Can you describe a time when you helped a client navigate a complex Medicare issue?

Question

Cathy Reeck · Accepted Answer

I recently met with a new client that thought he was covered for everything. Upon asking several questions, it was discovered that he had lost his medicaid, extra help, his medicare advantage plan, and his drug coverage! In other words all he had was orgianl medicare parts A and B. 

With lots of due diligence I was able to enroll him into a proper medicare advantage plan with drug coverage. We also did a new application for "Extra Help". I communicated with his son the urgency of obtaining specific documents so that we could reapply for his medicaid. 

It is expected that in the next 6-8 weeks we will have him receiving his extra help benefits and his medicaid!

Steve and Sue Brauer · Answer

So the question is, can you describe a time when you helped a client navigate a complex Medicare issue? Well, I'll bring up one lady in particular. She retired from the post office of all things in Nevada back in 2008. She had the wherewithal to go to Social Security and get information about the retiree health plan that she was being offered. The person at Social Security gave her wrong information. Imagine that, it happens. They told her it was what they call credible coverage, which is what you need to have if you're over 65 and not enrolled in Medicare. They told her she had credible coverage. Turns out she didn't. She came to us, my wife and I, in 2023 because she got a letter from Medicare saying that she owed a bunch of money and a bunch of penalties. Long story short, we went with her to Social Security and worked through it. She still had a penalty, but they were able to knock it down quite a bit. She was ecstatic. But that's probably the most complex thing we've had.

William Lawler · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/can-you-describe-a-time-when-you-helped-a-client-navigate-a-complex-medicare-issue#william-lawler

Larry Dalton · Answer

I'm always available for a phone or Zoom meeting and can usually arrange to meet in person if they request it. Navigating the Medicare system takes time and should be done with someone with whom you can share confidential information about your health and finances. Again, a trustworthy agent is very important in making your Medicare decisions.

Answered by Larry Dalton on March 26, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Christopher Boyd · Answer

A recent retiree transitioned from Group health insurance to Medicare Supplement coverage. They have called me a few times with claim or coding problems from the hospital billing their prior coverage after they joined Medicare. After calls to Medicare and the hospital, we were able to correct the billing dispute.

Answered by Christopher Boyd on March 4, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

Charise Karjala · Answer

A present, my most pervasive challenge is navigating the dual eligible market. That means for people who are either aging in or have Medicare and Medicaid.

This market is always particularly challenging in my area because the networks are constantly shifting. Medicaid is going under massive changes and there’s a lot of uncertainty with the Provider networks. In addition, those networks are very busy and flooded with patients. So I’m consistently challenged to make sure that I have the most timeline and relevant information

Edward Smith, ChFC, CRPS, AIF · Answer

I was able to explain to a person who wanted to enroll into a Medicare Advantage plan, that since he had very expensive infusions every 3 months, he would max out his out-of-pocket expenses with the MAPD plan due to the infusions being given in the medical facility. They would have been covered under Part B (20% co-insurance). Instead, I enrolled him in a Medicare supplement that covers all part B except the small part B deductible each year. It has saved him approximately $5,000 every year.

Answered by Edward Smith, ChFC, CRPS, AIF on March 25, 2025

Broker Licensed in OH, GA, IN, KY & TN

Answered by Edward Smith, ChFC, CRPS, AIF Medicare Insurance Agent

Jonathan Potter · Answer

Just this past month I was able to sign up two ladies that had major problems applying for Medicare part B. I probably spent over 15 hours with them calling social security to get them on the part B of Medicare. I was persistent when they wanted to quit and we finally got it done.

Answered by Jonathan Potter on March 25, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Gregg Matheny · Answer

Every time a client calls me that is approaching their 65th birthday I help layout steps for what they need to do next depending upon where they are at for example, income levels, currently on SS, trying to continue work coverage. Etc.. since there are many routes to Medicare I tend to put on my “detective hat” and ask pertinent questions so that I can best educate my clients and give them the best Medicare plan that’s suited to their needs. I will ask about their gross monthly income to determine if they are eligible for any state benefits. If they are, I can guide them to where they would apply for such benefits and explain how it works with their chosen plan. I’m under the impression that this is always a two-way street, And That my clients healthcare needs may change. Because of this, I like to view myself as an employee, and my clients are the “boss”. I love solving problems, And helping people.

Answered by Gregg Matheny on March 25, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Clarence &quot;Mark&quot; Christiansen · Answer

It happens every day! Much of my work involves helping people leave their employer group plan and jumping onto Medicare. There are a couple of forms that need to be filled out, signed and submitted. I am pleased to facilitate in this process.

Answered by Clarence "Mark" Christiansen on March 26, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Steven Graves · Answer

One case that stands out involved a client who had recently retired and was overwhelmed by the transition from employer-sponsored insurance to Medicare. She was unsure whether to enroll in Original Medicare with a Medigap policy or opt for a Medicare Advantage plan, and she also had a chronic health condition that required ongoing specialist care and expensive medications.

I began by reviewing her current providers, prescription needs, and projected healthcare usage. I then walked her through how each option—Original Medicare plus a Medigap plan versus Medicare Advantage—would cover her specific needs, including costs, network flexibility, and prescription drug coverage. We also checked which plans her preferred doctors participated in and compared out-of-pocket maximums.

After a thorough review, she chose a Medicare Advantage plan with strong local network coverage and a built-in Part D drug plan that covered her medications at a lower cost. I stayed in touch during the first few months of her coverage to help with claim questions and to ensure she understood how to use her benefits.

She later told me she felt confident and informed throughout the process, which made her transition into retirement far less stressful. Helping her navigate that complex decision with clarity and reassurance was a great example of the value personalized guidance can bring to Medicare planning.

Contact me.

Lauren Fodde · Answer

“One of my clients came to me completely overwhelmed after getting bills for care she thought was covered. When I reviewed her plan, I discovered her doctor had been marked as out-of-network due to a system error during the enrollment feed — her PCP selection hadn’t transferred correctly, so she was auto-assigned elsewhere. I immediately contacted the carrier, submitted documentation to correct her PCP, and ensured her visits were reprocessed at the in-network rate.

What started as a stressful experience for her turned into a learning moment for both of us — she realized how valuable it is to have someone who understands the fine print, and I was reminded how much impact a patient advocate can have when navigating Medicare’s complexity.”

Jacqueline Proffit · Answer

The Case: Repeated Denial of Necessary Skilled Nursing Care
I had a client, Mr. A, who was auto-enrolled in a Medicare Advantage plan and required an extended stay in a Skilled Nursing Facility (SNF) for intensive rehabilitation after a major medical event.

The Complex Issue: Mr. A's physicians and therapists all documented his continued need for daily skilled nursing and therapy to regain maximum function, but his MA plan issued repeated coverage denials, claiming he had reached his "maximum level of practical improvement". The plan's refusal would have forced him home without the medically necessary care he needed, costing his family tens of thousands of dollars for the SNF stay.

My Intervention: I worked closely with Mr. A's family, his attending physician, and a legal advocacy group to meticulously document his progress and his continued need for skilled care. The key was to ensure the appeals precisely countered the plan's stated reason for denial—that he had reached his maximum improvement—by using detailed clinical evidence and referencing the specific Medicare coverage rules.

The Outcome: We successfully navigated the lengthy appeal process, which involved multiple appeals against the MA plan. Ultimately, a Medicare Quality Improvement Organization (QIO) reviewing the case overturned the MA plan's denial. This decision ensured Mr. A received continuous, covered care until he was truly ready for discharge, saving his family significant financial and emotional stress. This type of success is common in appeals; in fact, over 80% of appealed denials are fully or partially overturned at the first or second appeal level.

Brian Moore · Answer

A few months back, I worked with a couple who’d been on Medicare supplement plans for years, paying high premiums with little extra benefit. They were hesitant to switch, so I walked them through their options, showing how a Medicare Advantage plan could cut costs and add perks like dental, vision, hearing, over-the-counter items, and transportation. By breaking down the numbers and network details, they confidently made the switch and saved hundreds monthly.

Answered by Brian Moore on March 26, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Melonie Wood · Answer

I had a sweet older lady who had lost her Medicaid-Medicare & was not aware that she no longer qualified for her current Dual Eligible plan. I spent several hours on the phone with her & Medicaid helping her naviagte the confusing world of getting her Medicaid reinstated.

Answered by Melonie Wood on March 30, 2025

Agent Licensed in FL & AL

Answered by Melonie Wood Medicare Insurance Agent

Robert Pennington · Answer

I have along time elderly client that called me today upset because I was the only one she felt she trust in what she was facing and didn’t want to lose me as her Agent and Advisor. She is having to move from NC to TX so her daughter can give her the care she needs. I told her to worry no more, because I can handle her Medicare coverage needs when she moves to TX and I will still be her Agent. She was one happy lady.

Answered by Robert Pennington on March 25, 2025

Broker Licensed in NC, GA, SC & VA

Answered by Robert Pennington Medicare Insurance Agent

Cheri Rogers · Answer

On a daily basis I help clients navigate complex Medicare Insurance issues. Every one of my clients and prospects have specific and individual needs to navigate to find the best fit for them. Licensed and Certified Agents are the best bet for the best fit. My services are complementary so let me do what I'm trained to do and ease your mind, save you hours of fretful seaching and research, and find the insurance for your specific needs.

Answered by Cheri Rogers on March 24, 2026

Broker Licensed in NM & TX

Answered by Cheri Rogers Medicare Insurance Agent

Joseph Bachmeier · Answer

I assist clients every day with questions on their Part D drug questions and just recently how Jefferson Health is not accepting the Cigna Commercial Network.

Patricia &#039;Tif&quot; Bush · Answer

Yes. It was a client who was being referred to rehab, and the insurance carrier didn’t want to pay under a Medicare advantage plan I spent days on the phone going back-and-forth with the client, the rehab center, the primary care, physician, and the plan. Eventually, an appeal was made, and the client got to stay for an extended period of time until they were ready to go home.

Answered by Patricia 'Tif" Bush on September 7, 2025

Broker Licensed in ct, FL, NC & SC

Answered by Patricia 'Tif" Bush Medicare Insurance Agent

Randall Taylor · Answer

I usually can resolve the situation sitting with the client or on the phone at the time that I'm made aware of the situation. Occasionally, it takes more time and research. But I ALWAYS find a way to take care of the situation. My years of experience and 'bull dog' tenacity is why I can.

Answered by Randall Taylor on September 2, 2025

Broker Licensed in TX, MI & WI

Answered by Randall Taylor Medicare Insurance Agent

Esther Miller · Answer

There are all kinds of situations that are unique when considering Medicare options. Sometimes its just helping a client navigate how to sign up for Medicare if they don't feel confortable using their smart phone or a computer; other times it's making sure their medications are covered, helping them find a new physician or dentist. Requests come all year long and I am happy to help where I can.

Answered by Esther Miller on February 9, 2026

Agent Licensed in WA

Answered by Esther Miller Medicare Insurance Agent

David Bell · Answer

I’ve helped with a lot of problems. Biggest of late: a client had her part b cancelled by Medicare. They said it was her request. It was not. It took three months of back and forth to resolve. It was a mistake by Medicare. They did get her back to where she was. Your agent should help you navigate claims, billing and enrollment.

Answered by David Bell on May 26, 2025

Agent Licensed in ID, AZ, CA & 8 other states

Answered by David Bell Medicare Insurance Agent

Edward Wooten · Answer

I got a call from a business owner whose wife had been diagnosed with cancer. She had opted out of Part B since she was covered under their company’s group plan. During her treatment, they began receiving unexpected bills and couldn’t understand why insurance wasn’t covering them. After meeting with them, I was able to pinpoint the gaps and secure the best coverage for her. Now she can focus on getting healthy and enjoying life without the stress of mounting medical bills.

Answered by Edward Wooten on December 26, 2025

Broker Licensed in IL & MO

Answered by Edward Wooten Medicare Insurance Agent

Mark Zaruba · Answer

Yes, I have walked many clients who are low income through the entire process of applying for Medicaid or any other low income or high-risk health aliments. It is my pleasure to help someone through a process that will make them a more quality living.

Answered by Mark Zaruba on March 2, 2026

Agent Licensed in WI & IA

Answered by Mark Zaruba Medicare Insurance Agent

Ryan George · Answer

We had a client that was on a very rare, and expensive, drug. However, her premiums for her plan were outrageous, price wise. She wanted us to move her to a different Advantage plan, but the problem was she was on a group Medicare plan via her husbands employer. That plan was a union worker plan and it made her rare drug be free. So ultimately she needed to stay on the high premium plan to ensure her drug was covered.

Answered by Ryan George on February 3, 2026

Broker Licensed in PA, AK, AL & 49 other states

Answered by Ryan George Medicare Insurance Agent

Mitchell Jerome · Answer

Many times I've helped clients through complicated issues and generally it's around their medications. I can calculate to the penny what their costs will be. I can help them get onto Patient assistance programs when appropriate.

Answered by Mitchell Jerome on March 12, 2025

Broker Licensed in TX

Answered by Mitchell Jerome Medicare Insurance Agent

Charles Fletcher · Answer

I had a client who visited an E.R. after having something propelled into her eye. After treatment in the middle of the night the E.R. said to her, "Go see this Dr tomorrow to complete the work. We can't complete it for you here." So, taking the E.R. Doctors instructions she did go visit that Dr who happened to be "out of network". She got the care she needed and was surprised when she received a bill from that specialist Eye Dr's office because the insurance plan was refusing to pay. We worked closely together to file "exception" requests in order to have the plan pay for the specialist visit as part of the E.R. visit. It took a while, but eventually we had followed the necessary steps for this situation and she was able to re-coop the $350 or so that had been requested by the Dr's office and the insurance treated it as part of the E.R. visit.

Answered by Charles Fletcher on March 24, 2025

Agent Licensed in WA, AZ, ID, NV & TN

Answered by Charles Fletcher Medicare Insurance Agent

Bill Green · Answer

One client came to us after receiving a large bill for a surgery they thought was fully covered. They had enrolled in a plan over the phone with a national call center and weren’t aware the surgeon was out-of-network. After reviewing their plan details, we discovered that while the hospital was in-network, the surgeon wasn’t—something the call center never explained. We helped the client file an appeal, connected them with the right billing department, and ultimately got a portion of the charges waived. Then, during the next enrollment period, we switched them to a plan that included all their preferred doctors and hospitals. They’ve been with us ever since and now call us anytime something feels off.

Answered by Bill Green on March 26, 2025

Broker Licensed in FL, AL, AZ & 19 other states

Answered by Bill Green Medicare Insurance Agent

Ezel McIntee · Answer

I once worked with a client who had both TRICARE for Life and Medicare but wasn’t sure whether they still needed a Part D drug plan. They were receiving conflicting information from different sources and worried about penalties. I took the time to review their coverage, explain how TRICARE already included prescription benefits, and showed them how Medicare and TRICARE work together. By the end of our meeting, they understood exactly what was covered, avoided enrolling in unnecessary coverage, and felt confident about their benefits moving forward.

Answered by Ezel McIntee on October 30, 2025

Broker Licensed in OK

Answered by Ezel McIntee Medicare Insurance Agent

Ruben Trejo · Answer

Had a client who was completely confused choosing between Medicare Advantage and Medigap (a Medicare Supplement Plan), worried about costs and whether their doctors would be covered. I broke it down for them, helped them understand their options, found the best fit for their needs, and made sure they didn’t get stuck with unexpected expenses.

Answered by Ruben Trejo on March 4, 2025

Broker Licensed in TX, AL, AR & 44 other states

Answered by Ruben Trejo Medicare Insurance Agent

Christopher Palazzini · Answer

My client retired in the middle of the year, wasn't drawing social security and had no clue where to go and what to do. Was unaware of multiple Medicare forms to enroll and prevent penalties. I was able to help them navigate the forms, help them contact their HR and provide the forms and get them enrolled into A, B, D and a Medicare Supplement plan in a timely manor.

Answered by Christopher Palazzini on March 25, 2025

Broker Licensed in FL, CA, CO & 7 other states

Answered by Christopher Palazzini Medicare Insurance Agent

Jon Kelderman · Answer

I had a client who had lost their Medicaid and sort through a number of bills not being paid by their current plan. We were able to get them back on Medicaid and even get the plan to back pay the bills that were not covered. It was really satisfying. I love helping people work through difficult issues.

Answered by Jon Kelderman on March 25, 2025

Broker Licensed in IA, AZ & TX

Answered by Jon Kelderman Medicare Insurance Agent

Robert Fracchia · Answer

I have helped clients navigate through the application process for their Medicare Beneficiary card.
Advocating for claim payments

Vincent Esposito · Answer

You need to  listen..  I like to have a conversation and see what is important to the prospect. Try to have a sense of humor..  laughter is good medicine

Nathan Wright · Answer

One that comes to mind — I had a client who wanted to keep working and decided to cancel her Part B to avoid the premium. What she didn't realize is that getting it back isn't simple, and we spent months waiting and hours on the phone with Medicare to get her Part B reinstated. Once we finally got her back on track, we found her a giveback plan that actually covered most of her Part B premium — but that whole situation is exactly why I tell people, before you make any changes to your Medicare, call me first.

Answered by Nathan Wright on May 23, 2026

Broker Licensed in TN, AL, FL & 10 other states

Answered by Nathan Wright Medicare Insurance Agent

Corey Romero · Answer

Sure! Here’s a recent one that sticks with me:

I had a someone call in who was transitioning from employer coverage to Medicare, but she was still working part-time and had COBRA offered to her. The HR department gave her some half-baked advice and basically told her to take COBRA and “figure out Medicare later.” Problem is, that can screw up your Medicare Part B enrollment and lead to a lifetime penalty or delayed coverage start.

When she reached out to me, she had no idea that COBRA doesn’t count as creditable coverage for delaying Medicare enrollment. If she followed their advice, she would’ve ended up paying more forever and had a gap in her health insurance.

I walked her through exactly how to enroll in Part B on time avoiding those penalties and helped her choose a supplement that kept her doctors and medications covered without all the network drama that she had faced on her group plan.

Her exact words after we finished: “Why didn’t anyone tell me this earlier?”
My answer? “Because they don’t get paid to.” 

The unfortunate truth is that HR employee likely didn’t have bad intentions but was simply going off of the limited knowledge that they had so it is a great example of why it’s so important to work with someone who really knows the intricacies of Medicare enrollment.

This is what we a great agent will do. We cut through the noise and get people the right coverage the first time. No guessing. No confusion. Just the truth.

Jill Belvin · Answer

I help clients navigate complex medicare issues daily. Medication is an issue that can be difficult to navigate and I help clients determine which prescription drug coverage will be the least cost for medications and provide the best coverage for their prescription drug needs. 

I also help navigate starting Medicare after turning 65 and leaving a creditable group plan by submitting the correct paperwork to Medicare to prevent any late enrollment penalty charges!

Brady Kidwell · Answer

I once received a call from a member who was confused about their benefits and felt frustrated. Another agent signed them up on. I calmly listened to their concerns (Situation) and assured them I would help. I took the time to explain their coverage in detail and provided them with written documentation for their reference.

Answered by Brady Kidwell on June 4, 2025

Broker Licensed in TN, FL, GA & KY, NC, SC & VA

Answered by Brady Kidwell Medicare Insurance Agent

Charles Boone · Answer

I have had multiple seniors call me after falling victim to fraudulent activity pertaining to Medicare. In these situations we typically gather all the necessary information to begin unraveling what took place, how it occured, and what needs done to correct the issue moving forward.    

This most commonly occurs with telemarketing calls and TV advertisements that promote "extra benefits" for Medicare beneficiaries. Often times we have been able to limit the damage but unfortunately that is not always possible.

Michele Vina · Answer

Most often, prescription medications can be a complicated issue for my clients. However, I'm able to help them find the best coverage for the lowest cost. There are plenty of options beyond traditional Part D plans.

Answered by Michele Vina on March 26, 2025

Broker Licensed in TX, KY, OH & OK

Answered by Michele Vina Medicare Insurance Agent

Wade Lashley · Answer

In early 2024 I had a Client who used a special enrollment period to start he's Medicare benefits at the time of his retirement. He had issues getting enrolled in part B but managed to get it taken care of in late January. 

We submitted an enrollment for a Medicare Advantage plan to begin on February 1st. There was a mix up at Medicare and they instructed the insurance company to cancel his enrollment. Too many details to share here but I took the additional steps required to get his coverage reinstated. It took some time and a few phone calls but I was glad to do it.

Greg Milliser · Answer

Often times when Medicare beneficiaries receive a bill they don't understand or are unsure why they are receiving it in the first place, I am able to walk them through it and know what to do next and where to get the answers to their question about the bill. Often times the thing that needs to be done is simply ask the provider to resubmit the claim and the issue is often found that there was a mistake made in the coding or some other detail like that and once it's been sent again to the carrier, the mistake is found and the bill is corrected and the client never hears from them again. Having many years of experience with Medicare helps me to navigate those complex issues quite easily.

Answered by Greg Milliser on March 25, 2025

Broker Licensed in MO, AR, IN, KS, OH & OK

Answered by Greg Milliser Medicare Insurance Agent

Bob Thompson · Answer

The individual thought they had applied for Part B in a timely manner, when actually they had not. I guided them through the process of getting that corrected so they would not have a preiod of not being insured.

Answered by Bob Thompson on March 25, 2025

Agent Licensed in IA

Answered by Bob Thompson Medicare Insurance Agent

Jason Rubin · Answer

I assisted an individual last week who was new to Medicare and had no idea the difference between original Medicare with a supplemental plan or a Medicare Advantage plan. After conducting a thorough needs analysis, it was determined that most of his doctors accept Orignal Medicare only. I proceeded to enroll the individual in a Medicare supplement plan along with a Part D drug plan.

Answered by Jason Rubin on March 25, 2025

Broker Licensed in CA, AK, AL & 33 other states

Answered by Jason Rubin Medicare Insurance Agent

Tina VanPhung · Answer

I remember a client whose Medicare Advantage plan denied coverage for their mobility scooter, which is considered durable medical equipment.

They had just had surgery and needed the scooter to help with their recovery. They bought the scooter on their own, without a doctor’s referral. Their family felt overwhelmed and confused for several reasons:

They didn't know that the doctor needed to prescribe the scooter 
The scooter supplier must be in the network 
The plan denied covering the scooter right off the bat

Naturally, they were upset and blamed the plan, not realizing they didn’t fully understand the Medicare procedures.

It is important to work with a broker so they can help when this sort of thing happens.  

I reminded them of the plan's fine details. It was an HMO-POS plan, and for 2026, referrals were required. Rules have updated in 2026.  

Medicare rules are complex:

Prior authorizations
Referral requirements
Tier exceptions
Formulary changes
Network limitations

What looks like a “no” is often what seems like a “no” is really just a paperwork or process problem.

Jim Neil · Answer

The complexities of Medicare cases typically revolve around the prescription drug coverage. I save people hundreds and sometimes thousands of dollars just by a thorough search through the plans to ensure proper coverage and saving money through copays. Many drug plans have copays of 25% but other drug plans have copays of $47 per refill. I take great pride in ensuring customers don't overpay for their insurance and for their prescriptions.

Answered by Jim Neil on March 26, 2025

Agent Licensed in MI, AL, AR & 31 other states

Answered by Jim Neil Medicare Insurance Agent

Lauren Singer · Answer

Diabetes care can be complex. Between finding the supplies, or the paperwork or the costs, a few of my clients experienced some issues. I had to find a ads, or an advanced diabetes supplier who helped my clients set up for home delivery as soon as there medicare plans began.

Answered by Lauren Singer on March 25, 2025

Broker Licensed in SC

Answered by Lauren Singer Medicare Insurance Agent

Shane Thomas · Answer

The timing of this question could not have been better. Just yesterday (5/27), we received a call from a client who was overwhelmed, confused, and in urgent need of guidance after unexpectedly losing his health plan coverage.

We immediately stepped in to assess the situation and determine the best path forward. After doing extensive research into his coverage history, medications, providers, and current healthcare needs, we uncovered the issue: he had previously been enrolled in a DSNP plan but lost eligibility after his Medicaid coverage became inactive. As a result, he was disenrolled from his plan and left with only Medicare Parts A & B and a standalone PDP plan.

At the same time, he and his social worker were actively working to restore his Medicaid eligibility. Knowing how critical timing was, we quickly gathered all the necessary information, including his 12 medications, provider network needs, and the fact that he was receiving dialysis treatments. From there, we identified a plan that would properly support his healthcare needs and moved immediately to get him enrolled.

Because technology was a challenge for him, we didn’t stop there. Within a few hours, we personally drove to his residence to meet with him face-to-face and assist him through the enrollment process to ensure everything was completed correctly and without added stress.

The client was extremely grateful for how quickly we responded and for the personal attention and care we provided during such a difficult situation. We also reassured him that we will continue monitoring his Medicaid status and help transition him back into a DSNP plan once his Medicaid becomes active again.

This is exactly why we do what we do — helping clients navigate complex Medicare situations and stepping in when they need an advocate the most.

Isaac Lind · Answer

Most of the time the billing and claims for these plans are not complicated..... until you have a time when things are messed up. 

In these circumstances, working with a local agent like me has its advantages. I provide lifetime billing and claims support for all of my clients, at no extra charge to them! This definitely beats calling a phone number where you wait on hold or can barely understand the person! 

It does not cost a penny to work with me, but you get extra help!

Brittney Brock · Answer

Every client’s situation is different, so I’d say every interaction involves navigating a unique Medicare issue. For example, some people might qualify for state assistance, while others have VA benefits or Tricare for Life. Then there’s the fact that everyone’s medical history is different, which can significantly affect their coverage needs.

To really help someone, I make sure to take the time to understand their specific circumstances. It’s all about listening to their needs, their healthcare situation, and any other benefits they might be eligible for. Once I have a clear picture, I can guide them toward a good option based on their individual situation. It is not just a one-size-fits-all solution.

Allison Klein · Answer

All the time!! I had a client have an unexpected expense at that pharmacy with a new insulin they were prescribed. I helped them find an assistance program and get the medication free of charge!

Steven Bleicher · Answer

This is a case which happened around the pandemic. I have a female client who went to her specialist who prescribed a drug for her malady. The doctor ordered it for her and it went directly to the specialist's office for dispensing. However, once the Covid 19 crisis became a major problem for the entire country, my client discovered that the medication would NOT be advisable and was "contra"-indicated due to the pandemic which by then was running rampant. The specialist sent a large invoice to the client who by the way, was not even aware that the specialist had ordered it from the pharmaceutical manufacturer. Since the client didn't want to make waves, she was kind enough to pay for the drug which now couldn't be used by anyone. 

Subsequently, the client related this story to me, as her agent. Since she had a unique Medicare Supplement policy which pays for anything that is coded as "Preventive" and had not been paid for by Medicare. 

My response to her was: "Put in a claim. It will only cost you a stamp to mail a copy of the paid invoice to the insurance company's claims dept. Nothing ventured, nothing gained". We talked further and the more I thought about it, the more upset I became with this entire incident. I also reiterated one of my favorite expressions which I give everyone reading this my permission to use: "If you don't ask the question, the answer is always NO!.  

The result of the claim was that my client received a check about 2 weeks later from the Medicare Supplement company for over $2,000.00!  Needless to say: when my client notified me of this windfall, it made my day, my week and my month!!

Priscilla Ramos · Answer

A client turning 65 was confused about whether to stay on Original Medicare or switch to Medicare Advantage. I reviewed her doctors, prescriptions, and costs, then helped her choose a plan that kept her doctors and lowered her medication expenses, all at no cost to her. Happy client.

Answered by Priscilla Ramos on March 28, 2026

Agent Licensed in OH, AZ, FL & 5 other states

Answered by Priscilla Ramos Medicare Insurance Agent

Walt Smith · Answer

I had a client that was taking 21 different medication’s. We had to find the right plan for him and we looked at every single plan in New Jersey and we found the one that was cheapest for him at his drugstore.

Answered by Walt Smith on March 25, 2025

Agent Licensed in NJ, NY, PA & VA

Answered by Walt Smith Medicare Insurance Agent

Leslie Helene Sussman · Answer

Yes - Medicare can be complex especially for those New to Medicare that continue to work and decide to stay on Employer benefits.    I would suggest still contacting a Medicare Broker to confirm your choice.    Many times, Medicare can be less expensive than employer benefits (You want to compare).   If you are able to continue on your employer health plan -you are able to delay your Part B (not pay the Medicare premium) when you continue to have credible coverage (Part D).

I have clients that pay part B while able to stay on Employer benefits.

Frank Woerner · Answer

I have assisted seniors save money on high-cost prescriptions. I have also found lower cost drug plans and Medigap plans form my clients.

Celeste McGrath · Answer

A new person called me recently because he had just received his citizenship status but when he applied for Medicare (at the age of 70) he was hit with a high late enrollment penalty for not enrolling in Medicare at 65. Together we called the SS office and explained that due to his citizenship status he was not eligible for Medicare at 65 so he should not have a late enrollment penalty. They had to escalate the issue and finally they agreed that our math was correct and they dropped the penalty.

Answered by Celeste McGrath on May 26, 2026

Broker Licensed in GA, FL, NC & SC

Answered by Celeste McGrath Medicare Insurance Agent

Alan &quot;AL&quot; Minthorn · Answer

I had a client call a TV ad 800 number during Annual Enrollment in a moment of emotional weakness having just lost their spouse. They were assured all their docs and drugs were covered by that new “TV giveback plan.”  They had 13 docs and 23 drugs. Ten docs were out of network on the giveback plan; the cost sharing for the 23 drugs was over $10,000 more than their current plan.

They called feeling shame and embarrassment for succumbing to the fast talking agent at their low point emotionally. I KNEW I COULD “FIX” IT. It took hours to reverse the damage caused by the fast talking TV call center agent. As it was still AEP, it was easily reversed with a few days to spare. But still caused the customer a lot of worry over the several weeks of processing time.

Donald Elliott · Answer

Wow, that is easy to understand but so challenging to answer. A Medicare Agent is very limited due to HIPPA regulations. I do go as far as I can to help. That often involves submitting a service inquiry and/or an appeal.

Answered by Donald Elliott on January 5, 2026

Broker Licensed in AL, GA & MS

Answered by Donald Elliott Medicare Insurance Agent

Tammy Stoner · Answer

Every client I meet is treated as though their Medicare is a complex issue.  

Over the last 10 years, I have helped 100's of clients find the right plan at the right price for the right reasons.  Some are easy decisions, others are more difficult, but each is very important to ensure the best coverage available.

Stephanie Yarberough · Answer

The world of an insurance broker is never boring, as each client's situation and specifics are different. I have had many clients that received misguided advice from a 1-800 number or even local Govt organizations before coming to me and ended up in a Medicare Insurance Plan that caused them significant out-of-pocket financial exposure, or they could not see the doctors they wanted to see. I have then provided a thorough explanation of options that were often not explained to them originally and navigated enrollment windows to get them on an insurance plan much better suited for their needs.

Answered by Stephanie Yarberough on March 4, 2025

Broker Licensed in PA

Answered by Stephanie Yarberough Medicare Insurance Agent

Gretchen Morris · Answer

It's important to have an agent who is experienced and willing to help. I had a client who was on an advantage plan and within the first year had a catastrophic health event. We were able to switch them over to a medigap plan that would ultimately save them thousands of dollars in addition to relieving their stress and giving them peace of mind. This way they could focus on getting better rather than where they were going to get the funds to pay the bills.

Answered by Gretchen Morris on March 4, 2025

Broker Licensed in MN, AZ, FL & WI

Answered by Gretchen Morris Medicare Insurance Agent

Sean Davis · Answer

There was a client who was confused about transitioning from employer-sponsored health insurance to Medicare. They were unsure about when to enroll and how to avoid penalties. I guided them through their Initial Enrollment Period, explaining the importance of enrolling in Medicare Part A and Part B. We compared their current plan benefits with what Medicare offered and I helped them understand potential Medicare Advantage plans that would meet their needs. In the end, they felt more confident and relieved to have a clear roadmap for their Medicare coverage!

Answered by Sean Davis on March 26, 2025

Broker Licensed in NY, LA, MD & 6 other states

Answered by Sean Davis Medicare Insurance Agent

Michael Crocker · Answer

I once met an individual who had paid thousands of dollars over the years due to a late enrollment penalty. I assisted him with filing an appeal and we were able to get his penalty completely removed.

Julie Joyce · Answer

My parents! My dad was overpaying and has a lot of medications, my mom has zero meds. They were very overwhelmed we had to find a good fit for my dad and his meds along with he had doctors in 2 very different networks. I ended up saving them over $600 a month!

Answered by Julie Joyce on March 25, 2025

Agent Licensed in PA, CT, DE & 9 other states

Answered by Julie Joyce Medicare Insurance Agent

Christopher Orr · Answer

I do it everyday thru our innovative program that looks your doctors and prescripts up before enrolling ranking plan choices for your review with agent recommendations

Tammie Rutledge · Answer

We recently had a 70 year old male contact us. He never activated his Part A and Part B or Part D with Medicare.  He also has no income per se'.  We advised him to file for the Medicare Savings Plan with DSHS first and then apply for Medicare.  If he is approved by DSHS, they will pay his penalties.  He is also started Kidney Dialysis so he is automatically qualified for Medicare. 

He had not filed taxes in years, even though he has a business. The business was constantly losing money, so he took no income.  He has a partner who has been supporting him financially.

George Kolitsas · Answer

Every single day. From saving money on prescription cost, or reviewing there benefits, or helping them qualify for state specific programs that they were not aware of.

Paul Dzierzanowski · Answer

I recently received a call from a lady referred to me through an existing client. The lady had original Medicare only and desperately needed some type of supplemental coverage due to the fact that, unfortunately, she was battling cancer. With the recent cancer diagnosis and no guaranteed issue qualification, I showed her the available Medicare Advantage (MA) health plan options in her area for which she qualified. I met with her personally and we carefully examined the various plan details and benefits. She selected a plan that included all of her physicians and covered her current prescriptions. Her first course of treatment under original Medicare was going to cost her close to $14,000 out of pocket. Her expected treatment under the MA plan she chose was a Part B drug, and would make her reach her maximum out of pocket of $4,900 in the second week of a six week treatment plan, but $4,900 is less than $14,000. After her plan took effect, the insurance utilization manager at the oncologist's office submitted the lady's information to the chemotherapy company and they granted her a scholarship for the chemotherapy drugs. Her out of pocket will be $0.

Answered by Paul Dzierzanowski on March 25, 2025

Agent Licensed in FL & GA

Answered by Paul Dzierzanowski Medicare Insurance Agent

Ron Hamilton · Answer

Sure!  I do the same thing every time I meet a new client.

Because often, people understand concepts more quickly with pictures and/or diagrams.  I have a diagram that I walk each customer through, showing the options and paths available to them.

Almost without exception, by the end of the conversation, people have made a decision on whether a Medigap plan or an MAPD plan is best for their health and their wallet.

Hope this helps

David Koller · Answer

We are there for our clients and we are known for answering our phones. One client had a very expensive medication that she could not afford. We helped her ask the right questions to her provider and she found out about a pharmaceutical grant to pay for her medication.

Answered by David Koller on March 26, 2025

Broker Licensed in UT, ID & NV

Answered by David Koller Medicare Insurance Agent

Lowana Richardson · Answer

Too many times to think of. Probably when a client came to me because he did not have Part A and when he went to SS they said to go to Medicaid, and when we went to Medicaid, they said no go to SS. We were eventually able to get him covered through Medicaid who paid his penalty to allow him to be able to afford Part A. For Hawaii, it was Medicaid that was supposed to do someting first - their "thing". Each were saying they could not do it without the other doing something first.

Answered by Lowana Richardson on May 19, 2026

Agent Licensed in HI, AZ & CA

Answered by Lowana Richardson Medicare Insurance Agent

Deborah Zanelotti · Answer

I had a client that was paying for their Part B premium and didn't need to be. They thought because they retired they needed to but their spouse was still working and the one holding their health insurance plan. I explained what they would need to do to disenroll from Part B, they would not have a penalty and when the spouse decided when they were going to retire, to reach out to me so I could give them the proper forms to have filled out to confirm "creditable coverage" as so not to have to pay a penalty. They saved thousands of dollars because the spouse did not retire for at least another 10yrs. Medicare is a spiderweb of scenarios and an experienced agent will identify any issues with the proper questions, if they treat each client individually.

Answered by Deborah Zanelotti on December 13, 2025

Agent Licensed in MD, CA, DC & 11 other states

Answered by Deborah Zanelotti Medicare Insurance Agent

David Ghiorso · Answer

I can think of multiple times when a client was facing complex Medicare issues, which really means, they were having to compare the two different Medicare Pathways. More complex situations can arise when one has, employer retiree health insurance and has too look at price and coverage when comparing that to outside Medicare plans.

Answered by David Ghiorso on March 25, 2025

Agent Licensed in CA, AZ, IA, MT, NV & TN

Answered by David Ghiorso Medicare Insurance Agent

Jeffrey Simpson · Answer

Restructuring a choice of plans so that their PCP and medications were inclusive.

Reexamining a person's plan through a thorough "needs analysis" and found this person to qualify as a dual beneficiary.

Martin Cahill · Answer

Had a woman in need that was Mass health standard level in Massachusetts. I asked her how she was doing and she replied i have not eaten in two weeks! Her being Mass health Standard level she was eligible for our Senior Care option plan. Subsequently had some food delivered and got her some help coming in to check on her...

Answered by Martin Cahill on March 4, 2025

Agent Licensed in MA, CT, FL & 5 other states

Answered by Martin Cahill Medicare Insurance Agent

Ted Heckel · Answer

Client was in a Medicare Advantage plan and recently was told would have to start dialysis, luckily we were able to switch to Original Medicare with a Supplement as secondary, saving him a few thousand dollars.

Vachik Chakhbazian · Answer

I provided clear and concise explanations of the Medicare regulations and plan's coverage rules, helped the client gather necessary documentation, and filed an appeal on their behalf.

Mary Brown · Answer

One of my clients was struggling to afford an important medication because her costs had gone up significantly. I took the time to carefully review her plan and compare options across multiple carriers. By looking closely at the formulary and medication tiers, I was able to find a plan that not only brought her prescription costs down but also kept her doctors in network. She left feeling relieved and supported, and I was grateful to know that my knowledge and guidance made such a meaningful difference for her.

Jennifer Kalbach · Answer

I had someone come in my office talking about another line of insurance when they mentioned that they were going to change from Medi Gap Plan g to a a MAPD.  I took lots of my time to explain to him the differences and why he should consider to stay on the Medi Gap plan and not move to a MAPD plan.  Unfortunately, the other agent he spoke with that talked him into the MAPD plan did not have his best interests at heart as there are significant differences between the coverages.

Andrew Kelly · Answer

I've had the privilege of helping many clients with complex issues and supporting the resolution. Below are a few examples.

1) Discovered that a client was inadvertently enrolled in a MAPD plan and was paying for a Medicare Supplement.

2) Helped a Veteran navigate the world of VA benefits and making decisions about what parts of Medicare they need to engage with.

3) Supported multiple clients in understanding how their annual income affects their Part B premium, and when appropriate, helping them make retirement plans to maximize their assets and minimize their out-of-pocket expenses.

Michael Kim · Answer

Just yesterday a client of mine thought just because he enrolled into Medicare Part A and Part B that he had everything and he no longer had a penalty charge. I explained to him that he had to enroll into a plan like a Medicare Advantage Plan that covered a prescription drugs to not get a penalty charge. So he really did thank me for that and now he is one of my clients under my Book of My Business.

Ben Washington · Answer

I had client paying out over 3,000 for premium for a Medicare Supplemental plan but was not sure about getting into a Medicare Advantage Plan.  I explain to the client that even though he has had a Medicare supplemental plan for over ten years.  He still has a one-year trial period to enroll in a Medicare Advantage plan and get back into Medicare Supplemental plan without having to answer any medical questions. (Called guarantee issued right)

Toni Chavez · Answer

Thanks for your question!

Yes, actually today I am helping a client submit a claim form to get reimbursed for his quarterly exercise benefit his plan gives him.   He has peace of mind knowing as his broker he doesn't have to call an 800# to get it his issue resolved.     Most Medicare beneficiaries don't realize using a local broker is no-cost to you. 

Hope this answers your question.

Be well,
Toni Chavez 
Medicare Broker

John Motsinger · Answer

I have a client who had partial medicaid, and therefore they were still responsible for copays. They are also an organ transplant survivor and they use an insulin pump. Well, anti rejection drugs and insulin for an insulin pump (by medicare rules) is billed through medicare part B. That meant my client was required to pay 20% of those drugs, and it was costing them almost $200 each month. We reached out to their doctor prescribing the medicine and unfortunately they weren't able to assist them with these drugs. Then I did more research and found out there was no prescription assistance program for these drugs. With that in mind, I wrote a letter to the state of Kentucky medicaid on behalf of my client, and asked them to please make an exception and give my client full medicaid, so they didn't have to pay almost $200 a month for drugs. The state of Kentucky saw the desperate place my client was in and they approved him for full medicaid, even though his income only qualified him for partial medicaid. My client is no longer having to pay $200 each month out of pocket on his drugs and it changed his life. This is what happens when you get a knowledgeable agent like myself that is willing to go the extra mile to help their clients.

Robert Remin · Answer

Hello, I'm Robert Remin, expert Medicare plan advisor, licensed and Medicare certified, and certified with the carriers I represent in New York, Connecticut, New Jersey, and Florida. I assisted a very well-known retired actress who, for some reason, her current Medicare agent could not get her Part B done in the timeframe that she needed. It was actually getting delayed and delayed, and she didn't know how to get it done in the timeframe necessary for her to start her Medicare plans because she was leaving her work coverage. I was able to assist her in doing that. So that's an example of a complicated Medicare situation where I assisted a client.

James Wareheim · Answer

I have several clients move from one state to another.  With a Medicare Advantage plan we have to find the plans that are available in their new home area and help them pick a plan.  In some cases we need to get a non-resident insurance license for that state in order to be able to help them.

Blaine Shipe · Answer

I often work with clinicians who are helping the patients they see to transition out of hospital and back home with the tools necessary so they do not return as often to hospital

Christine Brewer · Answer

Certainly! Once, I assisted a client who was overwhelmed by the myriad of Medicare options available. I simplified the information, guiding them through the selection of a plan that best suited their health needs and financial situation, ensuring they felt confident and informed in their decision.

Tony Hardwick · Answer

I had a caller who was losing their Medicaid assistance because they moved to a different state. I was able to assist them with finding a plan in their new area. Since they lost Medicaid, I suggested a plan with the Part B reimbursement benefit that would provide some of their premium back since the state was no longer paying it. I informed them that they can re-apply for Medicaid in their new state if approved, they would then be able to enroll in a new plan that reflects that they have that assistance and will qualify for a special election period due to regaining Medicaid assistance.

Ingrid Kollmann · Answer

It was actually a Medi-Cal related matter.... Huge share of cost..... client ended up dropping out of Medi-Cal and opted for a Medicare Supplement Plan G with a Medicare Prescription Drug Plan

Robin Duffey · Answer

Almost daily!  Seriously, to most individuals, Medicare is a maze and I love explaining Medicare,  Medigap and Medicare Advantage options so it is easy to understand.  I feel once the person understands it is not that complicated and to approach their healthcare options for them and not what their family, neighbor or what they see on TV, I feel a calm comes over them with a nice understanding.  So, pretty much that is how I help clients since I am a major research nerd and love when I see the 'light bulb shine" of understanding once we work it all out.
Hope that answers your question ~~ Robin

Jim Carroll · Answer

The spouse of a man who had Original Medicare Parts A and B, and was very ill contacted me for help. The man had developed a chronic condition that is listed under one of the 15 categories designated by Centers for Medicare & Medicaid Services. Medical bills were foreseen to stack up quickly.

The woman asked if I knew how she could get Medicaid for her husband. In addition to explaining how and providing the website, I help enroll him into a Medicare Advantage Chronic Special Needs Plan (C-SNP). The insurance company sends a chronic condition verification form to the primary care physician. Once the form is faxed back, the plan is approved and the goodness starts to happen.

C-SNPs are tailored to help the client with their specific medical needs, and assigns them a Care Coordinator from the insurance company. Typically, there are very minimal out-of-pocket expenses with these plans. And, many even have a Medicare Part B giveback, which means that a portion of the $185 monthly premium for Original Medicare Part B that is deducted from a person's Social Security Check each month is returned.

My client's wife had no idea these type of plans were available, and I was so happy to help alleviate the medical and financial burden from them.

Sean Macbean · Answer

Since everyone's healthcare situation is different, we take a custom approach to help you design a plan that works best for you. 

We review these plans annually and adjust them as needed.

Lori Marion` · Answer

I will withhold from sharing too much. But if you're ever made someone's power of attorney,  just know that you're responsible for their well-being and they can't do anything or get any other help without you.

Daniel Underwood · Answer

Absolutely! I remember a client who was really overwhelmed trying to switch from their Medicare Advantage plan back to Original Medicare and add a Medigap policy. I took the time to walk them through the steps, explained how to avoid any penalties, and helped them find a plan that fit their needs and budget. Hearing how much easier it made things for them was incredibly rewarding.

Robert Rowe · Answer

Very recently I had a client who was paying over $300 a month for his Medicare supplement plan, and when I tried to do a rate reduction for that, I uncovered an underlying condition with his heart and it was heart failure. From the heart failure he was prescribed very expensive heart medication‘s that while still covered under his drug plan were coming back with very high costs for him. So what I did was look at C-SNP Options that would actually put those expensive heart medication’s into his tier 6 drug formulary and we ended up saving him just by switching Medicare plans, over $9000 a year in drug costs.

Babs Atwell · Answer

I recently had a member who was prescribed an expensive biologic medication for Crohn's disease.  Her Medicare Advantage plan had the medication listed as a tier 4, and the insurance company had another plan where the same medication was listed as a tier 2.  I had recommended that the member request a tier exception.  The company approved the tier exception and reduced her medication to a tier 2 making it affordable for her without switching her plan.

Paul Mercier · Answer

I have been helping people with Medicare for over 30 years and the one thing I tell everyone is that Medicare itself is complex so you csn start with that. But, to give a specific instense, I have a client that lives in N.H. but all of their Drs. are in Massachusetts and not onl that but where they live in N.H. does not have many companies that cover that area so it is a constant battle to get them coverage between Drs. and Hospitals changing who they except and the lack of options because of wgere they live.

Deborah Lee · Answer

Many times, the one that stands out for me are clients who have no idea what is available and how to get extra benefits... DSNP

Linda Bolan · Answer

Most of the complex issues I have dealt with seem to be when a client has Medicare and Medicaid.  Often the client doesn't know what he/she has.  So I help determine their level of Medicaid if they have it and find a plan that will best fit their needs.

John Stagner · Answer

Yes. I met with a couple in their late seventies who had never had a Part D plan, and the husband was now getting prescriptions for several expensive drugs. They really couldn’t afford them. Enrolling them into a Part D plan would trigger a late penalty of 12% for every year since age 65. 

After doing the math on the late penalty, paying the late penalty plus the cost of the drug plan and the cost of the drugs turned out to be the best decision. They went from over $700 per month without coverage to around $150 per month, and they were very happy with that.

These stories are more common than you might think, and many times, we’ve been able to find a workaround for Rx issues. Having been through extensive training on solving these issues and having an entire team of pharmacists as a backup doesn’t hurt!

George Francis · Answer

The most complex Medicare issue I've had to assist a client with was getting their Part B reinstated after termination. On its face, it appeared to be an easy task. However, unpacking the reasons for termination, insuring client's eligibility for reinstatement and determining the appropriate Special Election Period (SEP) were not so simple. But through patience and persistence the client objectives of the client were met.

Ricky Gonzalez · Answer

I remember helping a client in Florida who had just been diagnosed with cancer when she received a letter saying she was losing her Medicaid, which meant she would not only have to start paying her Part B premium but also risk losing access to the chemotherapy and specialists who were treating her. 

We moved quickly to enroll her in a Medicare Advantage plan that kept her doctors in place and protected her with a maximum out-of-pocket limit, allowing her to continue her treatment without interruption and without the financial fear that had been keeping her up at night.

Robert Vitale · Answer

I once received a call from a member who was confused about their benefits and felt frustrated. Another agent signed them up on. I calmly listened to their concerns (Situation) and assured them I would help. I took the time to explain their coverage in detail and provided them with written documentation for their reference.

Answered by Brady Kidwell on June 4, 2025

Broker Licensed in TN, FL, GA & KY, NC, SC & VA

Mirian Mercado · Answer

A client was turning 65 and still covered under spouses plan and was confused about whether she should enroll in Medicare. I reviewed her current plan, explained how Medicare would coordinate with employer coverage and helped them understand possible late enrollment penalties. My client avoided gaps, penalties and felt confident about enrollment.

Christian Marti Del Campo · Answer

One of my clients, a 72-year-old gentleman with diabetes, was struggling to afford his insulin under his current Medicare coverage. He had been paying hundreds of dollars each month and wasn’t aware that there were Medicare Advantage plans and Extra Help programs that could significantly reduce his out-of-pocket costs.

I sat down with him and carefully reviewed his medications, his doctors, and his eligibility for savings programs. Together, we compared several plans available in his county that included enhanced Part D coverage for insulin at a capped cost. I also helped him complete the application for the Low-Income Subsidy (Extra Help) program through Social Security.

The result was life-changing for him: his insulin dropped to $35 a month, and he also gained dental and vision benefits he never had before. What mattered most to him wasn’t just the savings, but that he felt someone had taken the time to explain the options in simple terms and guide him step by step.

That experience reinforced why I love this work — helping people cut through the complexity of Medicare and find a plan that truly supports their health and financial well-being

Cory St. Etienne · Answer

I helped a family of 3 on 3/25/25 find a plan with the medicare benefits they were looking for and assisted them with the enrollment process. I had to explain their level of benefits they were approved for and help explain the new coverage they were going to recieve with their new plan.

Wayne Victor · Answer

A couple who had just moved to Colorado called me confused because their Medicare Advantage plans no longer covered their doctors or prescriptions. I explained their Special Enrollment options, compared local plans, and helped them switch to one that included their providers and saved them over one hundred dollars a month. They later told me it was the first time Medicare actually made sense to them.

Abbie Choate · Answer

I helped a client who was losing their Medicaid (Medi-Cal) coverage and was completely overwhelmed. They had no idea what that meant for their Medicare or how they were going to afford their prescriptions. I took the time to walk them through their options, helped them apply for a Medicare Savings Program, and found a plan that covered their medications at a much lower cost. By the end of our conversation, they went from stressed and unsure to relieved and confident. That moment really stuck with me because it reminded me why I love doing this—making sure people don’t have to go through these challenges alone.

Deborah Bates · Answer

Just today.  I helped someone figure out how to appeal their healthcare need to their plan.  It was not hard for me, but it made their life easier.

Jaime Umanzor · Answer

I had a client once who had specific doctors and clinics she had to visit because of a health issue, but she had a plan that wouldn't cover the facility or the prescriptions. We navigated all options in her area and found the most suitable for her healthcare needs and her medication as well.

Mindy Foran · Answer

I go above and beyond assisting clients that are confused on how to navigate setting up their online accounts when applying for Medicare.

Edward Allen · Answer

In a 3 day appointments I helped a 57 year old client who is deemed disabled and Medicare eligible, untangle the mess made by Covered California before he could enroll in a Medicare Medi-Gap Plan and PDP

Erin Stott · Answer

I had a client who had several health issues and a very high premium, I was able to help them work through their plan and found a plan that helped to save them money and fill in the gaps so they had complete coverage.

Micheal Rohlmeier · Answer

Most issues with Medicare can get complicated…just the nature of the beast.  Having someone on your side to help you navigate it is important.  I recently helped a client refute their Part D late enrollment penalty.  They were approved and the penalty was removed as we could show they had creditable coverage for the time in question.

Lynsy Meier · Answer

In a recent Medicare plan review, I discovered that the person qualified for the Medicare Saving Program and this opened the door to more plan options with lower out of pocket costs.  She shared with me that her status had not recently changed, however she had never been told she qualified for the additional plan options.  She reached out to me within 2 weeks of enrolling in her new plan and was so happy to be saving money when seeing her health care providers!