Rob Taylor, Medicare Insurance Broker

Answer: That’s a great and here’s the honest answer.

Medicare brokers are generally paid by the insurance company when someone enrolls in a plan through them. The cost of the plan is the same whether you work with a broker or enroll directly with the insurance company yourself.

For Medicare Advantage plans, commissions largely standardized by CMS, the Centers for Medicare & Medicaid Services. That means brokers are paid the same regardless of which carrier a client chooses within a market. This helps reduce incentives to steer clients to one plan over another based only on compensation.

Medicare Supplement plans can vary somewhat in compensation between companies, but for professional independent brokers, long-term client relationships matter far more than a one-time commission.

That’s especially true in my practice.

I work with people who are often approaching Medicare for the first time and simply want honest guidance without pressure or confusing sales tactics. My goal is not just to help someone enroll in a plan today. It’s to become a trusted resource they can continue to call year after year as their needs, prescriptions, doctors, or budgets change.

The reality is this:

If a broker puts someone into the wrong plan just to make a quick commission, that client probably won’t stay with them very long.

That’s why I focus on education first. I want clients to understand:

• How Medicare actually works

• The differences between Medicare Supplement and Medicare Advantage plans

• Provider networks and prescription coverage

• Potential out-of-pocket exposure

• How their coverage may fit their personal situation and future goals

A good Medicare advisor should be willing to explain both the pros and cons of each option, not just push a single plan or company.

A high-quality broker acts as your advocate, ensuring that your healthcare coverage fits your life, not the other way around.

Answer: Yes, you absolutely can stay with just Medicare Parts A and B and not enroll in anything else. For some people, that works fine. The key is understanding the financial risk you may be keeping.

Under Medicare Part B, after you meet the annual deductible, Medicare generally pays about 80% of covered outpatient and medical services, and you’re responsible for the remaining 20%.

What many people don’t realize is that Original Medicare does not have an annual maximum out-of-pocket limit on that 20%. That means your share can continue to grow if medical expenses become significant.

Example:

$500 in Medicare-approved Part B expenses = about $100 out of your pocket.

$100,000 in Medicare-approved Part B expenses = about $20,000 out of your pocket.

Because there’s no built-in cap on that 20%, I often call it an “asset eater.” A major illness, cancer treatment, dialysis, surgery, or ongoing outpatient care can start eating into retirement savings faster than many people realize.

That’s one reason many beneficiaries choose to explore additional protection, such as a Medicare Supplement plus a prescription drug plan, or a Medicare Advantage plan, depending on their health, prescriptions, doctors, and budget.

The right answer depends on the individual, but understanding your risk exposure first is always a good place to start.

Answer: This is one of the most common questions I’m getting right now, and honestly, the answer is a mix of “we’re already seeing real benefits” and “some parts are still developing.”

The biggest win is there’s now a hard cap of $2,100 on your Part D prescription drug costs for the year.

That means once your out-of-pocket costs for covered medications hit that amount, you’re done paying for the rest of the year. For anyone taking higher-cost medications, this is a huge financial protection and peace of mind.

Another clear win is insulin costs are now capped at $35 per month for Medicare beneficiaries. No surprises, no spikes. This has already made a meaningful difference for a lot of people.

You’ve heard that Medicare is now negotiating drug prices. That part is real, but how much it will actually impact most seniors day-to-day still remains to be seen.

The negotiated prices are rolling out gradually and only apply to a very limited number of medications at first. So for now, some people may benefit directly, while others may not notice much change.

The bottom line is that the most important changes are already here. The $2,100 out-of-pocket cap and the $35 insulin cap are the real game changers right now.

The drug price negotiations may bring additional savings over time, but the biggest benefit today is knowing your costs are more predictable and protected than they’ve ever been.

Answer: This is one of the most common questions I get from clients transitioning into retirement.

The short answer? Yes, you can.

When you lose creditable employer or union coverage, it usually triggers something called Guaranteed Issue rights. That’s a big deal because it means insurance companies must accept you for a Medigap plan, regardless of your health. No medical questions, no denials, just straightforward coverage.

Here are 3 things you’ll want to know:

1. The 63-Day Window:

You typically have 63 days after your employer coverage ends to enroll in a Medigap plan using these rights. This is a firm window, so it’s important not to let it slip by.

2. COBRA Can Be Misleading:

COBRA lets you keep your current plan for a period of time, but it doesn’t always work the way people expect with Medicare. In some cases, waiting on COBRA instead of moving forward with Part B and a Medigap plan can cause you to miss important timelines.

3. Your Plan Options

Depending on when you became eligible for Medicare, you’ll have access to certain standardized plans like Plan G or Plan N. These are designed to cover the out-of-pocket costs that Original Medicare doesn’t pay, like the 20% coinsurance.

Pro tip: Keep the letter from your employer that shows your coverage is ending. You may need it to confirm your eligibility for Guaranteed Issue.

If all of this feels a little overwhelming, that’s completely normal. This is exactly the kind of situation where having someone walk you through your options can make things a lot easier.

Answer: Not every Medicare Advantage plan includes an over-the-counter (OTC) benefit, but many of them do. When a plan offers it, members receive a set allowance they can use to purchase certain health and wellness items.

Most plans provide a monthly or quarterly allowance, often somewhere in the range of about $25 to $100, depending on the plan. That credit can typically be used for things like pain relievers, cold and flu medicine, vitamins, allergy medications, bandages, and other basic health supplies.

How members use the benefit depends on the plan, but it usually works in one of three ways:

• Ordering items from the plan’s OTC catalog and having them shipped to their home

• Ordering through the plan’s website or mobile app

• Using a benefit card at participating retail stores

It is also worth noting that certain Special Needs Plans (SNPs) can offer much larger allowances. For example, some plans designed for people who qualify for both Medicare and Medicaid, or those who have specific chronic conditions, may provide higher monthly benefits that can be used for OTC items and sometimes other health-related expenses.

One thing many people do not realize is that these allowances usually do not roll over, so if the credit is not used during the month or quarter, it is typically lost.

If someone is unsure whether their plan includes this benefit, the easiest place to check is their Summary of Benefits or Evidence of Coverage, or they can contact their plan directly to confirm. It can be a helpful perk when available, but the details vary quite a bit from one plan to another.

Answer: That is a very common concern, especially if you take several medications.

The first thing to know is that not all Part D plans cover drugs the same way. Each plan has its own formulary, which is simply its list of covered medications. You want to make sure every one of your prescriptions is on that list and preferably on a lower cost tier.

Next, look at where you fill your prescriptions. Many plans have preferred pharmacies or offer better pricing through mail order. That alone can lower your costs.

It is also worth asking your doctor if any of your medications have a generic or lower cost alternative that works just as well. Sometimes a small change can make a big difference in what you pay.

Finally, review your Part D plan every year. Plans can change their drug lists and pricing, and switching during the Annual Enrollment Period can potentially save you hundreds or even thousands over time.

A quick personalized drug review each year is one of the smartest ways to keep costs under control.

Answer: Great question. A lot of people are surprised to learn they may already have benefits they are not using. What is available depends on how your Medicare is set up.

No matter what type you have, Medicare covers preventive services like an Annual Wellness Visit, certain screenings for heart disease, diabetes, and cancer, plus vaccines such as flu, pneumonia, and shingles. Mental health counseling and some telehealth visits are also commonly covered.

If you have Original Medicare with a Supplement, one big benefit people overlook is flexibility. You can usually see any doctor nationwide who accepts Medicare, without referrals.

If you have a Medicare Advantage plan, you may have extra benefits like dental, vision, hearing, gym memberships, over the counter allowances, transportation to appointments, or even some in home support. Many of these reset each year, so if you do not use them, you lose them.

It is worth reviewing your plan once a year. You might discover benefits that save you money or make life a little easier.

Answer: That's a Great question!

Most people can enroll in Medicare when they turn 65. Your Initial Enrollment Period is a 7-month window that begins 3 months before your birthday month, includes your birthday month, and ends 3 months after.

Example: If your birthday month is May, your enrollment window runs from February through August.

Here's a little known fact: If your birthday is on the 1st day of the month, Medicare treats you as if you turned 65 the month before, so your coverage can start one month earlier!

If you’ve been receiving Social Security (or Railroad Retirement) benefits for at least 4 months before your 65th birthday, you’re usually automatically enrolled in Medicare Parts A and B, and your Medicare card is mailed to you.

If you’re still working and covered by an employer health plan, your timing may be different, and you may be able to delay Part B without a penalty.

If you’re turning 65 soon, it’s a good idea to review your situation early so you understand your options and avoid surprises.

Answer: I’m sorry your dad is dealing with ongoing back pain. That can be hard for him and stressful for the family, especially when you are trying to figure out what Medicare will and will not help with.

Medicare does cover chiropractic care in some situations. It will pay for visits only if the treatment is meant to fix a specific spinal problem. The care must involve hands-on spinal adjustments and must be expected to improve the condition. Medicare does not cover care that is only meant to manage pain over the long term.

Medicare usually does not cover routine or maintenance chiropractic care. If the visits are mainly for general back pain, ongoing pain relief, or to keep the condition from getting worse, Medicare typically will not pay. Medicare also does not cover X-rays ordered by the chiropractor, massage, or other therapies provided during the visit.

There is no set limit on how many chiropractic visits Medicare allows. Coverage continues only while the treatment is helping improve the condition. Once the care is considered maintenance, Medicare usually stops paying, even if the pain continues.

Some Medicare Advantage plans may offer extra chiropractic benefits, such as a certain number of routine visits each year. These benefits depend on the specific plan and where someone lives.

It can be helpful to ask the chiropractor a few clear questions.

First, ask: Do you accept Medicare assignment?

If a chiropractor accepts Medicare assignment, they agree to take Medicare’s approved amount for covered services. Medicare pays 80 percent of that amount directly to the provider. Your dad is responsible for the remaining 20 percent, unless he has a Medicare Supplement or other secondary coverage. If the chiropractor does not accept Medicare assignment, your dad may have to pay more out of pocket.

Other helpful questions to ask include:

Do you believe this is a spinal problem that Medicare would consider medically necessary to treat?

Is this treatment expected to imp

Answer: Working with a licensed Medicare agent can save you a significant amount of time, money, and frustration. Medicare is complex, and the choices you make during your initial enrollment or during the Annual Enrollment Period (AEP) can have long-lasting effects on your healthcare and your wallet.

Working with a licensed Medicare agent provides you with professional, expert guidance at absolutely no cost to you. Because agents are compensated by the insurance companies, you receive personalized plan comparisons and enrollment assistance without any added fees or higher premiums. Furthermore, as an independent broker, I am not tied to a single carrier. While a specific insurance company can only offer its own products, I can shop the market on your behalf. This independence allows me to compare multiple top-rated plans to ensure we find the one that best aligns with your specific doctors, your current medications, and your personal budget.

Answer: Yes, the cap is real and it is a game-changer! In 2025, out-of-pocket costs for Part D drugs were capped at $2,000. For 2026, that limit has been adjusted to $2,100. Once you hit this annual cap, you pay $0 for your covered prescriptions for the rest of the calendar year.

Even with this protection, someone with expensive prescriptions, such as those for cancer or rheumatoid arthritis, could walk into a pharmacy in January and be asked to pay the entire $2,100 at once. For many seniors on a fixed income, this pharmacy counter shock is a major hurdle. Recognizing this, Congress worked with advocacy groups like the AARP to create the Medicare Prescription Payment Plan. This program ensures you do not have to choose between life-saving medication and daily essentials like food.

This plan allows for predictable budgeting by letting you opt to spread your drug costs over the entire year into manageable monthly installments. Unlike a credit card, there is zero interest, no service fees, and no late penalties. It is a straightforward buy now, pay later program designed strictly for your financial protection. This is a huge win for anyone managing high-cost medications.