Lauryn Ivey, Medicare Insurance Broker

Answer: Whatever your Advantage Plan lists for you copay is all you would be responsible for. Your Advantage Plan takes the place of Original Medicare so, that means your are no longer subject to those deductibles and percentages, only what is listed in your Summary of Benefits for the Advantage Plan, that is all you pay.

Answer: If you have plan F you do not have any co-pays. Medicare pays 80% of that bill and then your carrier that you have the Plan F through pays the other 20% of that bill.

Answer: Because it did away with the Coverge Gap, also called the Donut Hole. Basically the Coverage Gap caused you to pay a lot more for your drugs, for instance after the combined spending on your covered drugs reached a certain dollar amount (several thousand dollars) you then had to pay up to 25% of the drug manufacturers cost of the drug until that combined total reached closer to $8,000, then your copays would go back down, and that was called the catastrophic stage.

So, with now having a “cap” called a maximum out of pocket dollar amount, it can save you money, especially if you take a lot of named brand drugs.

In 2026 that cap will be $2,100, it is currently $2,000 in 2025, and Medicare determines that cap amount annually. If you ever reach the “cap” dollar amount (includes the deductible and your copays, but not any of the premiums) you pay zero for your medications, the plan you have has to cover that over and above costs, this is still called the catastrophic stage.

Answer: To ensure you completely understand what Medicare is and what it does and what it does not do. To see all of your other options. To understand there can be penalties, that would never go away, if you don’t have correct coverage. You can never have too much information. Agents are licensed, certified and trained annually to know all the ins and outs of Medicare and Medicare type plans. What worked for a friend or family member may not be the best thing for you.

Answer: Basically a Medicare Broker is contracted to sale numerous insurance carrier’s plans, while a Medicare Agent may only be contracted with one carrier. There are occasions that an agent may have more than one carrier; but the basic and easiest answer to you question is a broker will have more plan options for you, and an agent may have limited plan options for you to choose from.

Answer: I conduct what I call a Medicare 101 class. I explain what Medicare is and is not. I explain what original Medicare covers, what each alphabet part is, A, B, D, and what they call Part C. I also explain how a Medicare Supplement Plan works, and I explain how the Medicare Advantage Plans work. I explain why a penalty could be assessed, and how to avoid them. I let them ask questions and I answer each question. I always want everyone to be educated so they can make the best decision for them, their needs, and their budget.

Answer: Sometimes their friends or family persuade them to do whatever that did, and the plans are not a one size fits all. There are doctors, medications, and budgets to consider. Sometimes they see something on TV and they think it sounds good but unfortunately that’s not always the case. A local agent will always know more about the plans in the area where you live than any 1-800 number telemarketer ever could.

Answer: The red flag is that called you period. Unless you filled out a reply card and mailed it back, that’s really the only way an agent is authorized to call you about Medicare. So if you did not give someone written authorization to contact you, they are not allowed to call or knock on your door. If someone does, I encourage you to ask for their NPN number and call Medicare and file a complaint. That is the only way the industry can stop dishonest agents from trying to scam you.

Try to find a local agent that is contracted with multiple carriers so that you can make sure you get a fair review of all your options, and that they explain it in detail.

If you don’t recognize the number don’t answer the phone. That’s the best advice I can give a Medicare beneficiary.

Answer: There is not a lot of difference between a stand alone prescription drug plan and an advantage plan. Medicare regulates how they work, from deductibles, initial coverage stage, and catastrophic stage. Each carrier regulates their own formulary, which means what they cover and what tier they classify the drug at. The higher the tier the higher the cost of the drug and your copays. An agent needs to sit down with you and enter all of your drugs and show you all of your options. There is no way I can answer this question without knowing the drugs you are currently prescribed. But I strongly suggest letting an agent review your medications and explain your options; because if you drop your advantage plan then you are back to original Medicare and for Part B you will pay 20% of the bills after a deductible, as well as Part A deductibles. So it’s not just about your drug plan.

Answer: A Medigap plan is a secondary insurance plan. It is not regulated by Medicare, in Alabama it’s regulated by the Alabama Department of Insurance. Medigap Plans are issued by independent insurance companies they only cover where Medicare stops; like the 20% you would be responsible to pay after Medicare pays their 80% on Part B charges. It has nothing to do with paying into Medicare for years, because the Medigap Plan is not Medicare. The Medigap Plan is an independent company that sets its own rules, regulations, and policies; so, the only guaranteed issue periods are when you first become eligible for Medicare, or once you retire and pick up Part B if you worked past 65 years of age. So, if you are not in a guaranteed issue period, the Medigap Plan application goes through underwriting and there are health questions. If you have one of the companies disqualifying health conditions or medications they can and will deny the application. You would want to work with a licensed agent because each Medigap Plan has different underwriting guidelines, so an agent could help you find one that you would qualify for.

Answer: For 2025, if you reach a true out of pocket expense that totals $2,000 then you don’t pay anything else for the rest of the year. This $2,000 includes your copays and any deductible that may apply to your plan. Without knowing your plan and which medications you currently take that is as specific as I can be to your question, because plans vary and the deductible may or may not have to be paid by you depending on the tier drugs you take.

Answer: You can apply for your State Medicaid assistance, known as the Medicare Savings Program. Each state calls it something different. In Alabama it is Alabama Medicaid, and I believe in Tennessee it’s called TennCare. They set the income limits for you to qualify and it changes yearly. In Alabama it pays your part B premium currently in 2025.

Answer: A good agent should explain your options. They should explain what you get if you were to choose Medicare only. They should explain a Medigap/Supplement Plan as well as which plans are available in your coverage area. Then they should explain how Medicare Advantage Plans work. Then they should let you ask questions and they should answer them without leading you one way or the other. I go as far as explaining the pros and cons for each so that my customers have a full understanding; because it’s your healthcare insurance, not mine. I would be concerned if I felt like I was being pushed or pulled towards one or the other. I think you need to consider the costs, your budget, and your current health to determine what’s best for you.

Answer: In Alabama you get an Annual Enrollment Period from October 15th through December 7th every year and the plan would become effective and stay in place for the entire year (January 1st through December 31st). There are very few Special Election Periods to make changes through the year and you have to have a qualifying reason to be able to use those Special Election Periods, such as moving.

So, the short answer is you are locked in for the duration of the year until the Annual Enrollment Period to make any changes for the next years plan.

Answer: Medicare Advantage Plans vary. That’s why it is important to make sure the agent that you are working with is contracted with every carrier in your area; so that you get the absolute best plan to fit your needs. If an agent is not contracted and certified with each carrier in your area then you are not getting to see every plan on the market, they can only write the plans that they are contracted with. If you are trying to navigate all the plans in your area online by yourself then it’s hard to review that many plans by yourself. I am so sorry you didn’t get the plan with the benefits that you wanted and needed.

I highly recommend shopping for a local agent and then ask them how many carriers they are contracted with. If it’s only one or two, you will want to keep looking for an agent that has at least 5 or more carriers that they represent. And make sure that agent does a detailed review of your doctors, medications, and the plans benefits and make sure they know what other extra benefits are of importance to you like the dental and vision.

Answer: You can use Form SSA-44, Medicare Income-Related Monthly Adjustment Amount (Life-Changing Event) and file that with your Social Security Office with the supporting documentation that shows your income reduction. Also, if you have an accountant or tax professional that you already work with, they can assist you with this form because they do this on a regular basis. You should also be able to Google the above referenced form, or go to SSA.gov and navigate their website to locate the form.

Answer: Medicare Part B would offer counseling sessions to assist with smoking cessation, and Part D would cover any prescription medications prescribed to help with stopping smoking; but you would need to verify that the Part D insurer coveres whatever is prescribed, as they are independent companies and their formularies vary from one company to the next.

Answer: Original Medicare is not better than an Advantage Plan. Original Medicare does not include a drug plan, it doesn’t offer dental or vision coverage. Medicare Advantage Plans vary, but there are several that include your drug plan, and offer some vision and dental allowance, and most have the time have no additional premium. But you should let a licensed, certified agent assist you to ensure that you select a plan that is best suited for you and your needs to ensure that you have selected a Medicare Advantage Plan that has everything that you want and need. There are numerous plans on the market and each is designed and tailored for people with various needs, for instance Military Veterans have a specific type of plan designed for their needs. If you are not a Veteran, that would most likely not be a good fit for you.

Answer: Yes, under Original Medicare, Part B covers preventative screenings, shots, and exams. So no matter what option you decide when it comes to Medicare, currently in 2025, preventative screenings are covered.

Answer: Find an agent that will conduct a free Medicare 101 class. This should include what Medicare is, what it covers and what it does not cover. It should include what a Medicare Supplement is and how it works with Original Medicare, and also information about prescription drug plans. Lastly, it should also explain what a Medicare Advantage Plan is and how it works. There are also other additional plans on the market that should be explained, so that you have a full picture of what is available so that later you don’t find out you weren’t told and have missed something that could be very beneficial, such as a Hospital Indemnity Plan. But primarily Original Medicare, Supplements, drug plans, and Medicare Advantage Plans are a must to understand so that you can make the absolute best decision for you.

Answer: I don’t believe there is a trap. If your agent has done their job and explained how they work and also explained your other options then you can make a truly educated decision based on your specific needs.

Answer: I believe a common myth is that Medicare Advantage plans are bad. There are pros and cons to everything. Having Medicare only, pros and cons, Supplements aka Medigaps there are also pros and cons. Some agents are only writing Supplements, so why would they want to tell anyone about another option. I believe in giving my customers the unbiased pros and cons about every option and then let them decide what fits their specific needs.

Answer: Unfortunately, I don’t have an answer for this. One would want to assume that the government would find a way, pass new legislation, or something to ensure Americans did not lose this benefit. This comes down to elected officials and their agendas and therefore, I don’t think anyone has a definitive answer.

Answer: I enjoy helping people. If I had questions, I would want to find a trusted, reliable source to get those answers, and that's what I like about being an agent. I can be that source for others. I would encourage someone looking for a Medicare advisor to make sure that they are not pulling or pushing you. Preferrable contracted with every carrier in your area so that you can weigh all of the options available to you.