Clarence "Mark" Christiansen, Medicare Insurance Agent

Answer: Try a Google search for "Medicare agent near me" and see what pops up. Medicare insurance agents must pass annual testing requirements and are generally knowledgable and helpful. Talk to an agent! It should be pretty clear to you that the agent at the other end of the phone line knows what he / she is talking about. Ask questions such as, "how long have you been recommending Medicare insurance," and "do you represent all of the major Medicare plans in my zip code." That's a good starting point.

Answer: That's alot to unpack. To clarify, please note the following:

Medicare Advantage

These plans provide out-of-pocket maximums to protect you against significant medical bills. By law, Medicare Advantage must offer coverage at least as good as Original Medicare. While many Advantage plans have low or zero monthly premiums, it is important to note that not all doctors accept every Medicare Advantage out there. Find out before you sign up!

Original Medicare

More doctors accept Original Medicare, but you are responsible for 20% of all Medicare-approved outpatient medical bills (such as chemotherapy) with no limit on your financial responsibility.

Medicare Supplement (Medigap)

A great alternative to Medicare Advantage is a Medicare Supplement plan. These plans pay after Medicare and, depending on plan design, can cover the 20% coinsurance. Unlike many Medicare Advantage plans, Medicare supplement plans feature monthly plan premiums and on average, figure on $ 200 monthly but this can be lower or higher depending on how your supplement plan is structured as well as your age, sex and zip code.

Regarding your question about speaking with an insurance agent, I highly recommend it. Medicare insurance agents like me are3 here to help you navigate your plan choices and find the best fit for your needs.

Answer: Yes, many Medicare Part D prescription drug plans cover Breztri as a Tier 3 or 4 medication. It is recommended that you go to medicare.gov and use their "Plan Finder" tool to find out which plans cover the drug. It mostly depends on your zip code but make sure you have a Part D plan first. Many of the Part D prescription drug plans feature $ 0 (zero) monthly plan premiums now. Don't want to horse around? Contact your friendly, local Medicare insurance agent. There are many of us out there willing to help you.

Answer: You don't need it but it is highly recommended. If you're paying $ 0 for your Advantage plan, why wouldn't you get the added protection offered by a Hospital Indemnity plan? I have this myself and have never used it. Is that a bad thing? I say, no, it's a good thing. The best insurance of all is the plan you have never used which means you have never suffered a loss. Insurance is all about "what if," isn't that the case? Insurance such as hospital indemnity coverage will be there for you if you need it. I like to package the plan with a cancer benefit rider and a physical therapy benefit add-on, too. The coverage is low cost and will come to the rescue when / if something goes wrong. Alternatively, don't buy the indemnity plan, take your chances and keep your fingers crossed!

Answer: There are many opportunities to change your Medicare Advantage plan.

1) Annual Enrollment Period (AEP): Oct. 15 - Dec. 7th every year. New plan kicks in 01.01.

2) Open Enrollment Period (OEP): Jan. 1 - March 31 every year. This is for "like-to-like" plan changes (MAPD to MAPD or MA only to MA only).

3) There are several Special Enrollment Periods (SEP's) to consider, such as leaving your employer plan. This is the most common. Also, if you move to a new service area, you can change your Medicare Advantage Plan. Here's another one: if you are a member of your state's pharmaceutical assistance plan (in WI that's Wisconsin SeniorCare), you can switch to a different MAPD plan one time during the calendar year. The SEP code for that is SEP-SPAP which stands for Special Enrollment Period - State Pharmaceutical Assistance Plan member.

Answer: We all need help one way or another no matter what. Did you know that the best professional golfers have coaches and trainers to help them? Well yes, it's not the same thing but choosing a Medicare plan can be done without having anyone help but it's a good practice to have a second set of eyes (and a trained professional) to see what you're doing and possibly provide quite a bit of help. Here's the good news: a licensed Medicare agent typically will not charge you anything to help you. You don't pay more if you go through an agent and chances are you will save time, money and frustration.

Answer: The good news here is you will not have to enroll in Medicare a second time. Once you're in, your're in. Just make sure to pay your monthly Medicare Part B premiums if they are not currently auto-deducted from your Social Security benefit payment.

Answer: You can enroll in Part D directly from the insurers' websites. Here is a list of several of the major sites: aarpmedicareplans, humana, aetna, anthem, and bluecross. Or you can contact a licensed agent (check on the MedicareAgentsHub site or do a Google search to find one). You won't pay more if you go through an agent who will likely be able to make a suitable recommendation. Good luck!

Answer: Okay, well, 50% of the Medicare population has Medicare Advantage. Actually, it's a little bit more than that. Why do they have it? Well, I have Medicare Advantage. For one thing, I've had it for five years, and I guess you'd say I'm a believer. But why should you not have it?

So, I would say anyone with a serious preexisting condition that requires quite a bit of plan utilization would benefit from it. That would include insulin-dependent diabetics, anyone with heart disease, anyone with cancer, anyone with COPD, or Crohn's disease. So, people who have chronic conditions should not have Medicare Advantage.

Answer: Long term care is not covered by Medicare for more than 100 days so it's an expense that must be paid for out of pocket or look into long term care insurance. Life insurance with an LTC rider is a good idea, too.

Answer: That's the worst idea I have heard all day. Although 11% of the Medicare population has no other coverage, it's a very, very bad (and risky) idea.

Think of this: if you need $ 500,000-worth of chemotherapy, Part B Medicare will pay 80% of the bill and the rest of it (20%) will be on you.

Alternatively, a $ 0 (zero) premium Advantage plan will protect you with something called an "out of pocket maximum." The MOOP or Max out of Pocket will limit your exposure to a big bill like that.

Case closed!

Answer: Your Medicare Part D prescription drug plan will cover blood thinners. The most popular of these now is Eliquis and then here is the low-cost Warfarin which (unlike Eliquis) requires ongoing blood testing and here are a few more: dabigatran (Pradaxa), edoxaban (Lixiana) and rivaroxaban (Xarelto). Medicare Advantage plans include prescription drug coverage if they are MAPD (Medicare Advantage with Prescription Drug coverage) plans otherwise the standalone Part D insurance covers blood thinners, too.

Answer: Medicare supplement plans will cover all Medicare-approved services and will pay after Medicare. Plan G means you will be responsible for an annual outpatient deductible, currently set at $ 256 in year 2025. If your total knee replacement involves an in-patient hospital stay, Medicare will be primary, your Plan G will pay after Medicare and you will have $ 0 (zero) out of pocket costs. Good luck with it!

Answer: If it ain't broke, don't fix it. Changing Medicare plans depends on your personal situation vis-a-vis any plan changes your Medicare plan has in store. Some plans have stronger benefits in certain categories / worse in others. "It depends."

Answer: I love this question. Sure, call the insurance company directly and they will tell you how great they are and how much better they are than the competition. Then hang up and call your friendly, independent Medicare agent. That person will compare the various plans and show which one works best for YOU. It's a no-brainer!!!

Answer: Yes, that's right. Once you reach the out-of-pocket maximum for covered health services (not counting Part D prescription drug costs which are treated separately), your Advantage plan will pay out @ 100% for Medicare-covered and plan-covered health services. Be sure to get prior authorizations from your Advantage plan before taking on anything out of the ordinary such as CT scans, MRI's, surgeries, infusions, certain durable medical equipment and / or hospital stays. "Medically necessary" health services will generally be covered and will count towards your out-of-pocket maximum with a Part C Medicare Advantage plan.

Answer: We don't use the word "free" in this business. "Zero monthly plan premium" is another way to say it. Many Medicare Advantage plans have the $ 0 plan premium feature but there are copays and coinsurance responsibilities when it comes to Medicare Advantage plans. Lower health benefit utilization members are better served with Part C Medicare Advantage plans. A higher utilization member -- sick people or those who go to the doctor a lot -- should look at the supplements (Medigap plans). The bottom line is there is no "one size fits all" plan for Medicare eligible members. The best course of action will be to contact an experienced, independent Medicare broker for more insight. There is typically no cost to speak with an agent who will help you with this.

Answer: The financial risk is unlimited if you just have Medicare an and B you’re OK for the first 60 days in the hospital after a deductible and then it gets far worse.

On the outpatient side of things, you’re on the hook for 20% of all charges with no cap so people who need $1 million worth of outpatient services such as chemotherapy will be looking at a bill in the neighborhood of $200,000.

Answer: If you have an HMO plan, you cannot go out of network unless it’s an emergency. This information is available to you online and in your Summary of Benefits.

Answer: Find a local agent. Call that person. Ask how long in business and whether or not health insurance is the primary focus. Ask if the agent is independent and which companies he / she represents. Go see the rep in person, sit down, explain your situation and see what kind of advice you are getting. Easy / peazy!

Answer: That's a "Cadillac" Plan F and you will not have any medical bills for Medicare-approved services including E.R. visits from USA providers who accept Medicare. (I cannot think of an Emergency Room that does not accept Medicare.) Medicare will be primary and your Medigap plan will pay after Medicare leaving you with zero out of pocket costs.

Answer: Hello, the question is, can I use my HSA to pay my Medicare premiums? Yes and no. You can use your HSA money to pay for Part B Medicare premiums. You can use it to pay your Medicare Part C Advantage premiums. You can use your HSA money to pay for qualifying expenses, such as copays associated with Medicare Advantage qualifying health services. It's good to know you cannot use your HSA to pay for Medicare Supplement premiums. Very important, you cannot use your HSA money to pay for Medigap or Med Supplement.

Answer: Google this: "SSA-044", download, print, sign, date (OK complete the form)! and send it to the Social Security Administration ASAP! This is the form you should submit to help IRMAA go away. Good luck!

Answer: Okay, the question is, are Medicare Advantage plans really free or is that just clever marketing? Well, no one ever said the Advantage plans are free. I don't think the agent has ever said that. We're not allowed to say that. Medicare Advantage plans, many of them, have a zero plan premium. That's not free, it's a zero plan premium. You still have to have Part A and Part B Medicare in order to qualify for Medicare Advantage. You have to be a U.S. citizen with A and B Medicare, and you have to reside in a plan service area in order to get the Advantage plan you're looking at. Some of them have zero premium.

Now, the federal government, Medicare, is paying these plans approximately $1,000 a month for every month that you might have a membership in an Advantage plan. So there's money changing hands, and the government does this so they don't have to take care of you. The plan has to take care of you, and they are under very careful and close supervision by CMS, the Centers for Medicare Services. They have to obey the rules and do things right. They're getting paid to take care of you in exchange for you not having a premium. You are responsible as an Advantage plan member for certain copayments or coinsurance, depending on what happens, subject to a plan's maximum out-of-pocket. So, by law, Medicare Advantage must be better than Original Medicare, and it is.

Answer: Okay. The question is, should Medicare be expanded to include more alternative treatments? In a perfect world, absolutely. However, there's a cost factor involved. Medicare is funded by the federal government. The more the federal government has to pay to Medicare to cover things like alternative medical treatments, that ultimately will result in a higher cost of Medicare and higher income taxes. So, Medicare tries to cover medically necessary treatments. If you need a heart transplant, a kidney, or any other organ transplant, it's covered by Medicare. Your doctor needs to certify that this is a necessary treatment. Treatments are covered by Medicare. The more you bring in alternative treatments and make them the responsibility of Medicare to pay, the higher the cost, the higher our taxes, and the higher the cost of Medicare. It's too bad, but that's the way things are. Someone's got to pay for it. Might as well be us.

Answer: Okay, the question is, you have AFib and you would like to buy an Apple or smart watch so that your doctor can monitor your heart rhythm, and you want to know if Medicare will pay for it. I would say, nice try. No, absolutely not. You could get durable medical equipment. Some doctors have the ability to check your heart rhythm remotely using a specific DME. To the best of my knowledge, the Apple Watches do not really qualify. Medicare won't pay for it, but Medicare will pay for durable medical equipment, DME. So check with whoever wants to sell you the device and see. Some Medicare Advantage plans actually will help pay for an Apple or other smart watch, so that's plan-dependent. Check with your agent on that one. Phone's ringing. Gotta go.

Answer: The question is, with all these different Medicare plans in the current calendar year 2025, should I be switching or should I be staying put? It's too late to be switching. The annual enrollment period begins October 15th and ends December 7th, so that's your window to change, and we're way past that now. If you have a Medicare Advantage plan, you can switch from January 1 until the end of March, and we're past that also. Today is April 10th, 2025, so I wouldn't worry.

I think, you know, the government subsidizes Medicare Advantage. The plans have to really follow CMS guidelines, and Medicare Advantage by law must be at least as good as Medicare. So don't worry. Too many people think they have to change plans every year. I don't think that's necessary. Certainly, you ought to analyze your plan every year, but I don't feel that people need to be jumping around from plan to plan on an annual basis.

Now, if you have a supplement and you don't like that, your supplement plans generally are identical in terms of coverages, depending on what plan you have, like Plan F or G or whatever the letter code is for your plan. So if you're getting sharp increases in Medicare supplement premiums, your coverage isn't going to change. Generally, the coverage for the most part in a Medicare supplement isn't going to change. But if the premiums start going up and if you qualify to switch, then yeah, it's probably a good idea to talk to your experienced independent Medicare agent who has access to all the major plans in your zip code. I can think of at least one person who can do that for you, but I can't remember his name right off hand. When I think of it, I'll come back and let you know.

Answer: Will Medicare cover acupuncture? Yes, Medicare will cover acupuncture, but it's only for chronic lower back pain. So, keep that in mind. You can't get Medicare to pay for acupuncture if you have other issues beyond that. Now, some Medicare Advantage plans will also cover acupuncture treatments, but it's usually for the same condition, meaning chronic lower back pain. So check with your agent, who will have access to a variety of summaries of benefits for the different plans, and find out before you sign up.

Answer: Question about whether your Medicare plan will work if you're traveling to Europe. Well, there's a rider you can get if you have a Medigap or a supplement plan, a foreign travel rider. It's really not that good. There's a $250 deductible, the plan pays a $50,000 lifetime maximum benefit, and you're on the hook for 20% of the bill. So, for that reason, if you have a Medigap or a supplement plan, I would strongly recommend getting extra travel insurance. If you're going to Europe for a week or two, it's really not that expensive. It depends on where you live, how old you are, your resident zip code, and how much coverage you want, but you could get a pretty good foreign travel plan for your supplement. I mean, it depends on where you're going and that kind of thing, but generally, you're looking at about a $200 maximum premium for very good coverage.

Now, if you have Medicare Advantage, most Medicare Advantage plans have better coverage than the foreign travel rider you can get with a Medigap plan. Still, with an Advantage plan, typically there’s no deductible. Your plan will usually, not all plans, but most will pay 100% of your emergency care. Now, if you're admitted to the hospital following an emergency room visit, then everything changes. So, work with your agent. Consider getting a separate foreign travel plan. Even if you have Medicare Advantage, where the coverage is generally better than the Medicare supplement plans with the rider, work with your agent. A good, qualified, experienced, independent agent would be the way to go. I can think of at least one person who can help you with this.

Answer: Someone worried about picking the wrong plan? Well, I don't know if there's such a thing as the wrong plan. Medicare supplements are guaranteed issue when you're aging in, turning 65, or if you're leaving an employer group plan. After your guaranteed issue period is over, you will need to qualify and get through underwriting to switch to a different Medicare supplement plan, so pick a good one to start out with.

Other people start out with Medicare Advantage. Medicare Advantage, also known as Part C, has a 12-month trial period. That means if you don't like the plan you're in, you have the ability to drop it within the first 12 months and get guaranteed issue Medicare supplement. So pretty much, you've got a 12-month window here to pick a good plan.

There's a Medicare annual enrollment period for people who want to switch from one Medicare Advantage plan to another or to change their Part D enrollment. So that's an annual period allowing you, under guaranteed issue, to switch from one Medicare Advantage plan or Part D into another one. I mean, you don't really get stuck, but work with your agent. An agent who is independent and has access to all of the major plans in your zip code will be very helpful. I can think of at least one agent that can do that for you.

Answer: It's really not a true or false issue. The need for life insurance should depend on the purpose of the insurance: to take care of unpaid bills upon your death vs. taking care of a surviving partner or providing a legacy for your heirs. I don't believe that having Medicare should eliminate the need for life insurance.

Answer: This is no such thing as "Medigap Plan C". If you have a Medicare Part C Advantage plan, bloodwork / lab expenses will be plan dependent but many plans feature $ 0 copay (or low cost) for these services which can vary based on where the blood is drawn: doctor's office, clinic, hospital or other stand-alone facility.

Answer: Medicare covers DME, durable medical equipment, but does not cover stairlifts. The stairlifts are considered home modifications rather than DME.

Answer: Medicare supplement plans are generally much lower cost for people age 65 - to - 70 but after that, things change. I have customers who started paying $ 125 monthly for their supplements but their plans closed for new business and increased premiums on current grandfathered members to $ 500 monthly (and higher).

Answer: Make sure that your Part D plan has the best possible coverage for your specialty medication. All plans are different and some will cover your specialty meds better than others.

Answer: Original Medicare and no other coverage is a major mistake because you will be on the hook for 20% of all outpatient charged services with no limit. Medicare Advantage plans are all different but one thing they have in common is something called an Out of Pocket Maximum which will limit your financial exposure every year.

Answer: The star ratings are real and based on customer feedback and experience with the different plans. As an agent, my focus is more toward plan benefits than star ratings but the star ratings are worth noting.

Answer: Check with your health care team on this one but yes, generally speaking Medicare covers genetic testing if it's deemed "medically necessary." If the test you want is based on family history, your chances are good that Medicare will approve it.

Answer: Medicare plans are individual (not joint) but the cost of Medicare Part B will be based on your Modified Adjusted Gross Income. So married couples filing a joint tax return pay the $ 185 per person per month with $ 212,000 or less gross income and the breakpoint is $ 106,000 or less for single tax filers.

Answer: Go to this public web site: medicare.gov, click "Find a Plan Now" then key in your zip code and medications. Follow the prompts.

Answer: It's very real. Medicare members are capped when your Part D or C plan's actual retail cost of covered drugs reaches $ 2,000 during 2025. Be sure to confirm that all of your meds are listed as "covered" drugs. Check your plan's formulary for that.

Answer: You can budget for Medicare costs if you can provide your date of birth, residence zip code, current plan help, medication list, names of your doctors, family health history, current health situation, financial info and list of anticipated utilization including treatments that you might face.

Answer: Did you know that approximately 50% of the Medicare population has Medicare Advantage? Popularity for this type of coverage is surging. Still, Medicare Advantage is not for everyone and there aren't too many things that we're all happy about. I think it's a lack of understanding that causes displeasure with Medicare Advantage. As a Medicare Advantage member myself for the past 5 years and having sold these products for 18 years, I am 100% happy with Medicare Advantage considering the thousands of dollars I have saved by using Part C. So what's the problem with Medicare Advantage? Have you talked with your agent and gained a full understanding of Medicare Advantage and how it works? Medicare Advantage plans, many of which feature $ 0 (zero) monthly plan premiums, have deductibles, copays and coinsurance depending on the plan. All Medicare Advantage members are protected by an out of pocket maximum which varies depending on plan and service area. This is in exchange for higher premiums associated with traditional Medi-gap or Medicare supplement plans. It's important to take the time to learn about these products before making an enrollment decision.

Answer: Great question. Most Medicare Advantage DUAL plans for folks with Medicare and Medicaid have a monthly healthy grocery benefit so no cigarettes, alcohol or non-food products. There are a couple of Medicare Advantage plans which may help with groceries for people with A and B Medicare so you don't necessarily have to be on Medicaid to participate but check with your independent agent to find out which plans help with groceries and if you qualify for the added benefit.

Answer: Experience matters. Ask your agent how long they've been in business? What percent of their business is Medicare (important!). Have your agent provide you with the names of the states where they're licensed and list the Medicare plans they are licensed / appointed to sell in your resident zip code.

Answer: The plans are not random. If your friend pays nothing for his Medicare plan, this is highly likely to be a Medicare Advantage plan featuring deductibles, copays and coinsurance depending on the plan. Most advantage plans feature a $ 0-dollar copay to see your primary doctor but will have a $30-to-$ 50 dollar copay to see a specialist and there will be additional costs depending on what's going on. Now if you are paying over $ 200 for your plan, you may have a very high-benefit Advantage plan but it is more likely that you have a Medicare supplement plan and this is a different animal. Medicare supplement plan F pays after Medicare leaving you with no medical bills for health services for Medicare-approved services (or no bills after a 2025 $ 256 outpatient deductible if you have a supplement Plan G). Talk to your independent insurance agent about all this otherwise get your license and help me explain this stuff!

Answer: This depends on the nature of the procedure. Medically necessary cataract surgeries are for the most part covered by all Medicare Advantage plans and you will typically pay your plan's outpatient surgery amount or copay. If you need cataract surgery on both eyes, expect to pay an additional copay for the second eye. There is a very nice, "enhanced," multifocal procedure which is not an approved benefit by Medicare and this is likely not covered by any Advantage plan. Expect to pay $ 5,000 per eye for the privilege of not needing reading glasses! If your upcoming eye surgery is other-than-cataract, ask you doctor to secure a Prior Authorization from your plan before going ahead with the work.

Answer: In 2025, single tax filers making up to $ 1,976 monthly gross income with no more than $ 17,600 in assets (couples: $ 2,665 / $ 35,130) should qualify for Extra Help for Medicare Part D also referred to as LIS (Low Income Subsidy). To apply for help, go to ssa.gov/extra help, call Social Security, or call your local SS office. Walk in traffic is not recommended.

Answer: To appeal a decision by original Medicare, contact Medicare. If your Part D plan is denying prescription drug coverage, have will need to request that your doctor file for a "formulary exception" with your insurance. If the insurance company decision is to deny the requested exception, you need to feel an appeal with your insurance. The recommended plan of action for an insurance company's denial of coverage for a specific procedure is you need to contact your insurance company and file an appeal of the denial. Your independent Medicare health insurance agent (who sold you the plan) most assuredly should be able to help you.

Answer: Yes, some Medicare Advantage plans cover acupuncture and in order to find out if alternate therapies are covered, this too is plan dependent. Here in Wisconsin, an independent agent like myself has access to Medicare plans from UHC, Humana, Aetna, Network Health, Quartz Health Plans, Molina and Wellcare so it's always wise to check with an experienced, Medicare agent to learn about specific plan benefits.

Answer: Don't worry! The dreaded "donut hole" has been discontinued effective January 1, 2025. So you can not longer enter the donut hole. However, Medicare pays less to the insurance companies this year for your prescriptions so most Part D plans now have higher deductibles which will be offset by a $ 2,000 annual limit on the full price of a member's covered Rx costs, so members with expensive name brand drugs will be protected by the new rules. Be careful on this and make sure that all of your prescriptions are in fact covered by your Part D plan.

Answer: The biggest disadvantage of the Medicare Advantage plans is the negative publicity surrounding the insurance, the negative sentiment and fake news making Medicare Advantage seem like a bad idea. As an independent Medicare agent for the past 18 years and a Medicare Advantage member for the past 5 years, I have no regrets and if I could do it all over again, would stick with Medicare Advantage. OK, there are plusses and minuses with Medicare Advantage but the program is overseen by the Federal Government. That's CMS, the Centers for Medicare Services. By law, Medicare Advantage must be "at least as good as" original Medicare. Medicare Advantage members are protected by an out of pocket maximum so that's probably the best thing about the program. On the flip side, many doctors don't like Medicare Advantage because it's more work for them. Some procedures require prior authorizations so the additional paperwork is not popular among the medical profession. But, I have yet to hear of a medically necessary procedure that has been denied by any Medicare Advantage plan.

Answer: Medicare supplement plans are subject to Underwriting and you will need to be in reasonably good health when you are outside of your guaranteed issue period which will be when first enrolling in Medicare or within several months after leaving an employer group health plan.

Answer: CMS, Centers for Medicare Services, overseas the Medicare Part C Advantage program. By law, Medicare Advantage plans must be at least as good as Medicare, which is to say that all plans are better than original Medicare. CMS will shut down any plan advertising benefits that are not real. "They've got your back!"

Answer: In this case, you will be auto-enrolled in Medicare. When you get your red, white and blue Medicare card in the mail, pick a Medicare supplement plan plus a Part D Rx plan or an MAPD plan. Your independent Medicare agent can help with this.

Answer: Go to ssa.gov, log in or register (then log in), click apply for benefits and apply for Medicare Parts A and B. When you get your Medicare card in the mail, contact your friendly independent, Medicare agent who can help you pick a suitable Medicare plan, either a supplement (Medigap) plus a Part D plan or Medicare Advantage (Part C) plan with embedded Part D benefits.

Answer: You can't receive both your full benefit and your husband's survivor benefit at the same time. If your survivor benefit is higher than your own benefit, you can switch to the survivor benefit. However, the Social Security Administration will give you the higher of the two amounts, but not both.

Answer: medicare.gov has a public website allowing you to input your Rx list including name of drug, milligrams and dosage. Then key in your pharmacy preference to see which Medicare Part D plan will give you the best bang for your buck.

Answer: I would strongly recommend that you speak with a licensed, independent Medicare agent with access to all of the major plans in your zip code. An experienced Medicare agent will easily be able to help you and there should be no cost or obligation.

Answer: Helping Medicare clients select the most suitable plan for their individual needs then learning how happy the clients were with the decisions they made is the single most gratifying outcome I have ever enjoyed.

Answer: The biggest mistake seniors make when enrolling in Medicare is trying to do-it-themselves. I think it's a bad idea, especially considering that a knowledgeable, experienced, independent, licensed Medicare agent is most likely provide Medicare enrollment assistance at no cost or obligation. The technical term we use here is, "no brainer" to talk with an agent.

Answer: Every client is different and when it comes to Medicare, there is no one-size-fits all plan.

So I strongly recommend a phone call, needs assessment, then an in-person appointment or a virtual session. Let's start with one of those...

Answer: My best advice to every senior trying to understand Medicare is they should consult an independent agent who has access to all major health plans in their zip code. There is no cost or obligation to meet with most of us! So you have much to gain and nothing to lose by taking the advice of an expert. I like the DIY / youtube approach many times but not when it comes to Medicare.

Answer: The key questions here are, how good is the senior's employer group plan and what is the cost? Then compare that with the cost of Medicare Part B, typically $ 185 / month, in combination with a Medigap or Advantage plan.

Answer: The question is they have a new cholesterol drug and they want to know if it will count towards your coverage gap. Okay, well, there is no coverage gap. That's over now, also known as the donut hole. That ended on January 1, 2025. So the real question here is, is your drug covered? Most of these statins that cover cholesterol, we're talking atorvastatin, rosuvastatin, simvastatin, and pravastatin, are covered by all Medicare Part D prescription drug plans, and they're very low cost. Many of the Part D plans will have these meds listed under a tier one or a tier two. With many of the plans, you'll pay a very low, single-digit dollar co-pay or no cost at all. So you're really in good shape. You can check a plan's formulary to find out if the drug is covered. The real question is, is the drug covered, not will it count towards the coverage gap? There is no coverage gap, so the drugs are generally covered. Check with your plan's formulary. You can go to medicare.gov, which is a public website, click on Find a Plan Now, and then type in your ZIP code and the name of the drug. You will see right away which plans cover your drugs and what your co-pay will be, whether you're going to use a mail order or local pharmacy. It sounds a little complicated, but it really isn't. I think the best thing to do is to contact an experienced Medicare agent who is independent. I can think of at least one person like that you can call who can help you with that.

Answer: People are living longer due to innovations in healthcare but unfortunately the cost of healthcare is outpacing inflation. As the cost of healthcare increases, so will the cost of Medicare. Medicare Part B premiums jumped 6% from 2024 to 2025 (from $ 174.70 to $ 185 monthly). Retirees on a fixed income need to find a way to stay healthy and properly insure themselves at a reasonable cost.

Answer: The 2025 Medicare Part A deductible is $ 1,676 for the first 60 days of in-patient hospitalization. After that, it gets nasty: $ 419 copay per day for days 61 - 90 then $ 838 per day (that's not a typo!) for in-patient hospital stays for days 91 - 150. Noting that the average hospital stay for seniors ages 65 - 74 is 5.3 days (5.6 days for ages 75 - 84), most people with nothing other than Medicare Part A will be OK with the $ 1,676 deductible. But ... this is all about "what if" and to be on the hook for a monster bill (after 60 days of hospitalization) could be a financially catastrophic event, not to mention the physical issues. Get some insurance! Most Medicare plans have something called a "maximum out-of-pocket," or MOOP to protect yourself against a big hospital bill.

Answer: Making sure they have a plan that fits. Medicare is not a one-size-fits-all program so it's important to take the time to speak with an independent agent who can compare and contrast the numerous plan options.

Answer: It happens every day! Much of my work involves helping people leave their employer group plan and jumping onto Medicare. There are a couple of forms that need to be filled out, signed and submitted. I am pleased to facilitate in this process.

Answer: Many people like to get to know who they are dealing with and the best way to do that is in-person. Everyone is different so as an agent, I try to be flexible. The prospect / customer "is the boss!"