Rodney Powell, Medicare Insurance Broker

Answer: Fair question. Medicare brokers are usually paid commissions by insurance companies, not directly by clients.

For Medicare Advantage plans, CMS — the federal agency that oversees Medicare — sets commission limits. That means an agent often does not earn more by recommending one Advantage plan over another in the same area. However, agents may only offer plans from companies with which they’re contracted, and some plans may not pay commissions at all.

Medicare Supplement plans, also called Medigap, work differently. Their commissions are set by the insurance companies and can vary.

The bigger issue is often not one Advantage plan versus another — it’s Medicare Advantage versus Medigap. Agents can be paid significantly more to place someone on an Advantage plan.

Consequently, Medicare Advantage plans are heavily marketed, and agents or call centers may have a financial incentive to focus on them. That helps explain why seniors hear so much about “zero-premium” Advantage plans and far less about Medigap. Unfortunately, many people never get a clear, balanced explanation of the differences.

Answer: Yes — be mildly skeptical, not paranoid.

Some agents push Medicare Advantage over Medigap mainly because of how we’re paid, not because Advantage is always the better option. In many cases, we earn several times more by enrolling someone in an Advantage plan than in a Medigap policy.

That doesn’t mean agents are dishonest, but it does create a strong incentive.

Bottom line — if an agent heavily promotes Advantage while brushing off Medigap, follow the money and ask questions.

These choices have long-term consequences, so you deserve clear, balanced information to make an informed decision.

Answer: Palliative care helps manage pain, symptoms, and stress while you continue treatments aimed at fighting the disease.

Medicare covers it through standard benefits, like Part A for hospital care and Part B for outpatient services, so you can access this care at any stage of an illness with just the usual coinsurance.

Hospice care is for when a doctor believes someone is in the final months of life and has chosen to focus entirely on comfort rather than curative treatments.

Medicare provides a special hospice benefit under Part A that covers nearly all costs, including medications, equipment, and emotional support, often at little to no expense.

Answer: For starters, I’m really happy to be answering this question for you ! And the good news is that Medicare has some solid support to help you, too.

Medicare Part B covers up to eight face-to-face counseling sessions per year with a Medicare-approved provider. If they accept assignment (which most do), you won’t pay anything — no copays, no deductible.

If medication is needed, most Part D plans help cover prescription quit-smoking options like bupropion or nicotine patches. The cost will depend on your specific plan.

And if you have Medicare Advantage, you’ll get at least these same benefits, sometimes with extra perks like coaching programs.

Genuinely happy you’ve decided to quit smoking — hope it goes really well for you !

Answer: MEDICAL BANKRUPTCY. You might be exposing your savings to unlimited risk. There’s no stop-loss on out-of-pocket costs.

If you can't afford the premiums for a standard Plan G (or Plan N), consider an Advantage plan, which at least has a maximum-out-of-pocket limit to protect your finances.

If cost is an issue, as it can be in some states, I would opt for a high-deductible Plan G alongside a cash emergency fund.

This allows you to keep the portability and flexibility of Original Medicare without being subject to carrier prior authorizations.

Answer: Great question — as with many things with Medicare, the answer is “it depends.”

If you have a Medicare Advantage plan or a stand-alone Part D drug plan, the main time to review it is during the Annual Election Period, which runs October 15 through December 7 each year. That’s when you can switch plans, change drug coverage, or move back to Original Medicare.

If you’re already in a Medicare Advantage plan and realize it’s just not a good fit, there’s another option. From January 1 through March 31, you get a second bite at the apple during the Medicare Advantage Open Enrollment Period. You can make one change — either switch to a different Advantage plan or return to Original Medicare.

If you have a Medicare Supplement (Medigap) plan, the rules are more relaxed. These plans can be reviewed at any time during the year because they aren’t tied to set enrollment periods like Advantage or Part D plans.

That said, if you live in one of the few states with a “birthday rule” or “anniversary rule,” there may be a specific window that’s especially important. During that time, you may have Guaranteed Issue rights, which can make switching supplements easier and safer.

So — long answer to a simple question. Medicare can be like that. Hope it helps you !

Answer: Yes — Medicare Part D can cover Repatha. But not every Part D plan does, which is where people often get tripped up.

Repatha is an expensive medication, so it’s essential to verify that it’s listed on the formulary of any Part D plan you’re considering. Never assume — always confirm.

When it is covered, Repatha is most commonly placed on a Tier 3 (Preferred Brand) tier. That usually means you’ll pay the full retail cost until the plan’s annual deductible is met (and with Repatha, you tend to meet that deductible quickly). After that, you’ll move into the plan’s Tier 3 copay or coinsurance structure.

Bottom line: Part D coverage for Repatha absolutely exists — but choosing the right plan makes a significant difference in what you’ll actually pay out of pocket.

Answer: Probably, yes. What you need to do depends on the type of Medicare coverage you have — but a move is definitely something to address, not ignore.

First things first: notify the Social Security Administration of your new address. That part is easy and important.

If you’re enrolled in a Medicare Advantage plan or a standalone Part D drug plan, your move triggers a Special Enrollment Period. You generally have up to two months after your move to switch plans.

This also opens the door to moving from Medicare Advantage back to Original Medicare and adding a Medigap supplement with Guaranteed Issue rights. That can be a big deal — especially if health issues would normally make underwriting difficult.

If you already have a Medicare Supplement, the good news is that Medigap is portable. You can use it in any state. You’ll likely still need to update or change your Part D drug plan, though. Also, be aware that Medigap premiums and rules can differ by state, so your premiums may change after the move.

Bottom line: moving doesn’t automatically break your Medicare coverage — but it does create an opportunity (and sometimes a requirement) to make smart adjustments. A quick review after you unpack the boxes can save headaches later.

Answer: Probably not as much as people expect.

Medicare Advantage star ratings aren’t like Google reviews. They’re not based on free-form feedback from members or a simple measure of how happy people are with their care. Instead, they’re built from a long list of government-defined metrics — things like preventive care compliance, administrative processes, and certain health outcomes.

Those metrics also change over time. We’ve seen the emphasis shift from one administration to the next, which means star ratings can reflect policy priorities as much as real-world care delivery.

There’s also a big financial angle. Insurance carriers have strong incentives to hit whatever benchmarks the government sets, because higher star ratings mean bonus payments. That motivates compliance — but compliance doesn’t always equal better doctor visits.

All that said, star ratings aren’t meaningless. A plan with very low ratings is usually a red flag, and a true 5-star plan is probably doing a lot of things right. Where it gets fuzzy is the large middle ground. For most people, a 3½- or 4-star rating doesn’t tell you much about the quality of care you’ll personally receive.

That’s because your care experience still depends far more on the doctors, hospitals, and provider network than on the insurance company behind the plan. Star ratings can be a useful data point — but they shouldn’t be the deciding factor.

Answer: Short answer: maybe — but you have to check first.

With a Medicare Advantage plan, everything hinges on the network. Before enrolling, a good independent Medicare broker should help you confirm two critical things up front:

• Are your prescription drugs covered?

• Are the doctors you trust in the plan’s network?

Depending on how many doctors you see — and which health systems they’re associated with — that may or may not work out. There are no perfect Medicare plans, but there are solid ones. That said, if your “must-keep” list of doctors is long, asking a Medicare Advantage plan to accommodate all of them can be a tall order.

If network access is a concern, a PPO may be an option if one is available in your area. PPOs offer more flexibility but usually come with higher costs when you go outside the network. All else being equal, most beneficiaries do best with an HMO that has a large, well-established provider network.

The bottom line: don’t assume — verify. Checking your doctors before you enroll can save you a lot of frustration later.

Answer: Are Medicare Supplements worth it? In many cases, yes — absolutely. And it’s not always a math problem. A big part of this decision is about control over your healthcare and how much uncertainty you’re willing to live with.

The phrase that stands out in your question is “high-end,” as if a Medicare Supplement (Medigap) is a luxury item. If your premiums truly feel high, that’s worth reviewing — sometimes there is room to fix or optimize that. But “high-end” often just means more comprehensive and predictable, not extravagant.

It’s also important to remember that Medicare Advantage plans aren’t really “free.” They come with copays, coinsurance, and out-of-pocket limits that can add up quickly when you actually need care. Over time, the choice often comes down to this: pay more upfront with a Medigap plan for consistency and peace of mind, or pay as you go with an Advantage plan and accept more financial surprises.

And here’s a telling litmus test: ask doctors and independent Medicare brokers what coverage they would choose for themselves. The honest answer from most? A Medicare Supplement, without hesitation.

Answer: In 2026, once you’ve spent $2,100 out of pocket on covered drugs, you enter the Part D catastrophic coverage phase. From that point through the end of the year, your Part D plan pays 100% of the cost of approved drugs that are on its formulary.

Answer: Medicare does NOT cover:

• Ongoing custodial care (help with activities of daily living like bathing, dressing, toileting, feeding) in a nursing home, assisted living, or most in-home nonmedical personal care.

• Long-term residential care costs (assisted living, private-pay long-term nursing home care) except for limited, qualifying short skilled nursing episodes.

Alternatives for long-term custodial care:

• Personal/family resources: paying with savings, home equity, or family caregiving are common options.

• Private long-term care (LTC) insurance. Premiums can be costly and increase with age. Buying younger reduces premiums.

• Hybrid products: life insurance or annuity-based policies with LTC riders. These can be more flexible (return of premium, death benefit).

• Medicaid is the primary public payer for long-term nursing home care for people with low assets/income. Medicaid rules and eligibility vary by state.

Answer: Medicare Part B covers cataract surgery as a medically necessary procedure, including surgeon fees, facility costs, anesthesia, and a standard monofocal lens for basic vision.

However, premium lenses (multifocal or toric) and extra services like laser astigmatism correction aren’t covered — you’ll pay out-of-pocket for these upgrades.

Standard Part B deductibles and 20% coinsurance apply, though Medigap may help with coinsurance.

Medicare Advantage plans may offer similar coverage, but check your plan for details on premium lenses.

Answer: I teach the best Medicare 101 Boot Camp seminars you’ll ever attend — no PowerPoint, just me and a dry-erase board, explaining Medicare in a way you’ll remember.

Plus, I record the live sessions and share shorter clips on my "Medicare Video Guy" YouTube channel, so you can watch whenever you want.

Answer: Advantage plans have a maximum out-of-pocket limit, which helps cap your hospital and outpatient medical costs.

If you don’t have enough in personal savings or an HSA, a hospital indemnity and catastrophic illness policy can be a good safety net.

These policies usually pay per hospital stay, so two hospitalizations in one year are typically covered, BUT always check the details of any plan before signing up.

Answer: IRMAA doesn’t go away automatically if your income drops — you need to report the change to Social Security and request a review.

If you’ve had a life-changing event like retirement or a significant loss of income, you can file Form SSA-44 or contact Social Security to have your IRMAA reassessed.

Otherwise, Social Security will keep using your most recent tax returns (from two years prior) to determine your IRMAA amount.

Answer: Yes, if you lose employer coverage, you qualify for a Medicare Special Enrollment Period (SEP).

• For Original Medicare (Part A and/or Part B), you have 8 months from the date your group health plan ends or you stop working — whichever comes first—to enroll without penalty. This only applies if your coverage was through active employment (not COBRA or retiree coverage).

• For Medicare Advantage (Part C) and Part D (prescription drug coverage), the SEP is shorter: you have 2 months from the date your employer coverage ends to sign up.

Key points:

• The 2-month SEP for Part C and Part D starts when your employer coverage ends — not when employment ends.

• Missing this window may mean waiting until the next Annual Enrollment Period and possibly facing late enrollment penalties.

Answer: Creditable coverage means your group health insurance is at least as good as Medicare. To qualify, you must be actively working for an employer with 20 or more employees.

This matters if you delay enrolling in Medicare beyond your initial eligibility at age 65, often because you’re still working and covered by your employer’s plan.

Coverage that does NOT count as creditable includes:

• COBRA

• VA benefits

• Health sharing ministries

Answer: Some Advantage plans have a $-ZERO premium, but that doesn’t mean you pay nothing.

You’ll still have out-of-pocket costs like deductibles, copays, and coinsurance when you use services.

Answer: • Limited provider networks

• Most require referrals from your primary care doctor

• Out-of-pocket costs like deductibles, copays, and coinsurance

• The big one — prior authorizations are often required for many services

Answer: While it's possible to self-enroll for Medicare plans, it’s also easy to miss important details. Most people simply don’t know what they don’t know. Working with a trusted independent Medicare agent won’t cost you more, so take advantage of the guidance.

• Medicare has many options — Original Medicare, Medigap, Advantage plans, and drug plans. You'll get help with comparisons and find what fits your needs.

• Agents review your providers, prescriptions, finances, and health needs to recommend plans suited to your personal needs.

• They help you avoid missed deadlines, penalties, and coverage gaps.

• Independent agents have access to plans from a variety of insurers, not just one.

• You’ll want ongoing support for questions, claims, plan changes, and annual reviews — even after you enroll — again, at no cost to you.

Answer: No. The Annual Enrollment Period doesn't let you switch to a Medigap plan without answering health questions. The only ways to avoid medical underwriting are:

• During your Medicare Supplement Open Enrollment Period (the first 6 months after you start Part B at age 65)

• If you live in a "birthday rule" state (like California, Oregon, Idaho, Illinois, or Nevada) where you can switch Medigap plans each year around your birthday without health questions

• If you qualify for a Guaranteed Issue situation, such as losing coverage or moving out of your plan's service area

Answer: It usually comes down to whether you have "creditable coverage." That means:

• You’re actively working for a company with 20 or more employees.

• Your group health insurance is as good as, or better than, Medicare.

If so, you have options — you can stay with your group plan or move to Medicare — whatever works best for your needs.

Answer: Make choices with your future self in mind. Don’t just look for the best deal at 65 — think about what you’ll need at 75.

We're not always trying to solve a math problem. It can be more about autonomy over your healthcare when it matters most.

Answer: Medicare agents are all about guiding people through consequential decisions. I realized most of my friends didn’t understand Medicare.

This work is really about walking people through choices that fit their needs — I help them optimize their prescription coverage and keep the doctors they trust.

People appreciate having someone reliable they know they can trust, and that’s genuinely rewarding, personally.