Patricia Lewis, Medicare Insurance Broker

Answer: Yes, this change was made to the drug costs for 2025. Now that it is 2026, the max is now $2100. These changes came from the bill called the Inflation Reduction Act. It also removed the dreaded donut hole, which had a max of $8K.

Answer: Yes, also known as Medigap plans. They all work with Original Medicare to help pick up the big gaps, like the $1736 dedutcible for being hospitalized, as well as the 20% on Part B that has no max out-of-pocket. They are separate plans that aren't required, and they have a separate premium. Plans G, N, and a high deductible G are the most common ones in 2026.

Answer: Which is better, Part D or an Advantage plan, will depend on a lot of factors. Budget, current medications, doctors, and medical conditions are pieces of the puzzle in deciding what would work best. It's two systems that have different pros and cons, and it can be very individual; there is no best answer for everyone.

Answer: If you are already retired and taking Social Security, then you will be automatically enrolled in Medicare (Parts A and B) at age 65. They normally send you the red, white and blue Medicare card about 3 to4 months prior to your birth month. You will also get a letter from the Social Security Administration on what the anticipated costs will be for you. You will have to decide if you want to stay with Original Medicare with a drug plan, and possibly a supplement, or if a Medicare Advantage plan is better for you. That is where consulting with an independent broker comes in; they can explain in terms you understand what the pros and cons are of each one.

Answer: Yes, it's true that there is a projection of a shortfall in the Medicare Trust fund hitting around 2030 or so. There is also increased usage, with so many joining, they estimate about 10K per day. Let's hope the government can figure out a solution very soon.

Answer: If you have Original Medicare, a supplement, and a drug plan, there is no dental/vision included in that, so you would need to purchase a stand-alone policy for both, or one or the other, depending on your needs.

If you have a Medicare Advantage plan, those often will include a benefit for dental and vision, but this fall, some of the PPO plans have been decreasing the dental coverage to preventative only. It's important to check each fall that you are aware of those types of changes.

Answer: The value-added benefits in an Advantage plan can certainly be helpful, especially for things you might pay extra for like dental and vision. But the things to be wary of would be things like the over-the-counter benefit, or gym membership, or transportation, again these are helpful, but you must remember this is your health plan first, so the focus needs to be there.

Answer: The best person is a local independent broker. This is someone who knows your area, the best plans, the details of the local area and they can sit down with you and show you all the parts of Medicare and answer your questions. Independent means they are not captive to a particular company and can show you plans for many companies in your area. We are unbiased and are there to be helpful.

Answer: Unfortunately, yes. It can happen that even with all the due diligence of checking and double checking that your doctor is in-network for your plan, the providers don't have to stay, they can make changes any time of the year. They would normally send a letter to let you know. In my area just recently, there is a whole physician's group with hundreds of doctors who have fallen out of network in the middle of the year. And unfortunately, this doesn't create a special enrollment period to make a plan change, so you have to decide whether you will see your doctor and pay cash or find a new doctor and switch plans in the fall so you can go back the following year.

Answer: If you have been subjected to the IRMAA charge and your financial situation changes, you can appeal that IRMAA charge and hopefully get it reduced or removed. Since they look back 2 years, a lot could have changed, and you have to let them know.

The only other way I know to lower your Part B premium is to pick a Medicare Advantage plan that offers a giveback.

Answer: Staying organized is key when you get bills from various providers/pharmacies. It might be good to have a separate folder for each provider, or maybe each type of provider. Don't let it sit. If you don't understand a bill, there are many places you can call for help: your broker, the insurance carrier, Medicare, or the provider billing department. Sometimes you can get bills that have not been processed correctly, so important to make sure you are being billed properly. It can be overwhelming, but you can also get through it.

Answer: I love being able to explain Medicare in a way that people understand. Since there is so much to go over, I go step by step and try not to overwhelm, and help people narrow down options that work for them. I help answer the questions they don't even know to ask. It's so rewarding to educate and guide and be a trusted person for them.