Gregory Firmbach, Medicare Insurance Agent

Answer: Great Question Gloria…

If you are working with a Captive Agent or an Employee of an insurance company discussing Medicare, you will only get one perspective of the options available to you. By law, licensed insurance agents are forbidden to discuss the benefits offered by companies they are not appointed and certified with.

Independent Brokers… So let’s consider Manatee county FL where there are over 82+ plans available from 14+ companies… the choice of an Independent Broker who is appointed, certified and managing book(s) of business with numerous companies would be a wiser choice. And Medicare in their wisdom has done something so beneficial for the clients. Medicare has mandated that the commissions paid to the brokers are virtually the same between Medicare Advantage Plans… so a Broker Does Not Have a Horse in The Race. Meaning… My interest is in making the client happy with Peace of mind being enrolled in the best HealthPlan for the current year. An Independent Broker will do just that because he or she can!

Answer: This is a question that is asked frequently…

Creditable coverage as it relates to Medicare means… Health Care coverage that is considered as good as or better than Medicare. When someone has what is considered creditable coverage when aging into Medicare they can delay enrollment in Medicare without owing a late enrollment penalty.

Creditable Coverage is generally considered Large Group coverage (more than 20 EE’s) with >20 employees and is essentially the only type of coverage where there would be no penalty.

Examples of Non-Creditable Coverage for Medicare would be: COBRA, Retiree Insurance, VA Benefits, ChampVA, Tricare, Federal Employee Health Benefits FEHB).

Feel free to contact the author for more detail. GAF

Answer: Great question…

The Qualified answer is yes… Why Qualified? Because applying for a Medicare Supplement or MediGap Plan is normally subjected to medical questions and underwriting. So if you are within a guaranteed issue period or have no disqualifying conditions and or automatic deniable medications, you could change plans between companies or within the same company anytime.

But if you are outside the guaranteed issue time frames and are like some of my clients with heart or other problems and are taking medications like Eliquis (a blood thinner) you will be immediately denied the change. But don’t worry…as long as you pay the premium on the current policy, you can never be cancelled no matter how sick you become.

Answer: Good question… in my practice I have had numerous clients in this situation. Most were very healthy and faired very well… for a time! The Risks are numerous…

1. Going Medicare Bare exposes you to pay for all of the 20% (plus excess charges) that medicare doesn’t pay for part B medical expenses. You are also liable for the Part A deductible occasionally for hospital admissions. The deductible is about $1,700 dollars and has been increasing year over year. Medicare Part A provides you with the first 60 days of hospital coverage Lifetime (after the deductible). In 2025, the 61st to 90th day copay is $419 per day. The 91st and beyond copay is $838 and applies to the 60 reserve days. This can get very expensive with no upper limit or Maximum Out of Pocket (MOOP).

Other options exist:

2. A MediGap Plan. MediGap Plans pay some or all of the medical expenses Medicare doesn’t cover. You can apply for a Medicare Supplement at any time. The cost of Medigap plans range from $200 to $300 per month depending upon your age. If you have missed your open enrollment period the company requires medical underwriting in order to approve our application. And you could be denied. At some age you could develop or acquire a disability and or disease which could prevent you from being able to pass the underwriting to acquire a Medicare Supplement or MediGap Plan.

3. Medicare Advantage (Part C): You have the option to enroll in a Medicare Advantage plan during any open or special election period which is designated by CMS (Medicare). Part C plans do not require answering health questions and accept all eligible members. You are eligible if you live in the plans service area and have both Medicare Parts A & B. These plans pay medical expenses after a copay or co-insurance and will have a MOOP

Answer: Great Question…

Answer: Consult an “Independent Broker”, “In Your Local Area” who represents both MediGap insurance companies and “Multiple” Medicare Advantage (MAPD) Providers (there are 17 different companies offering 82+ MA/MAPD plans in Manatee Cty, FL.

At those discussions, perform a full analysis and comparison where you delve into your health conditions (especially chronic like diabetes, heart, lung, etc), medications, doctors and needs for services, and the ramifications and cost/savings difference between Original Medicare and an MAPD plan. Also, consider your travel and out of area requirements into any equation you are considering and whether the plan you’ve chosen will work in that environment.

Note: a Local Professional lives and supports you and your neighbors in Your community. The web can provide lots of information… that ubiquitous person you call from the TV Ad who asks for your Zip Code… you will probably never speak with again. If you call the MAPD HealthPlan by law they can only discuss their plan not a comparison to the myriad of plans available in your county including Special Needs Plans for Chronic Conditions.

Your Local Professional will be available year after year to support you and your family with discussion of your needs.

Answer: I believe they write books on this subject but here is my concise response in the space allotted.

Parts A&B are referred to as… Fee For Service Medicare, Original Medicare. They were created in 1965. You may receive care from any doctor and any hospital who will accept being paid by Medicare at the Medicare Approved Amounts.

Part A. Hospital Coverage: Generally earned by paying FICA (employment taxes) for 40 qualifying quarters (like Social Security). What is important to understand is that Part A is “in-patient hospital coverage”, End of life care and some home health and skilled nursing coverage… That’s it!

Note: We have paid for Part A… IT IS NOT AN ENTITLEMENT.

Part B Medical Coverage: Generally all those other “medical” treatment options not covered in Part A above… Doctors, tests, x-rays, therapy, Dr injected part B medications, etc. Medicare pays 80% of the Medicare Approved Amount (over 13,000 procedures) and the beneficiary is responsible for the 20% Medicare doesn’t pay, including any Excess Charge billed (contact the author for further explanation). Medicare Supplement Plans (aka MediGap Plans) are 10 Medicare designed indemnity plan supplements that pay all or some of what Original Medicare doesn’t pay. Your HealthPlan is Medicare, The Supplement only pays after Medicare pays. MediGap Plans are offered by private companies and the rates are filed in each state.

Part C. Medicare Health Plans also known as Medicare Advantage (MA, MAPD, Cost & PFSS Plans). In 1996 congress created Part C. In essence, they operate similar to Employer Plans we are familiar with. Most are either HMO or PPO by design… i.e. Managed Care. Private companies are Certified and paid by Medicare to take care of beneficiaries who enroll in their plans.

Part D Prescription Drug: in 2005 Congress created Part D The Medicare Prescription Drug Plans. Private companies offer Rx coverage under Medicare guidelines.

Answer: WOW! What a Great Question… The Answer unequivocally, “PEACE OF MIND”

Ultimately, I am an educator. Once a US Navy Instructor Pilot, I educate my clients regarding their options and will generally utilize what I call “The Ben Franklin” (after one of our country’s founders) by taking a pad… Drawing a line or 2 or 3, from top to bottom and list the positives and negatives of each course of action. Examples would be stay on the employer plan, go with Original Medicare, choose a Medicare Advantage Plan (MAPD) but which one?

As Independent Brokers specially trained to consult on Part C, Advantage Plans, and certified with numerous major companies to offer these plans we are able to properly create the comparison for our client to evaluate, for each spouse, because all Medicare is Individual.

As we together filter through medical issues, medications required, doctor preferences, cost of the policies and or copayments expected (for each spouse)… need for supplemental benefits like dental, eye, hearing, etc… clarity begins to emerge which is the dawn of “PEACE OF MIND” for this years plans. Throughout the year we stay available to continue to ensure that “PEACE OF MIND” and next Annual Election Period we do it all again… We enjoy hearing the “Thank You, We don’t know how we would have understood all of this without you!”

Answer: Than you for a questions many ask… Original Medicare (Parts A&B) is only a medical benefit. The Hearing, Dental and Vision needs are considered supplemental and not covered for reimbursement except under certain medical situations.

One option is stand alone plans offered by many companies (Aetna, Humana, Cigna, UHC, Careington, etc.) which will insure for these benefits or offer steep discounts for utilizing the network of practitioners contracted for discount pricing.

Another alternative is to consider a Medicare Part C plan (Medicare Advantage, MAPD & MA). These plans are numerous in any given county (there are 82 in Manatee Cty, FL for instance) and which offer a variety of supplemental benefits for there subscribers. The plans vary from just preventative exams to plans with generous payments for the appliances needed to help correct issues found such as, eye glasses, hearing aids, root canals, crowns, etc.

At AEGIS we would be pleased to answer additional questions on all available supplemental offerings in your state and MAPD plan offering(s) meeting your desires.

Answer: Thank you for this question… I’ve called 1-800-MEDICARE myself numerous times with clients to get confirmation of my answer and understand your frustration. The phone lines at Medicare are answered by numerous trained individuals. Like any customer service line, sometimes the person you get may be new or not as engaged on the subject you are inquiring about. It is our company policy to stay engaged with our client(s) and drill down into the Medicare.gov website and other publications on the subject such as the Medicare Managed Care Manual (2600 pages) which governs much of (Part C) Medicare Advantage operating rules.

We would be pleased, at AEGIS, to help you with any questions you have regarding Medicare parts A, B, C or D or many of the supplemental plans such as Hospital Indemnity, Dental, Eye, Hearing or delve into our specialty which covers it all… Retirement Transition Planning from Turning-65 and beyond.

Answer: If during your working life you paid FICA Tax and qualify for Social Security then you’ve earned access to Medicare.

Part A is hospital coverage and you should enroll when eligible. There is no cost. No penalty for not enrolling (but why wait).

Part B is Medical coverage and has a minimum premium ($185/month in 2025). If you do not have other coverage as good as medicare such as an Employer Health Plan, you will accumulate a 10% per year penalty if in the future you decide to enroll in Part B. If you still have employer coverage when turning 65, you will get a special election period when you leave the employer health plan to enroll in Part B and no penalty.

Part D is Prescription Drug coverage and like Part B if you are not enrolled and do not have other Rx coverage as good as Medicare’s at any time, you will accumulate a penalty equal to 1% per month of the medicare standard Rx premium when you decide to enroll in a Part D plan.

Consult with an Independent Licensed Broker for clear guidance when turning 65.

Answer: Original Medicare (parts A&B) allow freedom in your choice of doctor and hospitals. The structured MediGap Plans will pay some or all of the costs that Medicare doesn’t pay for a monthly premium. If money is no object them these are great coverage.

Medicare Advantage (MA & MAPD) plans are look-alike to an employer HealthPlan much like most of the folks have utilized in our working lives. As such they are mostly HMO (health maintenance organization) or PPO (Preferred Provider Organization) by design.

The HMO is the most restrictive whereby, beneficiaries need to utilize only Network Doctors and stay within the plans service area, except in an emergency where care can be received anywhere. HMO’s are Managed Care by design so the plan sponsor has more say in the care the person gets or does not get. Primary Care Providers (PCP) are charged with coordinating the care plan for the member and often acts like the gatekeeper to further care.

The PPO is less restrictive and while still Managed Care, allows the member to go out of network for care and usually pay a larger copayment. The plan still has a hand in allowing or denying certain tests and care.

In today’s market, the monthly premium is often $0.00 and the copay for PCP is also often $0.00. The Cost of Hospitalization is often the largest cost(s) facing the member, and all plans have a Maximum Out of Pocket amount that came be borne on an annual basis.

A Licensed and Certified Medicare Broker can do an analysis comparing costs and care differences of Original vs. MAPD Plans

Answer: Thank you for your question… This question is asked by many folks….

1. All Medicare health insurance plans (Part C aka Medicare Advantage)and Medicare Supplement Plans (that work only with Original medicare Parts A&B) have rates either filed with the state or approved by CMS (Medicare). So by utilizing a professional, licensed insurance broker you gain the knowledge he or she possesses about medicare and the cost will be no more than if you called some ubiquitous person on an 800 number or enrolled yourself on-line. You benefit by having a professional relationship, now and in the future.

2. Any Licensed Health Insurance Agent is able to sell you a MediGap or Medicare Supplement plan for original medicare beneficiaries.

3. Only Appointed and Certified Licensed Agents/Brokers may discuss and offer to you one of the many Medicare Part C Plans or Advantage Plans. As example, there are “82” different plans (HMO, PPO, PFFS) just in Manatee County , FL. They are offered by 13 different companies with names like Humana, United Healthcare AARP, Cigna, Aetna, Freedom, etc.. How is the average person supposed to now where to start figuring out which plan is best for them or spouse? By utilizing an independent Broker who is “Certified” with multiple company’s plans, you will get a professional analysis and exposure to many plans you may not have known existed and how to qualify for them. Names like D-SNP, C-SNP, I-SNP are available in most counties.

A D-SNP is for folks that have both Medicare and Medicaid and coordinates the benefits.

A C-SNP is for people with specific diseases like heart, lung and diabetes, etc.

The I-SNP for institutionalized beneficiaries

4. The choice should be an “Independent Insurance Broker” who will represent you to the insurance company. A “captive” or “Employed” Agent may only offer you “The Company Plans”. The independent Broker is special trained to find your needs and prescribe the best plan “This year and next.

Answer: Hello and thank you for our question… Medicare Low Income Subsidy or LIS is also known as Extra Help. This program is meant for individuals or couple who have incomes below a given threshold (which amount is modified each year). In 2025 for individuals that amount is: $23,725 and for a Married couple the amount is $31,725.