SHIP counselor outlines Medicare basics, enrollment windows and help options

Kathy Madden, a counselor with the Colorado Division of Insurance’s Senior Health Insurance Program (SHIP), gave a public presentation explaining how Medicare works, how enrollment windows operate and where beneficiaries can get free, personalized assistance.

Madden told attendees that Medicare is a federal health-insurance program primarily for people 65 and older and for certain disabled people, and that enrollment is handled through the Social Security Administration. “Medicare is not to be confused with Medicaid,” she said, noting Medicaid is an income‑based program that varies by state.

Why it matters: Many older adults face choices that affect coverage and out‑of‑pocket costs — from whether to take Part A while still employed to choosing a Part D drug plan that covers their medications. Madden said SHIP counselors help people compare options, file complaints or appeals, and enroll in cost‑saving programs.

Key facts and options
- Parts A and B are the core ‘‘original Medicare’’ benefits. Part A generally covers inpatient and certain post‑acute services; Part B covers medical services. Madden explained Part A is often “premium free” for workers with roughly 40 quarters of Social Security contributions, but that service costs (deductibles and coinsurance) still apply.
- Optional coverage includes Medicare Advantage (Part C) and Part D prescription plans. Medicare Advantage plans (sold by private insurers) often combine health and drug coverage; Medigap (Medicare supplement) policies are standardized lettered plans sold by private companies to fill gaps in Original Medicare.
- Enrollment windows matter. Madden reviewed the seven‑month initial enrollment window around a beneficiary’s 65th birthday, special enrollment windows tied to loss of employer coverage, the general enrollment period (Jan. 1–Mar. 31) and the Medicare Advantage open enrollment option (Jan. 1–Mar. 31) that was added in 2019.
- COBRA is generally not considered ‘‘creditable’’ for Medicare enrollment, Madden warned; relying on COBRA can create late‑enrollment risk if beneficiaries miss Medicare deadlines.

Costs and recent changes
Madden said premiums and cost‑sharing have been rising. She characterized the Part B premium increase for 2026 as one of the largest she has seen during her tenure and noted the Part D deductible for 2026 as stated in her slides ($615). She also summarized typical Part A hospital deductibles and explained IRMAA, the income‑related monthly adjustment that can raise Part B and Part D costs for higher‑income beneficiaries.

Choosing plans and drug coverage
Madden emphasized the importance of checking plan formularies: a beneficiary’s drugs must be covered by the plan they select, otherwise access can become difficult midyear (prior authorization and step therapy are common hurdles). She recommended picking a plan that includes all current medications rather than relying on ad hoc midyear fixes.

Help for low‑income beneficiaries
Madden outlined Extra Help/Low‑Income Subsidy (LIS) and Medicare savings programs that reduce or eliminate premiums, deductibles and copays for eligible people and explained that dual‑eligible beneficiaries may have additional flexibility and protections.

Resources and next steps
Madden pointed listeners to Medicare.gov, SSA.gov and CMS.gov for authoritative information and said Colorado’s Division of Insurance maintains a senior‑health web page and annual publications listing Medigap and Medicare Advantage options for the state. She encouraged people to contact SHIP for a free, unbiased plan comparison or to get help filing complaints; she offered to follow up by email for individual cases and provided her state email address during the session.

Audience Q&A
During the live Q&A, attendees asked whether people can keep HSA accounts after enrolling in Medicare (Madden: you cannot make HSA contributions after enrolling), whether Medigap can be purchased any time (regulated underwriting can apply outside guaranteed‑issue windows) and whether it is possible to enroll in Medicare without collecting Social Security (Madden: yes).

The presentation was recorded and slides will be posted; Madden said local SHIP locations across Colorado can provide in‑person assistance and referrals. For follow‑up, Madden offered her contact information during the session.