Michael Roberts, Medicare Insurance Broker

Answer: Generally for clients who travel significantly and have a significant retirement income I’d point them to original Medicare plus a Medicare Supplement plan that covers international travel. This would give them the flexibility they desire to see the providers they need to see whenever and wherever they may be.

Answer: Medicare Part B covers urgent care services. You’ll typically have a 20% coinsurance after you’ve met your deductible.

Answer: There have been several changes in most Medicare Part D plans that may be contributing to the increases you are seeing with your medications. The first may be a deductible, often up to $615, before you get any drug coverage, regardless of the medication. The second is that your copayments and or coinsurance may have increased. When the annual open enrollment period begins in October it may be a good idea to conduct a thorough review with your broker/agent before 2027.

Answer: The decision to participate in Medicare is between the hospital and the health plan. If the private hospital and the health plan can agree upon the contractual terms and conditions the private hospital will be included in the health plan network. However, quite often, the private hospitals and health plans fail to come to a satisfactory agreement between one or both of the parties involved.

Answer: You should review your plan annually with your agent/broker especially after you receive your Annual Notice of Change (ANOC) document usually in late September. During your review it is important to see if your conditions & needs have changed or if your Medicare plan has made significant changes that no longer fit your needs.

Answer: If you can receive deductible, copayment and coinsurance reductions by paying a greater premium it is possible that a plan with a higher cost makes sense. People who are high utilizers (many medications or few really expensive medications) may be potential candidates. You should have a broker analyze your unique situation and determine if this would be a sensible strategy for you!

Answer: Your doctor makes the clinical decisions associated with your health care. The insurance company may have clinical review processes referred to as prior authorization to ensure established clinical protocols have been followed and your doctors care plan for you is the financially prudent choice

Answer: The best way is to log into your My Medicare.gov account, assuming you have created one. I highly recommend this approach to avoid long wait times if calling Medicare. If you struggle with technology, you can call 1-800-MEDICARE or visit your local Social Security office, and they can assist you!

Answer: It is too simple! The beginning of a health plan enrollment process should always start with a Personal Health Assessment which should involve questions personalized to your needs & wants. Understanding your current health and wealth status will drive a plan selection approach. Additional details regarding your current providers (primary care physician, specialists, pharmacies & dentists) often is influential in the plan selection process.

Answer: If you are not receiving any assistance directly from the manufacturer of your biologic, you will likely be subject to a deductible phase, an initial coverage phase and finally the catastrophic phase.

In the deductible phase you'll pay cash for the amount set by the plan which will likely be $615 or less. You'll then enter the coverage phase whereby you'll pay the first $2,100 before reaching the catastrophic phase. Once you reach the catastrophic phase the Part D plan will pay the full costs for the remainder of the plan year.

Answer: You have likely experienced a deductible added to most plans this year. The deductible may be has high as $615 meaning you have to pay cash for your medications, including your insulin, until you reach the deductible. Once you reach the deductible your insulin co-pay will be no more than $35 per the Inflation Reduction Act.

Answer: There are certain qualifying conditions that may make you eligible for a Chronic Care Special Needs Plan(CSNP’s). If there is a plan in your service and you’ve been newly diagnosed with a qualifying condition you would likely be eligible for a SEP enrollment.

Answer: The short answer is yes you are. Since the IRMAA surcharge is based upon past earned wages if your current financial situation has changed and you are now lower or below the IRMAA income brackets you can contact Social Security for an adjustment.

Answer: Medicare does not cover hearing aids however Medicare Advantage Plans often offer a hearing aid benefit as part of an extra benefits package. Benefits vary by plan and you’ll likely have a co-payment and perhaps a limit but given the cost of hearing aids it certainly helps!

Answer: 2025 Changes did help people on expensive specialty medications largely due to the elimination of the “donut hole”. After you paid $2000 out-of-pocket you no longer had to pay for your medication. 2026 is going to be a little more difficult. Many plans have added a $500-$615 deductible for medications while also raising coinsurance amounts for medications falling into Tiers 3-5. Finally you need to reach $2100 in the “initial” phase in out- of-pocket before you no longer pay. The net result is that you’ll spend more in 2026 than in 2025 and that will likely be in the $2700+ range.

Answer: Crisis is a reasonable word. Not only are more people aging in but the number of claims as well as the cost of those claims is outpacing the current rate of government reimbursement. No easy fixes and of course, unfortunately, it is a major political issue!

Answer: There isn't a single answer to this question. If I'm asked this question I would discuss a framework with my client to form a response. The first part of the framework would be related to low, medium or high annual healthcare utilization. The second part of the framework relates to their financial income status using low, medium or high income. Finally, I'd layer in their response as to a preference as to how they prefer to pay for their healthcare. They can choose between financing to "fix and forget it" meaning they insure themselves so they don't worry about individual health care transactions & claims OR they can choose "pay as you go" whereby they pay premiums, deductibles, coinsurance & copayments as they occur.

Putting this framework to work is a logical methodology about finding which Medicare option is the most "cost effective" for an individual.

Answer: No - typically wearable devices, especially if they are available without a physician’s prescription, are not covered by health insurance carriers.

Answer: A Medicare agent is under an agreement with a single health insurer while a Medicare broker is contracted with multiple health insurers.

Answer: You should ensure you have a clear strategy of what you are trying to achieve with Medicare and then a crystal clear process of how you'll execute your Medicare strategy. There are so many Medicare plan options and there are so many variables to consider & compare when aligning and or reevaluating your strategy. A good broker will perform these functions on your behalf at no cost to you. Why not use a good broker!!!