Matt Maresch, Medicare Insurance Agent

Answer: Do not choose a Medicare plan simply because your neighbor, coworker, friend, or family member chose it. Their doctors, prescriptions, budget, travel habits, and healthcare needs may be completely different from yours.

Take the time to understand Original Medicare, Medicare Advantage, and Medicare Supplement insurance. Then compare your options based on your own circumstances.

Educate yourself first. Enroll second.

Answer: What is the Medicare Give Back Benefit and how does it lower my Part B premium?

The Medicare Give Back Benefit, also called a Part B premium reduction, is offered by some Medicare Advantage plans. It means the insurance carrier pays a portion of your Medicare Part B premium for you.

For 2026, the standard Medicare Part B premium is $202.90 per month. Some Medicare Advantage plans may reduce that amount by giving back part of the premium. For example, if a plan offers a $50 giveback, your Social Security deduction for Part B may be reduced by $50.

The important thing to understand is that a giveback does not mean Medicare Part B is free, and it does not eliminate your need to keep Part B. You still must have Medicare Part A and Part B, and you must continue paying any remaining Part B premium to stay enrolled in the Medicare Advantage plan. Medicare Advantage plan premiums, copays, deductibles, coinsurance, and out-of-pocket costs vary by plan.

Here’s the tradeoff: some plans that offer a giveback may have higher out-of-pocket costs, higher copays, smaller provider networks, or different drug coverage. So while the plan may lower your monthly Part B premium, it may not always lower your total healthcare costs.

That’s why I would not pick a plan based on the giveback alone. The better question is: after we review your doctors, prescriptions, hospitals, copays, and maximum out-of-pocket exposure, does the giveback plan still make sense?

Answer: In my personal opinion, there are no “bad” plan types. Medicare Advantage and Medigap are simply two different ways to navigate the healthcare system once you move into Medicare.

Medicare Advantage may work well for someone who is comfortable using a plan network, wants lower monthly premiums, and understands that copays, prior authorization, and network rules may apply.

Medigap may be a better fit for someone who wants more flexibility with doctors and hospitals, is comfortable paying a higher monthly premium, and wants to reduce out-of-pocket uncertainty.

As far as agents pushing one option over another, the honest answer is this: compensation can drive behavior. T hat does not mean every agent is giving bad advice, but it does mean you should ask a lot of questions.

A good agent should be able to explain both options clearly, compare the pros and cons, review your doctors and prescriptions, and explain why they are recommending one path over the other.

Answer: The old Part D “donut hole” is no longer the same issue it used to be. Today, the bigger concern is managing your medication costs before you reach the annual out-of-pocket cap.

The first step is to review your drug list against your current plan. We want to confirm:

1. Are all medications covered on the formulary?

2. What tier is each medication on?

3. Are there lower-cost generic or therapeutic alternatives?

4. Is prior authorization, step therapy, or quantity limit required?

5. Would a preferred pharmacy or mail-order option lower the cost?

6. Do you qualify for Extra Help, also called the Low Income Subsidy?

There is also a Medicare Prescription Payment Plan option that can spread eligible Part D out-of-pocket drug costs across the calendar year. It does not lower the total cost, but it may help with monthly cash flow.

The key is not to wait until costs become a problem. Medication costs should be reviewed every year because formularies, drug tiers, pharmacies, and plan pricing can change annually.

Answer: Medicare does provide important health insurance coverage, but it falls short when it comes to assisted living and long-term care.

Medicare was not designed to pay for long-term custodial care, such as help with bathing, dressing, meals, transportation, or daily supervision. It may cover limited home health care or short-term skilled care, but that coverage is generally tied to a medical need and is usually focused on recovery or improvement.

This is where many families are surprised. Assisted living, ongoing in-home care, and long-term care are often paid for privately, through Medicaid if someone qualifies, or through long-term care insurance.

Social Security also was not designed to cover long-term care costs. It can provide monthly income, but in many cases that income is not enough to pay for assisted living or extended care needs.

Have a blessed day!

Answer: Yes, it is absolutely okay to meet with multiple Medicare brokers or agents as you start looking for help.

As an agency owner and licensed agent myself, I actually think it is smart to compare who you are working with. Medicare is not a one-size-fits-all decision, and the person helping you should be focused on education first, not just enrollment.

Here are a few good questions to ask:

1. Do you offer the major carriers available in my ZIP code?

You want to know whether they can compare multiple options or if they are limited to only a few plans.

2. What does your enrollment process look like?

Listen for an answer that starts with education, doctor review, prescription review, plan comparison, and making sure you understand the trade-offs before enrolling.

3. Do you provide annual plan reviews?

Medicare is not a set-it-and-forget-it product. Plans, doctor networks, drug formularies, copays, and benefits can change every year. Ask them to explain exactly how they handle annual reviews and what kind of ongoing support they provide after enrollment.

The goal is to find someone who will help you understand your options, compare plans clearly, and support you beyond the initial enrollment.

Have a blessed day!

Answer: Unfortunately, yes, this can be normal. Medicare Advantage dental benefits are often advertised, but the actual coverage can be very limited. The key is to review the plan’s Evidence of Coverage, dental fee schedule, annual maximum, covered procedure codes, and whether the dentist is in network. Dental coverage on Medicare Advantage is an extra benefit, not the same as full dental insurance

Medicare Advantage plans often advertise dental benefits, but that does not always mean full dental coverage. Many plans only cover preventive services, limited cleanings, X-rays, or a capped annual dental allowance. Major services like crowns, dentures, implants, root canals, and extractions may have limits, coinsurance, waiting rules, prior authorization, or may not be covered at all.

Original Medicare generally does not cover routine dental care, so Medicare Advantage plans can offer dental as an extra benefit, but the coverage varies by plan. Medicare says most Medicare Advantage plans offer extra benefits like dental, vision, and hearing, but those benefits are plan-specific.

Answer: Based on your income, you should apply for assistance right away. The main programs to review are:

Medicare Savings Program: Apply through your state Medicaid office. This may help pay your Medicare Part B premium and, depending on your eligibility level, may also help with deductibles, copays, and coinsurance.

Extra Help / Low Income Subsidy: Apply through Social Security. This program helps lower Medicare Part D prescription drug costs. You can apply here: https://www.ssa.gov/medicare/part-d-extra-help

As a quick example, in Texas you can call: 211 to apply for Medicaid and Medicare Savings Program assistance. Each state has its own application process, so the best first step is contacting your state Medicaid office and Social Security.

Have a blessed day!

Answer: Unfortunately, yes, this can be allowed.

With Medicare Advantage plans, the doctor network is based on contracts between the insurance company and the doctor, medical group, or facility. Those contracts can change during the year. A doctor can leave the network, a medical group can stop participating, or the plan may update its network based on contract changes.

That is why a doctor may show as in-network when you enroll, but later show as out of network.

That does not mean it feels right, especially if you chose the plan specifically because that doctor was listed. But Medicare Advantage plans are not required to keep every doctor in the network for the full year.

The key question is what happened:

Was the doctor truly in-network when you enrolled?

Did the doctor or medical group leave the plan mid-year?

Or was the provider directory incorrect when you reviewed the plan?

The next step is to call both the insurance company and the doctor’s billing office and ask for the effective date of the network change. If the doctor was listed incorrectly, or if the network change creates a major access issue, then we can review whether there are any options available.

Important distinction: if the mistake came from the insurance company’s own provider directory, the special 2026 Plan Finder SEP may not apply. CMS says that particular SEP is only for people who relied on incorrect information from Plan Finder, not from a plan website. But the plan website error may still support a case-by-case SEP request through Medicare if the information was misleading or incorrect. Medicare.gov specifically says to call 1-800-MEDICARE if you think you have an exceptional circumstance.

Answer: VA benefits and TRICARE are treated very differently when it comes to Medicare Part B.

VA benefits are a separate health care system. Medicare gives the veteran more flexibility outside the VA system, but Part B is not technically required just because someone has VA benefits.

TRICARE is different. For most Medicare-eligible TRICARE beneficiaries, Medicare Part B is required in order to keep TRICARE active.

Even with VA benefits, I would still strongly consider enrolling in Medicare Part B in most cases.

The reason is simple. VA benefits and Medicare do not work together the same way employer insurance and Medicare do. If you receive care through the VA, the VA generally covers care provided within the VA system. But if you go outside the VA system, Medicare may be what gives you access to non-VA doctors, hospitals, outpatient services, specialists, and medical equipment.

If you have both Medicare and VA benefits, you can use either program, but they generally do not pay for the same service at the same time. That is why Part B is often an important planning decision, even though it is not technically required for VA benefits.

Unless you are enrolled in TRICARE For Life, you may also want to consider how you would cover the costs that Medicare Part B does not fully pay if you receive care outside the VA system. For some people, that may mean reviewing a Medicare Supplement plan to help cover Original Medicare cost-sharing. For others, it may mean reviewing a Medicare Advantage plan as an alternative way to receive Medicare benefits.

If there is a chance you may need or want care outside the VA system, Medicare Part B should be strongly considered. You may also want to review whether a Medicare Advantage plan or Medicare Supplement plan makes sense to help cover the Medicare Part B cost-sharing that VA benefits may not cover outside the VA system.

Answer: Yes, but it is important to understand that this is not blanket coverage for everyone.

Starting July 1, 2026, Medicare is expected to provide access to certain GLP-1 weight loss drugs through what is called the Medicare GLP-1 Bridge program. This would apply to eligible people who have Medicare Part D coverage.

The drugs currently listed under this program include Foundayo, Wegovy, and Zepbound. For Zepbound, Medicare specifically lists the Zepbound KwikPen, not the single-dose vials or pens.

This is also a temporary program. It is scheduled to run from July 1, 2026 through December 31, 2027. One important detail is that this program operates outside the normal Part D payment system, which means Part D plans do not have to opt in for eligible beneficiaries to access the program.

The expected cost is a $50 copay for a one-month supply. However, that $50 does not count toward the Part D deductible or the annual out-of-pocket limit, and it cannot be reduced by Extra Help or LIS.

The biggest thing to understand is that eligibility is not simply based on wanting to lose weight. A provider would need to submit a prior authorization, and the patient would need to meet certain clinical requirements.

Those requirements may include BMI levels along with specific health conditions. For example, someone may qualify based on a BMI of 35 or higher, a BMI of 30 or higher with certain conditions such as heart failure, uncontrolled hypertension, or chronic kidney disease, or a BMI of 27 or higher with conditions such as prediabetes, a prior heart attack, prior stroke, or peripheral artery disease.

It is also important to separate weight loss coverage from coverage for another medical diagnosis. If a GLP-1 medication is prescribed for a Medicare-coverable diagnosis, such as Type 2 diabetes, obstructive sleep apnea, or MASH, that would generally be reviewed through the person’s regular Part D plan, not the GLP-1 Bridge program.

So the short answer is yes, but not for everyone.

Answer: Why Work With a Non-Captive Medicare Agent?

When reviewing Medicare options, one of the most important decisions is not just which plan you choose, but who is helping you compare those plans.

A key reason to work with a Non-Captive Medicare agent is that the conversation is not centered around one insurance company. A captive agent typically represents one carrier. A non-captive agent generally represents several carriers in your area, not every carrier, but often many of the major options available.

That matters because Medicare plans can look very different depending on your doctors, prescriptions, preferred hospitals, pharmacy, budget, and health needs. One company may have a stronger doctor network. Another may have better prescription coverage. Another may offer lower out-of-pocket exposure or additional benefits that better fit your situation.

It is also important to understand that working with an agent does not increase your plan premium. Agent commissions are already built into the plan pricing. Whether you enroll directly through the insurance company or work with an agent, the commission so going to be paid out regardless.

Since commissions from one Medicare plan to another are often similar, the value of working with a non-captive agent is the ability to compare multiple carriers and help narrow the options based on what actually matters to you.

The goal is not to force you into one company’s plan. The goal is to help you make a more informed decision through by reviewing several available options and matching the plan to your doctors, medications, health needs, and financial priorities.

In short, a non-captive Medicare agent can help you:

1. Compare multiple carriers instead of only one company

2. Review doctor and hospital networks

3. Check prescription drug coverage

4. Compare premiums, copays, deductibles, and maximum out-of-pocket limits

5. Understand the trade-offs between Medicare Advantage, Medicare Supplement, and Part D plans

Answer: I understand the frustration. The review period is meant to help prevent issues like this, but the key step is confirming your doctors and specialists before the plan change is submitted.

Did you confirm with your regular specialist, or with the plan directly, that the doctor was in-network before enrolling?

Also, did your doctor leave the plan mid-year, or were they already out of network when the plan started?

Provider networks can vary by plan, location, and even by the specific medical group the doctor bills under. Sometimes a doctor may appear connected to a carrier but not participate in the exact plan selected.

The next step would be to call the plan and confirm whether your specialist is truly out of network for your specific plan. If they are, we can review what options may be available, such as using another in-network specialist.

Have a blessed day!

-Matt