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Real Results

Client Success Stories

Real savings from real people. Every case below was handled by a Licensed Medicare Advisor — no call center scripts, no upsells, just the right Medicare plan for the situation.

8
Cases Highlighted
$12,500+
Combined Annual Savings
$0
Cost to Client
Christopher O'Kieffe headshot
Christopher O'Kieffe
Senior Medicare Advisor
Book a Call with Chris
Veteran — VA + Medicare Coordination

Veteran Thought He Was Disqualified from Medicare Advantage

$1,500+
Est. Annual Savings

A veteran believed he couldn't enroll in a MAPD plan because he never had Part D or dental. He was also afraid of a late enrollment penalty. Chris confirmed his VA benefits counted as creditable drug coverage — meaning no penalty — and enrolled him in a plan with dental, vision, and hearing included. He also walked the client through reporting VA coverage to Medicare to keep his record clean.

Savings Formula
Part D late penalty avoided: ~$36–$60/mo (permanent, cumulative)
Dental/vision/hearing added: ~$50–$80/mo value (was uninsured OOP)
Penalty savings: $36–$60 × 12 = $432–$720/yr (compounds annually)
Benefit value: $50–$80 × 12 = $600–$960/yr
$432 + $600 = $1,032/yr minimum → $1,500+ with avoided OOP dental

Part D late enrollment penalty is 1% of the national base premium per month for every month without creditable coverage. VA coverage prevents this penalty entirely. Dental savings assume routine cleanings, X-rays, and one procedure per year.

Veteran — Prescription Coverage Gap

VA Didn't Cover Key Medications — Client Was Paying Cash

$2,000+
Est. Annual Savings

A veteran relied solely on the VA for prescriptions, but the VA wouldn't cover needed pain management medications. He assumed he was stuck paying out-of-pocket. Chris enrolled him in a MAPD plan with Part D coverage for the drugs the VA wouldn't provide, while keeping VA access for everything else — eliminating the gap entirely.

Savings Formula
OOP pain meds (cash price): ~$200–$400/mo
MAPD Part D copay (Tier 2/3): ~$20–$47/mo
Monthly delta: $200 − $35 avg = ~$165/mo
$165 × 12 = ~$1,980/yr → $2,000+ est. savings

Cash prices for pain management medications vary widely. Estimate assumes mid-range brand/specialty medication. MAPD plan had $0 premium, so no offsetting plan cost.

Medicaid Loss — IRMAA Surcharge

Lost Medicaid After Selling Home — Premiums Spiked

$3,000+
Est. Annual Savings

A client lost Medicaid after selling her house — the proceeds temporarily boosted her assets, triggering full Medicare premiums and IRMAA surcharges. Chris explained exactly why it happened, walked her through the SSA appeal process, and sent her the correct form to document the home sale as a one-time life event so she could get the surcharge reduced.

Savings Formula
Standard Part B (2026): ~$185/mo
IRMAA Tier 1 surcharge: +$74/mo (based on temp. income spike)
Part D IRMAA: +$13/mo
Lost Medicaid MSP: +$185/mo (was paying $0 for Part B)
Total surcharge exposure: $74 + $13 = $87/mo IRMAA
If appeal succeeds: IRMAA removed retroactively
$87 × 12 = $1,044 IRMAA + MSP restoration → $3,000+ total

IRMAA tiers depend on MAGI from two years prior. Home sale proceeds can create a one-year spike that SSA will adjust via Form SSA-44 (Life-Changing Event). MSP restoration depends on state Medicaid re-determination after asset spend-down.

New to Medicare

New Beneficiary Shocked by Medicare Costs vs. Employer Plan

Lower OOP
Net Cost Reduction

Peggy was new to Medicare and frustrated that Part B plus a supplement cost more than her employer plan. Chris reviewed her total cost picture and showed her that while premiums were higher, her actual out-of-pocket exposure was lower under Medicare — and a long-delayed surgery would be easier to get approved. She moved forward with confidence.

Savings Formula
Employer plan: ~$250/mo premium, $5,000–$8,000 OOP max
Medicare + Plan G: ~$185 + $150 = $335/mo premium
Plan G OOP max: $0 after Part B deductible ($257/yr)
Premium difference: +$85/mo ($1,020/yr more in premiums)
OOP exposure reduction: −$5,000 to −$8,000/yr
Net benefit: $4,000–$7,000/yr lower worst-case cost

Medicare Supplement Plan G covers all Medicare-approved costs after the annual Part B deductible. For someone needing surgery, this eliminates coinsurance and hospital deductibles that would apply under most employer plans.

TRICARE Coordination

Client Overpaying Because Claims Weren't Going to TRICARE

Immediate
Cost Recovery

A client was overwhelmed by medical bills and couldn't understand why out-of-pocket costs were so high. Chris discovered she had TRICARE but wasn't submitting claims for secondary coverage — none of her bills were being processed through it. He showed her exactly how to submit claims correctly, immediately reducing her financial burden.

Savings Formula
Medicare pays: 80% of approved amount
TRICARE (secondary) pays: remaining 20% coinsurance
Client was paying: full 20% OOP (claims not submitted)
Example: $10,000 in annual claims
20% coinsurance not submitted: $2,000/yr paid OOP
TRICARE secondary filing recovers ~$2,000/yr going forward

TRICARE for Life acts as secondary payer to Medicare, covering most remaining out-of-pocket costs. Savings scale with utilization — higher medical spend means higher recovery.

Scott Martin headshot
Scott Martin
Senior Medicare Advisor
Book a Call with Scott
Veteran — VA + Medicare Coordination

Veteran Paying $400/mo for Coverage He Didn't Need

$7,000+
Est. Annual Savings

A veteran was paying nearly $400 per month between his Plan G and standalone Part D, despite receiving all doctors and prescriptions through the VA. Scott moved him to a Medicare Advantage plan with a $170 Part B giveback, added dental coverage he'd been paying for out-of-pocket, and reduced his net monthly costs by roughly $570.

Savings Formula
Before: ~$400/mo (Plan G + PDP premiums)
After: $0/mo net (MA plan w/ $170 Part B giveback)
Dental: ~$170/mo offset (was paying OOP for dental)
Monthly delta: $400 + $170 giveback = ~$570/mo
$570 × 12 = $6,840/yr → $7,000+ with dental savings

Actual savings depend on specific plan premiums, giveback amounts, and prior dental spend. Figures are representative of client's reported costs.

Guaranteed Issue — Medigap

Guaranteed Issue Window — Saved With One Day to Spare

$2,500–$4,000
Est. Annual Savings

A woman contacted The Pocket Protector three days before her guaranteed issue window closed — she had no idea about the deadline. Her previous agent had placed her in a MAPD plan and incorrectly told her she could switch to Medigap during AEP. Because of a medical condition, waiting would have meant underwriting and inflated premiums. Scott moved her to the Plan G she originally wanted, preserving her rights.

Savings Formula
GI Plan G rate: ~$150–$200/mo (standard issue, no health questions)
Underwritten rate w/ condition: ~$350–$550/mo (rated up or declined)
Monthly delta: $200–$350/mo avoided premium surcharge
$200–$350 × 12 = $2,400–$4,200/yr → $2,500–$4,000 est.

Underwritten Medigap premiums vary by carrier, state, age, and health status. Some applicants with pre-existing conditions face 25–75% rate-ups or outright denial. GI rights eliminate this risk entirely.

Drug Formulary — Plan Switch

Hidden Drug Cost Increase Caught Before It Hit

$3,000+
Est. Annual Savings

A client's UHC plan was silently changing his Tier 3 medication from a $47 flat copay to 18% coinsurance — a jump to nearly $1,000/month. Scott confirmed doctor acceptance with an alternative carrier, switched the client to a plan with a $100+ monthly giveback and the $47 copay restored. The client had no idea the change was coming.

Savings Formula
Old copay (2025): $47/mo flat (Tier 3, UHC plan)
New coinsurance (2026): 18% of ~$5,500 list = ~$990/mo
Drug cost delta: $990 − $47 = $943/mo increase avoided
Plus giveback: $100+/mo Part B giveback on new plan
($943 + $100) × 12 = $12,516/yr potential → $3,000+ conservative est.

Conservative estimate accounts for $2,000 OOP cap under the Inflation Reduction Act, which limits true annual Rx exposure. The $3,000+ figure reflects real net savings after the cap, including the giveback.

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