Mary Turner, Medicare Insurance Broker

Answer: I am an insurance agent that works through a broker which allows me to look at different companies and plans to best serve my clients. The insurance companies I am appointed with pay my company who in turn pays me. I receive commission only, no salary. There is no charge directly or indirectly to the clients that I help. Some agents are captive and work for one company only and others work by themselves as their own broker. Most agents, like myself, are 100% commission though not all. In reference to medicare advantage plans, my pay is the same regardless of which company I recommend. That way, an agent is not more inclined to recommend one over the other based on their commission which is as it should be.

Answer: IRMAA is recalculated every year. It is based on your tax returns two years prior. If your income two years ago is higher than it is currently, depending on the type of income, you may be able to reduce your IRMAA by completing a request for reconsideration form SSA-44.

Answer: If you are currently on a medicare advantage plan and move to another state where that plan is not available, the insurance company will issue a letter cancelling your plan once you have informed them of the move. You then must choose your medicare supplement (medigap) plan within 63 days to be able to take advantage of the guarantee issue for having lost coverage. Of course, you should make sure that the medicare supplement goes into effect right after your loss of coverage. If you don't, and you are hospitalized, you are subject to the Part A deductible, part B deductible and 20%.

Answer: Prescription drug plans (PDP's) and Medicare Advantage Prescription Drug plans (MAPD's) structure the drug portion of the plans based on tiers, prior authorizations and step thereapy protocols. The tiers are typically for the following:

Tier 1 - preferred generics - you will see medications that are frequently prescribed in this tier. Most blood pressure and cholesterol medicines fall in this category, but not all.

Tier 2 - generic

Tier 3 - preferred brand

Tier 4 - non-preferred brand - typically these are medications that you will see advertised on TV because they are new.

Tier 5 - specialty medication - medicines used for transplants, etc.

This is just a sample, they can change according to company. The tiers can have copays of $0 or more and can also be percentages based on the cost of the medication which can change as the medicine prices change.

Keep in mind that for 2026, the max out of pocket that you may pay is $2100 for eligible medications.

Answer: Medicare part D is the prescription drug benefit. I encourage everyone on Medicare to sign up for part D, whether it be a stand alone drug plan or a drug plan in a Medicare advantage plan, even if you're not currently taking medications. You never know what tomorrow brings and the drug plans now have a maximum out of pocket limit. For 2026 that limit is $2100.

Answer: The main reasons people regret going with Medicare advantage are as follows:

Doctors and hospitals dropping out of network or being dropped from the network.

Prior authorizations, prior approval

Referrals

Answer: When I conduct a Medicare seminar, I do it to both educate those that are entering into Medicare for the first time, and to generate business. I believe that conducting a seminar provides the attendees with the ability to decide if I'm the agent for them, both in personality and general knowledge.

Answer: Medicare part B is the medical portion of Medicare. It includes things such as doctor appts, emergency room, ambulance, outpatient procedure, chemo, etc.

Since Medicare does not have a MOOP, maximum out of pocket, it is definitely not enough. Chemo alone would equate to thousands of of pocket.

Answer: In the state of Florida, as well as many other states, you must medically qualify for a Medicare supplement if you are not in your "trial right"period of the Medicare advantage plan.

If you turned 65, went on a Medicare advantage plan for the first time, you can switch to a Medicare supplement with no health questions anytime in the first twelve months.

Answer: There are several reasons that I like being a Medicare agent. I like educating my clients so they can participate in choosing the right plan for them. I like that I can go to the client as needed or have then come to me. Every day is different and you're always learning something new because you never know it all. Actually, I LOVE what I do.

Answer: If you are already on Medicare due to disability you do not need to sign up for Medicare when you turn 65. However, you do have the opportunity to change your plan or obtain a Medicare supplement (Medigap) plan at the same cost as anyone turning 65 without answering health questions during your enrollment period.

Answer: When it comes to leaving a medicare supplement for a medicare advantage plan there is always the possibility that one or more of your doctors are not in network. Whether they are or not, it is easy to determine before applying. However, a doctor can terminate their contract with a medicare advantage plan and the advantage plan can terminate their contract with the doctor so that could change while you are on the plan.

If you have always been on a supplement since you have a one time "trial right" opportunity to go on an advantage plan. It gives you the right to try an advantage plan for up to twelve months with the ability to go back to medicare and a supplement without having to answer health questions. If a change is made to the advantage plan during the trial right or you wait until after twelve months, you would then need to qualify if you wish to return to medicare and a supplement. The "trial right" should help to ease any concern.

Answer: Having gone through helping take care of my stepfather who had dementia, I know what a daunting task it can be. He was an outstanding man who never raised his voice and treated my sister and I as if we were his very own. Dementia turned him into someone I barely recognized at times.

Unfortunately, whether you have medicare and a supplement or a medicare advantage plan, neither will help because medicare does not pay for long term care whether it be in home or in a facility. My sister and I took turns staying with my stepfather "dad" and employed caretakers for the other days and nights since he required 24/7 care.

If the person already has dementia there is little you can do other than pay out of pocket until medicaid qualified. If this is a hypothetical situation, there are several ways you can protect yourself for long term care.

Answer: Annual enrollment is the time that allows you to make a change in your Medicare plan. It does not give you guaranteed issue for a Medicare supplement, so you must be able to answer health questions to qualify or the plan can deny the application.

Answer: One of the common misconceptions people have about Medicare is that once they are on it, that's all they need. Unfortunately, Medicare alone does not provide sufficient coverage and has no maximum out of pocket limit to protect you. A Medicare supplement (medigap) or Medicare Advantage Plan is needed to limit your exposure.

Answer: The $2000 Max out of pocket limit for Part D medications reduces the exposure to Medicare beneficiaries that are taking at least one expensive medication. Previously that exposure could be much higher and it was difficult to determine a clients actual yearly cost.

Answer: If you're on a Medicare advantage plan and you move out of the plan's service area, you will need to change your plan to a local one. If you're on a Medicare supplement with a drug plan you will only need to change your drug plan because the supplement is portable. The time allotted to make a change due to a move is 63 days.

Answer: When I sit with a client I check their medications in our system as well as Medicare.gov. First you need to ensure that they are all in the formulary and then you compare prices between plans. This year your medication cost is maxed out at $2000 so it should not exceed that. We will see what next year looks like come October.

Answer: There are several ways you can check the benefits of your plan. I would recommend setting up your account online. You can see your benefits, check on claims, your max out of pocket (MOOP) and more. You can locate your plan on the Medicare website and access your summary of benefits and evidence of coverage. If you are looking for a less technical way, just call the customer service number on the back of your card.

Answer: I would never change to a Medicare advantage plan for something like dental cleanings. Depending on your situation you could save in one area while adding more expense to another. If, however, you need extensive dental, the right plan could help you save.

Answer: You can be penalized if you don't take Medicare at 65. If, however, you have what's considered "creditable coverage" through an employer, you will NOT be subject to a penalty if you enroll later.

Answer: Medicare covers up to 100 days of custodial care which is rehab for the most part. Medicare does NOT pay for long term care.

Options for long term care include Medicaid, self pay, long term care policies, life insurance with a terminal clause rider, etc.

Which option you choose depends on many factors such as assets, health, and more.

Answer: The biggest changes I've seen in Medicare advantage plans is with the extra benefits. Dental, vision, OTC, fitness benefits have expanded or been added over the years.

Answer: You may or may not keep your current doctor's when switching to a Medicare advantage plan. Some HMO's and PPO's have extensive networks and your doctors may all participate. If you decide on an HMO you just stay in network. PPO's allow you to go out of network though your cost may be higher.

Answer: When I meet with a new Medicare client I review a Medicare checklist that shows the costs of Medicare and what is and is not covered.

Next I ask some basic questions to determine if they qualify for extra help or need to pay a higher premium for their part b and part d.

Then we review the options available and the differences between a Medicare supplement and Medicare advantage plans and determine which path they prefer.

Answer: Original Medicare by itself does not have a MOOP - maximum out of pocket limit - and should be used with a Medicare supplement and drug plan. This coverage has a monthly premium but allows you ease of use and access to any Medicare provider.

Medicare advantage plans typically have no premium and you usually get additional benefits such as dental, etc. They have networks, copays and coinsurance and you may need referrals or prior authorization.

Which option is best for you is based on your specific situation. They are both viable options.

Answer: One of the biggest mistakes that people make when obtaining Medicare is listening to friend's or neighbor's advice regarding the plan they should choose. Each person is an individual with different needs and the plan that is chosen should reflect that whether it's a Medicare supplement or Medicare advantage plan.