Nathan Danovski, Medicare Insurance Broker

Answer: Yes, the cost of Medicare can vary quite a bit from person to person. While everyone pays the standard Part B premium (which is adjusted yearly), higher-income earners pay more due to Income-Related Monthly Adjustment Amounts (IRMAA). Beyond premiums, your out-of-pocket costs depend on the type of coverage you choose—Original Medicare requires paying deductibles and coinsurance, whereas Medicare Advantage plans often have different premiums and cost-sharing structures. Adding prescription drug coverage (Part D) or supplemental Medigap plans also changes your overall expenses. So, your total Medicare costs depend on your income, health needs, and the specific plan options you select.

Answer: One of the most frustrating misconceptions I have to clear up every year is that Medicare covers everything like a regular health insurance plan. Many people assume once they’re on Medicare, all their medical costs are covered, but that’s far from true. Medicare has gaps—like limited coverage for dental, vision, hearing, and long-term care—and there are deductibles, copays, and coinsurance to pay. Plus, Original Medicare doesn’t cover prescription drugs without adding Part D, and many people don’t realize they need to sign up for supplemental coverage (like Medigap) or a Medicare Advantage plan to help fill those gaps. Clearing up these misunderstandings early helps people avoid costly surprises later.

Answer: Totally understandable—deciding when to claim Social Security can feel like navigating a maze, especially with so much conflicting advice. Here’s the gist: claiming at 62 gets you the earliest benefits but at a reduced monthly amount (about 25-30% less than if you wait until full retirement age). Waiting until your full retirement age (usually 66-67) means you get your “full” benefit, while delaying until 70 increases your monthly check by about 8% each year after full retirement age, giving you the biggest monthly payout. The best choice depends on your health, financial needs, work plans, and life expectancy. If you need the money early or have health concerns, claiming sooner might make sense. But if you can afford to wait and expect to live into your 80s or beyond, delaying can significantly boost your income. Want, I can help you crunch some numbers based on your specific situation?

Answer: One Medicare decision that many people regret later is choosing a Medicare Advantage (MA) plan without fully understanding its network restrictions and coverage limitations. While these plans often offer extra benefits and lower premiums, people sometimes don’t realize how tightly they restrict which doctors and hospitals they can see, require prior authorizations, or limit coverage for certain treatments and medications. This can lead to unexpected out-of-pocket costs, delayed care, and frustration—especially for those with complex or changing health needs—prompting many to wish they had stuck with Original Medicare paired with a Medigap policy instead.

Answer: People are leaving Medicare Advantage plans for several reasons, including limited provider networks that restrict access to preferred doctors and hospitals, especially when traveling or if providers leave the network. Many enrollees are frustrated by annual changes in benefits, formularies, and out-of-pocket costs, which can create financial uncertainty. High or unexpected expenses, prior authorization requirements, and complex rules often delay or limit needed care, causing dissatisfaction. Additionally, some insurers are reducing benefits or dropping plans in certain markets, forcing members to find new coverage. Overall, lower plan quality ratings and difficulties accessing timely, affordable care have led more beneficiaries—particularly those with greater health needs—to switch back to traditional Medicare or seek other options.

Answer: Your friend is likely referring to Medicare’s free “Annual Wellness Visit,” which is fully covered under Medicare Part B, provided the doctor accepts Medicare assignment. However, this visit is not the same as a routine physical exam. The wellness visit focuses on preventive care, such as reviewing your medical history, assessing risk factors, and creating a personalized prevention plan—it doesn’t include a hands-on physical exam or treatment for specific medical issues. If your doctor provided services beyond the scope of the wellness visit, such as addressing new symptoms, diagnosing conditions, or conducting a full physical, those additional services can be billed separately and may result in out-of-pocket costs. In some cases, visits are incorrectly billed as physicals, which Medicare does not cover. It’s worth reviewing your bill or Medicare Summary Notice and contacting your provider’s billing office if you believe there may have been a coding error.

Answer: PPO (Preferred Provider Organization) health insurance plans offer flexibility in choosing healthcare providers, but they come with several disadvantages. One major drawback is the higher cost—PPOs typically have more expensive monthly premiums, higher deductibles, and greater out-of-pocket expenses compared to other plans like HMOs. Additionally, if you choose to see out-of-network providers, you may face balance billing, where you're responsible for charges not covered by the insurance. PPOs also lack care coordination, which can lead to fragmented treatment, and navigating the network rules and claim processes can be confusing and time-consuming. Overall, while PPOs provide freedom of choice, that flexibility often comes at a higher financial and administrative burden.

Answer: Once you reach your maximum out-of-pocket (MOOP) limit on a Medicare Advantage plan, you will not pay any more copays, coinsurance, or other out-of-pocket costs for Medicare-covered services for the rest of the calendar year. That means:

No more copays for doctor visits, hospital stays, or outpatient services

No coinsurance for procedures, labs, or diagnostic tests

Your plan covers 100% of covered medical services after you hit the MOOP

Answer: Medicare Advantage (Part C) offers some different benefits compared to Original Medicare. It often includes additional services like dental, vision, hearing, and prescription drug coverage, which Original Medicare does not cover unless you buy separate plans. Medicare Advantage plans also have an annual out-of-pocket maximum, which can provide financial protection if you have high medical costs—something Original Medicare lacks. However, Advantage plans typically require you to use a network of doctors and hospitals, meaning fewer doctors accept them compared to Original Medicare, which is accepted by most providers nationwide. This can be a drawback, especially if you see many specialists or need care from providers outside the plan's network. While premiums for Medicare Advantage plans are often lower, you may pay more out of pocket through copays and coinsurance when you actually use services. In contrast, Original Medicare combined with a Medigap plan and Part D drug coverage usually costs more per month but offers broader access to care and more predictable costs. For people with multiple or serious health issues, the choice depends on whether they value flexibility and access (Original Medicare) or lower premiums and extra benefits (Medicare Advantage). It's wise to speak with a licensed, independent insurance agent who can compare multiple plans.

Answer: Medigap plans are underwritten in most states once you’re outside your initial enrollment window (usually 6 months after you turn 65 and enroll in Part B). That means:

• Insurance companies can ask about your health

• They can deny coverage, charge more, or exclude pre-existing conditions

You don’t need to go through underwriting if:

1. You’re in your Medigap Open Enrollment Period (the 6-month window after you enroll in Medicare Part B).

2. You qualify for a guaranteed issue right, such as:

• Your current Medigap plan ends or stops covering your area

• You move out of your plan’s service area (for Medicare SELECT)

• You lose other creditable coverage (like employer or union coverage)

• You’re within 12 months of trying a Medicare Advantage plan and want to switch back to Medigap (the “trial right”)

If you’re switching Medigap plans just because of cost or benefits, and you’re outside of those protected periods, expect to answer health questions — and possibly be declined.

Answer: Medicare gives plans a 1 to 5-star rating (5 is best) based on several factors, including:

• Member satisfaction (from surveys)

• Customer service

• Managing chronic conditions

• Preventive services (like screenings and vaccines)

• Drug safety and accuracy (for Part D)

Higher-rated plans usually have better customer service, fewer complaints, and do a better job helping members stay healthy.

• Plans with 4 stars or more are generally considered high quality.

• Bonus payments go to plans with 4+ stars, which can mean more money for extra benefits (like dental, vision, or OTC allowances).

Use star ratings as a starting point, but not the only factor. Always also check:

• Your doctors’ network participation

• Your prescriptions and their cost tiers

• Maximum out-of-pocket limits

• Extra benefits that matter to you (like travel coverage)

If you travel a lot or have specific health needs, sometimes a lower-rated plan might actually serve you better than a 5-star plan.

Answer: Why choosing Medigap was probably a smart move for you:

• Travel-friendly: Medigap (especially Plans G or N) gives you nationwide access to any provider that accepts Medicare — no referrals or networks.

• Predictable costs: You avoid the surprise out-of-pocket costs that come with many Medicare Advantage (MA) plans.

• Foreign travel benefits: Some Medigap plans cover emergency care abroad, which Advantage plans often don’t.

• Flexibility: You aren’t stuck navigating HMO/PPO networks or needing prior authorizations.

But yes — the premiums can sting.

• Medigap premiums (especially at older ages or in higher-cost states) can feel steep — often $150–$300+ per month, depending on your plan and area.

• On top of that, you still pay your Part B premium (~$174.70/month in 2024) and Part D drug plan separately.

What to consider before switching:

If you’re thinking of jumping ship to save money:

• You may have to go through medical underwriting if you want back into Medigap later (unless you qualify for a special guaranteed issue right).

• Medicare Advantage can be cheaper up front, but:

• Travel flexibility is limited

• Networks can change yearly

• Cost-sharing can add up quickly if you need more care Final Thought:

You didn’t make a mistake — you made a decision that prioritized freedom, flexibility, and protection. That’s smart if you:

• Travel often

• Want to avoid networks and surprises

• Value access over saving every dollar

But if cost is becoming a burden, we can explore:

• Switching to Plan N or a high-deductible Plan G

• Comparing your current plan to lower-cost carriers

• Running a full Advantage vs. Medigap cost analysis

Answer: 2023 estimate is 4.7 Trillion That's $4,700,000,000,000 and the approximate per person spending is $14,423.00

Answer: “How will my Medicare choices today affect my ability to change coverage in the future?”

“If I develop a chronic condition later, will my plan still cover the specialists and medications I’ll need?”

Answer: Listen first

Understand their concerns, priorities (like keeping doctors or managing prescriptions), and what confuses them.

Don’t rush: Medicare is complex. They may need time to feel confident.

Use plain language: Avoid jargon when explaining Parts A, B, C, D, and Medigap.

Highlight timelines: Help them remember key dates (like Initial Enrollment Period or Annual Election Period).

Create a checklist: Note their doctors, medications, and preferences (e.g., low premiums vs. low out-of-pocket cost.

Let them lead: Ask questions like, “What matters most to you?” or “How would you like me to help?”

Avoid taking over: Instead, offer to help them navigate, not decide for them.

Review annually: Revisit their plan during the Annual Enrollment Period to ensure it still fits their needs.

Answer: Staying up to date with Medicare changes is crucial as an agent- both for compliance and to serve my client well. Here's how I do it effectively:

Subscribe to Offical CMS updates thru CMS.gov

Join carrier newletters with all the majors for example United Health Care, Aenta, Humana, Wellcare and more

Complete annual certifications thru the Carriers and AHIP

Attend webinars and events

Network with other agents