Kim Mitchell-Hargis, Medicare Insurance Broker

Answer: If you are turning 65 next month the first thing you need to know is if you are currently working and not taking your Social Security, you need to go to SSA.gov website and apply for your Medicare.

If you are collecting Social Security, your Medicare card will come to you automatically.

You have 3 months before your birthday, the month of your birthday, and 3 months after your birthday to enroll in a Medicare plan.

The next thing is to call an insurance broker like myself to come and determine which plan is best for your needs.

The last thing is that you will receive a bill for your Medicare in the mail. The first bill if you are new to Medicare, will be for a quarter of the year. That bill usually hurts the wallet since it is a big one. Once you are enrolled in either a Medicare Supplement or Medicare Advantage plans your payment will be monthly.

Answer: Yes. Every year in the month of September, the notice comes out.

Just be sure to check all mail, including mail that might look like junk mail.

Answer: Each year you may change your plan if you decide to. During AEP, is Annual Enrollment Period and that time is from October 15 to December 7 every year. That change will take place on January 1st of the following year.

Another time you are able to change plans if you are currently on a Medicare Advantage Plan is OEP, which is Open Enrollment Period. This time starts January 1st and goes to March 31st.

This time is for people who got into a plan they now do not like can switch to another Medicare Advantage plan.

Answer: So the question is, what is the best way to compare Medicare plans? The way I do it is the most unbiased way. I go to medicare.gov. You put in your zip code, and after you put in your zip code, it will ask if you get any extra help. If you do not get any extra help, you just put "No." It asks if you want to look up prescriptions. Of course, you want to look up prescriptions. So whatever prescriptions your parents are on or your family members are on, bring out the prescriptions, and you're gonna go to Medicare Advantage plans. You're gonna look up the plans. You're going to put in the prescriptions, and then by your zip code, it might come up with ten. It could come up with thirty-five. You just go through those plans and make sure it has RX so that you're getting a Medicare Advantage plan with prescriptions. And that's how you check. It's the most unbiased website, mostly up to date. So prescriptions are usually updated and in there. It will let you know you can pick three plans, and then it compares them for you. It tells you what you're going to pay and what your prescriptions are going to cost on that plan. And that's what I would do: medicare.gov.

Answer: So the question is, what Medicare penalties are most common? As far as I can tell, the most common penalty is if you don't sign up for Part D when you get your A and B. So say you go into the Social Security office, you sign up for Part A and Part B. It's not their job necessarily to tell you you have to have Part D. So a lot of people don't know that, and they don't apply.

So Part D is your drug plan. Part A is your hospital coverage. Part B, as in Bravo or Boy, is your doctor coverage. There is a fee for Part B, but there is no fee for Part A. If you start with original Medicare and go right to a Medicare Advantage plan, your Part D is included in almost all of the Medicare Advantage plans. You just have to make sure you get into one that has no plan included. Otherwise, you have to make sure you get Part D.

So if you stay on original Medicare, you will have to call an agent for Humana, United, or whoever you like, or whoever has your prescriptions that you're on. You call them directly and you get on a Part D plan there. Anywhere from, and this is 2025, Part D plans are anywhere from $13 to $113, just based on what prescriptions you take. But yeah, the Part D penalty is probably one of the more popular penalties.

Answer: So the question is, should I sign my parents up for Medicare? Your parents will be signed up automatically if they're already collecting their Social Security 2 to 3 months before they turn 65. They'll get their red, white, and blue Medicare card, which will say Part A and then the date they start Part B, the date it starts. The only time you have to enroll your parents is if they are still working and not collecting Social Security. Then you'll need to go to the Medicare site and click on apply for A and B, or you can go to the magnifying glass and put in applying for Medicare A and B. Or you can go to the ssa.gov website, which will also tell you how to sign up. But yeah, your parents, you don't need to sign them up. It's automatic if they're getting Social Security. Otherwise, they will need to be signed up through the Medicare website. Or you can go into the Social Security office and apply there.

Answer: Original Medicare does NOT cover any Dental. No cleanings, no x-rays... NO dental.

Most Medicare Advantage plans cover preventive dental.

**Original Medicare has no extra benefits built in. The Medicare Advantage plans, for the most part, have Dental, Vision and Hearing benefits.

Answer: The PPO plans are advantageous to people who don't want to get a referral. Those who travel a lot and people who have a lot of specialists and need the PPO network.

PPO plans have higher copays and if you do go out of network, you will pay a higher rate.

That is the benefit of having a PPO is that you do have access to out of network. An HMO you cannot go out of network. It is your choice... but one that can cost you more if you go with the PPO and go out of the network.

Answer: When you have an HMO plan, you have to stay in network. So you would pay the full price of the cardiologist bill.

Answer: Most Medicare Advantage plans have extra's like Dental, Vision, Hearing and gym memberships. Depending on which state and which plan will determine if you get OTC, Chiropractic, Acupuncture, home care, food cards, and more.

Answer: This is currently July of 2025 and you cannot change plans unless you have a special election period. That could mean you lose employer coverage or perhaps move out of the county you live in currently. You need an SEP to change until October 15th when AEP begins.

Answer: The Inflation Reduction Act created a max out of pocket for prescription drugs of $2,000 annually. This was $8,000 total max out of pocket for the year 2024. That means once you spend the $2,000 on your prescriptions, you pay no more the rest of the year.

So, no lower costs on the prescription per say.

Answer: Some Medicare Advantage plans have a $0 premium... we as agents are not going to tell you they are free. There is no premium.

Some plans do have a premium. All states and all insurance carriers offer different plans and different premiums.

Answer: The financial risk is huge if you only have Original Medicare. Original Medicare is $185 a month for the year 2025 (based on earnings). There is no Prescription Drug coverage and no max out of pocket. You could go broke with hospital and doctor visits if something very serious medically happened to you.

The Medigap plan would cost you anywhere from $150** a month to $250 (for 65 years old)*** plus the drug plan which could be as low as $35 **a month and then add the $185 a month for the part B that you must pay. But, the Medigap plan will benefit you and keep you from going bankrupt.

**This is just an estimate. Plans vary based on age/location/and what type of plan you choose. Also important is make sure you can afford the monthly payment based on your budget. My members pay on average $450-$500 a month total for their Medigap plan.

***If you are under 65 years old and eligible for Medicare the prices for a Medigap plan are substantially higher.

Answer: Medicare cannot drop you for health reasons. They can drop you for not paying your Part B or your premiums (if you pay a monthly premium).

Answer: The question about Medicare Advantage plans taking over the system. I am not sure what system you are referring to. Your options are original Medicare, Medicare Advantage and Medicare Supplement plans unless you have an employer sponsored plan. Medicare Advantage plans exist because they are in demand. The competition between the insurance carriers causes an increased number of plans to choose from. It can be a good thing because they offer so many benefits and hopefully a plan that will work for every situation.

Answer: Yes. Dental plans are generally preventive only. The majority of the Advantage plans give $1,000-$1,500 unless you are Medicaid-Medicare.

Answer: There is no need to worry about the "donut hole" as it does not exist anymore. Once you spend $2,000 in prescription drugs you pay no more the rest of the year.

Answer: Medicare Advantage plans have what they call preventive services. One free wellness check (physical) is permitted each year. If you got billed for it, it is possible you used your free one.

The other possibility is your plan did not offer a no cost annual physical.

Answer: I personally do not see a disadvantage when it comes to Medicare Advantage compared to Original Medicare. Original Medicare has no max out of pocket and no extra benefits. No drug plan is included. Medicare Advantage has a max out of pocket, drug plan, and lot's of extras including some plans giving gym memberships, dental, vision, and hearing.

Answer: Original Medicare does NOT cover hearing aids. Most Medicare Advantage plans do cover hearing aids. You will have to pay a copay for each ear.

Answer: Medicare Part D is prescription drugs.

When you go on Original Medicare, you must get a Medicare Part D plan. Original Medicare doesn’t include a drug benefit.

Most Medicare Advantage plans have the Part D built in.

Answer: Call the Medicare 1-800-MEDICARE helpline.

You can also report it online through Medicare.gov or through the Internet Crime Complaint Center

Answer: When the member/beneficiary doesn’t have internet. And when they don’t know their password. Makes it difficult to do a good job.

Answer: It's heading toward all digital and no more paper. No paper enrollment kits, no paper applications. All digital.

Answer: Some Medicare Advantage plans have telehealth for specialists. It just depends on the insurance carrier. You could check it out on Medicare.gov website.

Answer: Yessss. Original Medicare has NO max out of pocket meaning you could go broke with the 80/20 split.

Answer: If you can afford the monthly payment, a Medigap plan is the route I would recommend. When you turn 65 is the best rates and guaranteed issue when aging in. If you’re younger than 65 and not on Medicare, it’s quite expensive.

Answer: The Inflation Reduction Act’s changed what plans offered as far as extras. The OTC, food cards are a couple things affected by the IRA. The insurance companies lost a lot of funds due to the prescription max out of pocket going down to $2000 for the year. The Medicare Advantage plans are as good as ever as far as benefits.