Joseph Bachmeier, Medicare Insurance Agent

Answer: This question is pretty easy to answer. Most people who ignore a broker's advice usually take what their friend said is the best. Although that plan may be best for your friend it absolutely does not mean it is best for you.

Next time your friend say's you should sign up for their plan, ask them if they completed their 24-hour continuing education, or their annual HIIPA training which consists of new regulations etc. Also ask them if their drug needs are exactly your drug needs.

These are just a few examples of why you should not take your friend's or doctor's advice on which plan is best for you.

Most insurance brokers have your best interest at heart. That is why we are appointed with multiple carriers, so we don't bang a square peg in a round hole for all. If you feel the broker you are talking to does not have your best interest then move on to another broker. We are here to help you. I lifelong client is definitely better than a short-term client.

Answer: Your knee replacement is covered. Medicare will cover 80% and your supplement will cover the other 20% after your $257 deductible

Answer: It is not just talk, it’s really happening. However the drug or drugs must covered in the Medicare formulary. If the drug is not covered then you can expect to pay full cost.

Answer: One, no one should ever pick a plan because their "friends" say it's better. I cannot tell you how many people made that mistake. Medicare insurance needs are different for everyone.

Two, she should be concerned about her doctors accepting the insurance because Medicare Advantage plans are network plans. But that is why you have me as a broker to check all the networks to make sure your doctors accept the plan you may be switching to.

Answer: The biggest change in 2025 was closing the coverage gap also known as the "Donut Hole".

If your drugs are covered under your plan's formulary then you will spend no more than $2000 per year, no matter how expensive your prescriptions are. That is great news for folks who have been spending 4,5, 6 even 7 thousand a year. However, if you are taking a very expensive drug that is not covered under the Medicare formulary you could end up spending more than the 2K cap.

Answer: One of the questions is, "Are Medicare Advantage plans really free?" Technically, no, because the Part B premium that you pay once a month comes out of your Social Security, or if you pay quarterly, it goes right over to the Medicare Advantage plan. Basically, you're subsidizing your own plan. Years ago, Medicare Advantage plans all had monthly premiums, but right now there's such a big market for them, and they're all competing against each other. Most of these plans have zero premium a month, where you don't pay a monthly premium. If you're looking at a Medicare Advantage plan, that's one of the plans I would consider.

However, you do also have a lot of copays. If you see a specialist, it's usually on average about $30, depending on the plan. For inpatient hospital stays, you're looking at around $250 each day for days one through seven, and again, that varies per plan. Your outpatient procedures are usually $400, MRIs are $200 to $400, an ambulance ride is $250, and the emergency room is about $100. So, you are paying into the plan as you use it. If you remain healthy for the rest of your life, well, guess what? You will win because you will not incur all those out-of-pocket costs.

These are the differences I explain between original Medicare and a Medigap plan compared to having a Medicare Advantage plan. Hopefully, when I explain the differences, you can choose what's best for you. I hope that helps, and if you have any other questions, just reach out to me. Have a great day! Take care.

Answer: One of the questions that I'm asked quite often is, “What am I not thinking about in regards to Medicare?” Is there something that I'm missing, some information? A lot of folks think that long-term care is covered under Medicare or Medicare Advantage plans, and it's not. Medicare will cover some skilled nursing care. Skilled nursing care is the care around the clock, 24 hours a day, that is required, and it has to be prescribed by your doctor. It's only covered for a certain amount of days. Custodial and intermediate care is care that most people fall into after their hospital stay, and that's the care most people do need. Unfortunately, Medicare doesn't cover that care, but that's where you would get a post-hospital care plan. There are some really good carriers out there like UnitedHealthcare and Aetna who offer those plans and will cover that benefit. So that's a big thing with post-hospital care. A lot of people don't think about it. They think that once they're done in the hospital, they're good to go, but there's a lot of care that is needed after your hospital stay. Some carriers have some really good products and plans that can cover that benefit. I hope that helps, and talk to you soon. Have a great day.

Answer: Hello everybody. A big question that someone asked is why should you work with a Medicare broker? The good thing about a broker compared to a captive agent, and I worked as a captive agent many years ago, is that I could only sell one carrier. If you didn't fit that profile for that carrier, or if that plan wasn't the best, that's the only thing I was able to offer you. In some cases, some captive agents push people into that product. The great thing about being a broker is I basically work for you. My concern is not with the carriers; my concern is with you, the client. I'm able to shop you around to every single carrier out there and get you the plan that makes the most sense for you. If we need to make changes down the road, we do that. But that's one of the best reasons to work with a broker. You're not paying me personally; I get paid by the insurance carriers. So, that's another thing you don't have to worry about. My services come free, and you decide what you want to do with that information. I hope that helps. Have a great day.

Answer: The best thing to do is have a licensed broker review the coverage for you. There are numerous Part D drug plans that are offered, but all offer different pricing for their formularies. As a broker for my clients, I offer a free review for their prescription coverage annually during the Annual Enrollment Period to help them fray expensive costs for their prescriptions. I try to place them with the most cost-effective plan for the new year.

Answer: If you have a Medicare Advantage HMO plan, then you need to use the doctors in the Network. If you have a PPO plan, you can use Medicare doctors outside the network, but you can expect to pay 40% out of pocket costs for services. If you have a Medigap plan, Original Medicare is your primary insurance. With Original Medicare you can use any doctor or hospital in the United States who accepts Medicare.

Answer: You will be considered “guaranteed issue” as long as your employer coverage is considered credible coverage, which in most cases it is. There are a few other instances where you can be considered guaranteed issue.

Answer: With Medicare Advantage plans you have worldwide emergency coverage. That is strictly emergency only.

With most Medigap plans you have $50,000 of foreign travel money to use. Basically, it is enough money to get stabilized if something were to happen and get you back to the United States for your Medicare coverage.

Answer: If you do not sign up for Part B or Part within a certain period of time of your credible coverage ending you end up with a lifelong penalty for Part D. It is 1% for every month you don't sign up.

Answer: Technology has already had a hand in Medicare insurance. There are certain carriers who do their underwriting online immediately after I complete their application. We have seen more signs of the technology being used every year.

Answer: They do not affect your Medicare insurance and they do not help your Medicare insurance.

Discount cards and programs line GoodRx are separate programs that work very well with purchasing inexpensive generic drugs in case you didn’t have a Part D drug plan.

Answer: If you have a Medicare Advantage plan and never use it too much it could save you a lot of money. Most Advantage plans I sell are $0 premium a month. However, if you have a lot of chronic conditions and see medical providers often it could cost you a lot of out of pocket expenses. The good thing though there are out-of-pocket maximums on Advantage plans

Answer: Anyone who qualifies for Medicare disability

You have an open enrollment period and you have another enrollment period at age 65

Answer: The biggest mistake I find is that they choose the same policy their friend purchased. What is good for someone else may not be good for you. This goes with Part D drug plans also. I’ve seen a lot of people cost themselves a lot of extra out of pocket expenses because they didn’t sit down with a broker. Brokers should have your best interest at heart. Personally, I don’t represent the insurance carriers, I represent you. If I represent you then you’ll more than likely stay a loyal client and will tell all your friends about me. You don’t pay me for my services, the carriers do, so take advantage of my assistance.

Answer: That is a great question. There a few Medigap carriers who will give you a discount on your premium. I just visited a new client today and she has an Apple Watch and will get a monthly discount. This carrier I just sold gives you a discount if you have an Apple Watch or a Fitbit.

Answer: When new Medicare prospects call me, I advise them to sign up for Medicare Part B two months before their start date, so it leaves plenty of time to generate a Medicare number and start date.

Answer: That is something you want your Medicare agent to advise you on. In some cases, you may fall into a Special Election Period. But for the most part before you purchase an Advantage Plan you will want your broker to check the network for your hospital and doctors.

Answer: It is very important to a lot of folks who in years past have spent thousands of dollars a year for expensive tier 3 drugs. I've had so many clients who spent over $7,000 a year in drug costs. The $2000 out-of-pocket is not perfect but at least it is a start to help seniors with large out-of-pockets costs.

Answer: If you have an agent who pushes any certain plan you should be skeptical, and the said agent is probably not looking out for your best interest. No one plan is perfect for everyone. You need to know the differences between Original Medicare and Medicare Advantage plans and how they could affect your healthcare.

Answer: Medicare Part B is the medical portion of Medicare. It is not enough to cover all costs because if you do not have a Medigap plan you would be responsible for 20% of the medical costs you incure.

Answer: In most cases you do not need to worry as much if you have a Medigap plan. The change in your health could affect your medical costs under a Medicare Advantage plan or your Part D drug plan.

Answer: Some seniors think that Original Medicare covers all aspects of post hospital care. That is not the case. Original Medicare only covers "Skilled Nursing Care" and only for a certain period of time. Occupational and speech therapy is post-hospital care most people need but is only covered under Long-Term and Short-Term care plans.

Answer: That depends on what you want to get out of your Medicare plan. Some people don't mind paying a higher premium with little to no copays. Some people would rather have a lower monthly premium and don't mind the copays associated with the plan. I review all aspects with my clients so they can make the best decision for themselves.

Answer: As a broker I review my clients drug plans on an annual basis. I do so because the drug plans change such as your monthly premium, the deductible and the copays. Sometimes the formularies change. You get an annual letter in October which is usually titled "Notice of Change" explaining any changes to your plan for the forthcoming year.

As a broker I email all my clients once in September and once in October reminding them about the upcoming Annual Enrollment Period, and to reach out to me with their updated scripts so I can review their coverage and suggest any changes they may need to make.

Answer: You do fall into a Special Enrollment period. You will have 60-days to choose Original Medicare with a Part D drug plan or enroll into a Medicare Advantage plan.

Answer: If you currently have a Medicare Advantage plan and you move to a new state, you will fall into a Special Election Period you will have 60-days to enroll into a new plan.

If you are enrolled in a Medigap plan, in most cases you do not need to change. However, you may decide to do so if you can get a lower premium.

Answer: In most cases you do but you can switch any time during the year, and you will not be held under the Annual Enrollment Period like you would for a Part D drug plan or Medicare Advantage plan. You may not need to answer underwriting questions if you fall into a Special Election period.

Answer: If you miss your window to sign up for Medicare can result in a penalty if over 60-days. You can still sign up for a Medigap plan but may have to answer underwriting questions.

Answer: Estimating your total Medicare costs will depend on how many doctor visits you have and the cost of any diabetic medicine you take which can be outlined in your Part D drug plan. I can provide you with a PDF outline of your costs.

Answer: Original Medicare will cover glaucoma eye exams because that is considered a medical condition . Original Medicare does not cover routine eye exams. Some Medicare Advantage plans will cover routine eye exams.

Answer: You will not incur a penalty as long as you have credible coverage such as an employer group plan. If you turn 65 and do not have credible coverage for over 60-days then you will incur a penalty.

Answer: I assist clients every day with questions on their Part D drug questions and just recently how Jefferson Health is not accepting the Cigna Commercial Network.

Answer: I would like seniors to ask information on the differences between Original Medicare and Medicare Advantage. I would like seniors to know how important long-term care and short-term insurance are.