Abigail Turner, Medicare Insurance Broker

Answer: "Fully covered" is tricky as in, no, it's not covered at 100%. However, you can absolutely see a mental health provider for things like therapy if they are contracted with Medicare. Depending on your Medicare plan, your supplement (Medigap) plan will cover the 20% due (since Medicare pays 80%) or your Medicare Advantage plan will likely have a copay for therapy services.

Answer: The most common one we run into would be the LEP (late enrollment penalty) for Part D prescription coverage. Most of the time it's due to someone who is self employed or on COBRA thinking the marketplace or COBRA coverage is considered creditable by Medicare but it's not. Every now and then we run into someone who delayed enrollment into Medicare Part B and had no other coverage options (which is the second most common penalty) but the Part D LEP is by far the more common penalty we see.

Answer: Yes we will as long as there is someone else present who can legally help/represent the individual with dementia. As advisors, if we begin to see signs of cognitive decline in any way, we will always request someone else be present at our meetings. Ideally the individual has a POA or someone with legal authority set up but if not, we will work to find someone who can at least be a second set of eyes and ears for that person. We will NOT meet with them without a third person present.

Answer: Don't sign up for a policy with ANYONE unless and until they have first gone through some kind of educational presentation on what Medicare is (define the four parts), what they cost and cover (and don't cover) as well as what your options are for Medicare coverage. How could you possibly know which option or coverage is right for you if you don't know what all of the options are, along with their pros and cons? Then make sure that person you're meeting with represents most or all companies in your area so you know they aren't being swayed to put you into one company or plan only.

Answer: They can but it totally depends on the area. If the rural area has a decent sized hospital and network of doctors/specialists, then yes, it could. But if there isn't a large medical footprint in the area and/or the hospital doesn't take any medicare advantage plans, then it could be an issue. There generally aren't networks on ER or urgent care services but if you live in a rural area, you'll want to talk with a broker who can review your area's options to make sure you have more access than just an ER on your Medicare Advantage plan.

Answer: No matter what plan you have, check your monthly statements/summaries to make sure there aren't any charges you don't recognize. This is a great first step, especially with Medicare Supplements where it's easier to miss things. Call Medicare to report any charges you know aren't yours for anything, whether a doctor visit you didn't have or a piece of medical equipment you didn't order or need.

Answer: Medicare is a very comprehensive program that covers most any treatments you would need. You don't have to worry about losing a plan or having your plan cancelled just because your health changes; that's actually not allowed. So as long as you keep current with your premium payments, if there are any, for your plan, you're covered, not matter what changes.

Answer: Absolutely; we have access to searching any and all specialists, including Chiropractors. I will say, a Chiropractor is commonly a specialist who chooses NOT to take Medicare due to Medicare's limited coverage of their treatment codes. That said, we can certainly help find the ones who do take it.

Answer: That is a loaded question! Medicare, similar to any other health insurance, was never meant to cover everything, and certainly not at 100%. There is no health insurance that offers that kind of coverage, unfortunately!

Many people argue Medicare should add coverages it currently doesn't include (such as dental/vision/hearing) but we also have to remember, Medicare is a government program so that just means we would have to pay in more money.

Answer: I would honestly caution anyone from just having Original Medicare only, no matter the circumstances, just due to potential out of pocket cost risks since there is no max out of pocket limit with Original Medicare.

That said, if you add a supplement to original Medicare, you do have a ton of flexibility and can see any doctor anywhere in the US who takes Medicare. For frequent travelers, this is appealing for sure.

On the flip side, most national MAPD plans (Medicare Part C) offer national networks meaning you can see any doctor anywhere in the country that takes their plan and still be considered "in network". We have many clients who have utilized this feature whether traveling for vacation or even living as a "snow bird" for months.

Both options can work; it just depends on what makes the most sense for you.

Answer: IRMAA, which stands for Income Related Monthly Adjusted Amount, can make your Medicare premiums higher based on your income. There are five "brackets" of IRMAA, much like taxes, and depending on your income and which bracket you're in, that will determine how much more you'll pay for your Medicare Part B and Medicare Part D premiums.

SSA and the IRS work together to determine if IRMAA applies to you. They look at your two year previous tax return (example - in 2025 they are looking at your 2023 income) and specifically look at the MAGI/AGI (adjusted gross income) line on your taxes. The amount of income depends on how you file your taxes (married/joinly; married/individual; single/individual). That line determines whether or not you pay the "standard" Medicare amount or more.

Answer: In most cases/states, yes. There are some states that do allow you to change annually guaranteed without having to qualify and it's usually a 30 day window around your birthday. Also, a few companies will let you "downgrade" your plan internally without having to qualify but you have to choose a plan that covers less, typically. Most states do not have the birthday rule and most companies do not allow you a guaranteed change internally, however, and do require you to answer health questions to qualify to switch plans.

Answer: Yes there is but you don't need to fill it out until you're within about 90 days of leaving his plan and making the switch to Medicare. You can continue on his insurance for as long as you need/want to and then make sure to give yourself a few months (we recommend 90-120 days, depending on what time of year it is) to get that form and your Part B application form turned in.

Answer: You're exactly right! Once you've met your Part B deductible ($257 in 2025), your plan G will cover all remaining costs that Medicare approves but doesn't pay for. This is assuming you have a standard Plan G and not a high deductible Plan G.

Answer: Well, two things. First, there will be another opportunity to sign up but it could be a few months from now, depending on the coverage. Second, you could be penalized, depending on the coverage and how long you went without coverage before signing up.

If you missed your Part B window to sign up, there is a General Enrollment period every year during the first quarter, January through March, and coverage begins the first of the next month. If you went a full 12 months without coverage, will could face a 10% penalty for each 12 month period you went without Part B coverage but were eligible for it.

If you missed your Part D window to sign up, you can enroll during the Annual Enrollment Period every year from October 15th - December 7th and coverage begins January 1st. If you went more than 63 days without Part D prescription coverage and didn't have creditable coverage, you could be penalized 1% for every month you went without coverage but were eligible for it and that % is multiplied by the average drug plan cost that year (this means the amount can and will vary slightly from year to year).

Answer: Everyone has a story to share and I love learning about people's stories and what brought them to this point in their lives. I really enjoy helping them walk through the transition that they've looked forward to for years but are now anxious about and help them feel confident during that transition.

Answer: As a licensed agent, we are required to go through multiple certifications every year to stay on top of these annual changes. We have to take a course the government provides that goes over national changes and then we have to go through certifications with every company we work with. It will take anywhere from 1-3 weeks a year to get all of those certifications done before we can legally represent those Medicare plans and companies.

Answer: This is a hotly debated question! There are dozens of companies offering multiple supplement plans and it's impossible to say with full confidence one or the other is the best. We look at longevity, rate increase history, stability, and many other factors before writing a supplement company's policies. You'll usually have a strong history and longevity with "name brands" like Mutual of Omaha, Aetna, United HealthCare, Cigna, etc. However, they aren't necessarily the best when it comes to rate stability. If we could predict the future, it would be an easy question to answer but since we can't, talking to an independent licensed broker who is familiar with your area and market will be key. These are things they should take the time to research and know before making a recommendation.

Answer: All new to Medicare clients, regardless of age, go through a "Welcome to Medicare" presentation with us. This can be done in person or via a prerecorded webinar presentation they can watch on demand, depending on their preference.

This presentation walks someone new through the four parts of Medicare, defining them all and talking about costs, coverage, lack of coverage, etc. Then we go through the three options or directions someone can go with their Medicare coverage. We talk pros and cons of all three. We then talk about the ability to move and switch plans down the road... when they can, when they may not be able to and when they absolutely can't and what plans fit into what category.

Once we've discussed all of the info that's true for everyone on Medicare, we apply that to each individual person: their health issues, budget, lifestyle, medications, etc. to help them decide which is the right option for them.

Answer: This is a great question! I would encourage anyone to "interview" a potential broker, especially if you came across them online or in some way other than a strong referral from a trusted friend/family member.

Some good questions to ask: how long have you been a Medicare broker? Of your Medicare clients, roughly how many have Medicare supplements and how many have Medicare Advantage plans (this will tell you if they seem to lean or steer people one way or another)? What does your process of working with someone new to Medicare look like? What happens after I'm your client? Do you provide any service or ongoing support? These are some questions I'd encourage you to ask to see if someone is a good fit for you and what you're looking for.

Answer: More than likely, your MRI was Medicare approved and covered. That said, your supplement plan N does have a couple of items you could be responsible to pay for. If you have not paid your annual Part B deductible ($257 in 2025) yet in 2025, you will likely owe that deductible and be billed for it. It's also possible you could be charged up to a $20 copay imaging services. That may have been collected at the time of your visit but if not, it's possible they could add that copay to your bill as well. Beyond that, unless the MRI provider does not accept Medicare assignment (meaning takes Original Medicare Parts A and B and agrees to their pay schedule), that should be all you would owe. If the provider does NOT accept Medicare assignment, you could be charged up to 15% more than the Medicare approved rate and be responsible for that 15% upcharge.

Answer: First and foremost, don't answer your phone for ANY phone number you don't know or have stored in your contacts. I realize it could be a doctor's office but they will leave a message with a call back number. When you answer your phone, it tells the scammers they have a good number and they will continue to "work" it with more and different scams.

Answer: When looking at Part D plans, I tell clients we don't want their cheapest plan but their least expensive plan. Sometimes those are the same plan but many times they aren't. Sometimes a more expensive plan (in terms of monthly premium) will actually cover someone's meds better so they pay less out of pocket than they would if they had a cheaper plan but had to pay more for their medications. In looking at out of pocket cost, the number to pay attention to is the TOTAL for the YEAR, not monthly, and then determine the least expensive using that information.

Answer: Your enrollment windows will vary based on the plan you're in. Here is a simple breakdown:

The annual enrollment period (AEP) is every year from October 15th through December 7th. This is when you can change you Medicare Part D (prescription only) and Medicare Part C (Medicare Advantage) plans. Any plan changes will take effect January 1st.

There is also Open Enrollment which is January 1st - March 31st, where you can make a one-time change to your Medicare Part C plan or reenroll back into Original Medicare only.

There can be special enrollment periods (SEP) as well and those will vary extensively. Situations like moving to a new city/state, losing Medicaid benefits, gaining Medicaid benefits, having a five-star rated plan in your area, having a qualifying chronic health condition, etc can open up SEPs.

Your Medicare Supplements (also known as Medigap) plans can actually be reviewed year round; you can change those anytime with a couple of exceptions, depending on your state. Those plans have medical questions in most states so you have to qualify to switch so they don't make you wait until a certain time of year for a review. Some states allow for a guaranteed change once a year but most states do not. A licensed agent will know your options based on your state's rules.

Answer: This is true for so many on Medicare and one of the first things your agent should go over with you. Are there any specific programs you would qualify for and if so, help you apply.

The main program to help with Medicare prescription drug costs is Extra Help, also known as low-income subsidy (or LIS). This program will dramatically lower the costs of your medications, both name brand and generics, putting a cap on your copays along with possible help towards plan premium costs and deductibles. Extra Help allows for a slightly higher income level than Medicaid (your state aid agency) allows for so you may still qualify for Extra Help even if you don't qualify for Medicaid.

Medicaid is another program you can apply for that can go beyond prescription cost help and may also help pay your Medicare Part B premium and possibly even medical copays. Again, this is where a licensed agent is so helpful as they should know what questions to ask to determine eligibility and be able to help walk you through the application process.

Answer: My personal answer to this question is YES! While Medicare is pretty proactive and preventative friendly in coverage, it's not so much "alternative treatment" friendly in most cases. But I don't think this is just a Medicare issue and is a health insurance issue at large. We are more educated than ever and have access to information that confirms things like diet, certain vitamins/supplements, hormone therapies, etc are hugely successful and cost effective but are currently not covered by insurance or approved by the FDA for general medical use. I hope this changes as I have seen the benefits in my own life. For now, the best answer I can give is use your insurance for traditional treatments and if you can, put a little extra cash aside to pay out of pocket for some of those "alterative" treatments.

Answer: Medicare Part B is your Medical coverage, providing coverage for most things you will have done. This is where every provider bill Medicare (from your primary doctor to any specialists, to surgeons and anesthesiologists) as well as your durable medical equipment (DME - CPAP, nebulizers, CGMs, oxygen, etc.) and Part B medications (Chemo, dialysis, infusions, etc.). So outside of being admitted to the hospital, many of your charges are coming through Part B.

Is it enough... certainly not. What Part B will NOT cover be anything in-patient in the hospital as well as in-patient rehab (Skilled Nursing). So, if you ever need hospital or in-patient rehab care, you need Medicare Part A as well.

Answer: Star ratings are based on a number of factors. In general, we feel comfortable recommending a plan with three stars or higher. That means they are doing their job at least at an average level and have met CMS (Medicare) expectations. The higher the star rating, the "better" they're doing at the metrics CMS has set up for measuring plan success. Anything lower than a three star, we are a bit leery. Those ratings aren't given lightly so that plan/company has some work to do.

Answer: Yes, your zip code definitely matters but I wouldn't use the word "random". There are two different Medicare plan options and from your question, you and your friend have two different Medicare options. Plans that are $0 premium are nice but you will get bills and/or have to pay copays for doctor visits, ER, ambulance, etc. If you're paying a high monthly premium of $200/month, you likely don't pay copays or get bills; paying your monthly premium takes care of most or all of your medical expenses. Talking with a licensed Medicare broker/independent agent will be key to help you understand the different options, the pros and cons of each option, and ultimately deciding which option is the best fit for you personally.

Answer: The first place I'd go to check would be the carrier's website. With a few clicks and putting in your zip code, you can review plans available in your area, including the one you're trying to verify. You can see the summary of benefits that would confirm the benefits available in the plan and you'd know from there if the benefits were "legit". If you have a broker/agent, I'd give them a call as a second opinion to make sure they explain ALL of the plans available to you so you don't miss anything.

Answer: This is definitely going to depend on the type of Medicare plan you've chosen and frequency of doctor visits. With Medicare supplement (also known as Medigap) plans, typically the higher the premium payment means greater coverage from plan letter to plan letter (such as Plan N costs more AND covers more than Plan A but Plan G costs more AND covers more than Plan N). So price can certainly determine coverage.

With a Medicare Advantage plan, many are $0 premium per month but you WILL be billed or charged copays for any services rendered or doctor visits made.

Answer: This is going to vary and be dependent on what plan you have. Original Medicare is not an international health insurance program so the coverage available internationally will be based on your Medicare plan.

Several Medicare Supplement (Medigap) plans (specifically Plans C, D, F, G, M, and N) offer 80% "foreign travel emergency" coverage, subject to plan limits.

Many Medicare Advantage plan companies also offer some international coverage. In general, Emergency Room and Urgent Care is covered by some companies and may or may not have a copay associated. At least one other company also covers ground ambulance transportation internationally for a copay.

Checking with your broker/agent or going through your plan's full Explanation of Benefits documentation will give you the coverage available with your specific plan.

Answer: Nothing worthwhile is free and that certainly goes for your insurance. In the world of Medicare, $0 premium does NOT mean free. There are going to be costs for services received while on a Medicare Advantage plan. However, the $0 premium does mean you will only pay for services when you need them, as you need them, and not automatically every month.

As a general rule, if it's marketing, proceed with caution! An independent agent can help you see through the "noise" of marketing and get to the real info that matters.

Answer: I love helping people but more specifically, I'd have to say I love clearing up mis-information and providing solid education. Medicare is actually a pretty simple program but it has been made out to be complicated and confusing and I love breaking it down for clients, helping them understand it in a way that they feel confident to make a decision for their themselves.