William Murray, Medicare Insurance Broker

Answer: Secondary insurance and supplemental insurance are 2 different names or references for the same insurance coverage.

Answer: Modified Adjusted Gross Income (MAGI) is evaluated annually for an Income Related Monthly Adjustment Amount (IRMAA).

The amount of IRMAA can change annually. And when the MAGI falls to within the range which qualifies for the base amount, your monthly payment will be adjusted accordingly.

Answer: Medicare will cover your stay in a skilled nursing facility for rehab, after a medically necessary qualifying hospital stay.

Once the stay becomes non-medically necessary, Medicare coverage will not be extended for long-term care because long-term care is not a Medicare covered benefit.

You would have to pay out-of-pocket or have other long-term care insurance coverage.

Answer: Yes, you would normally have to answer medical questions if you switch from one Supplement/Medigap plan to another without having a guaranteed issue (GI) situation available to you.

Answer: There should be no penalty I can think of for a switch such as that, unless you are already being assessed a penalty or if you go 63 or more days without a prescription drug plan.

Answer: Whether or not you should switch plans depends on your personal experience and comfort.

If your current plan meets your specific medical needs at a cost and service level which is acceptable to you, and the plan is accepted by the medical providers you currently use and those you may expect to use going forward, then it doesn't make sense to switch.

If you think there is a plan out there which may be better suited for your specific needs, then you should talk with an agent you trust who can point you in the right direction.

I am not someone who would switch a members plan just so I can gain another client and/or increase my commissions.

The most important situation is one that is best for you, not anyone else.

Answer: You can if your application is approved.

You may have to answer qualifying medical questions and may not qualify for the change.

You may also have to wait for a Guaranteed Issue qualifying event.

You could have a Trial Period right for change.

You could still be in your 6 month initial open enrollment period.

There's no guarantee you can change your Supplemental/Medigap plan at any time.

Answer: Your Medicare Advantage card takes the place of your Original Medicare Card. The provider won't accept that either.

Answer: Medigap has no network and requires no referrals. If the provider accepts Medicare, they will accept your Medigap plan without network considerations.

(Medigap Select plans do, however, have some hospital network considerations.)

Advantage plans may or may not have network considerations. Advantage plans are where you find HMO and PPO plans.

By definition, HMO plans have no coverage for out of network providers (you're 100% on the hook). PPO (Preferred Provider Organizations) have lower costs when using preferred providers and costs are greater when using out of network providers.

PFFS plans have some more plan specific requirements or terms and conditions which may or may not limit in, versus out of network provider care. Read them before committing to a plan.

Answer: Your plan is portable. You can take it with you, change your address of record and your monthly premium will change to the premium in affect in your new geographical home area.

Changing your coverage is another choice. It depends on how your monthly premium compares to other plans in the new area.

Answer: Medicare.gov has a link where you can run through the specific drugs, dosages, quantities, frequencies and pharmacies to easily and accurately identify the lowest cost plan for your specific menu of drugs and pharmacies.

You should do this each year beginning Oct 15 so you can change your plan to the one which fits your specific needs.

It is very intuitive and useful. Your information is saved in your own medicare.gov sign in.

If you do it each year, it will become easier and easier.

Answer: Medicare premiums, deductibles & copays work just like the premiums, deductibles & copays of any other health insurance plans you may have or may have had.

There could be differing premium, deductible &/or copay amounts for any of the Parts A, B, C and/or D of Medicare.

Answer: Social Security will notify you by U. S. mail if you are subject to IRMAA well in advance of the start of your IRMAA assessment for the coming year.

Answer: One of the most common misconceptions people have about Medicare is that Medigap or Medicare Supplement plans are PPO plans. In actuality they are Fee for Service plans, the same as Medicare itself.

Answer: The right agent should make your parents feel like what concerns them are the most important concerns, not pushing them to make a decision.

Answer: There's no simple answer.

Partly, it depends on your perception of your longevity, family lengths of life, quality of health and the things you're afraid might happen to you. You have to be comfortable with your decision.

Partly, it depends on if you continue to work and earn a good taxable wage that may increase your benefit over time.

Mathematically, calculate how many years it may take you after age 70 to break even.

There is calculator help on ssa.gov. Sign up to access the site.

Answer: I would advise talking with an agent.

Have the agent assess the current situational criteria necessary to advise your folks of the options available to them.

The options should be narrowed to just a couple to make selecting the right plan less confusing and more comfortable for your folks.

The right agent should be patient and not push to get a commitment or write an enrollment application.

The agent should not be more interested in receiving a commission than making certain your folks understand their options and are comfortable with their choices.

If the agent pushes, end the appointment and find a new agent.

Wishing you well with helping your folks.

Answer: Good question. Your good health is valuable to others.

The short answer is mostly my opinion and nothing I have empirical support for.

Medicare insurance is a social program which analyzes costs for treatment by age, gender and tobacco use.

In short, the healthy use fewer services or treatments and as such have fewer claims and costs for care.

The savings are spread out among the population to make services and treatments more affordable for those who have fewer resources for paying for care.

Answer: Without knowing anything about you, I would have to say, "all of them."

Especially those you are most curious about or if you have a hint of something going on.

Also, preventative services which help relieve your concerns about familial medical history.

Answer: Medicare does not cover most of such treatments.

You should check specific notations in the Medicare & You Booklet available at Medicare.gov.

Some Medicare Advantage plans offer over-the-counter benefits in addition to what Medicare requires they cover. It would be a plan-by-plan possible benefit, extra coverage.

Medicare Supplement plans do not typically cover anything which Medicare does not cover. Although I have seen one plan which does offer over-the-counter, additional benefits.

Answer: I would never tell you what you need or don't need or what's best or not for you. My job is to help you make certain you don't overlook something in your consideration.

The best part is, you pay me $0 to talk with me or if I write a plan for you. And I don't just work for one insurer, I am in 36 states and represent 15 or more companies with hundreds of plans.

I usually don't have to seek help to advise you. I have been doing Medicare plans since 2009, written a few thousand plans for folks and still have almost 1,000 clients on Medicare plans. So, I usually have your answers off the top of my head.

I don't have to call insurance companies to find answers.

One last thing, it doesn't matter to me which plan you want, my job is to help you find the plan that makes you comfortable. I don't pressure you to have me write a plan or to call me back, it's all up to you.

I believe that if you don't have me write your plan, you'll tell someone else how I helped you. And they'll call me, too.

Answer: Thank you for asking...

If your knee replacement will occur as an Inpatient Hospital procedure, your plan G should bill Medicare under Part A and your Medigap Plan G, as such, will cover your Hospital Benefit Period Deductible with no out of pocket costs to you.

If the procedure will occur as an outpatient procedure under Part B, then you will be responsible for the $283 Part B Deductible. The remaining 20% coinsurance should be covered by your Medigap Plan G.

Answer: In addition to eliminating the donut hole, the Inflation Reduction Act implemented a Maximum Out of Pocket limit for your share of costs of the drugs you purchase which are covered by the plan you have.

In 2025 the Maximum Out of Pocket for covered drugs was $2,000. This amount includes what you paid for your deductible, copays & coinsurance. After hitting the $2,000 limit, you would pay $0 for the rest of the year for the covered drugs you purchase.

In 2026, the Max Out of Pocket limit with be $2,100 for drugs covered by the drug plan you have.

This would not include the monthly premium you have, if you pay one.

Answer: It's hard to say without knowing the reason for the denial.

Is the specialist out of network?

Do you need a referral from your primary care provider?

Is the visit for a non-medically necessary condition?

A recommendation requires more information to be provided.

Answer: The most frustrating misconception I have to clear up with clients year after year is that they think they can continue to keep their Prescription Drug Plan (PDP) without reviewing if their drugs are still covered in the formulary, that their pharmacies are still "Preferrred/ In-Network" that their specific drug, dosage and frequency taken haven't changed and/or caused their plan to no longer be the least expensive plan for their specific menu of drugs and pharmacies used.

Answer: If all you have for non-inpatient coverage is Original Medicare Part B, then physical therapy is covered just like all Part B treatments.

That is, you have your 2025 Part B deductible of $257. Whatever is left to be met must be paid first. After that, any remaining charge will be covered at 80% by Part B. You will be responsible for the remaining 20%.

Answer: What is "Medicare treatment?"

There is medical treatment, covered by Medicare approved guidelines and procedures, and performed by providers who accept Medicare's Terms & Conditions.

Answer: All I do is educate new-to-Medicare folks.

I don't worry about getting paid. I just help.

If I end up writing a plan for you, well good, I must have helped.

If I think you would be better off staying where you are, or going with someone else you know, I'll say so.

You'll still tell someone else about how I helped you without worrying about whether or not I get paid.

Medicare 101 starts with what you need to know about Original Medicare A & B. If it's your time to enroll, we'll save the rest until you get through the process of enrolling in A & B.

Later, we'll talk about the differences between Medicare Supplement Plans plus Prescription (Part D) coverage compared to Medicare Advantage plans.

I'll remind you that you don't have to remember everything I tell you, just remember my phone number.

We'll be done talking about it when you're ready, not when I say you're done.

It's not about me getting paid. It's about you getting Medicare.

Answer: It is a common problem, but more from a dentist search perspective.

You will likely have better success by calling the member services number on the back of your Medicare Advantage card.

You will likely get a recorded menu of options. Don't listen, just say "representative" each time you hear the recording start. You will usually get a live person after a time or 2.

Keep your request concise and brief, "I would like to find a dentist in my area which accepts the embedded dental in my Medicare Advantage Plan." Have your plan member ID card handy.

These plans are usually more of a dental HMO (DMO) or a discount dental plan. If you intend to keep the coverage, you may want to try calling each time you need to see a dentist for a new recommendation, if you didn't like the previous visit.

Answer: The only reason I can think of is if the Medicare Advantage plan is an HMO and the traveler may be in need of routine care as they travel, domestically. Original Medicare allows you to see any provider without referrals or regard for network, as long as they accept Medicare.

Original Medicare does not offer international coverage, maybe except for dialysis, beyond a short distance, for non definitive care, on the other side of the borders.

If the need is for urgent, emergency care or dialysis, the Medicare Advantage plan may offer superior coverage, both internationally and domestically.

Answer: Like most service providers, the greater their experience, integrity & resources are the qualities that define advantages/disadvantages.

Brokers/agents usually give you more choices.

Listen for whom they are most interested in helping, you or themselves.

Contacting insurance companies directly limits your options to only that specific companies' plans. That is a disadvantage.

Answer: I like to recommend Medicare.gov to "Find Health & Drug Plans."

By entering each of your drugs, dosages, frequencies taken/quantities & pharmacies preferred, you can research the lowest costs plans for your specific menu of prescriptions and which pharmacies have the lowest prices for your specific menu.

If you'd like a guide to walk you through the steps, I'd be happy to assist.

Answer: The Annual Enrollment Period (AEP) has no influence on enrolling in Medicare Supplement plans.

The AEP is for changing Medicare Advantage and Prescription Drug Plans.

However, you are allowed to apply for a Medicare Supplement plan any time throughout the year.

If you don't qualify for the your 6 month Open Enrollment Period after obtaining Part B, or qualify for one of several guaranteed issue situations available, you'll have to answer health question.

Answer: Annual Physicals are NOT A COVERED MEDICAL EXPENSE under original Medicare A & B.

By definition, Medicare Supplement Plans A - N also DO NOT COVER Annual Physicals because Supplement Plans cover some part of what Medicare covers.

Preventative visits and Annual Wellness visits are covered.

If you have Original Medicare and a Supplement plan be certain to request annual or wellness visits, specifically.

Annual Physicals are covered by some Medicare Advantage Plans, usually at $0 cost.

Be certain to review the Summary of Benefits of the plans you are interested in.

Compare coverage with your friend to find out why her's didn't cost, but yours did.

Answer: Most of the information is an attempt to entice you to make a call by promising a lot of $0 costs to you for a lot of different benefits.

It's true that there are a lot of $0 cost benefits available, but not all on one plan. Every plan has a certain amount of benefits for $0 cost depending on each plan's own actuarial analysis of costs.

Generally, more $0 or low cost benefits are more available to folks who qualify, because of lower incomes, for extra help or who qualify for Medicaid.

(Medicaid is what we used to refer to as "welfare".)

To sort through the information, look for advertisements which talk about finding the right plan for your specific situation, not the plans promising a lot of $0.

Look for someone more interested in answering your questions, helping you feel comfortable, making sure you can keep your doctor and get the care you need.

Look for someone who will work for you at your speed, not someone pushing you to buy.

It's you who is important, not me.

Answer: I don't mean to be evasive on this subject, but Medicare prohibits agents from using superlatives, like best, most, lowest and so on, to describe plans' details.

That being said, if the AARP Medicare Supplement Plan by United Healthcare is not, then I don't know which is.

The AARP by UHC is very highly advertised/recognized nationally. I have heard doctors and members praise their cost reimbursement timeliness. Their rates are competitive.

Rating plans can vary tremendously because the nation is packed with smaller regional plans which makes it difficult to rank them without knowing what service area an inquirer is interested in.

A good agent will often improve a members perspective in the insurance carriers quality of care by the quality and availability of service offered by the agent.

Some questions are answered best by telephone or in person.

Answer: The one worst decision which came 1st to my mind is for someone to decide not to enroll in Medicare Prescription Drug coverage because they don't take any prescriptions on a regular routine maintenance basis and don't see any reason, at this time, why they would use the coverage.

Answer: "Medicare covers medical nutrition therapy services if you have diabetes...and a doctor refers you for services. Only a Registered Dietitian or nutrition professional who meets certain requirements can provide medical nutrition therapy services. If you have diabetes, you may also be eligible for diabetes self-management training...You pay nothing for medical nutrition therapy preventative services because the deductible and coinsurance don't apply."

You can find this information on page 45 of the Medicare and You 2025 publication, which you can find on Medicare.gov.

Answer: Whether you missed your initial window for enrolling in Original Medicare Part A & B, or if you missed your initial window to enroll in a Medicare Supplement, Advantage or Prescription Drug Plan, you would need to contact me and plead your case to them.

They are the only ones who may backdate effective dates.

Answer: Finding which plans are available in your area is the first solution.

Determining which of those plans you can use with your choice of doctors and other providers will narrow your choice of plans.

Making certain your prescriptions are covered will narrow the choices further.

The reputation and star ratings of the plans should be the next consideration.

Lastly, how do you feel about the company providing the plan.

This still may not narrow your choices to 1 plan. So, it is my opinion that the final reason for your choice is that size matters.

If you think you need more information than that, then we should have a conversation so I can answer your specific questions.

Answer: Being a Medicare Agent since 2009 has given me an opportunity to help more than 2,000 seniors make the choices that connects them with plans that match their unique healthcare needs.

Educating seniors in the workings of Medicare and Medicare plans has given them peace of mind that they have control over making choices that they feel comfortable with.

It is and should be their choice.

And, that is the most important part.