Emmond Wills, Medicare Insurance Broker

Answer: IRMAA (Income-Related Monthly Adjustment Amount) is an extra charge added to your Medicare Part B and Part D premiums if your income is above a certain level. It’s based on your IRS-reported income from two years ago — for example, your 2024 income determines your 2026 premiums. You can check if it applies to you by reviewing the annual Social Security letter you receive or comparing your income to the IRMAA brackets on Medicare.gov; if your income drops later, you can appeal to have the surcharge reduced.

Answer: How will my health and income changes over the next few years affect my Medicare costs and coverage?

This question helps you plan ahead for premium adjustments, drug costs, and eligibility for savings programs — instead of reacting after expenses pile up.

Answer: Medicare changes take effect in 2026, including higher Part A and B premiums/deductibles, expanded drug price negotiations with new out-of-pocket caps under Part D, and updated Medicare Advantage rules lowering the max out-of-pocket limit. Some prior authorization pilots will also begin in Original Medicare. These updates aim to control costs and improve transparency, but beneficiaries should review plans carefully during AEP to avoid surprises.

Answer: -When you choose Original Medicare (Parts A & B) — you’re getting the federal program directly, not a private plan.

-So if you had several doctor visits, imaging, or physical therapy sessions — you’d be on the hook for 20% of every charge.

That’s the reason many people who keep Original Medicare end up facing high bills.

Answer: When Medicare does not cover it

Medicare law (Part D) prohibits coverage of drugs when the sole purpose is weight loss

So, if Ozempic is prescribed purely for the purpose of weight reduction or obesity treatment (with no diabetes or other FDA-approved indication), Medicare won’t pay for it.

Answer: Yes — moving to a new state can affect your Medicare coverage, and it’s important to take a few steps to ensure you stay properly covered.

1. Medicare Parts A & B

If you have Original Medicare (Parts A and B), your coverage is nationwide — so you don’t need to make changes for hospital or medical coverage. However, you should:

Update your address with Social Security (since that’s where Medicare pulls your info).

Check that your new doctors and hospitals accept Medicare.

2. Medicare Advantage (Part C)

If you have a Medicare Advantage Plan, you’ll likely need to switch plans. These plans have service areas, and moving out of your plan’s area gives you a Special Enrollment Period (SEP) to:

Switch to another Medicare Advantage plan available in your new area, or

Go back to Original Medicare and add a Part D (prescription drug) plan.

3. Medicare Prescription Drug Plan (Part D)

If you have a stand-alone Part D plan, you may also need to change it, since Part D plans vary by state and region. You’ll get a Special Enrollment Period to pick a new plan in your new location.

4. Medigap (Supplemental Insurance)

If you have a Medigap policy, you can generally keep it when you move. However, premiums may change by zip code, and some states allow new guaranteed-issue options when you move. It’s smart to compare local rates.

Answer: Losing state-assisted health care coverage can be tough. We provide a complete analysis of your medications, doctors, and hospitals, even calling and confirming that providers accept your new insurance. We ensure your premium fits your budget while explaining all costs clearly. With us, you'll gain confidence and peace of mind during your transition.

Answer: To be eligible for Original Medicare (Parts A & B) at age 65 (or via disability), you generally must be a U.S. citizen or a lawful permanent resident (green card holder) who has been residing in the U.S. continuously for at least 5 years

Answer: Normally, PPO (Preferred Provider Organization) Medicare Advantage plans do not require referrals to see specialists — that’s one of their biggest selling points.

However, some carriers label their plans “PPO” but still have special rules or exceptions for certain services or specialties.

For Example:

-Requiring referrals for high-cost specialists (like dermatology or podiatry)

-Needing prior authorization before certain tests or treatments

-Having in-network vs. out-of-network cost differences that feel like referral requirements

Answer: Why “Cheapest” Isn’t Always “Best”

The lowest-cost Medicare plan might save you on premiums, but it can cost you far more later if:

Your doctors aren’t in-network,

Your prescriptions aren’t covered, or

You face high copays, deductibles, or hospital costs when you actually need care.

The right plan isn’t just about price — it’s about coverage that matches your health, medications, and preferred providers.

Answer: Providing education of what Medicare provides and just bringing an ease with the overwhelming of Medicare, and building relationships.

Answer: If your income drops after you retire, you can ask Social Security to lower your Part B premium by filing a “Request for Reconsideration” (Form SSA-44). In regard to life changing events like retirement, loss of income divorce, or death of a spouse.

Answer: It is perfectly fine to get a 2nd insight over plans and details that best fit your needs. Very wise actually.

Answer: Medicare Advantage (MA) plans are private insurance alternatives to Original Medicare.

They bundle Parts A (hospital), B (medical), and usually D (prescription drugs) — and often throw in extra perks like dental, vision, hearing, OTC allowances, or gym memberships. Whereas Original Medicare lets you see any provider nationwide who accepts Medicare — no networks

Answer: Pick a licensed, independent agent who represents multiple carriers — not just one. That way, they can compare plans side by side for your doctors, prescriptions, and budget.

Make sure they’re Medicare-certified, local or well-versed in your state’s options, and take time to educate you — not pressure you.

Answer: Yes, it’s perfectly okay to work with a Medicare agent from another state — as long as that agent is licensed in your state.

Answer: The truth is, well neither is “better” for everyone — it depends on the person’s health, doctors, budget, and lifestyle and needs.

Answer: usually, no — not without answering health questions. During the Annual Enrollment Period, You can leave your Medicare Advantage (MA) plan and go back to Original Medicare (Parts A & B). But if you then want to buy a Medigap (Supplement) plan, most states require medical underwriting — meaning you’ll likely have to answer health questions and can be denied or charged more based on your health.

Answer: Yes, when you retire you lose employee coverage, you'll need to activate part B and you will have an 8-month SEP (Special Enrollment Period) to enroll without any penalty. Also, you’ll need your employer to complete Form CMS-L564 (proof of coverage) when you apply for Part B. Then make sure your new plan starts the day after your work coverage ends to avoid gaps.

Answer: Yes, this is common, not every local Dentist contracts with your plan. That's why its great to have an agent look up a provider and contact to see if they take that plan or if they are taking new clients as well, not to mention check to see if they are in network.

Answer: Not quite, it does cover hospital stays , yet not entirely on its own. It only pays for inpatient hospital care, skilled nursing, hospice, and limited home health

Answer: That its free and covers everything when its not always the case and that it doesn't cover everything. That’s why working with a licensed agent is so important — we help clients understand their real costs and find plans that fit their health and budget instead of assuming “free” means “full coverage.”

Answer: To ensure you get personalized help in comparing plans and ensuring that those plans match your needs and medications, not to mention the Doctors and Hospitals.