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.