How Do I Apply for Medicare?

by | Oct 9, 2025 | Medicare Advantage, Medicare Supplement, Original Medicare, Prescription Drug Coverage, Rules & Enrollment

Understanding the Medicare Application Process

Enrolling in Medicare is a major milestone in your healthcare journey, but it doesn’t have to be confusing. Whether you’re approaching age 65 or qualifying earlier due to disability, knowing when and how to apply ensures you avoid gaps in coverage or penalties. Here’s a step-by-step guide to applying for Medicare with confidence.

Eligibility: Who Can Apply for Medicare

You are generally eligible for Medicare if:

  • You’re 65 or older, and either a U.S. citizen or a permanent resident who’s lived in the U.S. for at least five years.

  • You’re under 65, but have received Social Security Disability Insurance (SSDI) for 24 months.

  • You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease).

If you’re already receiving Social Security benefits, you’ll be enrolled automatically in Medicare Parts A and B. Otherwise, you’ll need to apply manually through the Social Security Administration.

How to Apply for Medicare Parts A & B (Original Medicare)

You can apply for Original Medicare in one of three ways:

Online: Visit SSA.gov/Medicare

By Phone: Call Social Security at 1-800-772-1213.

In Person: Visit your local Social Security office.

  • Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing, and hospice care.

  • Part B (Medical Insurance) covers doctor visits, preventive care, outpatient services, and durable medical equipment.

If you’re still working and covered under employer insurance, you may choose to delay Part B to avoid paying unnecessary premiums—but it’s important to confirm this with your HR department or a licensed Medicare advisor before making that decision.

Applying for Medicare Advantage (MAPD) Plans

After enrolling in Parts A and B, you may decide to choose a Medicare Advantage Plan (Part C) instead of using Original Medicare as your primary insurance. These plans are offered by private insurance companies and often include additional benefits such as:

  • Bundled Prescription drug coverage

  • Additional dental, vision, and/or hearing benefits

  • Wellness programs and gym memberships

Enrollment in a Medicare Advantage Plan is handled through the private insurer offering the plan, not through Medicare directly. The benefit of using a brokerage (like Emerald Medicare) to enroll in a MAPD plan is they will usually handle the enrollment & application process on your behalf, acting as the middleman between you and your insurance provider.

Medigap (Medicare Supplement) Plans

If you prefer to stay with Original Medicare, you can add a Medigap policy to help pay for costs that Parts A and B don’t cover—such as deductibles, coinsurance, and copayments.

  • You must have both Parts A and B to buy a Medigap plan.

  • Depending on your home state, you may or may not have to go through medical underwriting and wait for approval.

Just like with a Medicare Advantage (MAPD) Plan, the best & easiest way to enroll in a Medigap plan is to reach out to your Medicare broker, who will advise you on the coverage options available in your zip code. Otherwise, you can reach out to the carriers directly to get prices and/or compare options, and even enroll directly with the carrier by reaching out to their customer service and/or new enrollment department. 

Prescription Drug Plans (PDP – Part D)

If you choose Original Medicare (if you do NOT choose an MAPD plan) you’ll likely also need a standalone Part D prescription drug plan.

  • These plans are also available through private insurance companies.

  • Enrollment is typically completed via Medicare.gov or directly through the plan’s website.

  • Make sure to review each plan’s formulary (drug list) to ensure your prescriptions are covered affordably.

With Emerald Medicare, once you enroll in Original Medicare (Parts A/B), we walk you through all your coverage options and thoroughly explain how these options differ. We also handle your enrollment application(s) along with reviewing your list of Medications & Doctors to make sure there are no gaps in your coverage. 

Get Guidance from the Medicare Experts

Applying for Medicare doesn’t have to be stressful. At Emerald Medicare, our licensed experts can walk you through every step—from choosing Parts A and B to comparing Supplement, Advantage, and Part D options personalized to your needs.

Start your Medicare journey confidently—contact Emerald Medicare today!

(888) 683-6372 or (845) 358-1220

info@emeraldmedicare.com

2026 Drug Cost Reductions: What’s Happening?

by | Aug 19, 2025 | Industry Shifts & Updates, Prescription Drug Coverage

Prescription drug costs have long been a burden for Medicare beneficiaries, with many paying hundreds or even thousands of dollars each month for essential medications. The good news is that beginning January 1, 2026, Medicare will implement the first-ever negotiated drug prices under the Inflation Reduction Act. This is a historic moment for seniors and retirees, and it’s expected to save billions of dollars across the program while easing out-of-pocket expenses for individuals.

As your trusted Medicare brokerage, Emerald Medicare is here to walk you through what these changes mean and how they may directly benefit you or your loved ones.

The First 10 Drugs Getting a Price Cut

Medicare selected 10 high-cost, widely used drugs for the first round of negotiated price reductions. These medications treat conditions like diabetes, heart disease, arthritis, blood clots, and cancer—diseases that affect millions of Medicare beneficiaries.

DRUG NAME 2023 PRICE 2026 NEGOTIATED PRICE Est. Discount
Eliquis ~$521 ~$231 ~56%
Jardiance ~$573 ~$197 ~66%
Xarelto ~$517 ~$197 ~62%
Januvia ~$527 ~$113 ~79%
Farxiga ~$556 ~$178.50 ~68%
Entresto ~$628 ~$295 ~53%
Enbrel ~$7,106 ~$2,355 ~67%
Imbruvica ~$14,934 ~$9,319 ~38%
Stelara ~$13,836 ~$4,695 ~66%
Fiasp/NovoLog ~$495 ~$119 ~76%

These reductions will bring life-changing relief for many Medicare beneficiaries. For example, someone managing diabetes with Jardiance or NovoLog insulin could save hundreds of dollars every month, while cancer and autoimmune patients may see savings in the thousands. Across the country, these negotiated prices are projected to save Medicare $6 billion, with direct out-of-pocket savings for patients estimated at $1.5 billion annually.

Why 2026 Is Just the Beginning

This first round of negotiations is part of a larger rollout. More drugs will be added to the program in future years. For example, 15 additional medications have already been selected for negotiation and are expected to see lower costs in 2027. These include treatments for diabetes, obesity, and cancer—some of the fastest-rising costs in Medicare.

It’s also important to note that the $2,000 annual out-of-pocket cap for prescription drugs took effect in 2025. Combined with these new price reductions, Medicare beneficiaries will see some of the most significant financial relief in decades.

What You Should Do Now

  • Check Your Medications: If you take one of the drugs on the 2026 negotiated list, prepare for cost savings beginning in January.

  • Review Your Plan This Fall: During the Annual Enrollment Period (October 15 – December 7, 2025), plans may adjust formularies and premiums in response to these changes. It’s more important than ever to compare options.

  • Plan Ahead for 2027 and Beyond: Even if your current prescriptions aren’t on this first list, future rounds of negotiations could impact your costs in the years ahead.

Emerald Medicare Can Help You Lower Your Costs

Drug costs are one of the biggest challenges facing retirees, but these new 2026 changes mark a turning point. At Emerald Medicare, our role is to help you navigate these transitions, understand how your plan may change, and ensure you’re getting the best value available.

If you’re wondering how these price reductions—or the new $2,000 annual cap—will affect your personal coverage, we’re here to help.

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

Or, Contact Us
📞 Call us at (888) 683-6372 or (845) 358-1220
📧 Email us at office@emeraldmedicare.com

How To Choose A Part D Plan

by | Oct 1, 2024 | Medicare Supplement, Prescription Drug Coverage

As your go-to team of Medicare experts, we’re here to help you navigate your options with confidence. We understand how crucial it is to have the right prescription drug coverage. Choosing a Medicare Part D plan can be overwhelming with so many options available, but with the right guidance, you can find the best available drug plan that fits your needs and budget each year. In this post, we’ll provide tips on how to select the best Medicare Part D plan based on your individual needs, ensuring that you have access to the medications you require without unnecessary expenses.

What is Medicare Part D?

Medicare Part D is the prescription drug coverage component of Medicare. It helps cover some of the cost of prescription medications, which are not included under Original Medicare (Parts A and B). Part D plans are offered by private insurance companies, whom have been approved by Medicare. These plans are typically combined with a stand-alone Medigap plan, or in some cases, a Medicare Advantage plan. The specifics of each plan—such as the drugs covered, co-pay costs, and pharmacy networks—can vary significantly depending on the plan year, insurance carrier, and more.

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Tips for Choosing the Right Part D Plan

1. Assess Your Prescription Drug Needs

Evaluate Your Medications: Start by making a list of all the prescription medications you currently take, including the dosage and frequency and your preferred pharmacies. This list will be important when comparing different Part D plans, as each plan has its own formulary (the list of covered drugs and costs).

Consider Future Needs: Think about any potential changes in your medication needs since you last made this Medicare decision. If your doctor has mentioned that you might need new medications in the future, choose a plan that includes those medications.

2. Compare Formularies

Check Drug Coverage: Not all Part D plans cover the same medications. With the assistance of a broker or by your own research, review the formularies of each plan to confirm that your current medications are covered and at what cost. Some plans may cover certain drugs at a lower cost than others, which can significantly affect your out-of-pocket expenses throughout the year.

Understand Tiers: Many Part D plans categorize drugs into tiers, with each tier having different costs. Typically, generic drugs are in lower tiers and are more affordable, while brand-name and specialty drugs are in higher tiers and cost more. Knowing what tier your medications fall into on each plan’s formulary is helpful when looking at yearly costs or discussing options with your doctor.

3. Evaluate Costs Beyond Premiums

Look at the Big Picture: Calculate your expected annual costs based on the medications you take and the coverage each plan offers using medicare.gov. If you notice a very expensive drug, look at discount cards such as GoodRx for lower cost options.

4. Review the Pharmacy Network

Check Preferred Pharmacies: Each Part D plan has a network of pharmacies where you can fill your prescriptions. However, some plans offer lower medication costs at partner, “preferred” pharmacies. It’s essential to compare drug prices from multiple pharmacies.

Mail-Order Options: If you prefer the convenience of having your medications delivered, look for a plan that offers a mail-order pharmacy option. This can in many cases save you money but certainly can save you time.

5. Use Medicare.gov for Research

The best way to compare Part D plans is by using a reliable Medicare broker or by accessing Medicare.gov, the official Medicare website. This is the same tool that your Emerald Medicare team utilizes to research and identify the best coverage options for your specific health needs. The website allows you to enter your medications and compare plans based on costs, coverage, tiers, pharmacies, zip code, and more.

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Block Out the Confusion with Emerald Medicare

Choosing the right Medicare Part D plan is a critical step in managing your healthcare costs and ensuring you have access to the medications you need. By carefully considering your medication needs, costs, and pharmacy preferences, and using trusted resources like Medicare.gov, you can make an informed decision on your Part D coverage each year.

As Medicare’s Open Enrollment Period approaches, the Emerald Medicare team is here to help. This will be an especially challenging year for changes occurring with Medicare Part D plans. We’re committed to delivering personalized assistance and finding the best Part D plan options to meet your needs for the current year. Click below to schedule an appointment with one of our expert Medicare advisors through Calendly, or contact us directly at the number / email below.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

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