Mark Bilgere, Medicare Insurance Broker

Answer: The thing I like the most about being a Medicare agent is educating clients on how the program works and how it applies to each individual in a different way. Even though there are some strict rules surrounding Medicare, the large number of products and services available still leave a lot of options for each person. Being able to offer all the products and not being captive to a specific carrier, gives me the ability to focus on the client and not the quota required by an insurance company.

Answer: You're right to feel frustrated, this is a common misunderstanding about Medicare’s Annual Enrollment Period (AEP) and Open Enrollment Period (OEP). First, it is important to know which enrollment period we're discussing. During AEP (Oct 15–Dec 7), you can change your Medicare Advantage or Part D drug plan. However many plans change on December 31st so a provider that was in the plan when you enrolled may no longer be in the plan on January 1st. This is when the Open Enrollment Period OEP (Jan 1 - March 31st), is in effect. If you made a change to your Advantage plan during AEP, you get a chance to change again during the OEP. This is when you can find a new plan that your provider does accept. Keep in mind that after March 31st, there are no more chances to change due to network issues. The only way to change after the OEP is to use a Special Enrollment Period (SEP) which depends on individual circumstances and is a whole other topic.

Answer: This is a good question. Typically an Agent represents only one insurance carrier. They can only recommend the products that company offers, so their main goal is to sell that carrier.

A Broker, on the other hand, represents multiple carriers and offers a variety of products. For brokers, the main goal is to find the right plan and products for the client, so they feel comfortable with the coverages they have. In the Medicare market specifically, the commissions that brokers earn from the carriers (clients do not pay the broker) are regulated by CMS, so there is no financial incentive to sell one product over another. The incentive is to help the client find the right coverage, earn their trust and earn their referrals.

Because Agent and Broker are often used interchangeably, it is important to ask the person how many plans they represent. Then you will know if they are an agent or a broker.

Answer: This is a difficult situation but one every child of an elderly parent should consider.

If your parent still has the capacity to make decisions, the process is much easier. Although you can make an arrangement with Medicare to be your parent's "Medicare Representative", this only gives you permission to discuss their plan with Medicare. It does not give you the ability to make any changes. To do this, have your parent sign a Durable Power of Attorney. This will give you broad authority to help with medical and financial decisions. In most states this does not require using an attorney although you should check in your state as I am not an attorney and cannot give legal advice.

If your parent no longer has capacity to sign the DPOA, you will need to petition the court for guardianship to help with medical decisions and conservatorship for financial matters. This will require an attorney and is a longer process.

Answer: The $2000 cap is the max out of pocket for Part D drug costs for 2025. For 2026 the limit will increase $100 for a max out of pocket of $2,100.

Answer: There is no specific date to start preparing. You should should looking for a letter from your current Medicare Advantage plan starting in August. This is when the carriers start sending out you Annual Notice of Change letter (ANOC).

The ANOC letter will tell you if, and how, your current plan will change, starting January 1st of the next year. Because all plans don't settle on their changes at the same time they send their letters on different dates however they must be delivered by September 30th. Agents and brokers are not permitted to discuss the new plans until October 1st.

The annual Enrollment Period starts on October 15th.

Answer: The Part D tiers are often a point of confusion for many people. Here are some simple ways to think about them.

The Tiers are generally numbered 1-5. The lower the number equals a lower price

Tier 1 – Preferred generics (lowest cost): These are the common meds a lot of us take. Often $0

Tier 2 – Generic drugs: These are less common, but still relatively inexpensive

Tier 3 – Preferred brand-name drugs: Start getting expensive. If you see it advertised on TV, it's a Tier 3 or higher

Tier 4 – Non-preferred drugs: Expensive but often have a lower cost alternative

Tier 5 – Specialty drugs (very high cost) You know if you take one of these

Keep in mind that different carriers may place the same medication in different tiers. Although most are in the same category, it is not a requirement. Make sure you check your medication costs each year.

Answer: As of 2025, CMS has made some great progress in protecting beneficiaries from those "Horror Stories". The main change is the implementation of a $2,000 Maximum Out of Pocket annual limit.

If you select an Advantage plan, your drug plan is usually built into the plan. This means you will not have an additional Part D drug premium. You may still have a drug deductible and you will have drug cost. The good news is agents and brokers can look up your medications and tell you exactly what they will cost in each Advantage plan.

If you select a Medicare Supplement (Medigap) you will then need to add a stand alone Part D plan. This most likely will have an additional premium in addition to a deductible and the cost of the drugs. However, your agent can also look up all of your medications in the different Part D plans and tell you what your drug cost will be for the year.

Answer: This is a common feeling, and there are several things Medicare beneficiaries can do to avoid it.

1. Ignore all the Medicare commercials on TV.

2. Do not talk to any unsolicited call you receive from a medicare agent, broker or company.

3. Find a local broker or agent to work with. One that you can call with questions after you enroll.

4. Do not be swayed by the "Xtra benefits" until you understand the health benefits, drug benefits and the network requirements of an Advantage plan. For every Xtra they give you, you pay more somewhere else.

5. Make sure you you get a print out of your plan benefits and create your online portal once you are enrolled. One of the best parts of Advantage plans is that they have fixed costs that are stated in the Summary of Benefits, so any unusual bills are usually a misunderstanding of what procedures are going to be done, or a billing error after their done. A local agent or broker can help you determine costs before procedures and help guide you to the right place for billing errors.

Answer: You didn't make a mistake, but your rates may have put you in a tough spot. All Medigap plans increase in price over time. Unfortunately, there is no way to know exactly how much they will go up. There is a history to each company increases, but past history does not guarantee future rates. So, what options do you have?

Depending on your health, you can shop for a new plan. Your health matters because you will have to pass the underwriting process. Different companies charge different prices, so if you can pass UW, you may be able to get the same plan at a lower cost.

If your able to pass UW you can also change plan levels, for example, Plan F to Plan G or Plan G to Plan N. SO you may change companies and plans or just one of them.

If any Medigap plan is just too expensive now, you can switch to a Medicare Advantage plan if there are some in your area. The premiums are typically pretty low. Just make sure you understand all the benefits and network requirement as they are significantly different from Medigap plans.

Plus, if you decide to try an Advantage plan, you have a 12 month trial right. This allows you to go back to your Medigap plan within the first year if you are unhappy with the Advantage plan.

Answer: Like all things Medicare, any mental health services must be FDA approved and provider prescribed. This means if it is part of a treatment plan prescribed by your physician and it is FDA approved, your Part B should cover it after you have met your Part B deductible. If you're on an Advantage plan, be sure to make sure that any mental health provider, including telepathy, is included in the plan's network.