Ben Washington, Medicare Insurance Broker

Answer: The biggest mistake seniors make when enrolling in Medicare is not understanding their Medicare options. What difference between original Medicare and Medicare Advantage plans. Also enrolling into Medicare Part B (paying a premium for part B) when they still have coverage through their company or through their spouse.

Answer: I had client paying out over 3,000 for premium for a Medicare Supplemental plan but was not sure about getting into a Medicare Advantage Plan. I explain to the client that even though he has had a Medicare supplemental plan for over ten years. He still has a one-year trial period to enroll in a Medicare Advantage plan and get back into Medicare Supplemental plan without having to answer any medical questions. (Called guarantee issued right)

Answer: In 2025 there is an imbalance exists in prescription drug spending, because it uses to be four cost stages on a drug plan now it is only three cost stages. The deductible, initial coverage and catastrophic which comes when over 2000 has been spent on drug by client and plan. This means the client pay 0 dollars for rest of year which should be less than previous years.

Answer: If you are turning 65 next month; You should go to SSA.gov website, learn and sign up for part A and enroll in Part B or go to your Social Security office. if you getting Social Security you should by automatically enrolled in Medicare part A/B unless you opt-out of part B.

Answer: you avoid or reduce IRMAA charges on my Medicare premiums? By lowering your taxable in prior to taking medicare two years before 65 or submit Monthly Adjustment Amount form (life-changing event)

Answer: The 2025 Medicare Part D out-of-pocket cap means the cost lower, because the donut hole has been eliminated. After $2k has spent by senior and Part D carrier the senior cost will be zero. Also because of the part D payment plan the monthly cost will be less. https://youtu.be/3-TMT-fnZ9Q?si=W4EQoDf8JdHfOimh

Answer: so many coverage gaps, and is it designed that way on purpose? Medicare Coverage Gap for Medicare Part D has been eliminated. The coverage gap was to help reduce cost carrier and shift to the senior and the Part. D manufacturer.

Answer: Donut hole going away means that your cost will be less that last if your drugs cost was higher enough for you to get into the donut hole.

Answer: Yes , It is true in 2025 the limit is $2,000. A Medicare Part D has different phase : deductible phase you pay retail cost of your medication until you meet deductible limit ( some plans has deductible only on some tiers) or the plan does not then you and plan pay cost of the medication initial coverage level until $2,000 has been reached then you pay nothing for your medication.

Answer: You get qualified by your state to help individuals with limited means cover some or all of their out-of-pocket Medicare expenses. like your Medicare Premium Payment Programs, offer financial assistance to pay your Part B Premium as well.

Answer: Why am I paying more for Medicare Part B and D than my friends? because premiums based on your income.

The IRMAA (Income-Related Monthly Adjustment Amount) the premiums for Medicare Part B and Part D based on those with higher Modified Adjusted Gross Income (MAGI). It based on MAGI 2 years prior

Answer: Why are seniors losing Medicare Advantage plans? A company can choose no longer offer MA in area, or Non payment or they enrolled in a part D Plan will disenrolled from a MA or they travel away from plan area for over 6 months

Answer: What's the best way to avoid surprise bills for lab tests under Medicare Advantage? To go in network or go to lab in the office

Answer: What advice would you give to seniors who are feeling overwhelmed by all the Medicare options available? Well I would say don't be because a good broker can help. They should focus on their needs will eliminate most of the options.

Answer: I signed up for a Medicare Advantage HMO, and I'm wondering if I can see a cardiologist out of network without paying everything myself. You can not go out of the network, if you do you will always pay the full cost unless it is emergency.

Answer: I'm on Medicare Part B, and I'm wondering how my physical therapy visits are covered. Do I have to hit my deductible first? Yes medicare has part B deductible of 257 then you will pay 20% of the cost. under original medicare. With a medicare Advantage plan you don't have me et a deductible under most plans.

Answer: How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits? by using your part b outpatient services. There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.

Answer: I have Original Medicare, a Medigap Plan G, and a Part D plan, but I'm still facing high costs for my specialty medication. What options exist for someone in my situation? Since original medicare only covers prescription medication taken in doctors office; Supplemental plan want help reduce your cost for specialty medication ,but you request Formulary Exception: 
A request to get a specific medication at a lower cost or tier or
Tiering Exception a request to have a drug placed in a lower tier, which would result in a lower copay. or drug manufacturer for help or SSA for special help or LIS low income subsidy which help with drug cost.

Answer: I'm living solely on Social Security of $1,400 monthly and can't afford my Medicare premiums and copays. What assistance programs might help someone in my situation? You might be eligible for medicaid which can qualify for Medicare Saving Programs(MSP) like Qualified Medicare Beneficiary (QMB) Program or other MSP which can with premiums and other cost sharing