Guest Blog:
Understanding Medicare
Written By: Chris McArdle, President, MKE Benefits
As the years go by, many of us begin asking similar questions: How long do I want to work? Do I have enough money to retire? Where do I want to live in retirement? Eventually, another important question enters the conversation: How do I handle Medicare?
The good news is that while Medicare can seem complicated at first, the system follows a fairly predictable structure. With the right guidance, securing quality coverage is often much easier than people expect. As a general rule, it is wise to consult an insurance professional several months before transitioning to Medicare so you have time to evaluate your options and make informed decisions.
Medicare Parts A and B are administered by the federal government. Part A covers inpatient hospital services, while Part B covers outpatient medical care and physician services. Most people qualify for premium-free Part A, while Part B requires a monthly premium. That premium is income-based and typically starts at around $200 per month, increasing for higher-income individuals.
While Parts A and B provide a strong foundation, they were never designed to cover every healthcare expense. To help fill the gaps, private insurance companies offer additional coverage options, including Medicare Supplement plans (often called Medigap plans), Part D prescription drug plans, and Medicare Advantage plans (also known as Part C).
Many beneficiaries choose a combination of Parts A and B, a Medicare Supplement plan, and a Part D drug plan. Others select Parts A and B along with a Medicare Advantage plan, which combines many benefits into a single policy.
Each approach has advantages and trade-offs. Factors such as monthly premiums, out-of-pocket costs, provider flexibility, prescription coverage, and access to care all play a role in determining the best fit. An experienced insurance professional can explain these differences and help identify the option that best aligns with an individual’s healthcare needs and financial goals. There is no one-size-fits-all solution, and local market knowledge can be invaluable.
As of this writing (Fall 2026), the Medicare Supplement market remains relatively stable, with no significant changes anticipated for the standard plans. Wisconsin’s largest Supplement carrier recently introduced a high-deductible option with substantially lower premiums than its traditional plan offerings. It will be interesting to see how consumers respond to this new alternative.
For those choosing a Medicare Supplement plan, a Part D prescription drug plan is typically added to help cover medication expenses. In 2027, all Part D plans will feature a $2,400 annual out-of-pocket maximum for covered prescription drugs, an important safeguard that helps cap medication costs and reduce financial uncertainty.
The Medicare Advantage market, however, continues to evolve. Looking ahead to 2027, federal funding increases are not keeping pace with rising healthcare costs. As a result, some plans are being discontinued, while others are adjusting benefits and cost-sharing structures. Consumers may see higher premiums, increased out-of-pocket maximums, larger copayments, and somewhat reduced supplemental benefits such as dental and vision coverage. Even so, many Advantage plans continue to offer meaningful value at low or even no monthly premium.
One of the most important steps in the Medicare process is seeking advice early. An independent insurance broker can help navigate enrollment deadlines, explain coverage options, compare plans, and identify the most suitable solution. Ideally, those conversations should begin at least three months before coverage is needed.
There are also many misconceptions about Medicare, and mistakes made during enrollment can sometimes have long-term consequences. Working with a knowledgeable professional can help avoid common pitfalls and provide peace of mind throughout the process.
Transitioning to Medicare is an important milestone and, for most people, a positive one. With a little planning and the right advice, the combination of Medicare and private insurance coverage can provide comprehensive protection and a confident path forward into retirement.
Contact:
Chris McArdle, President, MKE Benefits
414-253-1807
MKE Benefits is an independent, local health insurance brokerage serving our friends and neighbors.
2026 Medicare Webinar
For a more in-depth conversation about Medicare coverage options, watch the recording of the 2026 Medicare Webinar presented by Chris McArdle and hosted by Shakespeare Wealth Management:
