Marc Butler, Medicare Insurance Broker

Answer: Yes, it shows CMS rating for how the plan has behaved taking care of its members... these star ratings are a reflection on how good they are.

Answer: I would need to see her Dr's names to check with the insurance companies' networks... then make recommendations.

Answer: Yes, you can get Medicare if you never worked or didn't pay into the system, but you will likely have to pay a monthly premium for Part A (hospital insurance). To get it for free, you generally need 10 years (40 quarters) of work or qualify for low-income Medicaid!

Answer: Yes, but you will have to get a referral from your PCP to see a specialist who, after a sleep study, may recommend a CPAP...

Answer: Dental is expensive, and there isn't any MAPD plan that covers much more than cleanings!

I always explain this... probably because I've been an agent for a long time!

Answer: Make sure your card is showing Medicare Part A & B; without these, you cannot join a plan and save money.

Answer: Special Needs Plans, SNPs, are Medicare Advantage plans built for specific groups. You must qualify to enroll.

Three types:

D-SNP

For people with Medicare and Medicaid.

Usually $0 copays, drugs included, extra dental, vision, transport, care coordinator.

C-SNP

For certain diseases like diabetes, heart failure, COPD.

Focused networks and treatment programs for that condition.

I-SNP

For nursing home residents or people needing long-term nursing care at home.

Doctors manage care directly where the patient lives.

Answer: Many insurance companies require prior authorizations for major surgeries, like a knee replacement. This is quite common.

Answer: Have a great agent who you can visit anytime you like.

We have our own office, which is open Monday to Friday. Our clients come in and see us, ask us questions, get help on medications, anything they need.

Answer: Yes.

Maximum Out-of-Pocket limits for Medicare Advantage plans are set each year by the Centers for Medicare & Medicaid Services.

• CMS sets a maximum cap annually.

• Plans can set lower MOOP limits, but not higher than the CMS limit.

• The amount often increases slightly each year due to inflation adjustments.

Always review MOOP during the Annual Enrollment Period. It directly impacts your worst-case financial exposure.

Answer: IRMAA is based on your tax return from two years prior.

Your 2027 Medicare premiums will be based on your 2025 tax return.

If the 401(k) withdrawal happened in 2024, it would affect your 2026 premiums, not 2027.

You file Form SSA-44 only after you receive an IRMAA determination notice, and only if you had a qualifying life-changing event, such as retirement or work reduction. A one-time withdrawal by itself is not a qualifying event.

If your 2025 income drops back to normal, your 2027 premium should automatically return to the lowest tier without filing SSA-44.

Answer: Yes.

Medicare Advantage plans are county-based. Availability depends on your ZIP code.

• Each plan has a defined service area.

• Benefits and premiums vary by county.

• Provider networks are local.

If you move outside the plan’s service area, you must switch plans.

Answer: If you qualify for both Medicare and Medicaid, you are “dual eligible.”

How it works:

• Medicare pays first.

• Medicaid pays second.

• Medicaid helps cover premiums, deductibles, and copays.

You may also qualify for Extra Help with prescription drug costs.

Bottom line: Medicare is your primary insurance. Medicaid reduces or eliminates most out-of-pocket costs.

Answer: TRICARE

If you have TRICARE for Life, you must enroll in Medicare Part A and Part B at 65.

• Medicare pays first

• TRICARE pays second

If you skip Part B, you lose TRICARE for Life.

VA benefits

You do not have to enroll in Medicare to keep VA coverage.

• VA only covers care at VA facilities or approved providers

• Medicare does not pay at VA facilities

Many veterans enroll in Medicare for access to non-VA doctors and hospitals.

Answer: • Plan comparison. Agents compare Medicare Advantage, Supplement, and Part D plans side by side so you see premiums, copays, networks, and drug costs clearly.

• Cost protection. They check your prescriptions and doctors to avoid expensive mistakes.

• Ongoing support. Plans change every year. You get help at enrollment and year-round service.

It costs you nothing. The insurance company pays the agent, not you.

Answer: Original Medicare does not cover supplements, herbs, homeopathy, or most alternative treatments.

Not covered:

• Vitamins and dietary supplements

• Herbal remedies

• Homeopathic treatments

• Naturopathic care

Limited exceptions:

• Chiropractic spinal manipulation

• Acupuncture for chronic low back pain only

Part D covers FDA-approved prescription drugs, not over-the-counter or natural products.

Some Medicare Advantage plans offer small OTC allowances, but coverage is limited and varies by plan.