Medicare FAQ
Why is Medicare so confusing?
There is so much to consider! And so many plan choices!
Most important of all, the decision can affect your medical coverage for the rest of your life.
A Medicare advisor can help you:
✔️ Understand your options (Parts A, B, C, D & Supplements)
✔️ Compare plans based on your doctors, prescriptions, and budget
✔️ Avoid costly penalties or coverage gaps
✔️ Stay updated on changes each year (like plan benefits and star ratings)
✔️ Get personalized guidance—at no cost to you
The right guidance can make all the difference in choosing a plan that truly fits your needs. Take the guesswork out of Medicare and get expert help!
What are the different types of Medicare plans?
Here’s a quick breakdown:
Part A – Hospital coverage (inpatient stays, skilled nursing, some home health, hospice)
Part B – Medical coverage (doctor visits, outpatient care, preventive services)
Part D – Prescription drug coverage
Advantage – Not referred to as Part C anymore, however a combination of Basic Medicare with a Medicare Advantage plan
Medicare Supplement (Medigap) – Helps cover out-of-pocket costs like copays, coinsurance, and deductibles in addition to Original Medicare (Parts A & B)
Understanding how each part works together can help you choose the coverage that fits your health needs and budget
Are Part D plans separate from Medicare plans?
Part D plans depend of the type of Medicare plan you choose and your individual needs.
Standalone Part D Plan (PDP) – Add drug coverage to Original Medicare (Parts A & B)
Medicare Advantage Plan – Many plans include prescription drug coverage (MAPD), combining medical + drug benefits in one plan
Employer or Union Coverage – Some retiree plans include creditable prescription coverage, so you may not need Part D right away
Other Creditable Coverage – Coverage from sources like the VA or TRICARE may count as Part D equivalent
Choosing the right path depends on your current coverage, medications, and budget. Make sure your prescriptions are covered and your plan meets your budget!
What do the stars mean in Medicare plan ratings?
The Medicare Star Rating is a government mandated system that helps you compare plan quality—from 1 star (lowest) to 5 stars (highest). These ratings are based on things like customer service, member satisfaction, preventive care, and how well the plan helps manage chronic conditions.
5 Stars = Excellent Performance
4 Stars = Above average
3 Stars = Average
2 Stars = Below average
1 Star = Poor performance
Star ratings can change every year based on a plan’s performance. It is important for you and you Medicare Advisor to review your plan annually – especially during open enrollment periods
Choosing a higher-rated plan can mean better service, better care, and a better overall experience. Take a look at the stars before you enroll, it can make a big difference!
How much does Medicare cost?
Medicare costs can vary quite a bit depending on the coverage you choose and your income.
Basic Medicare Costs (2026 rough ranges)
Part A (Hospital Insurance)
$0/month for most people (if you or your spouse worked 10+ years and paid Medicare taxes)
If not:
Up to about $505/month
Other costs
Deductible: ~$1,600+ per hospital stay
Daily hospital copays after a certain number of days
Part B (Medical Insurance)
Standard premium: about $202.80/month for 2026.
Higher income → you may pay more (up to $500+/month)
Other costs
Deductible: ~ $280/year
Typically 20% of services (doctor visits, outpatient care)
Then you choose your coverage path
Option 1: Original Medicare + Medigap + Part D
~$100–$300/month (varies by age, location, plan)
Covers most of the 20% and deductibles
Still must pay Part B (~$202.80/month)
Total typical monthly cost
👉 ~$250 to $500/month
(with very predictable out-of-pocket costs)
Option 2: Medicare Advantage (used to be called Part C)
Often $0–$90/month (some plans are $0 premium)
Still must pay Part B (~$202.80/month)
Other costs
Copays for doctor visits, hospital stays
Maximum out-of-pocket: ~$5,000–$9,000/year
Total typical monthly cost
~$202 to $275/month
(but higher costs if you need care)
Part D (drug plan)
~$10–$70/month (depends on meds and plan)
Why costs vary so much
Your total depends on:
Your income
Your health and how often you use care
Your prescriptions
Whether you want predictable costs (Medigap) vs. lower premiums (Advantage)
See why you need a Medicare Advisor? Contact me!
Do TrumpRX, Cost Plus Drugs, and other discount prescription drug programs apply to your Medicare deductible?
Usually no.
If you use TrumpRx, Cost Plus Drugs, GoodRx, or similar discount programs, the money you pay does NOT count toward your Medicare Part D deductible or out‑of‑pocket totals.
All of these services are treated as cash-pay transactions outside your Medicare plan.
You either use Medicare Part D or a discount/coupon — not both at the same time. When you choose the discount option, Medicare is not billed at all, so it doesn’t track that spending.
❌ Doesn’t count toward your deductible
❌ Doesn’t count toward your out‑of‑pocket max
❌ Doesn’t move you through Part D coverage phases
Cost Plus Drugs
You can use it with Medicare — but only by paying cash.
Costs do NOT count toward your deductible.
GoodRx / SingleCare / pharmacy discount cards
Cannot be combined with Medicare on the same prescription
If you use them instead of Medicare:
Costs do NOT count toward your deductible or out‑of‑pocket limit.
TrumpRx (new 2026 program)
Also a cash-discount system, not insurance.
Does NOT integrate with Part D.
Payments do NOT count toward deductible or out‑of‑pocket cap.
⚠️ One important exception (rare)
There are limited cases where spending might count towards your deductible.
If the pharmacy runs the prescription through your Medicare plan (not as cash).
Example:
Some plans (or specific setups with Cost Plus Drugs) allow billing insurance properly, then it behaves like a normal pharmacy claim.
HOWEVER if you:
use a coupon
choose “cash price”
or skip insurance at checkout
it will not count in almost all real-world cases.
Ask before you order, decide which option best balances your needs and pocketbook.
What questions will a Medicare Advisor ask me?
A Medicare Advisor will typically ask questions in a few key areas to match you with the right plan:
1. Basic personal info
Name, ZIP code (plans vary by location)
Date of birth / eligibility status
Whether you’re already enrolled in Medicare Parts A and/or B
2. Health & coverage needs
Do you have any chronic conditions?
How often do you visit doctors or specialists?
Do you expect surgeries or major treatments?
What prescriptions do you take (names, doses, frequency)
This helps them evaluate:
Medicare Advantage vs. Supplement (Medigap)
Which Part D drug plan fits your meds
3. Doctors and hospitals
Who are your current doctors?
Would you change doctors if your current doctor was not in a plan?
What hospitals do you prefer?
They check whether these providers are in-network.
4. Prescription drugs
Specific medications you take and dosages
Preferred pharmacy
This is one of the most important factors in plan selection.
5. Budget and preferences
How much you’re comfortable paying monthly
Whether you prefer:
Lower premiums with higher out-of-pocket costs
Higher premiums with more predictable costs
6. Current coverage
Do you have employer or retiree insurance?
Are you on Medicaid or receiving extra help?
Do you have a current Medicare plan?
7. Social Security #, Medicare #, and possibly checking account # if you are not yet on Social Security.
All of this information is required by the government to sign up for Medicare.
If you are on Social Security, any additional charges will be deducted from your Social Security check.
If you are not yet on Social Security, the additional charges will be an automatic debit from your checking account.
If you do not have a checking account, a bill may be able to be sent.
What questions should I ask a Medicare Advisor?
Asking the right questions puts you in control and helps you spot a good (or bad) advisor quickly.
Are you licensed in my state?
Do you represent multiple insurance companies or just one? You want someone who isn’t steering you toward only one company.
Can you explain ALL my options, including Original Medicare + Medigap vs. Medicare Advantage?
What would you recommend if I were your family member?
What is the total yearly cost estimate for this plan (premium + deductibles + copays)?
Are my doctors and hospitals in-network?
Do I need referrals to see specialists?
What happens if I travel or spend time in another state?
Are all my medications covered?
What tier are my medications in and what will they cost me?
If I choose this plan, can I switch later? When?
Could I be denied a Medigap plan later if my health changes?
What happens if this plan is discontinued?
In what situations would this plan NOT be a good fit?
Are there any prior authorizations or restrictions I should know about?
How is my personal information protected?
Will you help me review my plan each year?
Do you proactively check for better plans annually?
If I have issues with claims or billing, can I contact you?
How do I know if I can trust a particular Medicare Advisor?
Can you trust them with your information?
Generally, yes — IF they are legitimate. Licensed Medicare advisors are required to follow privacy laws (like HIPAA in many cases) and insurance regulations.
A Medicare advisor (sometimes called an insurance agent or broker) is there to help you choose the right Medicare coverage. Here’s what to expect—and how to decide whether to trust them.
Signs they are trustworthy:
✅ They are licensed in your state
✅ They clearly explain plans without pressure
✅ They represent multiple insurance companies (more unbiased)
✅ They provide written or emailed materials
✅ They don’t rush you or insist you sign immediately
⚠️ Be cautious if you notice:
❌ High-pressure sales tactics (“This deal expires today!”)
❌ Asking for banking info or Social Security number prior to you being ready to sign up for a particular plan.
❌ Unsolicited calls saying they’re from “Medicare” (Medicare itself doesn’t cold-call)
❌ Promises that sound too good to be true (e.g., “everything is free”)
Bottom line
Expect questions about your health, doctors, medications, and budget
Most advisors are legitimate—but you should stay cautious with sensitive data
A good advisor will educate you, not pressure you
Do Medicare Advisors get paid?
Yes — Medicare advisors do get paid, but NOT by you.
They get paid to cover expenses such as licensing, insurance, training, marketing, mileage, etc.
Independent brokers → represent multiple companies to offer a variety of plans.
Captive agents → work for one company and can only sell that company’s plans.
How Medicare Advisors are paid
Stipend from insurance companies
The insurance company pays them — you don’t
The commission is regulated by the government (especially for Medicare Advantage and Part D plans)
You pay the same premium whether you use an advisor or not.
Renewal stipend
Advisors usually continue to receive a smaller payment each year you stay enrolled in that plan which is why many advisors should offer ongoing support and yearly reviews of your plan. However, this is changing rapidly. Many insurance companies are removing this opportunity.
The fact that they do get paid can affect how unbiased their recommendations are
They may have incentives to recommend certain plans (see above definition of independent brokers and captive agents)
Some plans may pay slightly more than others
A less ethical advisor may steer you toward what benefits them most
How to protect yourself:
Ask directly:
Do you get paid more for recommending certain plans?
Are you showing me all available options or only some?
A trustworthy advisor will answer clearly and transparently.