John Stagner, Medicare Insurance Broker
John Stagner
Stagner Insurance Agency LLC
Medicare Broker Licensed in MO and TX
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Location
Salem, MO
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About Me
At Stagner Insurance Agency LLC, we focus on education first. How can you make an informed decision if you aren’t informed? You can’t.
We will break down the subject of Medicare without a bunch of insurance jargon. We also pledge to operate ethically with every client - our reputation depends on that!
As a former trainer for Medicare brokers across the country, we understand Medicare very well. But more important than that, we want YOU to understand it so you aren’t confused. Beyond that, we are here for you AFTER the sale - any time you have a question or an issue.
We have worked hard to build a great reputation. You only keep a great reputation when your clients are happy. Check out our reviews on Google: https://maps.app.goo.gl/YLrC9zkErrsurPseA?g_st=ic
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Q&A with John Stagner
What benefits are there to working with a Medicare Agent near me vs remote/virtual?
Answer: The biggest benefit is that a local broker understands the networks and medical providers much better. I’ve had many clients come to me who were put on a plan not accepted by the local hospital and they’ve found that out the hard way.
It has also been my experience that many remote agents aren’t as eager to encourage clients to call them if they have an issue. We local brokers must do everything in our power to maintain great relationships and provide service after the sale. Word of mouth matters - especially in a small town.
Can you describe a time when you helped a client navigate a complex Medicare issue?
Answer: Yes. I met with a couple in their late seventies who had never had a Part D plan, and the husband was now getting prescriptions for several expensive drugs. They really couldn’t afford them. Enrolling them into a Part D plan would trigger a late penalty of 12% for every year since age 65.
After doing the math on the late penalty, paying the late penalty plus the cost of the drug plan and the cost of the drugs turned out to be the best decision. They went from over $700 per month without coverage to around $150 per month, and they were very happy with that.
These stories are more common than you might think, and many times, we’ve been able to find a workaround for Rx issues. Having been through extensive training on solving these issues and having an entire team of pharmacists as a backup doesn’t hurt!
What imbalance exists in prescription drug spending, and how has it impacted overall costs?
Answer: The biggest imbalance, in my opinion, is Pharmacy Benefit Managers (PBMs). Most consumers aren’t even aware they exist. PBMs are the middleman between drug manufacturers and pharmacies. They negotiate all the pricing for the drug plans. They are a thorn in the side of many local pharmacies. Essentially, they are the ones who never seem to sacrifice, while the local pharmacies suffer.
Another recent issue that went into effect in 2025, is that the government has shifted the majority of the drug cost burden from themselves to the insurance companies, forcing them to cut other benefits in their plans and pass costs on to the consumer.
Why is the new $2,000 out-of-pocket maximum for drug costs important?
Answer: It has been a huge help to many Medicare beneficiaries. The biggest benefit is the way that TrOOP is calculated. That’s the True Out of Pocket cost that determines when a person reaches the catastrophic stage, making their drugs no-cost for the remainder of the year.
Many people will reach the $2,000 cap WITHOUT actually spending $2,000 out of their own pocket. That’s a good thing. Others may spend a little more than $2,000 because they have a drug plan with a high monthly premium (premiums are not included in the $2,000 cap).
I'm retiring next year - do I need to do anything with my Medicare?
Answer: Two possible scenarios - and the answer is yes for both.
Scenario 1: You are retiring at age 65. If you do NOT take medicare at age 65, you will have a lifetime penalty when you do finally enroll. The penalty will be for Part B AND for Part D. If you are drawing Social Security already, your Medicare will start automatically. If you are NOT drawing Social Security, your will need to self-enroll. You do that at ssa.gov.
Scenario 2: You are retiring AFTER age 65. In order to avoid late enrollment penalties, two conditions had to exist since age 65: you worked for an employer with 20 or more employees AND you had insurance with that employer. If either of those stop (i.e. retirement), you must enroll into Medicare to avoid penalties. You will need two forms: CMS 40B and CMS L564. The 40B is your request to start Medicare. The L564 is filled out by your employer(s) verifying you were covered by their insurance since age 65. If you had multiple employers since age 65, you will need the L564 from each employer.
Does Medicare cover eye exams, or are seniors left paying too much?
Answer: Two things to know:
1. Medicare covers eye exams once per year to check for diabetic retinopathy if you have diabetes. It’s covered under part B, so you pay 20% after you’ve met the Part B deductible. In 2025, that deductible is $257.
2. Routine eye exams are not covered by Medicare. If your vision is simply getting worse due to age, it’s not covered.
However, Medicare DOES normally cover cataract surgery and one pair of glasses afterward. It has to be cataract surgery that implants an “intraocular lens”.
Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?
Answer: It really comes down to personal preference and your budget.
It's worth it if you can afford it, and if you place a high value on being able to go wherever you want without worrying about networks. Also, with a supplement, the insurance company doesn't make decisions like approvals & denials. Their job is to write a check.
A Medicare Advantage plan, simply put, works more like the insurance you had through an employer. There are networks, and there are prior authorizations.
Maybe this is a dumb analogy, but is a Lexus considered overkill vs a cheaper vehicle? That depends on how you want the ride to go, and whether you have the budget.
What's one Medicare decision that too many people regret later?
Answer: Not getting a Medicare Supplement when they were healthy. Or not getting one during their initial 6 month window, when health questions aren’t asked.
So with all these 2025 Medicare changes, should I be switching plans or staying put?
Answer: That’s really on an individual basis. If you have a Medicare Supplement, those don’t change from year to year, so the only thing you need to review with your agent is your Prescription Drug Plan.
Medicare Advantage plans DO change from year to year. The two questions you should ask your agent:
1) Are there any negative changes to my plan, and
2) Any positive changes, or better options for me?
The one thing you should NOT do is assume that staying in the same Medicare Advantage or Prescription Drug Plan will give you the exact same coverage from one year to the next. They can change - even if you don’t.
I'm on Original Medicare with no supplement, and I'm wondering how much I'd pay if I need an ambulance ride to the hospital tomorrow.
Answer: Without a Medicare Supplement, it falls under Original Medicare, Part B.
The key thing is that it be considered medically necessary.
That can even include transport from a hospital to a skilled nursing facility - not just transportation toma hospital.
I've heard that once you're on Medicare, you might not need life insurance as much. Is that true?
Answer: There is no relationship between the two - one is for your healthcare while you’re alive, the other is a benefit to your loved ones after you pass away.
Medicare does not provide any type of death benefit. Social Security does provide a $255 death benefit, but that doesn’t go far toward the cost of a funeral!
I'm still working at 67, and I don't know if I need Part B. Why is something so basic so hard to figure out?
Answer: Answering the first question first: it’s hard to figure out because the government wrote it! They don’t really understand how to make things simple.…
Here’s the quick rule about employer insurance after age 65: if your employer has 20 or more employees and you are covered by the employer’s insurance and still working, you can delay part B as long as you want with no concern about having a penalty later. The moment that you stop working for that employer or discontinue that insurance, that’s the time that you need to enroll into Medicare part B in order to avoid a penalty.
I always advise my clients to compare the costs and coverage of the employer plan versus Medicare so they can make an informed decision.
I just moved to a new state. Do I need to do anything with my Medicare coverage?
Answer: If you move to a new state, it really depends on what type of plan you have.
If you have a Medicare supplement, you generally don’t have to do anything because they work nationwide. If you have a standalone prescription drug plan, you MAY need to switch to a different plan.
However, if you have a Medicare advantage plan, you almost certainly will have to get a plan that is specific to that area. Also, if you move to an area where your existing Medicare advantage plan doesn’t cover you, you have guaranteed issue right to get a Medicare supplement with no health questions.
Finally, if you have neither of those, but original Medicare only, you don’t need to do anything, because it is nationwide coverage. However, there are limitations and gaps in original Medicare that can be financially destructive in the wrong situation. That’s why most people have something that puts a cap on the unlimited 20% coinsurance of Medicare.