Jessica Breland, Medicare Insurance Broker

Answer: I highly advise finding a local, trustworthy agent to explain all of your options & help you understand. Start by asking friends, family, your DRs office or even your local Senior Center for recommendations.

Answer: The donut hole no longer exists. Hallelujah!! Annual RX costs are capped at $2000 for 2025 & $2100 for 2026. Once the maximum is reached, all covered RXs remain $0 for the remainder of the year.

Answer: No, income does not affect your eligibility for Medicare, however, if your income is above a certain threshold, an IRMAA (Income Related Monthly Adjustment Amount) will be applied to your Part B & Part D monthly premiums. The IRMAA is determined by your tax returns from 2 years ago- 2026 will be determined by your 2024 tax returns. There is an appeal form on the Social Security website ssa.gov. I recommend checking to see if an appeal category applies to your situation.

Answer: When you are enrolled in a Medicare Advantage plan, that plan is your primary (only) insurance. While Medicare requires Advantage plans to meet certain minimum standards, you are no llonger operating under traditional Medicare part A & B rules. Medicare deductibles, copays, etc do not apply to you as long as you are enrolled in an Advantage plan.

Answer: You can qualify for Medicare before 65 primarily through receiving Social Security Disability benefits for 24 months, having ALS (Lou Gehrig's Disease), or having End-Stage Renal Disease (ESRD) or permanent kidney failure, with

A few common examples of ways you can qualify before age 65-- After receiving disability for 24 months or with certain health conditions like ESRD, ALS, kidney failure. I recommend contacting Social Security to apply.

Answer: There are several types of MedicareAdvantage Plans (MA- no Rx drug coverage & MAPD- includes Rx drug coverage). PPOs- more flexible as far as network goes but that is usually associated with higher out of pocket costs. HMOs- more network focused, typically requiring referrals. SNPs- (Special Needs Plans) for those dually eligible for Medicare & Medicaid (D-SNP) as well as for people with chronic health conditions (C-SNP). PFFS- have a pay as you go structure & offer the freedom to choose any Dr. MSAs- (Medical Savings Accounts) typically has a high deductible with a savings account to use for medical expenses.

All Advantage plans typically include prescription drug coverage & extra benefits including vision & dental. Benefits vary so be sure to confirm the plan you are considering will meet your needs.

Answer: Agents are not allowed to charge beneficiaries a fee of any kind. We are compensated by the insurance companies for enrollment in their plan. It is illegal for an agent to charge a fee & violates CMS rules. This isn't specific to any specific state, this is a federal rule.

Answer: There are a lot of Medicare/Insurance rules that should be more well-known & this is definitely one of them. We have to put people through underwriting all the time for different reasons. This is one of the reasons I license with so many different companies... If one declines, try another. Depending on health issues, there's usually a company out there.

If you would like to give me a call, I can advise on your specific circumstances. And don't worry, no pressure. I'm happy to answer questions & give guidance with no strings attached.

Jessica Breland

Answer: That depends on the doctors & the plan. Every Advantage plan has their own network of doctors. When I am trying to find an Advantage plan for someone the goal is for that plan to cover all of their RXs at the lowest cost & all current doctors are in network. Be sure the agent you see checks everything before you enroll in a plan.

Answer: You should always be skeptical of an agent that is trying to push anything on you. My guess would be because the commission rates are higher on an Advantage plan that on a Medigap. Find an agent that will go over all of your options with you-- in an un-biased way. My main goal during initial consultations is education/information. I want to explain all of your options well enough for you to be able to make a good decision on your own. In my opinion, when someone is trying to push something on you, they have their best interest in mind, not yours.

Remember-- If it sounds too good to be true, it is!

Answer: I wouldn't say it is a common problem but it does happen. It is very important to check all of your Doctors, Dentist, etc before choosing a Medicare Advantage Plan. Most Advantage plans give a set dollar amount per year to use for dental services. In my area, many (not all) of those plans will pay the same on dental services regardless if the dentist is in or out of network. I would recommend checking your plan's Summary of Benefits to see how your plan's dental benefits work out of network. You can request a book or go to your plan's website to find that info.

Answer: No, Medicare Part A is Inpatient coverage. Part A covers things like being an inpatient in a hospital, Hospice, Home Health & Skilled Nursing. Outpatient surgery would be covered by Part B.

Answer: No. There are so many restrictions now that it is incredibly difficult for those of us that are following all the rules. I understand the regulations are to protect beneficiaries & for the people who aren't doing right but they're not following the rules anyway. So, it just makes it harder for the rule followers. I understand the need for regulations, I just feel like there should be stricter punishments for the ones breaking the rules.

Answer: All of it! I truly enjoy the relationships/friendships that I have made with clients over the years. There is no better feeling than when a client calls me & asks me to pray for them or a loved one. Knowing they trust me enough for such an important task is a feeling I can't describe. I love hearing their stories & taking their advice & using it going forward in my own life. And, I truly feel like I help people. It's my way of giving back to a generation that gave so much to me. It's not the "insurance" part for me, it's the people.

Answer: Find a local advisor you can trust that will sit down with you & explain the options to you. Usually once you have it all explained, it's not so overwhelming. One of my most important tasks is making my client's lives easier.

Answer: You can get telehealth services from your home until 10/1/2025, after that, if in a rural area, you will have to be in a medical office to receive telehealth services (After 10/1/2025 there will be certain services you can still get telehealth for). I advise checking with your Dr beforehand to ensure Medicare will cover the services you need.

Medicare.gov & the Medicare & You book have a lot of information that may be useful to you.

Answer: Nothing is free. Medicare Advantage plans do offer plans with a zero monthly premium, but there are other costs associated with those plans. I strongly advise you to find a local agent you can trust that can explain these plans, in detail, before enrolling in one.

Answer: That answer would be different for each person depending on circumstances. I recommend finding a local advisor that would sit down & go over everything with you in detail. I go over everything, in detail, with each person because most of the time people don't know what questions to ask. I look at initial consultations as informative/educational appointments.