Toyin Adeleye, Medicare Insurance Broker
Toyin Adeleye
Medicare Broker Licensed in NH
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Berlin, NH
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About Me
In an industry that often prioritizes profit, can be misleading, and is much too complicated, it is my highest priority to offer peace of mind to those I serve by being transparent, honest, and compassionate. I love my state, and want to be a source of clarity when trying to navigate the ever-evolving system that is Medicare.
My services are free, and I'm contracted with all the major carriers if you decide you would like to enroll in a plan or browse through your options. You have no obligation to enroll with me, so if you're just looking for someone to provide unbiased advice, I got you covered!
Call now, or schedule an initial call with me so we can get to know each other; and if you found me on Medicare Agents Hub, be sure to let me know!
Q&A with Toyin Adeleye
How do you explain to clients that "zero-premium" doesn't mean "zero-cost" with Medicare Advantage?
Answer: The zero or low premium Medicare Advantage plans are what initially reel most people into Medicare Advantage plans; people understandably want to save money where they can. However, let's explore an example where this plan is not as cheap as it seems:
Ms. Flynn sees a cardiologist once a month, and she's on a Medicare Advantage plan with Bloom Health that has a $0 premium- she won't pay anything for the plan itself every month, but she will pay a copay for the service itself. For seeing a specialist, Bloom Health requires Ms. Flynn to pay $50 every time (in this case every month) she goes to see her cardiologist. This might not be too bad for Ms. Flynn.
Now let's say Ms. Flynn finds out she'll need a heart surgery, and the copay for that is $400 per day for the first 6 days of hospitalization, she'll be responsible for that as well- and now she's immediately looking at $2,400 she has to cough up. If Ms. Flynn can make this happen, then no problem; but if this is well beyond her budget, this can put her in a bad financial situation and cause her a lot of stress.
Her Bloom Health plan has an $8,000 out of pocket maximum- meaning if the worst case scenario happens in a year, she can be responsible for paying up to this amount in copays. After this amount, the plan is responsible for all costs, but we absolutely do not want to get to that point.
It's up to Ms. Flynn to think about what a bad year for her could look like, and if that $0 premium plan, along with the other things the plan offers, is actually worth it.
I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
Answer: I'm glad you're taking steps to learn! I'll first explain the terms themselves: A Deductible is the amount you pay for services before the plan starts covering you (if your deductible is $100, the first time you use a covered service you'll pay that $100 towards it). After you meet your deductible, you start paying copays or coinsurance (your portion) for each service you use, when you use it, based on your plan- a copay will be a fixed amount (ie $45 for a doctor's visit), while coinsurance is a percentage of the costs (ie 20% for a doctor's visit). The premium is the fixed amount you pay- typically on a monthly basis- for the plan itself (ie the premium for GOLDPLAN is $30 a month). You're covered by the plan you choose as long as you pay that monthly premium.
Original Medicare is Part A (Hospital insurance) and Part B (Medical insurance). You pay the part B premium (for 2026 the standard is $202.90/mo). There is no premium that comes with Part A for most people, but there is a deductible for both part A (about $1700) and Part B ($283). Medicare spells out all the copays/ coinsurance that come with different services, and whether they are considered a part A service or Part B service. If you're using a Medicare Supplement or Medicare Advantage plan, your costs will look different based on the way those plans interact with Medicare, but you pay the part B premium on top of whatever premium you pay with these plans. Part D (prescription drug insurance) often does not come with a premium itself unless you have a penalty, but the carriers will often have their own premiums that come with the Part D plans they offer (usually low or $0 plans) . I hope this helps, but if you get in touch I'm happy to explain these thing to you more in depth.
I'm planning to delay Social Security until age 70, but I'm turning 65 soon. How does this affect my Medicare enrollment?
Answer: If you're delaying social security, you'll just have to apply for part A and enroll in Part B. You'll still pay what you would've paid, but your billing for the part B Premium would be direct to you instead of coming out of your Social Security. Keep in mind that delaying your social security can mean higher Medicare premiums in the future.
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
Answer: If you had already enrolled in Part B prior to losing your employer coverage, you have a Guaranteed Issue right. If you're within 6 months of enrolling in Part B, you'd be in your open enrollment period for a Medigap plan. Hope this helps :)
I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?
Answer: The short answer is yes and no. Medicare Advantage plans are often attractive to people who don't want to pay a hefty sum every month, especially if they aren't working with much. For someone who is relatively healthy, this isn't a bad option- since they won't encounter as many situations where they're paying these high out of pocket costs. But once you need those X-rays or the worst case scenario happens, that's when you really see how costly being on an MA plan can be.
One option to help mitigate those costs is to get on a Hospital Indemnity plan if there's one available in your area. These plans are made to cover those out of pocket costs you'll see with MA plans. They do come with their own premiums, but they usually end up still being way cheaper than paying for a supplement, and you get to keep all your coverages like dental, vision, prescription drugs from your MA plan.
If a person can afford a supplement, I usually suggest they go that route. If you are considering going on a supplement, you may have to go through underwriting to do so- some exceptions apply here; but if you are able to get onto one, the more the plan covers, the more you pay in premiums. Take a look at Plan N or Plan G for Supplements if you qualify- you'll pay a lot every month, but you'll often pay nothing for services when you need them.
Should I keep original Medicare or go with an Part C, Medicare Advantage plan? What is better?
Answer: It's almost never the better option to go with Original Medicare. You're responsible for 20% of costs for part B services (with no limit) for one.
Most people decide between Medicare supplement (medigap)- which covers out of pocket costs and that 20% for part B (while letting you see any doctor that takes Medicare), and Medicare Advantage (Part C)- which acts as a replacement for original Medicare with some added perks, but comes with its own limitations. You still pay the part B premium regardless of which path you take; but you have to factor in things like your lifestyle, budget, and providers/meds when deciding which is best for you. A good broker will explain these things in depth, do a needs assessment with you, and help you make an educated decision.
How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?
Answer: You will need to get a private long term care plan. Medicare does not cover long term/ custodial care. If you qualify for Medicaid, you'll have a few more options.
Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Answer: A lot of the time people decide that the coverage they have for their healthcare needs is all they need. Sometimes these other insurance coverages- like COBRA and some retiree health plans- do not count for Medicare as creditable coverage (what the government considers equal to or better than what medicare has to offer).
Say the person's health suddenly gets worse- which is more likely the older we get- and they decide they now want to get onto Medicare; well this person is now considered a higher risk health-wise, and will likely "cost more" for the system to insure. Medicare will penalize them for as long as they have Medicare to essentially ease the costs on the greater system and deter others from not applying on time. This person can choose to never get onto Medicare; but if they do decide to get on, they will pay more.
It sucks to find out about these penalties after the fact, which is why I always encourage people to look into Medicare well before they turn 65, and make a plan. If it's too late, one can look into appealing this penalty.
I hope this helps!