Wayne Hartzler, Medicare Insurance Broker

Answer: The easy answer is you probably don't need Part B yet. It is a good idea to do a side by side comparison though to make sure. What does your current healthcare cost you, what is the deductible, what is the max out of pocket limit? Let's compare those to being on Medicare and see which side interests you the most. Then, is your spouse on your plan as well? If so, can they stay on the plan if you are not the primary on the plan? Does your current plan have 20 or more people on it? If so, then Medicare will be secondary insurance, (you can have both). If not, then Medicare will become your primary insurance and your group plan will become secondary, in which case you may not need your current plan. Do you like to travel when you are not at work? If so, you will want to evaluate the options with Medicare that will allow you to be in-network while traveling. Saying "Yes" to Medicare or not is not hard, if you have someone who can help you ask the right questions.

Answer: Medicare agents are there to assist you by answering questions, they can't tell you what you should do. I have found the best time to call is either early morning during the middle of the week, or at 12:50pm to get into the call que when they return from lunch at 1pm. It is possible to have your Medicare plan agent on the phone with you to help ask the necessary questions. You will have to give consent to the person answering the phone to talk to them. Also, if you do not like the answer that you received, hang up and call back, you won't get the same Medicare employee.

Answer: Yes, Social Security should enroll you in Medicare automatically and start when you turn 65. If you have been on disability for years, you may already qualify for Medicare. Talk to an agent you can trust to help you do that research to make the necessary calls and find the most appropriate plan for you.

Answer: No, noby t yet. You must have lived continuously for at least 5 years. And then you will need to qualify for Medicare either by age, turning 65, or being on disability for 25 months.

Answer: Truth be told, the agent gets paid more for the Advantage enrollment than the supplement enrollment. The extra benefits such as dental and vision, and lower monthly premiums make the Advantage plans appealing. Secondly, they don't ask enough questions, such as travel plans, health needs or health desires.

Answer: Yes, that is really happening. In 2026, that maximum will increase to $2100. It won't count for non prescribed medications or supplements, nor will medications that are not on the plan's formulary count towards this out of pocket maximum.

Answer: Medicare pays 100% of Hospice care. Your plan may still cover any non-hospice expenses. If you have an Advantage plan, it will still cover dental, vision, and other benefits the plan may offer.

Answer: You will have to pay your Part B deductible, ($257 in 2025), plus 20% of the Medicare approved rate if the ambulance ride is medically necessary. If you choose to have an ambulance ride to return home, Medicare will deny that as necessary. I have seen clients have bills for this between $1600-2200.

Answer: Special Needs Plans (SNP) are Medicare Advantage plans that include chronic health conditions such as heart problems, kidney problems (C-SNP). Financial issues such as low income (LIS) may qualify someone for Medicaid that will qualify for another SNP (Dual-SNP). If someone on an Advantage plan gets admitted into an institution, that could qualify them for another type of SNP (I-SNP).

Answer: The biggest mistake I have seen is enrolling in a prescription plan (PDP) solely based on the monthly premium cost. Without actually evaluating a plan with a person's current, or known future prescriptions, it is possible to have to pay for 100% of the cost of the prescriptions. Not all prescriptions are on every formulary, nor are they all valued the same on the different formularies.

Answer: Yes, your new cholesterol medication will count towards your True Out Of Pocket (TROOP) expense as long as your new medication is on your plan's formulary. If it is not on the formulary, it does not count in your favor during your coverage gap. The coverage gap is the difference between $0 spent (January 1st of each year) until your TROOP meets the coverage cap. In 2025, that cap is set at $2000, in 2026 it will be $2100.

Answer: If you have Medicare, generally a change in health will not give you a Special Enrollment Period (SEP) during the year. But if your health change qualifies you for a Chronic health problem, then it is possible to make a change to your current plan. Also, if your health change allows you to gain eligibility for Medicaid, then you will qualify for a SEP.

Answer: At this time, no major changes are expected to the Medicare Help (LIS) program. I do believe the benchmark income level will increase consistently with the cost of living adjustment (COLA) that Social Security beneficiaries should recieve. The Centers for Medicare and Medicaid Sevices (CMS) hasn't released any changes yet. If there are, they will get announced during the 4th quarter of 2025.

Answer: Are they a long term thinker (3-5yrs+) or a short term thinker(1-2yrs)? What part of the insurance business do they want to be in, P & C, Life, Health, Medicare, Retirement Planning? How long have they been licensed already and what have they done so far?

Answer: Free food cards is the most misleading that I have had to deal with. I tell my clients it only applies to people on Medicaid as well. The majority of my clients do not qualify for Medicaid.