Nikki Rowland, Medicare Insurance Broker

Answer: Medicare does not cover everything. You should always ask, are there gaps in my coverage that could leave me with unexpected out-of-pocket costs?

Answer: If you want more provider options and no referrals, a PPO is the better choice. If you’re okay with sticking to a network to save money, an HMO might be a better fit. Would you like help comparing specific plans to see which works best for you?

Answer: When your husband passes away, you do not receive both your Social Security benefit and his in full. Instead, you will receive the higher of the two benefits.

Answer: When working with clients who are completely new to Medicare, I focus on making the process simple, clear, and stress-free by breaking it down into four key steps:

1.Understanding the Basics

I start by explaining:

* What Medicare is and who qualifies

* The four parts of Medicare (A, B, C, and D)

* The difference between Original Medicare and Medicare Advantage

2. Identifying Individual Needs

I ask questions to understand their healthcare needs, lifestyle, and budget, such as:

Do you take regular prescriptions?

Do you prefer flexibility in choosing doctors?

Do you travel often or live in multiple states?

3. Coverage Options

Once I know your needs, I walk you through:

* Medicare Supplement (Medigap) vs. Medicare Advantage

* Prescription drug plans (Part D)

* Out-of-pocket costs and ways to minimize expenses

4 Helping with Enrollment & Next Steps

I make sure they know their deadlines to avoid penalties and help them enroll in the right plan. I also offer ongoing support so they feel confident in their coverage.

Answer: This all depends on specific client needs as well as finances. Medicare is never one size fits all plan.

Answer: First, Confirm Your Enrollment Status.

If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A & Part B—your Medicare card should arrive about 3 months before your birthday. If you are not taking SS, you will have to call and let them know you would like to take your part B.

If you are still working and have credible insurance coverage through your employer you may opt out of Medicare for now.

I would sit down and cover all option available to you to ensure you make the right choice for YOU.

Again, its not a one size fits all.

Answer: The biggest disadvantage of Medicare Advantage is the network restrictions, which can limit your choice of doctors and hospitals compared to Original Medicare (with a Medigap plan) as well as high co-pays.

Answer: Because Medicare is a not a one size fits all plan, I never recommend one over the other without first doing a full needs analysis. Both options can work well if this is done first.

Answer: That can be frustrating! Medicare Advantage plans typically have contracts with specific networks of doctors, hospitals, and other healthcare providers. However, sometimes these contracts change throughout the year. Even if your doctor was in-network when you enrolled in your plan, they might have been removed from the network later due to changes in the insurance company’s agreements or policies.

Unfortunately, this can happen, but you do have some options.

Answer: PPOs offer more flexibility compared to HMOs (Health Maintenance Organizations), they still have a cost structure that favors in-network providers. There are many reasons why your out-of-network costs might be so high.

A PPO simply allows you to go out of network and still get coverage at a contracted rate. An HMO will not cover anything and you will pay everything out of pocket as if you don't have insurance at all.

Answer: If you are unable to keep the coverage from the spouse's employer, you would have a SEP Special Enrollment Period to the enroll into a new plan. This would be person and situation specific.

Answer: Original Medicare lets you see any doctor nationwide and works well for people who travel or want flexibility. It usually costs more monthly, especially if you add drug (Part D) and Medigap coverage, but you’ll have fewer restrictions.

Medicare Advantage is a lower-cost, all-in-one option from private insurers that includes extras like dental and vision. It often has network limits and copays, but can save you money if you’re okay with those trade-offs.

Answer: Yes, Medicare covers many preventive screenings and services, often at no cost to you, as long as your doctor accepts Medicare and the services meet the guidelines.

Answer: Yes. You have a Guaranteed Issue right if:

1.You're 65 or older and have Medicare Part B.

2.You're losing employer-sponsored group health coverage (this includes coverage through you or your spouse).

3.You apply for a Medigap plan within 63 days of the coverage ending.

Answer: Best Option: Original Medicare + a Medicare Supplement (Medigap) Plan

Covers you nationwide — any doctor or hospital that takes Medicare.

No networks, so it works anywhere in the US that accepts Medicare..

Pair it with a Part D drug plan for prescriptions.

Medicare Advantage Plans are network-based and area-specific.

If your plan is based in SC, it may not cover non-emergency care in FL (or may have out-of-network fees).

Some PPOs offer limited nationwide coverage, but it’s plan-specific and not guaranteed.

Bottom line:

If you’re a snowbird, a Medigap plan is your most flexible, travel-friendly choice.

Want help checking what Medigap plans are available to you now?

Answer: Your annual wellness visits should be covered at no extra cost. Now, if you are seeing a specialist with for this, you will have a specialist Co-pay.

Answer: You should not have any other out of pocket cost as long as you have met our yearly deductible. 2025 is $257

Answer: Typically a Medicare Advantage plan does not cost a monthly premium but you do have Co-pays as you use the services. That is how these type of plans are designed. Without knowing specifics, it's hard to say if your choice was a mistake or was just not explained properly.

Answer: Medicare will cover the basic lens. If you want to upgrade, you will pay out of pocket for the upgraded lens. This is normal.

Answer: Without know what kind of plan you have, this is a tough question to answer. More info is needed. Some plans require pre-auth and some do not.

Answer: You must have lived in the US for a min of 5 years. At that time you will likely have a Premium for Part A as well as the normal Part B premium since you have not lived her and worked at least 40 Quarters.

Answer: It is always a GREAT idea to review your coverage. Plans change and as you know, how health care needs change. There may or may not be something better for you. I always encourage plan reviews.

Answer: If you have a Medicare Advantage plan, there is a CO-Pay for each service provided to you including an ambulance ride. This is another reason I feel it is so important to have a local agent that explains all of the details to you so you don't have surprise bills.

Answer: Medicare Part B covers many preventive services, including screening mammograms, to help detect diseases early when they’re most treatable.

Answer: You can always reapply for lower premiums with a different carrier. The coverage would remain the same if you qualify.

Answer: LONG TERM CARE! No one thinks about the possibility of having to have a caregiver or even staying in a facility. Its is a HUGE problem and regular Medical Insurance does not cover it. You either have to have money in the bank or assets you're willing to give up. It is so expensive.

Answer: Part B covers your Dr. and Medical but only at 80%. You are responsible for the other 20% with no max. Meaning, if you have a hospital bill of $100K, you will receive a bill for the 20% at $20K. Supplemental plans are designed to pick up that other 20%. So in my opinion, NO Part A and Part B are not enough on their own.

Answer: Medicare costs come in a few parts. Premiums are what you pay each month just to have coverage. Deductibles are the amount you pay out of pocket before Medicare starts helping. Then, for most services, you’ll still have copays or coinsurance, which is your share of the cost. A supplement or Medicare Advantage plan can help reduce these out-of-pocket costs.

Answer: Yes, if there has been a significant change in your income, you need to let them know so that your Part B premium can be adjusted.

Answer: Medicare Advantage HMO plans generally require you to see doctors within their network to keep costs low. If you visit an out-of-network cardiologist, you may have to pay the full cost yourself unless it's an emergency or urgent care situation.

Some HMO plans have a Point of Service (POS) option, which might allow you to go out of network for certain services, but at a higher cost. Your best bet is to contact your plan provider to confirm whether any exceptions apply to your specific plan.

Answer: Paying into Medicare makes you entitled to Part A and Part B. Medigap (Medicare Supplement Insurance) is offered by private insurance companies, not the government. And outside of certain protected times, they’re legally allowed to deny you coverage based.

Answer: An insurance broker works for you, not the insurance company. We’re here to make sure your plan continues to fit your needs year after year.

When you call the insurance company, you’re often stuck on hold or talking to someone who doesn’t know your full situation. You'll never get the same person twice.

With a broker, you have a go-to person who knows you, your needs, and your plan inside and out. If you ever have a problem—like a billing issue, denied claim, or want to switch plans—we handle it for you.

Also, there is no cost to you for me to service your plan year after year.

Answer: It all depends on the type of plan you have what what the exam is for. If its vision and you need glasses, some plans have Vision built into them. Others you have to pay extra for the plan.

If it is for a medical purpose such as glaucoma screening, typically anything preventative will be covered.

Answer: Me! That's what I'm here for. Medicare is what I do every day. As a broker, I represent all of the carriers available in the area and it is my job to find the best fit for YOU. We would do a health and needs analysis 1st and then go from there.