Phillip Lovelady, Medicare Insurance Agent
Phillip Lovelady
Texas Senior Agents
Medicare Agent Licensed in TX
Contact Details
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Location
New Braunfels, TX
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Phone
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Website
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Phillip Can Help With:
About Me
Hi! My name is Phil, and I am your Certified Medicare Insurance Planner™, CMIP® I've been a licensed Medicare Agent for over 13 years! I'm a native Texan that provides comprehensive and personalized insurance solutions to Texas Seniors on Medicare. We believe that every Texas Senior on Medicare deserves the peace of mind and security that comes with having the right insurance coverage in place. We charge no fees for our services. Give me a call and experience the difference.
** You can also request a copy of my book The Alphabet Soup of Medicare**
Directions to My Office
Q&A with Phillip Lovelady
What is the biggest mistake seniors make when enrolling in Medicare?
Answer: One of the most common mistakes people make when aging into Medicare is not understanding their enrollment periods and deadlines. Many assume they’re automatically enrolled when they turn 65, but that’s only true if they’re already receiving Social Security benefits. If not, they need to actively sign up during their Initial Enrollment Period (IEP), which spans the three months before, the month of, and the three months after their 65th birthday. Missing this window can lead to late enrollment penalties—such as a permanent increase in Part B premiums—or gaps in coverage.
What is one of the the most common misconceptions people have about Medicare?
Answer: One of the most common misconceptions about Medicare is that it’s entirely free once you’re enrolled. Many people assume that because they’ve paid into the system through payroll taxes during their working years, all Medicare services will come at no additional cost. In reality, while Part A (hospital insurance) is typically premium-free for those who’ve worked long enough, it still has deductibles and coinsurance. Part B (medical insurance) requires a monthly premium——and covers only 80% of outpatient costs after a deductible, leaving beneficiaries responsible for the rest. Add in Part D for prescriptions or extra services like dental and vision (which aren’t covered under Original Medicare), and the out-of-pocket expenses can pile up quickly if you’re not prepared. This misunderstanding often leads to sticker shock when the bills start rolling in.
What’s the cheapest way to get Medicare coverage if I only need basic hospital care?
Answer: I would never advise someone to ONLY enroll in Part A (Hospital)
If you skip Part B (outpatient care) to avoid its monthly premium - here’s the catch: if you delay Part B and later decide you need it, YOU'LL FACE A LATE ENROLLMENT PENALTY —10% added to the premium for each year you could’ve enrolled but didn’t—unless you have other creditable coverage (like an employer plan). Also, Part A alone won’t cover doctor visits, labs, or outpatient procedures, so if “basic hospital care” might stretch beyond inpatient stays, you’d be paying those extras fully out-of-pocket. For pure cost minimization with a hospital-only focus, Part A solo is your leanest option—just be sure your needs won’t creep into Part B territory later.
What are the signs that it's time for me to switch my Medicare plan, and how often should I review my options?
Answer: Signs that it’s time to switch your Medicare plan include:
Rising Costs: If your out-of-pocket expenses—like premiums, deductibles, or copays—are creeping up beyond what’s comfortable, a different plan might save you money. For example, a Medicare Advantage plan could cap your annual spending, unlike Original Medicare.
Changing Health Needs: If your doctor says you need new treatments, specialists, or meds that your current plan doesn’t cover well (or at all—like dental or vision in Original Medicare), it’s a red flag. A plan that once fit might not anymore.
Provider Network Issues: If your preferred doctors or hospitals drop out of your plan’s network (common with Medicare Advantage), or you move to a new area, you might need to switch to keep care seamless.
Poor Coverage Fit: Maybe you’re overinsured—paying for bells and whistles you don’t use—or underinsured, scrambling to cover gaps. A plan tweak could align better with your reality.
Plan Changes: Every year, plans adjust. Your Medicare Advantage or Part D plan might hike premiums, cut benefits, or alter drug formularies in ways that hit you hard. The Annual Notice of Change letter (sent by September 30) will tip you off.
As for how often to review your options: once a year is the sweet spot. The Annual Enrollment Period (AEP)—October 15 to December 7—lets you switch Part D or Medicare Advantage plans, or jump between Advantage and Original Medicare, with changes kicking in January 1. Even if you’re happy, skimming your plan’s updates during this window keeps you from getting blindsided. Life shifts—like a new diagnosis or move—might warrant an extra look, and Special Enrollment Periods (SEPs) can pop up for those (e.g., losing employer coverage). Medicare’s website or a quick call to 1-800-MEDICARE can help you compare. Don’t sleep on it—plans evolve, and so do you.
Why is the new $2,000 out-of-pocket maximum for drug costs important?
Answer: The new Medicare $2,000 out-of-pocket maximum for drug costs, starting in 2025 under the Inflation Reduction Act, is a big deal because it caps what Part D beneficiaries pay annually for covered prescription drugs, bringing relief to millions who’ve been hammered by high medication costs. Before this, there was no upper limit—once you hit the "catastrophic" coverage phase (after spending $8,000 out-of-pocket in 2025), you’d still pay 5% of drug costs forever. For folks on pricey meds—like cancer treatments or specialty drugs that can run tens of thousands a year—that 5% could still mean hundreds or thousands monthly. Now, once you hit $2,000 (including deductibles and copays, but not premiums), Part D covers 100% of your covered drugs for the rest of the year. No more endless bleed.
This matters because it tackles a brutal reality: about 1.5 million Medicare enrollees spent over $2,000 on drugs in 2021, per KFF data, and many rationed or skipped doses due to cost. The cap could save those with the highest needs—like seniors with chronic conditions—thousands annually, while giving everyone peace of mind that drug bills won’t spiral out of control. It’s not perfect (over-the-counter drugs and non-covered prescriptions don’t count toward the cap), but it’s a lifeline for affordability and predictability in a system where drug prices have long been a wildcard.
In what situations will Medicare pay for medical services in a foreign hospital?
Answer: This answer depends on what kind of plan you have. If you have a Medigap plan, you have hospital coverage for foreign travel up to $50,000. If you have a Medicare Advantage, it depends on the plan that you are enrolled in. Many Medicare Advantage Plans do cover medical emergencies while in a foreign country. Keep in mind that with a Medicare Advantage there are co pays.
I'm worried about the 'donut hole' in my Part D plan. How do I manage my medication costs once I enter it?
Answer: There is no longer a "donut hole," thanks to the Inflation Reduction Act. Technically, it has been phased out.
Here’s the quick backstory: the donut hole was a gap in Part D coverage where, after hitting a certain spending threshold ($5,030 in 2025), you paid a bigger chunk of drug costs out-of-pocket until reaching the "catastrophic" phase ($8,000 in 2025). Pre-2020, you’d foot 100% of costs in that gap. By 2020, it shrank to 25% for both drug types, effectively "closing" it. Now, in 2025, you’ll never even feel a gap—once you spend $2,000 out-of-pocket (including deductibles and copays), Part D kicks in to cover 100% of your covered drugs for the year. No more weird middle zone. It’s simpler, cheaper, and a lot less stressful for anyone juggling multiple prescriptions.
How do you explain to clients that “zero-premium” doesn’t mean “zero-cost” with Medicare Advantage?
Answer: My Daddy use to say, "Son, there ain't no such thing as a free lunch." This is the case with the zero dollar premium Medicare Advantage(MAPD.) In order to enroll in a MAPD, you have to be enrolled in Medicare A AND B, so you still have to pay your Part B premium.
The Zero Premium does not mean "zero cost." MAPD plans are a "Pay as you go" plan. Depending on what plan you enroll in you may have co pays for Doctor visits, Specialist, and Hospital stays.
What is the biggest disadvantage of Medicare Advantage?
Answer: The biggest disadvantage of Medicare Advantage is the restricted provider networks. Typically, your MAPD plans come in the form of PPO or HMO.
If you had to pick just one, what’s the worst Medicare-related decision someone can make?
Answer: Procrastination. Many people wait until the last minute to get their "Medicare affairs," in order.
The worst Medicare-related decision someone can make is missing the Initial Enrollment Period (IEP) for Part B without a valid excuse. The IEP is that seven-month window around your 65th birthday (three months before, the month of, and three after). Skip it, and you’re not just delaying coverage—you’re harming yourself long-term. Unless you’re covered by a qualifying employer plan, you’ll face a late enrollment penalty: a 10% hike on your Part B premium for every 12-month period you could’ve enrolled but didn’t. That sticks with you for life.
Can I change my Supplemental/Medigap plan at any time?
Answer: You can cancel your Supplement/Medigap plan at any time of the year. You don't need to wait for an enrollment period. Once you have been on Medicare Part B for over a year with your Supplement, you would have to answer health questions and qualify medically in order to qualify for a new policy. Medicare beneficiaries usually look to change plans when their current premiums have increased, and want the same plan but with lower premiums.