Lyle Affleck, Medicare Insurance Agent

Answer: Much like the plans offered through the Affordable Care Act (ACA), Medicare Advantage plans are seeing more of the cost of care being put on the consumer. Deductibles are increasing. Co-payments are increasing and co-insurances are going up. In many cases, this rise is outpacing inflation, so cost of living adjustments are not sufficient to keep things at low costs for individuals.

Answer: There are several reasons your Part B premiums have gone up. In 2023, Part B premiums averaged $164.90. Today, average premiums are $202.90. One of the biggest factors is that healthcare costs have increased dramatically over the last few years. There are more seniors entering the Medicare portal today more than ever. The federal government will try to compensate for this change every year by increasing the amount of social security beneficiaries to compensate for inflation or for the cost of living. Unfortunately, these increases are inevitable, but most Medicare recipients don't notice the increase because it is usually directly withdrawn out of their monthly social security payment.

Answer: The short answer to your question is "Yes!" You will have 3 months from your loss of coverage to get into a Medicare plan without any penalties. It is best to be proactive and have your plan set up so there is no break in coverage. If you know the date your retirement will start, reach out to a Medicare expert to formulate a plan.

Answer: If a Medicare recipient can plan for and cover the cost of a Medicare Supplement, that will always, in my opinion, win out over Medicare Advantage plans in terms of overall medical coverage. However, not everyone can afford the monthly premiums for a Medicare Supplement. Medicare recipients on Advantage plans would do well to get an indemnity policy. These plans would cover at least some of the major out of pocket expenses the Advantage plan does not cover. Some additional protection is better than the bare minimum offered through a Medicare Advantage plan on its own.

Answer: If you have a Medicare Advantage plan, the new benefits are usable effective January 1st. If you have a problem with the plan you were placed into, you can make a one-time change to a new MA plan between January 1st and March 31st.

Answer: If you are working with a Medicare specialist, reach out to them and have them help walk you through the process of getting it fixed. If you are on your own, call or chat with someone at medicare.gov. They can help you get it straightened out.

Answer: There are several ways to save on your prescription drug costs. First, make sure you revisit your drug plan every year. Formularies change. Deductibles and co-payments change. It is good to stay on top of all of these things.

Second, ask your doctor if there is a generic for the medication you are taking. Generics are generally less expensive and will save you a lot of money.

Third, make sure you communicate with your doctor. Sometimes a person might keep taking a drug they no longer need. Go over your medications with your doctor and make sure you are all on the same page.

Finally, make sure your preferred pharmacy is accepted by your prescription drug plan. Some pharmacies are considered "preferred" while others show as just "in network." If you stick to preferred pharmacies or get your drugs through mail order, you will often get better pricing. Overall, these are great suggestions to help you save more money. Being proactive about your medications can help you save money.

Answer: Medications are one of the major drivers behind rising costs in Medicare today. To help keep costs low, switch to generic medications whenever possible. If there is no generic brand, contact the drug manufacturer to see about grants or coupons that will help reduce the cost of the medicines you need. Ultimately, though, nothing beats a healthy lifestyle, so diet and exercise can really benefit your pocketbook and reduce your consumption of medications. As always, talk about these things with your doctor.

Answer: Medicare will cover your annual wellness visit, which covers things like your annual flu vaccinations. It is a time for you to discuss your medical needs or worries with your doctor. Your doctor will check your vision, hearing, reflexes, bloodwork and a lot more, making sure you are in as good of health as you can be.

Answer: You're right. It's all about the marketing. $0 plans are enticing, but it is important for you to understand what you are out of pocket costs are going to be when using those plans. Meet with a medicare professional that can walk you through your options and give you the right education, so you can make informed decisions about your health care.

Answer: There are a lot of opportunities to adjust your Medicare Advantage plan. After AEP ends in December, you u have open enrollment (January through March) to switch to another plan if you need to (a one-time allowance). Sometimes Special Enrollment Periods (SEPs) occur during the year that would allow you to adjust your coverage as well.

Answer: Income does not affect Medicare eligibility for any eligible recipient 65+. Higher income may mean higher rates on Part B premiums or on prescription drug plans. Have a conversation with a Medicare specialist to figure out what your costs would look like.

Answer: The most frustrating misconception about Medicare I deal with ALL the time is that "Medicare Advantage Plans are the only plans available" on the market. The truth is that Medicare Advantage plans are just getting the most advertising attention. There are reasons for that, and hopefully your Medicare insurance specialist will walk you through those reasons with honest explanations. We work to ensure that our clients are thoroughly educated.

Answer: Not only is it okay for you to meet with multiple Medicare brokers, but my agency encourages you to do so. It's okay for you to not just settle with the first broker you meet. Be picky and make sure the broker you work with gives you plenty of information and knowledge about your options. If they attempt to steer you toward one plan in particular (unless your specific needs warrant their reasoning), they are trying to sell you something, and that isn't always being done in your best interest. So shop around. Make who you decide to work with a conscious decision.

Answer: Medicare Advantage plans have both advantages and disadvantages. Among the disadvantages is the fact that MA plans often come with deductibles and co-pays. The average deductible (for 2025) is around $4,700. The deductible resets every January 1st.

Medicare Advantage plans will also restrict your access to certain medical networks, dictated by the issuing insurance carrier.

Answer: This is a question whose answer is different for every individual and is something better suited to ask a trusted financial advisor; not an insurance agent. In general, however, the longer an individual waits to collect their Social Security benefits, the higher the monthly payout becomes.

Answer: Due to the nature and design of Medigap plans, you do not have to change your insurance coverage, as long as you still hold onto your original Medicare. You may want to see if the costs will increase for your plan, though. Different service areas (determined by your ZIP code) could change the premium cost of your plan, even if the plan itself does not change.

Answer: I absolutely believe that the advertising of Medicare Advantage plans should be more closely regulated. I speak with a lot of seniors whose knowledge of what was available to them was grossly limited. They made poor decisions about their care based on the limited knowledge they had. Medicare Advantage plans are not always the best choice for people's care.

At the same time, I believe this is a problem, not with agents, but with the insurance carriers and their marketing tactics. I don't think this can be solved with another form agents have to get signed in order to conduct business (there are enough of those already). There needs to be more truth and transparency in the marketing of these products.

Answer: Under new rules, you may have to jump through a few hoops and get prior authorizations to increase the number and/or frequency of certain procedures (i.e. more frequent colonoscopies), but, in general, if your doctor says it is necessary for your health, they will be covered by your Medicare plan.

Answer: The short answer to this question is 'no." There is only one time when an individual can apply for a Medicare Supplement and not have to answer the medical questionnaire, and that is during the recipient's initial application process (the first time they are signing up for Medicare. You CAN switch from an advantage plan to a supplement, but you will HAVE to go through underwriting.

Answer: The 'donut hole' is no longer an issue when it comes to Medicare Part D (prescription drug) plans. During the Biden administration, CMS (Centers for Medicare & Medicaid Services) changed the way Part D plans were structured. They eliminated the dreaded 'donut hole' and capped the Maximum Out of Pocket (MOoP) for prescription drug plans at $2,000 (for 2025). Those MOoPs will likely increase year over year as will the premiums for the various prescription drug plans, but you won't have to worry about extra costs for receiving too many medications in a year.

Answer: To a limited extent, yes. If the ship is either in a US port, or within 6 hours of a US port, Medicare would cover at least SOME services received on a ship. Outside of those parameters, coverage cannot be guaranteed. It is advisable to look into international travel insurance or to get a Medicare Advantage or Medicare Supplement plan that includes international coverage.

Answer: As a Medicare recipient, your Original Medicare (Parts A & B) will cover you anywhere you go. But it is not designed to pay the entire bill. Medicare Advantage plans are designed to fill in the gaps the original Medicare leaves behind. But a lot of Medicare Advantage plans only offer regional coverage. If you seek care outside of your policy's coverage area, you would likely be denied coverage for those appointments. Having just original Medicare (Parts A&B) and a prescription drug plan (Part D) would be more beneficial in this scenario, though the coverage would not be complete.

Answer: To put it simply, no. Medicare Part A will only cover in-patient services offered through hospitals. Outpatient services (including those performed at surgical centers) are covered under Medicare Part B. But remember that a Part B plan, in and of itself, will only cover 80% of the total bill. That is why having a Medicare Supplement or a Medicare Advantage plan is so vitally important.

Answer: A common misconception many people develop is that Medicare Advantage plans are the only type of Medicare available today. The truth is that there are a lot of different types of plans (Advantage plans, Supplements, Hybrid, Traditional, etc.). It can be very confusing. The best thing someone looking at Medicare can do is to find a competent advisor that will guide them in the right direction to a plan that will fit their needs and their budget. Medicare is certainly not a one-size-fits-all solution to senior healthcare. Knowledge is power, and there is nothing that can bring peace of mind better than knowing you are covered for the "what-ifs" that come your way.

Answer: We offer both in-home education appointments and various educational seminars in the area to educate those who will soon be eligible for Medicare benefits. The best time for people to get educated on the benefits available to them is 6-12 months prior to their becoming eligible for Medicare.

Answer: The majority of Medicare Advantage Plans will force you to stay within their network. Remember, though, that your part B will (after your initial Part B deductible) will pay for 80% of the visit as long as the doctor accepts Medicare. You can still see the doctor though they may be "out of network" knowing you will have more than the usual amount out of pocket.

Answer: Your ability to sign up for Medicare is in no way connected to your starting Social Security payments. You sign up for original Medicare benefits through Social Security, and work with a competent Medicare advisor to get you on the plan you need. You can start looking at Medicare plans 3 months prior to the month you turn 65. You have 7 months to select a plan without incurring any penalties.

Answer: The best part about being a Medicare agent is the people I get to work with. I learn a lot from my clients, about their lives, and the wisdom they impart. I feel like I am doing something significant for them, by helping get the proper coverage.