Christopher Stewart, Medicare Insurance Broker

Answer: The most enjoyable thing about being in the Medicare advisory industry is being a helper. When I meet with beneficiaries my goal, every time, is to treat them the same way I treat my grandparents. Honesty, building relationships, and transparency are the 3 major factors for me when meeting with beneficiaries. I do not want to make a sale; I want to create a relationship and build trust. I have open communication with all of my members, some don't call or text me as much as others, but it is very important to me that every person that I help enroll in any Medicare product knows that I am available to them as often as needed, which has been extremely beneficial in my 7-year career.

Answer: This is a common question. When it comes to HMO's and PPO's there are some key differences. First, let's discuss HMO's. HMO's usually, not always, but often have lower out of pocket expenses but they come with a more limited, still great, but more limited network. PPO's often, not always, but often times have higher out of pocket expenses but have a much broader "network". In fact, PPO's are good at any provider office that accepts Medicare AND the terms of the PPO plan (whether in or out of network). A lot, not all, but a lot of PPO plans have higher out of network costs than in network. So, when someone is choosing between an HMO and a PPO it is imperative that they understand the key differences between the 2. There is no 1 size fits all plan in the Medicare Advantage space, every plan is built for the different needs of every individual.

Answer: The best piece of advice I can give is to research. Where I live, there are almost 100 MAPD plan options, that is a lot. Make sure you have a trusted Medicare advisor that will do a proper NEEDS analysis and help you with your research in choosing the best option. Also, read your ANOC (annual notice of change) from your carrier. They are sent out every year and they review all of the plans changes for the following year. A lot of people don't read them and they should.

Answer: For low-income individuals, applying for Medicare Extra-Help can be key! For those that do not qualify for LIS (Low Income Subsidy) there are other pharmaceutical assistance programs through prescription manufacturers (Astrazeneca and others) that can help lower the cost of the medications. And if that fails, we can look at State Pharmacy Assistance programs.

Answer: Medicare Part B covers 80% of your medical expenses. For example, if you have Medicare A & B with a drug plan and no other supplement/advantage plan, you will pay a 20% co pay for all medical visits on top of your $257 Part B deductible (2025) and the $185 Part B premium every month. Is it enough is not a 1 size fits all question. For some people, the answer is yes, for some people the answer is no. Everyone's situation and Medicare needs are different. There are supplemental policies will cover the 20% co-pay (not the deductible) in exchange, you pay the supplement company a monthly premium. Some supplemental policies will also charge certain co pays at certain facilities. MAPD plans will charge you a flat co pay for medical visits, often times for no monthly premium, not including the Part B premium ($185 for 2025).

Answer: Medicare removed the coverage gap thanks to the Inflation Reduction Act. This is a major benefit for beneficiaries as they will most likely be saving thousands on their meds, especially if they are used to spending $6,000 per month as the new prescription max is $2,000 annually. However, in order for the new $2,000 prescription max to work all of your meds must be covered by your plan's formulary. If it is not, then we can look at manufacturer's discounts and other avenues to try to find ways to save on the medications.

Answer: If you cannot afford your Medicare premiums we need to apply for Medicaid through the state. If you are above the Medicaid threshold we need to apply for Medicare Extra Help, at the minimum.

Answer: Enrolling in the first plan they look at. There are a lot of great plans with a lot of rich benefits, however, before you enroll in a plan it is important to review all of your options, and there are plenty.

Answer: Find a trusted Medicare advisor, first and foremost. When moving to a new state it is imperative that you find someone that can review all of the plans with you and not just 1 or 2 plans. The more plans a broker can review, the more options you have with that broker. Also, the more knowledgeable the broker, the better. Finding a broker/advisor that knows the different doctors in the area is crucial, I often ask my clients for reviews on their providers so I can get a good gauge on what doctors seem to have the better reviews from current patients, not just Google reviews.

Answer: The standard Medicare Part B premium for 2025 is $185 per month. Now, if you make over a certain threshold ($106,000 for individuals and $212,000 for joint tax payers for 2025) you will incur an increased Part B and Part D premium, this is called IRMAA. Based on how much over the $106k/$212k threshold you make, you can incur increased premiums of 1.4x up to 3z4x the standard amount. So, in order to "lower" your part B amount under the standard $185, you would have to qualify for Medicaid through your state.

Answer: Total Medicare costs as in co pays or medications? Are you looking at or on a MAPD or a Medigap plan?

- IF you are on a MAPD and are asking specifically about co pay costs, the best way to estimate your costs are to sit down with your agent and review your plans co pays for specialists, hospital, diabetic supplies, etc.

- IF you are on a MAPD and asking specifically about medication cost estimates, you need to sit down with your agent and review your medications and determine which tier the medication is and the co pay for that med, and remember, there is no more donut hole. So, $2k is the TROOP for covered meds.

- IF you are on a Medigap plan you need to sit down with your agent and review which plan you are on (some have co pays whereas G only charges you the $257 part B deductible).

- IF you are on a Medigap plan with a part D and want to estimate the total cost of your medications, you need to sit down with your agent and review your medications and determine what tier they are in with your drug plan and then add those co pays to your monthly premium.

In the end, the best way to determine any cost estimate is to meet with your agent and review your policy and medications.

Answer: It is not. It is not legal to cold call Medicare beneficiaries. Unfortunately, this continues to be a problem. The best way around this is to ONLY speak with your agent/broker or your current insurance carrier about your Medicare plan and options.

Answer: Medicare does not cover medical marijuana. There may be some specific cannabis-based medications that are covered by Medicare and your plan, but you would need to review those with your agent.

Answer: I love working with Medicare beneficiaries, even when they are not my clients. When I entered the civilian work force, I told myself that I wanted to pursue a career where I could make a legitimate impact on people's lives. The Medicare industry allows me to pursue that goal. There are a ton of cold calls (illegally) that go out to beneficiaries on a daily basis, along with a lot of misinformation and unfortunately some bad apples looking to make a quick buck. For me, I told myself to treat everyone like they were my grandparent and to walk away from a "sale" if I did not feel that it was beneficial to the client. When I meet with beneficiaries I am as transparent as possible and make sure that they understand all of their benefits. So, what I enjoy most about working with Medicare beneficiaries is easing the stress of their health insurance concerns and ensuring that I am making a positive impact on their lives.

Answer: A lot of MA plans cover dental, to an extent. However, Medicare does not reimburse the plans for this benefit so the carrier comes out of pocket, often times leading to smaller/limited networks. So, in short, the answer is yes more often than not.