Robin Duffey, Medicare Insurance Agent

Answer: Any agent that is discussing Medicare options should explain when you get get a guaranteed Medigap plan. It does happen that might not be explained but even when the agent does explain the Medigap guaranteed versus underwriting sometimes so much information is being given to the person they are talking with it gets to be too much information and can be forgotten.

Answer: When you move to a smaller county, the less options you have for Medicare Advantage unfortunately. hope that helps. robin

Answer: Unfortunately, when you enter Medicare and you cannot provide creditable coverage you will have Part B and Part D penalties forever. robin

Answer: Some clients ignore my advice, which is unfortunate, as they prefer to rely on family and friends instead of a licensed Medicare agent.

Answer: Without a Medigap plan you would be responsible for 20% of all medical/hospital charges, which can be hugh considering a major operation could run up to 50,000 = 20% would be 10,000 and that is without a 15% additional charge which some hospital can charge over billing Medicare.

Answer: You can switch to a supp/medigap plan without answering health questions from a Medicare Advantage plan. IF your current MAPD plan is discontinuing for the next year. robin

Answer: Choosing a Medicare agent / company is easy -- go with the person you feel has your health interests at heart and will be available when you have concerns or questions.

Answer: Whenever there is a health change you should always consider re-evaluating your current plan. If your health is chronic related, there are specific plans that cover chronic care and sometimes it can offer more benefits. robin

Answer: The most common misconceptions are that Medicare covers everything 100% and sometimes even covers medications as well; both are incorrect.

Answer: Yes, Medicare and Medicare Advantage plans do cover recovery. Most Medicare plans even send you home with seven days of food so you can recover and there is also skilled nursing facilities that are part of Medicare/Medicare Advantage plans. robin

Answer: Yes. Almost all Medicare Advantage plans have smartphone apps :) car, and house insurance do as well. Hope this helps. robin

Answer: Go onto Medicare.gov and choose PDP option and then enter all your medications, then choose your pharmacy options and then you can review the plans and their costs. If you have a lot of Brand Names (Tier 3) medications you might want to talk with your doctor to see if those can be changed to a preferred generic / generic medication to bring your costs down. In 2026 the cap on medications will be 2100 for the year. Hope that helps - robin

Answer: Last year Medicare removed the donut hole and for 2025 the max medication copays is 2000 annually and for 2026 the max copays for medications will be 2100. robin :)

Answer: Get a good independant Medicare agent to take the time to discuss all their options and who will go over all the doctors and medications. robin

Answer: She can if she is the POA for your healthcare OR if you are on the phone with the Medicare agent with you on the phone as well. As a Medicare agent, I always want a family member as part of the team for a parent's or partner's healh care decisions. Hope that helps ~ robin

Answer: All Medigap plans increase premiums yearly or every two years or so. In 2026 there will be an increase to most plans from 8-12%.

Answer: It is totally up to the individual's wants and needs and their personal healthcare. There are advantages to either option. A PDP plan when you have Original Medicare covers your medications but you still do have to cover the 20% "gap" for your hospital & medical coverage. A Medicare Advantage plan bundles PDP into their plans. Be it a separate PDP or an Advantage plan both will have copays for medications. Healthcare needs, wants, doctors and medications are individual choices so 'better' in up to you. robin

Answer: The annual visit is the first visit with your primary care doctor and each PCP has it's own basic exam, reviewing any changes and ordering basic lab work is generally the annual visit.

Answer: Almost all HMO Medicare Advantage plan are zero monthly premiums and only some PPO plans have premiums. If you are referring to the Medicare Part B monthly premiums then that is another issue. If you cannot afford those premiums then Medicare will remove you from the Part B. robin

Answer: Easy :) MOOP is the most copays & coinsurance you will pay during the year and when you reach the MOOP you no longer pay those copays or coinsurance. HMO plans have lower MOOP over PPO plans. If you have a REALLY bad health year and you are in and out of hospitals, CT Scans, MRI, etc., you will be paying copays a lot and that is when you want to keep an eye on your MOOP so you do not go over that limit (I also call it a cap / limit).

Hope that helps ~ robin

Answer: Whenever a Medicare agent (independant one for sure as they are not contracted with just one carrier) must review all doctors and medications, hospitals and any other concerns the potential member needs done and then after researching all carriers and plans they will reach back out to your mother, and it is always nice to have you or a family member there as well, to discuss all her options. Our job is to do all we can, that is available, to help your mother with the right / best choice for her at the time. robin

Answer: Since I am not sure which Medicare plan you are on I can give you general information.

If you have a Medicare Advantage plan, you will always need authorization whether you have a PPO plan or an HMO plan. Referrals are different from authorizations and sometimes come from the carrier's network. If you have Original Medicare and a supplement plan you do not need authorizations BUT in AZ and two other states for next year there will be 10 surgeries that will require authorizations (they have not shared which surgeries / health issues these will be yet) as a testing ground... that is a wait and see.

Not sure if this helped answer your question but hopefully did a bit :) robin

Answer: You need to get a POA (power of attorney) for healthcare. This is typically done through a lawyer as it is a legal document that you sign and your parent would sign in front of a notary & maybe even two other witnesses.

Answer: Yes :) It is one of the most common ways to enroll into a Medigap plan within 63 days of losing the work ins. coverage. robin

Answer: There are two mistakes seniors make when enroling in Medicare:

Not enrolling when they are eligible for Medicare and do NOT have credible coverage which creates a "gap" in coverage and then when they do enroll for A&B they have a penalty for life -- I just HATE that.

The other mistake is just the opposite - they enroll into Medicare A&B when they still have credible coverage and then they are paying for their work insurance AND Medicare.

I always go over how to avoid penalties to all my members to be and especially when I do seminars AND no one who continues to work and have work insurance should ever be told they have to change to a Medicare plan due to their age. robin

Answer: I have members on Medigap plans and Medicare Advantage plans and my members are happy with their plans.

Sometimes people are unhappy with their plans due to misunderstanding what is covered, which is why I spend a lot of time discussing all options and making sure there is a clear understanding of the limitations to any plan.

I know some members get unhappy when a procedure is denied and they do not understand why. I always tell them if a procedure has been denied to contact the physician that requested the procedure, medication, etc., as sometimes the office just mis-coded the code or more detailed documentation was required. I never like my people to just take "denied" as the final answer.

There is always the "grass is always greener" feeling members get or they see something they think might be better on TV but if your agent takes the time to research all the doctors, medications and wants and needs of the member, hopefully they will be happy when also realizing that no plan will cover everything. Hope that helps. robin

Answer: Yes in a few ways - If you have Original Medicare A&B (and hopefully Medigap & PDP plan) you can travel throughout the United States and see any doctor or hospital that accepts Medicare.

If you have a Medicare Advantage plan, you can be seen at any emergency hospital or urgent care throughout the United States. Some Medicare Advantage plans have National providers, even if the plan is an HMO plan AND lastly, a Medicare Advantage PPO plan allows you to see doctors in and out of network (these PPO plans are becoming less and less in 2026).

Hope that helps answer your question. robin

Answer: Original Medicare covers 80% of hospital (PART A) and medical (PART B) but not additional benefits such as eye, dental or hearing; those are Medicare Advantage plans. robin

Answer: Extra Help or LIS is when your income is above the Medicaid income level for full healthcare but lower than the "standard" income. In AZ it is called AHCCCS. I always ask those I am working with about their income as every penny helps and when they are in between the income levels, I love that they can get Extra Help with their medication costs, as well as having their Medicare Part B monthly premium paid for through Medicaid (AHCCCS in AZ). robin

Answer: The easy answer is to have Original Medicare A & B plus a Medigap plan BUT you are only guaranteed into a Medigap (Supplement) plan when you start Medicare Part B, turn 65 or if you are on a Medicare Advantage plan and that plan is being discontinued for the next year. Not sure exactly what rare disease you are referring to, but there are Medicare Advantage plans that are chronic plans that do address heart and diabetic conditions, but I would not consider those rare. Hope that gives you some insight. robin

Answer: Almost daily! Seriously, to most individuals, Medicare is a maze and I love explaining Medicare, Medigap and Medicare Advantage options so it is easy to understand. I feel once the person understands it is not that complicated and to approach their healthcare options for them and not what their family, neighbor or what they see on TV, I feel a calm comes over them with a nice understanding. So, pretty much that is how I help clients since I am a major research nerd and love when I see the 'light bulb shine" of understanding once we work it all out.

Hope that answers your question ~~ Robin