Tony Kiepe, Medicare Insurance Agent

Answer: Star Rating are very important. The higher the rating the more CMS pays the carrier and the carrier has more money for contracting with physicians. A 4.5 star plan can get more than 100.00 per member to give to your healthcare provider than a 3.5 star plan. Your agent should always tell you the star rating. If a plan only has 2.5 stars means that members were not happy with the plan, they may have smaller networks and not have a lot of prescriptions covered in their plan. Your agent should always look at your medications and providers to make sure they are covered helps the plan get a higher star rating.

Answer: CMS has just released its 2026 payments to carriers for 2027. The average increase for contracted carriers is 0.09%, and some counties in Washington are getting 0.02%. Doctors want more money, and the carriers are being paid less. Plans that are 4 Star or higher get paid more and can pay doctors more. A 4.5-star plan receives more money than a 3.5-star plan. Doctors do not want to accept average-rated plans because they receive lower reimbursement. A 4.5-star plan will cost around $1,500 more per year for healthcare management. Naturally, they can pay more to the doctor. The best action you can take is get a high-rated plan or a supplement plan. Carriers are reducing benefits. I believe you will see larger reductions in WA next year, including OTC, Dental, and other benefit types. Doctors get paid less under PPO plans; in Spokane, Multicare and Providence are no longer accepting PPO plans.

Answer: Your Naturapath must be contracted with Medicare to accept Medicare payments, and you will pay 20% of the cost. In Eastern WA, many Naturapaths do not accept Medicare or Medicare Advantage plans. Best to check with your medical provider to see if they accept Medicare payments and/or Medicare Advantage payments from your plan.

Answer: They're really excellent supplement plans on the market, but they have become costly, and in general, people don't want to pay that much for their Medicare benefits when they can join an Advantage Plan. Advantage plans offer prescription, dental, hearing, and vision benefits that attract and save money. This is what the consumers want today. Medicare is paying carriers less for Medicare benefits, and doctors want more money. You see a tug-of-war between Advantage plans and physicians. PPO plans had many advantages over the past couple of years, but you are seeing doctors refusing to accept PPO plans in 2026. You are seeing a decrease in extra benefits. The industry has experienced significant disruption over the past two years, with many of my current clients purchasing standalone dental plans and moving to supplement plans to get the coverage they need.

Answer: Original Medicare does not cover basic eye exams. Most Medicare Advantage plans offer Vision benefits, including a glass-and-frame allowance every year or every two years. Work closely with your agent so they may help you find the best Medicare Advantage program that offers you the best vision and or dental benefits that you do not see with Original Medicare

Answer: The biggest challenge for carriers is that providers want more money while Medicare is paying less. The Inflation Reduction Act reduced the maximum a person pays for medications to $2,100.00 per year, and carriers must pay the costs for their members for expensive medicines. One carrier prescriptions were 71% of their healthcare coverage. Carriers are making changes to plans, less dental, less OTC, and more copays to make up for these losses. If a carrier decides they can't make money in an area, they are pulling their plan from that area. They do not offer commissions to agents on many plans to discourage agents from writing a particular plan. I have written many non-commissionable plans for my clients because that was the best option for them. We will most likely see more changes next year, too.

Answer: Make sure your medical provider is sending you to an in-network facility and that your medical provider is in network. Also, please keep a copy of your Summary of Benefits and review it before performing a lab test. Medicare has a panel that providers use, and if they request additional lab work outside the Medicare panel, you will be required to pay extra fees. Your medical provider should review before requesting additional tests outside the panel.

Answer: Good news, October 15-December 7 is open enrollment, and you can get an MA plan. If you have a penalty for not having a prescription plan, your local Agent can work with you to see if you qualify for Federal Programs that will pay that penalty and cover a prescription plan.

Answer: I have an app on my cell phone that lets me look up Medicare Procedures. It's called "What's Covered" by Medicare. Some MA plans will cover procedures that are not covered by Original Medicare. You may want to talk to your local agent, and he can find an MA plan that covers the procedure you need. If Medicare does not cover the procedure then your Medigap plan will not cover.

Answer: You have two types of seminars to attend. One is educational; the agent is not permitted to discuss a particular plan. The other is a marketing seminar where the agent provides basic information and discusses one plan. I like to do a lot of marketing seminars, and you know, before the meeting, I'm talking about a plan. This meeting is very informal, and you can ask as many questions as you like during the seminar. If you like what you see, the agent can enroll you after the meeting or schedule an appointment. At the educational meeting, the agent is not permitted to make appointments afterward. You will need to call the agent and schedule a time to meet.

Answer: Be very careful when you call an 800 number you see advertised. You may be told that those benefits are not available in your zip code. Next thing you know, you are enrolled in a different plan. A lot of this advertisement is geared toward people who are dual eligible, meaning they have Medicaid and Medicare. It's always best to meet with a local agent who knows which product you qualify for and which offers the best benefits. I always compare three different products based on your medications and physicians. Healthcare companies are taking away many benefits, especially in Washington. My best advice is not to choose a plan based on these extra benefits, but to choose the one that works best for you.

Answer: Talk to your agent; they can look up your specific medication with the Healthcare carrier you use. Some companies have different products on their formulary. Your agent can help you find the answer to ensure your medication is covered. Every prescription plan has a different formulary, so this is an essential question to ask when you meet with your agent.

Answer: Different insurance companies offer different discounts for hearing aids. They will pay for you to see the hearing provider, but you will pay most of the cost of the hearing aid. Work with your Agent, and he can share with you the best Medicare Advantage Plan that gives you the best benefit for hearing aids.

Answer: Medicare Advantage offers everything that Original Medicare does, plus additional benefits such as dental, vision, OTC cards, and hearing. Typically, a Medicare Advantage Plan has small co-pays when you see a medical provider. A Medicare Supplement only pays what Medicare approves, and it covers the 20% costs that Medicare does not pay. A supplement plan may cost between $200 and $400 per month, depending on the plan. The advantage of a supplement plan or Medigap plan it is easy to budget your finances. You will also need a Prescription plan in addition to your supplement plan. They run between zero per month to $100.00 per month, depending on your medication. Your agent can review your medications and ensure you are on the correct prescription plan.

Answer: The IRMA tax is based on your past two years of tax returns. High-income people pay more IRMA tax. If your income is over $106,000 for 2023, you pay an additional $74.00 for your Part B Medicare, using brackets to adjust your IRMA tax. If your income is over $133,000, you pay an additional $185.00 on top of your Part B premium. You may also pay a higher Part B premium.

Answer: Medicare does not cover dental care. Many healthcare companies do have dental in their insurance plans. Their dental may be just cleanings or cleanings and comprehensive coverage. Each healthcare company uses different networks for dental. You can either call your current dentist to confirm they accept your plan or contact your local broker, who can look up a dentist for you.

Answer: The Part B Premium is 206.50 for 2026 and 185.00 for 2025. These decisions are made by the government, taking into account the total cost to Medicare recipients of being enrolled in Medicare. Each carrier has a contract with Medicare and is paid by Medicare to manage your healthcare. The carriers have no say in what Part B will be.

Answer: You need to make sure you are using prescriptions on the carrier's preferred list of medications. You can save money by using a preferred generic drug or a preferred name brand. Every healthcare carrier will list different medicines as Tier 1, Tier 2, and Tier 3. You need to have your local broker review your medications to make sure you are on the best drug plan.

Answer: Every prescription plan has its own formulary. They probably changed their formulary this year, and your insulin is not a preferred product under that plan. The best thing to do is go to Medicare.gov, enter your information to view prescription plans, and see if that product is available for $35.00, or call your local agent, who will be more than happy to assist you in making sure you have the best prescription plan. This is a good reason to have a fantastic agent who can help you and answer your questions.

Answer: You need to look at your healthcare carrier. Carriers introduced special plans last year to help you with your expenses, such as Diabetes. These plans offer special benefits for Chronic Conditions. You can go to Medicare.gov and compare different plans that will help you the most.

Answer: You can take Social Security disability benefits before turning 65. Once you have been disabled for two years, you qualify for Medicare. Depending on your income, there are a lot of choices for different Medicare Advantage plans.

Answer: You certainly can, or do you want an agent who works for you? Clients may face challenges or issues, and your agent will go to bat for you. Maybe you need a new insurance card. Do you want to call the carrier and wait on hold, or would you prefer an agent to handle this for you?