A “Medicare Survival Guide” with Jonathan Macavoy

Planning to retire in 2026 or turning 65 soon?

In this episode of Caring Table, I welcome back Medicare expert Jonathan Macavoy of Members 1st Insurance Services to break down how to transition from employer or private insurance into Medicare without stress, mistakes, or costly penalties.

If you’re feeling overwhelmed by Medicare mailers, ads, and confusing options, this episode will give you clarity, confidence, and a plan.

Topics Covered

• The difference between Medicare Parts A, B, C, and D
• When (and when NOT) to enroll in Medicare if you’re still working
• How to avoid lifetime late-enrollment penalties
• How Medicare works with employer coverage and your spouse’s coverage
• The real timeline you should follow if you’re retiring in 2026
• How to choose between Supplement vs Advantage plans
• Why planning early gives you more control, better coverage, and peace of mind

🎧 Retirement doesn’t have to be stressful. You don’t have to do this alone.

Interested in learning more? Contact Jonathan Macavoy at: 717-319-7332 or email him at Jonathan.Macavoy@M1stInsurance.org.

Episode Sponsored by:

LIFESTYLES Over 50 Northeastern Pennsylvania is a print magazine that is distributed for FREE 6x annually and connects seniors and their families with senior housing, assisted living, wellness centers, local health care providers, healthy living activities, and community events.

Our Mission encourages vibrant, healthy, and productive living through stories about people we meet and serve.

Listen to us where all of your favorite podcasts can be found, plus connect with us on social media to receive notifications about upcoming episodes!

• Facebook: @Caring-Table-Podcast
• Instagram: @caringtablepodcast
• YouTube: @CaringTablePodcast
• Email: caringtablepodcast@gmail.com

Transcript

00:00:01:15 - 00:00:31:17

Welcome to Caring Table. I am Dianne Frana, your host. Having real conversations about real topics shaping lives in the Lehigh Valley and beyond. Today's episode we are focusing on retiring in 2026, and one piece of the retirement puzzle is Medicare. And to address this, we have a returning guest, John Macavoy, who is employed by Members First Insurance Services.

00:00:31:18 - 00:00:52:19

Hi, John. How are you today? Hi, Dianne. Doing well. Thanks for having me again. Great to be back. Well, we're glad to have you here with your experience in health insurance, the 20 years experience that you have. We loved having you back to inform and educate our audience. Yeah. When we were last together, we were during the open enrollment window.

00:00:52:19 - 00:01:12:23

That's for the folks. Looking at their options, deciding if they want to keep what they have or make a change for the following year. Whereas today we're going to be talking in regards to the newbies, to the, to the Medicare industry and how that transition from work benefits or private benefits rolls over into the Medicare world.

00:01:13:00 - 00:01:33:13

John, and I understand that you may feel it's confusing and overwhelming. We want you to relax and we're here to help you feel confident as we break it down. Prepare for the next chapter in your life. We're here to help you make that transition. We're not here to provide any more pressure or any more confusion to the process.

00:01:33:14 - 00:01:59:06

I can be overwhelming, and it can be a lot of bombardment, but we are here to help make that smooth transition 100%. I can tell you when you're hitting about three months towards that 65th birthday, you're going to feel like you're getting just left and right, bombarded with solicitations, mailers, anything and everything to try to work with, with anybody out there.

00:01:59:06 - 00:02:18:16

We kind of take that pressure off and are here to help answer questions. Wade through. Let's say all the muddy water and really show you what we should be looking at, what to look out for and how to find that plan that's going to work for you for your retirement. So together, we will give you clarity and peace of mind.

00:02:18:16 - 00:02:42:01

Very much so. With that said, we're going to start with understanding Medicare. For a lot of the newbies like you said, they may not be aware of the different parts of Medicare. So, John, can you share that information with our audience, please? Certainly, there's standardly two parts of Medicare that we hear about part A hospitalization, part B medical on that red, white and blue card.

00:02:42:01 - 00:03:03:21

That's that's exactly how it's listed. Part a hospital, part B medical. Now, your part a hospitalization. As long as you've worked your 40 quarters and have contributed and paid into through your employer, the Medicare program, that part comes in at no cost. It's a free service to set up established when when Medicare was set up that way.

00:03:03:22 - 00:03:31:03

The part B side, which is medical, does come in at a premium now for 2026. That monthly cost is $202.90. But he can be tiered up based off income and taxable income bracket. We can see an increase in that now traditional Medicare A and B only provides 80% of medical coverage. That's where someone like myself comes in, where we able to do the reviews to round out that coverage.

00:03:31:03 - 00:03:58:12

So you do end up with 100% benefits. So those are the options that we take a look at which we have Medicare supplemental plans, which by definition they're supplementing the 20% or what they call Medigap or what you may see on TV commercials. More the mailers, the Medicare Advantage product, which is kind of an all inclusive product. Now those are referred to as part C, and then we do have a part D of Medicare, which is a prescription plan.

00:03:58:12 - 00:04:25:16

So depending on how the benefits structure it may come with your advantage plan. We may look to get a standalone with your Medigap or supplement. But certainly what's going to fit your needs and provide you the most service for that upcoming year. Now with the part B, there is a deductible that typically is the individual's responsibility depending upon their letter code, which for 26 it's $283.

00:04:25:17 - 00:04:51:22

That's not something that changes from plan to plan. Those deductibles and premiums are set by the federal government. What we do look at as far as some costs that can vary, are your prescription drug costs, your co-pays, the cost for that supplement plan, or looking at the advantage plan, your co-pays per service. So those are the things on the monetary side that we want to take into consideration.

00:04:51:22 - 00:05:20:11

As far as that, for the 2026 plan year, the federal going, we have capped on the drug side a $2,100 max out-of-pocket. So that's something, regardless of the plan that we would look at and choose, that's the most you would pay for your drugs out-of-pocket in one year. Okay. So with that being said, what do you think is the important piece of information to understand Medicare for the audience?

00:05:20:16 - 00:05:46:17

I would say one of the biggest takeaways is that you want to look for what's going to fit your needs. A lot of ready to retire individuals, or even already retired individuals, discuss and talk about their plan with their friends or family, other individuals in their community. What's good for one person might not be what is needed to fit in, fulfill the requirements and what you're looking for.

00:05:46:18 - 00:06:06:05

So the big thing is, is understanding the product, the carrier, and how you can get what your needs are out of that different plan. Do you have to apply for Medicare at age 65? I know there's different scenarios. Some people, you know, they're turning 65 and they are retired. So do you have to apply? That's a great question.

00:06:06:05 - 00:06:39:06

And that's kind of where we wait to start. So at 65 you're automatically assigned the A and B. Now if you are still actively working and you would like to continue with your employer coverage and they allow. So you were certainly eligible to do so in that scenario you would actually want to defer your Medicare Part B, because there's no reason to have to pay for that benefit along with your employer's monthly premium for that coverage.

00:06:39:06 - 00:07:24:22

So the key thing is deciding and in that really three months, I'd say window before turning 65, doing the cost analysis, doing the benefit comparison. Is my employer plan equal to what I could potentially have Medicare A and B with a supplement or the A and B, and working with an advantage plan. The key thing to note with that as well, if you have a spouse certain to apply with them as well, if they are turning 65 and want to remain on your employer plan or they drop off, go Medicare A and B and look at the other options that are available out there.

00:07:24:22 - 00:07:50:17

More of the employer plans we're seeing having high deductibles, premiums high, certain things like that that we don't necessarily have going the Medicare route and let's say an advantage product. But again, it's doing the comparison and really looking at what makes sense for your situation. Some people are retiring at 67 or 70, but when you turn 65 is the eligible age for Medicare.

00:07:50:17 - 00:08:19:11

I'd like to clarify that. Correct. 65 is the eligibility age for Medicare outside of being on SSDI. Social Security, Disability. So that would be the soonest standard that someone would be eligible to start their A and B Medicare benefit. Yes. And then another thing would be you can stay working but still be on Medicare, which I'm sure a lot of people out there are not aware that, yes, you can certainly choose really either option.

00:08:19:11 - 00:08:44:07

Just the part a if your employer benefits are equal to or cost less, or go Medicare A and B, but continue to work with your employer and just terminate the employer benefits in that situation with not collecting Social Security. Because as I touched on that 290 part B premium, if you are receiving Social Security would become automatically deducted right off the top.

00:08:44:08 - 00:09:12:01

If you are deferring your Social Security benefits, Medicare will bill you quarterly, so you will see a bill. You will pay three months forward for that part B coverage. Now that doesn't have any bearing or impact on your Social Security benefits. It's just how they're able to receive or bill for that cost of the part B and also, it's important that you and your spouse coordinate together the coverage.

00:09:12:03 - 00:09:49:23

Very much so. Because if let's say I'm the policyholder, I'm turning 65. I like an option outside of my employer benefit, but I carry my spouse on the coverage. If I were to terminate my coverage, that would then certainly terminate their coverage. So in those instances, I have seen members or clients that do continue working past 65 until their significant other hits that benchmark, and then we're able to look at the options that are out there for individual advantage plan or supplemental policies.

00:09:49:23 - 00:10:17:09

Yes. And then is there a certain time that you have to do the enrollment is there a Roman period? I know, you know, with Medicare there's a yearly enrollment period. But what if your birthday is February of 2026 or March of 2026? So what we call your initial election period or initial enrollment period starts three months prior to the month you turn 65, that one and three months after.

00:10:17:10 - 00:10:48:08

So that's something that typically we would like to see the process or having conversations at that three month mark, which would give us an idea, are we going to pull the trigger with the A and B or stay with the employer? Plan gives us plenty of time to review our benefits and options outside or against the employer plan, and then plenty of time to make that a moment, because anything that you would pair, whether it's a supplement or advantage, would take effect on your Medicare effective date.

00:10:48:08 - 00:11:16:09

So if you have a June birthday, your Medicare Part A and B will be effective on June 1st. Ideally, we would like to marry up your supplement or advantage plan for that same day. So there's no gaps or missing periods of coverage. So if you decide to stay working and use your employer's benefits, is there penalties for not taking the Medicare Part B at the initial time of taking Medicare Part A?

00:11:16:09 - 00:11:40:02

A very good question, and something that definitely needs to be understood. As long as you have no breaks in your employer benefit, even if you change companies, the on 65, you will not incur a penalty for a late enrollment. Let's say you're 65, you continue to work. I'm 67. You're ready to make the move. You want to retire.

00:11:40:03 - 00:12:06:12

You're looking to pick up your Medicare A and B. There is a form that's a federal form that you would fill out with your employer through your benefits department or H.R. That they sign off acknowledging from 65 on, you had no breaks, gaps, or discontinued coverage. That would be submitted with the application to pick up and enroll in part B, and that would negate any penalty being applied towards the cost of coverage.

00:12:06:16 - 00:12:39:04

The Medicare Part B penalty for late enrollment is 10% of that year's premium. On the prescription side, they also apply that penalty at a 1% per month additional cost. These penalties do not go away. They are for life. So you certainly want to make sure that the proper paperwork is being submitted correctly, in a timely manner, to not have to go through the appeal process or potentially even just be automatically charged with those additional penalties.

00:12:39:05 - 00:13:10:22

So I have a scenario for you. You decide to stay working, you are on your employer's benefits, but you did not apply for Medicare in your 65. You're actually going to be turning 66. And that's perfectly fine. As long as you continued your coverage through the employer for that time. When you decide to enroll in the Medicare program, you just must complete and provide that written statement form saying you had no gaps or lapsing coverage.

00:13:10:22 - 00:13:33:18

Not that you recommend that they should wait, because it's better to put a plan in place and start the process. So once you turned 65 prior to that, you know, reach out and be using the Medicare Part A, and then when you do decide to retire from your job and not be on your employer's coverage, then to look into Medicare Part B supplemental.

00:13:33:22 - 00:14:02:13

Yeah. So it would be what we refer to as a coordination of benefits. So if you were to be hospitalized your employer plan would coordinate with the Medicare Part A, but you would certainly want to make sure that you have that card, have that identification number, show the effective dates. Because depending upon the number of employees a company has and their benefits, structure also determines coordination of benefits needing to or not needing to pick up that part B at 65.

00:14:02:15 - 00:14:23:18

Kind of why it's a good idea to reach out to someone like myself and just go through scenarios, situations to see how your plans might be for retirement and get a good strong footing to move forward with those plans. How can people find out this information? Be aware of this. Think through the mailers. They'll be aware as they're turning 65.

00:14:23:19 - 00:15:05:13

So Medicare does. When you are newly becoming eligible, send out a book of Medicare in you. And once you become eligible, you would receive that every year. It does lists plans in your area, benefits, the new cost of premiums, deductibles, and kind of more of a just a general overview of Medicare itself. Now wanting to look at the plan available options is, again, as I mentioned, Medicare A and B only cover 80% would be sitting down with someone like myself to review the plans that are available in your area, we want to look at, you know, potentially max out-of-pocket costs, monthly premiums.

00:15:05:13 - 00:15:29:00

Make sure that your doctors, specialists that you've been seen or are comfortable with are in the network of the plan that that we're looking at. I'm in the insurance field. I'm not in the medical field. I'm not here to say who you can and can't go continue to see. So we certainly want to make sure that you're able to continue with those doctor's treatment plans, course of actions that you are working within, comfortable with.

00:15:29:00 - 00:16:14:22

When they are looking at different plans and they are still working, they're still traveling. When you pick a Medicare supplement or vantage plan, what happens if you are traveling out of state? So we do see more of a, we'll say, restrictive network with the advantage plans. When reviewing those, you would typically see what they call an in network benefit and an out-of-network benefit, typically for any emergency or urgent cares, it is just a standard flat copay by you may see or incur up to a 40% coinsurance cost for services if you are out of that network or out of that coverage area with your traditional setup of Medicare A and B and a Medicare supplement

00:16:14:22 - 00:16:46:10

or Medigap anywhere in the country, as long as they accept Medicare as the primary, your supplement will pay correspondingly. So they go off of what Medicare says as the first Medicare pays their 80%. Your supplement would take up the 20% thereafter. Yes. I think there's a lot out there for them to have questions and start planning early. Do you have a timeline that a guide for that, for people who are retiring in 2026, something that they can follow?

00:16:46:11 - 00:17:07:11

All we do typically is you know, within about, you know, 12 months out to, you know, nine months. I'm sure you're feeling that you've, you know, put enough time, years in. Obviously you want to make sure you're financially able to retire as well. But the big thing is, you know, take into account medical costs. We do offer educational seminars.

00:17:07:11 - 00:17:40:18

They are not sales pitches. We do not touch on any specific carriers or insurance companies. It is a general, informative, educational setting. When we get to about 6 to 4 months out, I would say it's time to start speaking with your employer to see what and if they will continue. Benefits after 65. Some companies actually do terminate coverage at 65 for you to go outside, purchase your own benefit and join the Medicare A and B program.

00:17:40:18 - 00:18:20:02

The key thing is, once we get to that three month out window, that starts your eligibility period to enroll in your Medicare A and B, I would strongly suggest going on and visiting ssa.gov. And you can create your my SSA account. And by doing so it will show you one not only how to enroll in Medicare A and B, it'll show you what your forecasted Social Security payments would be and if taking that into consideration or when you're looking to retire, it'll show 65, 66, 67 when you hit your 100% mark.

00:18:20:02 - 00:18:43:19

What you're actually monthly income would be would be from there, after discussing or making up your mind on which fork in the road, we'll say you'd like to do potentially continue working on the A or looking at the AB coverage. That's the window when you would want to reach out and speak with your health insurance licensed advisor. With the questions please.

00:18:43:19 - 00:19:06:00

The more you ask, the more we sit down, the more we can help explain, get a better understanding, and see how it's going to be most advantageous for moving forward with what type of benefits structure. So what do you feel is the most important takeaway? Really understanding the options that are available to you once you get into the Medicare program and enrolled?

00:19:06:01 - 00:19:29:04

We have an annual review period every year. It's October 15th through December 7th, but we certainly want to get a strong grasp and understanding starting and getting into the program itself. Once we have that, then every year we sit down, we do a re review and make sure that moving into the next year we have you where you would where you need to be.

00:19:29:08 - 00:20:02:16

So what is not too early? What is the time frame that is not too early to be looking into Medicare and understanding Medicare? Typically I would say start thinking about options, asking some questions, getting some feelers around 64 because at 64 you have that year ramp up where maybe you do want to look at retiring. Maybe you do want to start collecting your Social Security, but that gives us plenty of time to sit down, look at your options, discuss perhaps what your spouse might need benefit coverage wise.

00:20:02:16 - 00:20:23:10

Are they going to be 65 as well, or do we need to look at another alternative for them? Are they already over 65 and do they just need to pick up that part B. But typically I would start thinking about these options 64 and on. There's some people out there that do retire before 65. So in that time what is the health insurance coverage that they would need.

00:20:23:10 - 00:20:53:16

What would it be if the employer did offer any type of retirement benefit? Let's say if you worked for the Commonwealth of Pennsylvania and you had state benefits, did you put your years of service in to continue those benefits? Does your employer just not offer anything once you retire in those situations? We would be looking at alternative coverage, possibly through the the ACA program or maybe going onto your spouse who is still working their employer benefit coverage.

00:20:53:19 - 00:21:12:23

But those are all things that we would sit down to look at prior to the Medicare eligibility. And again, that is start at age 60 for eligible 64, start thinking of it, or at least having backburner 64 years. So it's important to start in advance to understand there's a lot of information, a lot of options to weigh out.

00:21:12:23 - 00:21:36:02

And instead of being short on time, you want to be able to have the information that you need to make an educated decision. There is certainly nothing wrong with being proactive. That's correct. And the thing too is more specifically, we do see changes, with the federal government, with Medicare itself, but more so the individual plans. These plans do change from year to year.

00:21:36:06 - 00:21:54:07

So what we might be looking at for 26th May not be where we want to be for 27. So those are the other key things to to take into account. As you mentioned, do you travel out of state much? Do you have long periods of time? You know, are you a snowbird? Do you like to spend your winters in Florida?

00:21:54:13 - 00:22:16:12

Come back up here, north, you know, the summertime things like that. All things that are unique to your situation are what we're happy to discuss. Go over and find out how we can, support your decision. These are important facts that people need to understand, and we want them to know it's it may all seem overwhelming, but it's not.

00:22:16:17 - 00:22:36:16

You just need to reach out to someone like yourself, John, a broker. And you would be more than happy to sit with them and discuss with them their options. There are no stupid questions and there are no cost for consultations. So key things, you know, are you taking maintenance medications? We'll run through those. Make sure they be covered with your plan.

00:22:36:19 - 00:23:05:13

Are you currently in a medical situation where you are currently receiving treatment? We certainly don't want to disrupt that as well. Make a smooth transition into something that you may need to change. Because of being 65 now, no longer having employer benefits, just make it comfortable and easily as possible. Transition to the Medicare program. It is overwhelming. There is a lot there's a lot of bombardments, but we're here to help wade through that and make a clear path to easy options.

00:23:05:13 - 00:23:26:22

We want them to know that retirement doesn't have to be stressful. You don't have to be confused that there are people out there to help you. And it's a new chapter of your life. So understanding the health care choices is a key part of stepping into it with confidence and a peace of mind. No one has to do this on their own.

00:23:27:02 - 00:23:47:04

I am not a surgeon and I don't do open heart surgery, so I would certainly go to someone who knows what they're doing in that field. Just as much as I would feel you be comfortable coming to me to discuss options and help navigate and walk through what's available. And John, how can they contact you? As you mentioned in the beginning, I'm with members first Insurance Services.

00:23:47:04 - 00:24:19:11

My phone number is (717) 319-7332. And my email is Jonathan.Macavoy@M1stInsurance.org. Do they have to be in your area? I am licensed in the state of Pennsylvania. Whether you're a member with the credit union or not, I'm happy to help anyone answer any questions that may come up for yourself, a friend or family member or significant other.

00:24:19:11 - 00:24:37:20

We're really here just to provide the information for you to to make the choices that will navigate and put you in the coverage or benefit plan to fit all your needs. To our audience, we went over a lot of information today, and I want you to know that there is a Medicare Be ready survival guide that John has to offer for you.

00:24:37:22 - 00:25:06:11

Yeah, it's a great tool to start. We have some Q&A in there, a timeline to run down 12 months out as you get closer to that goal of retirement and a checklist box to keep yourself on track for that timeline. Like to learn a little more, receive the packet of material. Please feel free to reach out or email me at the listed email address, or call (717) 319-7332.

00:25:06:14 - 00:25:25:04

Happy to help in any way we can. Well, John, it was a pleasure to have you here on our podcast again. I appreciate you. It's great to be back. Thank you for the opportunity. I'm sure the audience appreciates this information that you have shared with them. We know you're here to help and guide them that so they have a nice, pleasant retirement for the next chapter of their life.

00:25:25:04 - 00:25:47:12

If anyone listening has any questions or input, please reach out to us, listen to our podcast Caring Table on YouTube and all other major podcast platforms. Thank you for listening. Talk to you next time.