Bud Griffin, Medicare Insurance Broker

Answer: Yes, IRMAA is recalculated every year. It is based on a two-year look-back at your tax returns by SSA, (e.g., 2026 premiums use 2024 income). Because it is reassessed annually, a one-time income spike won't permanently lock you into higher premiums.

Answer: As long as you pay your premium for Medicare Part A (if you're not eligible for premium free Part A) & Part B you can keep it undefinitly, but Medicare will not usually cove your health services abroad. If you plan to return to the U.S., it is often advisable to keep Part B to avoid lifelong penalties, even though you cannot use it abroad.

Answer: The out-of-pocket cost for Breztri can be different for different Medicare plans. Each plan's design is zip code specific. Check with your Medicare Health Plan or your chosen drug plan for co pay, or co insurance amounts.

Answer: Yes, Medicare plans are zip code specific. Plans in your zip code may be completely different than your friends plan.

Answer: It depends on the therapy you are receiving. Check with your provider and ask them what medical code they will be sending to your insurance company when they submit a claim for your treatment.

Answer: It depends on which plan you choose. Your doctor can join an insurance companie's provider network at his/her discretion. Check the provider network for any company you are considering.

Answer: Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan (Part C) designed for individuals with specific chronic conditions, folks eligible for both Medicare and Medicaid, or anyone residing in a nursing home. They tailor benefits, provider choices, and drug formularies to specific groups of individuals. They often offer lower costs and coordinated care.

Answer: The right way to find out the difference between an expierenced and inexperienced Medicare Broker is to visit with more than one Broker and ask them the same questions and compare their answers.

Answer: Find a Medicare Advantage plan available in your zip code that offers a limited dental allouance and enroll during the next valid enrollment period.

Answer: Wait until the next enrollment period. Enrollment periods come around every year, you can count on it.

Answer: Probably not. Most folks on Medicare don't know what Medicare covers. You're not alone. You can find out what Medicare covers by checking online at: www.medicare.gov

Answer: It's a mistery to me why any doctor would not like Medicare Advantage. You would likely get different answers from every person you ask as to why they prefer their current coverage over Medicare Advantage. What is important to you would be the right choice for you, and that may very well be a Medicare Advantage plan of your choice after comparing each plans options.

Answer: Medicare does not participate in clinical trials. If your treatment is covered by the clinicla trial Medicare would not pay any of the covered.

Answer: That Medicare covers everything at 100%. Medicare part A & part B both have applicable deductibles, copayment, and coinsurance responsibilities.

Answer: If you choose an HMO and go out iof network (without prior approval) you would be responsible for the entire bill.

Answer: Your Medicare (Part A & Part B coverage) is the same in every state, nationwide. The parts of Medicare that will be different in every zipcode is Private solutions that you may choose to enroll into, like Part C (Medicare Advantage plans) either with Part D (prescription drug coverage) or stand alone Part D (prescription drug coverage).

Answer: Going without any health coverage would be the worst Medicare-realted decision. Any insurance coverage is better than not having any coverage.

Answer: When the spouse (employee) loses their coverage, you (the dependent) will lose your coverage at the same time.

Answer: The easiest way to find out if you need Medicare Part B is simply call the administrator of your group insurance coverage (usually, that would be your companies benefit department) and ask them any related questions.

Answer: As of 1/1/2025 Medicare no longer has a coverage gap (donut Hole). Today is 10/27/2025 the donut hole is nonexistant (does not exist) in 2025. Consequintly, you are not in the donut hole.

Answer: First, all Medigap policies are standardized by Medicare, so it really doesn’t matter which carrier’s plan you choose, as long as while you’re shopping, you compare plans with the same letter notation. (For example, Plan F to Plan F, Plan G to Plan G, and so on). The respective plan benefits are identical. It makes no difference to your doctor or hospital, which company issues your chosen Medicare Supplement, because providers understand that plan sponsors have no say in designing plan benefits. They can only issue Standardized Medicare Supplement Plans.

By the way, with Medgap policies, there are no network restrictions. This is something widely misunderstood, due mostly to confusion caused by Medicare Advantage (another way to have basic Medicare benefits administered by private companies), which does have networks.

Second, no matter which Medigap policy you choose, monthly premiums will go up between 2% to 25% or more each year, due to each company’s operating expenses, and an increase in perceived risk that’s expected as we get older.

Third, and more important to you, when we receive notice from any of our partner carriers of premium increases, we’re here to make sure you are aware of how it’s going to effect you.

These are just a few of the things we do for our clients, and our services are always FREE. If you have any questions and feel we can help, contact us. – I’d be delighted to hear from you. I hope you found this information helpful. Thanks for your time.

Answer: Medicare generally covers certain bariatric surgeries for morbid obesity if you meet specific criteria and have at least one obesity-related health condition, (after non-surgical treatments have been unsuccessful). However, Medicare typically does not cover commercial weight-loss programs or anti-obesity medications for the purpose of weight loss alone.

Answer: Yes, it's not only acceptable but advisable to meet with multiple Medicare brokers and agents as you begin searching for help. Focus on working with independent brokers who represent several carriers to get a wider array of choices, and choose someone who prioritizes your interests and provides ongoing service beyond enrollment. Remember, your Medicare Journey doesn't end at your Initial Enrollment Period (IEP), it's just beginning.

Answer: If you currently have Medicare drug coverage (Part D), your 2025 yearly out-of-pocket costs for Part D drugs is capped at $2,000 and will be capped at $2,100 in 2026. Once you reach these caps, you won’t have to pay any more copayments or coinsurances for covered Part D drugs for the rest of the respective calendar year.

Answer: Seniors who don't sign-up for Part B and/or Part D during their Initial Enrollment Period (IEP) and don't have credible coverage will be subject to these late enrollment penalties when they do choose to sign-up for either/or both.

Answer: Not necessarily. Premiums are not the only thing you should look at when comparing plans. Plan benefits vary from one plan to another. Comparing plans benefits available in your zip-code is important whan shopping for your chosen plan.

Answer: Medicare Part A and/or Part B covers a wide range of health care services that you can get in your home for an illness or injury as long as you need part-time or intermittent skilled services and you’re “homebound,” which means: 1. You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury. 2 Leaving your home isn’t recommended because of your condition. 3. You’re normally unable to leave your home because it’s a major effort. A health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A health care provider must order your care, and a Medicare-certified home health agency must provide it. In most cases, "part-time or intermittent" means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours per week. You may be able to get more frequent care for a short time (less than 8 hours each day and no more than 35 hours each week) if your provider determines it's necessary. You won't qualify for the home health benefit if you need more than part-time or "intermittent" skilled care.

Answer: Not typically. Part B covers medical nutrition therapy services if you have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months. A doctor must refer you for the services.

Answer: Both are viable options. Each person should weigh the differences to see which coverage is the right fit for their anticipated treatment needs going foreward.

Answer: Local Agents are familiar with the Plans offered locally, whereas remote/virtual agents usually are captive and biased.

Answer: Most captive agents will push the products their company sells and steer you away from any they don't represent. Indipendent agents are usually more un-biased.

Answer: It depends on your age. You can start recieving retirement benefits at 62, but Medicare eligibility is 65 for most seniors not already on Medicare due to a qualifying disibility.

Answer: Typically, you will be automatically enrolled in Medicare Part A and Part B upon recieving your 24th disibility monthly benefit, or upon turning 65, whichever comes first. They should mail you a Medicare ID card 3 months before it is set to be active. If you don't get it in the mail then, you might want to call social security and inquire.

Answer: Every Part D plan available in your zip-code will cover different diabetes medications and have different co-pays or coinsurance charges that you will be responsible for. You should compare the plans available in your zip-code to be able to make an informed decision. I offer plan comparisons free of charge and wilhout any obligation to enroll.

Answer: With a Plan G, in addition to the premium, you will have to pay the part B deductible ($257.00 in 2025) and all Part A and Part B approved charges are paud by the policy at 100%. With the Plan K, in addition to the premium, you will pay the Part B deductible and be responsible for 50% of the approved charges for Part B coinsurance, Blood benefit (firts 3 pints) Part A hospice care, Skilled nursing facility coinsurance, and Part A deduclible. In addition, on Plan K you may be charged excess charges.

Answer: After satisfying the Part A hospital stay deductible ($1,676.00 per hospital stay benefit period in 2025) your copay is $0 dollars for the first 60 days per hospital stay. For days 61-90 pre hospital stay you will have a copay of $419.00 per day in 2025. You will pay $838 per lifetime reserve day after day 90 of each benefit period in 2025 (up to a maximum of 60 days in your lifetime).

Answer: No one can predict the future; but, you can count on Medicare Premiums and deductibles going up, in order to keepup with inflation.

Answer: Not visiting with a reliable Medicare Sales agent foce-to-face instead of finding a plan online or over the phone.

Answer: A common trick in Medicare marketing that hides restrictions on doctor choices is to use misleading advertising that implies broad access to doctors or doesn't clearly disclose network limitations.

Answer: Visual comprehension and verbal literacy are two distinct ways of processing and understanding information, each with its own strengths and limitations.

What I find most rewarding about being a Medicare sales agent is being able to offer local Texan's the opportunity to meet face-to-face for a plan review. Most seniors are visual comprehensive inclined and appreciate being able to get acquainted with me in the process.

Answer: The SOA specifies which Medicare plans (e.g., Medicare Advantage, Part D, Medigap) the beneficiary wants to discuss. In essence, the Scope of Appointment form is a crucial tool for ensuring that Medicare beneficiaries are protected and informed during the sales process, allowing them to make the best decisions about their healthcare coverage.