Mike Odle, Medicare Insurance Broker

Answer: Medications that have to be picked up a pharmacy and are self-administered are almost always charged to your part D coverage. If a doctor has to administer the medication, these are almost always charged to your Medicare Part B coverage

Answer: Find a local agent that represents multiple carriers. Make sure they will meet with you face to face.

Answer: All Medicare prescription drugs cover offer different coverage and different drugs on their formulary. Go to Medicare.gov or call and give them all your medications. It will help you identify the plans that cover the drugs you need.

Answer: You absolutely need to take action. Medicare plans will vary greatly by state and by availability. You may have moved to an area with options and carriers not available where you came from. Just because a carrier has a strong offering in the state you moved from, doesn't mean they will have a strong offering in the state you moved to. DO NOT call your current insurance carrier. You will only get their version of the best parts of what's available in your new area, while at the same time they may be trying to put lipstick on a pig. Find a LOCAL INDEPENDENT broker that represents multiple carriers to explain the products available to you.

Answer: Medicare does not cover end of life care. End of life care is where the focus is on comfort and quality of life rather than curing the illness. Medicare will cover 100 days in a nursing home or skilled nursing facility as long as a persons condition continues to improve. If improvement is not possible, such as with Alzheimer's or dementia, the care will the responsibility of the patient.

Answer: There are very strict rules around what can be discussed at a seminar. It really just depends on how the even is marketed. If it's advertised as an educational event, the presenter is not allowed to talk about specific plans. If its going to be a sales event, there will be an insurance carrier involved with the event listing. Don't confuse this with an insurance agency that may be doing an educational event.

Answer: It depends on what your situation is. For most people, the premiums they pay for a medigap plan will never equal out to the out of pocket that they would have on a Medicare Advantage plan. In my area in particular, once someone hits their mid-70s their annual premiums on a medigap plan will exceed the maximum out of pocket on an Advantage plan. Everyone's situation is different, but generally speaking most people waste money on medigaps

Answer: It depends which direction his income is going. Individuals making more than 109,000, $218,000 for married couples, will typically see an increase in their part B and D premiums. Individuals with incomes below $19,000 a year, $26,000 for couples, would be eligible to apply for a reduction in their part b Medicare premiums. All income points in between will pay the standard rate

Answer: Please share any marketing piece that says Medicare Advantage is "free". Don't mistake $0 premium for "free". Medicare Advantage is being paid by Medicare to take care of Medicare beneficiaries. If you are currently paying a part b premium you will continue to have to pay a part b premium in order to have Medicare Advantage. If you continue to work you will continue to have Medicare tax taken out of your paycheck to go to the cost of part A.

Answer: If you ask a doctor I don't think you'll ever get a straight answer, but the reality is that in a lot of cases with Medicare Advantage they get reimbursed 90% of what they would get reimbursed from original Medicare. The good thing for a doctor is that original Medicare offers a lot more flexibility on treatments, and the bad thing about Medicare is that it offers a doctor a lot more flexibility on treatments. While Medicare Advantage covers the same services as original medicare, the Medicare Advantage plan likely has more protocols in place to cut down on waste and fraud than does original Medicare, such as prior authorization and referrals. Original Medicare doesn't have these restrictions, but is also one of the main reasons why it's projected to be insolvent by the year 2033. Despite the restrictions and pre-authorization, some studies do show that people on Medicare Advantage can have an adjusted life expectancy 9 to 15% longer than people on original Medicare because of the coordination of care involved with a Medicare Advantage plan.

Answer: If the psychiatrist requires a visit to write the script (they normally do because they like to get paid) this will be treated as one visit and the therapist will be treated as a separate visit. In some instances the therapist works for the psychiatrist and a separate visit to the psychiatrist may not be required.

Answer: No. When you sign up for Part B you will have to prove that you were insured through your husbands plan.

Answer: Its important to understand first that Medicare Advantage plans are Medicare plans. They are approved by Medicare every year, and in doing so, Medicare is saying this plan is as good as Original Medicare. A person will have the same coverages, rights, and protections as Original Medicare.

The first thing I check is doctors and prescriptions. Assuming all doctors that are important are in network for an advantage plan, I compare the difference in individual prescription costs. A great deal of the time, prescription out of pocket is less on an advantage plan due to deductibles and copay structure. Then I compare premiums of a Medigap with a prescription plan vs Potential out of pocket with copay's on an advantage plan. If someone knows that they will require a great deal of medical attention over the next year, such as currently undergoing cancer treatment or having already scheduled a joint surgery such as a spinal or other joint replacement, a medigap is almost certainly going to be the way to go. If known medical attention over the next year is relegated to a couple of doctor visits and some tests, then it's time to take hard look at if paying those premiums over the course of the year, which in my area could be $2400, is going to be a better use of funds than paying copays on a Medicare Advantage plan with a max out of pocket of $2500 for the year. That is not to say if in the future if someone would require the aforementioned treatments that they made a bad decision by going with an advantage plan. Under those scenarios there's a good chance someone would have paid in more in premiums to a Medigap policy than they ever would have had out of pocket on an advantage plan. Simply put, lets make the best decision based on what we know to be true at the time we enroll.

Answer: Possibly. If you have been diagnosed with diabetes, heart or circulatory condition, or kidney failure, there are special Medicare Advantage plans that we come available that are geared specifically to take care of these conditions. You can enroll in them at any time throughout the year. Going into or coming out of a skilled nursing facility will trigger a special enrollment into Medicare Advantage plans as well.

Answer: Make an appointment with an agent that represents several different advantage carriers, and will meet with you face to face. They should be able to plug all providers into their quoting system and show you what plans her doctors take. Make sure they show you. Do not do this over the phone

Answer: Basically all you have to do is ask your group health insurance administrator if Part B is required for you to maintain your group health insurance. If not then you don't need Part B. With that said, you have to weigh all your options such as what the group health insurance plan is costing you and what the coverage is. It's quite possible it may be more beneficial for you to not have the group coverage at all and just use your Medicare.

Answer: Make sure you find out the "why" behind their reasoning for a certain product or carrier, and gauge how it lines up with what you told them your needs are. They should be making a file of your doctors and prescriptions, making note of any upcoming tests or surgeries. Ask to see multiple plans from the same agent and have them show you the actual differences. Extra credence goes to anyone that will come to you and go over things with you face to face.

Answer: 1. Long-term care, such as end of life care in a nursing home

2. Routine Dental Care

3. Routine Vistion Care

4. Hearing Aids and Exams

5. Prescription Drugs

6. Cosmetic Surgeries done for appearance

Also, routine foot care, incontinence supplies, acupuncture, most care outside the United States to name a few more

Answer: Sounds like your friends have a Medicare Advantage plan. They have looked at the potential copay's and out of pocket and have decided that keeping that premium in their pocket each month is better for their situation. Medicare Advantage plans vary by ZIP code, but a large majority of ZIPS have at least one Advantage plan with $0 premiums.

Answer: I don't know that I fully understand by "review". The therapy provider will have to document continued improvement from whatever therapy it is that you're receiving in order for it to continue to be covered, whether that's on an outpatient basis, or in a rehab facility. This is what's proving to the payer that what you're receiving is continuing to be medically necessary. If the provider fails to demonstrate to the payer that you're continuing to make improvement, the coverage will stop.

Answer: I think that really depends on who you are a person. I think the most benefit would come from meeting with an agent that works with several carriers so that you can information specific to your exact needs. I would tend to stay away from events where a specific Insurance company is there to talk about their product exclusively. You will most likely get a slanted presentation where all the good points of the plan are highlighted and none of the negative. Seminars on general product knowledge, such as one that talks about Medicare Advantage without going into the specific benefits of a specific insurance company, can be helpful in debunking what your friends may be saying, or what you're getting out of a YouTube video.

Answer: You will not be penalized for enrolling in Part B late as long as you have maintained major medical coverage through an employer. With that said, be sure you explore all of your coverage options before deciding that your wife's employer coverage is still the best option. Part B coverage will cost you approximately $205 in 2026. Depending on your area, you may be able to enroll in a $0 premium advantage plan with lower copays and lower max-out-of-pocket than what is currently being offered by your wife's employer. Find out what it's costing you to be on your wife's insurance plan, what your medical deductible is and, most importantly, what your maximum out-of-pocket is . It very well could be $1,000's more.

Answer: First you have to find out why the specialist was denied by contacting the insurance company. This could be any number of reasons not related to the insurance the company such as the primary not writing the referral or writing it incorrectly. If you are on an HMO and you are trying to see a specialist that it outside of your medical group, its possible that this type of referral will need extra documentation to prove that the current medical group you're assigned to doesn't have a specialist that will meet your needs.

Answer: Nothing elaborate. A medical professional will pop in periodically for a few minutes to check vitals and monitor medications.

Answer: Yes they can. However, every prescription drug plan is required to cover at least two drugs in every drug class. They may not cover the exact name brand drug that you take but they will cover at least two other drugs with different names that will do, in their, opinion the same thing. This is common with insulins. If your medical provider is convinced that a particular brand of drug is the only one that will work for you, they can file an appeal with the insurance company to have the drug covered and most likely it will be approved. The doctor does have to demonstrate that you have tried other prescriptions and the results have not been the same

Answer: Star ratings are a way for Medicare to grade each Medicare plan. There are several metrics that Medicare uses such as customer service, how well the plan helps members with preventive care, how well the plan manages chronic conditions, and overall member satisfaction. Is one affect the level of care that you receive from a provider but it may affect your overall experience with the plan. This is one thing that you can use when considering a Medicare plan but it is not the only thing that you should use. Just because a plan has a higher star rating doesn't mean that it will cover your particular medications the best or even offer you the lowest co-pays on services that you may use the most often.

Answer: The insurance company will pay a commission to the agent that's enrolling you in the plan. Unfortunately this can influence which plan a broker will choose for you, especially in the Medicare supplement market where commission percentage is paid on premium collected. The higher the premium, the higher the commission earned.

The Medicare Advantage market is a little less egregious as just a flat fee is paid to the broker every month, but the fees paid due still vary by carrier.

As a bit of self-promotion, my company actually caps and levels out my compensation to be the same across all carriers so as to take this bias away

Answer: She can do everything but sign an application for you. She will need a power of attorney to be able to do that

Answer: There's no cut and dry answer here. There's many things to consider such as health of the beneficiary, possible usage, doctors and hospitals, budget of the beneficiary, etc.

Answer: Meet with an agent face to face that represents several carriers. Make sure they're willing to come to you. They will need your permission to discuss current doctors, hospitals, prescription, medical conditions past or present, and any future planned medical events. You don't have to give them this information, but its going to make their job much easier. Each carrier treats this information differently in the way of coverage and/or underwriting. Even Medicare advantage plans that have no underwriting still have different copay structures and cover things differently among themselves. If they go right to plan presentation without asking for this information, find a new agent. Make sure they show you a few different plan options and the differences within each option. If they are only willing to show one carrier, find a new agent. Above all, do NOT do this over the phone.

Answer: The inflation reduction act closed out the coverage gap, also known as the donut hole, on prescription drug coverage. For 2026 the max out of pocket for a senior on prescription drugs is $2,100. To counter this, most prescription drug plans have moved to a $615 deductible on on prescriptions, although generic drugs are still exempt from this deductible on several plans. Also, A large number of plans are moving to a percentage paid on name brand drugs instead of a copay. For example, a plan now may pay 75% for a tier 3 drug. If the drug retails for $500, that would leave the Medicare beneficiary with an out-of-pocket of $125 on that drug.

There are still a handful of Medicare Advantage plans that do not have a deductible on name brand prescriptions, and are still offering a copay on those name brands. This could lead to a significant savings in prescription out of pocket over a standalone Medicare prescription drug plan, or another Medicare Advantage plan that has decided to add a deductible to its prescription coverage for name brand drugs.

Answer: Any plan offering a gift card for simply enrolling is breaking the law and should be reported. Some companies offer a spendables card that can be used for food, utilities, rent, transportation, among other things. The benefit is only available to people with certain chronic health conditions, or economic needs. Most plans will offer some sort of an over-the-counter benefit for use at the pharmacy, but only for certain items, brands, and locations. Neither of these are gift cards.

Answer: Part B covers a health behavior change

program to help you prevent diabetes, once

in your lifetime. The program begins with 16 weekly group sessions led by

coaches in a group setting over a six-month period. You can find a program in your area by going to this website:

https://www.medicare.gov/coverage/medicare-diabetes-prevention-program

If you have been prescribed a medication for the diabetes, some Medicare Advantage companies have specific plans that do offer additional benefits to people in the way of dietary coaching, meal programs, and gym memberships at no cost.

Answer: Low income subsidy may be available through the social security administration, but there are income and asset limit. 2025 income limits are approximately $23,475 (before expenses such as Part B) for a single individual and $31,725 for a married couple, while the asset limits are around $17,600 for an individual and $35,130 for a married couple.

If you are on a name brand drug consider contacting the manufacturer of the drug and see if they have any type of a special copay program for that particular drug.

Lastly, consider a Medicare advantage plan. If you are already on one, review the drug coverage on the all the Medicare advantage plans that are available in your area. Many Medicare advantage plans do not have deductibles on prescriptions up through and including tier 3 name brand medications. This could lower out of pocket by up to $615 a year.