Steve and Sue Brauer, Medicare Insurance Broker

Answer: Hi, thanks for watching. My name is Steve and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today. The question we have today is someone's asking, "My Advantage plan says I need a referral just to see a dermatologist. They thought PPOs didn't require that. What's going on?"

Okay, so I'll tell you this, at least for right now, most Medicare Advantage plans don't require a referral to see a specialist. Now, having said that, when you go to the specialist, you have a Medicare Advantage plan. You go to the specialist. Most times, the specialist will require your primary doctor to sign off on it because they want to make sure that they're going to get paid. They want to make sure that there's been a flow of information that you really need to see this person and that they're going to get paid from the Advantage plan.

But most plans themselves, except for one carrier in particular, most plans don't require a referral. But again, the specialist office may require that. And that's kind of where we're going.

Answer: Hi, thanks for watching. My name is Steve, and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today, so the question we have is how does the Inflation Reduction Act impact Medicare drug plans in '25 and '26?

To put it simply, the Inflation Reduction Act has shifted who pays for prescription drugs away from Medicare. Typically, Medicare covered about 80% of the cost of prescription drugs, and the carriers roughly paid about 20%. It was spread out a little bit, but that's basically what it was.

The Inflation Reduction Act makes the cost shift more to the carriers and the drug manufacturers versus Medicare. They kind of swap the 80/20, swapping from Medicare to the drug companies and the Part D drug plans. So that's why there's been such an impact in the way things are covered, how the formularies are set up, and why certain drugs are more expensive than others.

Answer: Hi, thanks for watching. My name is Steve and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today. So the question we have is someone's asking why is regular Medicare better than an Advantage plan?

I'm gonna start off by saying what's better is what you think is better. The reason I'm saying that is that for some people, original Medicare with a supplement, otherwise known as a Medigap plan with a drug plan, might be better than a Medicare Advantage plan, which I call a bundled product.

Okay, if you travel a lot, if you want to access benefits outside of your home state, and you want to go to any doctor that accepts Medicare, they call it Medicare assignment, which means that they've agreed to the Medicare fees that Medicare is willing to pay. If that's what you want, then regular Medicare, original Medicare, is what they call it, would be a better fit for you.

Medicare Advantage, on the other hand, is a plan where it's a copay, typically a copay-based pay-as-you-go model. The original Medicare with a drug plan is a pay upfront model, which means you pay a premium every month for the supplement or Medigap, whatever you want to call it. You pay upfront for the Medigap plan and the drug plan, whether you use it or not.

With an Advantage plan, it's a pay-as-you-go model, meaning there's typically, not always, but it's typically a zero premium every month. And when you go get services, you pay co-pays depending on the service. It could be a zero copay or whatever. There's all that's all over the map what the copays are.

So to really answer the question, what's better is what you think is better and what works for you. So if anybody says, "Oh, this is better" or "that's better," that might be better for them. But every situation is different.

Answer: Hi, thanks for watching. My name is Steve, and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today, so the question someone is asking is, are there any disadvantages to working with a Medicare broker? I can't think of a single reason why you would not want to engage with the broker. The right broker, and I underline that, the right broker, there's a lot of brokers out there that are brand new. Nothing against them, but unless you've been doing this a while, you just don't have the experience to figure out all the nuances with Medicare. There's a lot of moving parts, and it's complicated, and it takes a long time to figure all this stuff out.

So, I can't think of a single disadvantage. We get paid; we all get the same fee. We get paid when someone enrolls into a plan. Doesn't matter what plan. All the carriers pay the same. But the advantage to having an independent broker, and that's important, an independent broker to help you is that they're not tied to any one insurance company, and you're leaning on their expertise. It's like trying to do your taxes. Sure, people can do it, but you're probably missing out on things because that's not what you do full time. This is what we do.

Finding an independent broker that lives locally, that's not a snowbird, is important because when you're going to get a claim or an issue, it's going to be in the middle of summer when they're in Rhode Island or something. You need to find somebody, in my opinion, find somebody that's local that you think you can trust. Lean on their experience. I mean, it takes a long time to figure out how to do this stuff.

Answer: Hi, thanks for watching. My name is Steve and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue's off today, so the question we have is: someone is asking what is the main benefit of Medicare Part D? Just remember, Part D is for drugs. The Part D part of Medicare has to do with prescription drug coverage.

You have to remember, whatever plan you enroll into, you have to make sure that your prescription drugs are on the plan's formulary. Another name or way to describe that is what the plan covers. So there are two ways to get a Part D plan for Medicare. One way is what they call a standalone drug plan, which is usually attached to a Medigap plan when you're enrolling into a supplement or Medigap plan.

The other way is the Part D drug plan can be part of your Medicare Advantage plan. That's what I have. Either way, you have to make sure that whatever prescription drugs you're taking are on the plan's formulary because otherwise, you're not going to be covered.

Another thing to remember is there are other drugs. They're not prescription drugs, but they're drugs that are associated with a Part B, like boy, part of Medicare. Those are typically the injectable drugs, and they're usually administered in the doctor's office. People get confused when they give me a drug list or a prescription drug list. They have drugs on there that are covered under the B section of Medicare.

Big difference! And they're covered differently, and the copays are going to be different. So you have to be careful for that.

Answer: Hi, thanks for watching. My name is Steve, and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today.

So, the question we have is: what advice would you give seniors who are feeling overwhelmed by all the Medicare options available? My advice is, yeah, there's a lot of options. And my advice that I always give people is to find an independent Medicare broker who lives locally. Somebody out of state isn’t going to help you as much as someone local who can give you good advice and that you feel like you have a connection with. It's no different than looking for someone to do your taxes or some other part of your life where you have to relatively trust someone.

Talk to them, get their advice, and they can direct you to the right plan based on your situation. There's a lot of options out there. There are options for people with chronic illnesses, others that have low copays for certain things, and maybe a lot of dental benefits. It really depends on your situation and what is important to you.

Answer: Hi, thanks for watching. My name is Steve, and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today. So the question we have today is, how do you get paid as a broker, and does it affect the plan you recommend?

So Medicare has already thought this through, and it actually makes a lot of sense. Great question! The way that we get paid is from the insurance company that we enroll you into. But Medicare has flat fees, and they basically level the playing field. All the fees are the same, typically for the carriers. So it doesn't matter if you're getting enrolled into a Blue Cross plan, Humana, or United; they all pay the same fees to brokers when you're enrolled.

And the same goes for the renewal. So that's just how it works. It makes it pretty easy because there are some agents out there that might steer you to a plan depending on what the compensation is.

Answer: Hi, thanks for watching. My name is Steve, and I'm a husband, half of the husband and wife team here in Arizona. Sue is off today.

So the question we have today is, how often can I change my Medicare plan? Well, typically, there are two times a year when you can change your plan, depending on what kind of plan you have. If you have a Medicare Advantage plan, you can change it during the annual enrollment period, which runs from October 15th through December 7th. Or you can also change your plan from January 1st of every year all the way through March 31st. That's from one Medicare Advantage plan to another Medicare Advantage plan.

If you have a supplement, otherwise known as a Medigap plan, and you want to change to a Medicare Advantage plan, that would only be during the annual enrollment period, which is October 15th through December 7th. For the drug plans, for the standalone Part D drug plans, the only time you can change is between October 15th and December 7th for a January 1st effective date.

But just remember, if you move out of the area or if you move into a different area, that typically opens what they call a special enrollment period where you can enroll. You have a certain number of days or months where you can enroll into a different plan because your circumstances have changed.

So really, get yourself a good independent agent, have them help you with that, and they can explain the different enrollment times for you.

Answer: Hi, thanks for watching. My name is Steve and I'm the husband half of the husband and wife Medicare team here in Arizona. So the question we have today is someone's asking for the Medicare Advantage plan after they reach the maximum yearly out-of-pocket of $3,000 or more. Will they have co-pays or fees the rest of the year?

So the short answer to that is no, they will not have any more co-pays. But I'll tell you something, I've been doing this for 20 years and I've seen one time where somebody met their yearly max. I mean, it could happen, but it's pretty rare because the way the Advantage plans are set up, it's a co-pay based model. It's a pay-as-you-go model.

So when you go into the hospital, there's a co-pay depending on how many days you stay. If you need an ambulance, there's a co-pay for that, and for the doctor visit, there's a co-pay too. But the co-pays are pretty low. So to reach a $3,000 or $4,000 yearly maximum, it's pretty hard to do. I mean, you have to have services and issues the entire year to even get close to that.

But to answer the question that the person's posing, once you reach that maximum, that's it. That's the ceiling for in-network benefits.

Answer: Hi, thanks for watching. My name is Steve, and I'm the husband half of the husband and wife Medicare team here in Arizona. Sue is off today, so the question we have today is, does Medicare cover chiropractic appointments?

If we're talking about original Medicare, they will cover chiropractic for a manual manipulation. The coverage is pretty limited. If you have a Medicare Advantage plan, at least here in Arizona, the chiropractic coverage is usually pretty good. Most plans have it, but not all. So you have to find an agent that knows what they're doing, and they can direct you to the right plan.

But the plans typically cover the Medicare Advantage plans, which usually cover 15 to 20 office visits a year, and not just for manual manipulation. It could be for routine chiropractic issues. So again, plan by plan, it really depends.

Answer: Hi, thanks for watching. My name is Steve and I'm a husband, half of the husband and wife Medicare team here in Arizona. So the question we have today is, someone's asking what's the best Medicare plan for someone with chronic kidney disease? Well, here in Arizona and other places too, they have what they call a C-SNP plan. So it's an acronym for Chronic Special Needs Plan, C-SNP. And those plans are designed to be laser-focused for people with chronic illnesses. It could be diabetes, it could be heart issues, but they're laser-focused on those specific issues.

And most times, their formularies are set up to where they cover the drugs associated with that chronic illness a lot better and a lot cheaper than most other plans. So I've said it 100 times, find yourself an independent broker that only does Medicare and have them help you with that. Because the plans are pretty good, and the benefits are really super good too.

Answer: Hi. Thanks for watching. My name is Steve and I'm the husband, half of the husband and wife Medicare team here in Arizona. Sue is off today. The question is, don't you think Medicare should ban all of those Celebrity Medicare Advantage commercials? Yeah. You see the commercials with Tom Selleck. I think there's been a bunch of them. But you got to remember Medicare Advantage are private insurance companies with a contract with Medicare. So they want to advertise their plans so people will enroll in them. It is kind of annoying because what happens is a lot of times you get call centers that call you as a result of these commercials and they're shady. They ask you all kinds of questions. They're not supposed to do any of that. They're not supposed to call you ever unless they have your permission to call you. So right away, right out of the gate, they're not following the rules. But yeah, it's a little misleading, but I understand why they do it. They are private insurance companies and they're trying to sell their product.

Answer: Hi. Thanks for watching. So my name is Steve. I'm the husband, half of the husband and wife Medicare team here in Arizona. The question we're looking at today is, "I thought I signed up for Part A and B when I got my Social Security, and now I'm getting bills for Part B. Did I miss something during the enrollment period?"

Well, if you've worked at least ten years full-time and paid into the system, you're not gonna have a premium for Part A. It's premium-free. Part B, the medical insurance piece of Medicare, covers things like office visits, lab work, outpatient surgery, MRIs, X-rays, that kind of stuff. The premium starts this year, in 2025. It's $185. It's going to $206.50 in January of 2026. Everybody's gotta pay it unless your income falls below a certain threshold, and then you may pay part of it. You may not have to pay any of it, depending on where you fall on the scale. But that's how it is. We all have to pay into it. And each year, the Part B premium goes up a little bit.

Answer: Hi. Thanks for watching. My name is Steve. I'm the husband, half of the husband and wife Medicare team here in Arizona. The question is, if we're looking at today. My friend says a new Medicare drug payment plan will help with her expensive medications. How would it help me, too? This, again, is a great question.

So this came about the first of this year for 2025 and is being continued into 2026. What it means is your Medicare Advantage plan or your standalone prescription drug plan. If you have a Medigap plan, they will enroll you automatically unless you opt out and roll you into this plan. What they do is look at your forecasted prescriptions that you're going to take throughout the year, and they amortize it over 12 months.

Again, the maximum you're going to spend in a calendar year for drugs for this coming year, 2026, is $2,100. If you don't have a drug deductible or you have a lower drug deductible, it's actually less than that. We can get into that later. But it will help you because what happens is at the beginning of the year when you go for your really expensive medications, you don't have to come out of pocket for the first three months of those medications right away. Right out of the gate, they'll spread it over. They call it smoothing. They'll spread it over 12 months, and you'll pay an equal amount every month. It's a really cool plan.

Answer: Hi. Thanks for watching. My name is Steve, and I'm the husband, half of the husband and wife Medicare team here in Arizona. The question today is, will I be penalized if I don't enroll in Medicare when I turn 65?

So it's a complicated question, but it boils down to this. You're only going to be penalized by Medicare if you don't enroll in Medicare when you're supposed to, and then you want to enroll at a later date. What I mean by that is when you turn 65, if you're working for a company with more than 20 employees on their medical plan at work and the plan is deemed credible, meaning the plan is as good a coverage or better than Medicare, you're fine. You can waive enrolling until you leave that group plan.

When you leave that plan, the group plan gives you an enrollment window so you can sign up with Medicare after you leave your employer. So they try to be really flexible with people. But I've said it 100 times. Find an independent Medicare agent. They can walk you through this stuff because there's a lot of loopholes and a lot of ways you can get in trouble if you don't follow the rules.

Answer: Hi. Thanks for watching. My name is Steve, and I'm the husband, half of the husband and wife Medicare team here in Arizona. The question today someone asks is, does Medicare pay for the medical alert system? The little button that's usually on a chain that people can use to alert if they fall down or if they need medical assistance? Typically, Medicare will not pay for that. However, many Medicare Advantage plans will pay for that, especially the ones that are what they call C SNP, the chronic special needs plans. Not all of them, but many of them have that coverage. It's pretty cool. They pay for the alert, the little alert. And they also pay for the system itself. I have a lot of clients on it, and they love it, and it doesn't cost them anything each month.

Answer: Hi. Thanks for watching. So my name is Steve. I'm the husband, half of the husband and wife Medicare team here in Arizona. Sue is off today. The question we're looking at is which Medicare supplement plan offers the best value for most seniors, and why?

So when you look at supplement plans, in my opinion, there's really only two. There's Plan G, which is the most comprehensive, and Plan N, which a lot of people have. My problem with Plan N is that it's a lot cheaper. It's probably $45, maybe $50 a month cheaper, depending on how old you are. The problem is it doesn't cover access fees for certain providers, which means when a provider, a doctor, or hospital has a contract with Medicare, they're allowed to charge you and us. All of us 15% above what Medicare typically pays. Not all providers do it. Some do.

But what happens is if you have a big hospital bill or a big medical bill, and they charge you 15% of those fees, that could be a pretty big bill. So Sue and I, we don't sell Plan N. I've had people come to me and say, "Hey, I'd like to purchase a plan," and I send them with some other agent because I know it's all good. Now down the road, if they have some big giant bill, who are they going to be mad at? Steve and Sue.

So we only sell Plan G on the Medicare supplement Medigap side, with a Part D drug plan.

Answer: Hi. Thanks for watching. My name is Steve and I'm the husband half of the husband and wife team, Arizona. So the question is, why does Medicare have so many coverage gaps? And is it designed that way on purpose? So they're never going to tell you this. But yes, it is a sign like that on purpose. And I really feel that they have these coverage gaps because they want people to have some skin in the game. If everything is free, I mean, it would basically be socialized medicine. Everything was free. When you went down, you got everything for free and you never had to pay anything. I mean, people would be going down for everything. I think, but depending on your coverage, you have to either pay a monthly premium for your supplement or Medigap plan and drug plan, or it's a zero premium Medicare Advantage plan. And it's copay based. Meaning when you go to get services, it's a cost share pay. Like I use my plan, I go to the doctor, I go to my primary. It's zero. If I go to the specialist, it's $8. Go to the hospital. It's a copay for the first five days. They want that skin in the game because they know if it was totally free, people would abuse it. Not everybody, but a lot of people would.

Answer: Hi. Thanks for watching. My name is Steve. I'm the husband, half of the husband and wife Medicare team here in Arizona. The question today is that someone's asking, "I'm living only on Social Security. I make like $1,400 a month, and I can't afford my Medicare premiums, co-pays. What assistance programs might help someone in my situation?"

Easy answer. You need to immediately get online. Or if you have an agent, have them help you make an appointment with Social Security. They're very nice people, actually, surprisingly, but they are very nice people. They've helped us out several times. Make an appointment, go down there, and talk to them. Show them what you're making, and they can put you on what's called extra help. There's a lot of different levels on that. It has to do with your monthly income.

I know a lot of people, we've helped a lot of people that have pretty much a zero cost for their Medicare each month, and everything's covered. So do yourself a favor. Find an agent that knows what they're doing. Make an appointment with Social Security. Go down and talk to the nice people there and have them help you. That's what they're there for.

Answer: Right. Thanks for watching. My name is Steve, and I'm the husband, half of the husband and wife Medicare team here in Arizona. The question is, can you have just Part A and Part B and not enroll in anything else and still have good coverage? Well, I mean, it's good coverage, but the problem is that you're going to have deductibles and co-pays under Part A, and you're going to have costs. You're going to have 20% cost on Part B, so if you don't have anything else supporting that, you're going to have a problem. Well, if you never go, it's not a problem. But if you go and get services, it can get really expensive, especially if you go into the hospital. But yeah, I have come across several people that just have A and B, and what I tell them is if you don't want to pay for anything else, go with the Medicare Advantage plan, especially here in Arizona. Coverage is great. You know, the Phoenix, Scottsdale, the Valley here. Coverage is great. You typically get a dental benefit, and the networks are phenomenal because there are so many 65 plus people here. Most of them are zero premium, so it kind of costs you nothing each month. But it would cover most, if not all, of the A and B services underneath. So it just doesn't make sense not to have something.

Answer: Hi. Thanks for watching. My name is Steve, and I'm the husband, half of the husband and wife Medicare team here in Arizona. So the question today is, should Medicare cover dental, vision, and hearing, or would that just make it more expensive for everyone?

There's been a lot of studies on this, and they can absolutely link dental care to your overall health. So I think they should cover dental, at least preventative visits, X-rays, and cleanings twice, if not three times a year. Yeah, it would bump up the cost for Medicare. Absolutely. But I think in the long run, more people would benefit, and you'd have a lot less medical issues on the back end for this.

Is that going to happen any time soon? There's been talk about that for years, but at the end of the day, they're not going to cover something unless they have to. So we should have them make those changes. I think it'd be fantastic. It would help everybody.

Answer: Hi, thanks for watching. My name is Steve, and I am the husband half of the husband and wife Medicare team here in Arizona. So thanks for watching. The question today is, is the cost of Medicare different for everyone? Here’s how it breaks down.

Part A, the hospitalization piece, does not have a premium. As long as you've worked at least ten years full time and paid into the system, that's Part A. Part B is the medical insurance piece of Medicare. That's everything else other than hospitalization, office visits, bloodwork, ambulance, outpatient surgery, X-rays, MRI, that kind of stuff.

That premium for Medicare in 2025 is $185 a month. That's where it starts for 2026. It's $206.50. It's always gonna be an increase each year. If you were lucky to make more than $109,000 as an individual, or $218,000 as two people filing jointly, then you're gonna get what's called an IRMAA. It's an acronym, an IRMAA upcharge for that year. And it's calculated every January.

So this coming January 2026, if you made above those amounts, you're going to get an increase. You're not gonna pay $206.50. You're gonna pay more than that depending on how much you made. And the lookback is to your 2020 income for what they call the MAGI, the modified adjusted gross income on your income tax return.

Answer: Hi. Thanks for watching. My name is Steve, and I'm a husband, half of the husband and wife Medicare team here in Arizona. So the question we're looking at today is, does Medicare cover cancer screenings and how often can I get them? You probably know this, but I'm gonna tell you anyway. Medicare Advantage plans are mandated by the federal government to have the same exact service coverage as original Medicare. You don't get any more, you don't get any less. Coverage is the same in terms of cancer screenings. Medicare is the one that determines the frequency of each type of cancer screening, like breast cancer. There's a certain amount of time you can get checked every certain number of years or yearly. Prostate cancer, different cancers, different frequencies. So it really depends on the kind of cancer you're looking to check on.

Answer: Hi. Thanks for watching. My name is Steve and I'm the husband, half of the husband and wife Medicare team here in Arizona. So the question is, is it okay to meet with multiple Medicare brokers as I started looking for help?

So here's the deal. We all have access to the same companies and the same plans. If you're an independent agent, you have access to all that. But here's the thing. I look at this like you would sell your home. You're gonna meet with a real estate agent, and you're gonna make a connection with that agent and trust them to work on your behalf and do the right thing for you.

So is it okay to meet with them? Yeah. I mean, if you wanted to talk to them and meet with them to see who you think you could trust the most, yeah, I might consider doing that. But at the end of the day, you need to pick someone and use their expertise because it takes years to really become good at what you're doing with Medicare. It's very complicated. There's a lot of moving parts, and you kind of get a feel for people when you meet them. You can kind of tell if someone knows what they're doing, how long they've been at it, that kind of thing.

Answer: Hi. Thanks for watching. My name is Steve and I'm the husband, half of the husband and wife Medicare team here in Arizona. Thank you for watching. The question today is, what's the deal with Medicare covering medical equipment like wheelchairs and that sort of thing? Do I need special approval?

So all that stuff, the acronym Medicare is big on acronyms. The acronym for that is DME. It stands for Durable Medical Equipment. It's almost always, and like I say, always. But 99% of the time it's covered on any plan that you get. And typically the coinsurance on that, not copay but coinsurance, is 20% of the cost.

But here's the thing. A physician, your provider, has to sign off on that, and they have to show or verify that it's medically necessary for you to get that. It's not, I don't, I wouldn't say it's denied very often, but it does happen. And when that happens, you need to get your Medicare agent involved and have them help you with that. But it should be a fairly easy process.

Answer: Hi. Thanks for watching. My name is Steve. I'm the husband of the Medicare team here in Arizona. So the question we're looking at for today is someone asking, "I went with a Medigap plan because I travel a lot, but now I'm paying a fortune in premiums. Did I make a mistake?" Not necessarily a mistake. I mean, some people like Medicare plans, some people, they call it supplements. Also, some people like Medicare Advantage plans. It really depends on your situation.

But here's the thing. Recently, we're in November now of 2025. Over the last few months, the Medigap or supplement plan premiums have just skyrocketed. They've gone up 30, 50, sometimes $100 a month. The insurance companies are claiming it's Covid claims from back in 2020. Who knows what the real answer is? But that's what they're saying.

So, if you live here in Arizona, certain parts of Florida, if you're in the middle of the valley of Arizona, in my opinion, it totally makes sense to look at a Medicare Advantage plan. Why? Because the networks are really good. If I lived in Prescott, if I lived in a rural area or out of state, I wouldn't even consider it. Because the Advantage plan networks are just not that robust. But here in Arizona and the Phoenix-Scottsdale area, it's phenomenal.

So did you make a mistake? Probably not. But you can always switch.

Answer: Hi. Thanks for watching. My name is Steve. I'm the husband, half of the husband-wife medical team here in Arizona. Sue's off today. The question we're looking at is, why do some seniors end up paying lifelong penalties for Part B and/or Part D?

Now, remember, Part B is the medical insurance piece of Medicare, and Part D, D for drugs, is the prescription drug coverage. So here's what happens. Sometimes people get bad advice or they think they don't have to sign up. There's a million situations as to why people get penalties, but find an independent Medicare agent that only does Medicare, and they can help you through this.

But typically, when you turn 65, unless you have employer coverage that's deemed what they call credible, meaning it's as good a coverage as Medicare or better, if you have that, then you're fine to delay your enrollment until you leave your employer. If you have a small employer, or if you don't have any other coverage or whatever, if you don't have credible coverage, you have to sign up when you're 65.

So there's some moving parts to this. And that's why you should lean on your independent Medicare advisor to figure these things out and talk through it with you.

Answer: Hi. Thanks for watching. So my name is Steve. I'm the husband, half of the husband and wife Medicare team here in Arizona. Sue is off today. The question that we're looking at today is, do I need to do anything for the annual enrollment period, which is October 15th through December 7th?

Well, first of all, you should have gotten something from the plan you're on. I should have gotten what's called an ANOC, or annual notice of change. The company that you're with now, the insurance company, the carrier has to, by law, send you an ANOC notification, typically towards the end of September.

What that does is it shows you what your plan coverage is this year and what it's going to be covering next year. You can look at them side by side. What you should do with that is talk to your agent, see if it makes more sense to go to a different carrier, a different insurance company during the annual enrollment period, so you can have better benefits. Maybe it covers your providers better, your medications, whatever that looks like. But talk to your agent, your independent agent, and hopefully about this.

Answer: Hi. Thanks for watching. My name is Steve and I'm a husband, half of the husband and wife Medicare team here in Arizona. The question we're looking at today is how do I handle billing issues if something is wrong on a Medicare statement?

So I've said this before, I'll say it again. First of all, you should have an independent Medicare advisor help you with this. That's why we get paid. We get paid not just to enroll you, but to help you with issues that come up, whatever those issues are. You need to lean on your agent to help you with any billing issues.

If you don't have an agent, you need to find one at the next enrollment. Time and again, look for someone that's independent, that doesn't work for a specific insurance company. Someone that's local and hopefully not a snowbird, because the claims that come in are going to be in the middle of summer, where they're probably somewhere else, and you need to find someone.

Most importantly, find someone that only does Medicare, because I learned a long time ago, you can't be an expert at everything. You have to pick one thing and get really good at it.

Answer: Hi. Thanks for watching. My name is Steve and I'm the husband half of the Medicare husband and wife team. My wife, Sue, is off today, so I thought I'd answer a couple of questions. The one we're looking at now, this person asks, "I've heard about Medicare fraud. What steps can I take to protect myself from scams related to Medicare?"

I'll give you the biggest one right off the bat. When someone calls you, and we get these calls too, we're agents. When someone calls you and asks if you have your Part A and Part B, or do you have your grocery card, just hang up on them. They're usually from a foreign country calling you or some call center somewhere. And they're not legit. They're not legitimate agents, and they trick people.

We've had several clients get tricked into signing up. They didn't even know they were doing it, signing up for something that they didn't even know. And it just creates a big problem and it's a big mess. So that's number one. If somebody calls you because part of the Medicare rules, one of the Medicare rules is we can't just call people randomly. We have to get your permission to be able to call you. So hang up on them real easy, and that'll cut out 90% of it.

Answer: Hi. Thanks for watching. So my name is Steve. I'm the husband, half of the husband and wife Medicare team. Thanks for watching. The question today is about Medicare Part D, which is the prescription piece of Medicare. Why would someone pick a plan with a high total cost?

Well, here's the thing with the Part D drug plans, it really has to do with what you need. What drugs and prescriptions do you need to have covered? You need to make sure your Part D drug plan covers your prescriptions on their formulary. If they're not on their formulary, they're not going to cover it.

So sometimes if you take expensive drugs or something in maybe tier four or tier five, which is usually where brand name drugs fall, some of the higher cost brand name drugs, you're going to need to spend a little more every month for your Part D drug plan. They would cover those drugs, but really, it's a math problem you need to solve. I’ve said this 100 times. You need to find an independent Medicare advisor that only does Medicare because you can't be an expert at everything. Find somebody local because they know the market, they know the area, and lean on their experience.

Answer: Hey, thanks for watching. I'm Steve, and my wife Sue is off today. I am the other half of the husband and wife medical team. So the question today is, what's the difference between copays versus deductibles? I get that question a lot. A deductible is something that you typically have to satisfy every calendar year. Once that deductible is satisfied, then you go into one or two things. You either go into coinsurance or you go into a copay.

The coinsurance means that you're responsible for a certain percentage of the rest of the cost of that service. A copay is when you go in. Like with my plan, I go to the specialist, I pay $8. That's a copay. If I had a deductible, I would have to satisfy that deductible or pay towards that deductible first, and then it would either turn into a straight copay where I'd pay my $10 or $15 or whatever, or it would turn into coinsurance, which means I would pay a certain percentage of the rest of that cost. Kind of confusing, but it makes sense when you break it down.

Answer: Hi. Thanks for watching. We are the husband and wife Medicare team. I'm Steve and I'm Sue. The question for today is, is it okay to work with a Medicare agent from another state? Yes, technically it is, but I would highly recommend that you have a local agent that knows all the details about your state, because all the different counties matter. If you work in another state, you may not know all the different nuances for the different counties. And what's good and what might be a little bit more challenging. So yes, you could, is the answer, but I really wouldn't recommend it.

Answer: Hi, thanks for joining us today. We're the husband and wife Medicare team. I'm Sue.

And I'm Steve.

So the question we have today is, "My Medicare Advantage plan advertised dental coverage, but it barely covers anything. Is this normal?"

Well, like many times, you hear the devil's in the details. With Advantage plan dental plans, they can be really good, or they can sound really good but not be easy to navigate.

So here's my advice, and I've always said this in a bunch of videos: find a local Medicare Advantage advisor that only does Medicare and go with their advice. Find someone that's local and that only does Medicare.

But to answer the dental coverage question, it really depends on the carrier and the dental coverage. What network are they offering? There's a lot of factors, a lot of moving parts to this. You have to find an advisor that knows dental plans.

Answer: Hi, thanks for watching. We are the husband and wife Medicare team. I'm Steve, and I'm Sue. The question for today is, can a Medicare broker help us find a plan that includes broader chiropractic coverage? Long story short, yes, we can. Different carrier plans offer different types of coverage. Some will be limited to how many visits you can have, while others might be unlimited. But they may have a higher cost to it. We help to work that out with you.

Answer: Hi, thanks for watching. We are the husband and wife Medicare team. I'm Steve, and I'm Sue. So, the question is, how can Medicare Advantage insurance companies afford to offer plans with zero premiums each month?

The answer to that is fairly simple. When you're on a Medigap plan or a Medicare supplement, you're paying a monthly premium every month to have that plan, and it pretty much pays for everything on your Medicare. It's a pay-ahead model. The Medicare Advantage plans are more of a pay-as-you-go model. So, it's a zero premium upfront. Typically, they're not all like that, but most have zero premium upfront.

When you go to use services, you pay a copay. When you go to the doctor, you pay X. When you have an ambulance, you pay X. So, making it a zero premium each month makes it attractive for people. And that's just how they operate. It's a copay-based type system.

Answer: Hi, thanks for watching. So the question is, could Medicare ever adopt a tiered premium system based on lifestyle factors? A lot of people have brought that up, but I don't think honestly that Medicare has the bandwidth to check on someone's lifestyle and be able to adopt some sort of tiered premium system. I don't think that's ever going to happen. The system is just too large. There's 81 million people on Medicare, and to try to sift through that and say people's lifestyle changes... I don't see that being feasible, honestly.

Answer: Hi, thanks for watching. So the question is if someone enrolls in a Medicare Advantage plan C SNP, which is a chronic special needs plan, and gets dis-enrolled for not providing the verification form within 60 days, is there a special enrollment period to enroll in another Medicare Advantage plan? The simple answer to that is yes, but you gotta wonder. First off, why did someone put the enrollee on a chronic needs plan if they didn't have the chronic needs?

What's happening is people—there's a lot of fraud going on where you get telemarketers calling Medicare people and basically tricking them into enrolling. And they do this all year because when you have a chronic special need, you can enroll any time of the year, which is different than your typical open enrollment period.

So there's a lot of scams going on. We always tell people a legit agent is not going to just randomly call you on the phone. You have to be careful of that. But to answer the question, yes, you get an enrollment period. It's a 60-day window past the time that the chronic needs plan was terminated to be able to get into another plan.

Answer: Hi, thank you for watching. We are the husband and wife Medicare team here to help you. I'm Sue, and I'm Steve.

So, the question we're looking at is, "Can I meet with a Medicare advisor on behalf of my mom and dad?" Well, the simple answer is yes. You can meet with us, and you can talk to us in general terms. But when it comes to enrollment or actually giving specific advice to people, it has to be the Medicare beneficiary. Unless you've got a power of attorney over mom or dad, or both, then we can speak to you directly, and you can help them enroll with us.

Answer: Hi, thanks for watching. So we are the husband and wife Medicare team. I'm Steve, and I'm Sue. The question we're answering today is, "I've been paying into Medicare for a very long time, and I'm not sure why my specialists are so expensive. What am I missing here?"

Well, the payment that you've been making all those years goes towards your Medicare Part A, hospital. The specialist payment goes towards your Part B, and Part B comes with a deductible or 20%, which is helped out when you have Medigap, also known as a supplement or Medicare Advantage plan. Each carrier in their plans has different copays, and you just have to figure out which plan suits you best.

Answer: Hi, thanks for watching. So someone's asking about choosing the wrong plan with Medicare and if they're stuck with it. When you first enter Medicare, whether you're just turning 65 or you are leaving your group employer plan and you're enrolling in your Part B, which is the medical insurance piece of Medicare, if you go into a Medicare supplement, sometimes they call it a Medigap plan with a prescription drug plan, you probably want to go with Plan G. That's the most comprehensive plan out there. And you can always downgrade. Typically, you downgrade your plan later if you don't think you want that much coverage.

If you're enrolled in a Medicare Advantage plan, that's one of the good things about the Advantage plans. The way that the Advantage plans are set up is that each year during October and November, you can change your Medicare Advantage plan and go to a whole different plan with a January 1st effective date.

So let's pretend you had a plan and maybe mid-year you realize you have diabetes or you have a heart condition. There are specific Advantage plans out there that focus solely on those issues and others too. Those are the two top ones. Typically, you can enroll in a different plan many times, even in the middle of the year, depending on your condition. But you can always change your plan each year if you want different benefits. If maybe you need dental coverage and your Advantage plan doesn't have this year, or it doesn't have enough coverage, every year you can change, which is pretty cool.

Answer: Hi, thanks for watching. So the question is, can someone be denied for a Medicare supplement plan? This is a long answer, so bear with me. If you're brand new to Medicare, you're just turning 65 or you've just signed up for your Part B, you have a guaranteed issue situation with a Medicare supplement plan. It doesn't matter what your health condition is. If you have that, you have up to a certain amount of time to enroll in a supplement plan with no health questions.

Now, once you've been on Medicare for a while, maybe you're on a Medicare Advantage plan and you want to go to a Medicare supplement plan, typically you'll have to go through underwriting depending on your health and how you answer the health questionnaire. Underwriting can deny you completely. It really depends. So it just really depends on where you are in your Medicare journey in terms of if you can get denied or not.

Answer: All right, thanks for watching. So the question is, what if someone can't afford their Medicare premiums? My first advice is to go make an appointment with Social Security. Go down there, talk to them, and say, "Look, here's my income," and they can even look it up. You may have all the details on it. Ask them for help, and figure out if you qualify for extra help. Maybe you don't, or maybe you go on Medicaid, and then you go on what they call Medicare and Medicaid. It's called a dual program. Maybe you just need a little bit of extra help because you can't afford certain things related to Medicare. It all depends on what your income is and how they can help you strategize. If it's Social Security, they'll be the ones to help you.

Answer: Hi, thanks for watching. So the question is, what's the best way for seniors to protect themselves from Medicare-related scams? I've said this a hundred times already. Find an independent Medicare broker that you think you can trust. Go to them for advice, have them help you with any Medicare-related questions. If somebody calls you out of the blue, if they call and say they're from Medicare, I wouldn't even talk to them. Talk to your broker, tell them what's going on. They can advise you on the best way to go. If there are any issues, they can help you handle it. That's what we get paid for, helping people with that.

Answer: Hi, thanks for watching. So the question is, how do you approach educating people who are new to Medicare versus someone that's just wanting to switch plans? When somebody's new to Medicare, typically they're turning 65 or leaving a group employer plan. They don't really, many times, most times, they don't have a real in-depth knowledge of how Medicare works. The way it works is when you have your Part A and Part B, that's the point you have to decide, do you wanna go with a Medicare Supplement with a drug plan or do you wanna go with a bundled product, like Medicare Advantage, that rolls up your A, B, and drug plan all in one? It's a very different conversation because people are not used to navigating the Medicare system. The coverage is typically a lot better than what they're used to, and they're just not sure of which way to go. You kinda have to do a little more hand-holding, if you wanna call it that, with people just turning 65. Some people are very knowledgeable about it, but the Medicare brokers have typically, hopefully, done this a long time. They know what direction to go and the right questions to ask. They do a needs analysis to figure out what works best for people because everybody's different. I have some couples where one, the husband's on a Medicare Advantage plan, and the wife's on a supplement plan. It just depends on what works for them. But they came to that fork in the road. They had the A and B, and one went one direction, one went the other. So it really depends.

Answer: Hi, thanks for watching. So the question is, what's the biggest disadvantage of Medicare Advantage? I'll have to say that with Medicare Advantage, you have to stay in a network. But I've said it a hundred times, if you live in a metropolitan area, especially the Phoenix area, the Advantage networks are very, very robust. A lot of doctors in them, most hospital systems, but you still have to stay in the network to get your benefits.

With a Medicare supplement, sometimes they call it a Medicare gap plan, you can go to any doctor anywhere as long as they accept Medicare. So the cost on a supplement is a lot more than an Advantage plan. Advantage plans are typically zero premium, and some have a little bit of a premium each month. But the coverage is really good on the Advantage plans. And if you live in a relatively populated area, many times that's the way to go.

Answer: Hi, thanks for watching. So the question is, this person's doctor wants them to get several preventative type screenings and they want to know if Medicare covers them. It's a valid question. I will tell you that it's going to depend on whether you are on a Medicare supplement or Medicare Advantage. Most screenings, not all, but most screenings are covered by Medicare, and you're either covered at no charge or with a relatively low copay. Same with the Medicare Advantage plans, because Medicare Advantage plans have to have the same coverage or better than what Medicare has. So that's just how it is, and the screenings are done on an Advantage plan on a copay basis. But most preventative screenings are covered, and most of them are covered either at zero.

Answer: Hi, thanks for watching. So the question is, what's my go-to strategy for figuring out if someone should decide between a Medicare Advantage plan or a Medicare gap plan? The first thing to talk about is where does a person live? If they're in a metropolitan area, like we're in the Phoenix area, the networks here for Medicare Advantage are really good. I'm much more apt to suggest someone enroll in one. Here, because the networks are really super good, a lot of doctors and most hospital systems are in one of the Advantage networks, and it really works out well. If you're in a rural area, there's just not that many doctors. Typically, Medicare Advantage is not really the go-to kind of strategy, because the networks are a lot thinner. There's just not enough people up there. Typically, the benefits in a rural area are not as good on the Advantage plans as they are in the Valley or in a more metropolitan area. And typically, if somebody lives up in like Apache Junction, Prescott, Grand Canyon area, somewhere away from the Central Valley Phoenix area, I'm typically gonna recommend a Medicare gap plan or a supplement plan for them, because the coverage is really good. The downside to a supplement is you have to pay for it every month, whether you use it or not. And they start anywhere if you're 65, yeah, 170, 180 a month, plus a drug plan.

Answer: Hi, thanks for watching. So the question is, how does someone report a suspicious Medicare billing error without getting in trouble? I always tell people to go to your provider first, the doctor's office or the hospital, and pick it up with them first. It might have just been a simple error, they can fix it, and everybody can move on. The second place I would go, if you don't get any satisfaction that way, is 1-800-Medicare. They will help you, that's why they're there, to assist people with issues like this. They're very, very helpful when it comes to that. Hopefully, you can talk to your Medicare broker too. Typically, they can spot things that maybe don't look right or could advise you on where to go and all that stuff. That's the best way to go with that. But 1-800-Medicare, the people there are really good and they're very helpful.

Answer: Hi, thanks for watching. So the question is, this person had a change in their health condition. How does that affect your current Medicare plan, and should you reconsider your coverage? Well, if you're on a supplement plan, or we call it Medigap, with a drug plan, you really don't need to do anything because you're covered completely for everything. But you pay for it. You have to pay for that supplement and that drug plan every month. Probably $200 at the cheapest, $200 or more each month. If you're on a Medicare Advantage plan, this is where you can go to a different plan that's focused on your specific illness or whatever issues you're facing. There are certain plans that are focused on heart conditions, diabetes, and some carriers are a little more friendly when it comes to certain conditions. The medications are typically better with some plans than others in their formulary. But that's where your broker makes their commission. You should go to your Medicare broker, hopefully, that's all they do, an independent Medicare broker, and talk to them about it. Say, "Listen, I've got XYZ condition. What do you recommend? What are the plans out there that are available? And should I move from what I currently have?" You can do that from October 15th through December 7th of each year for a January 1st effective day.

Answer: Hi, thanks for watching. So the question is how can someone estimate their Medicare costs if they have a chronic condition like diabetes? I'll tell you one thing. If you're in an area where Medicare Advantage is available and has a robust network, they have specific plans in place focused, strategically focused on diabetes and heart conditions. I gotta tell you, these plans are super good. Usually, there's zero premium, meaning it doesn't cost you anything each month. Everything is a copay-based service, but these plans take a focused problem-solving approach when it comes to these chronic issues; diabetes is one of them. There's one particular plan here in Arizona that's very, very focused on diabetes. It doesn't matter what stage you're in, but the benefits are really good and they're centered around the medications that people take for diabetes. So they're typically very, very low cost, if not free, for these medications. Highly recommend them.

Answer: Hi, thanks for watching. So the question is, why do some people regret choosing a Medicare Advantage plan over original Medicare? First of all, you have to understand when someone goes on a Medicare Advantage plan, they have what they call a trial rights period, which is 12 months. They can test it out. If within those 12 months they don't like it, they can revert back. In most cases, they can revert back and go to original Medicare with their supplement. One of the biggest regrets, I think, is when someone gets on Medicare Advantage and then later on they want to go to a supplement plan with the prescription drug plan, but they have to go through medical underwriting to be able to do that. The medical underwriting is not super strict, but they typically ask you questions like, have you been in the hospital in the last many days? They ask you if you have specific medical conditions. They're pretty serious. I mean, it's not, they call it an abbreviated underwriting, but more times than not, people can get through that underwriting and they'll be able to get a Medicare supplement plan and move away from Advantage.

Answer: Hi, thanks for watching. So the question is, what happens to someone's Medicare coverage if they move to a U.S. territory like Guam or the Virgin Islands? A couple of things. If you're on a Medicare Advantage plan and you move to Guam or a territory, it's not going to be applicable. You're going to have to move or segue back into original Medicare, which is A and B. The supplements, I'm not sure how they operate in Guam, but typically if you have one in the States already and you move to a territory, they will probably stay in effect, but they may adjust what you pay each month for it. But again, check with your Medicare broker. And honestly, if I was moving to Guam or the Virgin Islands, I would go down to Social Security and let them know that and find out what that looks like with them because they're going to be the first people that you need to check with and tell them where you're going to be moving to. That's definitely good advice, at least to start out with.

Answer: Hi, thanks for watching. So this question is, this person's 67, they're still working. They want to know if they need Part B, and they're asking why it's so hard to figure out. Well, honestly, Medicare's confusing. You may not need your Part B if you're still working, but you have to make sure if you're on the group health plan at work, on the employer plan, that it's what they call credible coverage. So once you turn 65, you have to be enrolled in an employer plan that has coverage that's as good or better than Medicare. That's how you figure out if it's credible coverage. If you have credible coverage, you can delay enrolling in your Part B until you leave your employment. Part A, on the other hand, is usually premium-free. If you've worked at least 10 years and you paid into the system, there's no premium for Part A. So when you turn 65, most times we will advise people to sign up for Part A, because now whatever plan you're on at work, you also have your Part A coverage with Medicare and you're doubly covered. And it's not costing anything each month. The only thing with Medicare that charges is Part B.

Answer: Hi, thanks for watching. So the question is, why is it helpful to follow up with parents after they've been discussing Medicare? It's always good to follow up with your parents when they've been discussing Medicare or the Medicare broker for a few reasons. Medicare is confusing. Most insurance agents don't understand Medicare. That's why it's really good to find somebody that only does Medicare as far as being a broker. But there are a lot of reasons to keep your eye on what their enrollment looks like. You want to make sure they don't miss any enrollment deadlines. There are details if they need specific chronic illnesses covered, all that stuff. Because if at some point you need to step in, if your parents are ill and you need to help them, you're not starting from scratch, and you can kind of get ramped up pretty easily. Hopefully, your broker will help you with that too, but not always.

Answer: Hi, thanks for watching. So the question has to do with extra reserve hospital days with Medicare. What is it, and what does it mean? So with original Medicare, you get up to 90 days of in-hospital benefit in a certain benefit period. If you go over that 90 days, then you'd have to draw on your extra 60 days of lifetime. Every person that enrolls in Medicare has an additional 60 days in their lifetime to use in excess of the 90 in a specific benefit period. So that means you can draw on that a little bit, or all of them, or whatever that looks like. And if you have a Medicare supplement plan, that kind of coverage can go far beyond that. You have a Medicare Advantage plan, same thing. It really depends on the plan. And it's something to look at because 90 days goes pretty fast if you have a significant illness.

Answer: Hi, thanks for watching. So the question is, how can someone avoid or reduce IRMAA charges on the Medicare premium? Just to recap with IRMAA, if you make over $106,000 this year, or if you're filing jointly and make over $212,000, you're gonna be charged an upcharge from Social Security on your Medicare Part B premium. How do you avoid that? If there's some way to tailor what you show as your modified adjusted gross income, that's one way. If you have maybe an uptick in your income for one year, a lot of times you can go to Social Security, sit down with them, show them that you don't typically make that much money, and provide a history of what you've made and what you anticipate to make. Many times they can make an adjustment, but other than that, it's pretty clear cut in terms of what the upcharge is when you make over a certain amount.

Answer: Hi, thanks for watching. So the question is, what's one hidden Medicare expense that people don't think about until it's too late? The first one that comes to mind has to do with Medicare supplement coverage. Another name for it is Medigap. Certain provider groups charge an excess of 15% above the typical Medicare expenses. If you don't have the right supplement plan, it's not gonna cover it.

So if you have a big bill, that can happen with one provider here in Arizona. Do you have a gigantic bill and they bill you 15% over what that is because they're allowed to do that through Medicare? If you don't have the right supplement that covers that, you're on the hook for it. So if it's an 80 or $100,000 procedure, you could be liable for $15,000 in that case. It doesn't happen all the time, but that's one of those gotchas that could creep up if you make a mistake and you don't even roll into the right plan.

Answer: Hi, thanks for watching. So the question is, what's the biggest mistake people make from the enrollment to Medicare? I think one of the biggest mistakes is people are unsure of when to enroll. A lot of people are working past 65, they're on an employer health plan at work. Do they keep it? Do they give it up? There are different scenarios. It's not a one size fits all kind of thing. And not every employer plan is what they call credible coverage in the eyes of Medicare. So if you're on one employer plan with a small company, that's not gonna be seen as credible coverage and you have to enroll into Medicare on your 65th birthday. If you work for a different employer, maybe a larger employer, most likely that's gonna be credible coverage and you can waive off or put off enrolling into Medicare until you leave work. But talk to your advisor, hopefully you pick one that's good, that's very knowledgeable because it's crucial.

Answer: Hi, thanks for watching. So the question is, does Medicare cover eye exams or are people left paying too much? Medicare will cover eye exams, but they will not cover glasses, contacts, or frames. They will not cover things like that. If you have a medical issue with your eyes, Medicare will cover it. But that's one of the beautiful things about Medicare Advantage: they have eyewear benefits. You typically have $100 up to $500 a year to spend on glasses, frames, lenses, and contact lenses. But in terms of a medically necessary issue, Medicare will cover it when it comes to your eyes.

Answer: Hi, thanks for watching. So the question is, someone just moved to a new state and they want to know if they need to do anything for Medicare. The number one thing you need to do is make sure that Social Security knows where you live, because that is the key to where you set up your Medicare plan. Social Security needs to know you've moved, and they need to have your current address. Once you get into the new state, find an independent Medicare broker that you think you can trust and have them navigate the waters for you. Have them look around at the different plans. Does Medicare Advantage make more sense? Would it make more sense to do a Medicare supplement or the drug plan? I don't know. Every state's different. If you're from Phoenix or Central Arizona, if you're from most parts of Florida, or even maybe Southern California, Medicare Advantage might be okay because the networks are really good due to all the competition. There are so many 65-plus people that you're going to get a lot of competition, and the networks are really good. Here in the Phoenix area, there are typically around 11 insurance carriers that make the most sense for most people. So you just have to really know the market and know what you're looking at, and trust the advice of the person that you retain as your Medicare advisor.

Answer: Hi, thanks for watching. So this question is, what's one piece of advice that I could wish for everyone before they pick a Medicare plan? So the number one, hands down, the number one thing would be to find an independent Medicare broker that you trust, because it's a big deal. I mean, these people, me included, are in charge of your healthcare. If we have a misstep, if we miss a deadline, you guys are the ones that have to pay for that. And typically, it's for the rest of your life. If you miss an enrollment date, if there's a penalty, it's typically for life. So picking an advisor is like picking someone that you're gonna have manage your money. It's an important decision. Having somebody on the phone call you and sign you up, I just really wouldn't recommend that. With us, with Sue and I, we like to meet people typically face to face, unless they live really far away. Just to get a feel, see if we're the right fit for them, because it's a big deal helping people with Medicare. It's confusing, and you can get in a lot of trouble if you miss certain deadlines and different things like that. So that's my biggest advice. Find someone that's knowledgeable, that's independent, that only does Medicare, not a hundred other things, just Medicare, and go with their advice.

Answer: Hi, thanks for watching. So this person asks, should there be stricter regulations on Medicare Advantage marketing and sales practices? I’ll tell you, I came from the group benefits world. I had a group benefits agency for 20 years and I did health insurance for small companies. There are basically, there’s not no rules, but the rules are very lax. Medicare is extremely highly regulated. Meaning when we call people, when we're doing a sales presentation, most things have to be recorded. The regulations they have are really, really strict now. What’s happening is all these call centers that are calling people out of the blue, first of all, they’re not supposed to be able to do that. But if there was a way to crack down on that, those are the people that are the worst offenders. They’re the ones making it bad for the good agents, the good local agents that are just trying to do a good job. But the regulations are pretty strict now. I can’t imagine them getting any stricter, honestly.

Answer: Hi, thanks for watching. So the question here is someone picked the Medicare Advantage plan last year, and they want to make sure their hearing aids are covered. How do they figure all this out? Well, if you use a broker, hopefully a Medicare-only broker, you shouldn't have to figure it out. If you're my client, I should be your first call when you have any questions at all about your plan, whether it's a Medicare Advantage plan, Medicare Supplement, Medigap, whatever, we should be your first call.

But in terms of hearing aid coverage, most Medicare Advantage plans will have hearing aid coverage. And the benefit is really all over the map. Some coverages will pay for one year, actually two years each year with a copay, with a set copay. But honestly, when you really look at it closely, you're probably going to be better off going to Costco or Walmart, checking out their prices. And what I've learned with hearing aids is you get what you pay for. The cheaper the hearing aid, the least it's going to work. It's just built like that.

Answer: Thanks for watching. So the question is, this person is on disability and they're on their Medicare right now, at least for Part A. And they're wondering if they have to sign up again when their 65th birthday comes. The answer to that is no. If you're already on Social Security, you've been deemed disabled. Usually, that takes 24 months and a doctor has to sign off. Once you're into that, they will automatically enroll you into Part B the first of the month of your birth month when you turn 65. That's typically an auto-enrollment. I would make sure that that's done though, but typically that's how it happens. It's kind of a seamless process.

Answer: Hi, thanks for watching. So the question that's asked is if someone needs long-term care in the future, how does Medicare fit into that whole thing? Well, first of all, Medicare does not cover long-term care, but a close second would be the short-term health care plans that a lot of the Medicare Advantage carriers have. It's pretty inexpensive. It'll usually cover you up to about a year, sometimes more, and it's not that expensive. So I always tell people if you think you are looking at a long-term care plan or you want to plan for it, that's probably the best way to go. But again, talk to your broker. Hopefully, you have an independent broker that only does Medicare because if you don't, you're probably missing out, because Medicare is very complicated and it's a niche product.

Answer: Hi, thanks for watching. So the question is, how can someone avoid IRMAA surcharges when they have an unusually high income year? Remember, IRMAA is an upcharge that Medicare Social Security actually charges you when you make over a certain amount of money in a particular year. The look back is two years. So someone enrolling now, Social Security would look back at your 2023 returns. If you made over $106,000 in that year, or $212,000 as a couple, they would tack on a surcharge or an upcharge basically to your Part B premium, which right now is $185. It can go up significantly. And they're wondering how they can avoid that. So here's what I tell people. The folks at Social Security, the Social Security Administration, are actually very helpful when it comes to sitting down with people and figuring things out. So my advice to this person in particular would be to take your income, maybe for the last five or ten years, and your current income, go to them, sit down, and say, "Look, I had an unusually high year, how can I avoid paying that upcharge?" And I'm pretty sure they can work out something for you. I've had clients do that, and they've had success.

Answer: Hi, thanks for watching. So the question is, what happens if someone is already retired and collecting Social Security when they turn 65? Maybe they started collecting at 62. Well, in most cases, Social Security will automatically enroll you into Medicare at age 65. You don't have to enroll yourself. That's typically done automatically. So should you get your card, Part A and Part B should become effective the first of the month of your birth month. And that's done automatically.

Answer: Hi, thanks for watching. So the question is, how can someone lower their Part B premium if their income drops after retirement? The answer to that is the Part B premium this year in 2025 is $185 a month. That's if you made under $106,000 two years ago. The look back is two years; they always look back two years. If you made over $106,000 or $212,000 as a couple, then you're going to get what they call the IRMAA upcharge. It's a surcharge. Basically, they're going to charge you more because you're making more than most people. But you can't get it lower than $185 unless you qualify for extra help. Maybe you're on Medicaid or if you have a lower income. In that case, you want to go to Social Security, tell them what you're making, and maybe they can help you with that Part B premium.

Answer: Hi, thanks for watching. So the question is, what happens if someone delays their Part A, which is hospital insurance, because they're still on their spouse's employer plan? Well, in most cases, Part A is premium-free, meaning if you or your spouse have worked at least 10 years and paid into the system, the Part A hospital coverage is going to be premium-free. So in most cases, it's usually better to enroll in Part A because it doesn't cost you anything. Even if you are on your spouse's plan, you can delay your Part B enrollment, which is the medical insurance piece of Medicare. You can delay that until you retire and move off of the group health plan and go into Medicare. That's a good idea. Typically, enrolling in Part A when you turn 65 is a good idea because what that does is give you double coverage. You've got your Part A with Medicare hospital coverage and you've got the hospital coverage attached to the group health plan on your spouse's plan or your plan, depending if you're working. So it's usually always advisable to enroll in Part A when you turn 65.

Answer: Hi, thanks for watching. So the question is, this person has original Medicare and they're wondering if they'd save money on dental cleanings if they switch to a Medicare Advantage plan instead. I will say that most Medicare Advantage plans have some sort of dental benefit, which typically includes cleaning. A lot of them have comprehensive coverage, like fillings, crowns, and some even have implant coverage, depending on the plan and the carrier. But original Medicare does not have any dental benefits like cleaning attached to it. You'd have to go on a Medicare Advantage plan or purchase a separate dental plan, which is out there. In fact, I just ran across one recently that's very comprehensive. If somebody has original Medicare with a supplement, the individual standalone dental plans are really good and they can be very comprehensive.

Answer: Hi, thanks for watching. So the question is, this person wants to know if they should keep their original Medicare or go on a Part C Medicare Advantage plan, which is better. I've said it a hundred times, and I'll say it again: if you live in a rural area or an area that does not have a lot of 65-plus people living in it, typically the Medicare Advantage plan networks are going to be fairly limited. I would probably go on original Medicare with a Medicare gap plan or a supplement plan. But if you're in an area like we are in Phoenix, many parts in Florida, or even Southern California, the Medicare Advantage plans have great networks. There's a lot of competition, and they offer a lot of extra benefits. Typically, the Medicare Advantage plans are offered at zero premium per month. They're all copay-based. Whatever services you obtain, it's all a copay-based system, and they're definitely worth looking at.

Answer: Hi, thanks for watching. So the question is, this person lives in a rural area with limited specialists and they're interested in telehealth options. They're wondering how Medicare covers a virtual visit. It depends if you're on a Medicare Advantage plan or original Medicare, but many times telehealth is really new or fairly new and it's covered typically at a very low cost or no cost. You can do it through Zoom or different ways like that. But it's very, very low in cost and many, I'll say, maybe not most, many plans cover telehealth at a very low cost.

Answer: Hi, thanks for watching. So the question is, how do discount prescription cards affect your Medicare prescription drug plan? They don't; the discount cards do not affect that at all. But they will give you a better rate if you don't have a prescription drug plan or if your prescription drug is not part of your drug plan formulary. GoodRx is one of them. There's a lot of different cards out there that give benefits to people who either don't have prescription drug coverage or maybe the particular drug is not in their formulary. That would be the only benefit. But typically, prescription drug plans are pretty comprehensive with most drugs.

Answer: Hi, thanks for watching. So the question is, are Medicare Advantage plans really free or is that just clever marketing? Well, when they say free, many, I'll say here in the Phoenix area, most of the Medicare Advantage plans don't have a premium. It's a zero premium. But it's a copay-based system, meaning when you go get services, it's all based on copay. If you go into the hospital, it's going to be a certain dollar amount for the first five or six days. If you go see a specialist, it's going to be a certain amount. If you have an ambulance, it's a certain amount. That's why people say that it's free. You don't pay monthly for it, but you pay based on the services that you're getting at the time. If you get a Medicare Supplement plan, sometimes called a Medigap plan, you're paying upfront for the monthly premium for what you might use in the future. Typically, you don't have any copays or any payments when you get services, but you're paying for that Medigap plan each month plus a drug plan. So it's just a matter of do you want to pay upfront or do you want a copay-based system and kind of a pay-as-you-go way.

Answer: Hi, thanks for watching. So, kind of a weird question, but they're asking, "What do you like most about being a Medicare agent?" I'm actually a Medicare broker, and that means I'm an independent broker. I don't work for any insurance companies, but I represent a lot of them here in the Phoenix area. The biggest benefit to being a broker is that I can help people cut through all the confusion and understand, as best they can, their Medicare coverage. Honestly, there's a lot of shady agents out there, so you have to really, like they say, choose wisely. Do your homework on people. Figure out what they're all about. If they do other lines of insurance, maybe they're not an expert in Medicare. Because as we all know, you can't be an expert at everything. It took me a long time to understand all this and to really get good at it, and that's all Sue and I do, is Medicare.

Answer: Hi, thanks for watching. So the question is being asked, what's the cheapest way to get Medicare coverage if they only need basic hospital care? Well, when you sign up for Part A and Part B, usually Part A is free if you've worked at least 10 years and paid in due to Social Security. Part B starts this year at $185 a month. And if you go on a Medicare Advantage plan, most of those, not all, but most of those are zero premium each month. So unless you utilize services, you're not having to pay out. That's probably going to be the cheapest way to get Medicare coverage.

Answer: Hi, thanks for watching. So the question is, this person's enrolled in a Medigap Plan F and they're not sure how the emergency room visit is going to be handled and if there's a copay. Typically, with Plan F, there are no copays. It's not 100%, but in most cases, there are no copays for services. But on the other end, you're paying for that Plan F every month, and that can range from anywhere around $150 when you first turn 65. I've seen some F plans as high as almost $500 a month. So it really depends on what works for you, whether to switch from a Medigap plan to a Medicare Advantage plan, or even switching from Plan F to Plan G. Right there, you could probably save some money. And the only thing different between G and F is the yearly deductible.

Answer: Hi, thanks for watching. So the question is, why do some doctors not like Medicare Advantage? Well, to be perfectly honest, the Medicare Advantage plan reimbursement to doctors, the fees that they pay doctors, are going to be less than that of original Medicare. It's not a huge amount, but it's definitely different than original Medicare. Some doctors have been practicing a long time, and they can afford it. They only accept people that are on a supplement or have original Medicare because the fee structure is bigger. It's just the way it is.

Answer: Hi, thanks for watching. So the question is, what is one of the most common misconceptions people have about Medicare? Probably the biggest one is that people think that when you get on Medicare, you don't pay for anything. Everything is free. And that's the farthest from the truth. There's only two ways to go with Medicare. You can either go with original Medicare and a Medicare supplement, sometimes called a Medigap plan, or you can go the Medicare Advantage route, which is more of a bundled product and a copay-based system. Meaning, when you go to your doctor, you get services for Medicare, everything is a copay. Go into the hospital, it's a copay. Go to the doctor, typically it's zero copay, but it's copay-based anyway. The second biggest misconception is that Medicare is going to run out of money. I'm not going to have my Medicare. That's just not going to happen. There's like 80 million people on Medicare. There's no way that this is going to go away. The cost might get a little bit higher, but it's not going away. It's just not going to happen. It's too big to fail. Let's put it that way.

Answer: Hi, thanks for watching. So the question is, this particular person is interested in nutrition counseling to help manage their diabetes. Will Medicare cover this? Yes is the short answer, but a longer answer and a better answer is that there are specific insurance companies out there that focus on people with chronic conditions. Diabetes, heart conditions, and the coverage on these plans are really, really good. If you have an insurance agent that only does Medicare, which I hope that's what you're looking for, an independent broker too, they should have all the information about these carriers and what they cover. But the coverage is tailored. It's a focused problem-solving approach to specific chronic illnesses, and I highly recommend you look at those if you have a specific illness.

Answer: Hi, thanks for watching. So the question is, this person picked a plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should that person have gone with a higher premium? Well, the great thing about Medicare Advantage is that you can switch it each year. If you get into a Medicare Advantage plan that has benefits that maybe don't align with what you need, at the end of the year, you can switch to another one. So it's not really about the higher premium or whatever. You have to pick the plan that you feel addresses your needs the best.

Answer: Hi, thanks for watching. So the question is, why do some insurance agents push Medicare Advantage plans over Medicare GAP, and should you be skeptical? Well, first of all, shame on them for doing that. Secondly, yes, the Medicare Advantage commissions are typically going to be larger than if they sell you a Medicare supplement. But the bottom line to all this is you have to do what's best for the client. If somebody's in a rural area, a supplement is going to be your best bet. It doesn't matter what the commission is. Or if somebody travels around the United States a lot, or if they want to just access any doctor that accepts Medicare, that's going to be a supplement. You want to go on a supplement plan or a Medicare GAP plan. And shame on them if they're trying to push them. They shouldn't be doing that. But there are a lot of shady people out there.

Answer: Hi, thanks for watching. So the question is, do my clients use Medicare Advantage over-the-counter drug cards? How does that work? Well, first of all, most Medicare Advantage plans have what they call an OTC, over-the-counter benefit. Now that benefit can be used for over-the-counter drugs, band-aids. It's a pretty comprehensive list of what can be used on that.

There are a couple ways you can use that. You can go into specific pharmacies or places like Walmart, different things like that to use it, or you can use them online and typically they'll ship them to you at no cost. You can request a catalog, you can go online and look at their catalog, and I'll tell you, the over-the-counter things that can be purchased, it's pretty extensive. I mean, things like water picks, band-aids, of course, over-the-counter medications, flu and cold stuff, but the list is huge. There's like pages and pages of stuff you can get with your over-the-counter benefit.

Answer: Hi, thanks for watching. So the question is this: this person's diabetic medication is really expensive, and they've heard horror stories about Part D prescription drug plans not covering what people need. They're asking if they should do a standalone Part D drug plan or get it through Medicare Advantage. So the answer to this is pretty simple. You have to do your homework on this. You have to figure out what medication you take, if there's any alternative that would work better, and find out what the formulary is on whatever plan you're signing up with. Whether it's a standalone Part D prescription drug plan with original Medicare or if it's a Medicare Advantage plan, that's the crux of all this. You have to make sure that your medication is covered on the plan that you enroll into. It's that simple.

Answer: Hi, thanks for watching. So the question is, someone's getting conflicting information about whether Medicare covers their specific medication. How can you get a definitive answer? Well, I’ve said this a hundred times, hopefully you have a broker that only does Medicare and can help you with this. That's why they get paid. That's why we make a commission. If you wanted to look at it on your own, go to Medicare.gov. You can put that specific medication into it and it'll tell you right away if it's a covered medication. From there, you have to figure out what Medicare plan is going to cover that particular drug, and you want to look at the insurance carrier's formulary. It's either on their formulary or it's not. If it's not on their formulary, they're probably not going to cover it.

Answer: Hi, thanks for watching. So the question is, why are people unhappy with Medicare Advantage plans? Well, I've been doing this a long time, and probably the biggest reason why people are unhappy with it is because their broker, or they, enrolled themselves, didn't do enough homework up front to make sure that their Medicare Advantage plan was what they needed based on their needs. Right out of the gate, you have to make sure your doctors are lined up in the network. What prescriptions do you take? There's a whole needs assessment with this, and it's really important to make sure that whatever plan they get into, it's the right one for them and what they need. I will tell you that if you're in a rural area, I probably would vote against a Medicare Advantage plan only because the networks are so thin. If you're in a major area that has a lot of 65-plus people, the networks are usually going to be really good, and there's a lot of competition. So here in the Phoenix area, there are 11 or 12 insurance companies that are pretty much the ones that most people go with, and there's a lot of selection. The networks are really good, and the benefits are really good too.

Answer: Hi, thanks for watching. So the question is, someone keeps hearing about Medicare Advantage plans and they want to know what the real deal is compared to regular Medicare. So let me start off by saying all Medicare Advantage plans must, by federal law, cover the exact same benefits that original Medicare covers. And typically, Medicare Advantage plans have a lot of extra benefits that they offer with that, like dental, vision, over-the-counter, hearing, that kind of thing. I think Medicare Advantage plans are better in areas that are 65 plus communities, you know, like the Phoenix area and some parts of Florida. If you're in the rural areas, I probably would stick with original Medicare with a supplement because that gives you more flexibility. You can go to any doctor that accepts Medicare. There's no network, so to speak, with the Medicare Advantage plan; you have to stay in a network. But if you're in an area that has a lot of seniors, the Advantage networks are really good.

Answer: Hi, thanks for watching. So the question is, is original Medicare or Medicare Advantage better and why would I recommend one over the other? I tell people all the time, if you live in the Phoenix area, if you live in Florida, many parts of Florida, or other parts of the country that have a large 65 plus population, a Medicare Advantage plan most likely would work out really well because the network is so big. There's a lot of competition. If you live in rural areas, if you're in states that don't have large 65 plus populations, I probably would not go with a Medicare Advantage plan because the networks are really thin. In that case, I would go with a supplement. They call it a Medigap plan. You can go to any doctor that accepts Medicare, and usually you don't have to pay anything for the services, but there's a monthly cost for the supplement. So you've got to weigh one with the other.

Answer: Hi, thanks for watching. So the question is, how can I save money on my Medicare supplement? Sometimes it's called a Medigap plan. The biggest savings is, in most instances, if you're on Plan F, hopefully you can move to Plan G because the only difference between F and G is the Part B deductible each year. If you're able to go from F to G, you're probably going to save a significant amount right there. Some states allow that without going through underwriting. Here in Arizona, you have to go through underwriting, even if you want to downgrade your plan from F to G. But the underwriting questions most times are abbreviated. Things like, have you been in the hospital in the last three months? Do you have any of these conditions, which are pretty serious? They're not fooling around with that. If you can go through underwriting and you're good, you can downgrade your plan. And typically you can save money that way. Another way is if you're on a specific insurance company plan, if you want to change to a different company. A lot of times certain carriers have better rates than others. But again, you are probably going to have to go through underwriting in order to switch companies.

Answer: Hi, thanks for watching. So the question is, what if I miss my window to enroll in Medicare? Okay, that's a complicated question. There's a lot of different enrollment times. There's the initial enrollment time when you first turn 65. That's a seven-month period surrounding your birth month. If you're on a group plan at your employer and you leave that group plan, you have so many months to be able to enroll with that. So my advice to that is find a broker, a local broker that only does Medicare, and talk to them about it because there's a lot of loopholes. There's a lot of enrollment periods, and you definitely don't want to get a penalty for enrolling late because once you get that penalty, you have it for the rest of your life. There's no getting around it.

Answer: Hi, thanks for watching. So the question is, are preventative screenings covered by Medicare? The easy answer to that is yes, they're covered. But if it turns to a diagnostic type screening, you're going to be billed for it. The type of preventative screenings are like your yearly visit, which should be free. The one-time welcome to Medicare within the first 12 months, that's free. Those screenings are covered, but you're going to be billed for a screening if it's considered diagnostic, meaning they're looking for something that they think is already there. If it's a preventative screening, like cancer, a lot of colonoscopies, mammograms, those types of things are covered and usually at no cost.

Answer: Hi, thanks for watching. So the question is, someone got a call from a Medicare agent promising free groceries, and they almost fell for it. Why is this kind of marketing allowed? Well, to be honest, it's not allowed. But the problem is there are so many of these call centers around the country that they can get away with stuff like that. They'll call you; you're not supposed to call anybody unless they give you permission. But these call centers, a lot of them are out of the country. They're calling people, and they're preying on people, promising the world and then not coming through. They're just trying to enroll them. This industry is very, very heavily regulated. But a lot of times, if they're out of the country or there's some mysterious call center in the Midwest or something, it's hard to regulate these people. But the legit agents are the ones taking the brunt of it. That's why there are so many rules. I would find someone local who knows the local market, and they can explain the grocery benefit. It's a great benefit, but you have to have certain medical conditions in order to qualify for it.

Answer: Hi, thanks for watching. So the question is, in your experience, what are the best Medicare supplement insurance companies and why? First of all, what I would look at is the length of time the supplement company has been in business in that particular state. That could range from one year up to 40 or 50 years. I would really look at the claims experience. Honestly, the best way to do this is to find yourself a Medicare insurance broker that only does Medicare. Because as we know, you can't be an expert at everything. It's really good when somebody picks one lane and gets really good with it. I would lean on their advice and ask them, why do you think this company is better than another one? They could hopefully give you some solid reasons as to why.

Answer: Hi, thanks for watching. So the question is, what states have the Medigap birthday rule and what is it? The Medigap birthday rule is in California, and the way it works is you have a 60-day window where you can switch from one Medicare supplement to another as long as it's equal or lesser in value with no underwriting. That means the 60-day window begins the first of the month of your birth month and then lasts for 60 days after that. You can only switch from one Medigap plan to another, and it's got to be equal or lesser in value. Now this does not apply if someone's on a Medicare Advantage plan and they want to go to a Medigap plan. It only applies from one Medigap to another Medigap of equal or lesser value. California has that rule. Arizona does not.

Answer: Hi, thanks for watching. So the question is, do you have to answer health questions when switching from one Medigap plan, which is a supplemental Medicare insurance, to another? Here in Arizona, the answer is yes. Even if you're downgrading coverage, like if you want to move from Plan F to Plan G, which is always advisable, you have to go through underwriting and answer health questions. I have no idea why that is, but yes. The health questions are typically what they call an abbreviated underwriting, meaning have you been in the hospital in the last three months? Do you have any of these conditions that you're seeking treatment for, which are pretty significant? They're not talking about minor things here. But if you can answer those questions, typically you can go through underwriting and you could switch plans.

Answer: Hi, thanks for watching. So the question is, someone's husband passed away and now their Medicare premiums went up. Why does losing someone raise your costs? There are like two reasons I can think of. The first one is maybe you lost your household discount with the insurance carrier. The second reason has to do with IRMAA, which is the income-related monthly adjustment amount. That's the income surcharge or upcharge Medicare charges you when you make over a certain amount.

But immediately, my advice would be to quickly go to the Social Security office, make an appointment, go down there, and find out what's going on because this could drag out for a long time. And actually, the people at Social Security are pretty helpful. I've gone down there with several clients, and they've been very, very helpful. So the first thing I would do is go there and try to get some guidance.

Answer: Hi, thanks for watching. So the question is, you're turning 65 next month, what steps do you take regarding Medicare enrollment? Well, with Medicare, you can apply up to three months prior to your birth month, your birth month, and three months after your birth month. So the sooner the better. I mean, we're talking about the federal government. So things can happen. Things can get screwed up. You want to apply as early as possible. If you're turning 65 next month, I would absolutely advise you to immediately go to ssa.gov and enroll in Medicare, your A and your B. If you don't need your B because you're already on your work plan and you're going to keep working, that's a separate conversation that you need to have with your broker, and you need to find a broker that only does Medicare. A lot of people do Medicare and a bunch of other stuff. You want to find somebody that only does Medicare because we learned a long time ago, you can't be an expert at everything.

Answer: Hi, thanks for watching. So the question is, can someone switch from a Medicare Advantage plan to a supplemental or Medigap plan during the open enrollment without answering health questions? The simple answer to that is no, you will have to answer health questions unless you've been on your Medicare Advantage plan less than 12 months, because they give you 12 months as kind of a free look and kind of a trial. They could call it a trial period. But if you've been past the 12 months, you're going to have to answer health questions. The health questions are things like, have you been in the hospital in the last three months? Do you have any of the following conditions, which are pretty serious conditions and things like that? But yes, you do have to go through underwriting. It's a little bit of an abbreviated underwriting, but it is underwriting.

Answer: So the question is, my friend gets Silver Sneakers with her plan and I don't. How are we both paying for Medicare and getting such different things? Well, here's the thing with Silver Sneakers. It's usually embedded or part of every Medicare Advantage plan, but not all of them—most of them. So it's covered when you're on an Advantage plan. If you're on a Medicare supplement or a Medigap plan, sometimes they cover Silver Sneakers or Silver and Fit, which is another company. Sometimes they don't. There are specific carriers that offer it, others don't. One in particular that I can think of is an upcharge. I think they charge like ten bucks a month more for that, but it really depends on your coverage and what's important to you.

Answer: So the question is, someone is overwhelmed and confused about when to claim Social Security benefits. Should they take it at 62? Should they wait till retirement at 67 or delay it to 70? There's no right answer or wrong answer to that. If you have a financial advisor, that would be the person I would lean on. Typical questions that people figure out if it works for them are, what am I going to draw now? What does that look like? How bad do I need the money? Should I wait till 67? What does that look like? Or can I wait till 70? You get a pretty good bump, typically about a $400 a month bump or more if you wait till 70. How long do you expect to live? If you have long living genes, maybe you want to wait till 70. So it's really a personal question and one that should be looked at by a financial advisor.

Answer: So the question is, I lost my Medicare card. What do I do? Easy answer. You can either call up Medicare at 1-800-Medicare, or you can go on the Social Security website. Hopefully, you have an account with them through login.gov or ID.me, and you can get a replacement card sent right to your house. It's super easy.

Answer: So the question is, can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones? Well, that all depends. It depends if your doctors are in the Medicare Advantage network. It depends if they accept Medicare, or specifically, the technical term for it is, do they accept Medicare assignment? If that's true, then you need to find, or if you have a Medicare advisor that you work with that only does Medicare, that's the person that you need to help you find out, because some doctors are in the network, some are not. And it's just a matter of really strategizing what works for you.

Answer: So the question is, are you eligible for a special enrollment period if you lose employer coverage? The answer to that is yes. But here's the thing, and it's very, very strange the way they work this. When you lose your employer coverage, you have up to six months to get into Medicare, to sign up for Medicare. But here's the catch. You only have 60 days to sign up for the drug coverage part of Medicare. Why is it different? Who knows? Nobody knows. What I tell people is you try to coordinate when you leave your employer or lose your coverage, try to make it seamless. Figure out when the last day that you're going to lose coverage is and coordinate it to where your Medicare coverage picks it up the day after you lose coverage. So that’s seamless, you have no lapse in coverage.

Answer: So the question is, what do I enjoy most about working with Medicare clients? I think the one thing that I enjoy the most, my wife and I work together, we're the husband and wife Medicare team. But the one thing that I like about working with Medicare people is that it's really satisfying to help people work through the complex navigations of Medicare. It's kind of cheeky to say, "Oh, I like helping people." I really do. I mean, I was a cop for 28 years, so I helped a lot of people in that time, and I'm proud of it and I like it. It just gives satisfaction. That's what we do, and that's all we do.

Answer: So the question is, what's the one Medicare decision that too many people regret later? Hands down, the one decision that too many people make and regret is not finding a Medicare advisor or an independent Medicare broker that they can trust. It's a very personal relationship, and when you get caught up with someone that is either a knucklehead or tries to do too many lines of insurance and is not an expert at any one thing, they're just not gonna give you good advice. They're gonna screw it up because Medicare is very complicated. There's a lot of moving parts to it. You just can't be an expert at everything, and you have to pick someone that you think you can trust, somebody that knows what they're doing and didn't start doing it a year ago.

Answer: So the question is, can Medicare drop someone for health reasons? And the quick answer for that is absolutely not. They cannot do that. Your health has nothing to do with being dropped from Medicare. The only way you're gonna get dropped from Medicare is if you move out of the country or if you don't pay your Medicare premiums. But short of that, they will not, cannot—federal law—cannot take you off of Medicare because of health reasons.

Answer: So the question is, someone signed up for a Medicare Advantage HMO and they're wondering if they could see a cardiologist out of network without paying everything themselves. The quick answer to that is no. If they're not in the HMO network, the carrier, the insurance company, is not going to pay for it. But that's the reason why some Medicare Advantage plans offer a PPO plan, which has the ability to go out of network. I gotta tell you, most times, most cardiologists are gonna be in one of the HMO networks. Not always, but most times. And if they're not, they're typically in the PPO network, so they can be seen. It's a matter of working closely with your Medicare advisor and having them help you navigate that.

Answer: So the question is, can you describe a time when you helped a client navigate a complex Medicare issue? Well, I'll bring up one lady in particular. She retired from the post office of all things in Nevada back in 2008. She had the wherewithal to go to Social Security and get information about the retiree health plan that she was being offered. The person at Social Security gave her wrong information. Imagine that, it happens. They told her it was what they call credible coverage, which is what you need to have if you're over 65 and not enrolled in Medicare. They told her she had credible coverage. Turns out she didn't. She came to us, my wife and I, in 2023 because she got a letter from Medicare saying that she owed a bunch of money and a bunch of penalties. Long story short, we went with her to Social Security and worked through it. She still had a penalty, but they were able to knock it down quite a bit. She was ecstatic. But that's probably the most complex thing we've had.

Answer: So the question is, what are the signs that it's time for me to switch my Medicare plan and how often should I review my options? The answer to that is you should look at it yearly, and your Medicare advisor should look at it yearly. They should be in contact with you at least a couple of times a year. If medications have changed, if you have other chronic illnesses, maybe that's the time to start looking around, because with the Medicare Advantage plans, there are specific plans that are dedicated to helping people with certain chronic illnesses. And the coverage on those plans is really good. Most of them are zero premium each month, and they have a very focused problem-solving approach when it comes to specific chronic illnesses, and it's definitely worth a look.

Answer: So the question is, someone has heard of other people's providers, insurance companies dropping the Medicare Advantage plan. Should you be worried about this? Well, I'm here to tell you I've been doing insurance a long time. This happens with insurance carriers in every segment, whether it's individual plans like the Obamacare marketplace plans or group health plans, all of it. Nothing is for certain with these insurance companies. The good thing is there are some stop gaps in place, so if an insurance company goes out of business or if they stop offering plans, that gives people what's called a special enrollment period to move into another one. If that happens—and it does happen, not all the time, but it does happen—have your Medicare advisor help you with that, and they will move you into a plan, maybe even a better plan, depending on what conditions you have and what works for you.

Answer: So the question is, do you think that Medicare will eventually be privatized completely? Who knows the answer to that? I'm not sure. I honestly think that privatizing most things and getting the government out of it, at least taking 100% control away from the government, might be a good idea. I think it spurs competition, and I think we can get some really good, competent companies and people that could run it. Maybe they could run it more efficiently. Who knows? But just look at the post office, in my opinion. I think if the post office was privatized, we'd have a lot better service and a lot better pricing all the way around. So who knows what's going to happen, but that's my opinion.

Answer: So the question is, if a senior is turning 65 but still working, should they enroll in Medicare or delay it? Well, there are a couple of ways we can go with that. If someone is turning 65 and they're still working and they're on a group health plan at work, and the company they work for has over 20 employees, it becomes a math problem. Meaning, what are they paying for their coverage through work and what would it cost them to go on Medicare and pay for the Medicare coverage?

Part A is going to be free typically for most people because as long as you've worked 10 years full time, your Medicare Part A, the hospital coverage, is free. Part B starts at $185 a month. If you were lucky to make more than about $200,000 a year, two years ago, because there's a two-year look back, if you made over that, you're going to pay more than $185. It's on a sliding scale. So it's kind of a math problem. I've said it a hundred times, find an independent Medicare broker that you trust and go with them. Make sure they only do Medicare because it's a very specialized niche insurance product.

Answer: So the question is, what do I need to do if you didn't take Medicare at 65 and you're now retiring? Well, hopefully you had coverage at your employer once you turned 65, and hopefully it was a company with more than 20 employees. Under 20 employees, you need to take Medicare, no matter if you're on the group health plan or not. But what you need to do is find an independent Medicare broker that only does Medicare, because as most people know, you can't be an expert at everything. You need to pick which way you're going to go and stick with it as far as being an agent. I couldn't do life insurance and all these other different lines of insurance and be an expert in Medicare. There's just not enough hours in the day.

Answer: So the question is that someone picked a PPO for their flexibility, but now every time they go out of network, the bills are outrageous. What's the point of having a PPO? Many times that's the issue. People think they need a PPO when in fact they could get the same, and most times better, coverage with an HMO. Probably nine out of ten people that I spoke or speak to with a PPO are better off in an HMO because their doctors are, in many cases, in the HMO, and the benefits under an HMO are significantly better. The reason for that is when you have a PPO plan, the company has to cover you for out-of-network benefits. That means there's more risk for the insurance company, and because of that, they're going to pull back on benefits for other things. But as far as a PPO goes, when you step out of network many times on a PPO, you're going to have higher out-of-pockets, higher copays most times. It's just not worth it, but everybody's different. It really depends.

Answer: Hi, thanks for watching. The question is, how can you select the right healthcare company and representative to work with? Well, there's only one way to do it in my eyes. You need to find an independent Medicare advisor or broker that only does Medicare. The reason for that is you can't be an expert at everything. You have to kind of pick your lane and get really good at it. As far as the right healthcare provider, that is something you need to talk to your advisor about. There's a lot of companies and a lot of different options and a lot of ways to go. So lean on them for their expertise, make sure they're independent, and make sure they only do Medicare.

Answer: All right, thanks for watching. So the question is about IRMAA and how it affects your Medicare premiums and does it apply to you? Here’s how it goes. IRMAA is an acronym, and I won't bore you with the meaning of it and all that, but basically it's an upcharge by Medicare if you've made a lot of money. The way it works is the standard Medicare Part B premium, which is the medical piece of Part A and B, Part B is the medical insurance piece of Medicare, is your standard price of $164.90 a month. If you make over a certain amount of money this year, it's $106,000 for an individual or $212,000 for a couple filing jointly. If you make over that, then they have what they call an IRMAA charge, which is an upcharge. They're going to charge you more for your Part B than people that make under that amount. What you have to remember is this is a two-year look back. So if you signed up for Part B today, they would look back at your 2023 tax return to assess if there's a... and that’s not a penalty, assess the upcharge. And it's on a sliding scale. There's five different levels. It starts out not too bad. If you make a little bit over $212, I want to say it's another additional $100 a month,

Answer: Hi, thanks for watching. So the question is, someone is worried about the donut hole in their Part D plan and how they manage their medication costs. Well, the donut hole went away as of January 1st, which is a good thing. The max you're going to spend for covered drugs, and that's an important part. They have to be covered drugs, meaning that your prescriptions have to be on the plan's formulary. Otherwise, it doesn't count. But your max out of pocket is $2,000 for this year and going forward.

But a little fun fact, if your Part D plan, whether you have a Medicare Advantage plan with a drug plan or a standalone drug plan, if you don't have a deductible on your Part D plan, you automatically get credit for the $590 deductible that a lot of plans have. So instead of $2,000 being your max, it's $1,410, which is a pretty cool thing. And most agents, even most Medicare agents, don't know that. But yeah, so that's the answer to that.

Answer: Hi, thanks for watching. Okay, so the question is, if you live in California and might be moving to another state, how will that affect your Medicare coverage? First of all, Medicare is a federal program, and it depends on how you have your Medicare now. If you have a Medicare supplement, sometimes known as a Medigap plan, that can be transferred from state to state. You can keep your California-based plan. I'm from California too; I fled there five years ago. Anyway, if you keep your plan, it's portable. They may charge you a different price based on the state that you live in, but it can still be based in California. If you're on a Medicare Advantage plan, you're gonna have to enroll in a Medicare Advantage plan in the state that you live in. But honestly, unless you live in Arizona or Florida or in a place where there's a lot of 65-plus people, a lot of Medicare Advantage plans just don't make sense for people because the networks are just not that great. Here in the Phoenix area, and also a lot of places in Florida, the coverage is great, the network is really good, everything's great. So if you have any questions, give us a comment.

Answer: Alright, thanks for watching. So the question is, what are some ways to ensure your parents feel supported during the Medicare decision-making process? If you've watched my videos, I've said this a million times: find an independent Medicare broker that only does Medicare. And find one that you think you can trust, because Medicare decisions are a big deal. I mean, this is important stuff. It's a big decision in terms of what kind of care you're going to get or not get. It's good to find someone that can advise your parents on this. A lot of people don't know our services are free. If they went directly to the insurance company or if they use their own broker, it's the same price. Our commission is baked into the price of the product, so there's no extra fee in it.

Answer: Hi, thanks for watching. So the question is, what's the difference between a Medicare broker and a Medicare agent? I get that question actually quite a bit. A Medicare broker is someone that typically is an independent agent, meaning they can write policies from different companies like Humana, Aetna, UnitedHealthcare, Devoted, and Sigmund. A Medicare agent is typically one that's tied to one insurance company. And it's really important, I've said this a million times, it's really important to find an independent Medicare broker. More importantly, one that only does Medicare. Because I've been doing this since 2003, and I learned a long time ago, you can't be an expert at everything. You need to pick your lane and stay in it.

Answer: Hi, thanks for watching. So the question is, why is the new $2,000 out-of-pocket max for drugs important? Well, it's pretty important because it used to be $8,000 up until the end of last year. But you have to remember it's a $2,000 limit on the formulary list for drugs. It's not just any drugs; you have to make sure your prescriptions are on the formulary. If they're not, they're not covered, and that $2,000 doesn't mean anything. So it's really important to use an independent broker to make sure that all your meds are in the plan that you select. Just a fun fact: if you have a drug plan, whether it's for a Medicare Advantage plan or what they call a standalone prescription drug plan, if you don't have a deductible on that drug plan, you automatically get credit for $590. So your $2,000 is now like $1,100, something like $1,200, something like that. But it's a lot less. They'll never tell you that, but that's the truth. Thanks for watching.

Answer: Hi, thanks for watching. The question is, do you need extra protection like critical illness insurance if you're on Medicare? Well, you don't need it unless you think that it will be a benefit to you, but I highly recommend what's called a hospital indemnity plan, a medical bridge plan, or an accident plan. What that does is help ensure your co-pays. If you have insurance for hospitalization and you end up going to the hospital, then you're going to be covered because you'll get a cash payment from the company to help pay for your co-pays, and each plan is structured differently.

Answer: Probably the most frustrating misconception Independent Brokers deal with each year with Medicare is that they have to re-enroll into their Medicare plan each year. The reality is that once you are on a plan, whether that is a Medicare Advantage Plan or a MediGap plan, the plan usually renews each Januay 1st unless you want to change.

Answer: It's actually pretty easy.... lean on the expertise of your INDEPENDENT Medicare Adviser, they can break it down pretty easy and show you the differences. Here is a good rule of thumb using generalities: a Medicare Advantage Plan covers EVERYTHING that a Supplement covers (by law) and also includes a lot of extra benefits like dental, vision, etc... The Medicare Supplement and Drug plan associated with it, costs money each month... depending on your age and where you live. The Medicare Advantage Plans usually have no monthly premium and "bundles" the Part D Prescription Drug plan within the medical coverage. Advantage Plans are more of a "pay as you go" model, since all of the services have a copay, where the Medicare Supplement or MediGap plans are a pre-pay model.... costing money each month whether you use Medicare services or not and there are little to no fees when you obtain services.

Answer: If you are retiring next year, over 65 and currently insured with your employer, you will need to coordinate terminating your employer coverage and enrolling in your Part B of Medicare (if you delayed your enrollment when you were first eligible) Once you leave your Group Health Plan from your employer, you have a limited time to ether enroll into a MediGap plan and Prescription Drug plan or a Medicare Advantage Plan. I highly recommend finding an Independent Medicare Adviser that ONLY does Medicare to assist you. Our services are free and vitally important to navigate the confusing Medicare waters.

Answer: The benefit of having a LOCAL broker is that they are (hopefully) experts at the local market and know the nuances of your area. In the Phoenix area, you also want to find an agent that is not a "snowbird".... meaning they leave for the summer to a cooler place. The reason is that your access to that agent will be severely reduced during the summer months when you may need to meet with them or need their help. Also.... you REALLY should hire a Medicare Adviser that ONLY does Medicare, because.... you can't be an expert at everything. There are just not enough hours in the day.

Answer: This is an EXTREMELY rare situation.... but if you can show a legitimate medical emergency situation that made you miss your enrollment, Medicare MAY give you what is called an SEP (Special Enrollment Period) which will allow you to enroll without the late enrollment penalties. They will NOT backdate your enrollment.

Answer: The only situation in which Medicare will pay for services outside of the United States is when you are NEAR the border of the United States; otherwise, you're out of luck. I ALWAYS suggest that my clients purchase a "Travel Medical" plan when they are outside the US. Its relatively cheap and VERY comprehensive

Answer: First of all, before anything else.... find yourself an INDEPENDENT Medicare broker that ONLY does Medicare. The reason is that all of our services are free, no matter what "agent" you use. I always ask people this.... if you had a heart issue, would you see a General Practitioner or a Cardiologist? When you hire an insurance agent (again, our services are free), you are tapping into their expertise. I learned a long time ago that you cannot be an expert at everything; there are just not enough hours in the day. When a broker does many lines of insurance, they cannot be an expert at all of them. Medicare is a very confusing and ever-changing thing. It's a full-time job staying current on all of the nuances and changes. Now, having said that, have your Independent Medicare Adviser HELP you find a Part D plan that covers all of your medications at a reasonable cost. Plan formularies change from one insurance company to another, and it can make a BIG difference which company that you're with.

Answer: When someone asks me this.... I remind them of the famous saying, "you get what you pay for". With Medigap plans, there are many to choose from. The only one that I recommend to people is the Plan G... which replaced Plan F in 2020, as the most comprehensive plan on the market. Other Medigap plans are less expensive, but there's a reason for that. Be VERY careful when a broker suggests Plan N or anything other than Plan G. The best time to purchase a MediGap plan is right when your Part B becomes effective. When you do that, there is no underwriting, and you enjoy the best pricing.

Answer: Well... that depends on your situation and what is important to you. With a Medicare Advantage Plan, you usually have to stay within the plan's provider network, which is centered around the area where you live and usually includes the Part D prescription drug coverage as part of the plan. It's a "bundled" product. With a Part D plan, people usually have a Medicare Supplement plan, or a Medigap plan, to "supplement" the 20% that Part B does not cover. The downside to this is that Medigap plans can be pricey.... not so much when you are 65, but over the years they increase substantially.

Answer: You can call 800 Medicare to confirm benefits, but just so you know, ALL Medicare Advantage Plans MUST have coverage as good, or better than Original Medicare.... by law. Medicare Advantage plans usually have a lot of extra benefits that Original Medicare does not offer

Answer: The short answer is yes. If you want to use Medicare services when you return, you must keep your Medicare Part A and Part B active and paid up. If you don't, there is a chance you will owe substantial penalties when you return AND want to use your Medicare. Just so you know.... the penalties can be several hundred dollars A MONTH, and they are for the rest of your life.

Answer: Thanks for asking!!...Your MediGap or Medicare Supplement SHOULD cover all or most of the cost of your knee replacement surgery. There should not be any copays associated with this procedure, as long as it is considered "medically necessary" and done by physicians that accept Medicare "Assignment". That means they accept what Medicare pays them for specific services and will not bill above and beyond that. A doctor can accept Medicare patients BUT not accept Medicare "assignment", meaning they can charge patients up to 15% above what Medicare pays them. Fortunately for you, Plan G PAYS the extra 15%, called Medicare "excess fees".

Answer: So the question is, how do you educate clients who are completely new to Medicare? Well, the first thing I tell people is that you're gonna get a ton of stuff in the mail six to eight months before you turn 65. Here's what I tell people: put that stuff aside, get a grocery bag, and throw everything in there. If you try to read everything, your head's gonna explode. There's just too much to absorb.

My recommendation, and I've said this a million times to people and I've recorded this too, is to find an independent Medicare agent who only does Medicare. The reason for that is an independent broker has the ability to search all around all the carriers, and they're not linked to one specific carrier. The reason I say to find a broker that only does Medicare is that there are only so many hours in the day. You can't be an expert at everything. I can't do Medicare and do life insurance and group health insurance and Obamacare plans and try to be an expert at all of them. You just can't do it. There's just not enough time, and there are too many nuances to Medicare, and it changes constantly.

So defer to your broker, find someone that you think you can trust, and have them guide you through it. When you break it down, it's really not that complicated. There are some twists and turns, but if you have a broker that knows what they're doing, they can guide you through it, and it's a total breeze, seriously.

Answer: Question: If Medicare Supplement Medigap plans are better for long-term coverage, why don't more people choose them? What I see in my practice here at State Farm on Kelly Street, and I've been doing Medicare planning now for the last decade, is that people don't understand the differences between Medicare Supplement Medigap and Medicare Advantage. Of course, Medicare Advantage gets all the commercials, all the hype, and stuff in your mailbox.

What we do here is explain to our clients both the advantages and disadvantages of both Medicare Supplement and Medicare Advantage. Whatever makes better sense for the client, we help them with that. So, work with someone who can offer you both Medicare Supplement and Medicare Advantage. More importantly, work with someone who's dealt with it for years and knows the good and bad about both plans. We would love to help you. Please, these decisions are way too important to take by chance or wait till the last minute. Let us help you; we'd be glad to.

Answer: So if someone lives in a different city than you, they could have, and probably do have, a much different Medicare plan. Whether that's a Medicare Supplement plan or a Medigap plan, if they have a Medicare Advantage plan, those are specific to that particular area and they're broken down by zip codes. It really depends on what area of the state you live in. If you're in a rural area, the Medicare Advantage plans are going to be less robust. They're not going to have as many benefits as, like, when we're in the Phoenix-Scottsdale area because there are so many 65+ people and there's so much competition. The benefits are just gonna be better versus a rural area where the networks are much smaller.

Answer: Hi. Thanks for watching. So when people talk about the different tiers of Medicare Part D plans, the Part D is the prescription drug piece of Medicare. Every drug has a tier, typically five or six tiers. Tier one is gonna be your preferred generic, which is typically zero dollars. Then it goes to generic and so on. Depending on the medications you take, you're gonna want to strategize, or your broker is gonna want to strategize what Part D plan is the best one for you based on those medications, because not all formularies are the same. You could have one... like, Humana could have one formulary and Aetna could have a different one. It just depends on what's the best fit for the drugs you take currently.

Answer: So if somebody is on their spouse's employer plan at work, they probably have at least Part A if they're a Medicare beneficiary. When you're on someone else's employer plan and you leave that plan, that gives you a special enrollment period to enroll in Part B, which is the medical insurance piece of Medicare. That's pretty much the impact; you would be eligible to enroll in Part B and then either get a supplement or a Medigap plan, or you can enroll in a Medicare Advantage plan. There are a lot of them out there, so it really depends on what your needs are.

Answer: When somebody asks me if they should just go with the cheapest Medicare plan, I always ask them what's important to them because every Medicare plan, every Medicare Advantage plan is gonna be different. It really depends on what kind of extra benefits you want. Do you want low copays for specialists? Is it important to have a big dental allowance? It's really not a one-size-fits-all, so everybody has their own wants and needs, and it's the broker's job to figure out what that is and what the best fit is for them.

Answer: So, Medicare does not cover hearing aids. They don't feel that it's medically necessary; it's more of a convenience, but that's how that is. If you have a Medicare Advantage plan, I can't think of a plan that does not cover hearing aids, but there may be one out there. Most of them do cover it. The coverage is pretty good, actually. Honestly, if you wanted to go to Costco, the prices there are pretty good, and you can get them right over the counter now. So that's usually what I recommend to people.

Answer: Hi, thanks for watching. So, the question is, does IRMAA go away automatically? Unfortunately, it does not. You have to notify Social Security that you've fallen below the threshold two years prior because it’s a two-year look back. So right now, in 2025, your IRMAA is based on your 2023 tax return. If you were lucky enough to make over $106,000 as an individual, or $212,000 as a couple, you fall into the IRMAA. I call it an upcharge; they call it an adjustment, but I don’t even know what they call it. It’s just an upcharge. But yeah, you have to get a hold of Social Security once the new year starts, and if you feel you fell below that threshold two years prior, that’s what you need to do.

Answer: Hi. Thanks for watching. So let's talk about Medigap Plan K, or in most cases, Plan N compared to Plan G. Those are the two plans—N and G—that most people are thinking about. It used to be, prior to 2020, everybody signed up for Plan F. Plan F was the plan to go to. It was really comprehensive; it covered practically everything. After 2020, Plan G is the go-to plan. Plan N covers almost what G does, except for the Part B excess fees, which I'll get to in a minute. Plan K doesn't cover nearly what Plan G covers, and what it does cover, it covers at 50%, so you'd be on the hook for a lot of money if you had some major things going on.

Anyway, the Part B excess fees—I'll use Mayo as an example here in Arizona. They're kind of the largest entity here that uses what I believe to be the excess charges. So, let's pretend you went to Mayo. You had a big medical issue, and the bill was $100,000. Mayo, and any Medicare provider, is allowed—most of them are—to charge you up to 15% over what Medicare allows. With Plan G, Plan G will pay those excess fees. Plan N and definitely Plan K will not pay those fees. So to save $20 or $25 a month and go to a cheaper Medigap plan, it's not a good idea in my opinion. I always advise people not to do that.

Answer: Hi, thanks for watching. So, the Medicare maze and alphabet soup. I've said it a hundred times before in my different blogs, and I've taught this quite a bit: find an independent Medicare broker that you think you can trust. Make sure they know what they're doing and that they only do Medicare. If they also handle life insurance, Obamacare plans, and all these other things, there's no way they can be an expert. You just can't be an expert at everything; there aren't enough hours in the day.

So, that's my advice. You don't have to do this alone. Our services are free, and we get paid the same no matter what you enroll in. It's standardized, and that's a good thing. Shady agents aren't going to try to manipulate you or push you in a certain direction. So, find somebody that you trust who only does Medicare and have them help you.

Answer: So if you just moved from New York to Florida and you have a Medigap plan, you don't need to get another one. Once you have a Medigap plan, it's portable to any state you want to live in. What will probably happen is that once the Medigap plan realizes you live in Florida and not New York, you're going to get a price adjustment. It could be an increase; it could be a decrease, which I doubt it would be. But maybe. Honestly, you might want to look around to see what's available in Florida, and here's why: Florida and Arizona have the largest populations of people over 65. You may want to look at a Medicare Advantage plan in those two states specifically. If it was anywhere else, or pretty much anywhere else, I would not probably recommend that. But we're in Arizona; it's unbelievable. The robust coverage and the amount of competition here is crazy, and it really makes sense for a lot of people, me included. I just turned 65 a year and a half ago, and I'm on a Medicare Advantage plan, and it's great. So anyway, that's the answer: you don't have to change, but you probably will get a price adjustment.

Answer: Hi, thanks for watching. Why do seniors wait till the last minute to enroll? Well, because they're just like everybody else. When something's complicated and confusing, they push it off to the last minute, which happens a lot. So my advice is to find, and I've said this a hundred times in my blogs and different things, find an independent Medicare broker that only does Medicare. Here's why: you can't be an expert at everything. There's no way I would be able to sell different lines of insurance and Medicare and be an expert at all of them. There's just not enough hours in the day. So my point is to find someone that you think you can trust, take their advice, and they will walk you down the path and help you navigate Medicare. It's confusing, there's a lot of loopholes, and a lot of things that can get you in trouble, like missed deadlines and that kind of stuff.

Answer: I heard something about Medicare drug costs being kept at $2,000 in 2025. Is that really happening or just talk?

No, it's a reality and it's a fact. As of January 2025, the maximum out-of-pocket drug costs for any Medicare individual will be $2,000. This is huge, folks, because up until this year, I've had clients that have spent $4,000, $5,000, or even $6,000 out of pocket for drugs, especially cancer drugs or heart medications. It used to be called the donut hole because you didn't know what you were gonna end up paying.

But great news for 2025: it is being capped at $2,000 out of pocket. Please do yourself a favor and work with someone like me here at State Farm on Kelly Street in Manchester. I work with Medicare, Medicare Advantage, Medicare Supplement, Medicare Part D prescription drugs—the whole Medicare alphabet soup, if you will. I work with it every day and I would be glad to help you with it so you can make the right decisions. Great decisions come from good information, and we're here to help. Thank you.

Answer: So mental health services like therapy are fully covered under original Medicare in the Part B section. If you were to go into the hospital as an inpatient, that's covered under Part A of Medicare.

Answer: Hi, thanks for watching. So, if you're on an employer health plan, as long as you have what's called credible coverage, then you don't have to enroll in Medicare until you leave that group plan. But I always advise people to sign up at least for Part A, which is the hospital coverage, because if you work 10 years and you've paid into Social Security, then the Part A premium is free. That's the hospital piece of Medicare. When you leave your group plan, this is kind of a weird thing: you have up to eight months. Why anybody would want to wait eight months, I don't know, but you have up to eight months to sign up for Part B of Medicare. You only have two months to sign up for Part D, the prescription drug plan, when you leave your group plan. Why there's a discrepancy of six months, I have no idea, but that's how it is. So I always tell people, if you know when you're gonna retire, plan early and sign up so it coincides exactly.

Answer: So you exercise regularly and maintain a healthy lifestyle. That's definitely important when it comes to Medicare or just your health in general. What happens is a lot of Medicare Advantage plans have incentives or additional benefits for people that maintain a healthy lifestyle. Using a Fitbit watch, setting and maintaining goals for keeping a healthy weight, doing steps every day, stuff like that, all of that can be, and many times is, incentivized by the Medicare Advantage plans. It really depends on the plan, the carrier, and what they offer.

Answer: I expect Medicare Advantage to evolve in the future in a way that they will have more coverage for wellness, more coverage for prevention, and probably more coverage in the dental area. Lots of studies have shown that when your gums and teeth are taken care of, it really affects your overall health. Also, over half of the population is covered by a Medicare Advantage plan, and that's been growing over the years. So, I anticipate a lot of changes where the coverage is going to get better and a lot of the extra benefits are going to improve.

Answer: My advice to people is to put all of it aside. If you try and read all of it your head will explode. Find an Independent Medicare Broker and use them as your Adviser, their services are free and if you choose one that only does Medicare, you'll be getting an expert

Answer: About the only reason I would not choose a Medicare Advantage Plan is if I traveled constantly and wanted to see Medicare providers out of my resident state. Other than that, I would absolutely choose an Advantage plan

Answer: Probably the biggest perceived disadvantage to Medicare Advantage Plans is that you have to stay within the network of the insurance company that you have. In reality, if you live in the Phoenix area, or Florida, the networks are VERY robust and easy to navigate.

Answer: When your Independent Broker strategized your new Part D plan, that should have been part of the discussion. Oh... you didn't use an Independent Broker... that may be part of the problem

Answer: Yes, typically most Advantage plans cover Home Health care. Some are more comprehensive than others, but the benefit exists with most of the Medicare carriers

Answer: With 68 million people using Medicare, I highly doubt that it will run out of money. They've been saying that about Medicare and Social Security since I was a kid in the 1960's

Answer: Probably the most underrated benefit of Medicare is the Annual Wellness Visit which can also include "end-of-life" care planning and assistance in completing the Advanced Directive

Answer: If you are healthy, enrolling into a Medicare Advantage plan would be the most cost effective, since most plans are premium free. They would pay copays when they use services

Answer: You would have to get a POA, Power of Attorney either with the parent giving consent, or by going through the court system and obtaining a Conservatorship or Guardianship. Its probably best to consult an Elder Law attorney

Answer: Medicare, or Medicare Advantage plans will cover "medically necessary" physical therapy. With Orginal Medicare, its covered under the Part B, and then you either have the remaining 20% covered with a MediGap plan or you'd pay a copay with your Medicare Advantage plan

Answer: Plans, depending on exactly what plan you're talking about, are priced based on your zip code, your age, your sex, and then discounted based on your income level.

Answer: If you fall into certain income brackets, you would be eligible for what they call Extra Help. It would either pay part, or all of your medications, copays and other charges. You would check with Social Security to see if you qualify.

Answer: All of the vaccinations that the CDC recommends are no cost to Medicare beneficiaries. That includes vaccinations for Shingles, Whooping cough, Tetanus, etc.

Answer: Your Medicare plan will only work NEAR the US border, and only in some circumstances. I always advise people that are traveling outside of the US to purchase a Travel Medical plan. They are fairly inexpensive and very robust in their coverage. They don't cover travel to some countries where there is unrest.

Answer: There is definitely more utilization with all of the people turning 65. They say that each day, 10,000 people turn 65 in the United States. Hopefully focusing on addressing all of the fraud will also help revitalize the system

Answer: That is one of the benefits of having a Medicare Advantage Plan. Most Advantage plans have hearing aid coverage or provide substantial discounts on them at their network providers. With the new Medicare laws, people can purchase hearing aids "over the counter" and don't need a doctor's approval. Honestly.... Costco has some pretty good deals with them too!

Answer: Since Medicare is not a "one size fits all", you should listen to your Independent Medicare Broker. We are trained and hopefully knowledgable about the industry and products in your area. In my opinion, you MUST find someone that only does Medicare, since you can't be an expert at everything.

Answer: Whenever you get married should have no bearing on when or how you enroll into Medicare. Medicare is based on your individual situation and not typically about your spouse

Answer: Medicare is a highly regulated industry, but yes, they do allow the companies to advertise on TV and radio. Once again... if you have an Independent Broker, it doesn't matter what they advertise, your broker will advise you on what would be the best plan for you

Answer: Yes, Medicare Advantage saves you money, but you will still pay copays when you use services. The copays and out of pocket costs vary greatly depending on the plan. With a MediGap plan, you pay quite a bit up front for services you MAY use. The Medicare Advantage model is more of a "pay as you go"

Answer: The most overhyped benefit is the "money back" plans that many Medicare Advantage Plans offer. Don't get me wrong, they are a good product IF you are aware of the other benefits that are not nearly as robust as the non "money back" plans. There are some insurance products to pair with "money back on your Part B plans" that most brokers are not aware of.

Answer: If you had a broker that was good, they would have explained all of this to you. Once again, its important to not only find an Independent Agent, but one that ONLY does Medicare. You can't be an expert at everything and if the agent does multiple lines of insurance, they cannot be an expert at Medicare, there's just not enough hours in the day to stay current.

Answer: Something does not sound right... insulin costs are capped at $35 each month. I would check with your broker if you were being charged more than that.

Answer: Enrolling in a Medicare Advantage plan offers incentives because Medicare is big business. Remember, all Advantage plans must provide the same coverage that Original Medicare covers and usually have many "extra" benefits. It's just a different model for administering Medicare.

Answer: IRMAA is an acronym for Income Related Monthly Adjustment Amount. It sounds like you were lucky enough to make more money than most people, two years ago. the Part B and Part D premiums are based on a "lookback" of your tax returns of 2 years ago... if you made over $212,000 as a couple of $106,000 as an individual, you will be hit with the IRMAA upcharge for that particular calendar year. The next year, its recalculated and adjusted to whatever 2 years ago tax returns show.

Answer: Usually the biggest mistake people make when choosing a Part D Drug plan is they go for the cheapest alternative. Many Part D plans are very inexpensive, but if you look closely, the Prescription Drug list, or formulary, that they cover may be lacking or thin in some areas.

Answer: Ambulance rides and other types of services are covered under the Part B of Medicare. If you got a bill for an ambulance ride, that is most likely the copay for the plan that you've enrolled into. If you had a MediGap plan, you may not pay anything, but remember, there is a monthly premium (pretty high sometimes) with MediGap plans, based on your age and zip code.

Answer: There is a GREAT risk if you don't have what they call secondary coverage like a MediGap plan. Medicare covers 100% of the Part A (Hospital) coverage, but with Part B (physician services) it only covers about 80%, the other 20% is what you risk if you don't have a MediGap plan. Also... there is NO LIMIT to the amount of money you are responsible for with that 20%.

Answer: Again, if a physician deems the procedure medically necessary, Medicare will cover robotic knee surgery. You may still be responsible for some out of pocket costs depending on your coverage.

Answer: If someone is considered home bound and requires skilled care, AND is certified by a physician, Medicare will pay for some of the costs of Home Health Care. Medicare Advantage plans also have coverage for Home Health Care and differs from carrier to carrier.

Answer: Medicare covers cataract surgery like most other types of medically necessary procedures. It does not matter if you're on Original Medicare with a Supplement or a Medicare Advantage plans... they cover it the same, in terms of the procedure. IF you wanted to do the Lasik surgery while they are fixing the cataracts, it would be an additional charge, since Lasik is not considered medically necessary

Answer: Medicare covers people in Puerto Rico just like it would in the other 50 states, there is no difference, which makes some Americans relocate to places like Puerto Rico when they retire for a lower cost of living.

Answer: If you live in a rural area,. or an area that does not have a good Medicare Advantage plan "network", people can be disappointed in the amount of providers available to them. Sometimes people have been denied services from Advantage plans because the plan deemed the service not to be medically necessary.

Answer: That is more of a question for a tax expert... but I do know that IF you have an HSA that you've been building up for a long time, you can use those funds for any Medicare premiums, as well as Medicare services, on a tax free basis.

Answer: Most times, Ozempic and other medications are only covered if the member's Medicare plan has them in its formulary list or if they are deemed medically necessary. If someone just wants to lose weight, Ozempic is probably not going to be a covered service.

Answer: You can first tell him that nothing is free. Your Medicare Advantage plan may not have a monthly premium, but instead you'll have copays for services that you need, its kind of a pay as you go model. The MediGap plans are designed so that you pay a monthly premium up front, whether you use services or not, and then when you DO use services they are very low cost or free.

Answer: The "premiums" are what people pay each month, no matter if you use the Medicare plan or not. That is the cost of having the plan. Some plans have a "deductible" which means that when you receive covered services, you will pay towards the deductible first, before you realize any "benefit" on the plan. The copays are pre determined costs that you'll pay for certain services, based on your plan.

Answer: It depends on if your cholesterol medication is part of your Part D Prescription Drug plan formulary list. The formulary list is the list of drugs that the insurance company has agreed to make, part of their offering to the members that enroll on their plan. If the cholesterol medication is not part of the formulary, you will not have coverage and it will not count towards your yearly total spending of the $2000 limit.

Answer: You can change your MediGap plan at any time, but you will most likely have to go through underwriting. That means that depending on how you answer health questions, the carrier can deny you coverage.

Answer: Most Medicare Advantage plans do not have a monthly premium, but DO have copays for Medicare services. I tell people that Original Medicare is more of a "pre-pay" system, where Advantage plans are a "pay as you go" model.

Answer: This is another example of having a competent broker that ONLY does Medicare and is INDEPENDENT. Your broker should have explained the rules and deadlines to you so you would not miss your opportunity. The reason Medicare recipients should have a broker that only does Medicare is simple.... you can't be an expert at everything; there just aren't enough hours in the day.

Answer: That really depends on what type of "plan" you have. If you have a Medicare Supplement Plan or MediGap plan, you can change it any time of the year, but you must go through an underwriting process most times. If you have a Medicare Advantage Plan, you have two separate Open Enrollment times, October 15th thru December 7th is the Annual Enrollment Period, and then you have the actual Open Enrollment Period from January 1st thru March 31st. Both of these times you can change your Advantage Plan.

Answer: The best number we've found to reach Medicare is simply, 1-800 MEDICARE. I've helped many of our clients get through to Medicare and have been surprisingly impressed with the people that answer the phone. Once in a while you'll get someone that obviously needs to change jobs, but overall, they've been pretty good.

Answer: The biggest red flag when you're interviewing agents is to ask them what other types of insurance do they provide. If they tell you that they can do multiple types of insurance, you're not dealing with a specialist. Secondly, you have to make sure that they are an INDEPENDENT agent... meaning they are contracted with many insurance companies and not tied to one or two. You want a SPECIALIST, not a GENERALIST

Answer: There are different ways to appeal a decision based on what type of Medicare coverage you have, whether that's Original Medicare, or a Medicare Advantage Plan. If you have a good Independent Broker, they should help you appeal any decision that you don't agree with.

Answer: Special Needs Plans for Medicare usually serve people with Heart, Liver, or Kidney issues and, in some areas of the country, lung issues. Certain Medicare Advantage Plans are designed to specifically address those medical issues with a more focused problem-solving approach.

Answer: Hi, thanks for watching. So the question is, can Medicare pay for your groceries? Specific Medicare Advantage plans have a benefit if you fall into a certain category, if you have a specific illness where you can receive a monthly or quarterly allowance for groceries. You can pay for gas. They'll help you with rent, utilities, even pet services, and a lot of them. But you have to have a specific chronic illness. There's about 15 of them. And if you qualify, the benefits are actually really good. Some of the benefits pay you $250 a month to pay for these certain things, but you have to qualify for it. And it's got to be with a Medicare Advantage plan. With original Medicare, they don't offer that. It's only on the Advantage plans.

Answer: Medicare and Life Insurance are two completely different types of insurance. Depending on the type, life insurance is usually a fixed-benefit type of product, meaning if you die, you will receive the amount of insurance you set up with your policy. Medicare is more like traditional Health Insurance and covers people for illnesses and injuries. A certain type of Life Insurance can cover people that are looking for Long Term Care, where when a person meets certain requirements, it triggers a daily or monthly payout of a certain amount.

Answer: If someone has Original Medicare without any secondary insurance, they will be responsible for 20% of any covered services under Medicare. Also important to note is that there is NO limit to the amount of money you're responsible for, if you don't have secondary insurance. A "guess" of how much it would cost you for an ambulance ride with just Original Medicare, would be in the range of about $400-$600, roughly speaking

Answer: Moving to a new state only affects your enrollment in your "secondary insurance" as it pertains to Medicare. The Part A and Part B of Medicare is done on a Federal level, so the enrollment periods are the same no matter what state you live in. If you were enrolling in a Medicare Supplement Plan or Medicare Advantage Plan, moving to a new state opens a window of enrollment for you, called an SEP, Special Enrollment Period.

Answer: Medicare does not have free annual physical exams but DOES have a yearly wellness visit. It's possible that your friend has a Medicare Advantage Plan and most of those have a $0 copay for visits to your primary care physician.

Answer: Private insurers will play a major role if Medicare expands its preventative care coverage, like offering many more "extra services" and benefits all centered around prevention. Currently almost all Medicare Advantage Plans and private insurers have some type of dental coverage, whether that be preventative checkups and maintenance to a more robust offering of basic and major services like fillings, crowns, deep cleanings, etc.

Answer: The Medicare Savings Program or MSP, is a program that helps lower-income seniors with help paying for things like Part A and Part B premiums, copays, co-insurance and other out of pocket costs. There are many "levels" of help that people can get, all based on your income level.

Answer: That's an interesting question. I just had this come up recently. With typical DME, Durable Medicare Equipment, like wheelchairs, hospital beds, etc., is usually covered under Medicare Part B. Stair lifts, in particular, would fall under Part A coverage and are generally not covered under Medicare. There is an actual exclusion for that type of Home Modification need.

Answer: If they're done right, they can be both informative and also gives the broker a chance to show the audience that they would be the right choice for people to work with. "Its all in the delivery" as they say, so choose your broker wisely.

Answer: If you are under 65, and your disability has been ongoing for at least 24 months, you should qualify for Medicare under those circumstances. Workers Comp plays a part in that, but your Medicare may be available to you if you are deemed "permanently disabled".

Answer: The absolute earliest you can discuss Medicare options with your Independent Medicare Broker would be October 1st. The newest plans and options are released to brokers in September and the earliest they can discuss them is in October.

Answer: Yes... but that is the cornerstone of the Medicare Advantage programs. They take a proactive approach to healthcare and are incentivized by the Federal Government to do so.

Answer: I would absolutely do the yearly wellness exam to start with. Medicare Advantage plans offer "incentives" for people who are willing to be proactive with preventative services, join gyms, etc.

Answer: There are various levels of "Extra Help" that you can explore with Social Security. Its based on your Modified Adjusted Gross Income (MAGI) and they determine what level of extra help you qualify for.

Answer: You can get denied for a MediGap plan if you did not enroll in that plan when you were first eligible, at that time, it would have been given to you without underwriting. After a certain time, if you want to change plans, or try to enroll into one for the first time, they can deny you coverage.

Answer: Its a great thing.... you're out of pocket limit has been reduced greatly. Its a complicated formula, but generally, you will not have to pay more than $2000 for "covered" or formulary prescription drugs in a calendar year. The formula takes into account, what YOU'VE paid for your prescription and what the drug manufactures drug costs are. The trick is making sure that you have a Prescription Drug Plan that covers your prescriptions.... with all of the changes, many plan have revamped their formulary offerings or moved drugs into different "tiers" to save money.

Answer: Concierge medicine is usually not affiliated with or accepts any type of insurance coverage. I've heard that Concierge doctors' offices often bill Medicare for some of the services performed by their doctors, but I would not count on that to be the case 100% of the time.

Answer: When you leave your Employer coverage, you usually have a "Guarantee Issue" scenario called a Special Enrollment period where your health issues are not a factor. But... you have only 60 days to obtain that Medigap coverage when you lose your employer health insurance. By the way, you have up to 8 months to enroll into Part B when you lose your employer coverage if you have not already enrolled.

Answer: If someone travels extensively throughout the year, it usually makes the most sense for them to be in a MediGap plan, or sometimes called a Medicare Supplement plan. With a MediGap plan, the person can see any doctor in the United States, as long as they accept Medicare patients. With International travel I ALWAYS recommend a "travel medical" policy.

Answer: Medicare Advantage Plans are incentivized to not only give good service to their enrollees but also to proactively strategize people's healthcare. When one of their enrollees ends up in the hospital or has a chronic illness that is not treated properly, the Advantage plan is penalized, meaning it affects their star rating on that plan. The better the star ratings for a plan are, the more money they get from the federal government.

Answer: Well, hopefully you have an Independent Medicare Broker that does that for you... at no charge by the way. It's not easy to stay up with all of the nuances of Medicare and all of the plan options... that's why I HIGHLY recommend finding a broker that ONLY does Medicare.

Answer: Typically, the "outpatient surgeries" are covered under Part B of Medicare. There may be some situations where you are actually in the hospital and go home that same day, which may be covered under Part A of Medicare

Answer: Nice question.... OK, if you're talking about a Medicare Advantage Plan and the "Open Enrollment" you're speaking of is the Annual Enrollment Period between October 15th and December 7th, then yes, you have what is actually called the "Open Enrollment Period" at the first of the year, between January 1st and the end of March. Between that time, if you want to change your Medicare Advantage Plan you can do that, but only once, during that time.

Answer: Your 30 years of work with the Federal Government should not affect your Medicare when you reach the age of 65. Every situation is different, but you may have different options after you've enrolled into your Part A and B since you've been with the Federal Government.

Answer: Green card holders have to have lived in the US for at least 5 continuous years and either qualify for a disability or reach the age of 65. They also may have to pay a premium for their Part A hospitalization coverage if they have not worked enough quarters and paid into the Social Security system

Answer: Expanding the Medicare program to younger Americans COULD be a good thing, but like most things, the devil is in the details. That's really a political hot potato issue... there are a few scenarios introduced where it may make some sense.

Answer: Annual Wellness Vists or AWV should be free to anyone with Part B of Medicare. It doesn't matter if you have a PPO or an HMO Medicare Advantage Plan.

Answer: With employer plans, if you are still working and want to stay on the Employer Health Insurance plan, and you have more than 20 employees at the job, you can delay your Part B enrollment until you leave the employer. With VA-type benefits, it's a little trickier. The VA covers some people, and others have Tri-Care for life. With both you have to enroll into Part A and B of Medicare, but its a longer conversation with the coverage beyond that.

Answer: It really depends on who's running the show! The Medicare seminars, if they are "Educational", should be done without using any sales tactics. Agents can pass out their business cards and ask if they can call attendees, but other than that, they should be ONLY educational. This can be a shady industry.... you have to choose your Independent Agent wisely!

Answer: They are two separate things entirely. You can enroll into Medicare at age 65 or delay it if you are still working and insured by an employer plan, IF your company has more than 20 full time employees. It will not affect your Social Security draw later in life.

Answer: Anyone legally in the United States can enroll into Medicare if they are at least 65 years old or if they have been deemed disabled for the last 24 months by a physician. Someone that has worked overseas and not paid into the system may have to pay a premium for Part A (Hospital coverage) of Medicare, that people who have paid into the system get it premium free.

Answer: Every Part D Prescription Drug Plan, whether its a stand alone plan, or attached to a Medicare Advantage Plan has a list of Formulary Drugs.... the prescription drugs they're willing to cover on your plan. You enter the Catastrophic Coverage phase once you've reached the $2000 limit, a formula between what YOU'VE paid on prescriptions and the cost of those prescriptions from the drug company. All your FORMULARY drugs are covered at no charge for the rest of the calendar year.

Answer: There should be no copay for preventative services with Medicare, or with any health plan for that matter. That was addressed with the beginning of the Affordable Care Act, or in slang terms ObamaCare.

Answer: Yes, if you fall into one of the SEP's, the Special Enrollment Periods. If you change your residence to outside of the service area, you move from another state, you lose coverage through no fault of your own, you leave your Employer Group Health insurance plan are a few examples.

Answer: You have the right to an appeal and to request the reasoning behind the denial. I would have my agent discuss with the carrier the reason for the denial and possible alternatives.

Answer: In easy-to-understand terms, you are only responsible for up to $2000 in Prescription Drug costs on formulary medications. In previous years, you were responsible for part of the Prescription Drug costs up to $5030, and then the Donut Hole, or Coverage Gap, began. Then a formula ensued where between what you paid and the Prescription costs reached $8000, you would enter the Catastrophic phase and you portion was finished for the calendar year.

Answer: There is never an "always" answer... but in most cases vaccines are covered at 100% now with most plans. Again, if you have an agent, they should be able to answer that question for you

Answer: Yes, it is. As they say... the devil is in the detail. When a Medicare Advantage Plan offers "dental" coverage, it can mean a lot of things. Is it "first dollar dental", meaning that you have a pot of money to draw from, usually without having to pay anything first. Is there a "network" associated with the dental coverage offered. Is it an HMO dental plan or PPO? If you have a good Independent Broker, they know things like this.

Answer: There is never a "one size fits all" approach to picking a Medicare Advantage Plan. If you have high copays, you most likely have other benefits to that plan that maybe other plans do not have. The best part, is that you can switch your plan once, and sometimes twice, a year!

Answer: I like to stick to my own lane...I always send people, and even accompany my clients many times, to the Dept of Social Security here in Phoenix. The people I've worked with there are super knowledgeable and helpful. I would not want to inform you about something like that if I was not 100% comfortable with it.

Answer: Your Independent Medicare agent that solely does Medicare should be able to strategize plans for you that cover your particular medication with the best coverage. Every carrier has their own "Formulary", which can differ greatly. If you have an expensive medication, you may have to spend a little more money each month to have it covered under a specific Part D plan.

Answer: Well... with a Medicare Advantage PPO plan, you have a little bit of flexibility with going to a provider OUT of the HMO network, however, if you compare the PPO benefits to the HMO benefits on Medicare Advantage Plans, you'll see that for a little bit of out of network coverage, your in-network benefits suffer.... and you'll get a lot less "extra benefits" like Dental, Vision, Over the Counter, etc...

Answer: Well... I would only recommend working with an INDEPENDENT Medicare agent, and one that you think you can trust. Our services are free, and I highly recommend you find an Independent broker that ONLY does Medicare.... Medicare has a lot of nuances, and I've learned over the years, you can't be an "expert" at everything!