Douglas Carney, Medicare Insurance Broker

Answer: The best part of being a Medicare Broker is the ability to provide options tailored specifically to each of my clients. This allows me to spend more time getting to know them and letting them tell me what their needs are.

Answer: The most frustrating misconception I have to clear up with clients about Medicare every year was the Doughnut Hole (if you know, you know). Now it's how the insurance carriers can afford to offer zero-dollar monthly plans.

Answer: Original Medicare offers flexibility to see any provider nationwide but lacks drug coverage and an out-of-pocket cap, risking higher costs. Medicare Advantage (Part C) bundles benefits, often includes extras like dental, and caps costs (e.g., $8,850 in 2025), but limits you to networks and may require prior approvals. If you want choice, consider Original Medicare with Medigap; if you’re healthy and prefer lower premiums, Advantage might suit you. Compare plans at Medicare.gov during open enrollment (October 15–December 7, 2024).

Answer: Absolutely. Health insurance is a relationship-based business. If you don't like the first person you talk to, or they don't have the coverage you need, there is plenty of other agents and brokers available to help take care of your needs.

Answer: I often hear clients grapple with Social Security timing, and the best choice depends on your health, finances, and goals. Claiming at 62 gives you immediate income but reduces your monthly benefit by up to 30% for life. Great, if you need cash now or have health concerns. Waiting until full retirement age (67 for those born in 1960 or later) secures your full benefit, balancing income and longevity. Delaying until 70 boosts your benefit by 8% annually (up to 24% more), ideal if you’re healthy, can afford to wait, and want maximum lifetime payouts. Consider your savings, work status, and life expectancy: if you’re short on funds, 62 may be necessary; if you’re secure, delaying pays off.

Answer: The answer hinges on your situation. Suppose you’re still working and covered by an employer health plan with 20 or more employees. In that case, you can delay Medicare Part B (and Part D, if your plan includes creditable drug coverage) without penalty until you retire. However, you should enroll in Part A at 65—it’s usually premium-free and may supplement your employer plan. If your employer has fewer than 20 employees, Medicare becomes primary, so you must enroll in Parts A and B at 65 to avoid gaps or penalties (8.33%–10% premium hikes for late Part B enrollment).

Answer: I'd recommend you update your address with Social Security (1-800-772-1213 or ssa.gov) to ensure plan notices reach you. For Original Medicare, use Medicare.gov to verify that providers in your new state accept Medicare. If you’re on Medicare Advantage (Part C) or Part D, confirm your plan’s availability in the new state; if it’s not offered, you’ll get a Special Enrollment Period (SEP) to switch—call a licensed agent/broker or 1-800-MEDICARE to check. Compare new plans during open enrollment (October 15–December 7, 2025) or your SEP on Medicare.gov, reviewing costs, networks, and drug coverage. For Medigap, ensure your policy transfers or shop for a new one. Explore state-specific programs like Extra Help for low-income support.

Answer: You can tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker by their approach. Are they asking you or telling you? An experienced broker will do a needs analysis and let the client tell them what coverage works best for their needs. Then the broker will align the client with the plan best meets their needs

Answer: I see the universal healthcare debate as a catalyst for positive evolution in Medicare’s structure over the next decade. Proposals like Medicare for All could expand Medicare’s framework, potentially lowering the eligibility age or covering more services like dental and vision, making healthcare more accessible for all. This might streamline costs, reduce private insurance reliance, and enhance benefits for current enrollees, such as lower out-of-pocket caps or broader provider networks. While debates spark concerns about funding or wait times, innovations in care delivery and technology could offset challenges, creating a more inclusive, efficient Medicare system.

Answer: To help you plan for Medicare costs while preparing for potential long-term custodial care in a nursing home or assisted living. There are smart steps to take for a secure future. Medicare doesn’t cover long-term custodial care, but you can plan by exploring Medicaid, which often covers these costs for low-income individuals—check eligibility at Medicaid.gov and consider spending down assets strategically. Private long-term care insurance, purchased early, can also offset expenses, with policies tailored to your needs. Budget for Medicare Parts A, B, and D premiums and deductibles ($185/month, $257, and up to $590 in 2025, respectively), and consider a Medigap plan to cap out-of-pocket costs.

Answer: As a Medicare-specialized health insurance broker, I’m here to guide you through the 2025 Medicare changes and help you decide whether to switch plans or stay put with confidence. With the new $2,000 Part D drug cost cap, shrinking Medicare Advantage (MA) plan options, and rising Part B premiums ($185/month).

If your current MA or Part D plan still covers your doctors, drugs, and budget—great, stay put! But if your plan’s network, benefits (like dental or vision), or costs are changing, or you’re in one of the 1.4 million terminated MA plans. I always recommend an annual policy review to ensure you’re all set. As you age so does your coverage needs.

Answer: As a Medicare-specialized health insurance broker, I can tell you that both offer unique benefits. A local agent knows your area’s specific Medicare Advantage and Part D plan options, provider networks, and even regional healthcare trends, ensuring personalized recommendations tailored to your community’s needs. They can meet face-to-face to explain complex details, building trust and clarity.

Whereas virtual agents offer convenience and broader expertise, to those that are a little more tech savvy. In the digital world you can find answers online or over the phone instantly. A local agent may have hands-on guidance and knowledge of nearby resources—like doctors or state programs while a virtual agent may have a better understanding of national cost saving programs.

It all depends on what the client prefers.

Answer: Yes. As a Medicare-specialized health insurance broker, I hear your call for Medicare to cover more alternative treatments that truly benefit seniors, and it’s an exciting idea with real potential for the future! Expanding coverage to include evidence-based alternative therapies—like acupuncture for chronic pain, massage for mobility, or nutritional counseling—could enhance seniors’ quality of life, reduce reliance on medications, and even lower costs long-term.

Medicare already covers some alternatives, like chiropractic care or wellness programs in certain Medicare Advantage plans, and the 2025 expansion of mental health services shows progress. Advocating for more through Medicare.gov or supporting pilot programs could push this forward, promising a future where seniors thrive with holistic, effective care options tailored to their needs.

Answer: Original Medicare (Parts A and B) offers unmatched flexibility, letting you visit any doctor or hospital nationwide as long as they accept Medicare which is great for rural areas. Unlike MA plans, it doesn’t require prior authorizations or restrict you to networks, ensuring faster access to care.

However, MA plans cap out-of-pocket costs and bundle extras like dental. Original Medicare only covers 80% of health care costs and there is no cap on out of pocket expenses.

Answer: As a Medicare-specialized health insurance broker, I’m here to reassure you that missing your Medicare sign-up window isn’t the end of the road and you still have options to get covered. If you missed your Initial Enrollment Period (three months before and after your 65th birthday), you can enroll during the General Enrollment Period (January 1–March 31, 2025), with coverage starting April 1. Also, depending where you live, you may be able to enroll using a Special Enrollment Period. Call an agent/broker to see if you are eligible.

Answer: If you only need hospital coverage, enrolling in Medicare Part A is your best bet—it’s premium-free for most people with 40 quarters of work history. It covers inpatient hospital stays, skilled nursing, and hospice care. Skip Part B ($185/month in 2025) and Part D if you don’t need outpatient or drug coverage which avoids extra costs.

However be just know that without Part B, you’ll pay full out-of-pocket for doctor visits, so confirm your needs first. Check eligibility and enroll during your Initial Enrollment Period to secure this cost-effective coverage, keeping your healthcare simple and budget-friendly!

Answer: To break down the buzz around Medicare Advantage (MA) plans versus Original Medicare. MA plans called "Part C" bundle Parts "A", "B", and often "D", offering extras like dental, vision, or gym memberships, and cap out-of-pocket costs. They’re budget-friendly with low or $0 premiums but limit you to provider networks and may require prior authorizations.

Original Medicare gives you freedom to see any doctor nationwide that accepts Medicare, no approvals needed, but lacks a cost cap. To have full coverage with Original Medicare you'd have to enroll in a separate Part D and Medigap plan, which usually cost more.

Answer: As a Medicare-specialized health insurance broker, the right choice always depends on your needs! Some agents favor MA plans because they often have lower premiums, including extras like dental or vision, while Medigap plans have higher premiums and stricter enrollment rules.

MA plans suit those seeking affordability, capped max-out-of-pocket expenses, and bundled benefits but come with network limits and prior authorizations. Whereas Medigap provides standardized coverage and nationwide provider access but with a monthly premium on top of the part B cost. Be wary of pushy agents; a good one will compare both to find your best fit, empowering you to choose with confidence!

Answer: As a health insurance broker, I understand the importance of clear answers for seniors exploring assisted living options. Unfortunately, Medicare does not cover the core costs of assisted living, such as room and board or custodial care like help with daily activities. However, it shines in covering medically necessary services—think doctor visits, hospital stays, or skilled nursing care—that seniors in assisted living may need. Some Medicare Advantage plans even offer expanded benefits, like in-home support or adult day care, which can ease the financial burden. While Medicare alone isn’t a complete solution, combining it with Medicaid, long-term care insurance, or VA benefits can create a robust safety net.

Answer: A senior might pick a higher-cost Medicare Part D plan for better coverage of costly or specialty medications, lower copays or coinsurance, access to preferred pharmacies, or a wider drug formulary that includes all their needed prescriptions, ultimately saving on out-of-pocket costs for frequent or expensive drugs.

Answer: Medicare Part B covers occupational therapy for arthritis or mobility issues if deemed medically necessary by your doctor or healthcare provider. It pays 80% of the approved amount after you meet the Part B deductible, with you covering the 20% coinsurance. If therapy isn’t deemed necessary, you may pay out-of-pocket unless you have a Medicare Advantage plan with additional coverage or a Medigap plan to help with coinsurance. Always ensure your provider accepts Medicare assignment to maximize coverage.

Answer: Whether you can keep seeing your current doctors after switching to a Medicare Advantage plan depends on the plan’s network. Most Medicare Advantage plans, like HMOs or PPOs, have a network of doctors and hospitals you must use to get the lowest costs. If your doctors are in the plan’s network, you can likely continue seeing them. However, if they’re out-of-network, you may face higher costs or need to switch doctors, especially with HMO plans that typically require in-network care except for emergencies. PPO plans offer more flexibility for out-of-network providers, but at a higher cost. Some plans, like Private Fee-for-Service (PFFS), allow you to see any Medicare-approved doctor who accepts the plan’s terms, but not all providers do.

To ensure you can keep your doctors, check the plan’s provider directory on their website or call the plan directly to confirm your doctors’ participation. You can also contact your doctors’ offices to verify if they accept the specific Medicare Advantage plan you’re considering. Always review the plan’s network rules before enrolling to avoid unexpected costs or changes in care.