Terri Reagin, Medicare Insurance Broker

Answer: The clientele are loyal and very thoughtful about the decision making process. They want to make sure they can trust the person and that they have been strategic about the choice they make. I can both admire and respect my client base.

Answer: In the case of a customer with a strong preference that a family member make the decision for them, it is essential to have a power of attorney in place by Medicare's guidelines. We always say we will "get around to it" but the truth is you must make it a priority. Schedule it on the calendar and get it handled because once you are in a crisis situation, without one, your family member will need to go to court.

Answer: Consider the bias of the people around you making comments about various options. While they are well meaning, ultimately everyone's needs are very different. Everyone has a different budget in mind and will qualify for different plans. For that reason, it's important to treat your own needs based on YOUR preferences.

Answer: I'm a pretty firm believer that Original Medicare is only the best choice when paired with a supplement. The reason is simple. There is NO max out of pocket to Original medicare. Part C is a great choice for those that do not mind paying low copays and enjoy the low premiums, but at minimum they at least have a max out of pocket in case something catastrophic happens

Answer: Contact a local agent. There may be a special election period available that you aren't aware of. Your agent can help guide you.

Answer: There is a one time change available to current Medicare Advantage customers between January 1- March 31 where you can make a one-time change in this instance. Additionally, there may be other special election periods you qualify for. Contact your local agent for help.

Answer: Hospice is covered by Medicare. It is important to note that long term care is not covered by any medicare plan, so I always advise families to have an appointment that addresses the entire picture including hospice

Answer: I think it is a combination of seeing negative things written about them or hearing the doctors complain and failing to prepare for the out of pocket costs such as hospitalization or a cancer diagnosis where the bills could be higher. There are plans that can cover those expenses that are pretty low cost. Ask your agent about them for a better experience with your advantage plan.

Answer: The likely scenario is that when you came for your annual physical, the conversation took a diagnostic turn. Then the doctor bills the visit as diagnostic, causing a copay. Be sure to clearly communicate with your doctor your expectations about the annual physical and that you want to be notified first if anything will cost a copay

Answer: Weight loss in general is not a covered expense on Medicare. I do not typically see Ozempic approved unless the person is being treated for diabetes with it.

Answer: That depends on the job insurance being offered. The plans on the individual market are becoming more and more attractive. Typically there is a zero deductible choice, and very low copays. The drug coverage can often be the difference maker. I recommend a careful review with a local agent who can guide you about the pros and cons of the decision to enroll.

Answer: It really just depends on the medication. The insurance companies are not required to cover every drug, but they are required to have drugs in every category. Check with your agent about your options.

Answer: The doctor always has the choice whether or not to accept the plan or participate in the insurance network. The best thing you can do is check into whether or not you qualify for a special election period to make changes or look up a new doctor on the network.

Answer: Insurance is based on a risk pool, not just an individual person. Unfortunately, it is illegal to either discount or increase someone's rate because they are healthy or unhealthy. It is part of the legal protections in place.

Answer: I think it will play the same role as it does now. You can already self enroll online, or through an app, or any number of ways using the internet. There is a very big difference in satisfaction, though, when you use a local agent who can point out the things you may not know to look for. In that way, I selfishly hope the need for good advice never goes out of style

Answer: Yes, it is possible that the dental coverage will be better with your medicare advantage plan. It is important though that you don't make decisions on your dental without considering the fact advantage plans are also tied to your medical. Make sure you understand all the implications of making the switch by talking to a local agent

Answer: The answer can be a little bit complex. There is home health aid, which is typically covered by Medicare, however some people require private nursing in your home which is under the umbrella of long term care and is not covered by Medicare.

Answer: You may want to consider a Medicare supplement, which will keep your out-of-pocket cost to a minimum or you can check into ancillary plans to cover your out-of-pocket expenses on a Medicare advantage plan. Check with your local agent about your options to cover your out-of-pocket expenses.

Answer: IRMAA, or the Income-Related Monthly Adjustment Amount, is an additional charge on Medicare Part B and Part D premiums for individuals with higher incomes. In 2025, if your modified adjusted gross income (MAGI) from 2023 exceeds $106,000 (individual) or $212,000 (joint), you will likely pay an IRMAA. The IRMAA is calculated based on income brackets, and the amount increases as your income rises.

Answer: No, it’s based on a lot of factors. You could have a supplement plan and she could have an advantage plan which are two totally different options. Or she could have Medicaid or low income subsidy that is helping pay for her expenses based on income. You may not be comparing apples to apples like you think you are.

Answer: A Medicare supplement or Medigap has no network providers so any doctor that takes original Medicare will take your supplement plan. Medicare advantage plans are based on private insurance companies with network bases so you will have in and out of network doctors with the Medicare advantage plan.

Answer: Well, your friend is well intentioned but there are many factors to consider with your Medicare plan. Budget is one of them but so is doctor choice prescription coverage and risk tolerance. I encourage you to have an appointment with your local agent so that they can cover those things with you carefully since they are licensed and have experience in this area.

Answer: Medicare assigns star ratings based on various performance measures across different categories, such as customer service, getting needed care, and member experience. They are a "big picture" look at the plan. It is just one of the many things you can use to consider having a relationship with a specific insurance company. Your doctor however, is bound to a certain standard of care regardless of which insurance company you are affiliated with. Your star ratings should say a lot more about your relationship with the insurance company than your relationship with your doctor.

Answer: The short answer is it depends on when you are enrolling for it. If you enroll for a supplement plan within the first 6 months of your medicare age in (open enrollment) or you are enrolling due to a loss of employer coverage or other reasons that could give you a "guarantee issue" then NO you cannot be asked medical questions or denied. If however, you choose to apply outside that time frame, you will be asked medical questions and they can either increase your rate or decline your coverage based on pre-existing medical history.

Answer: Provided that you did so during an "open enrollment" or "guarantee issue" time frame then YES your supplement plan will pay for a scheduled surgery, provided it is approved.

Answer: Everyone is subject to the new laws that were aimed at providing relief to prescription drug costs for medicare recipients. This includes the removal of the donut hole and the $2000 out of pocket maximum for covered prescriptions. Ask your local agent how this may impact the drugs you are taking!

Answer: Yes. The medicare part B premium is not designed to be picked up and put down at will. You could be subject to penalties and definitely will have to wait several months to get it back if you don't pay your premium.

Answer: There are PPO's, HMO's, PFFS and MSA's to name a few. Typically there are many to choose from. I recommend you speak with your local agent about your particular needs to help narrow choices.

Answer: A good agent will help be a filter for you. They know which plans your doctors take, what formulary your prescription is on, can give you a cost analysis of what to expect in copays and prepare you for the things that medicare does not cover. Our help is free. You do not pay more for any plan because you use an agent. It has been my experience that people are far more satisfied with the choice when they have all the background information that you may not always know where to look for. I usually toggle between about six screens when researching a plan! In addition, I offer yearly plan reviews for my clients so that they are up to date on any changes in the market.

Answer: The best way is to contact your local agent to plug them all in for you and see what is the lowest out of pocket costs based on what you take. That is the only way to get accurate pricing on what to anticipate.

Answer: Its really not. There is all kinds of strict rules and regulations that telemarketers must follow in order to be compliant. The short answer is not every person that tries to contact you is compliant. Here are a few of the rules that ethical agents follow:

1. unsolicited contact is not permitted without express written consent- thats why its important you do not respond to text or emails that you do not personally know the sender.

2. they are not permitted to door knock, or approach you in common areas such as doctors offices, without express prior written consent.

3. they are not allowed to talk about the benefits of a medicare advantage plan (AKA grocery benefits) without a signed scope of appointment.

4. they are not allowed to target specific demographics like low income, or minorities

If you see this happening, you can always call 1-800 MEDICARE to report the behavior. I hope this helps.

Answer: If you go with Original Medicare with a supplement plan then the coverage is identical nationally. If you go with an advantage plan then yes, plans vary by county and by state.

Answer: Only in the event of non payment. Otherwise your medigap plan should be guaranteed renewable. Always check with your agent for questions!

Answer: There’s a difference between being able to see an out of network doctor for a higher co-pay and the carrier still having certain restrictions on their plan such as needing a referral or needing a pre-determination before surgery. All private insurance companies have different restrictions so it’s always good to check with your local agent to see what’s gonna meet your needs the best.

Answer: It depends on the hospital, but it’s rare to see one that doesn’t take any at all simply because they are cutting off such a large population of people by doing so. Check with your agent about your preferred hospital choice.

Answer: Usually the last few days in September or the first week in October. Be sure to ask your agent for any recent updates to your plan too!

Answer: You would need to speak with social security for IRMAA related questions, however it is doubtful you will be able to circumvent the IRMAA surcharges for the years that your income is high enough to meet the requirements.

Answer: The plan you are enrolled with should send you an email”annual notice of change” document in the month of October which is when open enrollment begins with Medicare advantage or prescription drug cards. This document tells you the changes made for the upcoming year. October 15- Dec 7 is the time to look at other companies offerings or to meet with a local agent to compare plans.

Answer: You must have a minimum number of working credits in order to qualify for Medicare. You should always contact social security to verify your eligibility but for those individuals that are not eligible for medicare, the Marketplace may be available for you for your major medical. Talk to a local agent about your options!

Answer: I think it is simply easier to not have to get out of bed if you are sick in order to have a conversation with a doctor. Telemedicine cannot handle everything but they are very advanced in what they can handle and the convenience can't be beat!

Answer: 5 star ratings are the highest rating awarded to a medicare advantage plan based on the customer experience. In order to qualify for a 5 star enrollment period (which is year round) a plan must have been awarded a 5 star rating. The enrollment period cannot be used on any other plan.

Answer: The process for usage of the over-the-counter benefits vary from carrier to carrier but some carriers have a pre-loaded card that can be used at major retailers such as Walgreens and CVS for common over the counter medications such as aspirin or vitamins.

Answer: An easy litmus test is did they contact you unsolicited? Did they ask for a scope of appointment prior to discussing benefits? These are both required by CMS by all agents who sell medicare products. Beyond that, anyone credible should be willing to give you first and last name and even license number or national producer ID which can be searched with the state licensing data base. If none of those things check out, then it should raise many red flags.

Answer: I have a pretty standard "Welcome to Medicare" appointment for customers that are new to the process and aren't sure of what plans to choose. I try to do a thorough needs analysis including doctors or prescriptions they would want me to look up and to find out where their cpmfort level is with risk, copays, doctor networks and care coordination. No two people are identical in what they need or want with Medicare so I want to make sure I treat each appointment individually.

Answer: Original Medicare by itself has NO maximum. With that said, I don't subscribe to a one size fits all mentality or that one is "Better" than the other. It quite simply depends on the needs and wants of the client.

Answer: LOCAL is the way to go when it comes to choosing a representative to work with. There really is no better way to establish trust or ask the hard questions than looking someone in the eye and reading what their local neighbors have to say about them on google and other social media resources.

Answer: Really the only way to know the TRUE cost of what you are going to pay is to have someone plug it into a prescription calculator for you or of course, you can attempt to do it yourself but the brochures are simply a guide. They are not going to tell you if a drug is cheaper than the standard copay or if there is a manufacturers savings that has been passed on to you. That is why I never do a medicare appointment without plugging in the medications.

Answer: You are not required to to carry Medicare when you have access to Native American services for prescription drugs. It is important to note, however, you are not legally allowed to carry any Healthcare.gov plans beyond becoming ELIGIBLE for medicare, even if you opt out of it.

Answer: Depends on several factors not the least of which is if you already have Medicare prior to going on dialysis or if you are going on Medicare BECAUSE of dialysis. I would consult a local agent about all options.

Answer: Most of the appeals I have to work are actually not medical: they are dental. I just call the provider, find out what got denied, help the customer get a copy of the explanation of benefits so I can see the exact status code and then conference call with the carrier to work it out. Most of the time it is a missing x-ray, wrong code, some type of error on the claim that just has to be corrected. On the ultra rare occasion I'm brought in on a medical appeal we use pretty much an identical process to get to the bottom of it. I would never say that I can guarantee that it will always go our way. What I can guarantee is that I will put up a good fight.

Answer: The donut hole was eliminated in 2025. The out of pocket max has been reduced to $2000 per year for covered drugs. In addition, consumers can ask the insurance carrier about being placed on the "Medicare payment plan" wherein they are allowed to break up the yearly cost into monthly payments and not pay anything at the pharmacy. We can always check with your carrier about that.

Answer: Absolutely! many reputable agents carry licenses in multiple states, myself included! I would just make sure they are willing to offer a license number that you can look up and contact information that you can save in your phone if you need them.

Answer: There are 2 types of events that you can register with CMS: sales events which are meant to steer or “sell” a product and educational events which is prohibited from discussing copays or features. They can only be generic in nature. The RULES are that you are not even allowed to distribute marketing materials or contact attendees without them soliciting you in a separate appointment. The challenge is not every agent follows the rules and people inherently will want to know the details of copays and features when you open it up for questions. I think it’s just important to know what type of event you are going to (you can ask) and know that there are no obligations just because you listen. It sounds like you just encountered someone that wasn’t very good at it.

Answer: I think you need to research your choices for yourself and go with what feels right for YOUR needs. Just like everything else, people will always have an opinion but you will be the one who lives with the coverage so it should be your choice ultimately

Answer: Your Medicare plan is a major medical and as such it covers not only people that use it rarely it covers people that use it often.

Answer: It depends on the plan and the brand you are using. Most carriers cover those glucose monitors but some may have preferred branding that they require.

Answer: You got me there! I'm not sure what you mean by "Medicare treatment". If you mean the "welcome to medicare" exam then yes that should be covered at 100%

Answer: You can enroll in parts an and b Medicare starting 3 months prior to your birthday, the month of, and three months afterwards. Go to ssa.gov to apply onine