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Are the agents licensed?

Yes. Every agent is verified to be licensed in the state(s) they serve.

What is the difference between Medicare Advantage and Medicare Supplement?

Medicare Advantage replaces Original Medicare with a private plan. Medicare Supplement (Medigap) works alongside Original Medicare to cover gaps in costs.

When can I enroll in Medicare?

Most people enroll at 65. You have a 7-month Initial Enrollment Period around your 65th birthday.

How do I choose the right agent?

Look for local experience, independent status (works with multiple carriers), and strong reviews from people in your situation.

Does it cost anything to talk to an agent?

No. Medicare agents are compensated by insurance carriers, not by you.

Does Medicare cover Ozempic and other drugs prescribed for weight loss?

Paul hasn't answered this question yet. Contact him directly to get personalized guidance.

What is the difference between Plan G and Plan N of Medicare?

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What are the reasons why I should work with a Medicare agent?

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Medicare Glossary: Simple Definitions & Terms

B

Brand-name drug

Part D

A prescription drug sold under its trademarked name. Brand-name drugs are typically more expensive than generic alternatives and may be in a higher formulary tier, requiring a higher copay or coinsurance under Part D.

C

Catastrophic Coverage

Part D

The phase of Medicare Part D drug coverage that begins after you and your plan have spent a certain total amount on covered drugs in a year. In this phase, your copays are significantly reduced. In 2025, out-of-pocket costs are capped at $2,000 annually.

Coverage Gap

Part D

A phase in Medicare Part D where you pay a higher share of your drug costs after your total drug spending reaches a certain amount. Sometimes called the "donut hole." In 2025, the coverage gap was effectively eliminated for most beneficiaries due to the Inflation Reduction Act.

Also known as: Donut Hole

F

Formulary

Part D

A list of prescription drugs covered by a Medicare Part D plan or Medicare Advantage plan with drug coverage. Drugs are organized into tiers, with each tier having a different cost. Plans can change their formularies annually.

Also known as: Drug list, Preferred drug list

G

Generic Drug

Part D

A prescription drug that has the same active ingredients, dosage, and effectiveness as a brand-name drug but is sold at a lower price after the brand-name patent expires. Generic drugs are typically in lower Part D tiers with lower copays.

I

Independent Payment Advisory Board

Part D

The point at which your total drug spending under Part D reaches a set threshold, after which you enter the coverage gap phase. This limit applies to the combined spending by you and your plan.

Also known as: ICL

M

Medicare Part D

Part D

Medicare prescription drug coverage. A voluntary program offered through private insurers to help pay for outpatient prescription drugs. Plans vary in which drugs they cover (formulary) and what you pay. You may owe a late enrollment penalty if you don't join when first eligible.

Also known as: Prescription drug coverage

P

Prescription Drug Plan (PDP)

Part D

A stand-alone Medicare Part D plan that provides prescription drug coverage for people enrolled in Original Medicare. PDPs are separate from Medicare Advantage plans that already include drug coverage.

Also known as: PDP, Stand-alone Part D Plan

S

Standard Benefit Package

Part D

The minimum level of coverage that Medicare Part D prescription drug plans must provide. Plans may offer enhanced coverage above this standard, but all must include at least the standard benefit.

Step Therapy

Part D

A coverage requirement where you must try a less expensive drug first before your plan will cover a more expensive one. Commonly used in Medicare Advantage and Part D plans to control costs.

Also known as: Fail first policy

T

Tier

Part D

A level in a Part D formulary that determines how much you pay for a drug. Most plans have 4–5 tiers. Generic drugs are typically in lower tiers with lower copays; brand-name and specialty drugs are in higher tiers with higher copays or coinsurance.

Also known as: Drug tier

True Out-of-Pocket (TrOOP)

Part D

The amount that counts toward moving you through Medicare Part D phases and into catastrophic coverage. TrOOP includes what you pay out of pocket for covered Part D drugs, plus certain payments made on your behalf.

Also known as: TrOOP

Medicare Glossary: Simple Definitions & Terms

Brand-name drug

Catastrophic Coverage

Coverage Gap

Formulary

Generic Drug

Independent Payment Advisory Board

Medicare Part D

Prescription Drug Plan (PDP)

Standard Benefit Package

Step Therapy

Tier

True Out-of-Pocket (TrOOP)

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