Jason Meadows, Medicare Insurance Agent

Answer: A “zero-premium” Medicare Advantage plan means you don’t pay a monthly premium for the plan itself, but it doesn’t mean your healthcare is free. You still typically have out-of-pocket costs like copays, coinsurance, and possibly deductibles when you use services.

A simple way to explain it is: you’re not paying upfront each month, but you may pay as you go when you receive care. That’s why it’s important to look beyond the premium and understand the full cost of using the plan, including the maximum out-of-pocket limit.

Answer: The “birthday rule” is a state-specific Medicare Supplement (Medigap) protection that allows you to switch plans each year without medical underwriting around your birthday. This means you can change to a plan with equal or lesser benefits without being denied or charged more due to health conditions.

States that currently have some version of the birthday rule include California, Oregon, Idaho, Illinois, Nevada, and Kentucky (rules can vary slightly by state). Each state has its own timeframe—often a window starting on your birthday and lasting about 30–60 days—so it’s important to check the specific guidelines where you live.

Answer: Moving to a new state can trigger a Special Enrollment Period (SEP), allowing you to make changes to your Medicare coverage outside of the normal enrollment periods. The timing depends on when you notify your plan—typically you can switch plans starting before your move and continuing for a limited time after you relocate.

If you have a Medicare Advantage or Part D plan, you may need to choose a new plan that’s available in your new area. Original Medicare generally stays the same nationwide, but you may still want to review your coverage to ensure your doctors and services are accessible in your new state.

Answer: The terms are often used interchangeably, but there is a subtle difference. A Medicare agent can represent one or multiple insurance companies and help enroll you in their plans, while a Medicare broker typically represents multiple carriers and works to compare options across different companies.

In practice, many independent agents function like brokers by offering plans from several insurers, so the most important thing is whether the person you’re working with can show you a range of options that fit your needs.

Answer: If you’re diagnosed with a rare disease, the most important step is to review your current coverage to make sure it supports the specialists and treatments you need. Check whether your doctors, hospitals, and any specialty medications are in-network or covered under your plan.

Depending on your situation, you may benefit from a plan with broader provider access or stronger coverage for out-of-pocket costs. It can also help to review your options during an eligible enrollment period to ensure your coverage is better aligned with your needs going forward.

Answer: Medicare Part B covers many preventive screenings, including mammograms, to help detect issues early. In most cases, screening mammograms are covered at no cost to you as long as your provider accepts Medicare assignment.

Generally, Medicare covers one screening mammogram every 12 months for women age 40 and older. If a diagnostic mammogram is needed (for example, due to symptoms or follow-up), you may be responsible for the Part B deductible and typically 20% coinsurance.

Answer: Medicare generally does not cover care outside the U.S., but there are a few limited situations where it will pay for services in a foreign hospital. For example, if you’re in the U.S. and a foreign hospital is closer than the nearest U.S. hospital that can treat you in an emergency, Medicare may provide coverage.

It may also cover care if you’re traveling through Canada between Alaska and another state and have a medical emergency, or if you live in the U.S. and a foreign hospital is closer to your home than a U.S. facility. Outside of these specific situations, Medicare typically does not pay for care abroad.

Answer: One of the most common misconceptions is that Medicare covers all healthcare costs. In reality, Original Medicare (Parts A and B) still leaves you responsible for deductibles, copays, and coinsurance—and it does not cover everything, such as most dental, vision, hearing, or long-term care.

Because of these gaps, many people choose additional coverage to help manage out-of-pocket costs and avoid unexpected medical bills.

Answer: There are several ways to save on prescription drug costs under Medicare. Reviewing your Part D or Medicare Advantage plan each year is key, since formularies and pricing can change. You can also ask your doctor about lower-cost generic alternatives or preferred medications that your plan covers at a lower tier.

Additionally, using in-network or preferred pharmacies, applying for programs like Extra Help (if you qualify), checking manufacturer discounts, and seeing if your state participates in a State Pharmaceutical Assistance Program are just a few ways to help reduce your out-of-pocket costs.

Answer: If your income drops after retirement, you may be able to lower your Medicare Part B premium by requesting a review of your income. Medicare uses a prior tax year to set premiums, so if your current income is lower due to a qualifying life event—like retirement—you can file an appeal using Form SSA-44 with the Social Security Administration.

If approved, your premium can be adjusted to reflect your current, lower income instead of your past earnings, which can significantly reduce what you pay each month.

Answer: It’s a fair question — and it’s smart to think about 👍

Some agents may lean toward Medicare Advantage because those plans can be more widely available, have lower upfront costs, and in some cases may offer higher commissions. However, that doesn’t automatically make them a bad option — they can be a great fit for the right person.

The key is whether the recommendation is based on your needs. Medicare Advantage and Medigap work very differently, so you should feel comfortable that the pros and cons of both are clearly explained. If you ever feel like only one option is being pushed without a full comparison, it’s reasonable to ask more questions or get a second opinion.

Answer: Yes — you’re not alone in feeling that way, and there are ways to get more peace of mind with Medicare. The key is choosing coverage that fits your needs and reduces surprises, whether that’s a plan with more predictable costs, broader coverage, or additional protection for out-of-pocket expenses.

Working with someone who can review your doctors, prescriptions, and budget each year can help make sure everything lines up correctly so you’re not caught off guard. The goal is to simplify your options and put a plan in place that you feel confident about — not something you have to worry about year after year.

Answer: Great question — and it’s something a lot of people don’t realize at first 👍

Original Medicare (Parts A and B) covers many healthcare services, but it does not pay for everything. Some common gaps include deductibles, coinsurance (like the 20% you pay under Part B), and no cap on out-of-pocket costs, which can add up over time. It also generally does not cover things like dental, vision, hearing, or most long-term care, which is why many people look into additional coverage to help fill those gaps.

Answer: Yes, Medicare deductibles can change from year to year depending on the type of coverage you have. Original Medicare deductibles are set by the government and usually increase slightly, while Medicare Advantage and Part D plans may change based on the plan you choose.

Answer: Why Work With a Medicare Agent?

Choosing the right Medicare coverage can feel overwhelming — but you don’t have to figure it out on your own.

✔ Simple, Clear Guidance

Medicare has a lot of moving parts. A licensed agent can help explain your options in plain language so you can make an informed decision.

✔ Compare Plans in One Place

Instead of contacting multiple companies, an independent agent can review plans from several carriers and help you compare what fits your needs.

✔ No Cost for Assistance

Working with a Medicare agent does not cost you anything. Their services are paid for by the insurance companies.

✔ Avoid Costly Mistakes

The wrong plan can mean higher costs or limited coverage. An agent can help you look at the details ahead of time.

✔ Ongoing Support

Your needs can change each year. A good agent is there to help review your coverage and answer questions when needed.

✔ Personalized Recommendations

Everyone’s situation is different. An agent can help match your coverage to your doctors, prescriptions, and budget.