Barth Frankenberry Jr CMIP, Medicare Insurance Broker

Answer: It depends on the perspective Medicare Beneficary on what they look like.

Personally as a Fiducary Financial Advisor, I believe that you should pick the most effective coverage at the best price for your risk tolerance.

For example, if you are very risk impaired you may favor Origional Medicare.

If you are ok with paying for copays and have the resources to do so a Medicare Advantage plan will mirror the look of the plans you have had during your working years.

Barth Frankenberry Jr CMIP LUTCF

Answer: NO, you can not be dropped for Medical reasons.

I am making the assumption that this question is pertaining to Origional Medicare only. Once approved for Medicare at 65 you can not be cancelled due to Medical reasons

If you are on Medicare Disability you would only be disqualified for Medicare if your medical condition that qualified you for disability improved to the point where you no longer meet the Social Security Administration's disability Rules.

Answer: Well the best plan is the one inforce at the time of claim, So even if a plan provides better coverage, if it is unaffordable it is not actually benefical if it takes food off the table.

Medicare is an individual decision and exploring All your options provides the best coverage for you!!

Working with a broker like Barth Frankenberry Jr CMIP who is a Certified Medciare Insurance Planner will look different that a agent with only one or two carriers avaliable to them.

Answer: Depending on where you Claim Residency.

There are times depending on where you live that you can be declined for a Medicare Supplement Plan.

If you are within the 6 month window of turning 65 or Starting you Medicare Part B you can change as many times as you like with no underwritting.

However if you are outside this window, on a Medicare Advantage Plan or choose to not pick up coverage when first avaliable to you, you will have to pass underwirtting to be approved for a new plan.

In New York, Connecticut, and Vermont you can pick up a Medicare Supplement plan any time due to a continuous open enrollment window, however premiums will reflect this additional Risk to the Insurance Companies.

In some states like Maryland, California, Deleware, Idaho, Illinois, Indiana, Kentucky, Lousiana, Nevada, Oklahoma, Oregon, Utah, Virginia, West Virginia, and Wyoming there is a Birthday Rule that will allow existing Medicare Beneficaries to change their current coverge from one company to another to lower the monthly cost within 30 days of their Birthday annually.

You will need to provide proof of current coverage.

This information is correct as of 8.4.2026.

Barth Frankenberry Jr CMIP, LUTCF

Answer: First double check to make sure it is acutally out of Network, If it is then ask a local agent if there is a Special Election Period (SEP) to change your plan to allow for the Hospital of your preference.

Answer: In April of 2026 there is a pilot program that allows some Medicare enrollees to receive up to 500.00 in Hemp-derived products for medical purposes. These products do contain cannabidiol (CBD) but can not contain more than 0.3% Delta-9 THC to be avaliable thru this pilot program. This program is limited to Washington, DC, and states where these products are considered legal.

As of August of 2026 Marijuana. Marijuana is not approved at the Federal level (FDA) for specific Treatments, Medicare is proveded at the Federal Level, due to it not being approved with the FDA it is not covered thru the Federal Medciare Program at this time.

Barth Frankenberry Jr CMIP, LUTCF

Answer: Medicare Part D will cover a form of Ventolin, Depending on the formulary your plan uses it may be under the name brand of Ventolin or the Generic version of Albuterol. You may experience a Deductible and or a Copay/CoInsurance depending on what stage of coverage you are in at the time of claim.

Answer: GREAT NEWS!!!

In 2022, the Inflation Reduction Act removed the Donut Hole that was associated with Medicare Prescription Plans.

There is now even a PPP (Medciare Prescription Payment Plan) This option will set up a level payment plan throughout the year so you can budget your medication cost on a monthly basis.

Answer: It depends,

If you pick a plan with a HMO network, you may be restricted to who you can see within the plans network. If your Dr is not in the network, you can still go them but your plan will not pay for the cost of the visit. You can only see in-netowrk DRs unless it is a HMO_POS plan and your DR will accept the terms and conditions at the time of service and still may have a copay or coinsurance.

If it is a PPO plan you can see any Dr that is in the network or out of network that is willing to bill the plan. Out of network DRs will be at higher Copay or potentially Co-insurance than in-network.

Barth Frankenberry Jr CMIP, LUTCF

Answer: I LOVE this Question,

I explain to our clients that have you ever recieved a Medical Bill that was incorrect? Most have. Have you ever tried to explain to someone over the phone what you may think is wrong with this bill to have it corrected? Its not easy, As a Professional Medicare Insurance Broker. We Write, Service, provede unbias advise to what is going on in the Medicare Space at the time of the appointment. Also Brokers, have contracts with Many companies, not just one or a few. I personally have over 25 companies that i write for. So if you get an agent that calls and only has one of the carriers in your area, who do you think they will recemmond?

find someone you can trust, if you have an uneasy feeling there is a reason for it,

Barth Frankenberry Jr CMIP, LUTCF

Answer: Artificial Intelligence is a useful tool, that when used correctly can cut down processing times for claims, pre approvals and seek out patterns of abuse, waste, and Fraud.

But, It must be noted that I have personally seen AI fill in the gaps when it doesnt know something, this is called an Hallucination or Confabulation. Any tool can be useful if apporpriately positioned AI is no different.

Answer: Not Necessarly,

If you are getting bills, this would imply that you are recieving medical care somewhere, if you are drowning in bills you are more than likely using an above average amount of Medical Care at this moment in Life. The first thing i look at is, are the servcies you are recieving covered by Medicare, Medicare only covers Medically neccessary servcies. If it is cosmetic, Medicare doesnt cover it.

I then normally check to see if it is actually a bill or an Explination of Benefits, which looks like a bill but just explains what was billed to your Medicare and Medicare Supplement. Quite often there was a incorrect CPT code or error in the billing. I would talk to the agent that signed you up to have them provide service that they are being paid to provide to review your coverage and billing.

If this is all correct, then a review of your plan may be appropate at this time to make sure you are on the right plan.

If you would have had a Medicare Advantage the bills would have been the same or potentially higher, with a higher MOOP (Maximum out of Pocket).

Answer: There are 2 ways to receive your Medicare Based on what Zip code you reside in:

1. Original Medicare with a Drug Plan or other creditable prescription coverage. Adding a Medicare Supplement at an additional cost which will go up with age will help with out-of-pocket cost and remove the unlimited Liability of Original Medicare. Dental, Vision, and Hearing are at an additional cost.

2. The other option is Medicare Advantage, this option has a lower cost per month, as low as $0 per month, but you will have copays as you use care. This option is provided thru private insurance companies that will provide your coverage thru one plan which will cover Medical, some plans cover Prescriptions, some provide Dental, Hearing, and Vision coverage.

Please let me know how we can help?

Barth Frankenberry Jr. CMIP, LUTCF

Answer: As a Registered CMIP™ (Certified Medicare Insurance Planner) Medicare Planner, I believe that working with a Medicare Advisor can make all the difference.

We offer All lines of Medicare products for example, Medicare Supplements, Medicare Part D Drug Plans, Medicare Advantage Plans, Hospital Indemnity Plans.

At Frankenberry Insurance Group LLC we explain the pitfalls to avoid, Education before Enrollment, our agents help facilitate enrollment. Our agency is a client focused Medicare practice that can do In-Person, Telephonic, and Virtual appointments at the clients request.

Our slogan Is MEDICARE Made Simple!!

Barth H. Frankenberry Jr. CMIP, LUTCF

Answer: IRMAA surcharge is an additional amount that is added to the monthly cost for Medicare Part B and Part D. It is based on your income from 2 tax years prior to enrolling in Medicare and is reevaluated annually based on the Modified Adjusted Gross Income from 2 years ago. Once your income comes down below the IRMAA thresholds, the penalty will go away after the look-back period. For example, if your income was above the income limits (even by 1 dollar) in 2024 and that was the last year for the income above the penalty threshold. In 2027, you should see the penalty be removed or adjusted according to your taxable income in 2025.

Please feel free to reach out to us to schedule a no-cost in-person consultation to see how we can be of service to you in your medicare needs.

Barth H. Frankenberry Jr