Terry Salak, Medicare Insurance Agent

Answer: Working with a local and independent Medicare agent gives you access to building a relationship with a single point person, not just in the enrollment process, but long after your policy becomes effective.

An independent agent is also contracted annually with multiple carriers and will take the time to review the multitude of plan options available in your market and to find the one that is right for you.

They will also take the time to do an annual review during AEP (October 15 through December 7) to ensure you are in the right plan and, if adjustments need to be made, then they will help you with those as well.

An independent agent isn't a "call center" agent who will write you application and then forget your name. They will be there with you for any time you have questions, concerns or need help with any issues that may arise.

Answer: Contracts between carriers and providers are not "forever" and do change often. It is very important to look at your paper mail as this is typically the first form of communication that will let you know there are going to be changes.

If a contract negotiation is reached between the carrier and the provider (or medical system) then your provider will remain IN-NETWORK.

Most MAPD PPO plans will give you the option to see both in-network and out-of-network providers, with OON typically having a higher co-pay. MAPD HMO plans will not give you this option.

In order to avoid this, I would suggest looking at Medicare Supplement plans as an option. With a Medicare Supplement policy, you are paying an additional monthly premium, but you no longer have to worry about providers, facilities or systems being in or out of network.

Answer: As with your Medicare Part B monthly premium, your annual Medicare Deductible resets every Jan as well.

Typically, CMS will notify all Medicare recipients of these changes in mid-October. Therefore, it's very important to look at your PAPER MAIL for the official announcement of these numbers every year.

Answer: No you cannot. Pre-existing health conditions are not factored into a Medicare Advantage plan application.

Answer: Repatha can be tiered differently on and Part D drug plan, including both MAPD and PDP plans. That is why it's important to discuss these plan details with a licensed Medicare agent in your area. The services for a licensed agent do not cost you anything but you will be given a lot of useful knowledge and hopefully gain a trusted advisor to work with for years to come.

Answer: You do not need a Scope of Appointment to discuss Medicare Supplement plans. This form is only required when you speak to an agent about Medicare Advantage (MAPD and MA) as well as prescription drug (PDP) plans.

Answer: This form is to be filled out and submitted with your Medicare Part B application IF you chose to work, and receive credible medical benefits, through an employer. This form is filled out by your HR department showing that you've had credible coverage past the age of 65 and prevents Medicare/SSA from charging you a late enrollment penalty on your Medicare Part B.

Answer: Your SSDI will last as long as your medical condition prevents you from working or until you reach your "full" retirement age - which is currently 68 years old. At that point they will switch you to regular Medicare but you will keep your same MBI and Part A/Part B effective dates.

Answer: Original Medicare does not cover hearing aids and they would be your financial responsibility.

However, if you were enrolled in a Medicare Advantage plan, many plans offer this as an additional benefit to the members.

It is best to consult with a licensed Medicare Agent/Broker to understand the differences as they are required to be both trained and certified annually on the many ongoing changes with Medicare, Medicare Advantage and benefit changes.

Answer: Any Dr who accepts Medicare assignment will accept Medigap (also referred to as Medicare Supplement) plans. However, if you enroll in a Medicare Supplement Plan N and you see a provider who does not accept Medicare assignment you will be responsible for 15% excess charge.

Medicare Advantage plans are going to limit you to medical providers who are with those specific plans network.

Answer: As with most Medicare medications, it depends on if the vaccine is considered a Part B or a Part D drug as they will get billed accordingly.

- Medicare Part B will typically cover Flu, Pneumonia, Hepatitis and COVID

- Medicare Part D will typically cover RSV, Shingles, Tetanus and any others that are reasonably necessary to prevent illnesses.

Answer: Since all Medicare Supplement plans all function the same. Plan G, no matter what carrier, acts as a "Plan G". Plan N as a "Plan N". What is important is a.) How quickly are claims processed? b.) What is the level of communication with both members and brokers? c.) What is a specific carrier's rate stability? d.) What is a specific carrier's rate increases - long term? e.) What is a carrier's S&P rating / Am Best Rating???

Answer: The biggest misunderstanding, by far, is that seniors think Medicare will cover their long-term care in a nursing home (SNF) or assisted living.

The truth is, Medicare only covers skilled care (SNF), and only for a short time after a qualifying hospital stay and maximizes out at 100 days. It does not cover CUSTODIAL CARE (think along the lines of an Assisted Living Facility - NOT a nursing home! —which is the everyday help people need with things like bathing and dressing. Since custodial care makes up the vast majority of long-term care needs, many people are caught off guard by the massive costs. It's why long-term care insurance and Medicare planning is so crucial!

Answer: Yes, you should worry about Medicare cuts. Due to some of these unforeseen changes, people on MAPD plans (mostly PPO) are going to be increased co-pays, co-insurance, smaller Dr networks and have a more difficult time accessing care through PPO. HMO plans should stay more consistent with the path they have been on for the past several years. To better protect yourself, and to have the flexibility to see providers without networks, pre-authorizations and pre-certifications with traditional PPO's, and you feel you can pass underwriting to move your care to a Medicare Supplement and stand-alone PDP plan, now may be the best time to invest the additional monthly premium and move more towards this direction. A Medicare Supplement plan is going to be better able to control, and predict, your annual medical costs.

Answer: What may work for your neighbor may not be what's best for you. Every person needs to review their options and chose what they feel is going to be best for them. Make sure you work with an agent who will take the time to explain the pros/cons of both so that you are making a well-educated decision for yourself.

Answer: Tier 1 and Tier 2 drugs are always the least expensive and are going to be drugs such as, but not limited to, Metformin, Losartan, Amlodipine. Tier 3 drugs can either have a flat amount associated with them OR, with the changes implemented to the Medicare Prescription Drug Plans during 2025 some plans may require the member to pay a % of the retail cost of the drug.

Tier 4 and Tier 5 drugs are typically paid as a % of the retail cost of the drugs.

The 2026 MOOP (Maximum Out Of Pocket) is $2,100 and includes the plans annual deductible. Once this amount is reached by a member then they will not pay for any additional cost associated with prescriptions (with the exception of any monthly premium) for the remainder of the year.

Answer: To qualify for Medicare under the age of 65 you would have to be approved for SSDI (Social Security Disability) and have been on SSDI for 24 months. SSDI is determined by SSA.

Answer: As an independent agent, and owner of a family-owned agency, the most important aspect is to have an agent that is going to educate YOU on the complicated world of Medicare and to be there to help you navigate this process long after your enrollment is complete.

To me, it is important to understand the specific needs of each client as there are never two clients who are exactly the same. I like to know what each client is expecting with their Medicare insurance coverage, what is important to them and what they can/cannot live without.

Reviewing all Dr's and medications is also very important so you can understand what plan(s) will/will not work for them. And this review should not just be done when someone is NTM (New To Medicare), but annually so, as an agent, I know if the client has had any changes to their profile that I may need to be aware of. As Dr's/medications change Y2Y for people, these same elements can change Y2Y on MAPD plans as well as PDP plans.

Do not allow yourself to get involved with an agent who is only going to be around to write you application and then disappear. Find an agent who you know where be there to work with you for the long haul.

Answer: If you are on a Medicare Advantage plan, that specific plan may have a copay for ambulance transport. However, if you are on Original Medicare with a Medicare Supplement plan, OM will cover the first 80% with your Medicare Supplement covering the remaining 20% as follows: 1.) To the NEAREST facility (hospital) that will provide the required care 2.) Medicare Supplement will cover the remaining 20% and prior to either of these benefits "kicking in" you must have met your 2026 Medicare Part B annual deductible of $283.00.

Answer: My best suggestion would be for you to find a LOCAL Medicare Agent who can take the time to sit down with you and go through all the steps of Medicare. I will typically do a "Medicare 101" with potential clients so they understand the enrollment process, the Medicare Part B premiums (including IRMAA) that are required by Medicare/SSA, the differences between Medicare Supplement and MAPD plans and go over ancillary benefit details. A seasoned agent will make this process less confusing and pretty easy to understand. AND, if you chose to work with this agent moving forward then you always have a contact person for any questions that come up. As I tell my clients, I am not here to just write your application and disappear, I am here to service your account and be there for you any time you have a question!

Answer: There are several options to keep the cost of your prescription medications lower. 1.) Always make sure the medications you take are on your plans formulary. If they are not, work with your provider to find a similar medication that will be on formulary.

If you are unwilling to change medications, you can also look at GoodRx for coupon codes that will offer a discount.

Lastly, and this does not always work for people on Medicare, you can see if the drug manufacturer offers any type of patient assistance/financial assistance. This route will sometimes work for drugs that are a Tier 4 or Tier 5 as they cost the most.

Answer: It depends on the drug formulary on the plan you are enrolled in but these types of drugs are typically covered as a Tier 3 drug or higher.

Answer: Providers are contracted with plans at various dates. If a contract ends between a carrier and a provider mid-year you would have to either pay an Out of Network co-pay (if on a PPO) or change your specialist to an in-network provider if you were on an HMO.

If you were on a Medicare Supplement plan this wouldn't be an issue as any Dr. who accepts Medicare Assignment would still continue to see you as a patient.

Answer: Reach out to a local agent who is contracted with multiple carriers. They will be able to help you understand all the options out there, walk you through the process and answer any questions you may have. Trying to navigate the complexity of Medicare on your own is not recommended. Agents do not charge a fee for their services and I would also suggest you "interview" more than one person to make sure you find the right fit for YOU.

Answer: Are you asking if they can help you as "an agent", a family member or are you asking if they can help you as an authorized representative?

If you want to appoint a family member to act on your behalf as your "authorized representative" then they can certainly do that but would need to file the correct paperwork with CMS. Here is a link to that form:

https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms1696.pdf

If you want them to sit in on meetings to help you understand your Medicare options, but you will be the one who ultimately makes your final decision then you would not have to have this form on file.

Answer: With Original Medicare (Parts A & B), you pay 20% of the Medicare-approved amount for medically necessary ambulance services after meeting your Part B deductible, meaning Medicare covers 80%. The total cost depends on the service level (basic vs. advanced) and distance, but you'll be responsible for the 20% coinsurance unless you have Medigap or Medicare Advantage.

Answer: Without a doubt the BIGGEST and the MOST COSTLY mistake Sr's make when they are eligible for Part D is to NOT take it "because I don't take any medications". When opting out of this you are setting yourself up for "forever" LEP (Late Enrollment Penalty) down the road. The Medicare Part D LEP is calculated at a 1% penalty for every month you were eligible for Part D and you DID NOT enroll. This 1%/per month is based on the national average cost of a Part D drug plan and a.) stays with you forever b.) recalculates every January to new "national average".

The second biggest error is enrolling in a plan when turning 65 and having the monthly premium deducted from your monthly SS check. Over time, both plan premiums and member drug needs change and this is something that needs to be reviewed every year during AEP.

Most areas in the country will have $0 to low cost stand-alone PDP plans so do yourself a favor and don't bypass this when you are first eligible.

Answer: For people who only have a Part D, PDP plan, it is very important to review your plan, your medications and ANOC (annual notice of change) ANNUALLY! With the IRA (Inflation Reduction Act) changes that took place in 2025, most PDP plans are now seeing increases in a.) monthly premiums b.) annual deductibles and c.) increased prices for ALL Tiers of medications.

Without an annual review during AEP (Annual Enrollment Period - 10/15-12/7) you may be forced to stay in a PDP plan that no longer fits your needs for another year.

Answer: With OM (Original Medicare) you are responsible for all the deductibles connected to OM as well as the 20% that OM does not cover. With a Medicare Supplement (Medigap) plan, that plan would cover all these costs as long you continue to pay your Medicare Part B premium and your monthly Medicare Supplement premium.

Based on your Medicare Part B effective date, you may have an additional Medicare Part B annual deductible, which I would be happy to explain in more detail at any time.

Answer: For domestic travel, PPO plans will "travel" with you when you are outside of your plans area. There is a window of time that you can be away from your service area so make sure you understand your plans requirements.

For more flexibility of traveling domestically you can look into a Medicare Supplement policy. A MedSupp plan will cover the 20% that OM (original Medicare) does not cover. With a MedSupp you do not have the restriction of using "in-network" providers, referrals, pre-authorizations or pre-certifications.

Most MAPD and MedSupp plans will cover you for international travel. For the best protection I would recommend working with an independent agent who offers International Medical Travel Insurance so you would have better coverage when traveling outside of the US.

Answer: Original Medicare will cover you anywhere in the United States. A MAPD HMO plan will cover you out of your service area for emergency services only. A MAPD PPO plan or a stand-alone PDP plan will cover you when you are away from home as long as you use "in network" providers and if you are NOT out of your service area for a specific time (this can be found in your plans EOC - Evidence of Coverage). A Medicare Supplement plan will work to cover the gap that Original Medicare does not cover and, again, will provide you coverage anywhere in the country.

Answer: As an independent agent I do my due diligence with clients and show them both options. There are a lot of differences in benefits as well as monthly cost and I want them to understand both sides of this. It is my job to educate a potential client and help them make a decision that works for them. What is good for one person may not be what's good for someone else.

Answer: The first thing you should do is check your EOC (Evidence of Coverage) for either your Medicare Supplement or MAPD as most will offer some small amount of coverage for international travel.

Should medical air transportation "home" be needed, most companies will require you to pay for this service IN FULL prior to authorization. In situations such as this it's best to see if your Medical Health Insurance agent has access to a more comprehensive International Travel benefit package prior to leaving the country. Most plans are affordable and can be purchased prior to travel to cover you for the specific dates that you will be gone.

Answer: Your best bet is to find a local Medicare Specialist to walk you through this process. With professional help you won't feel so overwhelmed.

Answer: If you are new to Medicare I would suggest you reach out to friends/family for referrals on who they use. You may find there is someone locally who people within your group enjoy working with. However, it is ultimately up to you to find a local agent who "fits" with you. So, if you are more comfortable "interviewing" several agents then, by all means, do what is best for you. However, as a courtesy to those being "interviewed" I would suggest you let them know you are talking to multiple agents and you will advise them on your final decision prior to anyone digging in and getting you all the information you need. This will save both you and them valuable time.

Answer: Find yourself a local Medicare agent and work directly with them. They will be able to help you understand that health care systems and all the different plan benefits and options that would work best for you. Medicare (MAPD and PDP plans) are specific to certain areas (counties) and can vary greatly from state to state.

Answer: Medicare covers MANY preventative services to those eligible for benefits. Please refer to the attached document for a full list as there are a few that differ between men and women.

https://www.medicare.gov/publications/10110-your-guide-to-medicare-preventive-services.pdf

Answer: You file ac worn aural with Medicare or the carrier.

https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals

Answer: Medicare Advantage plans are NOT taking over the system. Every person who is eligible for Medicare has multiple choices when it comes to their Medicare insurance. They can choose to have Original Medicare and enroll in a Prescription Drug Plan (PDP), they can enroll in a Medicare Supplement plan with a stand-alone Prescription Drug Plan (PDP), or they can enroll in a MAPD (HMO or PPO) plan.

Answer: For either a MAPD or PDP plan you would have an SEP (Special Enrollment Period) that would start one month before your move and for two months after you move. All MAPD and PDP plans are written by COUNTY so a plan change would be necessary. If you were enrolled in Medicare Supplement plan you would only need to notify the plan of a change in address, which can result in a change in premium.

Answer: Trap? There is no "trap". With a MAPD plan it's going to work similar to an employer plan. You will have providers/locations that are IN NETWORK with your plan and some that are out of network. With an HMO (just like if it were an "employer" HMO plan) you will have a PCP provider that you must receive referrals from to see specialists. With a PPO (employer or MAPD) you can see IN-NETWORK specialists without a referral from your PCP.

Unlike "Original Medicare" a MAPD plans will include PDP (prescription drug) coverage, have a MOOP (Maximum Out of Pocket) and most will include additional benefits such as, but not limited to, dental/vision and hearing.

Answer: It depends on what type of Medicare plan you have. Are you on Original Medicare? A Medicare Supplement Plan? A Medicare Advantage Plan? Each can have a different answer.

Answer: That depends if you are still working and are receiving health insurance benefits through an employer.

Answer: First, contact your insurance carrier to find out why a claim was not paid. Sometimes is as simple as a billing code entered improperly. If that’s the case then you’ll need to contact your providers office to have them correct, ACA resubmit, the charges.

Answer: A Medicare plan review (MAPD and PDP) should be reviewed annually. Medicare Supplements do not need an annual review.

Answer: That depends on how much it changes AND if was a one-time change or something that will contrite over years to come. Please keep in mind that Medicare Part B premiums adjust annually. These premiums are based off the MAGI from two years prior. Since we are moving into plan year 2026, Medicare Part B/IRMAA payments will adjust in January.

Answer: If an agent is in this business to just “make a sale” then you have found the wrong agent. An agent should always look out for your best interest based on your medical needs. As I often say, I treat my clients the way I expect my own mother to be treated.

Answer: Everyone’s situation is going to be different based on your medical needs. There is no “one-size fits all” shredder to this question.

Answer: Medicare Advantage and Medicare PDP plans are written for specific counties. If you move outside of your plan “area” you would qualify for a SEP (Special Election Period) and would be able to make a plan change based on this. Hope this helps to answer your question!

Answer: I enjoy working with seniors to help them understand the A to Z’s of Medicare. There are so many options and being able to take the time to educate seniors and giving them peace of mind that they are working with someone who truly cares is important to me.