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We are delighted to recommend Greg MacDonald to assist in handling your insurance options. Working through a maize of options available was overwhelming. Greg was so knowledgeable in all areas and worked extremely hard to find the best possible protection at the best price. Working with Greg has been a blessing and we highly recommend him. - Keith & Marna G
Greg has been a wonderful resource for us, as well as my mother. He helped us sort out our options in choosing the right insurance plan to fit our needs. He provided a precise detailed approach in assisting us and we are very pleased. - John & Judi S
Greg MacDonald has represented us for about five years. He has been very kind to help us with our questions, and provide sound advice in insurance needs. Recently a relative needed advice, and Greg did not represent them, but he did contact their company and solved their problem. We highly recommend Greg. He is a man or great principle, and we trust him to take care of our needs. Thank you, Greg! -
Jan & Russ S
Martha P
Greg MacDonald has represented us for about five years. He has been very kind to help us with our questions, and provide sound advice in insurance needs. Recently a relative needed advice, and Greg did not represent them, but he did contact their company and solved their problem. We highly recommend Greg. He is a man or great principle, and we trust him to take care of our needs. Thank you, Greg! -
Jan & Russ S
Martha P
Do you need medical insurance? Get it done right – with Greg MacDonald. He will put every effort to work for you. -
Ron & Vonda M
Advice from an industry expert
Medicare Program Guide
Medicare Parts A&B
Medicare Supplements
Medicare Advantage
Medicare Part D
Medicare Savings Account
Medicare Parts A&B
Find out what Medicare Part A and Part B cover, what they cost, and how to enroll.
2026 Medicare Part A
Part A is Hospital Insurance and covers costs associated with confinement in a hospital or skilled nursing facility.
When you are Hospitalized for:
Medicare Covers
You Pay
1 – 60 days
Most confinement costs after the deductible
$1,736 Deductible Per benefit period*
61 – 90 days
All eligible expenses after the patient pays a per-day co-payment
$434 a day co-payment
91 – 150 days
All eligible expenses after a per day co-payment. Lifetime maximum of 60 days.
$868 a day co-payment
151 days or more
Nothing
All costs
Skilled Nursing Confinement: When you are hospitalized for at least 3 days and enter a Medicare approved skilled nursing care facility within 30 days after hospital discharge and are receiving skilled nursing care.
All eligible expenses for the first 20 days; then all eligible expenses for days 21-100, after patient pays a per-day copayment.
After 20 days $217 a day co-payment for days 21-100. For days 101+ You pay all costs.
Part A also covers: Blood, Home Health Services, Hospice Care
*Benefit periods are defined by confinement periods that are separated by 60-days. If you are confined in a hospital and then released, your Benefit Period will continue for the next 60 days. If you are readmitted to the hospital during that time, your Benefit Period will continue. However, if you are readmitted to the hospital after more than 60 days have elapsed, a new Benefit Period begins, and you will have to meet the deductible again.
2026 Medicare Part B
Part B is Medical Insurance and covers physician services, outpatient care, tests and supplies.
On expenses Incurred for:
Medicare Covers
You pay $283 Annual Deductible PLUS
Medical Expenses – Physician’s services for inpatient and outpatient medical/surgical services; physical/speech therapy, diagnostic tests.
Home Health Care – Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services.
100% of approved amount; 80% of approved amount for durable medical equipment
Nothing for services; 20% of approved amount for durable medical equipment
Outpatient Hospital – Treatment Hospital services for the diagnosis or treatment of an illness or injury.
Medicare payment to hospital, based on outpatient procedure payment rates
Coinsurance based on outpatient procedure payment rates
Blood
After first 3 pints of blood, 80% of approved amount
First 3 pints plus 20% of approved amount for additional pints
On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare “assignment.” This means the patient will not be required to pay any expense in excess of Medicare’s approved charge. The patient pays only 20% of the approved charge not paid by Medicare. If the health care provider does not accept assignment, the patient is responsible for the “excess” charges that Medicare does not cover.
Monthly premium for those filing as single taxpayers with income under $109,000 per year, or married and filing jointly with income under $218,000 annually. Part B premiums increase with income level.
2026 Part B Monthly Premium
Tax Filing Status
Individual
Joint
Married but Separate
Premium is
If Your 2023 Annual Income Was*
$202.90
$109,000 or less
$218,000 or less
$109,000 or less
$284.10
$109,001 – $137,000
$218,001 – $274,000
$405.80
$137,001 – $171,000
$274,001 – $342,000
$527.50
$171,001 – $205,000
$342,001 – $410,000
$649.20
$205,001 – $499,999
$410,001 – $749,999
$109,001 – $390,999
$689.90
Above $500,000
Above $750,000
Above $391,000
Social Security uses the income reported on your federal tax return two years ago to determine your Part B premium. If your income has decreased, you can ask for a more recent tax year to be used to determine your premium, but you must meet certain criteria.
Part B Covered Services
Part B Covered Services
Details
Bone Density Measurement
One every 24 months
Cardiac Rehabilitation
Exercise, education and counseling
Cardiovascular Screenings
One every 5 years
Chiropractic Services
Limited
Clinical Laboratory Services
Certain screening tests
Clinical Research Studies
Tests to determine safety of new procedures
Colorectal Cancer Screenings
• Fecal Occult Blood Test
• Sigmoidoscopy
Colonoscopy / Barium Enema
One every 12 months
One every 4 or 10 years depending upon risk
One every 4 or 10 years depending upon risk
One every 4 years
Defibrillator
Implantable automatic
Diabetes Screenings
Up to two each year
Diabetes Self-Management Training
With doctor’s order
Diabetes Supplies
Includes monitors, test strips and lancets Insulin is covered if using an external pump
Doctor Services
Includes outpatient and some hospital inpatient
Durable Medical Equipment
Oxygen equipment and supplies, wheelchairs, walkers, and hospital beds
EKG Screening
Initial Medicare exam and as a diagnostic test
Emergency Room Services
Doctor’s services
Eye Glasses
One pair after cataract surgery
Health Center Services
At federally approved community-based organizations
Flu Shots
Once per flu season
Foot Exams
If you have diabetes
Glaucoma Tests
One every 12 months
Hearing and Balance Exams
Does not include hearing aids
Hepatitis B Shots
For people at high or medium risk
HIV Screening
One every 12 months
Home Health Services
Part-time skilled nursing care or physical therapy, speech-language pathology, or occupational therapy
Kidney Dialysis
Services and supplies
Mammograms
One every 12 months
Medical Nutrition Therapy Services
If you have diabetes or kidney disease or kidney transplant in the last 36 months
Mental Health Care
Outpatient to help with conditions like depression
Non-doctor Services
Physician assistants, nurse practitioners, social workers, physical therapists and psychologists
Occupational Therapy
After an illness or accident to help you return to work
Outpatient Medical and Surgical Services and Supplies
For procedures like X-rays, a cast or stitches
Pap Tests, Pelvic and Breast Exams
Checks for cervical, vaginal and breast cancer
Physical Exams
One per year – must be 12 months apart
Physical Therapy
For injuries and diseases
Pneumococcal Shot
Helps prevent pneumonia
Prescription Drugs – Limited
Injections at a doctor’s office, certain oral cancer drugs, drugs used with some types of durable medical equipment, and some outpatient drugs at a hospital
Prostate Cancer Screenings
Once every 12 months
Prosthetic/Orthotic Items
Limbs and braces; includes ostomy supplies
Pulmonary Rehabilitation
If you have moderate to severe COPD
Rural Health Clinic Services
Includes many outpatient primary care services
Second Surgical Opinions
If surgery is not an emergency
Smoking Cessation
If you’re diagnosed with an illness caused or complicated by smoking
Speech-Language Pathology Services
Treatment to regain and strengthen speech and language skills and swallowing skills
Surgical Dressing Services
For treatment of a surgical wound
Telehealth
Provided in an approved rural facility
Tests
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Transplants and Immunosuppressive Drugs
Pays for doctor services in a Medicare-certified facility. Immunosuppressive drugs covered if Medicare or employer group plan paid for the transplant and you were entitled for Part A at the time of transplant
Urgently-Needed Care
For sudden illness or injury that isn’t an emergency
Services and Items Not Covered by Part A and Part B
Long-term care
Routine Dental Care
Dentures
Cosmetic Surgery
Acupuncture
Hearing Aids
Exams for Fitting Hearing Aids
Most Prescription Drugs
How Do I Enroll in Medicare? If you are receiving Social Security benefits or benefits from the Railroad Retirement Board, you will be automatically enrolled in Parts A and B. Benefits will begin the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and B will begin the first day of the prior month. So if your birthday is September 1, Medicare benefits will begin on August 1. If you are younger than 65 and disabled, Medicare benefits will automatically begin 24 months after you begin receiving disability benefits. If you are not receiving Social Security benefits, you will need to enroll. Beginning 3 months prior to the month you turn 65, you can sign up for Medicare. The fastest way to enroll is go to www.ssa.gov/medicareonly/. It should take you fewer than 10 minutes. You can also call Social Security at 1-800-772-1213. For Railroad Retirement Board benefits call 1-877-772-5772. Finally, you can make an appointment at your local Social Security office and enroll there.
Medicare Supplements
Medicare Supplements work with Medicare to help you pay what Medicare does not. Several plans are available, and many insurance companies offer them. How do you select a plan?
Medicare Supplement Plan Benefit Chart
All plans include these basic benefits:
Hospitalization – Part A coinsurance plus an additional 365 days of benefits after Medicare benefits end
Medical Expenses – Will pay for part or all of Part B coinsurance or co-payments for hospital outpatient services
Blood – First three pints of blood each year
Hospice – Part A coinsurance
Percentage of Benefit the Plan Pays
A
B
D
G1
K
L
M
N
C
F2
Part A Coinsurance
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Skilled Nursing Facility Coinsurance
100%
100%
50%
75%
100%
100%
100%
100%
Part A Deductible
100%
100%
100%
50%
75%
50%
100%
100%
100%
Part B Deductible
100%
100%
Part B Coinsurance
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Preventative Care
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Part B Excess Charges
100%
100%
Foreign Travel Emergency
80%
80%
80%
80%
80%
80%
Out-of-pocket limit; 100% paid after limit
8,000
4,000
Note: Plan C and Plan F are not available for those born after 1954, unless they already have those plans.
Plan F and Plan G also have a high deductible option. High Deductible Plans F and G offers the same benefit as Plan F and Plan G after an annual deductible of $2,950 is met. Foreign Travel Emergency expenses are not counted toward the $2,950 deductible.
Plan N requires a $20 copayment for office visits and up to a $50 copayment for an ER visit.
Medicare Advantage
Medicare Advantage plans are offered by insurance companies and cover the same services as Medicare, plus additional services Medicare does not. Is an Advantage plan right for you?
Medicare and Associated Health Insurance Options
Medicare Part A & B provides comprehensive health insurance. Each part has a deductible and co-pays or coinsurance. Payment for Medicare insurance is deducted from your social security.
Medicare Supplements
Independent company insurance working in conjunction with original Medicare
Federally approved plans offering various combinations of coverage
Plans are uniform regardless of the company offering it.
Policy holders pay premiums. Supplements fill in the gaps of what Medicare does not cover. Additional out of pocket cost depends upon the supplement plan selected
Medicare Advantage Plans
Insurance provided by a private company, not original Medicare
Plans approved by Medicare but vary between companies
Policy holders must verify if their providers accept the insurance company plan
The Government will pay the insurance company for each participant on their plan. This means participants pay lower premiums, and with some plans, no monthly premiums.
Comparison of Medicare, Medicare Supplement Plan G and a Medicare Advantage Plan
Original Medicare 2026
Medicare Supplement Plan G
Medicare Advantage Plan Example (See note below)
Hospital Care (Part A)
Days 1 – 60: initial $1,736 deductible (per admission subject to benefit period) Days 61 – 90: $434/day Days 61 – 150: $868/day Days 151+ All Costs
Plan pays Part A deductible and all daily co-payments. Plan pays up to an additional 365 days of hospital coverage over the course of a lifetime
$400/day for days 1-7 Emergency room: $85 co-pay Urgent Care: $70 co-pay
Skilled Nursing Facility
Days 1 – 20: $0 Days 21 – 100: $217/day
Plan pays daily co-pay up to day 100.
Days 1 – 20: $5/day Days 21 – 100: $170/day
Doctor visit (Part B)
$283 annual deductible then 20%
You pay $283 annual deductible then Plan pays 100% of assigned services.
Medicare pays the majority of the claim. Insurance company pays remainder. You may share in the cost based on your plan
Insurance company pays the claim. You share in the cost based on your plan’s co-pay.
Networks
No networks – you may go to any provider that accepts Medicare
Plans have networks. You may go out-of-network, but co-payments are higher.
Plan Benefits
Plans are standardized and benefits do not change annually.
No plan standardization. Plan benefits vary and typically change annually.
Prescription Drugs
Cover only Part B drugs
Cover Part B drugs and may include Part D drugs.
Medical Underwriting
No medical questions when first enrolling in Medicare. Will ask medical questions when changing plans.2
Only one health question: Do you have end-stage renal disease?
Premiums
Typically increase annually
Most plans have lower premiums then Medicare Supplements; some have been as low as zero. Premiums may change annually.
In an emergency, you may go to the nearest provider and be responsible for only in-network co-payments
Exceptions apply. Please call for details.
Selecting a Medicare Advantage Plan
Look at the plan’s co-pays. Low doctor office visit co-pays are nice, but look too at the co-pays for hospitals, diagnostic tests, outpatient surgeries, and any other services you feel you may need. Are the co-pays a percentage of the cost or a fixed dollar amount?
What is the plan’s out-of-pocket limit? This is the most you can pay for medical services during the year. Does the plan have both in-network and out-of-network limits, or does it have one limit for all medical charges?
Are your doctors and hospitals in the plan’s network? Will the plan pay for out-of-network expenses?
If the plan includes Part D, are your medications in the plan’s formulary? What are the tiers for each drug? What are the co-pays?
If you live in another area for an extended time during the year, does the plan have a network in that area?
How does the plan’s premium compare to other plans?
Does the plan offer any extra benefits, such as vision and dental services or health club memberships?
Medicare Part D
Part D prescription drug plans can work with Medicare, Medicare Supplements, some Advantage plans, and within some Advantage plans. The rules are complicated. This tutorial helps explain the rules and how to pick a plan.
Medicare Part D Standard Basic Benefit 2026
Prescription drug plans offer a wide variety of deductibles and co-payments. However, all plans have to follow this basic benefit outline.
Total Drug Expenditures
Catastrophic Stage
Enrollees pay $0
Enrollee Expenditure
Coverage Gap
Eliminated
$2,100
Initial Stage
Drug Plan Co-pays or Coinsurance up to 25% of retail cost
The amount not paid by insurance up to the $2,100 level.
$615
Deductibles range from $0 to $615
$615
$0
$0
Additional Part D Premium for High Income Earners
Medicare charges high income earners an additional Part D premium. The premium is collected by insurance companies and is added to the plan’s standard premium.
Tax Filing Status
Individual
Joint
Married but Separate
Part D Premium is
If Your 2024 Annual Income Was*
Plan Premium
$109,000 or less
$218,000 or less
$109,000 or less
Plan Premium
+
$14.50
$109,001 – $137,000
$218,001 – $274,000
Plan Premium
+
$37.50
$137,001 – $171,000
$274,001 – $342,000
Plan Premium
+
$60.40
$171001 – $205,000
$342,001 – $410,000
Plan Premium
+
$83.30
$205,001 – $499,999
$410,001 – $749,999
$109,001 – $390,999
Plan Premium
+
$91.00
Above $500,000
Above $750,000
Above $391,000
* Social Security uses the income reported on your federal tax return two years ago to determine your Part B and Part D premium. If your income has decreased, you can ask for a more recent tax year to be used to determine your premium, but you must meet certain criteria.
Selecting a Part D Plan
Make sure all your medications are on the plan’s formulary list.
Each plan places the drugs on its formulary list in tiers, and then sets a co-pay for each tier. See which tier the plan places each of your drugs. One year, some plans rated Crestor a tier 1, some plans rated it a tier 2, and some rated it a tier 3. The price difference between tiers is significant.
Avoid plans that require Step Therapy. This means the company will initially supply your medication, but will require you to transition to a less expensive drug the next time the prescription is filled.
Does the plan place limits on any of your medications? Plans will ask consumers of an expensive drug to switch to a similar prescription with a lower cost.
Look at the plan’s mail order program. What are the savings available through mail order when compared to a retail pharmacy?
Is your pharmacy on the plan’s preferred pharmacy list? If not, you could pay higher co-pays.
Part D Late Enrollment Penalty
Medicare imposes a Late Enrollment Penalty (LEP) for beneficiaries who do not initially enroll in a Part D plan when they transition to Medicare, then sign up at a later date. The LEP equation is (1% per month of the national average Part D monthly plan premium) X (the number of months without creditable drug coverage).
Example: John, who did not take medications, turned 65 in July 2016 and decided not to enroll in a Part D plan. In May of 2017, John was prescribed high blood pressure and cholesterol medications. John decided to enroll in a Part D plan for 2018 during the Annual Enrollment Period. Since John could have had Part D coverage for 18 months prior to enrolling in a plan (six months in 2016 plus twelve months in 2017), he will be assessed an 18% Late Enrollment Penalty. The LEP in 2018 was $0.35/month. John’s penalty is $6.30 (.35 x 18) which will be added to the monthly premium of the Part D plan he selects for as long as he has any Part D plan.
The 2026 National Average Part D Premium is $38.99.
The LEP for 2026 is $0.39 X the number of months without credible drug coverage.
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Medicare Savings Account
Medical Savings Account (MSA) plans are Advantage plans with a twist. The government actually gives you money to pay for medical services. Learn how MSA plans work and if it is a good option for you.
Medicare Savings Account Plans
NOTE: Beginning in 2024, we are not aware of any companies offering MSA plans. Those with an MSA retain their funds and can still use them for qualified health expenses. No additional deposits will be made.
Medical Savings Account (MSA) plans are a type of Medicare Advantage plan. Medicare pays an insurance company to insure you, and together you and the insurance company pay your medical expenses. But that is where the similarity ends. MSA plans look much different than typical Advantage plans.
How different are MSAs?
The government gives you money to spend for medical expenses. Not just for Medicare covered services; you can use it for medical services Medicare does not cover, like dental, vision and prescriptions. Each January, Medicare will put funds in your MSA. Money put into the account becomes yours. Any funds not used during the year roll into the next year. If you decide to quit the plan and go to a different Medicare plan, you take your MSA funds with you. If you die, funds can be left to a beneficiary. MSA funds deposited and used for medical expenses are not taxed. However, funds used for non-medical expenses are included in taxable income, plus a 50% tax penalty. A big advantage of MSA plans is no network. You can see any medical provider that accepts Medicare, and agrees to treat you, anywhere in the country. A disadvantage of MSA plans is they do not cover drugs. You would need to buy a separate drug plan.
How do MSAs work?
MSA plans have a deductible, which is more accurately described as a maximum out-of-pocket. You, the insured, would be responsible to pay your medical expenses up to that deductible. Once reached, the insurance company pays 100% of all Medicare covered services for the rest of the year. Note, while you can use MSA funds for services Medicare does not cover, such as dental and prescriptions, these expenses do not count toward the plan’s deductible. Only Medicare covered expenses count.
How much would you pay for services?
You would pay providers what Medicare would pay them. In other words, whatever the Medicare established reimbursement rate is for the services you used, that is what you would pay. Your MSA funds are there to help you pay medical expenses. For example:
Bob joins a Medical Savings Account Plan, with a $5,000 deductible, during the Annual Enrollment Period (AEP). The insurance company sets up an MSA with a national bank in Bob’s name. The beginning of January, Medicare puts $2,000 into Bob’s MSA. In March, Bob needs some blood tests. The amount Medicare would pay providers for Bob’s tests is $155. Bob uses his MSA debit card to pay for the tests. The $155 is applied to the plan’s $5,000 deductible. In June, Bob gets his teeth cleaned. He uses his MSA to pay for his cleaning, but this amount is not applied to the plan deductible. In August, Bob is prescribed a blood pressure medication. He has a Part D plan and uses his MSA to pay the drug’s co-pay. This amount does not apply to the MSA plan deductible. (If Bob needed a drug covered under Medicare Part B, the amount spent would apply to the MSA plan’s deductible.) During AEP, Bob decides to keep his MSA plan for the following year. On December 31st, he has $1,500 in his account. In January, Medicare adds another $2,000 to his MSA bringing the balance to $3,500.
Is a Medical Savings Account Plan Right for You?
It is my opinion that MSA plans work well for two types of people:
Those who are healthy and do not often need a doctor; and who have the ability to pay for medical services if they have spent their MSA funds and have not reached the plan’s deductible. For example, if Sam needed emergency surgery and the bill was more than $5,000, Sam would have to spend $3,000 ($5,000 – $2,000) of his own money.
Those who have Medicare Supplements, whose annual premiums are now greater than the MSA’s annual deductible minus the MSA contribution. For example, if Sue’s annual Medicare Supplement premium is $3,400, she will save money with an MSA with a $5,000 deductible and a $2,000 contribution, as the most she will spend is $3,000 ($5,000 – $2,000 = $3,000), a $400 savings.
For those who do not spend much on medical expenses, the annual MSA contributions make MSA plans a nice way to save money for future medical emergencies. The longer you are in the program, the more money should be in your MSA, and the lower your personal out-of-pocket risk is. Keep in mind, though, the amount you pay the provider is the actual Medicare reimbursement rate. While this is discounted from the amount the provider bills, it is higher than what one pays on original Medicare or on an Advantage plan. For that reason, MSA plans are not a good fit for those who are likely to spend more than the amount of money they have in their Medical Savings Account each year.
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Sage Insurance Advisors does not offer every plan available in your area. As of 9/1/2023, we represent 20 insurance companies and offer 58 plans, including Medicare Supplements, Advantage plans, and Part D plans. Please contact Medicare.gov, 1800-Medicare, or your local State Health Insurance Program to get information on all your options.
