Jonathan Potter, Medicare Insurance Broker

Answer: You don’t need to fill out anything. Just be aware that if you go off of his insurance, you need to be ready to go with your part B. So, if you know, your husband‘s going to retire in six months, I would say four months before he retires I would start working on your part B paperwork.

Answer: There are usually zero-premium plans available in most areas. Some do not but most area do. The coverage usually involves paying a copay whenever you use the plan so if you are someone who uses the insurance many times a month for very large amounts of dollars out of your pocket you would be best suited for a Medicare Supplement.

Answer: Creditable coverage is health or prescription drug insurance from a non-Medicare source (like an employer, union, or VA) that is expected to pay, on average, at least as much as standard Medicare coverage. It matters because it allows you to safely delay enrolling in Medicare Part D (and sometimes Part B) without paying long-term late enrollment penalties.

Answer: You can stay abroad indefinitely without losing your Medicare eligibility or benefits. Medicare enrollment itself is not terminated by extended time outside the U.S., but coverage for health care services received abroad is extremely limited, and there are important considerations for maintaining your coverage.

Answer: Because of the reduction in payments to medicare and medicare advantage companies there has been a pull back in especially rural areas with respect to these plans.

Answer: Not every company will have it at a 3 but I checked three local companies and they all had it at a tier 3.

Answer: You need to get at least a RX plan to be mostly covered. Medicare itself has a large deductible and then you pay a percentage of whatever the doctors charge. I would at least get on a medicare advantage plan so you don't have to pay for the RX plan separately and you will have a much lower financial risk if you do go to the hospital for something.

Answer: Medicare itself doesn't cover any type of gym membership. Medicare advantage companies do and also some supplements do cover this. Ask your agent which ones cover they gym you want to go to.

Answer: Medicare itself doesn't cover any of these but some medicare advantage companies do. I would check with a local agent to find the companies that do.

Answer: The best way to answer this is to give a list of inhalers you like to an agent or put them into a medicare rx calculator. Every insurance company is different.

Answer: Many of the new medications are made available but at a very high cost. This high cost impacts the whole system by shifting costs from the medical side to the prescription side.

Answer: So now once your total cost of your drugs hits $2100 you don't have to pay any copays and the insurance company pays everything else. Let's say you have a medication that is $500 without insurance. You would pay a copay of $45 for that medication with your plan. After 4 months you would have spend $45 four times. The company has paid $2000. The next month you would only have to pay very little and the rest of the year you would pay nothing for that medication.

Answer: With just regular medicare they do not cover dental and vision. You will have to find it though an insurance company.

Answer: Do you have any history of major illness or a family history of major illness. Do you have a decent amount in savings for medical expenses or an HSA from an employer?

Answer: You can ask your current dentist if they take your plan. You can ask your agent to check it for you. You can go online and search for dentists near you with your zip code on the insurance companies site.

Answer: I love to make new relationships. I love to help people and sometimes it makes a huge difference in which plan they are on.

Answer: You do not need to sign up for Part B coverage yet. If your employer is offering amazing coverage or you need to have that coverage to cover a spouse then I would wait to sign up. Ask your local broker which would be best for your situation.

Answer: Lifetime reserve days are a one-time backup supply of 60 additional hospital days that Original Medicare gives you to use after you've exhausted your standard inpatient benefit in a single benefit period.

How the standard benefit works first. Medicare covers inpatient hospital stays in "benefit periods." Within each benefit period, you get up to 90 days of covered hospital care. Days 1–60 have no daily coinsurance (just the Part A deductible), and days 61–90 come with a daily coinsurance charge ($816/day in 2026). Once you've used those 90 days in a single benefit period, you've hit the wall — that's where lifetime reserve days kick in.

What lifetime reserve days are. The extra 60 days are a pool that sits on top of your standard 90-day benefit. They are not renewable — you get exactly 60 of them across your entire lifetime, to be used however and whenever you need them. In 2026, each lifetime reserve day comes with a $1,632 daily coinsurance (double the days 61–90 rate), which you pay out of pocket.

How they're used. They kick in automatically on day 91 of a continuous hospital stay within a single benefit period, unless you explicitly opt out in writing. Once used, those days are gone permanently — even if you later switch Medicare plans or take a break in coverage.

You can decline to use them. If you'd rather preserve your lifetime reserve days — say, because you have a Medigap policy that would cover the gap differently, or you want to save them for a potentially longer future stay — you can submit a written request to the hospital to not use them. The hospital is then required to issue you a denial notice, which you can use to appeal or to trigger other coverage.

Why they matter less with Medigap. Most Medigap supplement plans (Plans A, B, C, D, F, G, etc.) cover the lifetime reserve day coinsurance, and some cover an additional 365 hospital days beyond Medicare's limits entirely. So if you have a supplement, the $1,632/day charge may be fully covered anyway.

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Answer: I love the relationships I have made with people. I like to be relied on for questions and I love that people trust me to help them find the best solution for them.

Answer: If you are on Medicare Advantage the please don't show your Medicare card to providers. Only show the MA card. Medicare is paying whatever company you chose to administer your benefits. That company is paying your bills because Medicare is paying them to pay all bills and administer the benefits. If you show your Medicare card and the office tried to bill services on it then it would be denied.

Answer: Medicare itself doesn't cover telehealth options. You need to ask your provider or insurance company if they do provide that service. Many Medicare advantage programs do offer this.

Answer: IRMAA does not go away automatically — but the good news is that Social Security does review it every year using your most recent tax data on file, so it can drop on its own without you doing anything, depending on the timing.

Here's how it works:

The automatic annual review. Each year, Social Security redetermines your IRMAA surcharge using your tax return from two years prior (so your 2026 IRMAA is based on your 2024 income). If your income naturally fell in that prior year and it's already reflected in the IRS data SSA pulls, your IRMAA will simply be lower or gone when the new year starts — no action needed.

When you should proactively report it. If your income dropped more recently — say in 2025 or 2026 — SSA won't automatically know about it yet because they'd still be looking at older tax data. In that case, you can (and should) request a reconsideration using form SSA-44. The qualifying life-changing events that allow you to appeal early include retirement or reduction in work hours, marriage, divorce or annulment, death of a spouse, loss of income-producing property, loss of pension income, and employer settlement payments.

The process. You file the SSA-44 with Social Security, provide documentation of the income change (like a letter from your employer, or evidence of retirement), and they'll use your more recent estimated income instead of the two-year-old figure. If approved, the lower premium kicks in relatively quickly.

One thing to watch for. If you appeal based on estimated future income and your actual income ends up higher, SSA can come back and collect the difference — so it's best to be conservative in your estimate.

The bottom line: if the income drop already shows up in a tax return SSA has on file, it'll likely resolve itself at the start of the next calendar year. If it's a recent change, filing the SSA-44 is the way to get faster relief.

Answer: Have them get you a list of any doctors, dentists and medications that they have. From there you can ask them the medical history and explain to them the differences between the plans available to them.

Answer: When someone doesn't have part A or B. Also if they don't know what the Medicaid number is or what level they are at.

Answer: Gym membership, preventive tests, over the counter credits, hearing aids, vision, zero copays to see the doctor.

Answer: You do not need Critical Illness coverage. If you are worried about getting those costs coverage or you have a history of those illnesses then it might not be a bad idea depending on how much you can afford.

Answer: Medicare Advantage is actually growing every year. Some people do leave because it is not for everyone. Make sure to look at your individual situation and find an agent that will show you all options to help you make an educated decision.

Answer: You can have any health condition and still get on a medicare advantage plan. With medicare supplements you have to answer health questions unless you are coming off of group coverage or you are new to medicare.

Answer: Medicare alone doesn't cover hearing aids. Some Medicare supplements do along with most medicare advantage plans. Make sure to check with your agent that the plan you are looking at covers hearing aids and what the coverage is.

Answer: You can enroll three months before you turn 65. The month of your birth. Also, three months afterwards.

Answer: Some plans include money for food. These plans do have a requirement that you have some sort of health condition that would qualify you for it. It is a real benefit but be careful that they inform you and you are SWITCHING TO A DIFFERENT PLAN! Make sure they confirm your doctors and medications are covered.

Answer: To save money on a supplement you can have your household on the same plan for a small discount. You also get a discount if you set up autopay through your bank.

You can also choose a plan with a high deductible and then throw on a accident rider that would cover the deductible in case something happens.

Answer: Premium is the monthly cost of the plan.

Deductible is the money that YOU pay before the plan pays anything.

Copays are the cost for care that you have to pay.

All the money that you spend out of your pocket for medical (not prescription) costs goes towards your max out of pocket. Once you hit your max then you don't pay any more and the plan pays the rest of your medical costs for the rest of the year before it resets in January.

Answer: I wouldn't think of it as concerning. In my experience it is a good thing to have many options available to you when you are looking at coverage. That is why it is important that you talk to an experienced agent so they can point you in the right direction instead of you being lost in a sea of options. Good agents study the details of the options and ask good questions to be able to help you find the best plan for you.

Answer: When an agent talks to someone about Medicare options it can be very overwhelming for most people. It is a good idea to understand what they know and so you can help your parents and understand their coverage.

Answer: Medicare supplement is probably the best way to do your health insurance if you travel a lot. You can ask an agent to look into a PPO Medicare advantage plan. If they get a list of your doctors you use then then can look and see if they are on a national plan and you would save money going that way. One thing to keep in mind is that you only have a year to go back to your supplement without health questions. If you are someone who only sees the doctor a couple times a year then a PPO medicare advantage would work for you if those doctors are in network.

Answer: It’s usually not that simple. Although, any zero dollar plan would be better than nothing, but you should really have somebody evaluate which doctors you use and the drugs that you take to make sure you are on the proper plan. It cost the consumer nothing to do this.

Answer: I would express this concern to your agent and have them do the legwork for you to figure out which plan has the best value for your dollar.

Answer: First, I would double check and make sure that the company build the insurance properly. If it was done properly, but the insurance is denying it then I would fill out an appeal form that you can get from the customer service or your agent can send that to you. Once the appeal has been sent in and you’ve waited the appropriate time you should get your answer from the insurance company.

Answer: I usually start off by asking someone what they do know about Medicare. Once we established they know the basics of Medicare. Then we move onto choosing a plan option.

So first off, you have to know what Medicare covers and what Medicare doesn’t cover and then from there you can move onto find out if doctors will take plans and using their medication in the calculator to find which plan would be the best for them for next year.

Answer: If you just have Medicare and no supplement or no, Medicare advantage program than your mammogram would be no cost to you but if they do have to cut anything out during the procedure, then it would be considered a surgery and you would have to pay your deductible and a percentage after that.

Answer: I would say going with the Medicare advantage program over. Just Medicare any day of the week. If you go just Medicare, you’re still going to have to purchase a drug program and with Medicare advantage you can have that drug program usually for no cost per month and have lower co-pays and costs to see your doctor. You also get extra benefits like Jim, memberships and money for over-the-counter items.

If you have just Medicare, you’re going to have massive deductibles when you use the plan and you’re gonna be penalized. If you don’t get a drug program.

Answer: If your doctor finds it medically necessary then it will be covered. You would just have to get approval and then it will be covered.

Answer: If you are unable to provide credible coverage through a group plan, then I would suggest getting on Medicare as soon as possible to avoid any penalties for now and the future

Answer: Yes, she can work in your behalf, but you will have to have her name on the application as assisting. You can also sign the application, but if she is assisting, it is good to have both of your signatures on there to make sure that all things were understood in the appointment.

Answer: Yes, Medicare advantage programs will cover chiropractic. You just need to make sure that they are in network with the plan that you have chosen.

Answer: Yes, your agent should be able to use their tools to find a chiropractor near you that takes the coverage.

Answer: Coverage under just Medicare only covers for the subluxation of the spine and that is it. Other services will not be covered at a chiropractor. With Medicare advantage they do have some coverage for those type of procedures.

Answer: Medicare itself does not cover holistic care at all. Some Medicare advantage plans will give you discount discounts or a small co-pay for that kind of care. Medicare supplements usually do not cover holistic care.

Answer: As long as you have credible coverage with her then you will not pay a penalty. Credible coverage means you have medical and prescription coverage included in her package for you.

Once she is ready to retire, then about three months before I would contact Social Security and get your paperwork going for your part B.

If for some reason the cost for keeping you on the plan goes up to more than $200 a month. I would consider going on part B. If her plan also has a high deductible. I would also consider going on Medicare because there are many plans that would suit you for little to no cost out of your pocket.

Answer: Original Medicare and Medicare advantage are two great options and one is definitely not better than the other. Medicare supplements are really good for people who travel a lot and for somebody who has a chronic condition where they are going to be spending a lot of money out of pocket every month to maintain that condition. Medicare advantage is really good if you generally stay in your area and if you only see the doctor a couple times a year. It’s good to have the information about both plans and make a decision knowing all of the options.

Answer: Medicare plans won’t cover genetic testing for certain types of conditions. You could ask for an exception, but a lot of elective procedures and tests are not covered under Medicare.

Answer: There is an enrollment period from 15 October until 7 December that you can use to change your plan. There is also one from January until March 31. After that you’d have to have a special enrollment to be able to change your plan. Some examples of this are if you move, if there is a natural disaster in your area and you were not able to make a plan change, if you are signing up for a chronic plan for a diabetic or heart conditions

Answer: Medicare coverage is different in different counties in different states. To really see what the plan would look like you would need to know which city you’re moving into and then from there we can evaluate and see which plans are available. So just so you know each county can have a different plan from the neighboring county so it’s important to look up your information by city name or ZIP Code.

Answer: They don't realize that many doctors will not accept Medicare because of the low reimbursement rates. Many people don't realize how many options you have when you are enrolled in Medicare.

Answer: The biggest disadvantage of Medicare Advantage is the network of doctors in your area. Some plans provide coverage for most doctors in your area. Some plans only provide a small portion of doctors. It is important to check and make sure that the doctors that you want to see are in network.

Answer: So think of Medicare A and B as basic coverage. There will be a deductible and then you will have to pay a percentage of the cost. This changes every year. Medicare doesn't provide any type of dental, vision, hearing or drug coverage. Because of this many people buy supplements or enroll in medicare advantage.

Answer: Any preventive medical services will be zero cost with any Medicare Advantage program. It just depends if the doctor is in network.

Answer: Yes, your annual physical should cover all or most of the preventive screenings you need. It depends on if your doctor has all of the required equipment to accomodate those screenings.

Answer: The biggest disadvantage for Medicare Advantage would be a couple of things. If you see doctors that are not in network then it won't really work for you. If you are someone who has places to live in different states and see doctors in those states then it might not work for you. If you are someone who has many chronic conditions which would make you pay hundreds of dollars in copays with MAPD then it might not be the best.

Answer: Medicare advantage plans aren’t allowed to offer you any type of incentive to enroll. You just get the benefits of the plan. If someone is offering you some prize to enroll then they are in violation of the Medicare rules and you should avoid that agent like the plague.

Answer: If you just need emergency care you can go to any hospital or instacare with any plan that you have and be covered.

If you need to see doctors on a regular basis then a PPO plan will work if they are in network. Your agent can help you check on this easily.

If you have a supplement then you just have to ask if they bill medicare and the supplement that you have.

Answer: If you can access the "Summary of Benefits" for the plan then you have in writing what the plan HAS to cover. Every plan has a plan number. It should look something like this: H4606-011. If you do an internet search for that plan number and the current year, you should find the Summary of benefits for the plan.

Answer: The biggest mistake you can make is not being educated on your options. In most areas you have dozens of supplement companies and possibly up to 10 Medicare advantage companies. Evaluating those companies with the medicare and you handbook or going online is cumbersome because of all the options you have. A good agent will be able to narrow the options down to just a couple and make the decision much easier.

Answer: You can try to chose a plan by yourself but a good agent will know the differences between all the companies. Not all companies will cover the same doctors, hospitals, dentists and medications. A good medicare agent will be able to find the best plan for you with a little research and they can be a resource for you every year to evaluate the plan changes.

Answer: Medicare agents are supposed to go over all the details of the plan and make sure you understand it before you sign up. Sometimes when an agent goes over the plan details it can be draining on the brain because of all the numbers you go over. I would talk to your agent and see if there is another plan option that would work for you or if you can add dental for a fee with your plan.

Answer: Choosing between a supplement and Medicare Advantage is a individual choice. One option is not perfect for everyone. I would get with your agent and have them evaluate both options with the following information: List of Doctors, dentists and any medications that you take. They can take that information and calculate the best option for you.

Answer: If someone is pushing just one type of product, then I would be a little bit skeptical. I try to always show people both options that they have and the pros and cons of both. Then they can decide for themselves what is best for their situation.

Answer: If you are currently getting Social Security and you are being billed for part B for the Medicare, I would call Social Security and make sure that they are deducting that part B premium out of your Social Security check. That normally should be happening.

Answer: It depends on the medication that you take. If it is covered under the formulary of the company you chose then you will have a great experience. If you need to get a pre authorization then that will be a more tedious situation but it is possible to get it covered depending on how much time your doctors office wants to spend on your case to fight for the coverage of the medication.

Answer: I listen to a weekly podcast that does a deep dive on the news and notes of the industry. I just got back from an insurance conference in Las Vegas to keep me up to date and make connections. Because of the way the industry is constantly changing you have to keep up to date of you will be left behind.

Answer: Part A covers hospital and Part B covers medical. Think of part A as the physical side of coverage and part B is the human side. Part B will cover the doctors fees and Part A will cover the facilities and other such fees.

Answer: Many seniors don't know how to enroll in part B for medicare when they retire or turn 65. The government doesn't make the steps very clear. For this reason it is important to align yourself with an agent that has experience in the field. Most people don't know that your need to be starting the process of applying for medicare 3-4 months before you want it to go into effect. Because of this many seniors are rushed into a decision that they may not be comfortable with.

Answer: Yes, the cost for the part D plans did go up and the deductibles are very high but it will reduce what you pay for medications only if you take name brand drugs. If you don't take non generic drugs then you can get away with getting on the cheapest plan available.

Lets say that you take a drug that costs $500 retail. The first month on the plan you would pay your deductible and then a copay of around $45. The next three months you would just pay the $45 copay. Then for the rest of the year that medication should be free because you have hit your $2000 max drug coverage.

Answer: Well that depends on a lot of factors. If you are not 65 then you don't have an option to get on medicare unless you are diagnosed with a disability.

If you are 65 and the your coverage will stop at 65 then you need to get on medicare part A and

B.

If you are 65 and the government is giving you lifetime coverage then you need to see if it is worth paying the medicare part B premium and adding medicare or just staying on your current coverage.

Answer: So the word premium refers to how much the plan will cost you every month. Generally they are zero or no premium plans but there are some that will cost anywhere from $33-100. This is the cost to subscribe in the plan.

Zero cost can refer to the plan premium but some people get that confused with the plan copays when you use the plan for doctor visits. If someone uses the term zero cost I would clarify if they are talking about the cost to be on the plan or the copays when you use the plan.

Answer: The way it will change the coverage is dramatic. If you take expensive brand name drugs you will see a large difference in how much you pay. You will pay thousands less every year now.

Because of this change the insurance companies had to take some of the money they use for medical benefits to increase the coverage for the RX plan. You will notice higher medical copays.

If you only get a stand alone RX plan then your plan cost will be much higher than in the past.

Answer: Just this past month I was able to sign up two ladies that had major problems applying for Medicare part B. I probably spent over 15 hours with them calling social security to get them on the part B of Medicare. I was persistent when they wanted to quit and we finally got it done.

Answer: All agents local and remote can look up a doctor or medications for you. The real value in seeing a local agent is that they know the local networks of doctors and dentists that take the plan and a good agent can make recommendations because they have actual relationships with local physicians.

It’s also nice to have someone that can drop off books and information to your home if they are close enough.