Cody Hebden, MBA, CLU, FLMI, Medicare Insurance Broker

Answer: If you've had a change in income after retirement and are currently paying an increased premium for your Medicare Part B and Part D, you may be eligible to request Social Security Administration to reconsider your Medicare Income-Related Monthly Adjustment Amount based on various life events, including marriage/divorce/death of a spouse, work reduction/stoppage, and loss of income. You can do this by completing form SSA-44.

Answer: While insurance rates and products are regulated by your State's Department of Insurance - meaning you pay the same regardless of purchased directly from the company versus through an agent, quite simply its because as agents, we understand and live our daily lives in your local community. This is important because we're intimately aware of local health providers and health networks and as an active member of the community, we also contribute to our local economy! Having that been said, I work with folks how they prefer to work - whether that's virtually via phone or email, or we meet up for a cup of coffee. Lastly, there's no 1-800 number associated with a giant call-center that could be halfway across the country or world! When my clients call me, only I answer. And I never charge for anything I do! I work for my clients, not the insurance company.

Answer: I assume you are still under age 65 and that you implied that you had Medicare Part A&B PLUS your husband's employer provided healthcare (as additional coverage). Since he's now retired, and you've lost his coverage, you may have "guaranteed rights" to purchase additional private medicare supplemental insurance (like a medicare supplement), as long as you can prove that you had creditable coverage from his employer all this time. Any insurance company is going to want additional written evidence to prove this information. I suggest you reach out to a local agent directly for more details and instruction.

Answer: Original Medicare is uniform nationwide. Medicare Supplements may vary in cost based on where you live, but the coverage is standardized and uniform nationwide (except in WI, MN, MA). And while the guidelines for Part D prescription drug plans and Part C (ie. Medicare Advantage) are set Federally, coverage options, availability and pricing can vary widely across the country. This is why in some cases, if you move, you may have an opportunity to review and change to a new plan option (known as a Special Election Period).

Answer: Congratulations! From a financial standpoint, you're reporting higher earnings on your tax returns than your friends! But in all seriousness, while Medicare Part B & D premiums are income based, the increase you may have to pay is not always permanent - as there are ways to request the Social Security Administration to re-review your assessment (ie. reduction in income, temporary income spike, etc). IRMAA is calculated based on your Modified Adjusted Gross Income (your adjusted gross income with some deductions added back in). Furthermore, how you file your taxes also play a role (ie. Single versus Married Jointly). Since the IRMAA income thresholds change every year, I highly suggest you refer directly to Medicare.gov for the specific amounts.

Answer: Break it down into bite-sized chucks. While the government publication "Medicare & You" is a great publication, reading it from front to back may put you to sleep. Instead, pick out sections that are highest interest to you and study those first. Furthermore, a good independent agent should be helpful to break down all the moving parts and components of Medicare and be able to easily explain how private insurance fits into the combination. Leverage Medicare.gov and its resources along with a local experienced agent. You've got this!

Answer: It can be uncomfortable or awkward to discuss our healthcare needs, especially with our closest family members like our children or our parents. However, these are one of the important topics worth discussing to ensure we (and they) have the best support if/when needed. Its really about making your parents comfortable with talking about their health and aging (something no one loves to talk about). They should know that you (their child) is there to help them in any way possible - whether through helping them seek appropriate care, or help them with the administrative side of healthcare. Through these talks, you can also help make sure your parents have chosen the correct Medicare-related health insurance, such as prescription drug coverage, Medicare supplements, or a Medicare Advantage plan.

Answer: First off, unless they have prior permission to call you, they shouldn't be calling you! Unfortunately, there's lots of scam calls and unfortunately many originate from overseas - who ignore our National "Do Not Call" list. If you don't recall giving them permission and/or do not have a previous relationship with them - I might suggest you just hang up the phone. Its important to establish trust in any relationship before providing any personal information.

Answer: One of the ways to validate coverage and benefits is to get it in writing! All plans have a document known as a "Summary of Benefits" which spell out the specific benefits of the plan you are considering. Just keep in mind that each plan, while the name may be the same, may vary in benefits based on zip code - so make sure you get the proper documents for the exact plan you're considering.

Answer: Now a days, there are many dental practices who aren't in-network for ANY insurance company. Do not fear! I might suggest you review your Summary of Benefits of your Medicare Advantage plan as there may be out-of-network dental benefits available. Just keep in mind that you may have lower coverage or higher out-of-pocket costs, but something is more than nothing. Ideally, you would likely want to make sure the Dentist is in-network, so contact your plan sponsor (insurance company) or your insurance agent to help find one that is.

Answer: If feels obvious, but unfortunately, simply not knowing all of your options. There are so many nuances and rules for folks who initially become eligible for Medicare, whether from a disability, turning 65, working past 65 and subsequently retiring. Not knowing your full options could be incredibly costly both on your pocketbook but also on your quality of healthcare. Before making ANY decisions, make sure you've been aware of all your options, weighed all the pros/cons - you'll thank yourself later.

Answer: Quite simply because we understand and live our daily lives in the local community. This is important because we're intimately aware of local health providers and health networks and as an active member of the community, we also contribute to our local economy! Having that been said, I work with folks how they prefer to work - whether that's virtually via phone or email, or we meet up for a cup of coffee. Lastly, there's no 1-800 number associated with a giant call-center that could be halfway across the country or world! When my clients call me, only I answer.

Answer: First off, never assume that something that is $0 per month is "free". There's always costs associated with health care, especially Medicare Advantage plans - in the form of copays, deductibles, and coinsurance. Having that been said, the reason why some Medicare Advantage plan providers are able to offer their plans for $0 monthly premium has to do with how they leverage government funding and strategic cost management. When a person leaves Original Medicare to a Medicare Advantage plan managed by an insurance company, it should be noted that the Medicare beneficiary is no longer a "liability" or on the "balance sheet" of the US Government, but rather is now the "liability" of the private insurance company - to manage their care and associated costs. As a result, Medicare Advantage plans receive monthly payments from Medicare for each individual they have enrolled in their plans. These payments are designed to help cover the costs that would have historically been provided under Original Medicare. Private Insurance companies also deploy strategic cost management through negotiating lower rates with providers, putting attention on preventative and healthy membership to help pass the cost savings to the individual.

Answer: I always recommend someone to take a step back first, think about all the things you like and dislike about the health insurance you currently have or the coverage you last had (from employment prior to retiring, individual plan from your business, etc). This is a great starting point if you can have a list of likes/dislikes to help us set the tone for how to ensure your Medicare related coverage has most of the "likes" and little or none of those "dislikes".

Answer: Your choices around Social Security and Medicare are separate. I cannot provide tax or financial advice, so I do recommend you speak to a licensed financial advisor as to your strategy for Social Security withdrawal. As for Medicare, if you're no longer working, it is important to enroll in Medicare when you turn 65. Keeping in mind that the earliest your Medicare (Part A&B) would begin is the first day of the month in which you turn 65 (unless your birthday is on the 1st, and then Medicare would begin on the 1st day of the prior month). It's important to opt into Medicare when first eligible, especially if you do not have employer-provided health insurance from yourself or your spouse, to avoid any potential pitfalls (like Medicare associated penalties or late enrollment delays).

Answer: Everyone and no one! Statistically, in 2025, Medicare eligible folks who choose private insurance, about 50% choose a Medicare Advantage plan while 50% choose a Medicare Supplement plan. That goes without saying that while a Medicare Advantage plan works for some people, it doesn't work for everyone. There are many pros/cons for either option, so its most important that you assess what matters most to YOU, not your friends or family members. What you value in your health insurance coverage may or may not be what your friends value.

Answer: Yes and No! While you can certainly change your Medigap plan at any time during the year, unless you have guaranteed issue rights (Based on state or personal situation), you may have to answer health questions and be subject to underwriting - meaning the insurance company does not have to approve you for coverage. But do not fear! A "decline" by an insurance company doesn't carry too much weight - it just means they don't want to provide you coverage. Every insurance company will look at you differently, so there is potential that another company will happily provide you your coverage. AND, as long as you continue to pay your premiums on your existing coverage, your existing company will continue to honor their promises and coverage.

Answer: What a great question! I wish I had a crystal ball to look into the future, but unfortunately I can only share what my experience has been thus far. What I have seen is the evolution of private insurance companies (think medicare supplements) integrating discounts for their members in sharing their fitness data. The thought process is that by the member staying physically active, it will lead to less health concerns and lower health insurance claims and costs - saving the insurance company money and thus saving their member's money. I don't foresee this becoming a widespread offering across all companies, nor ever a mandate that someone participate, but time will tell if the data they get truly results in those savings.

Answer: Unlike the health insurance plans you were most familiar with during your working years, Original Medicare does not have an annual maximum out of pocket. This means that you could be at risk of losing substantial savings to pay for medical bills. This is where private insurance comes in, to help cap and limit your financial exposure and risk.

Answer: Great Question! There's really two answers here, so it depends on if your specialty medication is covered by Part B, or if it falls under Part D prescription drug coverage. Based on you having high costs, I am assuming your drug does not fall under Part B. As such, since every Part D plan has a "formulary" (list of covered drugs), by law, they must provide drugs that provide care to nearly every type of illness or issue. However, that doesn't mean your drug is on the formulary. And if it is not, you're not covered by insurance for the cost. You should work with your doctor to see if there is another acceptable drug that will have the same therapeutic benefits that is on your plans formulary. Otherwise, you can request an appeal from Medicare, and with your doctor's assistance, you can request a formulary exception - to get your Part D plan to cover the drug. If the drug is still too expensive, you should see if you qualify for any "extra help", by going to Medicare.gov for more information.

Answer: Maybe! I love when I get to answer a question with a "yes" and a "no". Since Medicare Advantage plans are "managed care" plans, you may be restricted by a plan provider's network (of doctors and facilities) or the type of network (ie. HMO vs. PPO). This is why it is important to verify if your doctor is in-network for any plan you may be interested in. If the doctor is out-of-network, depending on the plan, you may or may not have any insurance coverage to see that doctor - resulting in significantly more out of pocket expenses.

Answer: Picture Medicare Part A & B as this. You're in a hospital room. The room and the bed itself is Part A (hospital) and anytime someone comes into the room or plug something into you, that's Part B (medical). Part D is the coverage for drugs (D as in Drugs). The problem with Original Medicare is that there is no annual out-of-pocket maximum. And that's where private insurance comes in - to help cap your financial exposures and reduce or eliminate your out-of-pocket costs.

Answer: My passion around Medicare started when my parent's turned 65. And to this day, every client gets the "mom test" (ie. Would I make the same recommendation to my own mom?). I love helping people understand the unnecessarily overly complex structure of Medicare in ways that are easy to understand. In this complexity, unfortunately many people don't realize some of the opportunities and pitfalls that come along with Medicare, and I love being able to help them make notice. Consider me a nerd who loves to read contracts, but I do this to help ensure folks buy what they want and need, and to make sure they actually buy what they thought they were buying. As the old adage says, "Do the right thing and the money will follow".