Alyssa Gonzales, Medicare Insurance Broker

Answer: I wish every senior knew that the 'best' Medicare plan isn’t the same for everyone...it’s the one that fits your specific needs and budget.

Too many people pick a plan based on what their neighbor has or just go with the cheapest option, only to find out later that their doctor isn’t covered or their medications cost way more than expected.

Take the time to compare your options, ask questions, and make sure you’re choosing a plan that actually works for you. And if you're feeling overwhelmed, talk to an expert, because guessing your way through Medicare can be an expensive mistake!

Answer: You’ll be automatically enrolled in Medicare Parts A and B, no need to sign up yourself. Your Medicare card will arrive in the mail a few months before your 65th birthday.

Answer: You bet! The key words are preventative and that it's medically necessary. It’s usually covered once every 24 months, or more often if medically needed. As long as your provider accepts Medicare assignment, you won’t pay anything out of pocket.

Answer: This is a hot topic! Medicare mainly covers treatments that have strong clinical evidence behind them, but many seniors find relief through alternative options too. Medicare is evolving! It would be great to see more coverage for alternative medicine! Stay tuned!

Answer: I hear this all the time! "You can only change your Medicare Supplement plan during the Annual Enrollment Period (AEP)."

That’s not true! You can apply to switch your supplement plan any time of year — as long as you can pass medical underwriting (in most states).

If you are wanting to go from a Medicare Advantage Plan to a Medicare supplement outside of Annual Enrollment Period then you need to make sure you have a qualifying Special Enrollment Period (SEP) before you begin.

Answer: Yep, your Medicare deductible can change each year! It's set by the government and usually goes up just a bit to keep up with inflation. I always keep an eye on it during Annual Enrollment Period which is October 15th to Dec 7th of each year.

Answer: Very common issue and to answer this YES, Medicare Part B can help cover medically necessary occupational therapy when it’s ordered by your doctor. Just know there’s an annual threshold, once you hit that amount, your provider may need to confirm that ongoing therapy is still medically necessary for coverage to continue.

Answer: Yup ..... it's real talk! Starting January 1, 2025, anyone with a Medicare Part D plan (or Medicare Advantage with drug coverage) will pay no more than $2,000 in out‑of‑pocket costs per calendar year for covered prescriptions this includes deductible, copays, and coinsurance. Once you hit that cap, you’ll have catastrophic coverage and pay $0 for the rest of the year.

Answer: People are shocked to find out that Medicare doesn’t cover routine dental care, no cleanings, fillings, crowns, or dentures. You can get dental in most Medicare Advantage plans and/or seek private coverage if you want to cover this exposure.

Answer: Don’t panic! You’ve got the right to appeal. Start by reading the denial letter, then follow the instructions to file a Level 1 appeal, usually just a simple form and a doctor’s note explaining why the service is medically necessary. A whopping 81.7% could be fully or partially overturned(Kaiser).

Answer: Well, it’s a solid start....but it doesn’t cover everything, so most folks end up pairing it with a Medigap plan or Medicare Advantage to fill in the gaps (and avoid surprise bills). Medicare Part B covers doctor visits, outpatient care, preventive services, lab work, durable medical equipment, and things like physical or occupational therapy.

Answer: You can qualify for Medicare if you've been on Social Security Disability Insurance (SSDI) for 24 months, have ALS (you get Medicare right away), or have End-Stage Renal Disease (ESRD) and meet certain treatment criteria. It's not super common but you have options if you have one of the mentioned conditions.

Answer: Absolutely. The MOOP is the most you’ll pay out-of-pocket in a calendar year for covered services under a Medicare Advantage plan...after you hit that cap, the plan pays 100%. In my experience, it's a lifesaver if something major happens.

Answer: If you're turning 65 and still working with creditable employer coverage, you might not need to enroll in full Medicare just yet. My rule of thumb is to always compare group coverage to what Medicare would offer you. I find that most folks are shocked at what they learn! After comparing coverages, you are able to make decisions based on facts and not emotions. Compare things like cost of insurance, deductible, and max out of pocket to start with!

Answer: Some parts of Medicare are already privatized through Medicare Advantage and Part D plans, but full privatization is unlikely soon. The program has strong public support, and major changes would face heavy opposition. Which is why it's very important to review your plan every year during Annual Enrollment Period October 15th to December 7th.

Answer: Usually yes, unless you’re within your Medigap Open Enrollment Period (6mo from Part B start date) or have a Guaranteed Issue right (losing employer or union coverage, your Medicare Advantage plan leaving your area, or moving out of your plan’s service area. ). Outside of those times, yes, the insurance companies can require what's called underwriting and decide to approve or deny coverage based on the answers to the questions they ask.

Answer: Yes losing employer or union coverage qualifies you for a Special Enrollment Period. You generally have 8 months to enroll in Medicare Part B and 63 days to enroll in a Part D or Medicare Advantage plan without penalty. Don't wait. Processing times can very, and you don't want to be left holding a bag full of penalties!

Answer: Regulations help keep the industry coloring inside the lines, but we need to address the egg before the chicken. I believe having advocates for both the beneficiary (you) and the broker (me) in front of lawmakers would create more balanced and effective policies.