicare-eligible participants each year whether the prescription drug coverage is creditable, meaning it is expected to pay at least as much as standard Medicare drug coverage on average. If you do not receive that notice, ask your COBRA plan administrator directly. If the coverage is not creditable, enroll in a Part D plan to avoid a late enrollment penalty.

Frequently Asked Questions