FAQs

Start about three months before your 65th birthday — that's when your Initial Enrollment Period opens (it runs three months before your birthday month, your birthday month, and three months after). First, decide whether you'll enroll in Medicare Parts A and B, which you do through Social Security, not through us or any insurance company. If you're already drawing Social Security, you'll be enrolled automatically; if not, you'll need to sign up at ssa.gov. Once Parts A and B are in place, the real decisions begin: how to cover the costs Medicare doesn't, and whether you need drug coverage. That second part is where a conversation with us helps — but the Social Security step comes first, and it's yours to do.

The standard Part B premium for 2026 is $202.90 per month — up $17.90 from 2025. Higher-income households pay more under IRMAA, the income-related adjustment — the income brackets and surcharge amounts are on Medicare.gov. Figure from the official CMS announcement (November 2025); we update this each fall when the new year's number is announced.

For 2026, the Part A inpatient hospital deductible is $1,736 — and note it applies per benefit period, not per year, so it can occur more than once. The Part B annual deductible is $283. Both from the official CMS announcements (November 2025); updated here each fall.

For 2026, your out-of-pocket costs for covered Part D drugs are capped at $2,100 for the year, and no Part D plan may charge a deductible higher than $615. The cap is one of the most consequential recent changes in Medicare — once you hit it, covered drugs cost you nothing more that year. From CMS's official 2026 Part D guidance; updated here each fall.

The Annual Enrollment Period (AEP) runs October 15 through December 7 every year. That's when anyone on Medicare can switch Medicare Advantage plans, change drug plans, or move between Original Medicare and Medicare Advantage, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period (OEP) runs January 1 through March 31, and it's narrower: it's only for people already on a Medicare Advantage plan, and it allows one switch — to another Advantage plan or back to Original Medicare. Outside those windows, you generally need a qualifying event that triggers a Special Enrollment Period — Medicare.gov keeps the full list. If you're not sure which window applies to you, ask us — the chat, an email to help@mnhealthagents.com, or walk-in office hours.

They're two different ways of handling what Original Medicare doesn't pay. A Medicare Supplement (Medigap) works alongside Original Medicare: Medicare pays its share, the Supplement pays most or all of the rest, and you can see any doctor in the country who takes Medicare. You pay a monthly premium for that predictability, and you'll typically add a separate drug plan. Medicare Advantage replaces how you receive your Medicare benefits: a private plan takes over, usually with a lower (sometimes zero) monthly premium, often with drug coverage and extras built in — but with a provider network and cost-sharing when you use care. Roughly speaking, Supplements front-load cost into premiums for flexibility and predictability; Advantage plans lower the monthly cost and shift more cost to the times you actually use care. Neither is "better" — it depends on your health, budget, travel, and doctors, which is exactly the conversation we have with people every week.

Probably yes, and here's the honest reason: the late enrollment penalty. If you go 63 or more days without drug coverage that Medicare considers "creditable" after you're first eligible, Medicare adds a penalty to your Part D premium — about 1% of the national base premium for every month you went without — and that penalty lasts as long as you have Medicare drug coverage, which is usually the rest of your life. The insurance logic is the same reason you can't buy fire insurance while your house is burning: if everyone waited until they needed medications, the system wouldn't work, so Medicare charges you for waiting. Low-premium Part D plans exist precisely for people in your situation — they keep the penalty clock from running and cover you if a prescription need appears suddenly. If you have creditable coverage from an employer or the VA, that counts and you can skip Part D without penalty; just make sure it's actually creditable.

Nothing, and we'd rather explain exactly how that works than just say "free." When you enroll in a plan through us, the insurance company pays us — contracts label it a commission, an agent fee, a service fee, or a broker fee, but whatever the label, it's compensation from the carrier, never from you. The key fact: your premium is set by the insurance company and filed with regulators, and it is the same whether you enroll through a broker, directly with the carrier, or online. You cannot get a discount by cutting us out, and you don't pay a markup by using us. What you get for the same price is someone who compares plans across multiple companies, knows the Minnesota market, and stays in your corner when something goes wrong mid-year — reach out and a real person follows up. Carrier compensation is also broadly similar across carriers within a market, which limits the incentive to steer you toward one company over another — but you should know the model exists, and now you do.

Yes. You don't need to be a new-to-Medicare customer, and you don't need to switch anything for us to be useful. We can review your current plan — many people are on plans that made sense years ago but no longer fit their medications, doctors, or budget, because plans change every year even when you don't. If your current plan is still your best option, we'll tell you that and you'll have lost nothing but an hour. If we can become your agent of record on an existing plan, we also step in when service gets tangled — billing that doesn't match the plan, records that disagree, denials that need experience to untangle. Quick items like an address change or a replacement ID card are fastest through your carrier's member portal — our Current Clients page links every one.

Not necessarily, and this is one of the most consequential timing decisions in Medicare. If you (or your spouse) are actively working and you're covered by an employer plan from a company with 20 or more employees, you can usually delay Part B — and often Part D — without penalty, then enroll through a Special Enrollment Period when the employment ends. If the employer has fewer than 20 employees, Medicare generally becomes primary at 65 and delaying can leave you badly exposed. One sharp edge worth knowing: you cannot contribute to an HSA once you're enrolled in any part of Medicare, and Part A enrollment can be retroactive up to six months. The right move depends on your employer's size, your plan, and your HSA situation, so bring those details to a conversation before your 65th birthday, not after.

MNsure is Minnesota's official health insurance marketplace — our state's version of the federal exchange, where individuals and families who don't get coverage through an employer buy plans. You don't have to use it, but there's one big reason most people should: tax credits that lower your monthly premium are only available on plans purchased through MNsure. If your income is too high to qualify for credits, buying the same plan directly from the carrier works fine too. MNsure is also the front door to MinnesotaCare and Medical Assistance — when you apply, it checks whether you qualify for those lower-cost programs automatically. We're a MNsure-certified Broker Enrollment Center, which means we can handle the whole MNsure process with you at no cost.

The premium tax credit is based on your estimated household income for the coming year — not last year's income. MNsure calculates how much you're expected to contribute toward coverage at your income level, and the tax credit covers the gap between that and the actual premium; you can take it monthly as a discount on your bill. Here's why the estimate matters: it gets reconciled against your real income when you file taxes. If you underestimated, you may owe some of the credit back; if you overestimated, you get money back. So an honest, careful estimate isn't just paperwork — it's the difference between a smooth tax season and an unwelcome bill. We spend real time on this number with clients, because it's the single input that drives everything else.

Report it to MNsure — promptly. Your tax credit was calculated from your income estimate, so when reality changes, the credit should change with it. If your income drops, reporting it can increase your credit (or qualify you for MinnesotaCare or Medical Assistance) starting the next month — money you'd otherwise leave on the table. If your income rises and you don't report it, you keep receiving a credit that's too large, and the IRS reclaims the difference at tax time. A raise, job loss, retirement, marriage, a new baby — all of these are worth a five-minute call. Reporting the change is a five-minute job in your MNsure account, and doing it yourself is genuinely the fastest path. If anything about it is confusing — or the numbers that come back don't look right — we'll work through it with you.

Both can help you use MNsure at no cost to you, but they do different jobs. Navigators are trained to help you complete the application and enroll, and they're funded to do that — but they are required to stay neutral and cannot recommend a specific plan. Brokers are licensed and carrier-appointed, which means we can do everything a navigator does plus give you an actual recommendation: this plan, for these reasons, given your doctors, your medications, and your budget. We're paid by the insurance companies through carrier-paid compensation, which is why our help costs you nothing; navigators are paid through grants. If you just need the application done, a navigator works. If you want advice and a person to call all year, that's a broker.

Outside the annual open enrollment window, you can only sign up for or change individual coverage if you have a qualifying life event — and that event opens a Special Enrollment Period, usually 60 days long (MNsure's official qualifying-life-event list). Common qualifying events: losing other coverage (leaving a job, aging off a parent's plan at 26, losing Medical Assistance), getting married or divorced, having or adopting a baby, or moving into a new coverage area. The 60-day clock is real and unforgiving — miss it and you generally wait for the next open enrollment. If something in your life just changed and you're wondering whether it counts, call us before the clock runs out; that question takes minutes to answer.

No — this is a common misconception worth killing directly. Plans sold through MNsure are real plans from the same major Minnesota insurance companies, covering the same essential benefits, using the same provider networks as the identical plan sold off-exchange. "Marketplace plan" describes where you bought it, not what it is. In fact, the same plan often exists both on and off MNsure at the same premium — the only difference is that the MNsure version can carry a tax credit. Where people get the "worse" impression is comparing a subsidized bronze plan's deductible to a generous employer plan — but that's a difference in what tier was chosen, not in the marketplace itself.

For a MNsure application, bring: Social Security numbers (or immigration documents) for everyone applying; birth dates for your household; your best estimate of this year's household income, backed by recent pay stubs, last year's tax return, or self-employment records; and details of any coverage currently available to you, such as an employer offer. If you want us to compare plans meaningfully, also bring your list of medications with dosages and the names of doctors and clinics you want to keep — those two lists drive more of the recommendation than anything else. Don't stress about arriving with a perfect file; we can start with what you have and chase the rest together.

Nothing — you will never receive a bill from us, and there's no fee hiding anywhere. We're paid carrier-paid compensation by the insurance companies when you enroll in a plan through us, and premiums are filed with regulators so the price is identical with or without a broker. That means our advice, enrollment help, and year-round service come at no cost to you, and skipping us saves you nothing. We'd rather you understand the model than take "free" on faith.

We're independent brokers appointed with multiple major Minnesota carriers — the companies whose plans you'd actually be comparing anyway — and we maintain a current list on our carriers page. We deliberately don't work for any single company; being appointed across the market is what lets us compare plans honestly rather than sell whatever one carrier offers. If a company we don't represent genuinely has the best fit for you, we'll say so. The list can change year to year as carriers enter and leave markets, which is one more reason we keep it on its own page rather than in an FAQ answer.

No. Plenty of people come in with questions and leave with answers and nothing else — that's a fine outcome, and it happens every week. Sometimes the honest answer is "your current plan is right, keep it," and we'll tell you that. Our business works because people come back and refer their friends when their situation does call for a change, not because we pressure anyone in the moment. Come in with questions; the decision timeline is yours.

Simple: show up at our Bloomington office Monday through Thursday between 10 AM and 1 PM — no appointment needed. You'll sit down with a licensed broker — our team may help you get your documents and questions organized first, so your time with the broker counts. Bring whatever you have: current plan documents, medication lists, a letter that confused you, or just questions. If your situation needs more time than a walk-in slot allows, we'll schedule a follow-up before you leave. Outside those hours, we work by scheduled appointment, phone, and video.

Yes — we're licensed throughout Minnesota and work with people across the state by phone, video, and email. Our educational resources and guided tools work anywhere, and screen-sharing is genuinely good for walking through plan comparisons together. Wherever you are, the goal is the same: help you understand your options, navigate the process, and know your next step. When licensed insurance guidance is needed, a licensed agent is available regardless of where you live.

No — enrollment is the start, not the end. Questions keep coming all year: a letter you don't understand, a bill that doesn't look right, a doctor leaving your network, an income change to report to MNsure. Think of us as the place to come when you're not sure what to do next. Sometimes the answer is an educational resource; sometimes it's a quick self-service task we'll point you to; sometimes the right move is contacting your carrier directly — and as agent of record, we step in on the tangled problems that take experience to untangle. Carrier compensation already pays for year-round help, so never hesitate to ask. Our goal isn't to do everything for you — it's for you to understand your coverage and make informed decisions with confidence. And every fall we can review whether your plan still fits, because plans change annually even when your life doesn't.

For 2026: $4,400 for self-only coverage and $8,750 for family coverage. The IRS has already announced 2027: $4,500 self-only and $9,000 family — useful for planning ahead. If you're 55 or older you can add a $1,000 catch-up contribution in any year (that amount is set by statute and doesn't change). From IRS Revenue Procedures 2025-19 and 2026-24; updated when the IRS announces each year's limits.

Four terms, one sentence each. Your **deductible** is what you pay out of pocket for most care before the plan starts sharing costs. A **copay** is a flat fee for a specific service — say, a fixed amount for an office visit — often owed regardless of the deductible. **Coinsurance** is a percentage split after the deductible: the plan pays its share (often the larger one) and you pay the rest. The **out-of-pocket maximum** is the ceiling — once your deductibles, copays, and coinsurance for covered in-network care add up to that number in a year, the plan pays 100% of covered costs for the rest of the year. That last number is arguably the most important one on any plan: it's your worst-case scenario for the year.

A network is the set of doctors, clinics, and hospitals that have contracted with your insurance company at negotiated rates. In-network care gets those negotiated prices and full plan cost-sharing; out-of-network care can mean paying far more, or in many plans, paying everything yourself. This is why "is my doctor in-network?" should be one of your first questions when comparing plans — a plan with a slightly higher premium that includes your clinic usually beats a cheaper one that doesn't. Networks are also how insurers control costs, which is part of why narrower-network plans tend to carry lower premiums: you're trading provider choice for price. Always verify your specific doctors before enrolling; we do this check as a standard part of every plan comparison.

Mostly history and economics: dental and vision developed as separate insurance markets decades ago, with their own carriers, networks, and pricing, and the systems never merged. Adult dental and vision aren't "essential health benefits" under the ACA, so individual health plans generally don't include them (children's dental works differently in Minnesota). The practical answer: standalone dental and vision plans exist, they're usually modestly priced, and we can add them alongside your health plan. Whether they're worth it is a real math question — for routine cleanings and an eye exam, the premium sometimes roughly equals paying cash, but coverage earns its keep when you need major dental work. We'll walk the numbers with you honestly either way.

A formulary is your plan's list of covered prescription drugs, organized into tiers — generics on the cheapest tiers, brand-name and specialty drugs on pricier ones. If a drug isn't on the formulary, the plan generally doesn't pay for it, and formularies differ meaningfully from plan to plan. This is why we ask for your medication list before recommending anything: the same drug can be inexpensive on one plan's formulary and costly or absent on another's, and that difference often outweighs the gap in monthly premiums. Formularies can also change year to year, which is one of the standard things to re-check at each annual review.

Not automatically — the premium is only one part of what a plan costs you. Your real annual cost is premium plus what you pay when you use care: deductibles, copays, coinsurance, and prescriptions. A low-premium plan with a high deductible can be the cheapest choice for someone healthy who rarely sees a doctor, and the most expensive choice for someone managing conditions with regular visits and medications. The useful exercise is estimating total cost under your actual expected usage — and under a bad year, using the out-of-pocket max as the worst case. That arithmetic, run against your real medications and doctors, is the core of what we do when we compare plans with you.

Our office is in Bloomington, Minnesota, with free parking right at the building — no ramps, meters, or hunting for a spot. The full street address and a map are on our contact page, or call 952-444-9720 and we'll get you pointed the right way. We're an easy stop from most of the south metro.

No. Walk in any Monday through Thursday between 10 AM and 1 PM and a licensed broker will sit down with you — that's what those hours are for. Outside walk-in hours, we meet by scheduled appointment in person, by phone, or by video, and virtual meetings can be scheduled at times that fit your day. If you know your situation is complicated (multiple family members, a Medicare-plus-employer question), calling ahead lets us block enough time, but it's never required.

Call 952-444-9720 and leave a voicemail, or email help@mnhealthagents.com — email is the better channel for anything with documents attached. We're honest about this: no one answers our phones at night or on weekends, and we respond during the next business hours rather than pretending to be a 24/7 call center. What we will promise is that messages don't disappear into a void — a real person who knows Minnesota insurance reads them and gets back to you. For urgent issues with active coverage (a pharmacy rejection tonight, for example), the member services number on the back of your insurance card is staffed around the clock by your insurance company and is the fastest path.