Common questions
Straight answers, including the inconvenient ones
Twenty questions we get asked most. Where the honest answer is "it depends", we have tried to say what it depends on rather than leaving it there.
Working with us
Does it cost anything to talk to you?
No. There is no fee to review your coverage or compare options. Insurance carriers pay agent compensation when a policy is placed, and it does not change your premium.
Are you affiliated with Medicare or the government?
No. Benefits Empire is an independent insurance agency. We are not connected with, affiliated with, or endorsed by the U.S. government, the federal Medicare program, CMS, or the Social Security Administration.
Do you offer every plan available?
No, and no agent does. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer. For a complete list of your options, contact Medicare.gov, call 1-800-MEDICARE, or reach your State Health Insurance Assistance Program (SHIP).
What areas do you serve?
We are licensed in seven states — Wisconsin, Florida, Michigan, North Carolina, Virginia, Kentucky and Maine — and work with clients statewide by phone and video. Our home base is northeast Wisconsin: the Fox Valley, Green Bay and the Lakeshore.
Will I be pressured to buy something?
No. A meaningful share of reviews end with keeping what you already have. Comparisons are provided in writing so you can take them away and decide without anyone sitting across from you.
Medicare basics
When do I first sign up for Medicare?
Your Initial Enrollment Period runs seven months — the three months before the month you turn 65, your birthday month, and the three months after. Enrolling in the three months before your birthday month is the only way to have coverage active on the first day you are eligible.
What does Medicare cost in 2026?
The standard Part B premium is $202.90 per month with an annual deductible of $283. The Part A hospital deductible is $1,736 per benefit period. Higher-income beneficiaries pay more for Part B through an income-related adjustment. Source: CMS.
What is the Part D out-of-pocket cap?
Part D now has a hard annual limit on what you pay out of pocket for covered prescriptions — $2,100 for 2026. Once you reach it, covered drug costs stop for the rest of the calendar year. Before 2025 there was no ceiling at all.
When can I change my Medicare plan?
Annual Enrollment runs October 15, 2026 to December 7, 2026, with changes effective January 1, 2027. If you are already in a Medicare Advantage plan, you get one additional change between January 1 and March 31. Life events such as moving out of your plan's service area can open a Special Enrollment Period.
What happens if I don't sign up on time?
Late enrollment penalties can apply to both Part B and Part D, and the Part D penalty is permanent — it is added to your premium for as long as you have drug coverage. If you have creditable coverage through an employer, different rules apply, which is worth confirming before you delay.
Supplement vs Advantage
Is Medigap different in Wisconsin?
Yes, significantly. Wisconsin is one of only three states — with Massachusetts and Minnesota — where Medicare Supplement is not sold under the federal Plan A through N letters. Wisconsin uses its own basic policy that insurers may add optional riders to, plus 50% and 25% cost-sharing variants. The other states we serve all use the standard lettered plans.
What is the six-month Medigap window?
It starts the month your Part B coverage begins and lasts six months. During it an insurer cannot decline you or charge more for your health history. It happens once and does not repeat. Missing it means most future applications are medically underwritten.
Which is better — Supplement or Advantage?
Neither in the abstract. A supplement gives nationwide provider freedom and predictable costs for a higher monthly premium. Advantage bundles extras and usually costs less monthly, in exchange for a network and prior authorisation. Across our northeast Wisconsin home area roughly seven in ten people choose Advantage, but the right answer depends on your doctors, drugs and budget.
Can I switch from Advantage to a Supplement later?
Sometimes, but it is not guaranteed. Outside specific circumstances you would generally need to pass medical underwriting. This is why the decision at 65 deserves more thought than it usually gets.
Does a Supplement include drug coverage?
No. You need a separate Part D plan alongside it. Going without creditable drug coverage can trigger a permanent late-enrollment penalty.
Health plans, supplemental & annuities
Will I qualify for a subsidy on a Marketplace plan?
Many households do — it depends on your estimated income and family size. We check where you land before comparing plans, because the premium tax credit changes which plan is actually cheapest.
Can I be turned down for a pre-existing condition on an ACA plan?
No. ACA Marketplace plans cannot deny you coverage or charge more because of your health history, and they cover essential health benefits.
Doesn't Medicare cover the dentist?
Original Medicare covers almost no routine dental, vision or hearing care. A standalone dental, vision and hearing plan fills that gap; some Medicare Advantage plans include a limited benefit that often runs out quickly.
What is hospital indemnity insurance?
A supplemental policy that pays you a fixed cash benefit when you're hospitalized. The money goes to you, to spend on copays or anything else, and it's often paired with Medicare Advantage to offset per-day hospital costs. It is not a substitute for a medical plan.
Are annuities a good idea?
For some people, for part of their money. An annuity handles longevity risk well and liquidity badly. If someone suggests putting the majority of your savings into one, get a second opinion.
Figures cited are for plan year 2026 and come from CMS. They are reviewed annually and were last checked in August 2026. This page is educational and is not a recommendation, an offer of coverage, or a quote.
Still have a question?
If it isn't answered here, it is probably specific to your situation — which is exactly the sort of thing a phone call sorts out quickly.