Terri Reagin, Medicare Insurance Broker

Answer: Part D is your prescription drug coverage and is mandatory unless you have other credible coverage available to you. This could be employer coverage, VA, or Native Americans entitled to prescription benefits with their tribe. Failure to obtain prescription coverage will incur a monthly penalty.

Answer: I think it’s a great middle ground way to offset the cost of the cost of hospitalizations and skilled nursing with an advantage plan

Answer: Contact your primary care provider about your need for the equipment and he/she can actually write orders for your chair and then you give the orders to a durable medical equipment company who can file the insurance claim for you and fulfill the order.

Answer: Very rarely will Medicare pay for overseas treatment. Other countries have no concept of how American health insurance works and typically are not willing to wait for payment. The best option is travel medical insurance which will pay them up front or reimburse you when you get home.

Answer: Medicare clients are loyal to me because I work hard to treat them right. They are very appreciative of my style and they are fun to be around and be friends with.

Answer: It really is apples and oranges. The simplest explanation is that Medicare supplement is paying higher premiums up front for less copays at the doctor. Medicare Advantage is low premiums or no premiums but being responsible for copays at the doctor and hospital. I would highly encourage you to reach out to a local agent who can assist you in finding what might be right for you.

Answer: The maximum out of pocket is your threshold for copayments and deductibles. After it is met, you go to 100% coverage for the year. My experience as an agent is that shockingly few people ever reach the maximum out of pocket. The reason is because many plans do not have a deductible and the copays are very low. Even hospitalization is not going to be all that high. As a result, the only people I ever see reach it is people that go through very serious chronic conditions like cancer, kidney failure, and others that require so many specialist and high dollar treatments.

Answer: You can try to apply for Medicaid through your local Department of Human Services which would get your part B paid for. You could also inquire about a Low Income Subsidy through social security which would allow your part B to be paid for. One option that you may not have thought of is checking into a "giveback" plan with Medicare Advantage plans. They pay a good portion of your Medicare premium in exchange for enrolling with them.

Answer: People who are new to Medicare typically do not have any idea how it works so I try to offer the generic overview of how it all comes together first so they have a better understanding of what product they might want to look at. When someone is coming to the table with a clear cut agenda (plan change) then I am going to perform an analysis of what is making them want to make that change? If they are unhappy with the current plan, why? What features are they looking for in the new plan? It is kind of two different customers.

Answer: There are 2 types of seminars that agents are permitted to host: Educational, which are not permitted to present brochures, plan features or have any type of sales at them and a Marketing event which are required to be registered with the carrier weeks in advance and there are disclaimers given at the event that it is a sales event and its purpose is sales. There is no "hidden" or "disguised" agenda. Part of the way agents get the word out about their business is to host meetings for the general public to come and get questions answered and in the case of a marketing event, willingly listen to a sales pitch. If you would rather talk to people over the phone about your questions where I assure you the goal is to sell you, or self-enroll with no assistance, those are all options to every consumer.

Answer: You have two choices. Pick a different hospital that IS in network or contact an agent about changing to a plan the hospital accepts.

Answer: It depends on whether or not your doctors are in the network with the advantage plan you are considering. Contact your local agent to look those up for you.

Answer: The coverage goes to 100% once you have hit your maximum. I suspect you are reading old material. Contact your local agent if you need assistance

Answer: It kind of comes down to this: you're gonna have to find somebody that you trust. I would look at people's Google reviews or ask their trusted family member or friend what kind of agent they might recommend. Having somebody to kind of narrow down the choices and give you feedback on experiences they've had with the plan is really important.

What you know, like if your doctors take the plan or what your prescription drugs are gonna look like with the plan, that's gonna make all the difference in the world and reduce your anxiety. What you're truly afraid of is the unknown.

So finding somebody that you can know, like, and trust to handle your Medicare is really the best-case scenario. I hope this helps.

Answer: Insulin drugs treating diabetes are not created equally. There are insulins that have a year-round low co-pay, but there are some insulins, like Ozempic or Mounjaro for example, that do not fall under the regular insulin category. They can definitely have an increase in cost. And no, there was no magical fix with the Inflation Reduction Act that makes all medications that treat diabetes inexpensive. There are still some medications that are pretty expensive for diabetes, unfortunately.

So, hope this helps! If you have any questions, I would contact a local agent who can guide you to what your options are to lower your cost. Or you can always apply for extra help through Social Security and potentially get prescription drug assistance.

Answer: I think that there are many (the majority actually) clients that are completely happy and content with thier medicare advantage plans. You may have ran into someone online that is disgruntled or a doctor who makes less money on them, but that doesn't mean that everyone that has them is unhappy. Its a myth.

Answer: The reason is because they are compensated handsomely by CMS for handling the claims for them, which is how agents get paid too! That money partly comes from the Medicare deduction on your paychecks all your life. That’s why you had to have paid into Medicare for a certain number of credits to qualify.

Answer: This is a very loaded question. First of all, the "donut hole" (sometimes referred to as the coverage gap) was done away with in 2025. The out of pocket maximum would apply toward your medication if it is on your insurance company's formulary (list of drugs that are covered). If the drug is "NOT COVERED" then neither will it apply to the yearly maximum. I really would consult an agent if there is a question or concern

Answer: unfortunately no they do not. your medical marijuana would remain out of pocket and not subject to any of the maximums with medicare.

Answer: I think turning to a local agent is always the best solution to a stress free experience so that you can let an expert help you with what you do not know or are unsure about. Its important to remember that medicare does not cover Long term care so be sure to ask about coverage options for this too.

Answer: You can purchase a stand alone dental plan without enrolling in Medicare if you want to. If you wanted to make sure you always have the choice of private doctors and hospitals you could enroll in Medicare with an advantage plan with a "GIVEBACK" feature that would help you pay for the premiums on your Part B. Usually those plans also include dental. For all your options, you should contact a local agent.

Answer: The donut hole has actually been eliminated. You might want to talk to an agent about strategy on the card you are carrying and there is also a Medicare payment plan you can ask your carrier about.

Answer: My opinion is irrelevant. They don’t ask me my opinion on their commercials. So I try not to lose too much sleep over what I cannot control.

Answer: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Utah all have the birthday rule.

Answer: It’s important you know anything filled on a discount card will not go towards your drug maximum. Also most of the cards are lead generation tools where your information is given to marketers in exchange for you filling the prescription on their discount including goodrx.

Answer: If you missed your window, you have an opportunity in January to sign up late. Certain penalties may be involved with a late enrollment sign up. Consult your local agent about what your choices are.

Answer: No you are most likely just getting the monthly or quarterly bill for your Part B premium. Part B is not free. It cost $185 for the year 2025 and will increase to $206.50 for 2026. There are certain advantage plans called a "GIVEBACK" plan that could help reduce that cost for you but you must pay your part B premiums to be eligible for Medicare.

Answer: Yes, big changes for 2026. Federal legislation has had a large impact on the reason so much has changed. Funding has been reduced for Medicare Advantage plans and prescription drug plans. Legislation has dictated what money can be spent on. Several states have added prior authorizations to original Medicare, which will impact even people on Medicare supplements. As a result, things that were once extra, like dental, have been cut or reduced. Plans have been eliminated from the market. Commissions have been removed from agents, and premiums have increased. Drug costs have moved formularies. All the carriers are feeling the impact of the current legislation on the books. I highly advise you to contact a local agent and review the changes to your plan so that you're aware of what to expect and what else is out there. Hopefully, this helps.

Answer: The claims are going to be very much subject to the client that needs treatment. It is common for chiropractic to be limited to a certain amount of visits. Original medicare might offer longer stretches than an advantage plan, but of course nothing can be guaranteed until you are actually a member of the plan.

Answer: I would always advise consulting a broker when you are unsure of what is covered on the plans you are looking at or wanting to "shop" around as they are usually well versed in the plans in your area.

Answer: Its been my experience that holistic care, by and large is not covered with the exception of some Medicare advantage plans covering acupuncture. Vitamins can be a covered expense on some over the counter plans with Medicare advantage plans as well.

Answer: Yes these procedures are covered under your Part B coverage. There can be limitations and exclusions, so be sure to refer to your evidence of coverage document.

Answer: She can but you must be a part of the presentation and sign on your own behalf unless she has power of attorney.

Answer: whether you go through a Stand alone Part D or Medicare Advantage the prescription drug coverage should be the same. The modifiers are going to be the doctor and hospital coverage

Answer: Yes and no. Yes in the sense that the deductible isn’t sky high but there is NO maximum to original Medicare. People rarely hit the maximums on advantage plans but things like cancer and dialysis could be a disaster without a Medicare supplement to go with Original Medicare or an advantage plan to put a maximum on the situation

Answer: The difference between keeping original Medicare and going to an Advantage plan as far as copays is that they're both gonna have copays. But the difference is original Medicare has no maximum to it. So that means if you hit the wrong illness at the wrong time, you can have quite a bit out of pocket. An Advantage plan would give you a maximum out-of-pocket, meaning once you hit that threshold, you go to 100% coverage. So that is the difference between having original Medicare and an Advantage plan, and the reason why most people don't do original Medicare by itself. Hope this helps.

Answer: Guarantee issue means that your Medicare supplement plan cannot ask you any medical questions in order to qualify for enrollment in the plan. There are several scenarios that are guarantee issue.

Number one is when you age into Medicare for the first time. When you start your A and B coverage, that is the six-month window you have from the start date of your Part B.

Scenario number two is when you are leaving group coverage. If you have employer group coverage, you have 60 days from when you leave your employer group coverage to have a guarantee issue.

Scenario number three is if your Medicare Advantage plan cancels in your county for the upcoming year. So if they've completely removed your plan from the county, then you will have a guarantee issue on a Medicare supplement.

There are other more rare scenarios that are affected by guarantee issue, but those are the three that I can think of that are the most common. I hope this helps.

Answer: To my knowledge, there is nothing that prevents you from getting a CT scan because of your age. If you are getting denied a CT scan, contact your agent or your provider to help you find out why.

Answer: No you can't. The advantage plan takes the place of Original Medicare. So Original Medicare will NOT pay any claims for your services. If your provider doesn't take your plan, in most cases you need a new plan or a new provider.

Answer: it won't. Long term care (Nursing homes) are not covered by Medicare at all. Skilled nursing is a benefit but that is not the same service as full nursing home care and is maxed out at 100 days.

Answer: Hi, great question! So, the different enrollment periods are during October 15th through December 7th. That is what's called AEP, or the Annual Election Period. During this time, you can pretty much do anything you want as far as an Advantage plan or a standalone drug card. You can also go back to Original Medicare from an Advantage plan. You can go to a supplement plan with the drug card, but underwriting may be required to go to a supplement plan. It just kind of depends on your situation.

And then between January 1st and March 31st is what's called OEP, which is the Open Enrollment Period. This is the time that you can just enroll from an Advantage plan and go to Original Medicare and pick up a drug card. Or you can switch from one Advantage plan to a different Advantage plan. But this is just a one-time change. This period was instituted for people that maybe got on the wrong plan during AEP and are unhappy and want to make a one-time switch. This is just a one-time switch, but you do have to have an Advantage plan already in place on January 1st to take advantage of that election period.

In addition to the two big ones that I mentioned, there are a 60-day special election period when you move out of county or when you leave your employer group plan. Those are two common ones, and there are some other ones too, like if you get kicked off of Medicaid or if you become eligible for Medicaid for the first time.

In addition, there are plans that are called chronic special needs plans for people with diabetes and heart conditions. And those have year-round election periods on them. So, it's always a great time to check with your local agent, and they'll be more than happy to guide you through all the different codes you can use to change your plan or enroll. I hope this helps!

Answer: Plan G is easy and really the gold standard these days. There is the part B deductible ($240 this year) and then 100% coverage. Plan N is not bad per say but I do have one caution: it does not cover Part B excess (the difference between what Medicare charges and the doctors regular charges) which means they are allowed to balance bill you for up to 15%. Other than that, it’s a good plan with low copays and the part B deductible.

Answer: Never provide your medicare number to anyone that you don't absolutely intend to change your plan with or enroll in something or a doctor that needs it (of course). That is the biggest way to make sure you aren't scammed. Secondly, consider hanging up on phone solicitors and look up a trusted local agent in your area to assist you with your choices.

Answer: First of all I would recommend a local agent who can carefully comb through considerations such as budget for premium, doctor choices and out of pocket costs associated with your prescription drug benefits. Those would be the starting points for me sitting down with a retiree

Answer: As a licensed insurance agent, It is my responsibility to read the copays, deductibles, and out of pocket costs associated with each advantage plan choice by carefully reviewing the summary of benefits and the outline of coverage including drug costs.

Answer: Mental health and certain therapies are covered under original medicare including individual therapy and group therapy and mental health hospitalization.

Answer: Not Necessarily. New plans are being released every year between Oct 15-Dec 7. Contact your local agent to make sure you are on the right plan for you!

Answer: It would be impossible for me to answer this question without further clarification from you personally. Feel free to call me or another agent in your area for clarification.

Answer: While I don't think worry or panic is necessary, being prepared for the fact that changes are going to come to the 2026 benefits due to those cuts. Pay careful attention to your "ANNUAL NOTICE OF CHANGE for 2026" that should come in the first couple of weeks in October. It will compare last years coverage to this year and you should be able to clearly see the differences that your plan has made.

Answer: Call 1-800 MEDICARE or go to medicare.gov and they can order a replacement card for you. I hope this helps.

Answer: During the Annual Election Period (Oct 15-Dec 7) contact your local agent to enroll and your new plan will become effective January 1, 2026. If you are switching from a medicare supplement, its important to note that you'll have to call and cancel the supplement yourself it will not automatically happen.

Answer: Special Needs Plans or Chronic Special Needs Plans are medicare advantage plans typically offered year round to individuals with specific chronic conditions such as Heart issues or Diabetes that offer robust comprehensive benefits to address those needs such as low copays and extra benefits like healthy food. The qualifying condition will have to be verified with your provider.

Answer: Star Ratings in a nutshell are based on how well the plans performed based on several metrics including customer care, member services, preventative care focus and much more. The care you receive is largely dependent on your doctor at the end of the day. Your plan is how that care is paid for. While Star Ratings should be one factor of your decision, I would not say it should be the only thing you base your decision on.

Answer: Yes, all plan offerings are based by county and state. It is absolutely possible that she has something that looks completely different than what you are offered simply because of her address being different.

Answer: Yes, good news. In 2025, the donut hole was eliminated and the annual out-of-pocket cost for covered drugs is $2,000. What you have to be careful of though is making sure your drug is on your company's formulary, because if it is not on the formulary, it will not go toward the $2,000 maximum. I hope this helps.

Answer: The biggest difference between the two is that Original Medicare has no out of pocket maximum. This means that the 20% has no cap to it should you be diagnosed with something serious. By law Medicare advantage must cover as good as or better than Original Medicare so you don't have to worry about "Losing" benefits by going to an advantage plan but you will have networks to contend with that Original Medicare doesn't have.

Answer: If you have had credible coverage this entire time, you should not be penalized for waiting. You will be applying for a "Delayed" Part B coverage. Go to ssa.gov and click on "APPLY for MEDICARE" and follow the prompts for Delayed B. Be sure to get the document for your employer that they fill out certifying you had group coverage to avoid the penalty. If you are unsure how to proceed, contact your local agent for assistance.

Answer: In a nutshell, not usually. Weight loss and obesity are not by and large a covered benefit of Medicare.

Answer: Ask for a summary of benefits to be sent to your email. It should list any incentives that are a part of the plan. Do not give your medicare number to anyone that you do not intend to change your plan. Also when you do that, you will lose your agent so make sure that is what you want to do.

Answer: I don't know of any legitimate advantage plans gift cards. The only legal incentive I'm aware of is the "GIVEBACK" feature which gives back a certain portion of the part B premium on your social security check. Other plans may have features like food card benefits or dental/vision plans as part of the package of the plan. If someone is either advertising a gift card or promising a gift card to enroll, then they are doing so against CMS guidelines and could lose licensing if found out.

Answer: They get paid less on them and there are more hoops to jump through to get procedures done. I am of the opinion that you really shouldn't base your decision on what to buy on whether or not it is your doctor's preferred plan. That is letting someone else's bias drive your decision and you should base it on what is right for YOU.

Answer: Most people that help seniors for a living do so because we genuinely enjoy the clientele and the product is something that brings a sense of satisfaction. What is annoying to the senior is everyday work for us so I know that there is very little that rattles me personally.

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

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: 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: 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: 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: 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: So, according to my quick search, it looks like the Inflation Reduction Act actually started in 2022. In 2025, the donut hole got eliminated from prescription drug plans, and the out-of-pocket maximum went from $8,000 a year to $2,000 a year for covered drugs. So it's important to know your drugs have to be covered on the formulary in order to be part of that $2,000 maximum. The insulins are capped at $35 copays for the full year, and they are now doing further negotiations with the manufacturers to transfer that savings along to the consumer. It's important to note that there is new legislation pending that would cut some of the funding from the Medicare Advantage plans and the Part D prescription drug plans that cause the rates to be low. We are anticipating a response from the insurance companies in 2026 where the premiums for Advantage plans or Part D prescription drug cards may go higher, and there may be a reduction of benefits because they are cutting some funding there. Hope this explains some of the changes that are coming with Medicare.

Answer: This is a very specific question, very specific to your individual plan. You're really gonna need to contact your insurance company and reach out to them about this. The standard coverage for skilled nursing, which is typically what rehab is, is going to be that they'll cover 20 days of skilled nursing at a zero copay, and then days 20 through 100 is going to have a copay to it. If you're on an Advantage plan, or if you're on a Supplement plan, then it may be covered by the Supplement. So it's going to be very individual to you. This is not a blanket type answer. I hope that helps.

Answer: Dental coverage definitely can vary depending on which Medicare Advantage plan you sign up for. It's important to keep in mind that dental, vision, and hearing are ancillary benefits included with the coverage as just a perk of signing up for the plan. So they can be pretty limited, depending on what the other benefits of the plan are. The best thing to do is contact the local agent and see which plan maybe has some of the higher dental benefits if dental is going to be a big concern for you. Because yes, they can. There are definitely plans that have very limited dental coverage. That's completely normal.

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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: If you spend a substantial amount of time out of state with your medical coverage, I would say in excess of six months a year, then you almost certainly want to consider a Medicare supplement plan. The reason why is they have no networks to them. So anybody that takes original Medicare will accept a Medicare supplement. For that reason, if you're gonna be hopping in and out of two states all the time, I think you'd want to give strong consideration to a Medicare supplement.

Answer: I'm going to be honest with you. I'm not a huge fan of Plan K. The reason why is because, for one thing, it does not cover Part B excess, which is the difference between what Medicare's allowable fees are and those allowable fees by the doctor. They are allowed to balance bill you if you do not have that coverage in place, so I personally see that as quite a big risk. The other thing is my attitude is if we're going to be paying so many copays and deductibles out of pocket, which when you put K and G side by side, you'll see that K has a lot of out-of-pocket expenses related to it that G does not. If you're going to be paying that much out of pocket anyway when you go to the doctor or when you go to the hospital, I don't see any reason why you wouldn't want to go with an Advantage plan, because there are many Advantage plans that have a zero premium. So that's just kind of my opinion on it. Not everybody may agree with me on that, but that's my take.

Answer: Estimating costs on your diabetes, on one hand, is pretty simple. We can plug in your medications and come up with a penny estimate on how much you're going to pay out of pocket with the current prescription drugs that you're on and your out-of-pocket medical supplies. What's a little harder, and what we don't really have a crystal ball on, is how many times you're going to see the doctor or if you're going to be hospitalized with complications due to diabetes. So there are going to be things that you can anticipate, and there are going to be things that you may not be able to anticipate. Be sure to talk with your local agent about what might be the right choice for you in addressing your diabetes.

Answer: Not addressing the areas that Medicare does not cover is definitely something that you will regret if you don't have a conversation about it and find adequate coverage. A good example is long-term care. Long-term care is not covered by Medicare. That includes nursing home, assisted living, and private duty round-the-clock care in your home. There are definitely some options, affordable options even, to cover long-term care solutions. There's even some affordable tax solutions for the self-employed, and the average cost for long-term care is anywhere between $6,000 and $7,000 a month conservatively right now, at least in my state, in the state of Oklahoma. I think it's an important thing because a lot of people just assume that it's covered by Medicare when they buy their Medicare coverage, and it's a conversation we should be having.

Answer: Oh, without a doubt, the elimination of the donut hole for prescription drugs was a game changer. And the out-of-pocket maximum on covered prescriptions going to $2,000 a year was a lifesaver for some people that were on very expensive medications. It did mean an increase in deductibles. However, I see a big push toward making prescriptions more affordable, and that's only a good thing for seniors.

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: 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: Medicare covers self-diabetic management care with up to 10 hours of counseling, both individual and group counseling. Also, medical nutrition therapy services can be covered for people diagnosed with diabetes. It just depends on your particular diagnosis. That is where they provide nutrition and lifestyle assessments, along with individual and group therapy services, to help manage lifestyle factors. Both of those may help in managing your care.

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: What you have to understand is that what you're getting in the mail is advertisements. There are a lot of different Medicare companies with a lot of different plans, and they're just sending you advertisements. So advertisements can be thrown away if you're going to contact a local agent. What they're going to do is filter through all of those plans and help you find the best coverage for you. That would be my suggestion. Otherwise, you don't half the time know what you're looking at or what your alternatives are. I hope this helps.

Answer: The biggest piece of advice that I can give seniors going into Medicare plans is not to get too emotional about the choice. The reason I say that is because the coverages with Medicare are excellent. No matter what choice you go with, you're going to have excellent coverage for your care, in my opinion far superior to what is available under the age of 65 in our country. So don't feel like you're just going to make the wrong choice or that you're going to lose vital coverages because the coverage is very, very good. So relax and try to enjoy the process because it's actually not that bad.

Answer: My best piece of advice would be to contact a local agent about your situation. It's possible that you might qualify for a special election period. There are various ones that they can go through with you. So I would definitely encourage you to get in touch with a local agent so they can ask the questions related to those special election periods and help you get on your way. Hope that helps.

Answer: To be eligible for a zero premium on your Part A Medicare, you must have worked 40 work credits, which is the equivalent of about 10 years. If you have worked less than 10 years or 40 work credits, you may still qualify for Medicare, but you'll just have to pay Part A and Part B premiums in order to qualify. Medicare is for people who are over the age of 65 or for people who have been drawing Social Security disability for over two years. That is who will qualify for Medicare. There are also certain individuals with end-stage renal disease and other various eligibility. Contact your Social Security office if you have questions or concerns about that, but it is not an income-based entitlement. It is a work-based entitlement.

Answer: It's gonna seem like an incredibly self-serving answer, but you really should talk to an agent. The reason why is you're not gonna pay anything extra in order to use an agent. Their services are complimentary to you. The insurance company compensates them, but they're gonna have the expertise and some of the laws that maybe you may not be aware of to be able to guide you on whether or not we could be getting a better rate on what we're looking for. Speaking with a broker that carries multiple companies is always a good idea. If you think about it, when I have brand new agents that get hired on as an advisor, we have to put them through weeks of training before they're ready to fully understand it themselves or explain it to somebody else. It is a very complex product, and for that reason, I do recommend the advice of an expert.

Answer: In a short answer, yes, Medicare Advantage plans will be the cheapest route when you are looking at premiums only. It is definitely going to be cheaper premiums than a Medigap or Medicare supplement. If you weigh the cost of a Medigap plan over a five or ten year span against the co-pays that you will pay out of pocket for an Advantage plan, I'm a firm believer that the math does favor the Medicare Advantage plan. People that make the decision for a Medigap plan are typically doing so for convenience, convenience of not having a network, convenience of not having a co-pay. But the math will favor the Advantage plan.

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

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: 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: 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: 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: 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: 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: 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: 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: 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: Medicare Advantage plans, while a very popular option, are not taking over the world. What is taking over is the rising cost of health care. Even people with supplement plans and original Medicare are going to start seeing the effects of that, not only in their prescription drug coverage, but also in the rising cost of Medicare supplements and the more restrictions that have never been a part of them in the past. They are now starting to talk about adding things like prior authorizations and things of that nature to Medicare supplements. So really, you're not seeing a push for Medicare Advantage so much as you're seeing the implications of the rising cost of health care in this country and the squeeze that it is putting on the insurance companies. I hope this helps.

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: 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: 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: 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: 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: 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: 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 didn't make a bad decision. Medigap plans are very good plans, very portable. There's nothing wrong with them. However, there is a misconception that Advantage plans do not travel well. Most Advantage plans will have out-of-state emergency coverage with ER. So most ERs are going to be covered on an Advantage plan. That's because by law they have to cover as good as or better than Original Medicare. If you're interested in that, check with your local agent about your next open enrollment date.

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: I definitely think there's something to be said about face-to-face contact with an agent. I don't think there's anything wrong with an agent using technology to help support the customer in the way they feel is best, but I would caution people that remote or virtual meetings do have a higher tendency to attract the bad characters out there who don't have your best interest in mind. A good local agent will be able to meet with you face-to-face, and I think that helps build trust and credibility.

Answer: I think the role technology will play will be the same that it is now. You can already do things like self-enrollment online or through an application or any number of ways on the internet. There is a very big difference, though, in satisfaction with your plan when you use a local agent who can point out the things to you that you may not necessarily know to look for. In that way, I selfishly hope that the need for good advice from a local agent never grows out of style.

Answer: I think it's always a good idea when you're retiring to have a visit with your local agent and discuss any election periods that you might be eligible for. A lot depends on if you're carrying your insurance through your job or if you're solely relying on Medicare now. If you're relying on Medicare already and you're on, say, a Medicare supplement or a Medicare Advantage plan, then no action is required or necessary. But I still recommend always checking in with your local agent and just sitting down to have a chat about it, because there could be special rights that you have depending on your situation with your job.

Answer: The first thing I would do if I could not afford my Medicare Part B premiums is contact my local Department of Human Services and apply for Medicaid, because if you're approved for Medicaid, they will actually pay your Part B premium. You can also apply for what's called a low-income subsidy, and that can pay either all or part of your Medicare premium. I hope this helps.

Answer: So a Medicare broker is an insurance agent that offers several different insurance companies to choose from when it comes to looking at either a Medicare supplement or a Medicare Advantage plan. A dedicated Medicare agent is somebody that has only one plan that they are contracted with, and the only thing that they advertise or sell is that one individual plan. Typically, you will find the brokers are going to be more your local agents that have a local presence in your city. Typically, you'll see the dedicated agents are going to be the ones that are going to be calling by phone, or you might reach them when you call the 1-800 number for the insurance company. I hope this explains it.

Answer: So here are my recommendations for when looking for an agent. First of all, I would try to find somebody local to your home if possible. You can do that by Googling "local Medicare agent" and then putting your city name behind it. Also, look to see if they have Google reviews. Do they have a local office, a local presence? Those are going to be your well-established agents that have actually had customers who can verify they had a happy experience with them. So that would be the first thing I did. The second thing I would do is make sure they're following the Medicare rules. Did they ask for a scope of appointment, which Medicare requires for all Medicare recipients? Ask them if they are a broker or if they only carry one company as a dedicated agent. I may be a little biased, but I think a broker is going to be able to give you more choices because they have several companies to choose from. You may want to ask friends and family who they might recommend because these days just about everybody knows somebody in this industry. And then, anybody that is legitimate can prove who they are. They can show you their license. They can answer questions about themselves and their business without getting defensive or hostile. So those would be the things I would be looking for if I myself was looking for a Medicare agent. I hope this helps.

Answer: Medicare Part B. If you only have original Medicare and it is only being covered by Part B, you have no supplement in place and you're not on an Advantage plan, then yes, your physical therapy will be subject to your Part B deductible and your 20% co-insurance. Additionally, they can limit the amount of physical therapy visits that they cover per year. So they can say we're only going to give you 20 visits or 30 visits, etc. But original Medicare does tend to be very liberal with how many visits they permit. I hope this helps.

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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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.