Jason Denniston, Medicare Insurance Broker

Answer: Most people ask about premiums first, but a better question is, “What kind of help will I have after I enroll?” Medicare can get confusing fast once bills, referrals, prescriptions, or claim issues start happening. Working with a real person who answers the phone and helps year after year matters a lot more than most people realize in the beginning.

Answer: Yes, you can leave your employer health insurance and move to Medicare if it makes sense for your situation. What employers can’t do is pressure you or offer incentives to get off their plan just because you’re Medicare-eligible. Working with an independent Medicare broker helps you look at the bigger picture, especially if a spouse or dependents still need coverage through your employer plan.

Answer: You can shop and apply for a new Medigap plan anytime during the year, so you’re not stuck waiting for a specific window. The catch is, outside of certain situations, you’ll have to answer health questions to switch. Some states do have special times throughout the year where you can move plans without that. Working with a local Medicare agent can help you figure out what’s available to you.

Answer: Original Medicare doesn’t cover routine dental or vision, so most people look at other options. Working with a Medicare agent, you’ll usually look at Medicare Advantage plans that often bundle those benefits, or add a separate dental or vision plan alongside a supplement. It really just depends on your specific situation and what works best for you.

Answer: Costs and coverage are important, but the company behind the plan matters too. Some carriers are easier to reach, quicker to fix issues, and more consistent year after year. If things like community involvement, customer treatment, or company values matter to you personally, it’s completely reasonable to factor that into the decision.

Answer: Social Determinants of Health are the everyday things that affect someone’s health outside of the doctor’s office, like transportation, housing, food access, and social support. Medicare plans are paying more attention to these because they can directly impact whether someone takes medications, gets to appointments, or manages chronic conditions well. A good Medicare agent can help you look beyond just premiums and benefits to see which plans actually offer support that fits your situation.

Answer: Going without a Medicare supplement can get risky fast because Original Medicare has no cap on the 20% they leave behind. One hospital stay, surgery, or ongoing treatment can create bills that are hard to recover from at their age. Before cancelling Plan F, it’s worth checking whether they could switch to a lower-cost supplement or even another company offering the same coverage for less. A Medicare Advantage plan may also be worth looking at since those plans are required to have a yearly max out-of-pocket limit.

Answer: Once you switch Medicare plans during open enrollment, you’re usually locked into that plan for the rest of the calendar year unless you qualify for a Special Enrollment Period. Simply having your doctor stop or change a medication doesn’t automatically let you switch plans again, although other situations in your life could still qualify you for a different enrollment window.

Answer: Working with a Medigap plan is a little easier than people expect when moving. In most cases, you keep the same standardized coverage nationwide, but your premium could go up or down based on your new zip code. Letting the insurance company know ahead of time helps make the transition smoother.

Answer: Most Medicare Part D plans do cover Repatha, but it’s commonly listed on one of the higher formulary tiers rather than a generic or preferred brand tier. In real life, that usually means you may pay a percentage of the drug cost instead of a flat copay.

The tricky part is that every plan handles it a little differently, so it’s worth working with a broker who can compare various plans’ formularies before enrolling.

Answer: If you move out of your current Medicare plan’s service area, you usually get a Special Enrollment Period to make changes. In most cases, you can switch plans starting the month before your move and up to two months after you update your address. Working with a Medicare agent can help make sure you don’t miss the timing or end up with a gap in coverage.

Answer: Creditable coverage means you already have health or drug coverage that Medicare considers “good enough” to delay signing up without getting penalized later. This matters because Medicare late enrollment penalties can stick with you for life, especially for Part B and Part D. The tricky part is that employer coverage, VA benefits, COBRA, and retiree plans all follow different rules, so it’s important to know what counts before you delay enrollment.

Answer: A simple way to think about it is this: if it’s a typical inhaler you get from the pharmacy, it’s usually covered by Part D. If the medication is used through a nebulizer machine that Medicare considers durable medical equipment, it may fall under Part B instead. A lot of people don’t realize the delivery method is what often determines which part of Medicare pays.

Answer: Medicare agents and brokers are generally compensated by the insurance company once someone enrolls in a plan. It’s usually a modest monthly payment, which encourages long-term help and support instead of a quick sale and disappearing afterward. The amount they’re paid doesn’t change your premium, so you’re not paying extra to work with an agent.

Answer: There usually isn’t a “worst” Medicare Supplement company in terms of coverage, because the plans themselves are standardized by Medicare. A Plan G is a Plan G no matter which company you buy it from, and Medicare is the one approving claims, not the supplement company. What really matters is picking a carrier that’s more likely to keep rate increases reasonable over time, even if they aren’t the absolute cheapest upfront. A good local broker should have enough experience with the various plans to let you know which ones to avoid.

Answer: The best thing you can do is make a list of all her current doctors, specialists, and hospitals before comparing plans. Then check each one directly with the insurance company, since provider offices may not know every network tied to a specific Medicare Advantage plan.

There are cases where doctors accept a plan but choose not to be listed publicly in the directory. That’s one reason many families like having a broker help with the research before making a switch.

Answer: Medicare does cover some chiropractic visits, but there are limits. Original Medicare generally only pays for spinal manipulation when there’s a documented treatment plan showing medical necessity. Some Medicare Advantage plans may cover routine chiropractic visits or offer broader benefits, but not every plan includes that coverage.

Answer: The easiest way to cut through the Medicare confusion is to find an independent broker who works with a wide range of carriers, not someone tied to just one company. The right person will slow things down, answer your questions, and focus on educating you so you actually understand what you’re choosing.

SHIP (State Health Insurance Program) counselors do provide a helpful service, but working with an experienced advisor who handles real client issues day in and day out usually gives you more practical guidance and ongoing support.

Answer: Original Medicare generally doesn’t cover hearing aids, so most people would pay out of pocket if they only have Parts A and B. On the other hand, Medicare Advantage plans typically do include hearing benefits. That might be an allowance toward hearing aids or a set copay, and you’ll usually need to use providers in the plan’s network.

Working with a Medicare agent can help you compare those details and see if separate dental, vision, and hearing plans make sense too.

Answer: Most insurance companies have an online provider lookup tool, and you can also call the customer service number on the back of your ID card to double-check if a provider is in network. I’d be careful about relying only on what the doctor’s office says, because many carriers have multiple networks and it’s easy for things to get mixed up.

Pro tip: some doctors choose not to appear in the carrier’s online directory even though they still accept the plan. Working with a local Medicare broker can help uncover providers that may be in network but harder to find online.

Answer: Yes. If you move out of your Medicare Advantage plan’s service area, you have a guaranteed issue right to buy certain Medigap plans without health questions. That usually includes Plans A, B, D, G, and in some cases C or F if you were eligible for Medicare before 2020. You may have additional rights under state law.

Answer: Plan G and Plan N are actually very similar in how they cover you, but there are a few key differences.

With Plan G, it’s pretty simple, you pay the annual Medicare Part B deductible, and after that, the plan covers essentially all of your Medicare approved out-of-pocket costs for the rest of the year. No copays, no surprise bills.

With Plan N, your monthly premium is usually lower, but you take on a little more cost-sharing. You may have small copays at the doctor and ER, and the biggest thing to be aware of is Part B excess charges.

Excess charges happen when a provider doesn’t accept Medicare’s standard pricing and is allowed to bill up to 15% more than what Medicare approves. Plan G covers those charges, Plan N does not.

Answer: For a lot of people, the biggest change is finally having a cap on what you’ll spend out of pocket for prescriptions each year. The donut hole going away really simplifies things, but behind the scenes, more of the cost is being shifted to the insurance plans (away from the manufacturers), and that is likely to affect your premiums and plan choices. As with most things in life, some people may benefit more than others, thankfully Medicare has a tool that can help you predict what your prescription costs for the year might be. If you aren't familiar, reach out to your local broker for guidance.

Answer: It definitely catches people off guard, but this is actually pretty normal, even on strong plans.

Prior authorization just means your insurance company wants to review the procedure ahead of time to make sure it meets their medical necessity guidelines. It’s something almost all health insurance plans do to help control costs and keep premiums from rising more than they have to.

The good news is, you usually don’t have to handle this yourself. Your doctor’s office will send in the information and work directly with the insurance company to get a decision.

If it ends up being denied, you have the right to appeal that decision.

And if the process feels confusing or stalls out, this is a great time to loop in your broker. They can often help figure out what’s missing and keep things moving in the right direction.

Answer: There’s no need to reapply for Medicare at 65 if you’re already on it due to disability. But turning 65 opens the door to more plan choices, especially with supplements, and sometimes better rates. It also resets any late enrollment penalties, which makes this a really important time to review your coverage.

Answer: For a lot of people, Medicare Advantage plans are more cost effective overall. A recent analysis found that folks on these plans spent about $3,486 less on premiums and out-of-pocket costs compared to Original Medicare. That said, it really depends on your specific doctors, prescriptions, and health needs, which is where having a broker walk through the details can make a big difference.

Answer: The main feature of an HMO plan is that all of your routine care needs to come from in-network providers. You’ll usually have to choose a primary care doctor and may need referrals to see specialists.

With a PPO plan, you have more flexibility. You can see out-of-network providers, you typically don’t need to choose a primary doctor, and referrals usually aren’t required, but that flexibility often comes with higher costs.

An HMO-POS plan works mostly like an HMO, but with a slight twist. The insurance company may allow certain services, often things like dental or specific types of care, to be done out of network and still provide some coverage for those services.

Answer: At 65, Medicare is usually available, but for green card holders there’s a 5-year continuous residency rule to meet first. Since you’re at 4 years, you’d likely need to wait until you hit that 5-year mark to enroll. This would be a good time to talk through your timing and options with a broker who can keep you on track.

Answer: Honestly, it’s the people. Everyone’s situation is a little different, and I like taking the time to understand what matters to them and helping them sort through their options. It’s not just about picking a plan, it’s about making sure they feel comfortable with their choice. And I stick around, so they’re not on their own after enrollment.

Answer: That’s, unfortunately, pretty common. Medicare is a big system, and it’s easy to get bounced between departments.

This is where working with a broker really helps. They can often answer the question themselves, or at least get you to the right place much faster. An experienced broker also knows the right words to say to keep the call heading in the right direction and avoid all the transfers.

Answer: Medicare supplement plans are designed to help cover the gaps in Parts A and B, including deductibles. That said, not every plan covers both, especially the Part B deductible on newer plans. It really depends on which letter plan you have, so it’s worth taking with a broker who can walk through the details with you.

Answer: It’s worth calling the provider’s billing office first because they deal with the exact procedure codes that get sent to Medicare or your plan. In some cases, they’ll need to request prior authorization anyway, so they can flag any issues upfront. Your agent can help you understand your coverage overall, but the billing department usually has the clearest view of how that specific service will be billed.

Answer: Original Medicare usually won't pay for medical alert systems like Life Alert. They're not considered medically necessary equipment under the program. That said, some Medicare Advantage plans include extra benefits like this, and a local broker can help you see what options you actually have nearby.

Answer: Working with a Medicare agent helps you make sense of what often feels like a really confusing system... without all the noise from ads and call centers. We compare plans, explain real world differences, and help make sure you don't overlook something that could cost you money later. And just as important, we stick around after enrollment, so you always have someone to call when questions or issues come up.