Alan "AL" Minthorn, Medicare Insurance Broker

Answer: As part of the sales process the agent should look up and inform you if all, some, or none of your doctors are contracted by any plan under consideration. If they don't look them up or worse just state they'll be covered, walk away, no run away, and find a better agent.

I typically look at their top three choices based on premiums and Part D cost sharing for the remainder of the year. Then, whittle down to looking up providers. Usually #1 or #2 have all your docs.

Answer: Many Medicare Advantage plans include generous Part D benefits. If you are NOT considering a Medicare Supplement, I would consider an Advantage plan.

Medicare Part A has a $1736 deductible (2026) if you are hospitalized, admitted as an inpatient 1 day or 60 days. You can have up to 5 of those charges per year.

Most advantage plans will be less than the deductible for a few day stay, more for a full week (depending on your county and state). The Advantage plan Maximum Out of Pocket or MOOP caps your annual out of pocket usually less than 4-5 multiples of that Part A deductible.

Advantage plans may also provide vision, dental, hearing, fitness, or other ancillary benefits offsetting some costs associated with exams, etc.

Answer: Local agents know local providers as opposed to reading them from a list on the screen. Many times they know the local managers at the insurance companies which can invaluable in getting assistance if you have a problem. A correct, compliant sales presentation requires 1-2 hours to thoroughly evaluate your provider and prescription needs, educate you on how to use the plan benefits, and make sure you understand the plan you're getting, then complete the paperwork.

Remote and Virtual agents you'll likely never speak to again. Most are paid based on how many policies they write; not the quality of service they provide to you as a customer after the sale. Most have a 30 minute countdown clock to get you sold and off the phone. A few years back when the Joe and JJ commercials were running, one company stated they had a 55% complaint rate from those customers.

Answer: Mistake no, it would have paid for a major health event. We all keep buying car insurance on the possibility of a big event.

That said, given equivalent claims over a five year period, the average advantage plan saves approx. 30-40% over G or F premiums. More if your Part D plan has premiums over the imbedded Part D included in most Advantage plans.

I know of individuals on advantage plans whose transplant bills exceeded $300,000 in one case and $400,000 in a second, and neither hit their plans $5,500 maximum out of pocket, with two different insurance companies.

Answer: File an SSA-44 form which may be found on the SSA.GOV homepage under forms. Good luck.

They require a major life changing event as the threshold for reductions; and again, they are looking back at your MAGI from two years ago.

Answer: When I was employed at the insurance company, we used to joke the Provider Directory had a 5 minute print life before it was out of date. Providers come and go usually due to poor management decisions. The old Catch-22 is healthcare systems blaming insurance and insurance blaming healthcare systems. Most denied Prior authorizations are NOT insurance companies being "bad guys" but, incomplete paperwork from providers.

Medicare Advantage plans pay the exact same amount as Original Medicare; however, their claims have a 10% audit rate requiring providers get it right. Original Medicare a much lower threshold for errors.

You should be more worried about the system changes coming from the current administration under false pretenses.

Answer: Yes, I would just make sure you are planning on being employed for at least 6 months. Medicare frowns on jumping on and off coverage. Also, avoid any gaps in coverage at all cost as they can be knockout criteria for some products.

AS AN ALTERNATIVE YOU MIGHT STICK WITH THE COVERAGE YOU HAVE and negotiate a higher wage since you are not using their benefits.

Answer: COBRA is NOT viewed as Creditable coverage by Medicare. You should already be enrolled in Part A and adding Part B when your ER plan ends. Most advantage plans are required to cover transition care for treatment in progress for 60-90 days. In many cases, the cost sharing is equal or less than that of ER - COBRA benefits.

Answer: Providers choose to contract and can also choose to leave. An individual doctor, versus an entire medical group has larger implications. Some providers "threaten" to leave as a source of leverage for contract negotiations. Some groups decide to leave or reduce their Medicare patient exposure as part of stabilize revenue streams.

In some case, Medicare will grant a Special Election Period on request; however, it is on a case by case basis, or may be granted to all patients a few weeks after a large provider group leave a contract.

Answer: Triple check your work and use the Medicare Plan Finder website. Medicare's website has been an agent's trusted resources for the last 25 years.

Next, why not select a local agent? Local agents know the products, providers, and pharmacies far better than most individuals. Independent brokers offering all carriers providing a single point of entry, continuity, for your Medicare journey. Better yet, your supporting small business in your area.

Answer: Many Specialty Medications have foundation or manufacturer discounts via their Specialty Drug units. While the $2000 cap 2025 helped most in your situation, the cap continues to go up year over year; 2026 - $2100 and 2027 projected to be $2400. Sadly, the cap had a hidden cost shift away from big pharma and back on health insurers eroding other plan benefits.

Answer: Many advantage plans offer dental benefits discounting or including preventative care. Before jumping into a plan for dental, do your home work and make sure your dental office is in network with the plan(s) you're considering. Some carriers offer reimbursement benefits vs embedded network benefits - again, do your homework and see which may be better for your situation all other considerations being equal.

Answer: Medicare Advantage plans, contrary to negative commentaries, independent researchers show a 20% savings to the Medicare Trust Fund vs Original Medicare and Supplements; and most beneficiaries enjoy a 40% savings or more over a five year period again compared to Original Medicare and Medicare Supplements. With many plans offering national provider networks and published knowledge that plans must follow Medicare's prior authorization rules, beneficiaries are not seeing the limitations once touted as major selling points by the med supp market.

Answer: Congress and CMS need to move forth legislation properly funding Medicare into the future. The current projections taper benefits in 2033. The current cap on contributions for the higher income earners would prevent insolvency in the long term.

Answer: PPO plans have higher actuarial costs due to the clearly defined out of network benefits available. Those higher costs are typically reflected in higher copays, coinsurances, and deductibles throughout the benefits; even a higher, or split MOOP.

For many individuals with either a HMO or HMO-POS plan - a national network of providers may be available without the PPO burden to the financial structure of the plan. As long as you stay in the national network of providers you have "local" cost sharing.

Having a provider strategy at both "ends" for snowbirds is the smart thing to do. All plans are required to cover emergency care as in-network.

Answer: All of the skills learned in teaching I use to assist seniors in navigating the Medicare system. It is very rewarding to help senior and disabled folks receive the benefits they are entitled.

Answer: I would identify and work with your local SHIP office, (SHINE, Agency on Aging, ServiceLink, and other names depending on state), to make sure your transition processes correctly. As states administer Medicaid benefits, not all enjoy thorough processing during transitions.

Answer: There are no expectations for changes in 2026 at this time.

Key details regarding Extra Help changes:

Annual Adjustments: Income and resource limits for the Low-Income Subsidy (LIS) are adjusted annually based on the Consumer Price Index (CPI), with 2026 limits increasing by 3.01%.

Effective Date: Any changes to your Extra Help status or coverage amount, often determined by a review in late summer, take effect on January 1.

2026 Enhancements: In 2026, beneficiaries will have access to 88 benchmark plans with $0 premiums, and maximum copays for drugs are set at $5.10 for generics and $12.65 for brand-name drugs.

Answer: 2026 plan details will be available in October. Most people do not have a valid Election Period to make a change before Annual Enrollment. As much as 2025 changes were dramatic; 2026 is likely to much worse in many markets.

Answer: It's really hard to answer this question without a lot more information.

Examples:

1) Do you, did you, have LIS or SPAP assistance?

2) Did you change pharmacies?

3) Has your pharmacy's relationship with your plan changed? (Standard vs Preferred)

4) Is it 2026 and you no longer get VBID subsidy?

5) Were you on transition refills and now your not?

Answer: I had a client call a TV ad 800 number during Annual Enrollment in a moment of emotional weakness having just lost their spouse. They were assured all their docs and drugs were covered by that new “TV giveback plan.” They had 13 docs and 23 drugs. Ten docs were out of network on the giveback plan; the cost sharing for the 23 drugs was over $10,000 more than their current plan.

They called feeling shame and embarrassment for succumbing to the fast talking agent at their low point emotionally. I KNEW I COULD “FIX” IT. It took hours to reverse the damage caused by the fast talking TV call center agent. As it was still AEP, it was easily reversed with a few days to spare. But still caused the customer a lot of worry over the several weeks of processing time.

Answer: Consult with a licensed agent or call Medicare to review possible options. There are multiple election periods annually. You may qualify for a Special Election Period depending on “why” you missed your Open Enrollment Period.

Answer: First you may not be comparing apples to apples; without knowing their income, plan details, etc, you are likely not comparing like plans. Some states allow “rating” insurance by zip codes, others gender, tobacco use, and age. Some use all of these. Agent’s can sort the details and risks making sure you needs are being met.

Answer: The best advice I give my customers - do not listen to your friends, family, or others not licensed in my business. Most do not disclose all their medical and pharmacy details, rarely know their insurance and your insurance plan nuances, and do not have the experience to make those generalizations and comparisons. I fix their bad advice more than bless it.

Answer: Most Medicare Advantage plan Dental Benefits are limited at best. Some reimburse, others use a national dental insurer, yet, others, are “internal” dental products under that carrier’s portfolio of products. A good agent can offer suggestions of local plans meeting your dental needs and balancing those with your medical/Rx needs.

Answer: I recommend 12-14 weeks prior to your birth month visiting the Social Security website and looking for the “Apply for Medicare” radio button. Do not procrastinate. The process typically takes a minimum of 4-6 weeks. During that time - you’ll get NO updates; then about 30 days later, you’ll get a brief email saying you’ve moved to the next step - within two weeks you’ll have your Medicare Card and about 3-4 letters.

Answer: In my case, I have spent 16 years developing, refining, and learning everything I can about the Medicare program, senior insurance products, and options I can offer my customers. It’s all I do. No home, auto, life, or other insurance products to dilute my time and expertise.

Answer: Medicare’s cost sharing is independent of your contributions through payroll deductions, or premiums paid. Specialist visits are expensive due to their expertise you’re accessing. You might review your current plan options with a good agent to see what other options may be available.

Answer: MOOP’s apply to Part A & B cost sharing - it is the maximum you should pay in total cost shares before the plan covers 100% of Part A & B costs the remainder of year. Greater than 90% hit their MOOP via chemo or other Part B medications, or radiation treatments.

Answer: First, make sure you have the plan providing lowest cost coverage for your formulary needs. Next make sure you use preferred plan pharmacies. Create a price sheet comparing plan co-pays/coinsurance vs Single Care, GoodRx, CostPlusDrugs, or other discount programs. I have one blood pressure med I pay approx. 23% for 90 days versus plan pricing.

Note: If you use a non-plan option, have your prescriber note that on your chart for audit purposes.

Some tablets can be split in half, others not - you may be able to pay a similar price for double strength tablet and half it. Just make sure your doctor knows and approves for your needs.

Answer: If you are still working, have creditable employer health and prescription insurance, meaning it is as least as good as Medicare (HR should know this), then enroll in Medicare Part A ONLY. It has zero cost, provided you've worked 10 years and paid into Medicare.

Approx. 3 months before you are ready to retire and selected an end date of employment (end of month is easier), enroll in Medicare Part B (for 1st of month following this end date). After receiving your revised Medicare Card showing Part A & B dates, have a local agent assist in educating and selecting the appropriate plan(s) to begin without a gap in coverage.

Answer: For about 90% of customers in markets with a minimum of a dozen advantage plans, they’ll be fine on these products. In more rural markets, those with high maintenance chronic conditions, or those living in three more locations yearly - a Med Supp may be a better choice.

Answer: Most common misconception about Medicare - they cover everything! Know your A, B, C, and Ds of Medicare.

Answer: My best advice would be talk to your fellow senior neighbors and identify a good local agent/broker representing most or all available insurance companies. Call centers and carrier agents are often hundreds of miles away and do not understand local providers, nor hear issues customers have with one plan over another in your backyard.