Ted Sims, Medicare Insurance Agent

Answer: I often receive this question from clients and agents alike: Why opt for a Medicare Supplement plan with a monthly premium when Medicare Advantage plans are frequently available at $0 premium (or very low cost)? The straightforward answer is that a Medicare Supplement (Medigap) plan delivers two key benefits that frequently make the premium worthwhile.

Benefit 1: True Freedom of Choice

This goes beyond basic access—it provides meaningful flexibility when health matters most. With a standard Medicare Supplement plan, you can visit any doctor or hospital that accepts Medicare nationwide, without network restrictions imposed by the insurer.

This means:

- You can seek out the top specialists for serious conditions (such as cancer, Parkinson's, or other complex illnesses) without barriers.

- No referrals are required to see specialists.

- Prior authorization is generally not needed for most services (though limited exceptions exist in certain states or for specific procedures, primarily to prevent waste, fraud, and abuse).

Since the primary purpose of insurance—especially after age 65—is to protect your health and ensure access to the best possible care, why restrict yourself to a narrower pool of providers?

Benefit 2: Reliable Peace of Mind and Predictability

Medicare Supplement plans offer stability that many Medicare Advantage plans cannot match:

- Fixed, predictable costs year after year.

- After paying your premium (and any plan-specific deductible or copays), covered Part A and Part B services are typically paid in full when provided by Medicare-approved providers.

- Plan F: You pay the premium and the Part B deductible ($283 in 2026), with the rest covered for approved Part A and B services.

- Plan G: Similar to Plan F, but without covering the Part B deductible.

- Plan N: Includes the premium, Part B deductible, modest copays for office visits and ER services, and potential excess charges—still highly predictable overall.

Answer: Ever heard the old saying, you get what you pay for? It is also very true with your health insurance.

The cheapest plans could leave you with:

Low up-front costs can mean much higher out of pocket maximums later, and upwards of potentially $9,000. And depending on the timing of you getting sick, this could stack up back-to-back. I just finished speaking to a client that was hospitalized and diagnosed with serious illness late in the year, hit max out of pocket for 2025, and now will be hitting it again for 2026. That is catastrophic for them. They wanted to switch and called me, but I can't help them now.

Restrictive networks and prior authorizations and approvals to see the specialists you need.

Not being able to switch to a different plan later if your health changes or you can't pass underwriting.

Paying a Premium for a plan could give you:

Peace of mind with predictable health costs yearly.

The freedom of choice to choose the best doctor or specialist for sickness and disease when the time arises.

Answer: With Medicare Advantage, In-network should equal lower costs where Out-of-network Coverage is limited or none at all.

With Medigap, there are no networks and no out-of-network penalties. Any doctor or hospital that accepts Medicare will see you. No referrals, no restrictions, no surprise higher costs. If you get sick and need a top specialist (especially for something serious), you can go straight to the best one available without barriers.

When educating a client on why pay a premium for a Medicare Supplement, I outline 2 premium benefits, this being one of them that makes paying a premium worth it for a premium product. You pay more upfront for the flexibility and security that lets you focus on getting better.

Answer: Yes, a Medicare broker can help you find a plan with broader chiropractic coverage, but Medicare itself limits what gets covered, so the real solution might be more complex.

Original Medicare (Parts A & B) only pays for chiropractic for medically necessary stuff, usually just a handful of visits.

But if you need a lot of adjustments or stuff beyond basic spinal work, plans might fall short.

Answer: This really depends on what type of plan you have and your networks, but this is exactly one of the biggest reasons I always educate my clients on how Medicare Supplement (Medigap) plans work in my pros/cons talk.

If you're on a Medicare Supplement, Find the best specialist anywhere who can treat your rare condition. You get to choose any one you want, in-state, out-of-state, doesn't matter. As long as they accept Medicare, you're good. No networks, no referrals needed, no prior auth. Just call, confirm they take Medicare, set the appointment, and go. That freedom to control your own care and chase the absolute best experts is hands-down one of the strongest benefits out there, especially with something rare where the right doc can make all the difference.

If you're on a Medicare Advantage, it can be trickier. Depending on how the plan works, networks can restrict who you see, and you may need referrals and prior approvals.

I would recommend speaking with your doctor or a trusted doctor to get a recommendation for a doctor in network.

Answer: I recommend you shop with your total yearly out-of-pocket cost as the #1 priority. That means zero in on the combo of premium + copays/coinsurance for your specific drugs over the whole year. That's what really hits your wallet.

You can have an agent do this or do it yourself on Medicare.gov's Plan Finder. Plug in your ZIP, list every med (name, strength, how you take it), and it'll show plans that cover them.

Compare by "Estimated Annual Drug Costs" or "Total Out-of-Pocket"—premium plus pharmacy costs for your exact list. Pick the lowest total for you

Big key step most skip: After you narrow to a couple plans, check pharmacy prices in the tool—costs can swing $50–$200+ per fill just by where you go. List at least 5 nearby ones to compare: Walmart (usually cheap generics), a grocery store pharmacy like Kroger or Publix (great for convenience and often low prices), a big brand like CVS or Walgreens (good selection but watch premiums), maybe Costco if you're a member, and an independent local one if you have a favorite. Run your meds through each—pick the combo of plan + pharmacy that keeps your yearly total lowest.

Plan stars or customer service ratings are nice to glance at, but they don't pay your bills. If two plans cover your meds the same, chase the cheapest total you pay—stars won't cover a big price difference.

Answer: Extras like SilverSneakers aren't part of standard Medicare. They come from certain plans that add them on as perks. Some bake it right into what they offer, usually as a value-added benefit from a Medicare Advantage plan, while others might fold it into the premium cost of a Med Supp or trade it off against other benefits.

But here's how I always look at it, focus first on the real meat—what your doctor and hospital coverage actually delivers. Get the best core healthcare benefits you can. IE doctor and hospital services.

Those value-added perks? They're nice, but they never sway my thinking when picking coverage healthcare comes first, add-ons second.

Answer: Part D plans change formularies, tiers, and prior auth rules all the time, and what one person hears isn't always spot-on. The easiest, most definitive way to get the real answer? Go straight to the source:

Get the official word straight from the plan is my recommended way, no guessing from forums or secondhand stories.

Call your current plan directly (the number on your insurance card) and ask a rep to check your specific drug for your coverage—have your member ID ready.

Or

Head to Medicare.gov... Use the Find a drug tool under Plan Finder. Plug in your meds, ZIP code, and it'll show exactly which Part D plans (or MA-PD plans) cover it, what tier it's on, copays, and any restrictions like prior auth or step therapy. Takes a few minutes and it's free/no login needed for basics. This relies on the website being updated and not being overly complicated for you, why I recommend calling directly first.

You can also ask your agent to help.

Get the official word straight from the plan is my recommended way, no guessing from forums or secondhand stories.

Answer: I have never seen them covered by Medicare. Original Medicare (Parts A & B) sticks to durable medical equipment (DME) like wheelchairs, walkers, hospital beds, or oxygen—things prescribed by a doctor as medically necessary for treating or managing a condition.

Some Medicare Advantage plans might offer limited extras for home safety stuff through supplemental benefits—like partial help with ramps or grab bars if you have certain chronic conditions, but very unlikely for things like stairlifts.

Some additional Ancillary plans also have home improvement pieces built in but typically not things along the lines of stairlifts. Some LTC and STC plans offer some home improvements like wheelchair ramps, shower and toilet railings and the like to help but those are not Medicare.

Answer: Medicare could be way simpler for everybody if we cut the fluff and focused on real education. Simplify the Medicare parts and names for seniors to better understand what they really mean.

I would also like to see better education for agents and seniors alike, so they understand their real choices. Maybe some sort of checklist that is required covering things like:

MA vs. Med Supp Head-to-Head Basics

Network vs Freedom of choice

Out of pocket costs for both plans

Predictability of yearly costs

Then the gaps each plan actually leaves.

Answer: Medicare won't cover everything your current employer group plan does.

Your employer plan (if it's with 20+ employees) usually covers a broader range of services.

You could have things like Dental, Vision, Hearing, better prescription coverage, wellness perks and things like this. Additionally, group plans have other riders that you may have purchased like cancer plans, critical illness riders and accident plans or life insurance that is not covered by Medicare.

Medicare is strong on the Hospital and Doctor side but does not match all in one feel of a group plan. Additionally, Medicare leaves gaps for things like Home Health care, confinement care and many other things that you should at least educate yourself on.

Answer: From what I've seen helping people over 25 years the hidden costs of cancer that folks don't see coming.

1. If you are working, Lost income from time off work — Bills don't stop, but paychecks do. Tons of folks lose salary, and it adds up fast.

2. Lodging and meals away from home. Staying overnight near a cancer center for multi-day treatments, eating out or grabbing takeout because you're not cooking.

3. Hidden drug and treatment costs. Don't overlook side-effect meds or anti-nausea stuff that insurance might not fully cover.

4. Experimental treatments, or treatments not covered by Medicare if you are on Medicare, also your Max out of Pocket yearly costs on MA plans. This also impacts people younger than Medicare like Group plan deductibles and coinsurance maximums.

Answer: If your spouse's employer has 20 or more employees, you can delay signing up for Medicare Part A (and Part B) with zero penalty.

You keep your current coverage without extra costs.

No late enrollment penalties hit you later, your group plan counts as creditable coverage.

Delaying saves you from paying unnecessary Medicare premiums while you're already well-covered. It's a win for your wallet and peace of mind

If this isn't your scenario (if the employer has fewer than 20 employees), delaying could mean penalties down the road—especially for Part B—so it's usually best to enroll during your Initial Enrollment Period to avoid extra costs but I would speak to a professional.

Answer: Why would you want to work with an agent like me? Simple—after 25 years in this business right here in Georgia, I've seen folks try to go it alone and end up frustrated, overpaying, or missing out on coverage that really fits their life. I focus on Medicare Supplements and solid ancillary plans (like cancer, hospital indemnity, dental, and short-term care) because that's where I can deliver the most real protection without the headaches of networks or restrictions. Here's why teaming up with a dedicated, independent agent makes sense:

Personalized fit for your needs — I don't push one company's plans. As an independent agent, I compare multiple carriers to match your doctors, budget, prescriptions (if relevant), and lifestyle. Plus, I specialize in those extra ancillary layers that protect against big surprises—cancer hits about 39% of us lifetime, hospital stays rack up hidden costs fast, dental keeps you healthy long-term, and around 70% of folks over 65 need some care support eventually. I own these same policies for me and my wife, so I know they work when it counts.

Expert guidance without the confusion — Medicare rules change every year, and the options can feel overwhelming. I break it all down plainly, explain the gaps in Original Medicare (like deductibles and coinsurance) so you can choose coverage that works for you, even if not with me.