Kip Nussbaum, Medicare Insurance Broker

Answer: Medicare Savings Programs (MSP's) can help with paying your Part A & B premiums and other cost shares like deductibles, coinsurance, and copays. You apply for this assistance through the state and your income must be low enough to qualify financially.

However, I will offer one word of caution. My experience is that many telemarketers will try to "bait" Medicare beneficiaries into switching plans by mentioning a "MSP" when in actuality it is a "Part B Giveback." A Part B giveback is where the actual insurance company covers part of the Part B cost (currently at $185 per month for 2025). This giveback is not part of any MSP and these plans usually have reduced allowances for the "extras" like dental, vision, hearing, OTC, etc. And generally the copays and annual maximum out of pocket (MOOP) on giveback plans are much higher than a non-giveback advantage plan would be.

Answer: I guess the short and simple answer is I enjoying helping people. My degree is in education and I've always enjoyed teaching in one form or another (whether it's coaching sports or helping people understand how taxes work). It is very rewarding when a Medicare beneficiary tells me "I don't understand any part of how Medicare works" and then seeing the calm and relief after we discuss in depth how the different pieces fit together.

Answer: First off, and I feel MOST IMPORTANTLY from my experience from meeting with hundreds and hundreds of prospects/clients, is to work with someone LOCAL to you. DO NOT enroll in a plan over the phone. And I say that for multiple reasons:

First, many of these "agents" are captive with one company and only have an interest in enrolling you in one of their companies plans. That means they are not shopping the broader market place to find what fits you best regarding costs, coverage, etc.

Secondly, too many times these agents will ONLY tell you about all the great things their plan has to offer. They don't tell you what other things you are giving up or how much higher the copays, cost shares, and maximum out of pocket is.

You need an agent who is willing to see you every year to shop the marketplace and find a plan that fits you best in your area.

Answer: For some folks on expensive drugs, the old model had no cap on drug expenses. This means that after they would go through the "donut hole" and into catastrophic coverage, they would have paid out of their pocket $7,400 or more per year on drugs. This $2,000 cap is a huge help to older adults who are getting by on a fixed income.

Answer: A couple of things to think about here. If you work with a competent and trusted broker, there shouldn't really be any "stress" over picking a plan. Usually upon comparing the costs and benefits of the available plans, most of them get weeded out on their own merit. The other thing is, you COULD choose to just purchase a Medigap or "supplement" plan (assuming you are able to qualify medically) and that avoids any of the "shopping" in the Fall. However, those plans come at a price as well. They all will have a monthly premium which, by the way, will increase every year due to your age. And you will most likely need to purchase a Part D drug plan which will still require some "shopping" every year. Just find a trusted broker who will treat you as a valuable client and not a number. This should eliminate most of your stress.

Answer: If you are on Original Medicare only, then yes, you would have to meet your deductible first ($257 for 2025). Upon meeting your deductible, Medicare would cover 80% of the visit and you would be responsible for 20%.

If you are on Original Medicare with a supplemental plan, some plans cover the Part B deductible but most do not.

If you are on Medicare with and Advantage Plan (also called Part C), most plans simply have a copay for your visit. Some plans (a limited amount in my area) do have a medical deductible but like I said, most just have a set copay amount.

Answer: An Advantage HMO will require that you must get all of your services from in network providers. If you want the ability to see providers that are out of network and still have it be covered, but generally at a higher cost to you than and HMO, you will need to select an Advantage PPO plan instead. The downside of the PPO plans are that generally the copays and cost shares are higher, along with the annual maximum out of pocket. They tend to also have smaller allowances for extra benefits such as dental, vision, hearing, OTC, etc.

Answer: The premiums and benefits are based on zip code and are higher in some areas than in others. In my area in Ohio, Advantage plans tend to be less in more densely populated areas with greater access to many different medical providers, and more expensive in the more rural areas with less providers. Also, it depends on the actual plan. It could be that your friend has a $0 premium Advantage plan while you are on Original Medicare with a Medigap plan. More information is needed.

Answer: I wouldn't call it a rule or regulation that is outdated. I would call it one that does not exist. Medicare needs to REQUIRE the insurance companies and doctors/facilities to sign network contracts with a January 1 effective date. This way the beneficiary would be certain that they will not lose their doctor part way through the year. It is not fair to seniors to pick a plan in the Fall, have plan start on January 1, only to be told part way through the year that their doctors or local hospital will no longer be in network. This does not open a special election period to change plans and forces the patient to find care from a different in-network provider.

Answer: Medicare does not cover drugs for weight loss. Ozempic is approved for the treatment of type 2 diabetes and may be covered if prescribed to control blood glucose levels. Taking Ozempic may result in weight loss but will not be covered if prescribed for weight loss.

Answer: A Medicare agent should not “push” one product over another. It is best to explain how the different products work and let the beneficiary decide which best suits their budget and lifestyle.

With that being said, if an agent “pushes” an advantage plan over a Medigap plan, it COULD be for selfish reasons. The advantage plan would have higher compensation for the agent.