Tyler Dalton, Medicare Insurance Broker

Answer: IRMAA is based on your income from two years ago, so what you made in 2024 is what Medicare looks at when they set your 2026 premiums. If you know a big income year is coming, maybe you're selling property, doing a Roth conversion, or cashing out a retirement account, try to spread that income out over a few years instead of taking it all at once. The best thing to do would be to plan ahead 5-10 years before you start medicare to make sure you do not have any income spikes to throw you over the IRMAA threshold

Staying under the IRMAA income brackets even by a dollar can save you a lot on your Part B and Part D costs.

Now if you already got hit with IRMAA, you can actually appeal it. There's a form called the SSA-44 that lets you request a reconsideration if you've had a life-changing event like retiring, getting divorced, or losing a spouse.

That drop in income could get the surcharge reduced or removed. Talking to someone who understands how Medicare pricing works — like a local insurance agent or financial advisor — is worth it if you're anywhere near those income thresholds.

Answer: Medicare is a federal program, so the basics are the same no matter where you live. Part A (hospital insurance) and Part B (medical insurance) follow the same rules across all states. Your eligibility and enrollment windows don’t change just because you live in Alabama, Florida, or anywhere else.

Where things get different is in the details. Medicare Advantage (Part C) and prescription drug plans (Part D) are offered by private companies. These plans are approved at the federal level, but the options vary by state and even by county. Networks, premiums, and available plans can look very different depending on your ZIP code.

Medigap, or Medicare Supplement Insurance, is also standardized at the federal level. A Plan G in one state covers the same benefits as a Plan G in another. But the cost of those plans and in some cases, the way they’re offered can change depending on local rules and markets.

So while Medicare itself is consistent, your choices around it are local. That’s why it’s important to review the options where you live and not assume what works for a friend or relative in another state will apply to you.

Answer: I open things up by asking what they’ve heard about Medicare, what type of plans their friends have, etc. Then we break down the parts of medicare

Part A is your hospital coverage

Part B is your doctor/ outpatient

Part D is your prescription club

Advantage plans are the all-in-one bundle and are medicare replacement.

Then I either send them to our next Medicare 101 workshop, where they see it laid out on a single timeline and can ask questions—or we sit down one-on-one with a simple worksheet and a follow-up to iron out whatever’s still fuzzy.

That blend of group energy and personal attention is what turns “Medicare who?” into “Medicare got it.”

Answer: With a local agent you get real-world know-how and the chance to meet face-to-face plus quick, in-person help when paperwork or questions pop up. A virtual agent brings digital speed and a wider pool of plans. Marry the two and you get neighborhood expertise with online convenience. I've always enjoyed meeting clients face to face and getting a chance to learn a bit more about them

Answer: Under Original Medicare (Part B), ambulance rides are covered, but you’re on the hook for:

Your Part B deductible for 2025 ($257)

Then 20 percent of the Medicare-approved fee for that trip

So if your deductible isn’t met yet, tomorrow’s ride might look like:

$257 (deductible)

20 percent of the approved amount.

– Example: if Medicare’s fee is $300, 20 percent is $60 → $317 total due.

– Once you’ve met that $257 for the year, you’d pay only the 20 percent (about $60 in our example).

Medicare-approved fees vary by service level (basic vs. advanced life support), mileage, and locality, so it pays to ask your ambulance provider what their Medicare-approved rate is. But the structure is always the same: deductible first, then 20 percent coinsurance

Answer: Congrats, you did well. High income, strong career, and now you're seeing that IRMAA surcharge show up on your Medicare premium.

That’s the government’s way of saying, “Thanks for your success. Here’s a little extra to pay each month.”

But here’s what most people don’t know.

Medicare bases your premium on your income from two years ago. So if you’ve just retired or had a big drop in income, you might be getting charged based on outdated info. And that means you could be overpaying.

The fix? It’s called an IRMAA appeal. You fill out a form SSA-44 and tell Social Security what changed. Retirement, income loss, divorce, work stoppage there’s a list of life events they recognize. If your income now is lower than what they’re using, they’ll often adjust your premium.

We help people with this all the time. The form is free. The savings are real. And the process is more straightforward than you'd think once someone shows you how to do it.

Don’t pay more than you should. If this sounds like your situation, give us a call or swing by the office. We’ll walk you through it step by step.

Answer: Most poeple would say the number one feature of original medicare is choosing your own doctor... which I agree is incredilbly important.

But here’s something nobody talks about.

Home health and skilled nursing coverage that actually works.

Not just a flashy promise.

Real help.

Wound care, physical therapy, recovery support.

If your doctor says you need it and you meet the rules, it’s covered.

No begging for approval. No waiting on hold. No network games.

Same with rehab after a hospital stay.

Original Medicare doesn’t nickel and dime your recovery.

It’s not flashy, but when you’re coming out of surgery or caring for a loved one, this kind of support matters.

And most folks don’t realize it until they’re already in the thick of it.

By then, switching plans might not even be an option.

Answer: You’re not alone.

Medicare can feel overwhelming, especially with all the parts and plans, Part A, B, C, D, Medigap, Advantage, drug coverage, networks, penalties.

It’s confusing by design, and most people don’t have the time or desire to dig through government handbooks or call centers that barely scratch the surface of what you actually need. If you feel led to spend hours and hours pouring over that information, by all means go for it. Or...

That’s where a licensed Medicare broker comes in. A good broker will take time to understand your specific needs, your doctors, prescriptions, travel plans, and budget, and help map out a plan that fits you.

We cut through the noise and walk you through the options in a way that actually makes sense.

It doesn't cost you anything to work with a broker.

We’re paid by the insurance companies when you enroll, so our help is free to you. And instead of being just another number in a call center, you get someone local, experienced, and available when things come up in the future.

If Medicare feels like a maze, we help build the map.

Answer: Yes, Guaranteed Issue is still available even after your Medicare Supplement Open Enrollment window closes, but only in certain situations.

These rights kick in during specific events, like if you lose coverage through no fault of your own, move out of your plan’s service area, or try out a Medicare Advantage plan and decide within a year that it’s not the right fit. That last one is called a “trial right” and you only get it once, so it’s important to time it right.

Guaranteed Issue means you can get a Medigap (Medicare Supplement) plan with no health questions and no underwriting, as long as you qualify under one of these special circumstances. It’s not tied to the fall Open Enrollment period. It’s a separate set of protections altogether.

Your best bet? Work with a local broker who actually understands the rules and can guide you based on your unique situation. That’s what we do every day.

Answer: It is true that many of the Medicare Advantage carriers may offer zero premium plans. They may come at no monthly cost, but that doesn't mean they are free. It is true they do come with tons of benefits and they can be fantastic plans. One thing people may not realize is that they should be considered a 'copay' plan. There will likely be a copay for most doctors, specialists and hospital benefits.

Answer: It's an incredible opportunity to meet and work with people from all walk of life. Over the years, Ive worked with fabulous clients from across the country. Although they are coming to me for advice on this specific topic, I feel Im the one who has gained many valuable relationships and even friendships.