Licensed Medicare Agent · Wake County, NC

Medicare Help You Can TrustRight Here in Wake County

Rob Simm helps Wake County and Triangle-area residents compare Medicare plans, avoid costly enrollment mistakes, and find coverage that fits their lives. Call (828) 761-3326 or compare plans online in minutes.

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NC License #10447418 AHIP Certified ★ 5.0 — 20+ Google Reviews No Spam Calls · $0 Cost 828-761-3326

What does Medicare Part B cost in 2026?

The standard Medicare Part B premium for 2026 is $202.90 per month, and the annual Part B deductible is $283. Higher-income enrollees in Wake County may pay more due to IRMAA surcharges, which apply when individual MAGI exceeds $106,000 or joint MAGI exceeds $212,000. A licensed agent can help you understand whether IRMAA applies to your situation before you enroll.

Source: CMS.gov – Medicare 2026 Cost Information

When is the Medicare Annual Enrollment Period (AEP) deadline?

The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7 each year, and any plan changes made during this enrollment window take effect January 1 of the following year. Missing the December 7 deadline means you may be locked into your current plan for another full year. Wake County residents should review their plans well before this enrollment deadline to avoid unexpected costs.

Source: Medicare.gov – When Can I Join, Switch, or Drop a Medicare Advantage or Drug Plan?

What is the Part D out-of-pocket cap for 2026?

In 2026, the Medicare Part D prescription drug out-of-pocket cap is $2,100, meaning once you reach that threshold your plan covers 100% of covered drug costs for the rest of the year. This cap is a significant protection for enrollees who take high-cost medications. Raleigh-area residents in Wake County should compare Part D plans carefully because formularies and tiers vary significantly between carriers.

Source: CMS.gov – Medicare Prescription Drug Coverage (Part D)

Here’s what most people in North Carolina don’t realize until it’s too late: The Part B late enrollment penalty is 10% per year and is permanent — it never goes away. Wake County residents who miss their Initial Enrollment Period often pay significantly more every single month for the rest of their lives. That’s the gap a local broker exists to close before you sign anything.

For 2026, the Medicare Annual Enrollment Period ends December 7. The Open Enrollment Period for Medicare Advantage runs January 1 through March 31. If you are turning 65, your Initial Enrollment Period is the 7-month window around your birthday — miss it without creditable coverage and the late-enrollment penalty is permanent. The deadline is the deadline; the carriers do not negotiate it.

Rob runs the numbers for all of it — premiums, deductibles, copays, network checks, and total annual cost across every plan available in your county. Call 828-761-3326, text the same number, or keep reading. There is no fee, no obligation, and your information is never sold to other agents.

2026 Medicare Key Figures

Know the numbers before you enroll in Wake County

Part B Monthly Premium

$202.90

Standard 2026 premium; higher-income enrollees may pay more via IRMAA

Part B Annual Deductible

$283

You pay this before Medicare Part B begins covering outpatient services

Part A Hospital Deductible

$1,736

Applies per benefit period — not annually; a Medigap plan may help cover this

Part D OOP Cap

$2,100

Once reached, your plan covers 100% of covered drug costs for the rest of the year

Source: CMS.gov 2026 figures. For personalized North Carolina plan data, call 828-761-3326.

Common Problems We Solve

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Missing an Enrollment Deadline

The Part B late enrollment penalty is 10% per year and is permanent — it never goes away. Wake County residents who miss their Initial Enrollment Period often pay significantly more every single month for the rest of their lives.

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Choosing the Wrong Plan

Not every Medicare plan covers your doctors, hospitals, or prescriptions at the same cost. A plan that looks affordable with a low premium may cost thousands of dollars more if your preferred Raleigh-area providers are out of network.

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Navigating Medicare Alone

Medicare rules, enrollment windows, and plan options change every year. Most employer HR departments are not licensed to give Medicare advice and frequently misunderstand IEP and SEP rules, leaving employees unprotected.

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Expert Tip from Rob SimmMedicare Advantage and Part D plans can change their formularies, premiums, copays, and provider networks every single year. A plan that worked well in 2025 may look very different on January 1, 2026. Wake County residents should sit down with a licensed agent during the Annual Enrollment Period (October 15–December 7) each year to confirm their medications are still covered at an affordable tier and their preferred doctors remain in-network. Skipping this annual review could cost significantly more over the course of the year.

Original Medicare vs. Medicare Advantage in Wake County

Key differences to consider when choosing your 2026 coverage

Feature	Original Medicare + Medigap	Medicare Advantage (MA)
Monthly Costs	Part B premium ($202.90) plus Medigap premium; predictable total	Often lower monthly premium, sometimes $0, but varies by plan and usage
Provider Access	Any provider nationwide who accepts Medicare — very broad	Typically restricted to an in-network provider directory in Wake County
Out-of-Pocket Maximum	No built-in cap on Original Medicare alone; Medigap fills many gaps	Federal cap set at $9,350 in-network for 2026 MA plans
Prescription Drug Coverage	Requires a separate standalone Part D plan (cap: $2,100 OOP in 2026)	Often bundled into the MA plan (MAPD), subject to formulary changes
Referrals Required	No referrals needed to see specialists under Original Medicare	Many HMO-type MA plans require a primary care referral for specialists
Plan Flexibility	Stable nationwide coverage; Medigap benefits are standardized by law	Network, formulary, and benefits can change every January 1
Late Enrollment Penalty Risk	Part B: 10%/year permanent; Part D: 1%/month of base premium permanent	Same penalties apply — MA does not exempt you from late enrollment fees

Real Situations We've Helped With

Avoided Permanent Penalty

Raleigh Retiree Nearly Missed His IEP

Situation: A 65-year-old man in Raleigh, Wake County, assumed his wife's employer coverage counted as creditable coverage for himself. When HR told him he was fine to wait, he nearly missed his 7-month Initial Enrollment Period — an error that would have triggered a permanent Part B penalty of 10% per year.

Without help: Without Rob's intervention, this enrollee would have faced a permanent 10% Part B surcharge added to the $202.90 base premium for every year he remained on Medicare — adding up to a significant extra cost over a 20-plus year retirement.

With Rob: Rob reviewed his coverage situation, confirmed it did not qualify as creditable employer coverage for Medicare purposes, and guided him through immediate enrollment during his IEP. He enrolled on time with no penalty, keeping his Part B premium at the standard $202.90 per month.

💰 $0 penalty vs. 10%/year surcharge saved

Saved Thousands

Cary Widow Overpaying on COBRA

Situation: A 63-year-old woman in Cary, Wake County, lost her husband and her connection to his employer group health plan. She enrolled in COBRA continuation coverage — which requires paying the full premium plus a 2% administrative fee — spending significantly more than necessary while waiting for Medicare eligibility at 65.

Without help: Had she remained on COBRA for two full years without exploring alternatives, she would have paid full unsubsidized premiums plus the 2% COBRA administrative fee — one of the most expensive coverage options available to individuals between jobs.

With Rob: Rob identified that she qualified for an ACA Special Enrollment Period triggered by losing her husband's coverage. She enrolled in a subsidized Marketplace plan, dramatically reducing her monthly costs while maintaining solid coverage until Medicare began at 65.

💰 Saved thousands vs. full COBRA cost saved

Right Plan, Right Drugs

Durham-Area Couple's Drug Costs Spiked

Situation: A retired couple living near the Wake-Durham county line had auto-renewed their Medicare Advantage plan without reviewing the new formulary. In January they discovered their two most important medications had moved to a higher tier, increasing their cost significantly — one specialty drug was now nearly unaffordable at the new tier.

Without help: Had they continued on the same plan, the couple would have faced substantially higher prescription drug costs throughout the year with no ability to switch until the next Annual Enrollment Period — potentially spending far more than the $2,100 Part D out-of-pocket cap threshold.

With Rob: Rob caught the formulary change during an October AEP plan review and moved the couple to a Part D plan that kept both medications at a lower tier. Their total 2026 drug costs stayed well below the $2,100 out-of-pocket cap, and both their physicians remained in-network.

💰 Drug costs kept below $2,100 OOP cap saved

Signs of a Trustworthy Medicare Agent in Wake County

✓ Holds a valid NC insurance license and National Producer Number (NPN) you can verify online.
✓ Asks detailed questions about your doctors, prescriptions, and how often you use medical care.
✓ Presents multiple plan options from different carriers rather than pushing one product.
✓ Explains the difference between Medicare Advantage, Medigap, and Original Medicare clearly.
✓ Never charges you a fee — licensed agents are compensated by insurance carriers, not enrollees.
✓ Follows up before each Annual Enrollment Period to review whether your plan still fits your needs.

Red Flags to Watch Out For

❌ Agent discourages you from comparing plans or rushes you to sign before you are ready.
❌ Cannot provide a valid NC license number or NPN when asked directly.
❌ Promises specific savings amounts without reviewing your actual medications and providers.
❌ Recommends the same plan to everyone regardless of individual health situation.
❌ Uses high-pressure tactics near the AEP December 7 deadline to force a quick decision.
❌ Fails to explain that provider networks and drug formularies change every January 1.

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Another Thing Most People MissIf your income has recently been higher — perhaps from a Roth conversion, home sale, or large capital gain — you may face an IRMAA surcharge on top of the standard $202.90 Part B premium. IRMAA is based on your MAGI from two years prior, so a high-income year in 2024 could affect your 2026 Medicare premiums. Triangle and Wake County retirees should discuss income planning with a financial advisor before transitioning to Medicare. A licensed agent can help you understand the IRMAA brackets so there are no billing surprises.

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WarningNever enroll in a Medicare plan based solely on a television advertisement or a mailer. Many Wake County residents have enrolled in plans that do not include their primary care physician, specialist, or preferred hospital system — because they did not verify network status with a licensed agent before signing up. Always check the actual provider directory and drug formulary for the current plan year.

What Happens When You Work With Rob

Confirm Your Enrollment Window

Identify which enrollment period applies to you — Initial Enrollment Period (IEP), Annual Enrollment Period (AEP, Oct 15–Dec 7), or a Special Enrollment Period. Missing the correct window can result in permanent late enrollment penalties that add up significantly over time.

15–30 minutes

List Your Doctors, Hospitals, and Prescriptions

Write down every provider you currently use in the Wake County and Triangle region, including specialists at Durham or Raleigh-area systems. Note every medication, dose, and frequency — formulary coverage varies widely between Part D and Medicare Advantage plans.

20–45 minutes

Compare Plan Types: Original Medicare vs. Medicare Advantage

Original Medicare (Parts A and B) pairs with a Medigap supplement and a standalone Part D drug plan. Medicare Advantage bundles coverage but typically restricts you to a network. A licensed Wake County agent can walk you through both structures side by side.

30–60 minutes

Run a Side-by-Side Plan Comparison

Use the plan comparison tool at https://planmatch.generationhealth.me to see real 2026 options available in Wake County. Review premiums, deductibles, copays, and out-of-pocket maximums — the Medicare Advantage out-of-pocket maximum in 2026 can reach $9,350 in-network.

20–40 minutes

Enroll with a Licensed Local Agent

Call Rob Simm at (828) 761-3326 or schedule at https://calendly.com/robert-generationhealth/new-meeting. Rob holds NC License #10447418 and NPN #10447418, and his help costs you nothing — agents are compensated by the carriers, not by you.

30–60 minutes

Key Takeaways

✓The standard 2026 Medicare Part B premium is $202.90 per month with a $283 annual deductible for Wake County enrollees.
✓The Medicare AEP enrollment deadline of December 7 is firm — missing it typically locks you into your current plan for a full year.
✓The Part D out-of-pocket cap of $2,100 in 2026 protects enrollees who take high-cost or specialty medications.
✓Late enrollment penalties for Part B and Part D are permanent and can significantly increase costs over a long retirement.
✓Medicare Advantage plans in 2026 carry an in-network out-of-pocket maximum of $9,350, and provider networks can change mid-year.
✓Wake County residents can compare 2026 Medicare plans at no cost by working with licensed broker Rob Simm at (828) 761-3326.
✓Always verify that your specific Raleigh-area doctors, specialists, and hospitals are actively in-network before enrolling in any Medicare Advantage plan.

Frequently Asked Questions

Common questions about Medicare in North Carolina. If yours is not here, call (828) 761-3326 and ask before you enroll.

How do I find a licensed Medicare agent in Wake County, NC?

You can work with Rob Simm, a licensed North Carolina Medicare broker (NC License #10447418, NPN #10447418), who serves Wake County including Raleigh, Cary, Apex, and the broader Triangle area. Rob compares plans from multiple carriers at no cost to you — agents are compensated by insurance companies, not by enrollees. Call (828) 761-3326 or schedule a meeting at https://calendly.com/robert-generationhealth/new-meeting to get started.

What is the AEP deadline and when does it end in 2026?

The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7, 2026. During this enrollment window, Wake County residents can switch Medicare Advantage plans, move from Original Medicare to Medicare Advantage, or change their Part D drug plan. Any changes made before the December 7 deadline take effect January 1, 2027. Missing the AEP deadline typically means staying in your current plan for another full year.

What does the Medicare Open Enrollment Period (OEP) allow me to do?

The Medicare Advantage Open Enrollment Period (OEP) runs January 1 through March 31 each year. During this enrollment window, individuals already enrolled in a Medicare Advantage plan can switch to a different MA plan or return to Original Medicare once. The OEP does not allow you to switch from Original Medicare into a Medicare Advantage plan. Wake County residents who made a switch during AEP but regret it may use the OEP as a second chance.

How much is the 2026 Medicare Part B premium for Wake County residents?

The standard 2026 Medicare Part B premium is $202.90 per month, with a $283 annual deductible. Wake County enrollees with higher incomes may pay more due to IRMAA — the Income-Related Monthly Adjustment Amount — which kicks in when individual MAGI exceeds $106,000 or joint MAGI exceeds $212,000. A licensed agent can help you understand IRMAA brackets and whether any income changes could lower your adjustment.

Is there a cap on Medicare Part D drug costs in 2026?

Yes. In 2026, the Medicare Part D out-of-pocket cap is $2,100. Once your total qualifying drug spending reaches this threshold, your plan covers 100% of covered prescription costs for the remainder of the year. This cap is particularly valuable for Wake County residents who take specialty or high-cost medications. Comparing plan formularies carefully before enrolling can help you keep spending well under this cap.

What is the Medicare Part A hospital deductible for 2026?

The Medicare Part A inpatient hospital deductible for 2026 is $1,736 per benefit period — not per year. If you are hospitalized more than once in a year and each stay begins a new benefit period, you could face this deductible multiple times. A Medigap supplement plan such as Plan G is designed to help cover this exposure. Wake County residents working with a licensed agent can compare Medigap options side by side.

What happens if I miss my Medicare Initial Enrollment Period (IEP)?

Missing your 7-month Initial Enrollment Period — which spans 3 months before, the month of, and 3 months after your 65th birthday — can result in permanent late enrollment penalties. The Part B penalty adds 10% to your premium for every 12-month period you were eligible but not enrolled. The Part D penalty adds 1% of the national base premium for every month you lacked creditable drug coverage. Both penalties are permanent and last your entire time on Medicare.

Can I keep my current Raleigh-area doctors on a Medicare Advantage plan?

Not necessarily. Medicare Advantage plans maintain in-network provider directories that are often six or more months out of date, and providers can leave a network mid-year without notice. Wake County residents should verify that their specific physicians, specialists, and preferred hospitals are actively in-network before enrolling — not just that the health system appears on the list. A licensed agent can help you cross-check current network status before you commit.

Should I choose Original Medicare or Medicare Advantage in Wake County?

The right choice depends on your health needs, budget, and how often you use medical services. Original Medicare offers broader provider access anywhere in North Carolina or across the country, while Medicare Advantage typically offers lower upfront premiums but restricts you to a network with an in-network out-of-pocket maximum of $9,350 in 2026. Rob Simm can run a personalized side-by-side comparison for Wake County and Triangle-area residents at no charge.

Does working past 65 protect me from Medicare late enrollment penalties?

It can — but only if your employer plan qualifies as creditable coverage and your employer has 20 or more employees. Many Wake County residents are surprised to learn that employer HR departments are often not licensed to give Medicare advice and may misstate the rules around Special Enrollment Periods. If you are approaching 65 and still employed, contact a licensed Medicare agent before making any decisions to confirm your specific situation and protect yourself from permanent penalties.

2026 reference figures (CMS.gov): Medicare Part B premium $202.90/month · Part B deductible $283 · Part A deductible $1,736 · Part D OOP cap $2,100 · MA in-network OOP max $9,350.