Mike Wetsel, Medicare Insurance Broker

Answer: Without getting too deep into the weeds, the government takes what it expects to pay for your Part A, plus what it expects to pay for your Part B, plus the amount you pay into Part B yourself and pays a private insurance carrier for an Advantage plan. Copays and coinsurance also should be considered. So, all of the money you’ve paid over the years into Medicare along with what you continue to pay makes it affordable for a private insurance carrier to offer you an Advantage plan at $0.

Answer: During your Initial Enrollment Period and certain Special Enrollment Periods you have guaranteed issue.

Outside this time you will likely have your enrollment application go through underwriting.

Answer: Help parents spot their ANOC (Annual Notice of Change) in the mountains of Medicare mail they receive, by the end of September.

Review changes with them.

Review changes with a trusted local agent for the most comprehensive support.

Answer: MA or PDP: ANOC-Annual Notice of Change

If you receive notification of changes with your current coverage impacting your network or RX tiers you may want to make a change of plan or carrier. You can also move to Supplemental (you may be subject to underwriting)

Annually During AEP (10/15-12/7)

Supplemental: If you receive a letter from your carrier that your current plan is no longer going to be offered OR the monthly premium is increasing more than you are willing to pay, you can investigate other supplemental plans and carriers at any time. You also have the opportunity to switch to a Medicare Advantage during AEP.

Answer: Medicare Advantage plans pay higher commissions and are an easier enrollment process for agents.

You should be skeptical if your agent is not taking your needs and expectations into consideration in the Medicare selection review time.

Answer: Medicare does not pay for foreign medical care. However, some supplemental and MA plans do offer limited coverage in an emergency.

Read you plans Summary of Benefits and Evidence of Coverage to see what your specific plan covers.

Answer: Arguably, the biggest mistake seniors make when enrolling in Medicare is not taking time to verify the doctors and facilities they use accept the plan and carrier they select.

Often, plans are chosen purely based on price and perks without considering the enrollees full range of care, now and into the future.

Answer: One of the promising changes for 2026 is CMS may use AI for approving preauthorizations. This is expected to speed up communications with providers, getting patients the help they need quicker.

Answer: Tiers 1 & 2 are typically generic drugs. They are usually zero or low cost to you and they do not go toward your annual deductible.

Tiers 3, 4 and 5 are typically brand name and specialty drugs. They cost more and the retail cost of the drug goes toward your annual deductible.

Drug changes within these tiers are one reason the ANOC and RX review is so important.

This protects you from unexpected high prescription drug costs.

Answer: If you did not pay into Social Security for at least 40 quarters AND your spouse did not pay into Social Security for at least 40 quarters, you may still enroll in Medicare at an additional cost.

Please visit for more information:

https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost

Answer: Banning is a really strong word.

I do wish they would clearly state the differences in coverage for metropolitan area vs rural area options and perks.

Answer: To verify a procedure you may contact Medicare.gov and check the name of the procedure or test for coverage details or call 1-800-Medicare to confirm.

If you have a Medicare Advantage plan you will want to call your carrier at the number on the back of your card to confirm coverage.

OR if you have a trusted local Medicare agent, give them a call and let them do the leg work for you.

Answer: The 2025 Inflation Reduction Act lowered the catastrophic stage from $8000 to $2000 annually, doing away with the donut hole.

The 2025 IRA also implemented average monthly billing with carriers to help seniors budget and manage their prescription expenses.

Answer: Annual wellness visits every 12 months, as well as many preventative screenings such as Mammogram and Colorectal Cancer Screening.

Also many adult vaccines are covered as a preventative measure.

Answer: Tough question. What's your medical situation? How do you see your future based on family history? Would you rather budget or pay as you go? Are you ok with networks or would you rather have more freedom? Do you live in a rural or urban area? If someone gives you an answer without asking you questions about your situation, I would be dubious of that answer.

Answer: All of the information about Medicare is online. What is lacking is the expertise to know what questions to ask to apply the information to your specific situation. Look for an expert that will ask you questions and give you real answers, not just sales.

Answer: With Original Medicare and a Medigap plan, yes. With a Medicare Advantage plan, probably, but pre-approval may be required.

Answer: Absolutely agree. In order to fund it, we need to be diligent about not funding treatments that do not benefit seniors.

Answer: Medicare can be confusing. Helping people figure out what is best for them and traveling the journey with them is fulfilling.