Danielle Jimison, Medicare Insurance Broker

Answer: Before the new $2,000 annual out‑of‑pocket cap, people sometimes chose high‑premium plans to avoid catastrophic costs. now that exposure is capped, that strategy is less common but still relevant for drug coverage differences.

Answer: You can change your Medicare Advantage plan during three main windows: the Annual Enrollment Period (Oct 15–Dec 7), the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31), or anytime you qualify for a Special Enrollment Period.

Answer: The biggest disadvantage of Medicare Advantage (Part C) is the restriction of choice regarding doctors and hospitals. Unlike Original Medicare, which allows you to see any provider in the country who accepts Medicare, Medicare Advantage plans generally limit you to a specific network of providers. If you go out of network, you may have to pay the full cost yourself. Even PPO plans, which offer more flexibility, typically charge significantly higher copays for out-of-network care.

Answer: I once assisted a family where the beneficiary suffered a sudden stroke. Because they had a Healthcare POA in place, their designated agent was able to immediately: Access medical Records, coordinate with Medicare to authorize specialized rehab , and advocate for specific treatments. Without it, the family would have had to petition a court for guardianship a process that is expensive, time-consuming, and adds immense stress during a medical crisis.

If you are considering establishing a Healthcare POA, Choose the Right Person: Your agent should be someone who remains calm under pressure, understands your values, and is willing to follow your wishes even if they disagree with them. Be Specific: Don't just sign a generic form. Discuss specific scenarios, such as your feelings on life support, blood transfusions, or hospice care. Distribute the Document: Once signed, give copies to your primary care physician, your insurance agent, and your designated representative. A POA is only helpful if the hospital can find it when they need it. Setting this up isn't about "giving up control"; it's about ensuring you have a handpicked advocate ready to speak for you when you can't speak for yourself.

Answer: Carriers only show you THEIR plans . They do not have the ability to show all your options.

An agent compares every carrier, not just one. Carrier reps cannot legally recommend a plan

This is the part seniors never realize. Agents can make recommendations because they’re licensed, certified, and trained to do so. Agents translate Medicare into plain English. They can explain important enrollment dates, penalties, explain how Medi-gap and Advantage work. They can help you navigate all the confusion.

Answer: Medicare will cover the cataract surgery itself. and the standard mono-focal lens. (the basic lens that restores vision at one distance) This is all considered medically necessary, so Medicare pays 80% after the Part B deductible.

Anything considered a premium upgrade is not medically necessary in Medicare’s eyes is NOT covered. for example: Lenses to correct astigmatism, Multifocal lenses. These are treated like “luxury add-ons,” similar to choosing leather seats in a car ,Medicare covers the car, not the upgrades.

Answer: An agent can compare plans, check drug formularies, and help check enrollment periods qualifications. You can also visit Medicare.gov and use the plan finder tool or call 1-800-Medicare.(1‑800‑633‑4227)

Answer: call the provider’s billing office first to request an itemized bill and ask them to correct or resubmit the claim, then contact your Medicare plan or 1‑800‑MEDICARE if the issue isn’t resolved.

Answer: When you have both Medicare and Medicaid, that is what we refer to as "DUAL " eligible.

Medicare is your main insurance and Medicaid fills in the gaps and lowers your costs.

You often pay little to nothing for your healthcare. You may also qualify for extra benefits that Medicare alone doesn’t offer.(Depending on your state Medicaid program). Review all your options with a licensed/certified Medicare Broker!

Answer: Original Medicare does NOT cover hearing aids or routine hearing exams.

Many Medicare Advantage plans do include hearing benefits such as:

• Coverage for hearing exams

• An allowance toward hearing aids

• Discounts on specific models

• Fitting and adjustment services

Coverage varies widely by plan and county, but typical plans offering $500–$2,000 allowances per ear

The VA provides free or low‑cost hearing aids for eligible veterans.

Medicaid- if you are dual eligible, you may receive hearing aids or little or no cost.

Over the counter Hearing aids are sold at pharmacies and hearing centers. This is often the most affordable option if you don’t want to switch plans.

Answer: Absolutely! Beneficiaries need clearer, more accurate information. Medicare Advantage is complex. Misleading marketing can cause real harm, especially for older adults or those with chronic conditions.

Answer: Medicare Part B requires you to pay 100% of the cost of your outpatient physical therapy until you meet your annual deductible. After the deductible: Medicare pays 80%, you pay 20%

nless you have:

• A Medigap plan (often covers the 20%)

• A Medicare Advantage plan (uses set copays instead of the 20%)

Answer: Initial Enrollment Period-7‑month window around your 65th birthday

(3 months before → birthday month → 3 months after)

• Enroll in Part A and/or Part B

• Join a Part D drug plan

• Choose a Medicare Advantage (MA) plan

Annual Enrollment Period-October 15 – December 7 every year

• Switch Medicare Advantage plans

• Move between Original Medicare ↔ Medicare Advantage

• Join, drop, or change Part D drug plans

Coverage starts: January 1

Medicare Advantage Open Enrollment Period-January 1 – March 31-(People already enrolled in a Medicare Advantage plan as of Jan 1st.)

• Switch to a different Medicare Advantage plan

• Drop MA and return to Original Medicare

• Add a Part D plan if returning to Original Medicare

Special Enrollment Periods- Varies — triggered by life events

• Moving out of your plan’s service area

• Losing employer or union coverage

• Gaining or losing Medicaid/Extra Help

• Plan termination or contract changes

• 5‑Star plan availability (Dec 8 – Nov 30, once per year)

Answer: Working with a local broker/agent gives a unique "insider info" that comes with someone that lives in your zip code. They will know the local hospital systems, doctors working with specific carriers. Face to Face its often easier to catch the "fine print' when someone is pointing to it on a specific page! The agent/Broker will also be familiar with local senior centers , community clinics or specialized pharmacies that a remote agent in another state wouldn't have on their radar!

Answer: Extra Help Or sometimes referred to as Low-Income Subsidy ( LIS) You would apply through Social Security https://www.ssa.gov/medicare/part-d-extra-help

Some states offer additional help with drug copays, premiums and coverage gaps. State Pharmaceutical Assistance Programs

or If you take band name medications many drug companies offer Manufacturer Patient Assistance Programs

Answer: Medicare Advantage plans love to advertise dental, but the fine print often tells a very different story. Most plans only cover preventive dental at 100%. Major dental (the expensive stuff) is where the limits show things like Low annual maximums, high coinsurance, waiting periods, limited network and caps on how many services you get per year.

You’re not imagining it, Medicare Advantage dental is one of the most misunderstood benefits.

It’s designed to be helpful, not comprehensive.

Answer: Yes, you can stay on just Medicare Parts A & B but it’s rarely considered “good coverage” because it leaves you exposed to unlimited out‑of‑pocket costs and no drug coverage. Original Medicare pays about 80% of approved medical costs, and you pay the remaining 20% with no cap!

Answer: You did pay into Medicare for years, but you paid into Medicare Part A and Part B, not Medigap. Medigap is sold by private insurers, and approval is not guaranteed outside Enrollment Periods. Insurers can deny your application based on health conditions or charge more. Medical underwriting applies any time you apply outside your protected window, and health conditions can lead to denial.

Answer: Yes, if you don’t enroll in Medicare when first eligible at 65, you may face permanent late enrollment penalties unless you have qualifying coverage (like employer insurance). It is best to check with a licensed Medicare agent to learn more of how these penalties will be applied.

Answer: Contact your plan directly: Sometimes denials are based on missing paperwork or referral codes. A quick call can clarify whether it’s fixable. Ask your primary care doctor for help: They can submit additional documentation or a referral that strengthens your case.

Answer: The best part of being a Medicare agent is knowing you’ve turned confusion into confidence for someone who really needed it.

Answer: Yes, Medicare star ratings do matter. They don’t guarantee perfect care, but they reflect how well a plan performs in areas like preventive services, managing chronic conditions, customer service, and member satisfaction. Higher-rated plans generally provide better support and outcomes

Answer: Medicare Advantage PPOs can add referral requirements to coordinate care and manage costs. Always double‑check your plan details before scheduling a specialist visit. The referral requirement may apply only to in-network providers. Out-of-network visits might not need a referral, but they’ll cost more.

Answer: If you're on Original Medicare, telehealth is more limited in 2026 unless your condition qualifies.

If you're on a Medicare Advantage plan, you likely still have broad access to virtual care ,especially from home.

Always check your plan’s Evidence of Coverage (EOC) or call Member Services to confirm which telehealth services are included.

Answer: Bottom line: A great Medicare agent is your personal GPS! Guiding you through the maze with clarity, care, and confidence.

We take the time to understand your doctors, prescriptions, and preferences, so your coverage fits you ,not just what’s trending.

We stay current on plan changes, enrollment rules, and special programs, so you don’t have to.

We’re here year-round, not just during enrollment and when questions come up about billing, coverage, or changes, you’ve got a real person to call.

Most importantly, we help you avoid costly mistakes and missed deadlines, giving you peace of mind every step of the way.

Answer: First, check your plan documents. The Evidence of Coverage (EOC) outlines exactly what's covered, including hearing exams, devices, and any copays or limitations. Secondly, Check your Annual Notice of Change (ANOC) this will show if any of the hearing benefits are changing for the upcoming year. Lastly, You can always call Member Services. There is a number listed on the back of your insurance card.