Amy Jones, Medicare Insurance Broker

Answer: Original Medicare does not, but some Medicare Advantge plans have a card for over the counter items which may offer coverage for certain items described above.

Answer: Original Medicare will not change at all from one state to another, but if you have a Medicare Advantage plan, relocation can affect your coverage, even from one zip code to another in the same state.

Answer: A good agent will take your specific situation into account, so a plan that works best for one person’s situation may not work the best for their neighbor. An agent should look into things like whether a plan covers your specific doctors, whether or not the prescriptions you take are on the plan’s formulary, whether or not you have any special needs such as chronic conditions or enrollment in Medicaid which may make you eligible for added benefits, but also keep in mind that sometimes one plan may have more of certain coverage but less of another, or more copays for certain services but less for other services than another plan. For example, if you say you need dentures and want a plan with a high level of dental coverage, you might have to pay slightly more when you go to your primary care doctor or stay in a hospital with Plan A vs Plan B, while Plan C might have a Part B premium giveback of $80/month but it might not have dental or vision coverage while Plan D gives the client coverage for those things but doesn't offer a giveback. There are also other factors to consider, like deductibles, maximum out of pocket limits, monthly premiums, etc, so sometimes it's a matter of trying to find a client the things they ask for in a plan while making sure they don't lose benefits in other areas. Most plans will not offer every possible option you see advertised in one plan, because if you qualify for a card to pay for healthy groceries, you typically won’t qualify for a giveback, or one plan might offer things like $3000 in dental coverage but have a way higher deductible.

Answer: Before signing up with a plan, you can go to the carrier’s website or Medicare.gov and search for doctors, and find plans that accept the specific doctors you want. If none of that carrier’s plans accept the doctor, you may need to look at a different carrier. You can also call the doctors office directly to ask which plans they accept before signing up or to ask if they accept a specific plan. If you have an insurance agent, you can ask them to search the doctors for you before signing up for a plan, and you can also choose a PPO plan that will cover doctors out of network as long as the doctor accepts the plan, but a PPO typically charges a higher copay when out of network doctors are used.

Answer: Medicare Part B should cover one pair of eyeglasses with standard frames or one set of contact lenses after cataract surgery. Coverage is limited to basic, medically necessary prescription lenses, and typically covers 80% of the Medicare-approved amount after the deductible is met. If you were denied coverage for medically necessary eyewear, check with your eye doctor or Medicare to find out why they didn't cover your lenses, and possibly file an appeal if you feel that your lenses should have been covered under Medicare covered eyewear.

Answer: People who work and pay taxes in America have a certain portion of their paychecks withheld for Medicare taxes. This money is kept in a fund held by the federal government specifically for Medicare. Since working people of all ages pay Medicare taxes, and only a small portion of the population is 65+ and/or on Medicare, the funds shouldn't just “run out” as long as people keep working and paying Medicare taxes. Only people who have worked and paid taxes for 10 years (40 quarters) and their spouses qualify for premium free Part A, and Part B charges a monthly premium that is not based upon work history.

Answer: No. You just have to do it during the Annual Enrollment Period or when you have a valid Special Election period.

Answer: Before you sign up for a Medicare Advatage plan, you should make sure the doctors you want to see are in the plan’s network. If you choose an HMO plan, you must see doctors within the plan’s network for the services to be covered. If you choose a PPO, you are allowed to see doctors outside the network as long as the doctor agrees to accept the plan, but typically out of network doctors have a higher copay. Also important to remember is that networks sometimes change from one year to another, so a doctor can be in a plan’s network this year but not participate in that network next year, so always double check that a doctor accepts your plan before you go to that doctor to avoid having the visit not be covered.

Answer: The part B premium does tend to increase each year. As far as sustainability, everyone who works in America and pays Medicare taxes to the federal government is contributing to that fund, so as long as people in this country keep working and paying Medicare taxes, the funds should be sustainable. You have to work and pay taxes for 40 quarters (10 years) in this country to be eligible for premium free Medicare Part A. Part B has a monthly premium regardless of work history, and the only way you would not have to pay that premium is if you qualify for Medicaid to pay it for you.

Answer: Ask them for their National Producer Number (NPN). If they have one, they are a licensed agent, and if they do not have one, then they do not have an insurance license. You can check the number on NIPR to ensure it is legitimate.

Answer: Check the plan’s formulary to make sure the drugs you take are covered, and take generics over brand names when possible because copays are lower.

Answer: Original Medicare has a 20% coinsurance on doctors and hospitals, but you are not limited to a network of doctors, which may work better for frequent travelers.

Medicare Advatage plans have copays which are often less than a 20% coinsurance, but they often require you to see doctors in network (HMO’s) while a PPO will give you more freedom and flexibility to see out of network doctors as long as they will agree to accept the plan. Another advantage to Advantage plans is that they have a Maximum Out of Pocket (MOOP) and once you hit that limit, you won’t have to pay anything further for the rest of the year for covered Part A and Part B services. Original Medicare doesn't have a MOOP so there is no limit to how much you can be charged each year.

Answer: You can enroll in Medicare 3 months before your 65th birthday, the month of your birthday, and 3 months after your 65th birthday.

Answer: Some Medicare Advantage plans include coverage for dental and vision. You coups also get a standalone dental and vision plan with Original Medicare or a Medicare supplement plan.

Answer: Medicare Part A has a 20% coinsurance for hospital stays. If you also have Medicare Part B, you could enroll in a Medicare Advantage plan, which typically has lower copays. You could also enroll in a Medicare supplement plan and/or a hospital indemnity plan to help cover the costs of staying in a hospital.

Answer: 1-3 years is the suggested time frame, but make sure to verify that you do not have any outstanding unpaid bills or charges which may need disputed.

Answer: You will be given an additional opportunity to make changes to your Medicare plan during the enrollment window in which you turn 65, even if you were enrolled in Medicare before 65 due to disability.

Answer: A licensed insurance agent should not charge you to give you advice, information, or a quote, regardless of their location.

Answer: Original Medicare does not cover hearing aids, but many Medicare Advantage plans offer that benefit.

Answer: Often, people are automatically enrolled in Part A when eligible and have to enroll for Part B on their own, and the Part B premium is typically withheld from their social security check unless they request to be billed.

Medicare Part A is provided at no cost for people who have worked in the US and paid taxes for 40 quarters of their lifetime (10 years), but Medicare Part B has a premium which is $202.90 for 2026, unless they are paying a higher cost due to having a large income. If you enrolled in Part B after your Initial Enrollment Period, you could be charged a late enrollment penalty. You can contact the Social Security Administration at 1-800-772-1213 or 1-800-MEDICARE if you believe you are being billed for charges you do not owe or to request information on the costs and charges.

Answer: Yes. You have 2 months after losing employer coverage to enroll into a Medicare Advantage plan using the SEP for loss of creditable coverage.

Answer: Many insurance carriers offer long term care plans which are purchased separately from Medicare plans, and can be used to cover the costs of nursing homes or long term care facilities. Original Medicare does not cover nursing homes or long term care facilities, nor does Medicare Advantage. The best way to plan ahead is to evaluate your options for long term care coverage and purchase a plan that will give you the right type of coverage if you anticipate the need for those services in the future.

Answer: Medigap plans are offered through private insurance companies, usually charge monthly premiums, are not funded by the government, and therefore, are not affected by you paying into Medicare via tax withholdings. Under federal law, you have an open enrollment period that begins the month you turn 65 and/or enroll in Medicare Part B, and that enrollment period lasts for 6 months. During that 6 month window, you have “guaranteed insurability”, which means insurance companies cannot deny you due to pre-existing health conditions. Outside of that time frame, there are only select cases when you are considered to have guaranteed insurability, and those would typically be due to involuntary loss of coverage through another insurance plan, such as employer sponsored healthcare, or having Medicare Advantage and moving to an area where no Advantage plans are available.

Answer: You can apply for state Medicaid assistance or apply for a low income subsidy (LIS), also known as extra help. To apply for extra help, you can contact the Social Security Administration at 1-800-MEDICARE or 1-800-772-1213.

Answer: If you have creditable coverage from another source such as an employer plan, then the late enrollment penalty does not apply for as long as you have that coverage. If you do not have creditable coverage and you do not enroll in Medicare Part B when eligible, then you will have to pay a penalty when you enroll, which increases every year that you were eligible for Medicare but did not enroll.

Answer: If your Medicare Advantage plan has a deductible, you would pay that amount before your plan pays, and then you would pay the per day copay once the deductible has been reached. However, many Medicare Advantage plans do not have a deductible, or have a much smaller deductible than the standard Medicare Part A Deductible. Check your plan’s Summary of Benefits or Evidence of Coverage documents to see if your plan has a deductible. The standard Medicare Part A deductible only applies to Original Medicare, which also charges a 20% coinsurance on hospital services, but those charges do not apply if you have a Medicare Advantage plan, because your plan pays instead of Medicare, so it is important to check the documents you received with your plan, or call the carrier who provides your coverage to get more information on your copays, coinsurance, and deductible amounts.

Answer: Nursing homes are not covered under Original Medicare and therefore, they are also not covered by Medicare Advantage plans.

Answer: Only if the cardiologist is in the plan’s network. Specialist visits normally have a copay which can vary by plan, but they must be a network doctor or you will be responsible for paying the entire cost of services. In order to make sure a cardiologist will be covered, you will also typically need a referral from your doctor, who should be able to determine which specialists are in network before making the referral.

Answer: Contact an insurance agent/broker who can compare plan options and look up the specific drugs to determine the estimated cost of each prescription, which can vary by plan. Also keep in mind that prescription drug plans have formularies and if a drug is not on the plan’s formulary, it will not be covered unless approved by the plan, which typically requires a letter from a doctor.

Answer: Medicare Advantage plans are essentially plans that are required to offer at a minimum, the same level of coverage that is offered by Original Medicare. The benefits are provided through private insurance companies who typically charge copays for services, whereas Original Medicare charges a flat 20% coinsurance on covered services. Medicare Advantage plans have Maximum Out of Pocket Limits to prevent members from being overcharged for covered services, and the copays are sometimes substantially lower than 20% of the cost of a covered services. Another major difference in Medicare Advantage plans is that because they are offered through private insurance carriers, many of them have a network of doctors and hospitals that members must use to ensure that their medical services are covered.

Answer: Medicare Advantage plans are designed to have low to $0 monthly premiums, meaning that the plan may cost you little to nothing out of pocket for the coverage, however they typically have copays and sometimes deductibles that vary from one plan to another. The difference from Medicare Supplement plans in that Supplements usually has higher out of pocket costs for maintaining the coverage, regardless of whether you ill use the plan or not, but the copays and deductibles are typically lower, often $0, on a Supplement plan. Another important thing to remember with Medicare Advantage plans is that they have MOOP (Maximum Out of Pocket) limits, and once that limit is reached, you would not be responsible for any further costs for Medicare covered Part A and Part B services for the remainder of the year. The MOOP also varies from one plan to another.

It is important when choosing a Medicare plan to discuss the benefits, costs of premiums , copays, and deductibles, as well as what is covered, with an insurance broker who can advise you of the costs you might pay on any plan you consider. A good broker will compare plan options to ensure that your coverage needs are met for the least amount of money possible.

Answer: Medicare will cover medical equipment such as wheelchairs if they are deemed medically necessary by your doctor and obtained from a Medicare approved supplier of medical devices. You should be able to obtain a list of approved suppliers from your insurance carrier or by calling Medicare at 1-800-MEDICARE.

Answer: Due to changes made in the 2026 plans, some members may qualify for a plan that includes a flex card that will cover healthy grocery items if a person is below a certain income level or has qualifying health conditions. Previously, these benefits were available in plans that were not DSNP (Dual Special Needs Plans) or CSNP (Chronic Special Needs Plans) but changes made to Medicare prior to the Annual Enrollment Period for 2026 eliminated the flexible spending grocery benefits for regular plans, limiting the benefits to people with special needs.

DSNP plans are for members receiving both Medicare and Medicaid benefits, and CSNP plans are available for members with specific chronic health conditions, such as Diabetes, Heart, or Lung Conditions.

Answer: Many Medicare plans only cover up to 90 days in the hospital per benefit period. Medicare lifetime reserve days are 60 additional, non-renewable, one-time-use days of inpatient hospital coverage provided by Part A when a hospital stay lasts longer than 90 days in a single benefit period.

Answer: You would still be eligible to make changes to your Medicare Advantage plan during the 3 months before, the month of, and 3 months after you turn 65, even if you had enrolled in a Medicare plan prior to that time frame. This would typically be the case if someone is receiving disability benefits before they turn 65.

Answer: You can change your Medigap plan at any time, but keep in mind that a Medigap plan only offers guaranteed insurability for the first 6 months after you enroll in Medicare. After that 6 month window, you may be subject to medical underwriting, and could be denied coverage under a new plan if you have pre-existing conditions.

Answer: Medicare typically covers one preventative bone density screening exam every 24 months if you are considered at risk for bone fractures. Your doctor should be able to determine whether or not you meet the eligibility criteria of being at risk and if eligible, you should be able to get a bone density screening every two years with $0 copay.

Answer: Preventative cancer screenings, which are routine screenings such as preventative mammograms, colonoscopies, skin cancer screenings, etc. Diagnostic tests for someone already having symptoms are not considered preventative and are subject to a copay.

Answer: The biggest difference between a Medicare Advantage plan and Medigap, aka Medicare Supplement is that Advantage plans usually have lower upfront out of pocket costs but typically have copays and coinsurance when seeing a medical professional. Medigap plans typically have higher monthly premiums to co tinye coverage but may have lower to no copays or coinsurance. The other major difference is that many Advantahe plans are HMO plans are require the client to utilize a network of providers, and may not work well for people who travel frequently, although PPO plans may give more freed and flexibility to see out of network providers. Medigap plans are less restrictivective to people who travel frequently orbwwnt more flexibility to choose doctors outside of network.

Answer: The best way to approach clients who are new to Medicare is to explain the various types of plans available, the way each type of plan works (Medicare Advantage vs. Medigap, etc), and once the client decides which type of plan they want, it gives an agent the ability to better understand the needs of the client and the type of plan that works best for them. From there, the agent can help them find a plan that is suitable to their specific circumstances.

Answer: If someone has dementia or other memory issues, it is recommended that they have a Power of Attorney to make their healthcare decisions, as someone with dementia may have difficulty understanding any changes that they might make. If an agent knows that a person has dementia, they typically do not work directly with the person who has dementia, but will need a POA form to be able to work with a third party to help them decide on what plans may work best for the client.

Answer: It really depends upon their employer coverage options. If a person doesn't have creditable coverage through an employer, they can accrue additional expenses by delaying Part B enrollment, but some people may find adequate coverage that is provided by an employer or included in their pension. Always consult your employer’s benefit coordinator for questions regarding how changing your benefits may affect you!

Answer: I love being able to help people who are looking for a plan that works best for their own needs. Because plans vary, it is important to to find someone with the expertise needed to make sure you find a plan that works for you! I love being able to help people find the right plan for their needs, while saving them money and maximizing their additional benefits.

Answer: Medicare agents are well informed on all of the Medicare rules, as well as your options for finding a plan that works for you! This can be a daunting task for someone with limited experience, but a licensed agent can offer you advice, guidance, and assistance with finding a plan suited to your personal needs. Because plans vary and benefits are not exactly the same from one plan to another, its absolutely vital that you have a needs assessment evaluation so that your personal needs are met!