Joseph Bachmeier, Medicare Insurance Agent

What's one piece of advice you wish every senior knew before picking a Medicare plan?

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.

Can you describe a time when you helped a client navigate a complex Medicare issue?

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.

Will I be penalized if I do not enroll in Medicare when I turn 65?

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.

Does Medicare cover eye exams, or are seniors left paying too much?

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.

How can I estimate my total Medicare costs if I have a chronic condition like diabetes?

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.

What if I missed my window to sign up?

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.

Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?

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.

How does moving to a new state affect my Medicare enrollment timeline?

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.

Am I eligible for a Special Enrollment Period if I lose employer coverage?

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.

I've been on a Part D plan for a while, and I'm wondering why my generic prescriptions suddenly cost more. Did something change?

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.

Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?

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.

What do seniors often misunderstand about Medicare's coverage for long-term care?

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.

I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?

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.

What does Medicare Part B cover? Is it enough?

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.

Why do some agents push Medicare Advantage plans over Medigap-should I be skeptical?

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.

Why is the new $2,000 out-of-pocket maximum for drug costs important?

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.

What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?

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.

Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?

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.

How will advancements in wearable health tech (like smartwatches) integrate with Medicare?

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.

What is the biggest mistake seniors make when enrolling in Medicare?

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.

Who qualifies for Medicare coverage if they are under 65?

Answer: Anyone who qualifies for Medicare disability

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

Do Medicare Advantage plans save money?

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

How do discount cards and resources affect my Medicare Prescription Drug plan?

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.

What role do you think technology will play in the future of Medicare?

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.

Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?

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.

What additional coverage options are available for international travelers?

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.

Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?

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.

What's the key difference in how Medicare Advantage and Medigap handle out-of-network providers?

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.

I have multiple medications; how can I ensure my Medicare Part D plan covers them all without breaking the bank?

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.

What are the reasons why I should work with a Medicare agent?

What's the most important question I should be asking about Medicare that I probably haven't thought of yet?

Are Medicare Advantage plans really "free," or is that just clever marketing?

I keep hearing about Medicare Part D changes for 2025. Will these actually lower what I pay for my prescriptions?

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.

My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?

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.

So I heard something about Medicare drug costs being capped at $2,000 in 2025. Is that really happening or just talk?

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.