Claudia Englert, Medicare Insurance Broker

Answer: No. You don’t need to sign up for Medicare again. You are already in the Medicare system but you may want to change your plan and can as you are entitled to your Initial Election Period

to select a plan.

Answer: I think it’s outdated and unfair to seniors that they have to do a Scope of Appointment at least 48 hours before a meeting they are requesting. What difference does it make?

Answer: The only time you can change your Medicare Advantage plan is during The Annual Election Period unless you develop a condition that qualifies you for a Chronic Care Plan if available in your area, are Institutionalized and an Institution Plan is available in your are &/or you become qualified for a level of Medicaid.

Answer: Yes. You are entitled to a Special Election Period if and when you lose your employer insurance coverage.

Answer: Too many people answer their phones to those Call Centers, answer some questions & the next thing they know they’re enrolled in a plan that their doctors are not in &/or their drugs are not covered. My advice is to not answer your phone unless you know who it is. If it’s important, they will leave a message. Also, if a Call Center calls you & you’re on the Do Not Call List, report them to the FCC & they’ll receive a $10,000. fine per violation. It’s against guidelines for them to call you without your permission.

Answer: I don’t know of any insurance companies that have applications without health questions for people trying to switch from a Medicare Advantage Plan to a Medicare Supplement. If you have bad health problems or conditions, they will turn you down.

Answer: I haven’t noticed that the push for healthcare price transparency has affected me at all. There’s not been any unexpected outcomes.

Answer: The insurance companies decided they didn’t want to service those plans in certain areas which is called Service Area Reduction. I had a several clients that lost their plans for next year but simply signed them up for another plan.

Answer: Make sure your medications are covered and pick a plan where your med costs are the lowest cost to you.

Answer: Yes. Medicare covers hospice care for no co-pay nor co-insurance. It doesn't matter if they have Original Medicare, a Medicare Supplement or a Medicare

Advantage Plan.

Answer: They do not read the Medicare & You book nor do any homework about Medicare and do not know what their options are which could end up being very costly to them. Some seniors do not take out a Prescription Drug plan, and if they go more than 63 days without creditable drug coverage, they will pay a penalty every month for the rest of their life unless they are on Medicaid.

Answer: I explain their options, a Medicare Supplement and a Prescription Drug Plan that keeps going up in premium as they age and a Medicare Advantage Plan & how it works where Medicare pays the insurance company money every month to take care of all of their healthcare needs, pays their claims and sends out a monthly Explanation of Benefits. I also tell them that with Original Medicare there's no maximum out of pocket where Medicare Advantage plans have a maximum out of pocket.

Answer: There is no donut hole or gap this year. The maximum out of pocket for outpatient prescription drugs for this year is $2,000. and then no more co-pays. The maximum out of pocket for next year 2026 has been to $2,100.

Answer: It depends on what plan you have. All plans generally only pay in foreign counties if it's a medical emergency, and they have limitations as to how much they will pay outside the United States.

Answer: It sounds to me as though you must be on a Medicare Supplement plan and should also have a Prescription Drug plan in addition where you pay a premium for that also. A lot of Medicare Advantage plans have $0 premium that are really good plans and include Prescription Drug coverage plus many other benefits that you don't have with a Medicare Supplement like dental, vision, hearing, over the counter benefits, etc.

Answer: Typically an Agent works for one company. A Broker represents several companies. I'm a Broker and represent 5 insurance companies

Answer: Medicare Advantage plans have HMO's and PPO's. With an HMO you use in network doctors, but normally I can find a plan where all of your doctors are in the network with the lowest cost for your outpatient prescription drugs. If not, you can go with a PPO plan where you can go out of network for a little higher co-pay. Medicare Advantage plans have a lot of benefits you don't have with a Medicare Supplement and a maximum out of pocket that you don't have with a Medicare Supplement. If you're in Ohio, I can do an analysis for you where I use a special software program to figure it all out for you. The Medicare.gov website isn't nearly as accurate and much more difficult than having an Agent/Broker to figure it all out for you as that is what we specialize in.

Answer: Yes. Medicare pays and then your Medicare Supplement should cover the remaining cost after your yearly Part B deductible of $257,

Answer: It all depends on your particular scenario. When I started specializing on Medicare plans, I worked for an insurance company writing Medicare Supplements only and ran into people with Medicare Advantage plans and paying no premium. With a Medicare Supplement, you have to pay that premium and then take out a Prescription Drug plan and pay for it, you have no maximum out of pocket and don't have dental, vision and hearing benefits along with a free gym membership and other benefits, and premiums keep going up and up as you age. I quit writing for that carrier, and I've been writing Medicare Advantage plans, and I've been on Medicare Advantage plans for over 12 years myself paying no premium or low premium with prescription drug coverage imbedded and am way ahead money and benefit wise and have gone through breast cancer and many other health problems and a lot of dental work. I highly recommend Medicare Advantage plans.

Answer: It all depends on what plan you are on, and the only way to know if you should keep your current plan or change is to do an analysis. All I need to know is what plan you are on now, a list of your doctors names and your medications with dosages, your zip code and pharmacy used. Then I can do an analysis and advise you whether to keep your present plan or change for next year.

Answer: If you’re on Medicaid & get married to a person with a decent or good income, you’ll lose your Medicaid where you pay nothing or hardly anything for your health and drug benefits. If you both have a good income or one of you has a good income that sustains both of you,

it won’t make a difference.

Answer: Original Medicare doesn’t cover hearing aids but they are covered in Medicare Advantage plans. Most of the MAPD’s require you use in network providers and will only pay so much & have Co-pays.

Answer: You can & should wait if you have good health coverage through your employer with creditable drug coverage & if it’s not super expensive for you. You should automatically get Part A coverage which doesn’t cost you anything so long as you have worked for 10 years or more but opt out of Part B which costs $185. per month this year & going to $206.50 for 2026.

Answer: Plans change every year. Drug costs vary somewhat like the cost of gasoline. Drug formularies change & now some drugs cost more due to inflation. The Inflation Reduction Act of 2025 aims to lower prescriptions drug costs at a rate slower than inflation.

Answer: There’s no way to avoid the Part B premium unless your income is so low that you qualify for low income subsidy or you qualify for Qualified Medicare Beneficiary or Medicaid. Also there are Medicare Advantage Giveback plans, but I’ve found that those plans have higher co-pays.

Answer: With Plan N, MRI’s are covered under Medicare Part B which has a $257. deductible and then 20% coinsurance. Also there may be a $20. Co-pay.

Answer: It depends on if you’re still working & in fairly good health. If so, I’d wait to draw social security as you get a higher payment. If you’re a woman divorcee and was married for 10 years or more, you can draw on your ex-husband’s social security if it’s enough income & then take yours at age 70.

Answer: Medicare has several services to help people with a pre diabetic diagnosis.

There’s a Medicare Diabetes Prevention Program, testing, risk assessment & medications as well as well as diet recommendations.

Answer: I really don’t know as I only write plans in Ohio that has many plan options but know some states like S Dakota have very few options.

Answer: What’s my maximum out of pocket on a Medicare Advantage Plan. Medicare by itself doesn’t have a maximum out of pocket.

Answer: Most people are happy with their Medicare Advantage plan if they have had a good agent help them with their plan choices. I’ve been on Medicare Advantage plans for over 12 years myself & I really can’t think of any reason why people would be unhappy with their plan except that some co-pays have gone up & some benefits removed or lowered for next year.

Answer: Doctors are permitted to discontinue

being in any plan’s network they choose for various reasons. When & if that happens, people can simply change plans where their doctor is in network. If not on a Low Income Dual plan &/or don’t have a Special Election, people need to wait until The Annual Election Period to change their plan, but doctors usually don’t drop out of a plan mid year.

Answer: In my opinion, it depends on whether you have Medicare by itself or a Medicare Advantage plan. Medicare Advantage plans have more benefits than straight Medicare & if you have a good Primary Care Physician, I can’t see where you need to pay the outrageous cost charged by concierge doctors that charge anywhere from $1,500. per year up to as high as $10,000. per year.

Answer: I don’t know of any of the companies I represent that fall short with support for those in assisted living. They are treated the same as those that are living at home & may even provide more support.

Answer: The insurance companies require prior authorizations for surgeries & certain other procedures as well as certain outpatient prescription drugs, especially the expensive drugs & procedures. They normally don’t take a long time to approve them, usually within just a couple of days maximum.

Answer: We get the prospects doctors names and prescription drugs they are on & use a software program that determines what plans are best suited for their particular scenario.

Answer: I would highly recommend a $0 premium or low premium Medicare Advantage plan with prescription coverage included plus many other benefits you don’t get with a Medicare Supplement plan & then having to pay for a prescription drug plan. I’m 77 years old & have been on Medicare Advantage plans since I turned 65 & am way ahead cost wise being on these plans. I’ve been through breast cancer & many other health issues plus a lot of dental work with very little out of pocket costs.