Althea Sanders, Medicare Insurance Broker

Answer: You should definitely evaluate your plan every year. Watch for premium, copay and coinsurance increases - Your drug coverage and Your preferred PCP still being in your network. It is a little different if you have a Medicare Supplement Insurance plan - but those premium increases need to be monitored. You can always shop for a better premium. In Washington state, for Medicare Supplement plans, you can evaluate at any time. You don't have to wait for a special enrollment period.

Answer: Best tool to use for this is Medicare.gov. You can set up your own profile and it will remember your current and past drugs. You can edit the list at any time. It is a great tool that you can use to filter according to your needs and what you are looking for. You can do side by side comparisons of the various carriers that are in your plan area.

You can also directly enroll yourself (during annual enrollment Oct. 15-Dec. 7th) - locking in your plan for the coming year.

Answer: Part B covers outpatient care - which is covers all doctor visits, testing, poking, prodding, etc. This also includes Urgent Care Office visits.

Part A is inpatient - your hospitalization stays.

Answer: Yes! You want to find an agent who makes you feel confident and comfortable with their services. You are relying on them for education, organization and guidance. You want to feel comfortable to ask your questions. Go ahead - look around. When you find one that you like - communicate your needs and concerns so they can best serve you!

Answer: It depends on you, your budget and your healthcare needs. A full needs analysis should be completed with a local agent/broker. This allows you to see several different carriers and what benefits they offer - even if you are considering a MediGap plan. Carriers have different benefits. I would advise speaking with a good agent/broker vs direct with any one carrier representative. It will allow you to explore all options and make the decision that best fits your needs and budget.

Answer: That depends on your medications and your personal needs. Medicare is not a one size fits all. This is why a personal evaluation with a skilled agent or broker is the best way to determine your needs.

Answer: The biggest mistake is not seeking help with the education portion. There is so much to know and there are so many moving/changing parts. Partnering with an Agent/Broker is complimentary so go ahead - find someone you enjoy working with and accept the help!

Answer: How does Medicare coordinate with other medical insurance (Medicaid, Tricare, etc.) or what are the complications with late enrollment? Do I have to have Part D coverage? What happens if I opt out of it?

Answer: The right ones are not... I can not speak for every agent or Medicare seminar.

Mine are intended to make myself available for those who are troubled with their choices, do not understand their options and have no advocate. If they have an agent or broker - I suggest they return to them. If they are displeased with the assistance and education they have been given - I am happy to provide knowledge and support. There is never an obligation to enroll or change plans. A good broker is content to be of service, to all who need guidance.

Answer: With Medicare Part A for your hospital coverage - you will still have some out of pocket expense. There is no co-pay for a hospital stay but there IS a deductible. For 2025, the deductible for a hospital stay is $1,676. Days 1 - 60 are $0 per day after you pay the deductible. However, there is a cost of $419 per day for days 61-90 and $838 per day for days 91-150.

You could pay the deductible multiple times each year if there are multiple admissions.

Feel free to message me if you would like further explanation!

Answer: It means that the former coverage gap known as the "Donut Hole" has gone away.

Stage 1 is the deductible - $590.

Stage 2 is the initial coverage phase where beneficiaries pay up to 25% coinsurance for medications until they reach a MAX out of pocket of $2000 for the year.

Stage 3 is the Catastrophic coverage - once a beneficiary has reached the MAX $2000 out of pocket for PART D drugs - medications on your plans formulary become covered at 100%.

Plan year restarts January 1.

This is for Part D drugs - prescription medications that are mailed to you from your doctor or that you pick up from a pharmacy.