Mike Sosso, Medicare Insurance Broker
Mike Sosso
InsuranceSmart
Medicare Broker Licensed in TX, AZ, NC and SD
20+ Years of Experience
Contact Details
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Location
San Antonio, TX
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About Me
Since 2005 our senior managing agent has been helping seniors understand and get the best value out of medicare. Our five-star rating and customer comments on Google says it all, because the confidence and trust of our clients is our top priority.
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We look forward to serving you!
Mike Sosso
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Q&A with Mike Sosso
What do you like most about being a Medicare agent?
Answer: I very much enjoy helping my clients get the very best value on Medicare. There are so many voices seniors have to deal with when shopping for their Medicare and understanding what is best for them. As our name InsuranceSmart implies, we are passionate about educating clients on thier plan options so they they have the confidence and assurance they need to make a fully informed decision.
It is also very satisfying knowing when medical care is needed, our clients have the best options available to them and are not limited in any way to find the care they need from a provider of thier choosing with limited out of pocket costs.
Are Medicare Advantage plans really "free," or is that just clever marketing?
Answer: Medicare Advantage plans may have little or no premium and therefore be considered free. But what did you ever get for free in life that was really good? Anything of great value, usually has a price. So too when it comes to Medicare.
Most seniors don't realize that enrolling in a Medicare Advantage changes how their coverage works and Medicare is no longer their primary insurance provider. Instead, Medicare pays a private insurance company, the Medicare Advantage plan they choose, a monthly dollar amount for that plan to assume 100% responsibility your medical care. The advantage plan gets paid when you sign up whether you see them for services or not and because the advantage plan is now 100% responsible for all costs of your care, when major medical services or testing is needed, preauthorization requirements can often delay or even deny coverage recommended by your doctor for cost reasons. In addition, Advantage plans limit you to networks for provider choices and have annual cost sharing requirements through copays and coinsurance that range from $2550 to $11,900 per year.
Orginal Medicare however with a good Medicare Supplement allows you to see any doctor or provider that takes Medicare and can as an example limit your overall out of pocket expenses per year to as low as $257 in 2025 on Plan G .
So while Medicare Advantage plans advertise low to no upfront cost or premium, and often even include benefits like limited dental, vision, hearing, and even gym memberships to encourage enrollment, but when major medical care is needed, Original Medicare with a good Medicare Supplement is often a better option.
I'm worried about the 'donut hole' in my Part D plan. How do I manage my medication costs once I enter it?
Answer: The donut hole is no longer a problem in 2025. The Inflation Reduction Act of 2024 eliminated the Part D donut hole and mandated that seniors prescription costs would not exceed $2000 per year beginning in 2025 for all prescriptions included in the plans formulary.
The challenge however is that many prescription plans changed thier formularies in 2025 and sent notices advising thier clients but many customers did not fully understand the cost changes or of prescriptions that thier plan would no longer cover.
Will Medicare cover everything my current employer plan does?
Answer: This is a great question because if you have qualified employer coverage from an empoyer of 20 or more employees, don't have to enroll in Medicare A&B when you first turn 65 if you are planning to keep your employer coverage. Otherwise you could face a penalty if you don't enroll at that time. But when you have qualified employer coverage you don't have to enroll until you lose that coverage.
For this reason we always recommend a detailed review of employer coverage to include the costs associated with that coverage and compare it with what Medicare would provide. In many cases, Medicare offers more and better coverage for less money. If that is the case, we would recommend staying with the employer coverage until you plan to retire.
A personal evaluation for each situation is always avisable so you or someone you know is facing this situation, have them reach out to us and we can review your situation for no cost or obligation.
What is the biggest mistake seniors make when enrolling in Medicare?
Answer: The biggest mistake senoirs make when enrolling in Medicare is signing up a low or no cost up front Medicare Advantage plan without doing a thorough evaluation and comparison of Original Medicare with supplemental coverage and Medicare Advantage and the long term inpact on thier coverage. That's because if you enroll in Medicare Advantage and later want to move back to Original Medicare, if you have existing health issues, or later develop health issues that affect underwriting, you may not be able to secure a Medigap policy to cover teh out of pocket expenses Medicare does not pay.
The second biggest mistake is they don't enroll in either Part B or Part D drug coverage on time. As a result, when they do enroll they will receive a penalty for Part B premiums and / or Part D premiums for the rest of thier life.
Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?
Answer: Medicare Part A: does not pay for outpatient surgery. Part A covers inpatient services to include inpatient hospital care up to 150 days and inpatient skilled nursing care for up to but no more than 100 days per stay. Part A has a modest deductible of $1676 for 2025, and is subject to per day coinsurance begining after day 60 of inpatient hospital care and day 20 of in-patient skilled nursing care. Medicare Part A does not pay for Long Term Care services.
Medicare Part B: pays for outpatient surgery and all other Medicare appoved outpatient services like like Doctor Visits, Lab Work, Outpatient Surgery, Physical Therapy, etc. Part B has a monthly cost to obtain coverage. The cost in 2025 for most Americans is $185 per month. If your Adjustable Gross Income (AGI) is higher than most, the premium for Part B is higher.
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
Answer: Enrolling in Medicare Advantage or Plan C, actually disenrolls you from Original Medicare and Medicare is no longer your insurance provider. Instead, Medicare pays a private insurance company, the Advantage plan you choose, a fixed dollar amount based on your geographic location, whether you see them for services or not! In exchange, the Advantage plan assumes 100% responsibility for all costs for care. As a result, all Advantage plans impose cost sharing requirements through coinsurance and co-pays with annual out of pocket expenses for members ranging from $2,550 to $11,900 per year. Be sure to look at this closely if you are considering an Advantage plan so you are not surprised by a high bill after treatment.
The benefit of Medicare Advantage is typically lower up-front cost like little to no premium and they often include limited benefits on dental, vision, and even gym memberships to encourage enrollment, but when major medical care is needed, clients may experience delayed and limited care options as well as higher overall out of pocket costs for care.
Original Medicare on the contrary allows you to go to any doctor, hospital, or provider that accepts Medicare. Medicare is primary insurance and pays providers for services when rendered with no preauthorization requirements for standard Medicare services. We recommend a good Medicare Supplement policy (Medigap) to the cover the cost for services Medicare approves but does not pay which reduces your annual out-of-pocket cost for approved services to as low as $257 per year in 2025 on a plan G.
Because Original Medicare with Medigap provides clients a better overall healthcare experience due to the increased service options available to clients along with a lower overall out of pocket costs for care when needed. For this reason we believe the better overall care experience far outweights the modest needed to cover the upfront costs for supplemental insurance premiums.
I have Original Medicare, a Medigap Plan G, and a Part D plan, but I'm still facing high costs for my specialty medication. What options exist for someone in my situation?
Answer: It is important that you shop your Part D prescription coverage every year. In 2024 all the Part D carriers revised formularies because Congress mandated that in 2025 seniors would not have to pay more than $2000 per year for prescription drugs. For this reason, many of the prescription plans revisions excluded some of the higher cost medications in thier formularies. If you are in a situation where your plan has excluded a medication you are taking, contact your drug Medicare (800) 633-4227 and your drug plan to ask for an exception. When you talk to Medicare, you can also see if you qualify for special financial help to pay for your medications.
Then next year during the annual enrollment period, October 15 through December 7th make sure you shop your Part D prescription coverage and include all your medications in the formulary search to find the most affordable coverage.
Who qualifies for Medicare coverage if they are under 65?
Answer: Those who have End Stage Renal disease (ESRD), Amyotrophic Lateral Sclerosis (ALS) or have a disability and have received SSI disablity for 24 months.
Why are seniors losing Medicare Advantage plans?
Answer: Some seniors are losing thier Medicare Advantage plans because many of these plans are leaving areas or no longer being accepted by some healthcare providers. As a result if the plan decides to either leave an area or is no longer accepted by providers in that area, seniors can lose that coverage. When that happens however, they are usually allowed to enroll in another advantage plan or revert back to Original Medicare