Nickey Baxter, Medicare Insurance Broker

Answer: What a great question. I get asked this often. No.... we don't charge a fee. Our compensation comes from the carriers. We are just there to help you figure out what plan will work for you! Isn't that great!

Answer: That is a hard question to answer. There are benefits to the commercials, as many people don't realize they have options. The commercials let the consumer know when it is very important for them to just take a second look at what they have, and if something might provide more benefits. I will agree, however, that the commercials do get annoying. I am honestly relieved when the Annual Enrollment Period is over and they are fewer and far between.

Answer: I'm sorry to say there are no Medigap Plans that don't have increasing premiums. They all have rate increases based on age bands, and rate increases based on claims for the entire group on that plan.

Answer: Hello, the "donut hole" ended in 2025. There is currently a maximum out of pocket, for covered medications, of $ 2100.00. Once you reach that maximum the prescription costs are zero. This will not apply to a drug that is not on the insurance carriers formulary. If it is not on their formulary you will pay the full cost of the drug each time you fill the prescription. This is why you should evaluate your plan yearly, so you know you still have your expenses covered.

Answer: Most insurance companies will ask for a procedure to be authorized. This helps both you and the insurance company as it will tell you that it is covered in network, so you don't end up with a surprise out of pocket expense. In addition, the insurance companies look at medical history, to make sure it is a necessary surgery or procedure. Elective procedures are not covered by insurance.

Answer: Hello. Many of the Medicare Advantage plans include some form of fitness, whether it be Silver Sneakers, Silver & Fit or Wellness Your Way. If you are in a Medicare Supplement plan, many of them also have a discount program attached to them. If you log into your member portal, for your current plan, you may find you have a benefit and just didn't realise it.

Answer: There are many Medicare Advantage plans that have zero cost. They also have to include all of the benefits of Original Medicare, but they also have additional benefits that are convenient to customers who may need vision coverage, dental coverage or hearing benefits.

Medigap plans have set out of pocket expenses, but are more costly monthly. I would suggest you speak with a professional, like me, who can explain the differences and let you make your own informed decision.

Answer: Don't listen to your neighbor. Every person has different needs. Your neighbors plan may not be the best choice for you, based on the network of doctors or hospitals you use and the prescriptions you take. Seek professional help to make an informed decision.

Answer: That is a complex question. Original Medicare covers approximately 80% of claims, and you would need to add another insurance plan to pay the other 20% not covered by Original Medicare. In addition, you would need to enroll in a separate prescription plan.

The Medicare Advantage plans are private insurance companies that will pay your claims. They have to have all the same benefits as Original Medicare, but they can also include other benefits such as prescription coverage, vision, dental, hearing, transportation or over the counter benefits which would help pay for things like bandaids, aspirin and cough syrup.

This is a very basic summary, and does not completely explain all of the benefits. Once you speak with a broker they can better explain the benefits so you can make an informed decision.

Answer: Hello. The tiers are designed to separate prescriptions by name brand or generic, and cost. They also vary by the prescription, if it has no generic equivalent. In general, Tier 1 and 2 are very common medications, that many people are prescribed. These tiers often have no deductible (what you must pay before a company begins to pay) or low copays. The higher the tier, generally, the more out of pocket expenses you will have.

Answer: Medicare Agents specialize in their craft. They get paid by carriers to help you. They know the products and can make recommendations based on your needs, and not someone else.

Answer: You will have loss of creditable coverage. This will provide a special enrollment period. There will be a form you will need to have filled out by your husbands hr to verify that you had continuing coverage.