Adam Simon, Medicare Insurance Broker
Adam Simon
Simple Senior Health Plans
Medicare Broker Licensed in MI, AL, AZ, CA, CO, FL, GA, IL, IN, NC, ND, NV, OH, SC, TN and TX
8+ Years of Experience
Contact Details
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Location
Macomb, MI
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Phone
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Website
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Pre-Appointment Form
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Facebook
About Me
With nearly 20 years in the insurance industry, my ultimate passion is making Medicare SIMPLE and stress-free for my clients. Your healthcare journey is as unique as your fingerprint—there’s no such thing as a “one-size-fits-all” solution. I understand how overwhelming and complex this process can feel, and it’s not always easy to know where to turn for trustworthy guidance. That is why my mission is to serve as an advocate first, providing clarity and helping you navigate your options with confidence and peace of mind. Every recommendation that I make will always be rooted in what’s best for you and your unique life stage. With a client-first, service-based approach, I’m here to walk with you every step of the way—from our very first conversation through life after enrollment!
Q&A with Adam Simon
I just moved to a new state. Do I need to do anything with my Medicare coverage?
Answer: Yes, both Medicare Advantage and Medicare Prescription Drug Plans are location dependent. You will want to notify your plan that you have moved and also use the SEP (Special Enrollment Period) to find a new plan in your area.
Is Guaranteed Issue available after the Medicare Open Enrollment period ends?
Answer: Yes, in certain situations. For instance, with a Medicare supplement, you have a six month open enrollment period from the time you enter Medicare part B. You are always guaranteed to be accepted during that timeframe. If you live in a state with the “birthday rule“, you can move plans with a guaranteed issue on the anniversary of your birthday if you so choose to. And states without the birthday rule, there is a guarantee issue right for somebody who leaves a Medicare supplement to enter a Medicare advantage plan for the first time and then goes back to their Medicare supplement within 12 months. That reentry into the Medicare supplement is guaranteed issue. Hope that helps!
Can you help me understand Maximum Out-of-Pocket (MOOP) limits in Medicare plans, from your experience as an agent?
Answer: The maximum out of pocket, or MOOP, is the total limit of all medical costs that you pay in any given plan year. It is “cost protection” for you. Meaning, you can wake up on January 1 of any given year and know that the MOOP in your specific plan is the MOST you’ll ever pay for medical expenses that year.
How do you educate clients who are completely new to Medicare?
Answer: I do this in a couple of ways:
1.) Educational Seminars, both online and in person. This is "Medicare 101" for anyone who is nearing Medicare age or family of someone who is. We go in-depth into Medicare from A to Z and help those in attendance understand and unravel Medicare. It should not be this complicated or complex! My sole aim through these is to Make Medicare SIMPLE.
2.) One-on-One Education. This is my primary means of helping to educate clients new to Medicare. Whether in-person, Zoom, or over the phone, I am honored to walk through Medicare and the options available to whomever calls, text, or emails me anytime!
Will Medicare Advantage plans start offering more digital health tools like apps by 2030?
Answer: This is a very good question. I've personally submitted a request to some of our carriers to implement digital physical therapy tools through a resource that has the power to truly transform how PT is administered to seniors. I have not been told that this is going to happen, but can assure you that we are working hard to get things like this implemented!
What's the best way to compare my current Medicare supplement plan to a Medicare advantage plan?
Answer: The best way to compare is to find an independent broker that you trust and whom others trust. Being fully independent allows us to show you most (or all) of the plans in your area and also to compare your current plan to a Medicare Advantage plan. They are very different plans with unique nuances and having a broker that doesn’t cost you anything is a smart way to shop!
I don't understand how my friend pays nothing for their plan and I pay over $200-are these plans just totally random by ZIP code?
Answer: This is something that I hear all the time. Typically, it is because your friend does actually “pay something.” More than likely, they pay their Medicare part B premium out of their Social Security check, which feels like “nothing” because they do not see it. Then, they may have a Medicare advantage plan that has a $0 per month premium. Whereas you more than likely have a Medicare supplement plan where you pay a premium every month out of your checking account. To your friend, it seems as if they “pay nothing” while you are paying a premium every month. The reality is both of you pay a premium for Medicare part B and they have a zero premium Medicare advantage plan and you have a monthly Medicare supplement premium.
In the end, everyone pays something regardless of which type of plan that they have. It all comes down to HOW you want to pay for it.
I hope that helps clear it up!
How do I appeal a decision by Medicare or my plan if they deny coverage for a procedure or medication I need?
Answer: You call the plan directly and file an appeal. The number will be on the back of your card. Also, if this is a drug plan, you can request a formulary exception if all other options have been exhausted.
What is one of the the most common misconceptions people have about Medicare?
Answer: When are the most common misconceptions that I hear is people thinking that Medicare covers everything after age 65. However, there are several things that Medicare does not cover that most people want or need to have a plan for. Those include (but aren’t limited to), long-term care, cosmetic surgery, certain things after an auto accident, etc.
What's one piece of advice you wish every senior knew before picking a Medicare plan?
Answer: Everyone’s Medicare “puzzle“ is as unique as their own fingerprint. A lot of well-meaning people i. your life will try to “help” by advising you to simply go with a certain plan or option because it worked for them. However, without a comprehensive analysis done on your personal situation (medications, doctors, needs, etc.) that advice could be very detrimental!