Author: John Serian

  • $0-Premium Medicare Advantage Plans: What ‘Free’ Really Means

    $0-Premium Medicare Advantage Plans: What ‘Free’ Really Means

    If you have looked at Medicare plans in South Florida, you have almost certainly seen plans advertised with a $0 monthly premium. A zero premium Medicare Advantage plan is a real thing, and many people enroll in one. But the word “free” leaves out most of the story. This article explains what a $0 plan premium does and does not cover, where other costs show up, and how to compare these plans on equal footing with everything else available to you.

    This article is educational only. Medicare.gov and 1-800-MEDICARE (TTY 1-877-486-2048) are the official sources for plan and coverage information.

    What a $0 Plan Premium Actually Means

    A Medicare Advantage plan, sometimes called Part C, is offered by a private company approved by Medicare. It provides your Part A and Part B benefits, and many plans also include Part D drug coverage. Medicare pays the plan a set amount each month to provide your care.

    When a plan lists a $0 premium, it means the plan itself does not charge you an additional monthly premium on top of what you already pay for Medicare. That is the whole of it. It does not mean your Medicare coverage costs nothing.

    You Still Pay the Part B Premium

    This is the point that surprises people most. To join any Medicare Advantage plan, you must be enrolled in Part B, and you generally continue paying the Part B premium whether your plan premium is $0 or not. For many people it is deducted from their Social Security benefit, which is why it is easy to forget it is there.

    So a more accurate way to describe a $0 premium plan is this: you pay your Part B premium, and the plan does not add one of its own.

    Where Other Costs Show Up

    Every Medicare Advantage plan, whatever its premium, has cost-sharing. That is what you pay when you actually use care. Common forms include:

    • Copays: a set amount for a doctor visit, specialist visit, urgent care visit or prescription.
    • Coinsurance: a percentage of the cost of certain services, such as some procedures or equipment.
    • Deductibles: some plans have a medical deductible, a drug deductible, or both.
    • Hospital stays: many plans charge a daily amount for a set number of inpatient days.
    • Out-of-pocket maximum: every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. Once you reach it, the plan pays for covered services for the rest of the year.

    Two plans with the same $0 premium can have very different cost-sharing. One might have lower office copays and a higher out-of-pocket maximum; another might work the other way around. The premium alone tells you none of that.

    Networks and Rules Are Part of the Cost Too

    Most Medicare Advantage plans use a provider network. HMO plans usually require you to use in-network doctors except in emergencies, and many require referrals to see specialists. PPO plans generally let you go out of network at a higher cost. Some services also need prior authorization from the plan.

    None of this makes a plan good or bad. It just means the real question is whether the plan’s network and rules fit the way you get care. If your cardiologist or preferred hospital is not in network, that will matter far more than the premium line.

    How Extra Benefits Fit In

    Many plans include extras that Original Medicare does not cover, such as some dental, vision or hearing benefits, or a fitness program. These can be useful. They also vary widely in how much they actually cover, and they can change from one year to the next. Read the plan’s Evidence of Coverage or Summary of Benefits to see the limits, and confirm details with the plan before you count on them.

    Comparing a $0 Plan Fairly

    The fairest way to compare any Medicare option is to estimate a realistic year of costs. A simple approach:

    • Write down your doctors and check each one in the plan’s directory for the coming year.
    • List your prescriptions with dosages and check how each plan covers them.
    • Add up the premiums you would pay, including Part B.
    • Estimate copays for the visits and refills you expect.
    • Look at the out-of-pocket maximum as your cost in a harder health year.

    Some people compare a Medicare Advantage plan with Original Medicare plus a Medicare Supplement (Medigap) policy and a standalone Part D plan. Those paths are structured differently: one tends to have a higher monthly premium with more predictable costs when you use care, while the other often has a lower premium with cost-sharing when you use care. Both are legitimate choices, and the right one depends on your health, your doctors and how you prefer to budget.

    When You Can Make a Change

    The Medicare Annual Enrollment Period runs from October 15 to December 7, and changes take effect January 1. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 to March 31 lets you make one change: switch to another Medicare Advantage plan, or drop it and return to Original Medicare and possibly join a Part D plan. Our Medicare page explains how we help people review these options.

    Frequently Asked Questions

    Is a $0 premium Medicare Advantage plan really free?

    No plan is free in the full sense. A $0 premium means the plan does not charge its own monthly premium. You generally still pay your Part B premium, plus copays, coinsurance and any deductibles when you use care.

    Do I still pay the Part B premium with a $0 premium plan?

    Generally, yes. You must be enrolled in Part B to join a Medicare Advantage plan, and you usually keep paying the Part B premium. Many people have it deducted from their Social Security benefit.

    How can a plan charge a $0 premium?

    Medicare pays private plans a set amount each month to provide your Part A and Part B benefits. Some plans are able to cover their costs without charging members an additional premium.

    What is the out-of-pocket maximum?

    It is the yearly limit on what you pay for covered Part A and Part B services in a Medicare Advantage plan. After you reach it, the plan pays for covered services for the rest of the year. The limit varies by plan.

    How do I compare a $0 premium plan with other options?

    Estimate a full year of costs. Check your doctors and prescriptions against each plan, add premiums including Part B, estimate copays, and look at the out-of-pocket maximum. Confirm details with the plan, Medicare.gov or 1-800-MEDICARE.

    Look at the Whole Picture With a Licensed Agent

    If you would like help understanding what a zero premium Medicare Advantage plan would mean for your own doctors and prescriptions, call Maher Insurance Group at (866) 220-2834. You can also start with our short online questionnaire, and a licensed agent will follow up when it is convenient for you.

    Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.

  • Group Health for 2027: Why Q4 Is When Small Employers Need to Act

    Group Health for 2027: Why Q4 Is When Small Employers Need to Act

    If you run a small company in Florida and offer health benefits, or are thinking about starting, the last quarter of the year is where most of the real decisions happen. Your small business health insurance 2027 picture is shaped by what you do in October, November and December. Plenty of groups renew on January 1, employees expect to know their options before the holidays, and changes take longer to set up than most owners expect. Here is how the season works and what to do with it.

    Why So Many Groups Renew in Q4

    Small-group plans can renew at any point in the year, usually on the anniversary of the date the group first started coverage. In practice, a large share of employers line their plan year up with the calendar year, so January 1 is the busiest renewal date of all. If that is you, the renewal packet from your current plan typically arrives in the fall, and it is the starting point for every decision that follows.

    Even if your group renews in another month, Q4 is a natural time to look ahead. Employees are already thinking about their own Marketplace or spouse’s coverage options, budgets for the new year are being set, and your accountant is asking about benefits costs for tax planning.

    Read the Renewal Before You React to It

    A renewal notice tends to lead with the premium change, and that is the number owners notice first. It is worth slowing down and reading the whole thing.

    • Premium: what each tier will cost per month, and how that compares with this year.
    • Plan design: any change to deductibles, copays, coinsurance or the out-of-pocket maximum.
    • Network: whether the doctors and hospitals your team relies on are still in network for 2027.
    • Prescriptions: changes to the drug list that could affect an employee on a regular medication.
    • Deadlines: the date by which the plan needs your decision and your updated employee information.

    Sometimes the plan that renews is effectively a different plan. A higher deductible with a smaller premium increase can look like a better result when it is really a shift of cost onto your employees.

    Your Options at Renewal

    You are not limited to accepting what arrives in the mail. Common paths include:

    • Renewing as offered, if the plan still fits your team and your budget.
    • Staying with the same plan but changing how much you contribute toward employee or dependent premiums.
    • Offering more than one plan option so employees can choose a richer or leaner design.
    • Moving to a different plan design or a different funding arrangement, such as comparing level-funded and fully insured approaches.
    • Adding or reviewing ancillary benefits like dental, vision or life, which employees often value more than owners expect.

    Each of these has paperwork and timing attached. The earlier you start, the more of them are genuinely available to you.

    What a Realistic Q4 Timeline Looks Like

    For a group renewing January 1, the work usually runs in roughly this order:

    1. October: receive and review the renewal. Update your employee census, since ages, dependents and headcount changes all affect pricing.
    2. Early November: compare alternatives and decide on plan design and your contribution strategy.
    3. Mid November: hold employee open enrollment. Give people time to ask questions and talk with their families.
    4. Early December: submit enrollment forms and any required group paperwork.
    5. Late December: confirm that ID cards and plan information have reached employees before January 1.

    Every plan sets its own deadlines, so treat this as a rough shape rather than a rulebook, and work from the dates in your own renewal.

    Getting Employees Through Open Enrollment

    A good employee open enrollment is mostly about clear communication. People want to know three things: what is changing, what it costs them per paycheck, and whether their doctor is still covered. A one-page summary with side-by-side plan options, plus a short meeting or call, prevents most of the questions you would otherwise get in January.

    Ask every employee to return a form either enrolling or declining. Written waivers help keep your records clean and make next year’s renewal easier.

    A quick example

    A family-owned marine services company in Broward County with a dozen employees received a renewal with a noticeable increase and a higher deductible. Instead of passing the whole change on, the owner looked at offering two plan designs and adjusting the dependent contribution. Employees with families chose the richer plan, single employees mostly chose the leaner one, and the owner’s total cost landed closer to budget. None of that would have been possible if the renewal had been reviewed in the second week of December.

    Starting a Group Plan for the First Time

    If you have never offered coverage, a January 1 start date is a clean beginning, and Q4 is when to set it up. You will need basic business documentation, an employee census, and a decision about how much you plan to contribute. Plans also set participation and contribution requirements, so check them before you promise anything to your team.

    You can see how we work with Florida employers on our group health insurance page.

    Frequently Asked Questions

    When should a small business start planning its 2027 health plan?

    If your plan renews January 1, start when your renewal notice arrives in the fall. That leaves time to compare options, run employee open enrollment and submit paperwork before plan deadlines in December.

    Do I have to accept my renewal as offered?

    No. You can renew as offered, change your contribution, offer more than one plan, move to a different plan design or explore a different funding arrangement. Each option has its own deadlines, so earlier is easier.

    What is an employee census and why does it matter?

    A census is a list of eligible employees with details such as age, coverage tier and dependents. Plans use it to price your group, so an accurate census means accurate quotes.

    Can I start a group health plan for January 1?

    Yes, many employers start new plans on January 1. Plan on gathering business documents, a census and your contribution decision in Q4, and check the plan’s participation and contribution requirements before committing.

    Does a broker cost my business extra?

    Brokers are typically paid by the insurance company, so working with one generally does not add a separate fee for the employer. Ask any broker to explain how they are compensated.

    Talk Through Your 2027 Plan With Us

    If you would like help reviewing a renewal or setting up small business health insurance for 2027, call Maher Insurance Group at (855) 238-7947. Or fill out our short online questionnaire and a licensed agent will reach out to schedule a time that works for you.

  • How Your 2027 Income Estimate Affects Your ACA Subsidy (Get It Right)

    How Your 2027 Income Estimate Affects Your ACA Subsidy (Get It Right)

    When you apply for Marketplace coverage, one number does more work than any other: the household income you expect to earn next year. Your ACA income estimate decides whether you get a subsidy, how large it is, and whether you owe money back when you file taxes. Getting the ACA income estimate subsidy calculation right starts with an honest number. For 2027 coverage it matters more than it has in years, because the rules changed at the start of 2026. This guide walks through what counts as income, how to build an honest estimate, and what to do when the year does not go the way you planned.

    Why the Estimate Matters So Much for 2027

    The enhanced premium tax credits that many Floridians relied on expired at the end of 2025. Under current law, for 2027 coverage, subsidies are generally available to households with income between 100% and 400% of the federal poverty level. Above 400%, there is no subsidy at all.

    That creates a hard edge. Under the enhanced rules, a household a little over the line still got some help. Today, a household that estimates just under 400% may qualify for a meaningful credit, while one that lands just over it qualifies for none. Congress has debated an extension, and as of this writing it has not passed. So the estimate you enter is not a formality. It can move your monthly premium a long way in either direction, and you should confirm your own numbers when you apply.

    What Counts as Income on the Application

    The Marketplace uses a figure called modified adjusted gross income. You do not need to memorize the definition, but it helps to know roughly what goes into it:

    • Wages and salaries, after pre-tax payroll deductions such as workplace retirement contributions
    • Net self-employment income, meaning what is left after business expenses
    • Unemployment compensation
    • Taxable interest, dividends and capital gains
    • Taxable distributions from retirement accounts and pensions
    • Social Security benefits, including the portion that is not taxed
    • Rental income after expenses

    Some things usually do not count, such as child support you receive, gifts, and supplemental security income. Contributions to a traditional IRA or a health savings account can lower the figure. If you are unsure about a particular source, write it down and ask, because guessing tends to go wrong in one direction or the other.

    Who is in the household

    Household size matters as much as dollars. Generally it means you, your spouse if you are married, and anyone you claim as a tax dependent. If you plan to marry, divorce or add a child in 2027, the household on your tax return may look different from the one living under your roof today, and that changes the math.

    How to Build an Honest Estimate

    Start with last year’s tax return. It is the best record you have of what your household actually earned. Then adjust it for what you know is coming.

    • Salaried workers: take your current pay, add any raise you expect, and include bonuses only if they are reasonably likely.
    • Self-employed and 1099 workers: look at the last two or three years of net profit, not gross receipts. If business is growing, say so in the estimate.
    • Early retirees: plan your withdrawals. A large IRA distribution or a home sale with a gain can push income past the 400% line for that year.
    • Seasonal and commission earners: use a realistic annual average rather than your best month or your worst.

    Here is a common situation we see. A self-employed couple in Broward County, one a contractor and one a part-time bookkeeper, had a slow 2026 and wanted to estimate low. But two new contracts were already signed for spring. Their honest estimate included that work, and it landed them in a different place than the slow year would have. Building it carefully up front was far less painful than repaying credits the following April.

    What Happens When Your Real Income Is Different

    Premium tax credits are an advance on a credit you settle when you file your federal tax return. The Marketplace pays part of your premium each month based on your estimate, and then the IRS compares that with what you actually earned.

    • If you earned less than you estimated, you may get the difference back as a larger refund.
    • If you earned more, you may have to pay back some or all of the extra credit you received.
    • If your actual income ends up above 400% of the poverty level under current law, you may have to repay the advance credit you received for the year.

    Reconciliation is the reason a careful estimate matters. A low guess feels good every month and stings at tax time.

    Report Changes During the Year

    Your estimate does not have to be perfect, but it should stay current. If you take a new job, lose one, land a big client or start drawing on retirement savings, update your application on HealthCare.gov, which Florida uses. The Marketplace will recalculate your credit going forward, and the adjustment is spread across the remaining months.

    Some households choose to take less than the full advance credit each month as a cushion, then collect any remainder at tax time. That is a reasonable option if your income is hard to predict. It means a higher monthly premium in exchange for less risk of a repayment.

    Timing for 2027 Coverage

    Open Enrollment for 2027 coverage runs from November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage that starts January 1; enrolling from December 16 to January 15 means coverage starts February 1. If you already have a Marketplace plan and do nothing, it renews automatically, and it renews using information that may be out of date. Updating your income during Open Enrollment is the simplest way to start the year with the right credit. You can read more about how we help with applications on our ACA Marketplace page.

    Frequently Asked Questions

    What income does the Marketplace use to calculate my subsidy?

    It uses your household’s modified adjusted gross income for the coverage year. That generally includes wages, net self-employment income, taxable retirement distributions, investment income and all Social Security benefits. Your estimate is for 2027, not the year that just ended.

    Who can get an ACA subsidy for 2027?

    Under current law, premium tax credits for 2027 are generally available to households between 100% and 400% of the federal poverty level. Above 400% there is no subsidy. Congress has debated an extension, so confirm the rules and your numbers when you apply.

    What if I underestimate my income?

    You may have to pay back some or all of the extra credit when you file your federal tax return. If your actual income ends up above 400% of the poverty level, you may have to repay the advance credit you received for the year.

    Should I update my income if it changes mid-year?

    Yes. Reporting changes on HealthCare.gov lets the Marketplace adjust your credit for the remaining months, which reduces the gap you would otherwise settle at tax time.

    Can a broker help me estimate my income?

    A licensed broker can walk through your income sources and household size with you and help you enter them correctly. For tax questions specific to your situation, a tax professional is the right person to confirm the details.

    Get Your Estimate Right With a Second Set of Eyes

    If you want help putting together a realistic ACA income estimate for 2027, call Maher Insurance Group at (855) 238-7947. You can also fill out our short online questionnaire, and a licensed agent will follow up at a time that suits you.

  • Questions to Ask Before You Switch Medicare Plans This AEP

    Questions to Ask Before You Switch Medicare Plans This AEP

    Switching Medicare plans can be a good move, and it can also create problems that are hard to undo until the next enrollment window. The difference usually comes down to whether you asked the right questions before switching Medicare plans, not after. The Annual Enrollment Period runs October 15 through December 7, and changes take effect January 1, so there is time to ask them.

    This article is educational only. Medicare.gov and 1-800-MEDICARE (TTY 1-877-486-2048) are the official sources for plan and coverage information.

    Below are the questions we encourage people to work through, in roughly the order they come up. Bring them to any conversation with a plan, an agent or 1-800-MEDICARE.

    Questions About Your Current Plan

    1. What exactly is changing in my plan next year?

    Your Annual Notice of Change, mailed in September if you have a Medicare Advantage or Part D plan, lists the changes for the coming year. Read it before shopping. Sometimes the answer to whether you should switch is right there, and sometimes it shows the changes are minor.

    2. What is the specific problem I want to solve?

    Write it in a sentence. A higher copay for specialists, a drug that moved tiers, a doctor who left the network. A clear reason keeps the comparison focused, and it helps you avoid switching for something that sounded appealing in an ad but does not change your actual care.

    Questions About Doctors and Hospitals

    3. Are all my must-keep doctors in the new plan’s network next year?

    Check each one in the plan’s provider directory for the coming year, and call the offices to ask which plans they expect to accept. Do not rely on last year’s directory or a friend’s experience.

    4. Do I need referrals, and how does out-of-network care work?

    HMO and PPO plans handle referrals and out-of-network care differently. If you see several specialists, or want flexibility, this question matters. Original Medicare works differently again, since it does not use networks in the same way.

    5. What happens when I travel?

    Many South Florida residents spend part of the year up north, or travel to see family. Ask how the plan covers routine and urgent care outside its service area. The answer varies a lot between plans and paths.

    Questions About Prescriptions

    6. Is every one of my medications covered, and on what tier?

    Check each drug by name and strength on the plan’s formulary. Note the tier and whether there are restrictions such as prior authorization, step therapy or quantity limits.

    7. What will my drugs cost at my pharmacy?

    Plans often have preferred pharmacies with lower cost-sharing. Ask how your pharmacy is treated, and whether mail order would cost less for maintenance drugs. The Medicare Plan Finder on Medicare.gov can estimate this when you enter your pharmacy.

    Questions About Cost

    8. What would a realistic year cost, and what about a hard year?

    Add up premiums, the deductible if any, copays for the visits you expect, and drug costs. For Medicare Advantage plans, look at the out-of-pocket maximum as your ceiling in a tougher year. Keep in mind that most people continue paying the Part B premium regardless of the plan’s own premium.

    9. Are the extra benefits ones I will actually use?

    Some Medicare Advantage plans include extras such as dental, vision or hearing benefits. They can be useful, but check the limits, the network and what you would really use. An extra benefit should be a bonus, not the main reason for a switch.

    Questions About the Switch Itself

    10. What happens to my other coverage if I switch?

    This one is easy to overlook. Enrolling in a new Medicare Advantage plan generally ends your old one when the new plan starts. Joining some plans can also end a stand-alone Part D plan, and Medigap policies do not work with Medicare Advantage. If you are thinking of moving from Medicare Advantage to Original Medicare with a Medigap policy, ask whether you would face health questions for the Medigap policy, since that can apply in some situations.

    What If You Change Your Mind?

    During AEP, if you enroll and then reconsider before December 7, you can choose again. The last enrollment submitted during the period is generally the one that takes effect. If you are in a Medicare Advantage plan on January 1, the Medicare Advantage Open Enrollment Period from January 1 to March 31 allows one change, either to another Medicare Advantage plan or back to Original Medicare, with the option to join a Part D plan.

    Knowing that safety net exists can take some of the pressure off, but it is still better to get the decision right the first time.

    Questions to Ask Anyone Helping You

    If you work with an agent, it is reasonable to ask:

    • Which plans in my county do you offer, and are there others you do not?
    • How did you check my doctors and drugs against each plan?
    • Can you show me the full-year cost estimate for each option?

    A good agent will answer those directly. Independent brokers can compare several plans, but no broker offers every plan, and Medicare.gov and 1-800-MEDICARE can show all your options. For a general overview first, see our page on Medicare plans in Florida.

    Frequently Asked Questions

    What should I check before switching Medicare plans?

    Start with your Annual Notice of Change, then confirm your doctors are in the new plan’s network for next year, your drugs are covered at your pharmacy, and the full-year cost fits your budget. Also ask how the switch affects any other coverage you have.

    When can I switch Medicare plans?

    The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. People in a Medicare Advantage plan can also make one change during the Medicare Advantage Open Enrollment Period, January 1 to March 31.

    Will switching to a new Medicare Advantage plan cancel my old one?

    Generally yes. Enrolling in a new Medicare Advantage plan usually ends your old plan when the new one starts. Confirm with the new plan or 1-800-MEDICARE if you also have a stand-alone Part D plan or a Medigap policy.

    Can I go back to Original Medicare after Medicare Advantage?

    Yes, during AEP or during the Medicare Advantage Open Enrollment Period from January 1 to March 31. If you want a Medigap policy as well, ask whether health questions may apply in your situation.

    Are extra benefits a good reason to switch plans?

    They can be part of the decision, but check the limits and networks first. Doctors, drugs and total costs usually have a bigger effect on your year than extra benefits do.

    Work Through the Questions With Us

    If you would like a licensed agent to go through these questions with you against the plans we offer in your county, call Maher Insurance Group at (866) 220-2834, or complete our short online questionnaire and we will follow up at a time that works for you.

    Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.

  • Renewing vs. Switching Your Marketplace Plan: Don’t Just Auto-Renew

    Renewing vs. Switching Your Marketplace Plan: Don’t Just Auto-Renew

    If you have Marketplace coverage this year and do nothing during open enrollment, HealthCare.gov will generally renew you for 2027. That sounds convenient, and sometimes it is. But an auto-renew marketplace plan is next year’s version of your plan, not this year’s, and the differences can include the premium, the doctors in network, the drugs on the list and the amount of financial help you receive.

    Open enrollment runs from November 1, 2026 to January 15, 2027, with December 15 as the date to enroll for coverage starting January 1. That gives you time to look before you let renewal decide for you.

    What Actually Happens When You Auto-Renew

    When you are re-enrolled automatically, you are generally placed back in the same plan if it is still offered, or in a similar plan if it is not. Your financial help for 2027 is calculated using the information the Marketplace has on file, which may not reflect changes in your income or household.

    That creates a few risks:

    • Your premium may change. Plans set new rates each year.
    • Your subsidy may change. The enhanced premium tax credits expired at the end of 2025. Under current law, for 2027, subsidies are generally available to households between 100% and 400% of the federal poverty level, with no subsidy above 400%. Congress has debated an extension, but as of this writing it has not passed. Many people will see a different net premium for that reason alone.
    • Your network may change. Doctors and hospitals can join or leave a plan’s network between years.
    • Your drug coverage may change. Formularies are updated, and a medication can move tiers or leave the list.
    • Your information may be stale. If your income, household size or address changed and you did not update the Marketplace, your financial help may be off, and premium tax credits are reconciled on your tax return.

    When Renewing Makes Sense

    Staying put can be the right choice. It often works well when:

    • Your doctors are confirmed in the plan’s 2027 network
    • Your medications are still covered at similar tiers
    • The 2027 premium, after any financial help, fits your budget
    • Your deductible and out-of-pocket structure still match how you use care

    Even then, update your application with your current income and household. That is what keeps your financial help accurate, and it takes much less time than dealing with a reconciliation surprise at tax time.

    When Switching Makes Sense

    Look harder at other plans if:

    • Your renewal notice shows a premium increase you did not expect
    • A doctor or hospital you rely on is leaving the network
    • A medication you take changed tiers or is no longer covered
    • Your health needs changed, for example a new diagnosis, a planned surgery or a pregnancy
    • Your income changed enough to affect your financial help or eligibility for cost-sharing reductions

    Switching during open enrollment does not carry a penalty. You simply choose a new plan, and it replaces your current one for the new plan year.

    A Simple Review Process

    Set aside an evening sometime in November. Then:

    • Read your renewal notice from the plan and any notice from the Marketplace
    • Log into HealthCare.gov and update your income estimate and household details
    • Look at your eligibility results for 2027
    • Check your current plan’s 2027 network for your doctors and its drug list for your prescriptions
    • Compare it against two or three other plans in your county on total yearly cost
    • Decide to stay or switch, and save your confirmation

    If you switch, remember to pay the first premium to the new insurance company. Coverage does not begin until that payment is received.

    A Real-World Example

    Consider a self-employed couple in Fort Lauderdale who renewed automatically last year without checking. In January, one of them called to book a follow-up with a specialist and learned the practice had left the plan’s network. The couple had to choose between paying out of network or finding a new specialist mid-treatment. A quick look at the provider directory in November would have flagged it, and they could have compared plans that kept the practice in network.

    Situations like that are common, and they are usually avoidable. The review is not complicated. It just has to happen before the deadline instead of after.

    Keep Your Paperwork Together

    Whatever you decide, keep the renewal notice, your eligibility results and your enrollment confirmation in one folder, paper or digital. If you switch, add the new plan’s welcome letter and first payment receipt. Early next year the Marketplace will send Form 1095-A for the current year, which you need to reconcile your premium tax credit when you file. Having everything in one place makes tax season and any follow-up call with the plan much easier.

    If you notice something wrong after you enroll, such as a misspelled name or the wrong household size, fix it on HealthCare.gov right away rather than waiting.

    Questions to Ask Yourself

    • Did my income or household change this year, or will it next year?
    • Are my doctors and hospital in this plan’s network for 2027?
    • Are my prescriptions covered, and on what tier?
    • How much would a realistic year cost, including premiums and care I expect?
    • Is there a plan that fits better for about the same total cost?

    If you answer those honestly, you will know whether to renew or switch. You can also read more about how we approach Marketplace plan reviews.

    Frequently Asked Questions

    What happens if I let my Marketplace plan auto-renew?

    You will generally be re-enrolled in the same plan for 2027 if it is still offered, or a similar plan if it is not. Your premium, network, drug list and financial help can all change, so reviewing first is wise.

    Is there a penalty for switching Marketplace plans during open enrollment?

    No. During open enrollment, November 1, 2026 to January 15, 2027, you can choose a different plan for 2027. Enroll by December 15 for coverage that starts January 1.

    Why might my subsidy be different for 2027?

    The enhanced premium tax credits expired at the end of 2025. Under current law, subsidies are generally available to households between 100% and 400% of the federal poverty level, with no subsidy above 400%. Your updated income estimate also affects the amount.

    Do I need to update my application even if I keep the same plan?

    Yes, it is a good idea. Updating your income and household details keeps your financial help accurate. Premium tax credits are reconciled on your tax return, so outdated information can lead to owing money back.

    If I switch plans, when does the new one start?

    If you enroll by December 15, the new plan starts January 1. Enrolling between December 16 and January 15 means it starts February 1. Coverage begins only after you pay the first premium.

    Get a Second Look Before You Renew

    If you would like a licensed agent to compare your renewal against other 2027 options, call Maher Insurance Group at (855) 238-7947, or start with our short online questionnaire and we will follow up when it suits you.

  • ACA Open Enrollment Is Live: How to Enroll in 2027 Coverage

    ACA Open Enrollment Is Live: How to Enroll in 2027 Coverage

    Open enrollment for 2027 Marketplace coverage opened on November 1, and it runs through January 15, 2027. If you are ready to enroll in ACA coverage 2027 plans now, this guide walks through the process from start to finish, including the step people most often forget: paying the first premium.

    Florida uses HealthCare.gov, so these steps follow that process. If you work with a broker, the steps are the same; you just have someone doing them alongside you.

    Know Your Deadline

    • Enroll by December 15, 2026 for coverage that starts January 1
    • Enroll between December 16 and January 15, 2027 for coverage that starts February 1
    • After January 15, you generally need a Special Enrollment Period from a qualifying life event, usually within 60 days of the event

    If you are losing other coverage at the end of December, aim for the December 15 date so there is no gap.

    Step 1: Gather What You Need

    Before you log in, have these within reach:

    • Names, dates of birth and Social Security numbers for everyone in your tax household
    • Immigration document details for lawfully present immigrants applying for coverage
    • Recent pay stubs, your latest tax return and any other income records
    • Information about any job-based coverage offered to anyone in the household
    • A list of your doctors and your prescriptions

    Having it ready means you can finish the application in one sitting.

    Step 2: Log In or Create Your Account

    Go to HealthCare.gov and log into your existing account, or create one if you are new. If you had Marketplace coverage this year, you will see your current application. Update it rather than starting fresh, so your information carries over correctly.

    Step 3: Complete or Update the Application

    The application asks about your household, where you live, any other coverage, and your expected income for 2027. Take your time on the income section.

    About financial help this year. The enhanced premium tax credits expired at the end of 2025. Under current law, for 2027 coverage, subsidies are generally available to households with income between 100% and 400% of the federal poverty level, and there is no subsidy above 400%. Congress has debated an extension, but as of this writing it has not passed. Your eligibility notice will show what you qualify for, so confirm the numbers when you get them.

    If you are self-employed or your income varies, use your best estimate of 2027 net income. Premium tax credits are reconciled on your tax return, so a realistic estimate now, and updates during the year if things change, help you avoid owing money back.

    Step 4: Review Your Eligibility Results

    After you submit the application, HealthCare.gov shows whether you qualify for a premium tax credit, cost-sharing reductions or other programs. Read this carefully. If something looks wrong, such as a household member listed incorrectly, go back and fix the application before you pick a plan.

    Step 5: Compare Plans

    Now the actual shopping begins. Narrow the list with filters, then compare the remaining plans on:

    • Doctors and hospitals. Check each plan’s 2027 provider directory for your doctors, and call offices you cannot do without.
    • Prescriptions. Look up each medication in the plan’s drug list and note the tier.
    • Metal level. Bronze plans generally have lower premiums and higher out-of-pocket costs; Gold and Platinum lean the other way. Silver plans may come with cost-sharing reductions for some lower-income households.
    • Total yearly cost. Add up premiums and what you would likely pay for the care you expect.
    • Network type. HMO, EPO and PPO plans handle referrals and out-of-network care differently.

    Step 6: Choose and Enroll

    Select your plan and complete the enrollment. If you are receiving a premium tax credit, you can choose to have it applied in advance to lower your monthly premium, or take some or all of it when you file your taxes. Most people apply it in advance, but it is your choice.

    Save or print your confirmation. It is your proof that you completed enrollment.

    Step 7: Pay Your First Premium

    This is the step that trips people up. Your coverage does not start until the insurance company receives your first premium payment, often called the binder payment. Enrolling on HealthCare.gov is not the same as paying.

    After you enroll, the plan will send payment instructions, or you may be able to pay online right away. Note the due date and pay it. If you do not, your enrollment can be canceled before it ever begins.

    Step 8: Watch for Your Member Card

    Your plan will mail a welcome packet and member ID card. When it arrives:

    • Check that names and dates of birth are correct
    • Set up your online member account
    • Give your new card to your doctors’ offices and pharmacy in January
    • Fill a prescription early in the month to make sure everything is working

    If You Already Have a Marketplace Plan

    If you do nothing, you will generally be renewed automatically for 2027. That can leave you in a plan whose price, network or drug list changed, with subsidies based on outdated information. Updating your application and comparing your options is the safer path, even if you end up staying in the same plan.

    When to Get Help

    Many people complete enrollment on their own without much trouble. Others prefer help, especially when income is irregular, a household includes people with different coverage, or a specific doctor matters a lot. A licensed broker can walk through the application with you at no extra cost. You can read more about our approach to Marketplace health coverage before you reach out.

    Frequently Asked Questions

    How do I enroll in ACA coverage for 2027?

    Log into HealthCare.gov, complete or update your application with your 2027 income estimate and household details, review your eligibility results, compare plans, choose one, and pay your first premium to the insurance company.

    What is the deadline to enroll for January 1 coverage?

    Enroll by December 15, 2026 for coverage that starts January 1. Enrollments from December 16 to January 15, 2027 start February 1. Open enrollment ends January 15.

    Is my coverage active once I enroll on HealthCare.gov?

    Not until you pay your first premium to the insurance company. If that first payment is not made by the due date, your enrollment can be canceled before coverage begins.

    Should I take my premium tax credit in advance?

    Most people apply it in advance to lower their monthly premium, but you can take some or all of it at tax time instead. Either way, the credit is reconciled on your tax return, so report income changes during the year.

    Can a broker help me enroll?

    Yes. A licensed broker can help you complete the application, compare plans and check doctors and prescriptions. Working with Maher Insurance Group does not add a fee to your premium.

    Enroll With a Licensed Agent

    If you would like help with your application or comparing 2027 plans, call Maher Insurance Group at (855) 238-7947, or fill out our short online questionnaire and we will follow up at a time that works for you.

  • ACA Open Enrollment Starts Sunday: What Florida Shoppers Should Know

    ACA Open Enrollment Starts Sunday: What Florida Shoppers Should Know

    Florida ACA open enrollment for 2027 coverage begins this Sunday, November 1. Florida residents shop and enroll through HealthCare.gov. The first few weeks tend to be busy, both on the website and at brokers’ offices, so a little preparation before Sunday goes a long way.

    Here is what Florida shoppers should know before the window opens, including the dates, what is different about financial help this year, and how to approach plan choices in a state where networks vary a lot from county to county.

    The Dates

    • November 1, 2026: open enrollment begins on HealthCare.gov
    • December 15, 2026: enroll by this date for coverage that starts January 1
    • January 15, 2027: last day to enroll; plans chosen between December 16 and January 15 start February 1

    You may have seen reports that open enrollment would end on December 15 this year. A 2025 rule would have done that, but a federal court vacated it in 2026, and HealthCare.gov lists January 15 as the last day. After January 15, you generally need a Special Enrollment Period tied to a qualifying life event, usually within 60 days of the event, such as losing other coverage, moving or having a baby.

    What Is Different About Financial Help This Year

    This is the biggest change for many Florida households. The enhanced premium tax credits that applied in recent years expired at the end of 2025. Under current law, for 2027 coverage, premium tax credits are generally available to households with income between 100% and 400% of the federal poverty level. Above 400%, there is no subsidy. Congress has debated an extension, but as of this writing nothing has passed.

    What that means in practice:

    • Some households who received help in past years may see less help, or none, for 2027
    • Your 2027 income estimate matters more than ever, so build it carefully
    • Your renewal notice may show a higher net premium than you are used to, even if the plan itself did not change much

    Confirm your own numbers when you apply, since your eligibility depends on your household size and income estimate. If your income is near the 400% line, small changes in your estimate can make a large difference, which is a good reason to work through it carefully or with help.

    Don’t Rely on Automatic Renewal

    If you are enrolled in a Marketplace plan now and do nothing, you will generally be renewed automatically for 2027. That is convenient, but it can leave you in a plan whose premium, network or drug list changed, with financial help calculated on old information.

    Log in, update your income and household details, and look at the plans available for 2027 before you let renewal happen. It is the only way to know whether staying is still the right move.

    Networks Matter a Lot in Florida

    Plans in Florida range from broad networks to much narrower ones designed to keep premiums lower. A plan that includes your doctors in Broward might not include them in Palm Beach, and the plan your sister has in Orlando may not be offered in your county at all.

    Before you choose:

    • Look up your primary care doctor, specialists and preferred hospital in each plan’s 2027 provider directory
    • Call the doctor’s office if a particular doctor is important to you
    • Check whether the plan requires referrals to see specialists

    Check Your Prescriptions

    Each plan has its own drug list. Look up every medication you take, by exact name and dose, in each plan’s formulary, and check the tier. The same drug can have very different costs in plans that otherwise look similar.

    Think About Total Cost, Not Just Premium

    Bronze, Silver, Gold and Platinum plans balance premiums and out-of-pocket costs differently. A lower premium usually means you pay more when you use care, through deductibles, copays and coinsurance. Think about how you used care this year and what you expect next year.

    For some lower-income households, Silver plans can come with cost-sharing reductions that lower deductibles and copays. Ask about it if your income is toward the lower end of the range.

    If You Are Self-Employed or Between Jobs

    Plenty of Floridians are self-employed, work gig jobs or are between employers, and many of them buy coverage through the Marketplace. Estimating income is harder when it changes month to month. Use your best projection of net self-employment income for 2027, keep records, and report significant changes during the year. Since premium tax credits are reconciled on your tax return, staying current with the Marketplace helps avoid surprises at tax time.

    A Word About Alternatives

    You may see ads for short-term medical plans or fixed indemnity plans this time of year. These are not ACA plans and are not comprehensive health coverage. They can have coverage limits and exclusions that Marketplace plans do not. If you consider one, read exactly what it does and does not cover.

    Getting Started

    You can apply on your own at HealthCare.gov, or work with a licensed broker who can help you compare plans side by side. Learn more about our approach to ACA Marketplace coverage before the window opens.

    Frequently Asked Questions

    When does Florida ACA open enrollment start for 2027 coverage?

    Open enrollment begins November 1, 2026 on HealthCare.gov, which Florida uses. Enroll by December 15 for coverage starting January 1. The last day is January 15, 2027, with coverage starting February 1 for enrollments after December 15.

    Did open enrollment get shorter this year?

    No. A 2025 rule would have ended open enrollment on December 15, but a federal court vacated it in 2026. HealthCare.gov lists January 15, 2027 as the last day to enroll.

    Are ACA subsidies still available in Florida for 2027?

    Under current law, premium tax credits are generally available to households between 100% and 400% of the federal poverty level, with no subsidy above 400%. The enhanced credits expired at the end of 2025, and an extension has been debated but not passed as of this writing.

    What happens if I do nothing during open enrollment?

    If you already have a Marketplace plan, you will generally be renewed automatically. Your plan’s price, network or drug list may change, and your financial help may be based on outdated information, so it is wise to update your application and review your options.

    Are short-term plans a substitute for ACA coverage?

    No. Short-term medical and fixed indemnity plans are not ACA plans and are not comprehensive health coverage. They can have limits and exclusions, so read the plan documents carefully before considering one.

    Talk to a Florida Broker

    If you would like a licensed agent to help you estimate income, check your doctors and compare 2027 plans, call Maher Insurance Group at (855) 238-7947, or start with our short online questionnaire and we will follow up when it works for you.

  • How to Compare Part D Drug Plans During AEP (Formularies, Tiers & Pharmacies)

    How to Compare Part D Drug Plans During AEP (Formularies, Tiers & Pharmacies)

    Drug coverage is where Medicare plans differ most from one another, and it is also where small details have the biggest effect on what you pay. If you want to compare Part D plans AEP is the time to do it: the Annual Enrollment Period runs October 15 through December 7, and a new drug plan you choose then starts January 1.

    This article is educational only. Medicare.gov and 1-800-MEDICARE (TTY 1-877-486-2048) are the official sources for plan and coverage information.

    This guide explains the three things that matter most when you compare drug coverage, formularies, tiers and pharmacies, and how to check each one against your own prescriptions. It applies to stand-alone Part D plans and to the drug coverage built into many Medicare Advantage plans.

    Start With an Accurate Medication List

    Every comparison depends on this list, so make it precise. For each prescription, write down:

    • The exact drug name, and whether you take the brand or the generic
    • The strength and form, such as tablet, capsule, injection or inhaler
    • How many you take and how often you refill, monthly or every 90 days
    • The pharmacy you use, or whether you use mail order

    Include medications you take only some of the year, such as a seasonal inhaler. A plan that looks great for your daily pills can look different once the occasional prescription is added.

    Part 1: The Formulary

    A formulary is the plan’s list of covered drugs. Every Part D plan has one, and they are not identical. A drug covered by one plan might not be covered by another, or might be covered only in a certain form or strength.

    When you check a formulary, look for each of your medications by name and strength. If a drug is not on the list, find out whether there is a covered alternative your doctor would be comfortable with, or whether the plan has an exception process. Do not assume a drug is covered because it was covered by this year’s plan; formularies can change from year to year, and your Annual Notice of Change will flag changes if you are staying put.

    Part 2: Drug Tiers

    Plans sort covered drugs into tiers. Lower tiers usually include many generics and carry lower cost-sharing. Higher tiers often include brand-name and specialty drugs with higher cost-sharing. The names and number of tiers vary by plan.

    Two things are worth knowing about tiers:

    • The same drug can sit on different tiers in different plans. That is one of the main reasons two plans with similar premiums can produce very different yearly costs.
    • Tiers determine whether you pay a copay or coinsurance. A copay is a set amount. Coinsurance is a percentage of the drug’s cost, which can vary through the year and is often used on higher tiers.

    Look at the tier for each of your drugs in each plan, and note whether the plan’s deductible applies to that tier.

    Part 3: Restrictions on Coverage

    Even when a drug is on the formulary, the plan may attach rules to it. Watch for:

    • Prior authorization: your doctor must get the plan’s approval before it covers the drug
    • Step therapy: the plan wants you to try a different drug first
    • Quantity limits: the plan covers only a certain amount within a period

    These rules are common and not a reason by themselves to avoid a plan. But if you already take a medication under one of these rules, it helps to know whether a new plan would ask your doctor to go through the process again.

    Part 4: Pharmacies

    Many plans have a network of pharmacies, and some have preferred pharmacies within that network. Filling the same prescription at a preferred pharmacy can cost less than at a standard network pharmacy. Out-of-network pharmacies generally are not covered except in limited situations.

    Check how each plan treats the pharmacy you actually use. If you have relied on the same local pharmacy for years, that relationship may matter to you more than a modest price difference. Mail order is another option in many plans and can be convenient for maintenance drugs, so compare that price too if it fits your routine.

    Putting It Together: Price a Full Year

    Once you know where each drug sits in each plan, estimate what a full year would cost:

    • Twelve months of plan premiums
    • The deductible, if your drugs fall under it
    • Your copays or coinsurance for each refill through the year

    The Medicare Plan Finder on Medicare.gov does this math when you enter your drugs and pharmacy, and it is worth using even if you also work with an agent. Part D also now includes a yearly limit on what you pay out of pocket for covered drugs, and Medicare.gov lists the current details. That limit can matter a great deal for people on expensive medications.

    If You Are in a Medicare Advantage Plan

    Most Medicare Advantage plans include drug coverage, so the same checks apply, but you are comparing the medical and drug sides together. A plan with a strong formulary for your drugs might not include a doctor you need, and the reverse can happen too. Check both before you decide.

    If You Get Extra Help

    If you qualify for Extra Help with Part D costs, your costs and enrollment options may differ from what is described here. Medicare.gov and 1-800-MEDICARE can explain how Extra Help applies to you.

    A Quick Checklist for Each Plan

    Before you settle on a drug plan, confirm for each of your medications:

    • Is it on the formulary, at your strength and form?
    • What tier is it on, and is that a copay or coinsurance?
    • Does it need prior authorization, step therapy or have a quantity limit?
    • What does it cost at your pharmacy, and at a preferred pharmacy or by mail?

    If you would like a general overview of how drug coverage fits with the rest of your choices, our page on Medicare plans in Florida is a good companion to this guide.

    Frequently Asked Questions

    When can I change my Part D drug plan?

    During the Annual Enrollment Period, October 15 through December 7. A new plan you choose then takes effect January 1. Other enrollment periods may apply in specific situations, and Medicare.gov can explain them.

    What is a Part D formulary?

    It is the plan’s list of covered drugs. Each plan has its own formulary, and a drug covered by one plan may not be covered by another, or may be covered only in certain strengths or forms.

    Why does the same drug cost different amounts in different plans?

    Plans place drugs on different tiers, use copays or coinsurance differently, apply deductibles differently and have different preferred pharmacies. Those differences add up over a year even when premiums look similar.

    Does my choice of pharmacy really change what I pay?

    It can. Many plans have preferred pharmacies where cost-sharing is lower, and mail order may be priced differently from a retail counter. Enter your actual pharmacy when you compare plans.

    What should I do if a drug I take is not on a plan’s formulary?

    Ask your doctor whether a covered alternative would work for you, and ask the plan about its exception process. If neither fits, that plan may not be the right choice for your medications.

    Want Help Running Your Drug List?

    If you would like a licensed agent to compare your medications across the drug plans we offer, call Maher Insurance Group at (866) 220-2834, or complete our short online questionnaire and we will follow up at a convenient time.

    Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.

  • Use It or Lose It: Maximize Dental & Vision Benefits Before Dec 31

    Use It or Lose It: Maximize Dental & Vision Benefits Before Dec 31

    If your dental or vision plan runs on a calendar year, the last few months of the year are when unused benefits quietly disappear. Most plans do not let you carry them forward, which is why it makes sense to use dental benefits before end of year if you have treatment or checkups you have been putting off. The same goes for vision allowances and, for many people, money sitting in a flexible spending account.

    This is not about booking care you do not need. It is about not leaving behind coverage you already paid for. Here is how to check what you have left and plan the next few weeks.

    Why Benefits Reset on January 1

    Many dental plans have an annual maximum, the most the plan will pay toward your care in a plan year. Many also have a deductible that starts over each year. If your plan year follows the calendar, both reset on January 1.

    That creates a few situations worth thinking about:

    • If you have met your deductible this year, more work done before December 31 may cost you less out of pocket than the same work done in January
    • If you still have room under your annual maximum, that room usually does not roll over
    • Preventive visits such as cleanings and exams are often covered at a higher level, and plans typically allow a set number per year

    Some plans run on a different benefit year, so check your plan documents or call the plan to confirm when yours resets. Do not assume.

    Step 1: Find Out What You Have Left

    Call the number on your dental card or log into the plan’s member site and ask:

    • How much of the annual maximum you have used this year
    • Whether your deductible has been met
    • How many cleanings and exams you have used and how many remain
    • When your benefit year ends
    • Whether any waiting periods still apply to major work

    Write the answers down. It is a short call, and it is the only way to plan sensibly.

    Step 2: Talk to Your Dentist About Timing

    If your dentist has recommended work you have not scheduled yet, such as a filling or a crown, ask whether it makes sense to do some of it this year and some next year. For larger treatment plans, splitting the work across two benefit years can sometimes let you use two years of annual maximums. Your dentist’s office handles this question all the time and can help you decide what is sensible clinically.

    Ask the office to send a pre-treatment estimate to your plan for anything significant. That gives you a clearer idea of what the plan will pay before the work is done, though the final amount depends on the claim.

    Step 3: Book Now, Because Everyone Else Is Too

    Dental and eye care offices in South Florida get busy in November and December for exactly this reason. Seasonal residents return, people realize their benefits are about to reset, and the holidays cut into available days. If you want an appointment before December 31, calling in October or early November gives you far more options.

    Vision Benefits Work Much the Same Way

    Vision plans usually include an eye exam once per benefit period and an allowance toward glasses or contact lenses. Those allowances also tend to reset each year.

    To make use of yours:

    • Check when you last had a covered exam and whether you are eligible again
    • Ask how much of your frame or contact lens allowance remains
    • Confirm the eye doctor or retailer is in your plan’s network before you go
    • If you need new glasses, order early enough to allow time for lenses to be made before year end

    Don’t Forget Your FSA

    If you have a health care flexible spending account through work, the deadline to use that money depends on your employer’s plan. Some plans give a grace period into the new year, some allow a limited carryover and some have neither. Check with your benefits administrator so you know your actual deadline.

    FSA dollars can usually go toward dental and vision costs such as copays, deductibles, glasses and contacts, which pairs nicely with the planning above. A health savings account works differently, since HSA money generally stays yours from year to year.

    What About Medicare?

    Original Medicare generally does not cover routine dental or vision care. Some Medicare Advantage plans include dental or vision extras, and these benefits often have their own annual limits that reset with the plan year. If you have one of those plans, the same idea applies: check what you have used and what remains. Medicare questions are a topic of their own, and Medicare.gov is the official source for coverage details.

    Thinking About Coverage for Next Year?

    If this exercise showed that you do not have dental or vision coverage, or that your plan’s limits do not fit the care you need, the end of the year is a natural time to look at options for next year. Individual dental plans vary in waiting periods, annual maximums and networks, so read the details before you enroll. You can read more about individual dental insurance and what to look for.

    Frequently Asked Questions

    Do unused dental benefits roll over to the next year?

    In most plans, no. The annual maximum and deductible usually reset at the start of each benefit year. Some plans have different rules, so check your plan documents or call the plan to confirm how yours works.

    When should I schedule dental work to use my benefits before year end?

    As early as you can. Offices get busy in November and December, so booking in October or early November gives you the best chance of fitting cleanings, exams or recommended work in before December 31.

    Can I split dental treatment across two plan years?

    Sometimes. For larger treatment plans, your dentist may be able to do part of the work this year and part next year, which can let you use two years of benefits. Ask your dentist whether that timing is sensible for your care.

    Do vision benefits also reset every year?

    Usually. Vision plans commonly allow one exam per benefit period plus an allowance for glasses or contacts, and those generally reset each year. Confirm your benefit period and remaining allowance with the plan.

    What happens to my FSA money at the end of the year?

    It depends on your employer’s plan. Some offer a grace period, some allow a limited carryover and some have neither. Check with your benefits administrator so you know your exact deadline.

    Questions About Your Dental or Vision Coverage?

    If you would like help understanding your current benefits or comparing dental and vision options for next year, call Maher Insurance Group at (855) 238-7947, or fill out our short online questionnaire and a licensed agent will follow up.

  • Switching Medicare Advantage Plans During AEP: Step by Step

    Switching Medicare Advantage Plans During AEP: Step by Step

    If you want to switch Medicare Advantage plans, the Annual Enrollment Period is the main time of year to do it. AEP runs from October 15 through December 7, and a new plan you choose during that window starts January 1. The mechanics are simpler than most people expect, but the preparation is where the switch either goes smoothly or turns into a February headache.

    This article is educational only. Medicare.gov and 1-800-MEDICARE (TTY 1-877-486-2048) are the official sources for plan and coverage information.

    Here is the process, step by step, the way we walk people through it in Broward, Palm Beach and Miami-Dade.

    First, Make Sure You Actually Want to Switch

    People usually start thinking about switching for one of a few reasons: the Annual Notice of Change showed a premium or copay increase, a drug moved tiers, a doctor left the network, or a neighbor mentioned a plan with a benefit that sounds appealing.

    Any of those can be a good reason. Before you go further, though, write down exactly what is bothering you about your current plan. That one sentence becomes the test every new plan has to pass. If a new plan fixes your problem but creates a different one, you want to see that before you enroll, not after.

    Step 1: Read Your Annual Notice of Change Carefully

    Your current plan mailed its ANOC in September. It shows what is changing for next year. Note any changes to:

    • The monthly plan premium
    • Copays for primary care, specialists and hospital stays
    • The out-of-pocket maximum
    • How your specific medications are covered
    • The provider network, if the notice mentions it

    Sometimes the ANOC settles the question. If the changes are small and your plan still works, you may decide to stay. If they matter, you now know what you need the next plan to do better.

    Step 2: Build Your Medication and Doctor Lists

    Write down each prescription with its exact name, dosage and how often you fill it, plus the pharmacy you use. Then list your primary care doctor, specialists and preferred hospital.

    These lists do the heavy lifting. Every plan you consider has to be checked against them.

    Step 3: Find Plans Available in Your County

    Medicare Advantage plans are offered by county, so what your friend in another county has may not be available to you. Use the Medicare Plan Finder on Medicare.gov, call 1-800-MEDICARE, or work with a licensed agent to see which plans serve your ZIP code.

    Step 4: Check Each Candidate Against Your Lists

    For each plan you are considering:

    • Look up every must-keep doctor and hospital in the plan’s provider directory for the coming year
    • Check every medication on the plan’s drug list, including the tier and any requirements such as prior authorization or step therapy
    • Confirm how your pharmacy is treated in the plan’s network
    • Note whether the plan is an HMO or PPO, and what that means for referrals and out-of-network care

    Drop any plan that fails on a doctor or drug you cannot do without. In most cases you will end up with two or three real candidates.

    Step 5: Compare the Whole Year

    For the plans left on your list, estimate the cost of a typical year and a harder year. Include the plan premium, the copays you expect, your drug costs at your pharmacy and the out-of-pocket maximum. Remember that you generally continue to pay your Part B premium in any Medicare Advantage plan.

    Also look at the practical side: how the plan handles travel outside Florida, whether you need referrals, and any extra benefits you would really use. Read the limits on those extras rather than assuming they match a full stand-alone policy.

    Step 6: Enroll in the New Plan

    When you have decided, enroll in the new plan directly, through Medicare.gov, by calling 1-800-MEDICARE, or with a licensed agent. In most cases, enrolling in a new Medicare Advantage plan during AEP automatically ends your enrollment in the old one when the new coverage starts January 1. You generally do not need to call your current plan to cancel.

    A word of caution for anyone who also has a stand-alone Part D drug plan or a Medigap policy: the rules for how those interact with Medicare Advantage are specific, and enrolling in some plans can end other coverage. Ask before you enroll so nothing ends that you meant to keep.

    Step 7: Confirm and Watch the Mail

    After enrolling, keep your confirmation number. Your new plan should send a welcome packet and member ID card before January 1. If they have not arrived by mid-December, call the plan to check that your enrollment went through.

    In early January:

    • Start using your new member card and put the old one away
    • Give your new card to your doctors’ offices and pharmacy
    • Refill a prescription early in the month so any issue surfaces quickly
    • Keep your old plan’s paperwork for a while in case a late claim from December comes up

    What If You Change Your Mind?

    If you enroll in a plan and then reconsider before December 7, you can choose again, and the last enrollment submitted during AEP is generally the one that takes effect. After AEP, people in a Medicare Advantage plan have the Medicare Advantage Open Enrollment Period from January 1 to March 31 to make one change, either to another Medicare Advantage plan or back to Original Medicare, with the option to join a Part D plan.

    If you are weighing a move from Medicare Advantage back to Original Medicare instead of to another Advantage plan, that is a different decision with its own rules. Our general overview of Medicare options in Florida is a good place to start, and Medicare.gov has the full details.

    Frequently Asked Questions

    When can I switch Medicare Advantage plans?

    The main window is the Annual Enrollment Period, October 15 through December 7, with the new plan starting January 1. People already in a Medicare Advantage plan can also make one change during the Medicare Advantage Open Enrollment Period, January 1 to March 31.

    Do I need to cancel my old Medicare Advantage plan before switching?

    In most cases, no. Enrolling in a new Medicare Advantage plan during AEP generally ends your old plan automatically when the new coverage begins. Confirm with the new plan or with 1-800-MEDICARE if you are unsure.

    Will switching plans affect my Medigap or Part D coverage?

    It can. Enrolling in some Medicare Advantage plans can end a stand-alone Part D plan, and Medigap policies do not work with Medicare Advantage. Ask about your specific situation before you enroll so you do not lose coverage you meant to keep.

    How do I check if my doctors are in the new plan’s network?

    Look up each doctor and hospital in the plan’s provider directory for the coming year, and call the offices to ask whether they expect to accept that plan. Networks can change from year to year, so confirm before you enroll.

    What if I switch and then regret it?

    Before December 7, you can make another choice, and the last enrollment submitted during AEP generally takes effect. After that, the Medicare Advantage Open Enrollment Period from January 1 to March 31 allows one change.

    Get Help With the Switch

    If you would like a licensed agent to check your doctors and medications against the Medicare Advantage plans we offer in your county, call Maher Insurance Group at (866) 220-2834, or complete our short online questionnaire and we will follow up when it suits you.

    Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.