Jamie Goble, Medicare Insurance Broker

Answer: An HMO- POS - id Health Maintenance Organization with Point -of Service option . It is a Hybrid Medicare Advantage Plan That combines elements of both HMO and PPO’s .

Traditional HMO plans you have to stay inside their network-except for Emergencies.

A Hmo- Pos plan provides more flexibility by allowing you to see out of network drs for certain covered services.

PPO- Gives you total freedom to see any dr with out a primary care dr referral.

Answer: Medicare Part A is for hospitals. You must have lived in the United States for at least 5 years.

If you have a work history of 10 years or more and are 65 years of age, or have been disabled for 2 or more years, then you do not pay a premium for Part A.

Answer: Well, this is 2026, and there is no donut hole. The max out on drugs for this year is $2021, then you pay nothing.

Answer: There are different enrollment periods throughout the year. So, seniors have many options and opportunities to change their plan if they are not happy with it.

Answer: That is a special enrollment separate from AEP and OEP. It is for plans that have a 5 star rating only. The member can only use that SEP once.

Answer: Well, there are a lot of questions when it comes to Medicare. How much is it? Are my doctors covered? Will my meds be covered? What is the max out of pocket for my plan?

What is the difference between Medicare Advantage plans and supplement?

Should I stay with Original Medicare?

Will I be covered if I go out of my state? The questions are different for everyone. Every situation is different. So the questions are different.

Answer: This is a common question. They can get on a Medicare Advantage. But unfortunately, Medicare Supplements go up every year.

Some hospitals also offer financial help, but if they don't qualify for Medicaid, I don't know if they would for that either. It is tough to say without sitting down and going over their drs, medications.

To find the right plan for them.

Answer: Sure, there is AEP - that is the Annual enrollment period, for all Medicare beneficiaries. That is Oct 15th - Dec 7th.

Then there is OEP - Jan 1st - March 31st. That is when you can move from one Medicare Advantage plan to another.

Medicare sups have different rules from state to state, but you do have guarantee issue when you are new to Medicare.

Answer: Hello, good question. You have GI after your coverage ends. You could also enroll now - and not go on to Cobra. Cobra tends to be more expensive.

Answer: Well, it depends on who is giving them. I would go to more than one. Also, speak to a licensed broker. So they can sit down with you and go through your options with you. Look at your medications and Drs.

Answer: Generally, Original Medicare does not cover routine supplements or over-the-counter vitamins, but exceptions exist for medically necessary, prescribed treatments, or via Medicare Advantage Plans.

Answer: On all Medicare Advantage plans - HMO or PPO - the wellness visits are zero dollars.

With Medicare Advantage, you are entitled to one free annual wellness visit every 12 months.

Answer: Yes, Medicare A covers inpatient hospital stays if you are formally admitted to the hospital by a Dr's order.

When you are inpatient, Part A generally covers:

Semi-private rooms and Hosp meals

General nursing care

Drugs, supplies, and medical equipment used during your stay

Lab tests and x-rays performed while you are admitted

Operating and recovery room services.

Part A does have a medical deductible of $1,736 in 2026.

Answer: The answer is not at this time. When you decide to get your Part B started, then you will have to prove that you had creditable coverage.

Answer: Well, Medicare Part D plans or Medicare Advantage plans do pay for antidepressants; they are considered a protected class drug.

As far as anti-anxiety drugs, they do pay for most, but it depends on the type of drug prescribed and wherever you receive it.

Answer: Special needs plans are for people who have both Medicare and Medicaid.

And to be able to get the food that comes with these plans, they must have a chronic condition.

Answer: I enjoy being able to get people extra benefits. Some seniors don't have anyone to fight or navigate this world. I enjoy helping them.

Answer: Good question. That it isn’t good insurance. That Medicare is going to end. That Medicare Advantage plans are no good.

That everyone is eligible for the same thing.

Example would be - just because your friend gets the food benefits with her plan - doesn’t mean you can get it too.

In order to get some of those benefits, you have to have Medicaid with your Medicare.

Answer: Seniors do not pay income tax on their basic Medicare benefits, but they may have to pay various other taxes related to Medicare or their income.

Answer: Good question. So what I do is sit down with my clients. I go through all their meds, Drs, hospitals. And explain the different ways that Medicare Advantage covers vs. a supplemental.

It all depends on what the client is more comfortable with - sup/med advantage.

Answer: I get this a lot. It actually is not. The only way they can contact you is if you fill out a lead card. Or you have contacted them in any way. Cold calling, they are not supposed to be doing. You can get a name and report them to Medicare.

Answer: Good question. For my clients who are snowbirds, I either put them in a PPO Medicare Advantage plan, so they can go in and out of network. Or I would go with a supplement plan.

Answer: Good question. The answer is simple. Shop around. With supplements, the times to change are different than from a Medicare Advantage plan. Depending on your birthdate, losing your current plan—those circumstances give you Guaranteed Issue. Otherwise, you would have to answer the health questions.

Answer: Good question. Dialysis does not change your eligibility for coverage. You would just need to make sure your Dr. and facility you go to are in-network.

Answer: Good question. There were a lot more changes for the 2026 year. I would be happy to help compare plans for you to get the best fit. You would just need a list of meds, drs, and hospitals you wish to go to.

Answer: I would reach out to a Medicare broker. They (myself) can look up all your dr, meds, and hospitals - to make sure they are in network.

On Jan 1st, it is OEP, so if you do not like your current Medicare Advantage plan, you have until March 31st to change.

Answer: Medicare caps the cost of a one-month supply of covered insulin at no more than $35 for both Part B and Part D plans.

You do not have to pay the deductible for insulins that are covered under Part D. Hope that helps.