Alisa Mathis, Medicare Insurance Broker

Answer: Original Medicare doesn’t cover any medical treatment outside of the country. Some Advantage Plans may cover up to a certain amount for any emergency treatment needed worldwide. You may have to pay the bill out of pocket and then submit a reimbursement request. However, I recommend that anyone going out of country should purchase a travel insurance policy.

Answer: Part A has a deductible that the patient is responsible for each time they are admitted to the hospital. For 2025, that deductible is $1676 and will increase to $1726 for 2026.

Answer: IRRMA is based on your income 2yrs prior. So unfortunately even if your income drops in 2026, your IRRMA payments will still be based on your income from your 2024 tax return.

Answer: Medigap plans are not Medicare, and they are not health insurance. They are supplemental plans that help cover your out-of-pocket costs associated with Medicare insurance.

Answer: Most people receive Part A Premium free as long as they have 40 credits (equivalent to working 10 years full time). Part B has a standard premium for all, but increases for those with an income above $109,000 individually or $218,000 jointly. Part C premiums differ between carriers and plans as well as Part D Plans. However, just like your income can affect your Part B premiums, it can also affect your Part D premiums. Medicare Supplement Plans premiums differ between carriers but also are based on age when you’re first eligible for Medicare, and after that, it will most likely be based on age and health (underwriting).

Answer: You should talk to an insurance Broker directly. That is the best way to get a good understanding of what options would work best for your specific needs.

Answer: Original Medicare doesn’t cover medical services out of the United States in any circumstances. Some Medicare Advantage plans will cover emergency services out of the country up to a certain amount. However, you may have to pay out of pocket first, then file a reimbursement claim. If you are a person who likes to travel out of the country, I recommend getting travel insurance.

Answer: Once you know your end date , you will just apply like normal. You can complete the application on the Social Security website, by phone, or by going into your local Social Security office. You will have to show proof that you were on your employer’s insurance the entire time you were eligible for Medicare to avoid any penalties. It’s best to do this process before your last day of employment. This way you will have no gaps in insurance and your Medicare would start the first of the month after your last day of employment.

Answer: Medigaps may be perfect for some but not all, and vice versa for Medicare Advantage plans. So an agent should be explaining both types of plans and recommending what is best for that particular client’s circumstances. However, it’s always the client’s decision in the end, no matter what was recommended.

Answer: The biggest mistake in my opinion is just going by the monthly premium price. Even though it is not required, they should always make sure all of their prescriptions are covered. Drug formularies may not only differ between carriers, it can also differ between plans with the same carrier. Also, make sure their preferred pharmacy is in-network or that they at least have an in-network pharmacy close to them.

Answer: If you reach the Maximum Out-of-Pocket (MOOP) cost for your Medicare Advantage plan, you won’t have any more out-of-pocket cost (i.e., copays, coinsurance) on covered services the rest of the year.

Answer: The point of a PPO is to have the option to see providers that may not be in your insurance plan network, but that option will most likely come at a much higher cost than using in-network providers. Insurance carriers negotiate rates with their in-network providers, which allows them to pass down a lower out-of-pocket cost to their members. However, when you go to an out-of-network provider, they don’t have any agreement with your insurance, which means you going out of network may cost your insurance carrier more and makes you responsible for more out-of-pocket cost.

Answer: As long as you are in a credible employer group plan, you can delay your Medicare until you retire from your job, and you will get a 2-month Special enrollment period to sign up for Part B without receiving any penalty.

Answer: Medicare only pays 80% for covered services and the Medicare Recipients are responsible for the remainder 20%. There is also annual deductible for part B and a part A deductible that has to be paid by the Medicare recipient every time they are admitted into the hospital. To help with these out of pocket costs some people get a separate insurance policy called a Medicare supplement plan that they combine with the Medicare card and it will help cover some or most of their out of pocket costs. While others may sign up for Medicare Advantage plan.

Answer: Even without a generic available, a Part D plan might deny the brand-name drug for a number of reasons, like:

- If the drug is not on their formulary.

- If the plan covers an alternative brand-name drug they consider therapeutically equivalent.

- If they require step therapy (try a different drug first—even if it’s another brand or a different class).

Answer: Upon the passing of your spouse, you may be eligible to receive their Social Security benefits if the amount exceeds your own. However, it is important to note that you are not permitted to receive both benefits simultaneously.