Erlynne (Elle) Massie, Medicare Insurance Broker

Answer: You're 100% right on that - Medicare changed the drug coverage limit to $2000 in 2025, and in 2026 it's $2100.

Whether you're in a standalone Part D plan or a Medicare Advantage plan, your total drug costs for covered prescriptions are capped at the annual limit. No more "donut hole" or "coverage gap." You just need to make sure your prescriptions are covered by the plan you select.

I'd be happy to help you quote your particular Part D costs & discuss it further - it's a bit of a journey to navigate the Summaries of Benefits to understand how they translate at the pharmacy counter, isn't it?

Please feel free to reach out to me at the contact information in my listing here. I'm licensed in all 50 states + Washington DC, and I have helped tens of thousands of Medicare beneficiaries in my career, since before becoming independent I was a top performing captive agent at one of the largest Medicare insurance companies in the country.

Answer: Honestly? Ask a qualified, licensed Medicare broker who is CMS (AHIP) certified to discuss and evaluate BOTH types of options for you.

We who have made it our life's work to help Medicare beneficiaries make clear, strong, informed decisions are qualified to be able to advise on your options more than any unlicensed individuals.

We must follow strict compliance rules in regard to providing unbiased, CMS-approved guidance. We cannot steer you one direction or another - that's a compliance violation. I actively write BOTH Medicare Advantage plans as well as Medicare Supplemental + Prescription Drug Plan coverage for my clients.

As someone who has guided tens of thousands of clients toward their own "right fit" in my career, after working for one of the largest Medicare insurance companies in the country before becoming independent, I can tell you that your decisions are ALWAYS based on your needs, priorities, budget, goals and values. You. Individually. Every time.

Having a relationship with a trusted, unbiased, licensed and certified Medicare Benefits Advisor is a lifelong path, and will never cost you a single penny. We are literally not allowed to charge for our professional services.

Sounds like a "second opinion" might be in order for you! Please feel free to reach out to me at the information in my signature, to discuss your situation in more depth.

Best,

Elle

Answer: According to the rules of Medicare, individuals who have been on Social Security Disability for 24 months, are "automatically enrolled" into Medicare upon the beginning of month 25.

I've found that this rule is not always strictly true, however. I used to work for one of the largest Medicare insurance companies in the country, and as a top performer there, I received thousands of calls from all over the US and discussed Medicare coverage with them.

My experience has shown that actual disability eligibility does not always create the "always true" scenario for individuals receiving disability to become eligible for Medicare in month 25. It can be for various reasons, including their state's rules, their social security eligibility, or even their disability level. Because it seems to be "a moving target," it is not something I ever provide as an "all or nothing" definitive answer. There are times I feel like I have "seen it all" and then still, I'm surprised when I hear my clients' stories.

This is a conversation that should be had with the Social Security Administration directly, in regard to your unique, specific situation. It is absolutely worth having that conversation, even if it's a phone call, because then you can be aware of their requirements, rules, your responsibilities in regard to proper documentation and next steps, and your specific timeline.

If you'd like to discuss the situation in further detail, please feel free to reach out to me to schedule a more in-depth conversation and receive additional guidance & resources that may assist you. My consultative services are always provided free of charge.

Answer: There are a few ways to accomplish dual-household coverage options with Medicare.

1. You can elect to choose Original Medicare, which means that you can see any doctor in the country that accepts Medicare for your covered services. You'll want to pair that with a Part D (Prescription Drug Plan) standalone plan, and of course a Medicare Supplement policy so that you aren't fully responsible for the deductibles, costs & coinsurance amounts not covered by Medicare. (Medicare's unlimited 20% Part B coinsurance is quite unsustainable for most people.)

2. You can choose a Medicare Advantage policy that has a PPO network nationwide.

3. You can choose a Medicare Advantage policy that is an HMO-POS, with a nationwide network. This means you'd absolutely want to make sure you're selecting an insurer who has a presence in every state, and that the plan is *national* versus *regional*

Please feel free to reach out to me via the contact information in my profile if you'd like to discuss your situation in more detail. I am licensed in all 50 states plus DC, and I write every major Medicare carrier as well as many regional carriers nationwide.

Answer: Once the true out-of-pocket cost of all of your covered medications reach the Part D out-of-pocket max during the calendar year (for example, $2,100 in 2026), that is when you move from the Initial Coverage Phase into the Catastrophic Phase.

When the catastrophic phase is reached, covered medication costs are $0 for the remainder of the calendar year.

Part D plans now have a feature introduced 1/1/25, called the Prescription Payment Plan (PPP). This allows you to set up a monthly payment plan directly with your Part D insurance company, where you pay a set monthly payment instead of experiencing the deductible all at once in January/February. This allows for simple, budgeted, plannable medication costs. If you're interested in creating your PPP arrangement, you'll contact your Part D insurance company directly to begin that conversation & set it up.

Answer: Great question!

Short answer - no. You are already on Medicare, so you will simply continue.

However... VERY important note. If you're within your 65th birthday window of 3 months before, the month of, and 3 months after your birthday, you have 2 opportunities:

1. Change Medicare Advantage plans in a Special Enrollment Period granted during your Initial Enrollment Period SEP.

2. A Guaranteed Issue opportunity to enroll into a Medicare Supplement (Medigap) policy *without health underwriting* and usually at a much lower premium than before turning 65.

That is a huge deal for many people, and it's generally only available once in their lifetime, during that 7 month turning-65 eligibility window.

I have experienced some deeply moving experiences as a Medicare agent throughout my career, when my clients on disability became newly eligible for a Medicare Supplement plan, and were able to enroll into it without health questions, and much, much lower premiums than before their 65th birthday.

Four of them had cancer.

Three of them had heart disease.

Two of them were on the transplant list for kidney or liver.

One of them had dementia.

Seven of them had a degenerative condition such as rheumatoid arthritis, multiple sclerosis or lupus.

The number continues to grow. It moves my heart to be able to do this for my clients.

Please reach out to me at the contact information in my listing, if you'd like to evaluate your Medicare Supplement or Medicare Advantage options.

Answer: Outpatient medical treatment is covered under Medicare Part B.

If you have only Medicare parts A&B, you will pay the monthly Medicare Part B premium. There is an annual deductible for Part B, and after that deductible is met, coinsurance of 20% of the cost will be patient responsibility.

If you have a Medicare Supplement (Medgap) plan, depending on the plan letter, you may have your coinsurance covered by the insurance plan, after Medicare pays.

If you have a Medicare Advantage plan, your outpatient medical coverage, including mental health coverage (individual or group therapy) is covered at the copays and coinsurance specified in the plan's Evidence of Coverage and Summary of Benefits.

It's always a good idea to review all of your Medicare coverage annually to make sure the coverage fits for the following year. Planning ahead can provide peace of mind, clarity, and alignment of goals to needs.

Please feel free to reach out to me at the information in my profile if you would like to discuss your coverage in more depth.

Answer: There is!

Plans that contain a Part B Premium Reduction are more and more popular every year, and in my experience, most people haven't even heard of them until they talk to someone like me.

Depending on your service area and plan availability, there are Medicare Advantage plans that provide a reduction in what their members pay toward their Part B premium each month. Most of these plans do not carry an extra premium, and they can and do reduce the Part B responsibility every single month for as long as the member stays in the plan, remains eligible, and continues to be enrolled into Medicare A & B.

It's not a one-time "gift." It doesn't hit your tax return. It's just... steady and awesome premium reduction every month for as long as the plan is enrolled, you stay eligible (meaning you're enrolled in Medicare Parts A&B and the state you live in isn't paying your Part B premium for you, such as Medicaid), and the benefit is included.

Please feel free to reach out to me directly at the contact information in my profile, if you'd like to review your own service area options, and to explore the possibilities in more depth with someone whose favorite thing is to give Medicare beneficiaries information on how to get more for what they already pay for.

Answer: Alphabet soup is my very favorite flavor!

In all seriousness, you're completely right, it is complicated and confusing and the many acronyms, abbreviations, terms & coverage details are like learning an entirely new language.

I used to be one of the top performers at one of the "Big 3" Medicare insurance companies before I left them to become an independent broker (so I could spend more time with my clients, help them understand their options and choices, and represent more than 1 insurance plan).

If you'd like to spend some time with me so I can help simplify and clarify the complexity, please feel free to reach out to me via the contact information in my profile. I would love to help.

Answer: That ambulance bill sounds like a copay on a Medicare Advantage plan. Before enrolling, a licensed agent or broker is required by CMS to fully present your plan to you, covering every cost & copay on it, and making sure you understand and can plan for each of them, and even teach you how to appeal the claims that fall outside of the range stated in writing on your plan.

If your broker fully explained the costs and copays associated with your plan, they legally were required to inform you of each one and check in with you to make sure you were fully informed and aligned with the choice of your plan, and that the copays were acceptable.

As a former captive agent at one of the largest Medicare insurance companies in the country, I fielded thousands of calls from clients who had questions just like yours.

The commercials, fast-paced-sales-tactics and depth of compliance avoidance is a problem in the Medicare Advantage industry, and something I saw thousands of times.

I would would be happy to provide my support for a thorough, in-depth conversation about your choice of 2026 coverage. If you can, a video conference so you can see the details in writing before your choice, as well as a visit to Medicare.gov to review all of your options, is highly suggested.

Answer: My take on hospital indemnity policies paired with Medicare Advantage plans is that it's ABSOLUTELY something I recommend and encourage to *all* of my Medicare Advantage clients, every time.

In fact, Medicare itself *allows* us to discuss the following coverage with our clients in the Medicare Scope of Appointment form that must be signed by the beneficiary every year as a compliance requirement.

Medicare Advantage, Medicare Supplement, Prescription Drug Plans, Dental, Vision, Hearing & Hospital Indemnity Plans.

The copays and coinsurance costs on a Medicare Advantage plan are generally really low for doctor visits, lab work, x-rays and urgent care, but the costs for ambulance, outpatient surgery, inpatient hospitalization and skilled nursing facility coverage add up really quickly in the event of medical events.

I make it a practice to keep track of the copays on the plans my clients select for their Medicare Advantage plans, and pair a thorough, robust, budget-friendly hospital indemnity plan for them. It's rare that my clients ever regret adding that coverage. I've heard from numerous clients who did *not* add it, that they regret the copays they've been charged after a sudden medical event.

Answer: Medicare is a program that covers seniors over 65 as well as those who are disabled at any age.

The rules of Medicare state that after an individual has been on Social Security Disability for 24 months, they are automatically enrolled into Medicare in month 25.

This is a CMS rule, but in speaking to thousands of clients in my career, I have encountered many scenarios where there isn't "automatic" enrollment due to multiple factors that usually require a specific conversation with the Social Security Administration at minimum, and often their state's Medicaid office as well.

Answer: Blood thinners are generally covered under Medicare Part D, prescription drug plan benefits.

Medicare itself does not provide prescription drug plan coverage. It's a required coverage, and clients need to enroll with an insurance company with a Part D - Prescription Drug Plan contract approved by CMS.

Prescription Drug Standalone plans are available nationwide from major carriers like Cigna, Humana, United Healthcare, Wellcare & more.

If one chooses to bundle their coverage, creditable prescription drug coverage is contained in most Medicare Advantage Prescription Drug Plans (MAPD), and the availability of those plans depends on the coverage area.

If you'd like to discuss your coverage further in regard to blood thinners, please feel free to reach out to me via the contact information in my profile. I have helped many, many clients navigate their prescription coverage.

Answer: Your Medicare coverage is written based on the place you live, so there are a few things you'll want to know as you prepare.

1. You have 60 days from the move date to make changes.

2. If you have a Medicare Supplement, you need to make sure you contact the insurance company to find out if they have your plan in your new area. If they do, you'll want to have them transfer your policy to the new address. If they don't offer the plan, you'll have a guaranteed issue opportunity to change insurance companies for the same plan type (example: Plan F to Plan F, Plan G to Plan G, Plan N to Plan N, equal or lesser coverage level).

3. If you have a Part D (PDP) or MAPD, you'll need to select a new one for the new area. Medicare Advantage and Prescription Drug Plans are written by service area, so even if you move from one county to another, you need to change.

4. Don't forget to update your address to Medicare and Social Security.

Please reach out to me directly if I may be of assistance to you in planning and preparing for this move. It's a good idea to have a broker on your side, to make sure you're aligning with all the Medicare special enrollment periods and guidelines.

Answer: Original Medicare does not cover dental cleanings, so yes. Medicare Advantage plans generally cover preventative and comprehensive dental services such as cleanings and exams, as well as certain x-rays. They also cover annual routine vision exams and annual hearing exams, with usually a small co-pay, if at all.

As Medicare Advantage plans have evolved, however, the "big stuff" has been less and less covered throughout the years. In every instance, it's important to review exactly which services are "covered" in any plan, and supplemental dental insurance coverage may be needed in order to have coverage for larger services like crowns, complex fillings, extractions, root canals, bridges & dentures.

Answer: Neither a Medicare Advantage plan nor a Medigap policy is inherently "better"; the right choice depends on your individual needs and preferences. Medicare Advantage plans are private, bundled alternatives to Original Medicare that often include drug coverage, vision, dental, and hearing benefits, but restrict your choice of providers to a plan network. Medigap policies, on the other hand, are supplemental to Original Medicare and cover out-of-pocket costs like deductibles and copayments, providing freedom to see any provider who accepts Medicare but without the bundled extra benefits of Advantage plans.

Choose Medicare Advantage if:

You want bundled benefits: These plans can combine your Part A, Part B, and Part D (prescription drug) coverage, plus extras like vision, dental, and hearing care, all into one plan.

You prefer lower monthly premiums: Advantage plans often have low or even $0 monthly premiums, though you'll still pay copays or coinsurance for services.

You don't mind a limited provider network: You must use providers within the plan's network for your care, so it's important to ensure your doctors are in the network.

Choose a Medigap Policy if:

You value freedom of choice: Medigap plans allow you to see any doctor or hospital that accepts Original Medicare, regardless of location or network restrictions.

You want predictable costs: Medigap policies help cover the remaining out-of-pocket costs that Original Medicare doesn't pay, such as deductibles, copayments, and coinsurance.

You prefer to keep Original Medicare: Medigap is a supplement to Original Medicare, whereas Medicare Advantage plans are a replacement for it. You can also buy a separate Part D plan for prescription drugs.

Answer: Great question, and one that is important especially right now, as 10,000 Americans turn 65 every day in this country.

Medicare is feeling pressure as more Baby Boomers age in, creating higher demand for care.

With fewer workers supporting more retirees, funding is stretched, and the Hospital Insurance Trust Fund is projected to run out by 2033.

Costs are also rising because people are living longer and managing more chronic conditions like diabetes and heart disease.

To stay strong, Medicare will likely need policy updates, smarter care models, and innovations like telehealth to keep care affordable and sustainable.

Answer: Medicare Part A is definitely not enough for hospital coverage.

Why?

Part A covers things like the hospital room and board, nursing services, drugs and lab tests. They are not free, they are subject to the Part A deductible for each benefit period before Part A starts covering costs. It also covers inpatient care in a skilled nursing facility, but you must have prior qualifying hospital stay (at least 3 days as an inpatient (not in observation).

Part B is crucial to have when it comes to the hospital because..

Part B covers the part of the hospital that includes:

Emergency Room

Ambulance

Observation status

Services from physicians and other medical professionals

Other medically necessary services not covered by Part A

Ancillary services provided by the hospital for your inpatient care, if the hospital bills them under Part B.

That is why, in a high-level overview of Medicare, it is critically important to have both A *and* B, because you can't have an inpatient hospital stay without seeing the doctors, and if it's a medical emergency you've likely experienced Part B costs such as an ambulance ride, an emergency room visit (Part B but waived if you've been *admitted* to the hospital as an *inpatient* within 24 hours of your ER visit), and an Observation status (Part B). And lots of consulting visits from hospital physicians, nurses, radiologists, phlebotomists, and whatever other professional services are needed for medical treatment in a hospital.

Answer: Medicare prescription drug plans do not cover Ozempic and other drugs prescribed solely for weight loss.

The guidelines have adjusted each year based on CMS rules and regulations, as well as the decisions made by insurance companies themselves.

This year (2025), those guidelines state that unless a GLP-1 drug such as Ozempic or similar is prescribed to treat medically diagnosed diabetes, it will not be covered by the plan.

Answer: This is a great question, and one that is commonly asked!

Up until 1/1/2025, the out-of-pocket maximum for drug costs was $8,000. That is a *lot* of money to potentially be responsible for paying, should a Medicare beneficiary have to experience the full amount of it in a calendar year.

After the Inflation Reduction Act went in to effect 1/1/25, CMS adjusted that cap to $2000, and that represents a $6,000 potential cost-share savings yearly. Huge, huge relief to many, many Medicare beneficiaries!

With the reduction in cap, the additional amazing news - CMS removed the "coverage gap" or "donut hole" phase in Part D coverage. If you've ever experienced a brand name medication costing quite a bit more during the second half of the year, you know that coverage gap pain firsthand. No more of that, thanks to the Part D changes.

A payment plan is available through Part D insurance companies, where a Part D member can spread their annual costs out over the course of the calendar year, which can really help budget prescription drug plan costs rather than having to pay a significant deductible the first month of the year. You can contact your insurance company to arrange that payment plan.

The cascading effect along all of this has been seen throughout *all* Medicare coverage. Drug companies are reducing the number of listed drugs on their formularies, changing the ones they cover, prescription drug plan premiums are increasing, and multiple insurance companies have chosen not to continue Part D coverage in 2026.

It's *more important than ever* to review your Part D plan annually during Medicare Annual Enrollment Period (AEP) October 15 - December 7, to make sure you know the following:

1. Are your prescription drugs going to be covered on the plan you are in right now?

2. What will they cost?

3. What will your Part D premiums be?

4. Will you Part D plan still exist next year?

Answer: Selecting the right healthcare company and representative can feel overwhelming, especially with all the noise around Medicare plans. Here’s what to look for:

Independence matters. A captive agent works for just one company, while an independent broker can compare plans across multiple carriers. Independent brokers can show you a bigger picture, making it easier to find a plan that truly fits your needs and budget.

Ask about support. The best representatives don’t disappear once you enroll. They should provide year-round service—helping with billing issues, coverage questions, prescription changes, and annual reviews.

Look for clarity. Medicare is complicated. A good broker explains things in plain, clear terms and makes sure you understand before you sign. If you leave a meeting feeling more confused, that’s a red flag.

Verify licensing and reputation. Always check that your representative is licensed in your state and has positive reviews or references. Trust is essential—you’re not just buying a plan, you’re building a long-term relationship.

Personal fit. Beyond credentials, notice whether they listen. Your healthcare is personal, and your broker should treat it that way. You deserve a representative who respects your values and preferences.

Answer: Yes!

Medicare covers items like insulin pumps, continuous glucose monitors, seizure monitors, cpap supplies, as well as many other items like them, as Medical Devices & Equipment.

They fall under the 80%/20% coinsurance rule under Medicare Part B. If you have a supplemental plan (Medicare Supplement, Medicare Advantage) your coinsurance percentage may be reduced thanks to that supplemental benefit.

I'd be happy to take a look at your particular medical device & supply needs and help you align with supplemental coverage that thoroughly protects your pocketbook. Please feel free to reach out to schedule with me at the information in my profile. :)

Answer: If you’re watching a commercial on television, you should know that they are advertising all of the benefits available in every level of Medicare Advantage plan, and certain benefits are subject to eligibility requirements. So, if you have health or income limitations, then you’ll have additional benefits available to you (VBID).

The “source of truth” is actually located directly on Medicare.gov, as well as the yearly Benefit Guide that is mailed to Medicare beneficiaries annually.

Medicare Advantage and Prescription Drug Plans are legally allowed to change once per year. Their plan numbers, summaries of benefits, evidence of coverage, formularies and provider directories are housed on each of the insurance companies websites and on Medicare.gov.

Navigating those details, though, is complex and complicated. Licensed and appointed and AHIP-certified Medicare agents and brokers are required by strict CMS compliance standards to thoroughly and comprehensively present every benefit to a Medicare beneficiary. In my experience, that doesn’t happen every time. It’s why I do what I do - to make sure my clients know exactly what they are choosing, and can make a decision across the multiple plans available to them.

Answer: This is a great question! There are a few misconceptions that I have encountered in my career both as a top performing captive agent at one of the largest Medicare carriers in the country, as well as now as an independent broker licensed in all 50 states + DC.

Here are a few common ones, for example:

1. Medicare is "free." - No it is not. Part A coverage is generally premium-free for people who have worked and paid taxes for at least 40 quarters (10 years) in their lifetime, or whose spouse has done so. Part B has a premium, and it is set by CMS yearly. In 2025, it is $185 per month. That premium is the beneficiary's responsibility unless their state's Medicaid organization is paying the premium on their behalf due to income-qualification.

2. Medicare covers "everything." No, it does not. Original Medicare (Medicare parts A&B only) does not cover prescription drugs, vaccinations, dental, vision, hearing or the cost of custodial care or long term care. That is why supplemental coverage exists - to cover the gaps left where traditional Medicare leaves off.

3. Medicare prescription drug coverage is optional for people who don't take medications - Incorrect. Creditable Part D (prescription drug) coverage is required by Medicare, either through an employer, Veterans Administration/Tricare, or a Part D plan through a Part D insurance company (PDP or MAPD) is required. If someone goes without creditable coverage while on Medicare, they are penalized for each month they go uncovered for the rest of their lives if they enroll into Part D coverage in their future. Penalties apply for delayed enrollment into all parts of Medicare without other creditable coverage, but the Part D coverage is the most commonly overlooked.

Medicare is complex and complicated, and it's important to navigate it with a thorough, compliant, certified advisor and advocate who can align with your unique, individual needs, so you can cut through the noise to make informed decisions.

Answer: In my opinion, I believe Medicare does focus on prevention, and my reasons are these:

1. Medicare's preventative annual physicals are extremely comprehensive, and are covered at $0 copay to the beneficiary. They cover over 35 health screenings for every part of the body, cancer screenings, mental health screenings, tobacco cessation, and many more.

2. Routine colonoscopies, mammograms & PSA screenings are also covered at $0 copay.

3. Vaccinations as recommended by the Advisory Committee on Immunization Practices (ACIP) are covered by Part D at $0 copay. These include the flu shot, pneumonia, COVID, tetanus and other routine immunizations. About 3 years ago, the instructions even encompassed the shingles vaccine at $0, which I believe to be extremely proactive in preventative health measures.

4. Primary Care Physicians and practices are subject to rigorous CMS standards that require alignment with strict protocols in preventative health.

Answer: If you miss your window to sign up for Medicare Parts A&B for your Initial Enrollment into Medicare, you'll need to wait until the General Enrollment Period, which is January 1 - March 31 of each year.

If it's that you got Medicare itself (A&B) but not a Prescription Drug Plan or Supplemental coverage (MAPD or Med Supp), you can sign up for the Med Supp any time but will need to pass health underwriting questions to do so, and you'll need to wait until Medicare's Annual Enrollment Period October 15 - December 7 to be able to select and enroll into a PDP or MAPD that will begin 1/1 of the following year.

Special Enrollment Periods and CMS timelines & penalties can be very confusing, and it's a very good idea to align with a broker who can help you navigate and strategize your steps through the process of compliance, enrollment & resolution.

Answer: Yes, hospice is covered under Medicare Part A. A couple of things to note:

Care must be received by a Medicare approved facility.

There must be a diagnosis of a terminal illness in which life expectancy is less than 6 months.

Palliative care and other holistic services are covered within that Part A scope.

Services and treatments other than those to treat the terminal illness will still be covered under the other Medicare part A & B services.

Planning for long term care and end of life expenses begins long before the need arises. Consult with a knowledgeable advisor to make certain you’re preparing for the logistics, the costs & protecting your assets and legacy.

Answer: Yes it does, as long as it's medically necessary and prescribed by a hospital physician after 3 days of inpatient hospitalization. Medicare quantity limits apply. This is actually not just a "Medicare Advantage" requirement, but a Medicare-itself requirement.

Medicare itself does not cover long term care, nor custodial care.

Answer: For international travel, certain Medicare Supplement and (as of 2023) all Medicare Advantage plans provide a lifetime benefit of $50,000 subject to 80/20% coinsurance for emergency treatment worldwide.

For domestic travel nationwide, the flexibility of a Medicare Supplement is superior to almost every Medicare Advantage plan's network. With a Medicare Supplement, your only requirement to see any provider is that they take Medicare itself. Medicare pays first, the med supp picks up the tab for the parts it covers (for example, in a Plan G thats the Part B deductible).

A Medicare Advantage PPO is another viable option, but PPO's are subject to networks just like every other PPO plan out there. If you go to a provider who is out of network for your plan, they do not have to agree to treat you. There are also out-of-network coinsurance and deductibles that are much higher than in-network costs.

Sit down with your calculator and consider the costs of each - how much is the premium on the Medicare Supplement? How much do you actually go to doctors while traveling? What is the Maximum Out of Pocket cap on the Medicare Advantage plan? Do you even have a PPO option available in your residential service area?

A good broker who writes *both types* of Medicare coverage and knows their facts and figures can help you truly align your goals with your plan choices. Make sure they know what you need and want, so they can tailor a fit for you.

Answer: Focus on investment and money strategies that will lower your modified gross income year over year with the following strategies in mind:

Make tax-deductible contributions to retirement accounts

Take qualified charitable deductions if you're age 70.5 or older

Convert traditional IRA funds to Roth IRA's to reduce future RMD's

Strategically manage large withdrawals by spreading them out over future years

Appeal the determination if you've experienced a significant life event such as a divorce or job loss.

Answer: Medicare itself is regulated at the national level (CMS), so Medicare’s premiums, timelines, compliance rules, costs, requirements, enrollment periods, premiums, deductibles, rules & regulations are standardized nationwide.

Medicare Supplements (Plan F, Plan G, Plan N & others) are also standardized nationwide, but a few states have rejected the standardized model and created their own unique model of Medicare Supplement that has its own set of coverages.

Medicare Prescription Drug Plans (Part D) and Medicare Advantage Plans, while being heavily regulated by CMS to follow strict guidelines, are service-area specific, and vary across the insurance companies who are contracted with Medicare.

The “service areas” are counties, and then differentiated again per state. Each insurance company must align with Medicare rules, but is allowed to provide additional benefits and services above the Medicare model.

Part D coverage is a Medicare requirement (with a penalty for going without it), but is provided by insurance companies, not Medicare itself.

Medicare plans change once per year January 1, and are available for agents and beneficiaries to see every October 1, with enrollments allowed into the following year’s plans October 15 - December 7.

In reviewing your Medicare coverage options and education, you can consult the Medicare & You Guidebook that is mailed to all Medicare beneficiaries, available on Medicare.gov. It’s also important to become aligned with an agent or broker who has been certified by CMS and contracted to represent plans *compliantly* with Medicare’s rules and regulations. Make sure they know their stuff!

Answer: Great question! Medicare agents certify with CMS (Centers for Medicare and Medicaid Services) every year during the summer, where we are thoroughly educated on the rules, changes, responsibilities and compliance we are required to comply with in order to be allowed to represent Medicare plans. It's called the AHIP certification. We are required to pass a 150 question examination to obtain AHIP, each year.

Then, we submit our AHIP scores to the insurance carriers we wish to become appointed with to write their Medicare plans. Each insurance company requires us to complete an in-depth training and certification exam to be contracted with them, each year. If we are brokers (like me) we generally contract with multiple carriers to be able to give our clients multiple plan options across Medicare Advantage, Medicare Supplement, Prescription Drug Plans and ancillary plans such as hospital indemnity, dental, vision, critical illness, accident, ambulance, short term and long term care.

We also comply with continuing education requirements for our resident state licenses and any non-resident licenses we hold.

If you're working with a Medicare broker or agent who is AHIP certified, they will be highly educated and informed.