Medicare and Gym Memberships
Are gym memberships included in Medicare plans?
Medigap plans may sometimes include wellness benefits or gym memberships. If you have a Medigap plan that comes with a wellness program, or if you're thinking about a Medicare Advantage plan that offers wellness benefits, here’s how it might work:
Medicare Advantage Plans: Some plans offer programs like SilverSneakers or Silver&Fit, which may allow members to join multiple gyms or fitness centers. These programs may provide access to a large network of gyms, meaning you can visit more than one gym as long as they are part of the network.
Medigap w/Wellness Benefits: If you purchase a Medigap plan that includes a wellness or gym membership benefit like SilverSneakers and RenewActive it may allow you to access multiple gyms.
To confirm whether you can join multiple gyms, check with the specific wellness program (e.g., SilverSneakers, RenewActive or Silver&Fit). They often allow access to multiple locations, but it's important to verify with the program or insurer.
The Medicare Part D Spending Cap
What is the spending cap and how does it work?
In 2026, the Medicare Part D spending cap has been increased to $2,100 from the original spending cap of $2,000 born out of the 2025 Inflation Reduction Act.
How It Works:
1. Annual Out-of-Pocket Cap:
Once your total out-of-pocket spending on Part D drugs reaches $2,100, you won’t have to pay anything more for covered prescriptions for the rest of the year.
This replaces the current system, which has a catastrophic phase where patients still pay a percentage of drug costs.
2. Monthly Payment Plan (New Option):
Medicare will offer an option to spread out drug costs over the year rather than paying large sums at once.
This can help enrollees manage expenses more predictably.
3. Who Benefits the Most?
Beneficiaries with high prescription drug costs—especially those taking expensive specialty medications.
Anyone who previously spent more than $2,100 annually on prescriptions.
4. How to Prepare for 2026:
Review your current Part D or Medicare Advantage plan to see how it covers your medications.
Look into enrollment options for the new monthly payment plan if you prefer spreading costs over time.
Stay updated with your plan provider on any changes in premiums, formularies, and copays.
5. Does using GoodRx count towards the spending cap?
No. In order to reach your spending cap, you must only use your Medicare prescription drug plan.
Shopping Medicare Part D Plans
Learn how to properly shop Part D drug plans on Medicare’s website.
When choosing a Medicare prescription drug plan (Part D), it's tempting to focus solely on the monthly premium. However, there are several reasons why you shouldn't base your decision on price alone.
1. Medication Coverage (Formulary)
Each plan has a formulary, which is a list of drugs it covers. Just because a plan is cheap doesn't mean it covers the specific medications you need. If your prescription isn’t covered, you could end up paying the full cost of the drug out of pocket.
2. Drug Tiers
Medicare plans categorize drugs into different cost tiers. A lower-cost plan might place your medication in a higher tier, meaning you'll pay more in co-pays or co-insurance. It's crucial to check how your specific drugs are tiered within each plan.
3. Pharmacy Networks
Plans often have preferred pharmacy networks. If you use an out-of-network pharmacy, you might pay more, or your plan might not cover your drugs at all. Make sure your regular pharmacy is within the plan's preferred network.
4. Deductibles and Out-of-Pocket Costs
Some plans come with a low premium but have high deductibles or co-insurance fees. A plan with a higher premium might save you money in the long run if it has lower deductibles or better coverage for your medications.
Choosing a Medicare prescription drug plan involves more than just comparing prices. Always review the formulary, pharmacy network, and potential out-of-pocket costs to find the best option for your specific needs.
**Please note that we recommend shopping your plan using the total estimated cost filter, not by plan or drug cost alone.
Visit our Medicare.gov for more information or to schedule an appointment.
Medigap vs. Medicare Advantage
What's the difference between Medigap and Medicare Advantage?
Medigap vs. Medicare Advantage: What’s the Difference?
When it comes to Medicare coverage, two of the most common options are Medigap (Medicare Supplement Insurance) and Medicare Advantage (Part C). While both help cover healthcare costs, they work very differently — and choosing the right one depends on your needs and lifestyle.
🧩 What Is Medigap?
Medigap works alongside your Original Medicare (Parts A and B). It’s designed to fill the “gaps” that Medicare doesn’t pay for — like deductibles, copays, and coinsurance.
With a Medigap plan:
You can visit any doctor or hospital nationwide that accepts Medicare.
Coverage stays consistent year after year with predictable out-of-pocket costs.
Prescription coverage isn’t included, so you’ll usually add a separate Part D plan for medications.
Many people choose Medigap because of its flexibility and simplicity — once you’re enrolled, there’s no need to worry about provider networks or plan changes each year.
🌟 What Is Medicare Advantage?
Medicare Advantage, also known as Part C, replaces Original Medicare with a private plan approved by Medicare. These plans often combine hospital, medical, and prescription coverage in one package — and may include extras like vision, dental, hearing, or fitness benefits.
However, Medicare Advantage plans use provider networks (HMO or PPO), meaning your costs and access depend on staying within your plan’s service area. Premiums are often lower, but you’ll have copays or coinsurance when you receive care.
⚖️ Choosing Between Them
Feature Medigap Medicare Advantage Type Supplements Original Medicare Replaces Original Medicare Doctor Choice Any provider accepting Medicare Limited to network providers Drug Coverage Separate Part D plan Usually included Extras (vision, dental, etc.) Not included Often included Monthly Premium Higher Lower or $0 Out-of-Pocket Costs Low and predictable Varies by plan, capped annually
💡 The Bottom Line
If you value freedom to choose any doctor and want consistent coverage with minimal surprises, Medigap may be your best fit.
If you prefer lower premiums and bundled benefits — and don’t mind using a network — Medicare Advantage might make more sense.
Every person’s situation is different, so it’s smart to compare both options and consider your travel habits, healthcare needs, and budget.
Medicare Advantage Open Enrollment
Learn about what you can do during the Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period (MA OEP) is a specific time each year when individuals enrolled in a Medicare Advantage Plan (Part C) have the opportunity to make changes to their coverage. This period runs from January 1 to March 31 annually and is separate from the general Medicare Open Enrollment Period that occurs from October 15 to December 7.
Key Actions You Can Take During the MA OEP
During the Medicare Advantage Open Enrollment Period, beneficiaries have the following options:
Switch to a Different Medicare Advantage Plan: If you’re currently enrolled in a Medicare Advantage Plan but find that it no longer meets your needs, you can switch to another Medicare Advantage Plan during this period. This includes plans with or without prescription drug coverage.
Return to Original Medicare: If you’re unhappy with your Medicare Advantage Plan, you can choose to disenroll from it and return to Original Medicare (Part A and Part B). If you make this switch, you also have the option to enroll in a Medicare Part D plan to cover your prescription drug needs.
Add a Medicare Part D Plan: If you switch back to Original Medicare during the MA OEP, you can also sign up for a standalone Medicare Part D Prescription Drug Plan.
What You Cannot Do During the MA OEP
It’s important to note that the Medicare Advantage Open Enrollment Period has some limitations:
No Switching from Original Medicare to Medicare Advantage: If you’re enrolled in Original Medicare (Parts A and B) and want to switch to a Medicare Advantage Plan, you cannot do this during the MA OEP. You’ll need to wait for the general Medicare Open Enrollment Period (October 15 - December 7) to make that change.
No Switching or Adding Medicare Part D if You’re Already in Original Medicare: If you’re already in Original Medicare, you cannot use the MA OEP to change your Part D plan or to add Part D coverage if you don’t already have it.
Why Is the MA OEP Important?
The Medicare Advantage Open Enrollment Period offers a valuable second chance for those who are already enrolled in a Medicare Advantage Plan but realize that their current plan isn’t the best fit. Whether your healthcare needs have changed, you’re dissatisfied with your provider network, or you find the costs higher than expected, the MA OEP allows you to adjust your coverage early in the year.
How to Prepare for the MA OEP
If you’re considering making changes during the MA OEP, here’s how to prepare:
Review Your Current Plan: Evaluate how well your current Medicare Advantage Plan has met your needs. Consider your experience with the plan’s network, out-of-pocket costs, and any extra benefits. Also, think about how your healthcare needs might change in the upcoming year.
Compare Other Plans: If you’re thinking about switching to a different Medicare Advantage Plan, compare other options available in your area. Use tools like the Medicare Plan Finder on the official Medicare website to review costs, coverage, and provider networks.
Check Eligibility for Medigap: If you’re planning to return to Original Medicare, consider whether you want to add a Medigap (Medicare Supplement) policy to cover out-of-pocket costs not covered by Original Medicare. Keep in mind that Medigap plans have different enrollment rules, and acceptance is not guaranteed unless you’re within your initial enrollment period or have a special circumstance.
Final Thoughts
The Medicare Advantage Open Enrollment Period is an essential opportunity for those enrolled in Medicare Advantage Plans to reassess their healthcare coverage early in the year. By taking advantage of this period, you can ensure that your plan aligns with your healthcare needs and financial situation, potentially saving you money and providing better access to the care you require. If you’re considering making changes, be sure to review your options carefully and make an informed decision by the March 31 deadline.
When is the Medicare Annual Enrollment Period?
Learn all about this important time of year for Medicare enrollees
The Medicare Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, is a specific timeframe each year when Medicare beneficiaries can make changes to their Medicare coverage. This period runs from October 15 to December 7.
Key Actions You Can Take During AEP
During the Annual Enrollment Period, you have the opportunity to:
Switch from Original Medicare to a Medicare Advantage Plan: If you're currently enrolled in Original Medicare (Part A and Part B), you can switch to a Medicare Advantage Plan (Part C), which often includes additional benefits like prescription drug coverage, dental, vision, and hearing services.
Switch from a Medicare Advantage Plan back to Original Medicare: If you're not satisfied with your Medicare Advantage Plan, you can return to Original Medicare. You may also choose to add a Part D prescription drug plan and/or a Medigap policy if you do so.
Change from one Medicare Advantage Plan to another: If you're already enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan, whether it's with the same insurance company or a different one.
Enroll in or change your Medicare Part D Prescription Drug Plan: If you're not currently enrolled in a Part D plan, you can sign up for one. If you're already enrolled, you can switch to a different Part D plan that better suits your prescription drug needs.
Drop your Medicare Part D coverage: If you decide you no longer need prescription drug coverage, you can drop your Part D plan.
Why Is AEP Important?
The Medicare Annual Enrollment Period is crucial because it’s the primary time each year when you can adjust your Medicare coverage to better fit your healthcare needs and budget. The choices you make during this period will take effect on January 1 of the following year.
Preparing for AEP
Before the Annual Enrollment Period begins, it's a good idea to:
Review your current Medicare coverage: Consider how well your current plan has met your healthcare needs over the past year. Are there any gaps in coverage, or have your healthcare needs changed?
Compare new plans: Insurance companies often make changes to their plans each year, so even if you’re happy with your current plan, it’s worth comparing your options. Look at premiums, out-of-pocket costs, covered services, and provider networks.
Check the Annual Notice of Change (ANOC): If you’re enrolled in a Medicare Advantage Plan or a Part D plan, your insurance company will send you an ANOC in September. This document outlines any changes to your plan for the upcoming year, including changes to coverage, costs, and provider networks.
What Happens If You Miss AEP?
If you miss the Annual Enrollment Period, you may have to wait until the next year to make changes to your Medicare coverage, unless you qualify for a Special Enrollment Period (SEP) due to certain life events, such as moving to a new area or losing other insurance coverage.
Final Thoughts
The Medicare Annual Enrollment Period is your yearly opportunity to ensure that your Medicare coverage aligns with your healthcare needs and financial situation. Taking the time to review your options and make informed choices can help you avoid unnecessary costs and ensure you have the coverage you need for the year ahead.