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Calrima Senior Services
& Insurance Solutions

About

We support and empower Seniors to optimize their financial planning with simple and streamlined solutions across insurance, annuities, and more while avoiding overwhelm or confusion.
Calrima Financial & Insurance Agency, led by Medicare specialist Mary Lee

Medicare Enrollment Snapshot 2025*

Total Medicare enrollment: About 68.9 million people are enrolled in Medicare plans in 2025
Medicare.gov - Medicare Basics

California Department of Insurance - Medicare Info

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34 Million have Medicare Advantage

Medicare Advantage (MA): 54% of all eligible Medicare beneficiaries—about 34 million out of 62.8 million with both Parts A and B—are enrolled in MA plans

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31.5–33.3 Million have Original Medicare

Original Medicare (Fee-for-Service, FFS): Approximately 46% remain in Original Medicare (with or without supplemental insurance), totaling about 31.5–33.3 million individuals

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6-7 Million have Medicare Supplemental (Medigap)

About 21% of those in Original Medicare also have a Medigap supplemental policy, equating to roughly 6 to 7 million beneficiaries, though precise 2025 national figures are estimated, as Medigap enrollment changes little year to year.

What Our Clients Say

Real feedback from people we've helped navigate Medicare options.

"Mary was so patient and clear about explaining Medicare choices — she made everything easy to understand."

- Linda G., San Jose
via Yelp

"Professional, kind, and thorough. I got my questions answered and saved money on my plan."

- Robert T., Sacramento
via Yelp

"I highly recommend Calrima! Mary genuinely cares and provides honest guidance."

- Susan M., Cupertino
via Yelp
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Too many Medicare options?​

Not sure what Medicare path is right for you?
Schedule a relaxed, no-pressure visit with Mary Lee—she’ll help you understand your options and feel confident about your next steps.

We’re here to support you year-round, though our availability can get limited as more people seek guidance.
Reaching out now ensures you have space to breathe and make informed choices.

Prefer to skip the conversation and dive right in?
You can head straight to getting your personalized Medicare Advantage quote—quick, easy, and obligation-free.

Confused by your Medicare options?

You don’t have to figure it out alone.
Mary Lee’s here to guide you with clarity and care.
Mary Lee is a Medicare specialist

2025 Medicare Annual Election Period (AEP) — Comprehensive FAQ

🖋️ 2025 Medicare Annual Election Period (AEP) — Comprehensive FAQ

Coverage Effective January 1, 2026

Brought to you by
Mary Lee | California Insurance License 0F34289
📞 408-786-0508 (call or text) ✉️ [email protected]
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Mary Lee Medicare Education 2026


🗓 AEP Overview

The Medicare Annual Election Period (AEP) is when beneficiaries can change how they receive Medicare coverage.
AEP 2025 runs October 15 – December 7, 2025, and all changes take effect January 1, 2026.


1️⃣ What is the Medicare Annual Election Period (AEP)?

  • Switch between Original Medicare (Parts A & B) and a Medicare Advantage (Part C) plan.
  • Join, switch, or drop a Medicare Prescription Drug (Part D) plan.

For the 2025 AEP (coverage effective Jan 1 2026), you can review and update your plan to fit your health and budget.


2️⃣ What can I do during the AEP?

  • Move from Original Medicare to Medicare Advantage or back again.
  • Change from one Advantage plan to another.
  • Join, switch, or drop a Part D drug plan.

These options help you adapt coverage to your current needs.


3️⃣ Why is reviewing my plan each year important?

Plans change every year. For 2026:

  • Annual Part D out-of-pocket cap: $2,100 (↑ from $2,000). After reaching that limit, you pay $0 for covered drugs for the rest of the year.
  • Standard Part D deductible: $615.
  • Catastrophic coinsurance: 5 % elimination continues (initiated in 2024).
  • Prescription Payment Plan: available nationwide Jan 1 2026 — lets you spread costs monthly.
  • Drug Price Negotiation: first 10 Medicare-negotiated drug prices begin Jan 1 2026.

4️⃣ What if I miss the AEP deadline?

  • Move to a new service area,
  • Lose employer or union coverage, or
  • Have your plan end its Medicare contract.

You may qualify for a Special Enrollment Period (SEP) under these circumstances.


5️⃣ What’s the difference between AEP and the Medicare Advantage Open Enrollment Period?

PeriodDatesWhat You Can Do
AEPOct 15 – Dec 7 (2025)Make any Medicare plan changes
Medicare Advantage Open EnrollmentJan 1 – Mar 31 (2026)Switch Advantage plans or return to Original Medicare

2026 cost trends: Average MA-PD premium ≈ $14/mo (down from $16); max in-network out-of-pocket limit → $9,250 (down from $9,350).


6️⃣ How do I know if my plan is changing for 2026?

Your plan must send an Annual Notice of Change (ANOC) by the end of September. Compare your ANOC with other available plans during AEP to ensure you have the best fit for 2026.


7️⃣ How do I compare plans effectively?

  1. Review your ANOC and current benefits.
  2. List your prescriptions and preferred doctors.
  3. Use the Medicare.gov Plan Finder tool.
  4. Check Star Ratings (5 stars = highest quality).
  5. Contact Mary Lee for personalized guidance and plan comparison.

8️⃣ What happens after I enroll or change plans?

Your new coverage starts January 1, 2026. Keep both old and new plan cards until you receive confirmation from your new plan.


9️⃣ How can I control my prescription costs in 2026?

  • Out-of-Pocket Maximum: $2,100 for 2026 – after that, $0 cost-sharing.
  • Standard Deductible: $615.
  • Prescription Payment Plan: available nationwide Jan 1 2026.
  • Extra Help Program: continues in 2026 with no premium, no deductible, and copays of $4.90 (generic) / $12.15 (brand).
  • Negotiated Drug Prices: first 10 take effect Jan 1 2026.

🔟 How can I get help or unbiased advice?

  • Medicare: 1-800-MEDICARE (1-800-633-4227)
  • Social Security Administration (Extra Help): 1-800-772-1213
  • State Health Insurance Assistance Program (SHIP): 1-877-839-2675

Or for personal support: 👉 Meet Mary Lee — call, text, or schedule a free consultation.


📚 Sources and Citations

Information accurate as of October 2025 for coverage year 2026.

  • Centers for Medicare & Medicaid Services (CMS) 2026 Fact Sheets & Final Rules
  • Kaiser Family Foundation (KFF) Medicare 2026 Analysis
  • Humana and PAN Foundation 2026 Policy Summaries
  • CMS Medicare & You 2026 Handbook

🪶 Educational Disclaimer

This article and video are for educational purposes only and do not constitute a plan recommendation.
© 2025 Mary Lee Medicare Education 2026. All rights reserved.

Frequently Asked Questions

Expert answers to your Medicare, insurance, and retirement planning questions

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare, offered by private insurance companies. It includes Part A (hospital), Part B (medical), and usually Part D (prescription drugs). Medicare Supplement (Medigap) works alongside Original Medicare to help cover out-of-pocket costs like copayments, coinsurance, and deductibles. Calrima's Medicare specialists can help you determine which option best fits your healthcare needs and budget.
Your Initial Enrollment Period begins three months before you turn 65, includes your birthday month, and extends three months after. Missing this window can result in late enrollment penalties. If you're still working and have employer coverage, different rules may apply. Contact Calrima to discuss your specific situation and ensure you enroll at the right time without penalties.
A Fixed Index Annuity (FIA) is a retirement savings vehicle that offers principal protection with the potential for interest earnings linked to a market index like the S&P 500. Your principal is protected from market losses, while you can earn interest based on index performance up to a cap rate. FIAs provide guaranteed lifetime income options and tax-deferred growth, making them ideal for conservative investors seeking protection with growth potential. Calrima specializes in helping clients understand how FIAs fit into comprehensive retirement strategies.
The amount of life insurance you need depends on several factors: outstanding debts (mortgage, loans), income replacement needs for your family, final expenses, education funding for children, and existing savings. A common rule of thumb is 10-12 times your annual income, but your specific needs may vary. Calrima's advisors conduct comprehensive needs analyses to determine the right coverage amount for your unique situation, ensuring your family is protected without overpaying for unnecessary coverage.
Term life insurance provides coverage for a specific period (10, 20, or 30 years) with lower premiums but no cash value. Permanent life insurance (whole life, universal life) provides lifelong coverage, builds cash value you can borrow against, and typically has higher premiums. Term is ideal for temporary needs like mortgage protection or income replacement during working years. Permanent insurance works well for estate planning, legacy building, and lifelong protection needs. Calrima helps you choose the right type based on your financial goals and budget.
Yes, you can change Medicare plans during specific enrollment periods. The Annual Enrollment Period (October 15 - December 7) allows you to switch between Original Medicare and Medicare Advantage, or change your Part D prescription drug plan. The Medicare Advantage Open Enrollment Period (January 1 - March 31) lets you switch Medicare Advantage plans or return to Original Medicare. Special Enrollment Periods may also apply if you move, lose other coverage, or qualify for Extra Help. Calrima's Medicare specialists can help you evaluate your options during these windows.
Fixed Index Annuities are considered safe, conservative retirement products because your principal is protected from market losses. Insurance companies issuing FIAs are regulated by state insurance departments and must maintain reserve requirements. Your principal and any credited interest are guaranteed by the issuing insurance company's claims-paying ability, not market performance. Unlike securities, FIAs are insurance products backed by the financial strength of highly rated insurance carriers. However, it's important to understand surrender charges and liquidity limitations. Calrima works exclusively with top-rated insurance carriers to ensure your retirement savings are secure.
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient care, preventive services, and medical equipment. Part C (Medicare Advantage) is an alternative to Original Medicare that bundles Parts A, B, and usually D through private insurers. Part D covers prescription drugs. Most people pay no premium for Part A if they paid Medicare taxes while working, but Part B requires a monthly premium. Calrima helps you understand your coverage options and coordinates all parts of your Medicare plan.
Consider long-term care insurance if you have assets to protect (typically $100,000+), want to avoid burdening family members with care responsibilities, don't have sufficient retirement income to cover potential care costs ($50,000-$100,000+ annually), and are in good health (typically age 50-65 for best rates). Medicare and health insurance don't cover most long-term care needs. If a nursing home or in-home care would deplete your savings, long-term care insurance may be appropriate. Calrima can assess your situation and explore options including traditional policies, hybrid life insurance with LTC riders, and annuities with LTC benefits.
The Medicare Part D 'donut hole' (coverage gap) is a temporary limit on what your drug plan covers. In 2025, once you and your plan have spent a certain amount on covered drugs, you enter the coverage gap where you pay 25% of costs for both brand-name and generic drugs. Once your out-of-pocket spending reaches the catastrophic coverage threshold, you pay only small copayments or coinsurance for the rest of the year. The Inflation Reduction Act is gradually closing this gap. Calrima's Medicare specialists help you choose Part D plans that minimize your exposure to the coverage gap based on your specific medications.
A fiduciary financial advisor is legally and ethically required to act in your best interest at all times, putting your needs ahead of their own compensation. Unlike brokers who follow a suitability standard (recommending products that are suitable but may not be best), fiduciaries must recommend strategies and products that are optimal for your situation. This includes transparent disclosure of fees, conflicts of interest, and compensation. Calrima operates under The Fiduciary Foundation philosophy, ensuring all advice—from Medicare planning to Fixed Index Annuities and wealth management—meets the highest fiduciary standard of care.
If you're working at 65 and covered by a group health plan from an employer with 20+ employees, you can delay Medicare Part B enrollment without penalty while maintaining employer coverage. However, you should still enroll in Part A (which is usually premium-free) when you turn 65. If your employer has fewer than 20 employees, Medicare typically becomes primary and you should enroll at 65. Once you stop working or lose employer coverage, you have an 8-month Special Enrollment Period to sign up for Part B without penalties. Calrima helps coordinate your employer coverage with Medicare to ensure continuous, cost-effective protection.

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