Randy Hill, Medicare Insurance Broker

Answer: Yeah, IRMAA can be a surprise hit to your Medicare premiums if your income’s above a certain level. But there are a few ways to either avoid it or bring it down.

First, it all comes down to your income from two years ago, so if you can keep your taxable income under those limits, you’re golden. You can use Roth IRAs or Roth 401(k)s because money from those dont count toward your income, so it helps keep you under the radar. And if you’re taking money from traditional retirement accounts, you could think about converting some to Roth early on (before Medicare kicks in) to lower your future tax hits.

Also, if you’ve had a big life change like retirement, loss of a spouse, or a drop in income—you can actually appeal your IRMAA charge. You just fill out a form (SSA-44) and explain your situation.

Keep in mind the sale of a home with capital gains income can affect your IRMAA as well which could throw you into a higher income level.

Bottom line: it’s all about planning ahead. If you’re getting close to retirement or Medicare age, it’s worth sitting down with a tax or financial advisor and figuring out what moves you can make now to avoid that extra premium later.

Answer: You can use them to possibly save money on prescriptions. However they will not go toward your deductible if applicable. Sometimes the savings is well worth using them. Always ask the pharmacist which option will give you the best deal.

Answer: Don’t choose a plan based only on the monthly premium or how much you receive in otc benefits. Look at the total cost of care. Your health care is the priority not benefits you hear about on TV.

A low-premium plan might seem like a great deal, but it could come with high deductibles, copays, limited drug coverage, or a restricted doctor network. You might end up paying much more in the long run.

Things to consider:

Your prescriptions and how they’re covered

Your doctors, are they’re in-network

Estimated annual out-of-pocket costs (not just premiums)

Your travel needs (some Advantage plans don’t travel well)

Talk to a Medicare expert. They can help avoid costly mistakes.

Answer: Thanks for your question!

If you're on Original Medicare without a supplement and need an ambulance tomorrow, here's the simple version:

First, you have to pay your Part B deductible if you haven’t already. In 2025, that’s $257.

After that, Medicare pays 80%, and you pay 20% of the approved ambulance cost.

So for example, if the ambulance ride costs $1,000 (the Medicare-approved rate), you’d pay $257 (deductible) plus about $148 for your 20% share — a total of about $405 out of pocket.

Medicare will only pay if it’s medically necessary and takes you to the closest hospital that can treat you. If it’s not an emergency or you ask to go farther away, you might have to pay more.

Hope this makes it super clear! Let me know if you have any other questions — happy to help!

Answer: Yes, Medicare can help pay for acupuncture — but only if it’s for chronic low back pain (that means back pain that’s lasted 12 weeks or more).

Here’s how it works:

Medicare will cover up to 12 visits to try and help with the pain.

If it’s helping, they’ll cover 8 more, for a total of 20 visits a year.

If it’s not helping, they stop covering it and you’d have to pay yourself.

You also need to see someone Medicare approves — like a doctor or nurse with special acupuncture training (not just anyone with an acupuncture license).

After you pay your Part B deductible (which is $257 in 2025), you’ll pay 20% of the cost for each visit.

Important: They only cover it for low back pain — not for other things like neck pain, arthritis, or stress.

Some Advantage plans have it included within their plan so be sure to check with your plan if you are on an Advantage plan.

Hope this helps.

Answer: If Medicare or your plan says “no” to paying for a procedure or medicine you need, don’t worry — you can ask them to take another look. This is called an appeal you can politely ask them to review it again.

Here’s how you can appeal, step-by-step:

1. Look at Your Denial Notice:

Medicare or your plan will send you a letter that says they won’t pay. It’s called a "Notice of Denial." Keep this paper — it explains why they said no and tells you how to start an appeal.

2. Ask for a Redetermination (First Appeal):

You’ll need to fill out a simple form or write a letter saying you disagree and why you think they should cover it. Send it to the address listed on your denial notice.

Tip: It’s smart to have your doctor write a note too, explaining why you really need the treatment or medicine.

3. Follow the Deadlines:

You usually have 120 days (about 4 months) from the day you got the denial to file your appeal. So don’t wait too long!

4. What Happens Next:

After you send your appeal, Medicare or your plan has to look at it again and give you an answer. If they still say no, you can keep appealing at higher levels if you want.

Important: Always keep copies of everything you send or get — like letters, forms, and doctor notes — just in case you need them later!

Hope this helps!

Answer: If you need a new wheelchair and want Medicare to help pay for it, there’s a special process you have to follow — kind of like going on a little treasure hunt where you collect the right “clues” to get what you need.

Here’s how it works, step-by-step:

1. See Your Doctor First:

You can’t just go pick out a wheelchair by yourself. First, you need to visit your doctor. Your doctor has to say, in writing, that a wheelchair is medically necessary — meaning you need it to move around safely at home.

2. Get a Prescription:

Your doctor will give you a prescription that says you need a wheelchair. Without this note, Medicare won’t pay!

3. Choose a Medicare-Approved Supplier:

You have to get your wheelchair from a store that’s approved by Medicare.

You can find one by asking your doctor or by looking it up at

www.medicare.gov/medical-equipment-suppliers.

4. The Supplier Checks With Medicare:

Sometimes, the supplier needs to send paperwork to Medicare to ask for approval first. This is called prior authorization. (It’s just Medicare’s way of double-checking.)

5. Pay Your Share:

If Medicare says yes, they’ll usually pay 80% of the cost. You will pay the other 20%, plus any deductible if you haven’t paid it yet this year.

Important Tips:

Make sure both your doctor and your supplier accept Medicare assignment — this helps keep your costs as low as possible.

Keep copies of everything your doctor and supplier give you!

That’s the whole treasure map!

Start by talking to your doctor, and soon you’ll be rolling along with your new wheelchair.

If you have any more questions, just let me know — I’m happy to help!

Answer: If your Medicare Advantage plan said “no” to the specialist you need, don’t panic — you still have some options!

Here’s what to do:

1. Read the letter they sent. It tells you why they said no and how you can ask them to change their mind. That’s called an appeal.

2. You can appeal! Just write a note (or fill out a form) saying why you need this doctor. You usually have 60 days to send it in.

3. Ask your doctor for help. A letter from them saying why this specialist is important can make a big difference.

4. Need it fast? If your health might get worse by waiting, ask for a fast appeal. They’ll answer in 3 days or less.

5. Still no? You can appeal again and again. Don’t give up!

You can get free help from your local State Health Insurance Assistance Program (SHIP). They can help you fill out forms and explain everything. You can find your local SHIP at www.shiphelp.org.

Always save copies of everything — letters, forms, notes from your doctor — just in case you need them later.

Answer: Thanks for your great question!

Let’s break it down super simply:

Right now, more and more people are picking Medicare Advantage plans instead of regular Medicare mainly due to affordability and additional benefits. Medicare Advantage is when private insurance companies (like Humana, UnitedHealthcare, or Aetna) run your Medicare benefits instead of the government.

Is it concerning?

Well… it depends who you ask! Here’s the simple version:

Why Some People Think It’s Good:

These plans often give extra goodies like dental, vision, hearing, gym memberships, and drug coverage all in one plan.

They sometimes have lower monthly costs than regular Medicare with a separate supplement.

Why Some People Are Worried:

Since private insurance companies are in charge, they can decide which doctors you can see and sometimes make you get permission (called prior authorization) before you can get certain treatments.

Some people worry that companies care more about making money than about patient care.

If you get really sick or need to see special doctors, you might feel more “stuck” in a network with fewer choices compared to Original Medicare or a Medicare (Medigap) supplement plan.

Big Picture:

Medicare Advantage is growing fast because lots of people like the extras and lower upfront costs plus they really market them on television.

But it’s super important to remember: not all plans are the same — some are awesome and some aren’t so great.

It’s smart to really look carefully at all optins before picking a plan to make sure it covers what you need.

In short:

Medicare Advantage isn’t bad, but it’s not perfect either. It’s just different — like choosing between a homemade sandwich and a fast-food meal. One might be faster and cheaper, but it may not always be the healthiest or best choice for everyone.

Always pick the plan that fits your health, doctors, and future needs best!

Let me know if you’d like help comparing your options — it can get a little tricky, but

Answer: When it comes to picking the best Medicare Supplement insurance company (also called Medigap), it’s kind of like picking the best backpack for school — you want one that’s strong, dependable, and fits you well.

Here’s what I’ve seen in my experience:

Some of the Best Medicare Supplement Companies Are:

Mutual of Omaha

Aetna

UnitedHealthcare (through AARP)

Cigna

Blue Cross Blue Shield (varies by state)

Why These Companies Are Good:

Strong Reputation: These companies have been around a long time and are trusted by lots of people.

Good Customer Service: When you call them, they actually help you (instead of making you sit on hold forever!).

Stable Pricing: Their monthly costs (called premiums) don’t usually jump up crazy fast each year.

Easy to Use: They make it simple to use your benefits — no tricky rules or secret charges.

Financial Strength: These companies are financially healthy, which means they’ll be there when you need them.

Important to Know:

The Plan You Pick Matters More Than the Company!

Medicare Supplement plans (like Plan G or Plan N) are standardized by law. That means Plan G from Mutual of Omaha is the same as Plan G from Cigna — it just costs a little differently or has different customer service.

Price and Service are Key: Since the benefits are the same, you want a company with a good price and good service.

Little Tip:

Always look at both the monthly premium and how much they’ve raised rates in the past — because even a good company can get pricey over time if they raise rates too fast!

In short:

Pick a strong, trusted company with good rates today and a good history of keeping prices steady tomorrow. That’s the real "best" choice!

Let me know if you want me to help you compare a few — I can help you find the one that fits you best.

Answer: Since you’re already on Medicare because of disability, when you turn 65, you don’t have to start over or sign up all over again.

You already have Medicare!

Here’s what will happen:

Your Medicare will just keep going.

You don’t lose anything. You don’t have to reapply.

You’ll get a new Medicare card.

Medicare usually sends you a fresh card around your 65th birthday. It will show the same Part A (hospital) and Part B (doctor) coverage you already have.

You might have new choices.

Turning 65 gives you a special chance to make changes if you want like:

Adding a Medicare Supplement (Medigap) plan.

Switching to a Medicare Advantage plan.

Signing up for a Part D drug plan (if you don’t already have one).

Important Tip:

Even though you don’t have to reapply for Medicare itself, it’s a great time to review your coverage and make sure you have the best plan for your needs and budget.

In short:

Nope — you don’t need to sign up again! But it’s a smart time to check if you want to make any updates or changes.

If you want, I can help you review your options before your birthday so everything is ready and easy!

Answer: When you go to the hospital, Medicare Part A pays for your stay but only for a certain number of days.

Here’s the simple way to think about it:

Medicare covers up to 90 days in the hospital for each “benefit period” (that’s like one full visit or one long hospital stay).

If you stay longer than 90 days, Medicare gives you a special gift called Lifetime Reserve Days.

You get 60 extra days that you can use over your whole life — not 60 extra days every year, just 60 TOTAL for your lifetime.

These extra days help pay for hospital stays that are longer than normal.

How they work.

If you’re still in the hospital after 90 days, Medicare will automatically start using your Lifetime Reserve Days, one day at a time.

Medicare pays most of the cost, but you have to pay a daily fee (called a coinsurance amount) for each Lifetime Reserve Day you use.

Once you use up all 60 Lifetime Reserve Days, they’re gone forever and you don’t get new ones.

Simple Example:

Imagine you’re in the hospital for 100 days during one stay:

Days 1–60: Medicare covers almost everything (you just pay a small deductible).

Days 61–90: You pay a daily copay, but Medicare still helps.

Day 91–100: Medicare starts using your Lifetime Reserve Days, and you pay a daily coinsurance each day you stay.

After the 60 extra days are used up, Medicare stops paying for that hospital stay — and you have to pay 100% of the cost for any more days you stay.

Tip:

Some people get extra protection by having a Medicare Supplement (Medigap) plan. Some of these plans help cover hospital costs so you don’t get stuck with a big bill!

In short:

Lifetime Reserve Days are like extra “bonus days” for long hospital stays but you only get 60 of them for your whole life.

Hope this helps!

If you want, I can also show you which Medicare Supplement plans help cover those costs to make it even easier!

Answer: That's a really smart question!

Most people getting ready for Medicare are thinking about things like, “How much will it cost?” or “Which plan should I pick?” and those are really good questions!

But the most important question you probably haven’t thought of yet is:

“How will my health needs change in the next 5 to 10 years, and will my Medicare coverage still fit?”

Here’s why this matters.

When you first pick a Medicare plan, it’s easy to just look at today:

What doctors you see right now

What medicines you take right now

What hospitals are close to you right now

But: As you get older, your health could change.

You might need different doctors, specialists, surgeries, hospital stays, or expensive treatments you don’t need today.

The problem is:

Some plans (like Medicare Advantage plans) have rules like small networks or you need "permission" before getting care (called prior authorization).

If your health gets more complicated, it can be harder to change plans later — especially if you want a Medicare Supplement (Medigap) plan, which often requires answering health questions after your first enrollment window.

Simple Example:

Imagine picking a cheap, easy plan at 65, but then at 70 you get really sick and realize your plan doesn’t cover what you need and now it’s too late (or too expensive) to switch.

So in short:

The best question to ask is:

“Will this plan still take good care of me if my health gets worse in the future?”

Tip:

Choosing stronger coverage early even if it costs a little more. This can save you a lot of money, stress, and problems later.

If you want, I can help you go over options that not only fit your needs today, but also protect you for tomorrow!

Answer: Hi there,

You're right — Medicare can feel like a big confusing maze with a whole bunch of letters like A, B, C, and D floating around! But don’t worry — you're not alone, and there are people who can help you figure it out in a simple, clear way.

Think of Medicare like a puzzle. It has different pieces (called Parts) that each do something different:

Part A is like your hospital coverage — it helps if you go to the hospital.

Part B is for doctor visits and things like lab work.

Part C is also called Medicare Advantage — it’s like a bundle plan from private companies that includes Parts A & B, and often D too.

Part D is for your prescription drugs.

And if you want help with the “leftover” costs that Medicare doesn’t pay, you can get something called a Medigap (or Medicare Supplement) plan.

Now here’s the good news:

There are licensed Medicare agents (like me!) whose job is to help you understand all of this for free. We’re trained to walk you through your choices step-by-step and help you find the plan that fits you best. You don’t have to do it alone.

You can also visit the official Medicare website at www.medicare.gov — it has tools and info if you want to do some reading yourself.

But if all these letters still feel like alphabet soup, I’m just a phone call or email away and happy to help you sort it all out — no pressure, no cost.

Answer: Great question! Let’s break this down super simply.

Think of Medicare like a lunch tray. Original Medicare (Parts A & B) gives you your main meal (hospital and doctor coverage). But you're still missing a drink and dessert — that’s where Part D (prescription drugs) and Medicare Advantage (Part C) come in.

Here’s the difference between Part D and Medicare Advantage:

---

Option 1: Original Medicare + Part D

You keep Original Medicare (Parts A & B) that pays 80% you are responsible for 20%

Add Part D to help pay for prescription drugs

Optional: Add a Medigap (Supplement) plan to help cover the 20% costs Medicare doesn’t pay

Good if you:

Want freedom to see any doctor that takes Medicare — no networks

Travel a lot or live in more than one state

Don’t mind paying more in monthly premiums for flexibility

---

Option 2: Medicare Advantage (Part C)

Replaces Original Medicare — you get everything in one plan

Usually includes Part A, Part B, and Part D

Often has extra perks like dental, vision, gym memberships

Good if you:

Want lower monthly costs (often $0 premiums. You pay small copays until you reach your maximum out of pocket (MOOP).

Are okay using doctors in a network

Like having all your benefits in one simple plan

---

So, which is better?

It depends on what's more important to you:

Freedom and flexibility? Go with Original Medicare + Part D (and maybe Medigap).

Convenience and savings? Try Medicare Advantage.

---

Bonus Tip: You can’t have both Medigap and Medicare Advantage — you have to pick one path.

If you want, I can help you compare both options based on your personal situation.

Answer: Great question — and you’re not alone! Medicare Advantage plans can sound super fancy with all their “extra” perks. But how do you know if those benefits are really what they say they are?

Let me explain it.

---

Imagine someone offers you a big shiny toy box. They say, “It has games, candy, and even a puppy inside!” Sounds great, right?

But before you get too excited, you’d want to open the box and read the instructions to make sure it’s not just full of stickers.

Here’s how you can “open the box” and check what’s really inside a Medicare Advantage plan:

---

1. Get the “Summary of Benefits”

Every real Medicare Advantage plan has a special booklet called the Summary of Benefits. It clearly lists:

What’s covered

What’s not

How much you’ll pay

Ask the agent or company to give you this document. If they won’t — that’s a big red flag.

---

2. Visit Medicare’s Official Website

Go to www.Medicare.gov

You can type in your zip code and:

See every plan in your area

Compare side-by-side what each one really covers

Make sure the plan is approved by Medicare

If a benefit isn’t listed there — be cautious.

---

3. Call Medicare or a Trusted Expert

You can call Medicare directly at 1-800-MEDICARE (1-800-633-4227)

Or talk to a licensed Medicare agent you trust — someone who can explain the fine print without tricking you.

---

4. Watch Out for “Too Good to Be True”

If a plan promises everything for free including cash, gift cards, or major dental work at no cost — slow down and double-check.

Medicare Advantage plans can have great perks like dental, vision, and hearing — but there are always details about how much is covered, which providers you can use, and any limits.

---

Bottom line:

Ask for the Summary of Benefits, compare plans on Medicare.gov, and talk to someone you trust. That’s how you make sure you’re getting the real deal — not just a shiny box with no puppy inside.

Let me know if you’d like help reviewing the plans available in your area.

Answer: I’m so glad you asked — and even happier you didn’t fall for it. Let me explain what’s going on here.

Here’s the truth:

No real Medicare agent is allowed to promise you free groceries just to sign up for a plan. That breaks the rules.

These people are usually telemarketers, not real licensed agents.

They want to trick you into switching your Medicare plan even if it’s not a good one for you.

Once you sign up, they get paid, and you’re stuck with a plan that might not cover your doctors or your meds.

---

So why is this allowed?

It’s not!

The government has strict rules about Medicare marketing, but:

Some people ignore the rules and call anyway.

They use fake names and spoofed numbers, which makes them hard to track.

Medicare does investigate and shut them down when they can, but it’s like playing whack-a-mole, new ones pop up every day.

---

What You Can Do:

1. Hang up right away if someone offers free gifts, groceries, or cash to join a Medicare plan.

2. Report the call to Medicare at 1-800-MEDICARE.

3. Only work with trusted, licensed agents (like me!) who will never pressure you or offer fake rewards.

---

Remember:

If someone’s plan is really good — they won’t need to bribe you with a grocery card to get you to join.

Your healtcare coverage is the most important part of any plan. Make sure your doctors and prescriptions are covered in any plan you select.

Let me know if you ever get another suspicious call — I’ll help you spot the fakes and keep you protected.

Here are the Top Scams to Watch Out For

1. “FREE Groceries” or Gift Cards

If someone says you’ll get free groceries or a gift card for joining a plan, hang up!

This is against Medicare rules

They're likely trying to switch your plan without telling you what you’re really getting

2. Fake “Medicare Agent” Calls

Real agents don’t call you out of nowhere without permission

If they ask for your Medicare number, hang up

Never give your Social Security number or banking info to a stranger

Answer: Here’s what to do if you spot something fishy on your Medicare bill:

1. Double-check the bill.

Look at your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).

Did you get charged for something you didn’t receive?

Did they bill the same thing twice?

Did the date look wrong?

2. Call your doctor or provider first.

Sometimes billing mistakes happen by accident.

Ask: “Can you help me understand this charge?”

3. Still looks wrong? Report it safely.

You can call Medicare’s fraud hotline at

1-800-MEDICARE (1-800-633-4227)

or

1-800-HHS-TIPS (1-800-447-8477) (Health & Human Services)

You can stay anonymous if you want and you will not get in trouble for asking questions or reporting a possible error.

Why this matters:

Medicare loses billions of dollars every year to mistakes and fraud.

When you speak up, you’re helping protect your money and everyone else’s too.

If you’d like, I can help you review your Medicare statement and make sure everything looks right no pressure, no cost.