Joel McKinney, Medicare Insurance Agent

Answer: Original Medicare (Part A and Part B) is a good base to build from. Let's say you have no clue about what to choose and any advice you get is making you lose sleep. Stick with Part A and B, pick up a Part D Prescription Drug Plan, and you're set for now. However, it is most likely not the best option as there's no max out of pocket, dental, vision, or hearing coverages on Original Medicare. The copays and that Part A deductible hit hard too. But, for peace of mind, Original Medicare is fairly simple compared to mixing and matching other options in.

Answer: Possibly. The MPPP (Medicare Prescription Payment Plan) is set up in a way that it offsets your copays/deductible if those first several months of copays are high at the pharmacy. For instance, let's just say you have a $1200 copay in January. The MPPP will take that copay and divide it up over the remain months in the year. You'll pay nothing at the counter and get a bill from your carrier. Where the payment plan falls short though is where your copays are already pretty much even for each month throughout the year.

Answer: The challenge. Brokers are a dime a dozen. But a knowledgeable and trustworthy one, not so much. The insurance business is built on "sell, sell sell" but I do not view it that way or let it dictate how I treat people or run my business. I truly enjoy the conversations and connections I build with people. I tell my clients that I'm the guy they can talk to about anything and just so happen to advise them on Medicare options in the process.

Answer: Firstly, be wary of any broker that does not explain all of your options if you are new to Medicare. If the person advising you on your options seems too eager to place you in an Advantage Plan, there's a reason. With that, Advantage Plans have pros and cons to them just like Original Medicare. The biggest issue I see is that someone expects an Advantage Plan to be a perfect solution to all of their medical needs without costing anything whether it be in premium or in copays. I find this more to be true when their prior broker/agent did not explain Medicare very well.

Answer: Part A (hospitalization) has a deductible associated with it for days 1-60 of being admitted. Days 61-90 have a per day copay. Days 90+ have a higher per day copay. Part B (medical insurance) has a deductible as well. After you pay that, Medicare pays 80% and you pay 20%. Finally, original Medicare does not usually cover vision, hearing, dental, or pharmacy drug costs.

Answer: In 2025 your max out of pocket for covered drugs was $2,000. After that, your plan pays 100% of all covered drug costs. In 2026 that amount increased to $2,100.

Answer: Medicare Supplement (Medigap) Plan F covers the deductible and copays associated with Part A hospitalization.

Answer: Without knowing the specifics, it is hard to say. If we are assuming that an Advantage Plan would cover all the same doctors/hospitals and approve all the procedures, then yes, because Original Medicare has no max out of pocket whereas an Advantage Plan does.

Answer: The first thing I do find out if they have learned, whether correctly or incorrectly, anything about Medicare. If they have not, I do a presentation whether in person or over the phone and modify it based on feedback or questions they have. I don't just spout off information. I tell them to interrupt me when a question arises.

If they do have information, I listen and decide if they are on the right track or not. Either way is fine. Medicare is complicated so I understand if things don't quite make sense. After hearing what they know, I adjust.

The most important things are comfort and communication. I hear too many conversations where brokers or carriers will argue or fight with a potential client over the simplest things that just needs explained in a different way. Most of my clients would tell you that we talk about all kinds of things. I have some that call me to tell me about a recent event or their families...I just happen to help them with Medicare in the process.

Answer: Find an advisor early into your eligibility and find one you trust to stick with year after year. Even then, do your homework. While asking family and friends is ok, I do not recommend you base your ultimate decision on their advice. The specifics of your situation as it pertains to plans in your area WILL BE DIFFERENT than your neighbor, family, or friends. They do not see what we see. The same goes for your doctor. I have seen people get in a bad situation with their insurance simply because a doctor hated the billing of their client's plan.

Conversely, if something feels "off" about your Medicare advisor, politely walk away and find someone else. Who you trust with your insurance after retirement is a major decision.

Answer: Without getting too far into the weeds here.... Medicare Advantage Plans take the place of Original Medicare with some pros and cons associated. The pros are hearing, dental, vision, and prescription drug coverage are rolled into your Medicare plan now. The plans are also $0 many times. They also cap out what you'll have to pay as opposed to Original Medicare, which does not have a max out of pocket. Think of a Medicare Advantage Plan as a private plan through a carrier.

However, the biggest caveat is now you'll have a network whereas Original Medicare does not. Carriers arrange plans by area. If your doctor, hospital, pharmacy, etc. does not take your plan then you'll pay out of network costs. Also, there is a pre-authorization for procedures you may need. Your carrier has to approve a recommended procedure from your doctor before it will be covered.

Truth is guys, I've seen good and bad with these plans. The most important thing is to make sure your broker knows your network and can compare all the plans to make sure your doctors and drugs are covered.

Answer: There is no more "donut hole." It was phased out at the beginning of 2025. Now, the phases of coverage are as follows:

Deductible phase: This is the first stage of prescription drug coverage. You will pay a deductible at the pharmacy, up to $615, before your plan "kicks in."

Initial coverage phase: This is the phase where your plan either pays for a drug in full or pays part of your drug cost with you paying the rest.

Catastrophic coverage phase: After you reach $2,100 in out-of-pocket costs for your covered prescriptions, your plan will pick up 100% of the costs of your covered drugs for the remainder of the year.

Answer: SSI is a needs-based program that is administered by the Social Security Administration, and while SSI and Medicare and not directly correlated, many people on SSI are also on Medicaid through their state. Those on Medicare will receive additional assistance if also enrolled in their state's Medicaid program. This can come in the form of Part B premium assistance, prescription drug copay assistance, and other supplementary assistance. It all depends on the level of Medicaid you receive. Also, if you are on Medicaid and 65 or over, there are private plans through Medicare called D-SNPs (Dual Special Needs Plans) that combine the benefits of both Medicare and Medicaid into one plan.

Answer: Broker, agent, specialist, advisor, etc. all mean basically the same thing. The important distinction is to make sure that your Medicare advisor is familiar with your area. Plans are split up by zip code and networks are extremely important within these different areas. Brokers also tend to have multiple carriers to be able to compare a large number of plans against one another to find the best plan that works for you.