Brett Johnson, Medicare Insurance Agent

Answer: There are several good places to start. Medicare.gov is a great resource for general Medicare information and comparing plans available in your area.

For information that may be more specific to where you live, such as Fresno or Madera, I also recommend looking for local community Medicare education events. Many independent Medicare agents host events, especially during this annual enrollment period (AEP). Eventbrite is an easy place to start — search for “Medicare Education,” “Welcome to Medicare,” or “Medicare 101” along with your city.

Local workshops can be especially helpful because Medicare Advantage plans, provider networks, and available benefits can vary by county and service area.

Just be sure to check whether the event is an educational Medicare workshop or a sales presentation for a specific insurance carrier. I recommend starting with an education event.

Answer: Ideally, I recommend that you start learning about Medicare about 6–9 months before turning 65. This gives you time to understand your options, decide which type of coverage may work best for your healthcare needs, and determine which plans your current doctors and providers accept.

You can generally enroll in Medicare beginning three months before the month you turn 65. If you plan to enroll in a Medicare Advantage, Medicare Supplement, or prescription drug plan, this is when we can begin putting your coverage in place.

One mistake I see often is starting Medicare Part B when it may not yet be necessary. If you're still working and covered by an employer group health plan, your Medicare timing can be different depending on the employer and the coverage.

That's why I recommend starting the conversation early. We can determine when you actually need Medicare before you enroll.

Answer: If you travel frequently, a Medicare Supplement plan is often worth a closer look because you can generally see any provider nationwide who accepts Medicare, without being limited to a local HMO network and various referrals.

Medicare Advantage can still work well for travelers, especially with certain PPO plans, but you need to understand the plan's service area, network, and out-of-network rules. Emergency and urgent care are generally covered anywhere in the United States for those on Medicare.

Travel outside the United States is different. Each carrier and plan may have its own rules for emergency or urgent care abroad, so I review those benefits carefully because most if not all of the plans use a reimbursement system. Be sure to understand how the reimbursement works.

This is exactly why I include travel in my suitability review. I want to know where you spend time, how often you travel, and whether you need the flexibility to see doctors outside your home area before recommending one type of coverage over another.

Answer: Yes, potentially. United Health Centers has multiple locations and providers throughout Fresno, but Medicare Advantage plans are network-based.

Before recommending a plan, I verify that your specific doctor and United Health Centers location are participating with the plan and medical group you’re considering. I also look at your prescriptions, specialists, hospitals, and other healthcare needs.

This is part of my suitability review — I don't recommend a Medicare Advantage plan first and then hope your doctors accept it. We verify your providers before making the decision.

Answer: When you turn 65 and become eligible for Medicare, your Covered California plan does not automatically transition to Medicare. The two coverages need to be coordinated so your Medicare starts on time, and your Covered California coverage ends correctly.

If your spouse or other family members are younger than age 65, they can often remain on their Covered California plan while you transition to Medicare.

Because I'm certified with both Medicare and Covered California, I handle these transitions regularly. Timing is very important to avoid a gap in coverage.

Answer: Medicare covers a lot, but it doesn't cover everything.

Original Medicare has two main parts. Part A generally covers inpatient hospital care, skilled nursing care when Medicare's requirements are met, hospice, and certain home health services. Part B generally covers your doctors, outpatient services, lab work, preventive care, durable medical equipment, and many other medically necessary services.

Remember. Original Medicare (OM) does not cover Prescription Drugs. You must get a standalone prescription drug plan (PDP).

This is why I spend time during my first consultation explaining how Medicare actually works before we ever start comparing plans. Once you understand what Medicare covers — and what it doesn't — we can determine what additional coverage, or Supplement plan works for you.

Answer: Inhalers and medications are becoming more and more popular, used to treat conditions like asthma and COPD have changed rapidly over the past several years, including the availability of more generic options.

Medicare Part D plans can cover generic inhalers such as albuterol and budesonide-formoterol, but coverage and cost will depend on your specific plan's formulary, drug tier, pharmacy, and sometimes prior authorization requirements. In many cases, a generic may cost less than the brand-name version, but I never assume that is automatically the case.

More importantly, I don't try to guess which medication should work for you. I follow the prescription and direction of your doctor or healthcare provider.

When I review your Medicare plan, I enter the medications you're actually prescribed and compare how the available plans cover them. If your doctor later changes your inhaler or medication, contact me and we can review how that change affects your coverage and cost. I do however make certain that you're using preferred pharmacies based on your plan, to maximize savings.

Answer: A good Medicare agent should do far more than simply help you enroll in a plan.

First, I start by understanding how you actually use healthcare — your doctors, prescriptions, hospitals, monthly budget, and whether you benefit from the structure of a Medicare Advantage plan or "need" the flexibility of a Medicare Supplement with a stand-alone prescription drug plan.

I also look at the bigger picture. Many of my clients are transitioning from employer group coverage, ACA or Covered California plans, or other retirement benefits, so Medicare is often only one part of the decision.

For me, it really comes down to suitability. The value of working with an experienced Medicare agent is having someone who understands the system, understands your situation, and can help determine which option is the best overall fit for you — not just today, but for the entire plan year.

Answer: This is because of the type of Medicare plan you're enrolled in.

Many people don't realize that their Medicare Advantage plan may be an HMO, which means it can have a defined service area, specific network of doctors and hospitals, and in most or all cases require referrals to see specialists.

That's one of the things I address during our very first consultation. As part of my suitability review, I ask you about your doctors, specialists, hospitals, and how important it is for you to have the freedom to see providers without network restrictions.

For some people, an HMO works super well. For others, especially those who want broader access to doctors or who travel frequently, a Medicare Supplement plan may be a better fit.

The goal is not to put everyone into the same type of plan. It's to understand how you use healthcare first, then determine which type of Medicare coverage gives you the access and flexibility you need.

Answer: It can look like benefits are based on ZIP code, but Medicare Advantage plans are really built around specific service areas, usually by county.

The benefits available in each area can vary based on several factors, including Medicare financial support to the plan, local healthcare costs, provider contracts, competition between plans, and the needs of that particular market. Each carrier also weighs and uses these factors differently when designing its plans and benefits.

That is why someone in one county may have access to lower copays, better dental benefits, or other extras that are not available just a few miles away. And why two carriers serving the same county may offer very different benefits.

As an agent, I don't assume one area, carrier, or plan is automatically better. I look at what is actually available where you live and then compare the benefits, doctors, prescriptions, and overall fit for your healthcare needs.

Answer: Yes, this is allowed. This is called step therapy, and it is common with Medicare Part D plans.

It means the plan may require you to try a lower-cost or preferred medication first before it will cover the drug your doctor originally prescribed.

That does not necessarily mean you have to accept the alternative. If your doctor believes the prescribed medication is medically necessary, they can request an exception from the plan.

As my client, call me first. I can help you understand what the plan is requiring. However, your provider is the one who will need to provide the medical information supporting the exception request.

Answer: Agents hear this often. But what may be a great plan for your friend, may not necessarily mean it is the right plan for you.

Medicare plans are based on many things, including where you live, which doctors and hospitals you use, your prescriptions, your healthcare needs, and the benefits available in your area.

However, as a seasoned Medicare professional, I review my clients’ plans each year along with any changes in their health, doctors, medications, and available options.

So if your friend tells you she pays nothing for her plan and gets a lot of extra benefits, contact me. We can look at what is available to you and determine which plan makes the most sense for your situation.

Answer: Call me. This is a very common question. Medicare, your health plan, your doctor, medical group, and/or pharmacy may send you letters that are difficult to understand, and sometimes it isn't obvious who you should contact first.

As my client, run it by me first. I'll help explain what the letter means, what action is needed, and who we need to contact next.

Don't ignore it and don't guess what it means. Send it to me and we'll figure out the next step together.

Answer: Your Medicare plan is required to send you an Annual Notice of Change, or ANOC, annually. And you should receive it by mail no later than October 1st.

I always tell my clients not to throw this one away. The ANOC explains what is changing in your plan for the following year, including premiums, copays, prescription drug coverage, provider networks, and other benefits.

As my client, you can also expect to hear from me a few weeks before your ANOC arrives. I use that time to get your annual review scheduled so that once you receive it, we can go through the changes together and make sure your plan still fits your doctors, prescriptions, budget, and healthcare needs. We, together at that meeting determine if a plan change is necessary.

Sometimes the changes are minor and your current plan still makes perfect sense. Other times, a change in benefits, costs, doctors, or prescriptions may mean it is worth comparing optional plans.

The most important thing is that you do not have to figure it out on your own. Reviewing your ANOC together is part of the ongoing service I provide as your Medicare agent.

Answer: The short answer is maybe. Medicare allows a Part D plan to consider reinstatement for “good cause” when circumstances outside the member's control prevented the premiums from being paid.

Dementia could potentially qualify if it affected the member's ability to understand the notices, make the payments, or arrange for someone else to handle them, but reinstatement is not automatic.

This is not one I would try to solve by guessing or even starting with an agent. I would contact your plans member services, explain the circumstances, and determine what options are available before proceeding.

Answer: Usually not under Original Medicare. An AeroChamber or other spacer used with a metered-dose inhaler is generally considered a non-covered supply, even when your inhaler itself is covered.

Medicare Advantage plans can be different, so I always check the specific plan before assuming it isn't covered. Some plans may provide additional coverage or benefits that Original Medicare does not. Some devises are covered as part of their durable medical equipment (DME).

Answer: I face this often with my retiree clients, and it sounds like you may be coming off an employer group health plan.

First, Medicare does not cover your spouse under your plan. All Medicare plans are individual, so when you become eligible and enroll, your younger spouse will need to have their own health insurance. And being not Medicare eligible, we need to explore alternatives.

Your spouse's coverage depends on the employer's plan documents and eligibility rules. However, in most of the situations, once the Medicare-eligible spouse leaves the employer plan, the younger spouse cannot simply remain on that same plan.

That's primarily the reason I'm also certified with Covered California and work direct with off-exchange health plans. If your spouse needs new coverage, I can help determine what they're eligible for, compare the available options, and get the appropriate coverage in place so there isn't a gap in care. This is something I confront regularly.

Answer: Sorry to hear about that. The answer can differ depending on whether your mom has Original Medicare or a Medicare Advantage plan and whether the rehab stay qualifies as skilled nursing care.

With Original Medicare, Part A can cover "up to 100 days" in a skilled nursing facility during a benefit period, as long as she continues to meet Medicare's requirements for skilled care. In 2026 for example, days 1–20 are $0 per day, and days 21–100 have a $217 daily coinsurance. After day 100, Medicare no longer pays for that skilled nursing facility stay.

If she has a Medicare Advantage plan, the copays and rules may be different by provider.

This is one of those situations where I recommend calling me before making assumptions about what will be covered. We can review her plan, the rehab facility, and what you should expect to pay. I will not leave you to solving this on your own.

Answer: Great question. This is one of those Medicare questions that doesn't come up very often, but I do cover it in my "Welcome to Medicare" workshops.

Basically, If you're enrolled in a Medicare Advantage plan and later/need elect hospice, Original Medicare generally becomes responsible for your hospice care related to your "terminal illness." You can still remain enrolled in your Medicare Advantage plan, and the plan may continue covering things such as supplemental benefits and certain healthcare services unrelated to the terminal illness.

So you don't necessarily lose your Medicare Advantage plan when you enter hospice. It's really a matter of understanding which part of Medicare is responsible for which services.

It's a good example of why I tell people that even when you choose Medicare Advantage, it's still important to understand overall how Original Medicare works. And also why I stay in-touch with my clients in case their health care needs suddenly change.