Mitch Anderson, Medicare Insurance Agent

Answer: The biggest mistake that someone would make when enrolling in Medicare would be not talking to an independent licensed insurance agent and getting an unbiased education on their options, timeline, and coverage expectations.

Answer: Unfortunately Medicare will not cover wearable technology to monitor heart rhythm. Medicare will only cover approved Durable Medical Equipment (DME) when it is considered medically necessary. Even when your doctor recommends a smartwatch for monitoring, Medicare will not approve it as medically necessary.

Answer: A Plan G is good fit for someone who is willing to pay more in premium to the insurance company for the benefit on not having any exposure to cost for Medicare eligible expenses at the hospital or clinic (after the Part B deductible ($283 in 2026) has been paid).

A Plan N is a good fit for someone who is looking to pay a little less in premium (approximately 20% less than Plan G) and is willing to take on some of the risk of cost for Medicare eligible expenses at the hospital or clinic ($20 copay for Dr visit and $50 copay for ER visit after the Part B deductible has been paid).

Both plan designs have their benefits.

Answer: Medicare provides some coverage (up to 100 days) for rehab in a facility. An example of this would be if someone had a hip replace, was discharged from the hospital, and went to a rehab facility for several days of therapy. Medicare does not provide coverage for Long Term Care. An easy way to consider the difference is that, if the patient is on the path to recovery, Medicare may provide some coverage. If the patient is no longer on the path to recovery and is in a long term care need, Medicare would not provide coverage.

Answer: The elimination of the donut hole for Part D happened with the addition of a maximum out of pocket risk cap. The cap for 2025 is $2000 and the cap for 2026 is $2100. This means that the consumer will pay no more than the cap amount for prescription copays in a calendar year. Only medications that are on the plan formulary will count toward the cap.

Answer: The answer, unfortunately, is both. Adding younger people to Medicare would potentially improve the program because, by adding younger people, the risk pool should get more healthy which would improve claims pressure on the Medicare system. Conversely, adding younger people to Medicare would potentially hurt the program because there would be more of a financial squeeze on an already tightly budgeted program and the reimbursement rates to providers would reduce (compared to commercial insurance) which could result in longer wait times for care and a narrower network of providers that participate in the Medicare program.

Answer: After your deductible is met, you should see no exposure for costs for any Medicare eligible expenses associated with your knee replacement surgery. You would be responsible for any costs there are not Medicare eligible expenses.

Answer: Although not required, extra protection could provide quite a bit of value. Original Medicare and Medicare Advantage plans can have substantial risk for cost when a catastrophic incident occurs. A critical illness, accident, or hospital indemnity plan can be a very economical way to mitigate the risk and ease the stress of a catastrophic event.

Answer: A disadvantage of HMO would generally be the network access. HMO plans have a narrow network, sometimes including only 1 healthcare system. Make sure you understand the network limitations of the HMO prior to completing an application, education is the key! The network limitations are not necessarily a negative as the premium is usually lower compared to other similarly benefited PPO plans.

Answer: You do not need to sign up for Medicare again. You will, however, qualify for a second initial enrollment period which allows you to change your plan without underwriting (Medigap).

Answer: The most important part to consider is that your independent Medicare agent communicates well with you and is able to explain your options in an understandable and educational way. Working with a Medicare agent near you can be valuable because a local agent may have more detailed knowledge about local plans, networks, copays, etc. compared to an agent that is not near and less knowledgeable about local markets.

Answer: When you move to a new state there are several variable that can affect your enrollment timeline. If you are on a Medicare Advantage Plan (Part C) or a Part D prescription drug plan, you likely will have 63 days to enroll into a new plan once you have moved out of the service area of your current plan. If you are on a Medicare Supplement, the supplemental plan is generally considered "portable" which means that the plan simply moves with you and you continue to utilize the same plan as before with no changes.

Answer: You likely will not need to change your Medigap plan. Medigap plans are considered "portable" meaning that when you move, the plan moves with you. Make sure you report your new address to the insurance company so your plan information makes it to the correct address. If you are enrolled in a stand alone Part D prescription plan based in New York, you WILL need to change your Part D plan to a plan that works in your Florida ZIP code.

Answer: It is ok to meet with multiple brokers to develop a good relationship. We all have our unique styles for communication, education, and ongoing customer service. Find the best fit for you!

Answer: Medicare does not provide coverage for long term care in a nursing home. Medicare does cover some of the cost of a skilled nursing facility for rehabilitation purposes - the coverage varies depending on the length of stay, improvement path, and other factors. Long term care coverage options can include a traditional long term care insurance policy, a long term care rider on a life insurance or annuity policy, or private pay. Talk to your local agent to find the best fit for you!

Answer: Traditional Medicare generally does not include coverage for dental and vision unless the care is considered medically necessary due to the diagnosis of an illness or injury. Many Medicare Advantage plans include "extra benefit" coverage for dental and vision care ranging from a reimbursements for services to network benefits for basic and comprehensive care. If your plan does not include dental or vision coverage there are also stand alone dental and vision plan options that can help fill in the gaps.

Answer: The "cost" associated with a Medicare Advantage plan can come from the premium, copays, and coinsurance. It is important to understand the risk of cost and how they are similar and different from one Medicare Advantage plan to the next as they can very significantly.

Answer: There are normally 5 tiers of medication on a Medicare Part D plan. Tiers 1 and 2 are generally generic medications, Tier 3 and 4 are generally brand name medications and Tier 5 is generally for specialty medications. One medications may be listed as Tier 1 on one Part D plan and may be listed as Tier 2 or Tier 3 on another Part D plan; there is not consistency on tiers from one plan to the next so it is always important to discus your plan options with an agent before enrolling in a plan. Usually, the higher the tier for a medication, the higher the risk of copay / coinsurance will be when filling the medication at the pharmacy.

Answer: The most common misconception people have about Medicare is that Medicare covers all of their health care needs and that it is free. Unfortunately, Medicare Part B is not free, there is a per month premium that is based in part by your income. There are also gaps in coverage with Original Medicare. Ex. - Part A has a per benefit period deductible, Part B has an annual deductible and uncapped (unlimited) exposure for medical costs. There is also no coverage from Original Medicare for prescriptions that are normally picked up at a pharmacy.

Answer: Yes but it is complicated. Part A and Part B are called Original Medicare and come from the government. Part A is hospital (inpatient) coverage and Part B is medical (outpatient coverage). Part A and B offer comprehensive coverage for medical care but they do have gaps. Ex. - Part A has a per benefit period deductible, Part B has an annual deductible as well as an uncapped (unlimited) risk for medical expense and neither Part A nor Part B provide prescription coverage for meds normally picked up at the pharmacy. To fill these gaps, a person eligible for Medicare would normally choose either a Medicare supplement plus a Part D prescription plan or a Part C Medicare Advantage plan which includes Part D prescription coverage. Choosing the right path to fill in the gaps is where it becomes very important for you to consult with an independent health insurance agent. We work with you to help you choose the path and plan that fit your individual needs.

Answer: Generally the answer is "yes". If you want to switch from one Medigap plan to another you would be required to answer health questions (medical underwriting) on the application. Some states, California for example, have a "birthday rule" that allows you to change plans annually around your birthday without underwriting requirements.

Answer: Medicare approves the surgery and lenses that are directly related to the medically necessary repair of the cataract. Unfortunately, Medicare (and subsequently your plan), does not consider advanced lenses used to correct conditions like astigmatism and nearsightedness as medically necessary, this is considered elective.

Answer: The short answer is "yes". Generally, when someone loses employer coverage they qualify for a Special Enrollment Period that allows them to get into a Medicare plan with no questions asked. The qualifier is that the employer coverage is "creditable". This means that the employer coverage is at least as good as Medicare's coverage. This information is provided by the group insurance provider and your human resources director should be able to answer this question for you.

Answer: I enjoy helping to educate and problem solve. Medicare can seem overly complicated and I enjoy trying to simplify the process and and help people find solutions that solve their specific and individual needs.

Answer: Sometimes clients may think that my advice is based on a motivation to sell them something. This could not be further from the truth. My goal is to educate and translate Medicare into something that makes sense and help people find the plan that best fits their individual needs. There is no single plan that works for everyone.

Answer: Each Part D plan has their own specific formulary (list of covered medications). There are also deductibles, copays, and coinsurance that factors in. It is very likely that your cholesterol medication counts towards your coverage gap but is much more complicated than yes or no. We need to know what cholesterol medication, the dosage, and plan that you are enrolled in to give a solid answer.

Answer: I start by explaining how Medicare works and how the pieces fit together. Then I illustrate the similarities and differences between options. This helps to create a package of personalized solutions, not just a list of plan options.

Answer: Too many people try to find the best "deal". There is no best deal, this is a long term decision and requires a thoughtful conversation to make a good decision.