Shalonda Cave, Medicare Insurance Agent

Answer: As a broker, we can’t use superlatives like “best” and “worst,” but I can tell you that Plan G or N is the same regardless of the carrier you choose. However, you should focus on the premium rates charged by each carrier. I usually recommend the lowest-cost rates for my clients.

Answer: Medigap insurance allows beneficiaries to use any doctor or facility in the United States that accepts Medicare. This provides them with the freedom to choose their preferred provider. On the other hand, Medicare Advantage plans typically restrict beneficiaries to a specific network of doctors and facilities. As a result, these plans often charge higher fees or even deny coverage for out-of-network services.

Answer: You didn't necessarily make a mistake but I always tell my clients to enter in your medications and doctors before picking any plan when it comes to Medicare Plan options. You can do this on Medicare.gov or call me to help you with your options. You can also change plans during the Medicare Open Enrollment Period (Jan 1 - March 31).

Answer: IRMAA is an additional amount added to your Medicare Part B & D premium based on individuals with higher incomes. It is based on your tax returns from two prior years. Check to see if your Modified Adjusted Gross Income exceeded $103,000 9individual) or $206,000 (married filing jointly) to determine your additional cost.

Answer: I normally send them my video on the Basics of Medicare I did before our appointment to get them familiar with what we will go over during our appointment.

Answer: Yes, the cost of Medicare can be different for everyone. While some aspects of Medicare have standard costs, such as the Part B premium set by the government each year, individual costs can vary based on several factors:

-Income: Higher-income beneficiaries pay an Income Related Monthly Adjustment Amount (IRMAA) that raises premiums for Part B and Part D.

-Medicare Plan Choice: Costs can vary depending on whether you choose Original Medicare with or without supplemental insurance, or a Medicare Advantage plan.

-Prescription Drug Coverage: Part D plans have different premiums, deductibles, and copays depending on the plan and the medications you take.

-Healthcare Usage: Out-of-pocket costs differ depending on how often you need care, the services used, and whether providers accept Medicare assignment.

-Location: Medicare Advantage and Part D plan costs may vary by region.

Answer: I would first reach out to your agent to inquire about any changes in Medicare and their plan options for the upcoming year. Additionally, I recommend regularly reviewing announcements and newsletters from the Centers for Medicare & Medicaid Services (CMS) to stay informed about the latest developments. It’s also beneficial to review your Medicare & You Booklet and Annual Notice of Changes (ANOC) to ensure you’re up-to-date with any changes.

Answer: Yes, stricter regulations on Medicare Advantage marketing and sales practices are necessary. I’ve noticed that my clients often feel misinformed during the AEP process. They’re bombarded with TV commercials and mailers from large call centers that prioritize their own interests over your best. Remember, I offer personalized, one-on-one service and am here to answer your questions and help you avoid any high-pressure sales tactics.

Answer: You generally don’t need to re-enroll in Medicare when you turn 65 since you’re already enrolled through disability insurance. However, you’ll enter your Initial Enrollment Period for Medicare based on age. Review your existing coverage to ensure it meets your needs. Consider enrolling in additional parts like Part B (Medical Insurance) if you previously declined it, Part D (Prescription Drug Coverage) to cover medications, or Medigap or Medicare Advantage Plans if they could benefit you.

Answer: I enjoy being able to help them better understand Medicare and guide them through the process of signing up and picking a plan.

Answer: I love how my clients appreciate my help and guidance when it comes to the entire Medicare process. This process can be very confusing and without an agent I don't know how beneficiaries can navigate this process.

Answer: It’s always beneficial to have a local agent appointed with multiple carriers to help you compare and select the plan for your needs. A local agent can provide valuable insights and guidance throughout the enrollment process. They will contact you annually, typically between October 15th and December 7th, to review your options and ensure that you’re making the most informed decision for the upcoming year.

Answer: Understand your enrollment period:

You have a 7-month Initial Enrollment Period (IEP) that starts 3 months before your birthday and ends 3 months after. I do recommend starting before rather than after due to Part D rules.

Decide which parts of Medicare you need:

Do you need Part A (Hospital Insurance) only because you are still working or do you need Part B (Medical Insurance) as well. Will you need Part C (Medicare Advantage) & Part D (Prescription Drug Coverage)?

Enroll in Medicare:

If you receive Social Security benefits, you may be automatically enrolled in Parts A & B. If not you can contact me to help you enroll or you can apply on the Social Security website.

Answer: Define zero-premium clearly and let them know that zero premium means you do not have to pay a monthly premium for the Medicare Advantage plan itself. Also, highlight potential out-of-pocket costs while using real-life scenarios to help them better understand.

Answer: You’ll face a monthly premium penalty that increases over time if you go without Medicare Part D. This can lead to gaps in coverage and higher out-of-pocket expenses for medications. Contact a local agent 3 months before your birthday or retirement to get help with your Medicare needs.

Answer: I believe it’s a trust issue because they’re being scammed repeatedly. Imagine receiving phone calls from 8 AM to 9 PM every day from third-party organizations claiming their plans are superior to the one you sold them. Meanwhile, the plan they purchased wasn’t thoroughly checked to ensure their doctors were in-network or that their medications wouldn’t incur higher copays or be excluded from the formulary.

Answer: Creditable coverage means health insurance, including prescription drug coverage, meets Medicare’s standard benefit, allowing for delayed enrollment without penalty.

Answer: If it falls within the Annual Enrollment Period (AEP) or Open Enrollment Period (OEP), I recommend switching to a plan that includes your doctors or facilities in-network. AEP is from October 15th - December 7th and OEP is from January 1st - March 31st.

Answer: The Income-Related Monthly Adjustment Amount (IRMAA) is an additional charge applied to Medicare Part B and Part D premiums for individuals with higher incomes. Whether you are responsible for an IRMAA surcharge depends on your modified adjusted gross income (MAGI) from your tax return filed two years prior.

For 2026, the income thresholds that determine IRMAA surcharges have not been specified in your provided information. Generally, if your income exceeds a certain limit, you will be subject to IRMAA. The Social Security Administration will notify you if you owe an IRMAA based on your income level.

If you’d like to confirm your specific situation, I recommend reviewing your latest Social Security notice or contacting the Social Security Administration directly.

Answer: Yes, depending on your location, Medicare plans can vary in terms of their details and benefits. For instance, I’ve observed that rural areas often have fewer coverage options compared to major cities.

Answer: These plans come with premiums in addition to Original Medicare’s Part B premium, which may not be the best financial option for all clients.

Answer: If you lost your Medicare card you can create an account on Medicare.gov to print a temporary one and order a new card.

Answer: Medicare, primarily funded through payroll taxes, premiums paid by beneficiaries, and general revenue from the federal government, is unlikely to “run out of money” entirely despite periodic reports about funding challenges faced by the Medicare Trust Fund.

Answer: Medicare cannot terminate your coverage due to health reasons. Once enrolled in Medicare, your coverage remains secure regardless of any changes in your health. This protection applies to both Original Medicare (Part A and Part B) and Medicare Advantage (Part C) plans. However, it’s crucial to continue paying any required premiums and adhering to the plan’s rules to preserve your coverage.

Answer: The decision regarding your medical coverage depends on your medical history. If you receive monthly or biweekly vaccinations at your doctor’s office, it is advisable to continue your Medigap plan. However, in light of the potential upcoming changes this year, it is recommended to compare both options and determine which one will result in cost savings in the long term.