Andrew Kelly, Medicare Insurance Agent

Answer: Yes, psychologists, social workers, and psychiatrists are generally covered under Medicare, so long as they accept Medicare. Generally, you can count on at least 80% coverage, and then depending on whether you are a Medicare Advantage client or an original Medicare client with a supplement, additional coverages may also be available.

Answer: My recommendation is to build a relationship with a local Medicare specialist who can help you explore options and/or programs. We work hard to serve all clients, regardless of financial situation, and there may be different times when a different solution makes more sense.

Answer: I would be skeptical of any plan or approach being "pushed" over another. A quality agent will transparently explain all options to you, as the client, answer questions, and then assist with sign up for either the Medigap plan or Medicare Advantage plan.

It may be the case that the agent really believes that the Medicare Advantage plan is superior. It also might be the case that the agent is doing that because their commission on Medicare Advantage plans is greater that a Medigap supplement.

Answer: It really depends on the kind of appeal you are making. It all depends on the type of appeal and complexity of your case.

Answer: If you have Original Medicare with a Medigap supplement, you're already covered! One of the strengths of Medigap supplement plans is that they are accepted nationwide by any doctor who works with Medicare patients.

Answer: Many agents provide personalized and differentiated support for clients and client families in "understanding" communication and getting through paperwork. I have this relationship with several of my clients. My recommendation is to find a Medicare specialist, in your area, who is able to support you in this way.

Answer: Six things that Medicare does NOT cover are: Routine Dental Care, Routine Vision Care, Long-Term Care, Hearing Aids, Prescription Drugs and Dental Procedures (root canals, crowns, etc).

Answer: A Medicare Special Needs Plan is a special plan that ONLY people who also are on Medicaid are eligible for. Each state has different eligibility requirements for Medicaid qualification. In terms of Medicare Advantage, Special Needs Plans provide the most comprehensive and inexpensive medical coverage available. In some cases, they also provide a monthly payment card for not prescription related needs/purchases.

Answer: Yes! Considering that Medicare was created in 1965 and hasn't changed much since its creation, the need for "re-thinking" is absolutely necessary. Think about how much things have changed... longer life expectancies, cost of medical care, many seniors needing to manage chronic conditions for decades, and the skyrocketing cost and frequency of long-term care. Unfortunately, I truly believe that our entire health care system needs to be overhauled for everyone. There are many countries, far less sophisticated and wealthy than the US, that provide healthcare for all their citizens.

Answer: Between October 15th and December 7th, the Annual Enrollment Period occurs. A knowledgeable insurance provider should be able to review your parent's prescriptions and advise of the most affordable. I also recommend using Good RX to see if additional savings can be realized there.

Answer: Medicare does cover some genetic tests and screenings, but coverage is limited and conditional.

Medicare will cover-

1) Medically necessary genetic tests

2) When diagnostically needed

3) Certain cancer-related tests

4) Colorectal cancer screening

Medicare won't cover-

1) Routine or predictive screening

2) Direct-to-consumer tests (23 and Me/Ancestry)

3) Tests without clinical indication

Answer: A knowledgeable Medicare specialist should be able to discuss assisted living/nursing care options while on Medicare. Depending on your monthly income, different options might be better for you. (Original Medicare/Medigap vs. Medicare Advantage) Additionally, it might be beneficial to discuss long-term care insurance that can cover nursing home costs and in home care.

Answer: Typically, no. Once you have Medigap insurance, so long as you make your premium payments, it can't be cancelled, for example, due to medical condition. In the event that your Medigap company leaves your state and is no longer able to offer coverage, that creates an opportunity for you to look to other vendors for guaranteed issue.

Answer: Part D coverages change every year. Different companies negotiate different price points annually.

It's imperative that anyone on Original Medicare work with a licensed agent who can do a Part D review annually during AEP (annual enrollment period).

This is a free service that I provide annually to all my Medicare clients.

Answer: Original Medicare with a Medigap Supplement provides you with the best/most coverage, with the most flexibility, with a fixed cost (Medigap monthly premium), which allows you to appropriately predict and budget your medical costs for the year.

Original Medicare is accepted at any doctor/hospital in America who deals with Medicare. You don't need to worry about "networks" or having your insurance accepted/rejected.

As a working agent in my mid-50's, when I'm Medicare age, I'll definitely be an Original Medicare with Medigap supplement guy!

Answer: So long as you maintain "credible insurance" (in this case through your wife) it's not necessary to sign up for Part B or Part D (prescription drug) until you are going to lose that "credible insurance." My recommendation would be to reach out to a knowledgeable agent about 6 months before your wife is going to retire and you'll lose that insurance and review your options at that time.

Answer: With Medicare Advantage you are required to use an "in-network" provider or risk paying a higher rate. There are many "unknown" costs with Medicare Advantage that you just can't predict, like co-pays, deductibles, etc. Medicare Advantage also has a M.O.O.P. or Maximum Out of Pocket, annually. This can be significant, depending on your health needs.

For all of the above noted reasons, many people prefer to go with Original Medicare and a Medigap Supplement. You have maximum flexibility with providers and have an absolute, predictable and budget amount for medical expenses/insurance.

Answer: There is no relationship between your income and Medicare eligibility. You "earn" access to Medicare by working at least 40 quarters/10 years in the US.

IRMAA-Income-Related Monthly Adjustment Amount can be altered based on your income. This is an additional amount that is added to your Part B monthly premium and your Pard D premium. This additional amount is added if you make more than $218,000 annually (married filing jointly)

Answer: With a Medigap Plan F you never have co-pays or out of pocket for any medical expenses. You should compare your Plan F side-by-side with a G plan. The only difference between the two is that you pay an annual Part B deductible with the G plan ($283 in 2026). Typically, F plans are $100-$200 more than G plans. You could be paying $1200 to $2400 to save $283. Depending on your state, there are typically ways to move you from F to G.

Answer: Any hospital, public or private, who accepts Medicare payments from the federal government MUST accept all Medigap supplemental plans and part A and B. The payment structure for Medicare Advantage plans depends on the network and decisions that the hospital has made regarding who they will work with.

Answer: There are several ways that you can save on the cost of your medications.

1) Work with a local and knowledgeable agent during the Annual Enrollment Period (AEP) to ensure that you're on the most affordable RX plan.

2) During that review, you can compare several different pharmacies. You would be surprised how much less expensive your medications might be at a different pharmacy.

3) Ask your doctor to consider generic medications rather than name brand.

4) Consider using Good RX or other medication discount programs to see if additional savings can be discovered there.

I hope these tips help!

Answer: It's unclear. The information we know right now is the data that was available during the Annual Enrollment Period, which ended on 12.7. There is national news about efforts to re-negotiate prices on some drugs and we know that there is a cap on what Seniors have to pay, annually, thanks to the Inflation Reduction Act.

Answer: Agents are paid a commission for signing up a client for Medicare Advantage or for selling them a Medicare supplement. The tricky part is... unless your agent is licensed to sell everything in their area, they may be limited as to what they can share with you, based on what they are licensed to sell. I pride myself on having all Medicare Advantage options and the least expensive options for Medicare Supplemental insurance.

Answer: My recommendation is to use a consistent and knowledgeable agent to help/support you. As a Medicare agent, my "job" is to stay up to date on all things Medicare and be able to support and answer questions. If you have a good agent... You don't have to worry about keeping up! :-)

Answer: I prefer Original Medicare, with a Medigap supplement over Medicare Advantage because one that investment is made/budgeted for you have 100% certainty about out-of-pocket expenses and can choose to go to any doctor you like. The M.O.O.P. of Medicare Advantage Plans and limitations around networks, as well co-pays and co-insurance throughout make them less desirable to me.

Answer: Medicare part A and B will cover 80% of the cost of the surgery. The client cost is 20%.

If you have Original Medicare with a Medigap supplement, that supplement pays the 20% and you would have no out of pocket expense.

If you have a Medicare Advantage plan, they typically have a surgery co-pay that you would be responsible for.

There are some other enhanced treatment options that may not be covered. (special lenses, etc)

Answer: It depends!

If you are super healthy, and have no major medical issues during the year, and you are on a "free" or low cost Medicare Advantage plan, then you save the money that you would have potentially paid for your Medigap plan. However, if your health isn't good or you need a major medical procedure, surgery, etc. you would have to pay your M.O.O.P. (Maximum Out Of Pocket). Should this happen, you will pay significantly MORE than you would have if you would have been on Original Medicare and had a Medigap G or N plan.

Answer: If you have a Medicare Advantage Plan, that can be changed annually during the annual enrollment period, between October 15th and December 7th.

If you have Original Medicare with a Medigap Supplement, each state has different rules. For example in WA, they crafted a special law that allows you to change supplement at any time, without health questions. If you live in OR, you can change without health questions during your "birthday month" (30-days before or after your actual birthday.)

Answer: All agents should review the details of the Medicare Advantage plans before sign-up. My recommendation is to reach out to a knowledgeable local agent and seek their counsel. There may be other options available, depending on your state and the specific rules in that state. I'm happy to help if needed! Contact me.

Answer: The Medicare plan that would provide the highest level of protection and a predictable annual cost would be Medicare Part A and B, coupled with a "G" Medigap plan.

Answer: The solution to the following things that make many people unhappy is to move to Original Medicare with a Medigap Supplement.

Many people do not like the limitations and structure of the "in network"/"out network" structure. If they travel, they can be frustrated with their MAPD not being accepted/in network or other areas.

The other huge concern is the M.O.O.P. or Maximum Out of Pocket. These numbers can be significant, with many plans having a M.O.O.P. of $9500. in 2026.

Answer: Annuities can play a key role in retirement by providing guaranteed income you can’t outlive. They help turn savings into a predictable monthly payment, offering stability even when markets fluctuate. Annuities can also complement Social Security or pensions, helping cover essential expenses and giving retirees confidence that their income will last as long as they do.

Answer: Medicare does cover asthma and other chronic respiratory (breathing) conditions quite comprehensively, though coverage depends on the type of care and which part of Medicare applies.

Answer: Most Original Medicare clients who have a Medicare Supplement never switch, or only when they find the same supplement (N, G, etc.) for a lower price with a different vendor.

Medicare Advantage and Medicare Part D (RX) plans should be reviewed annually during the Annual Enrollment Period (Oct. 15-Dec 7th) as these plans change every year and it's important to make sure that you are getting the best coverage for the best price.

I highly recommend partnering with an experienced Medicare agent to assist you in navigating these decisions.

Answer: You can switch to Medicare Advantage during the Annual Enrollment Period, October 15th to December 7th. I would caution you in this shift as you frequently will take on more fiscal liability with a Medicare Advantage Plan that you would have with Original Medicare with a Medigap Supplement. I'd encourage you to consult with a licensed agent who deals with both, so they can show you the comparison information.

Answer: Original Medicare Part B covers acupuncture only for chronic lower back pain, when your doctor prescribes it. You can get 12 acupuncture treatments in the first 90 days and have a total of 20 treatments per year.

Answer: Medicare does not provide extensive long-term care solutions. The best bet is to meet with an insurance agent who handles long-term care insurance and evaluate a plan that will make sure that you have a safety net without needlessly burdening family or placing your spouse/partner in a position where they have to liquidate all assets to qualify for Medicaid.

Answer: You can use a HSA to pay for some Medicare expenses but not all.

You can use HSA funds to pay for:

Medicare Part B premiums (medical insurance)

Medicare Part D premiums (prescription drug coverage)

Medicare Advantage (Part C) premiums

Out-of-pocket medical expenses like deductibles, copays, and coinsurance under Medicare

You cannot pay for Medigap supplements out of your HSA.

Answer: Some vaccines are covered by Medicare Part B and others are covered by Part D.

Part B generally covers vaccines that are considered “preventive” and medically necessary. These are fully covered (no deductible or copay) when administered by a provider who accepts Medicare.

Part B covers:

Influenza (Flu) vaccine – once per flu season.

Pneumococcal vaccines – two types are covered:

Prevnar 20 (PCV20) or

Pneumovax 23 (PPSV23)

(Usually given one year apart, depending on your doctor’s recommendation.)

Hepatitis B vaccine – for people at medium or high risk (for example, people with diabetes, ESRD, or certain health conditions).

COVID-19 vaccines and boosters – all recommended doses are covered.

Vaccines needed due to injury or exposure – such as tetanus (Td or Tdap) if you get a wound.

Part D (prescription drug coverage) covers all other commercially available vaccines that are not covered by Part B, when they are reasonable and necessary to prevent illness.

Part D covers:

Shingles vaccine (Shingrix) – a 2-dose series recommended for adults age 50+.

RSV vaccine – recommended for adults 60+ or based on individual health risk.

Tdap or Td for routine boosters (not related to injury).

Travel vaccines – such as yellow fever, typhoid, or Japanese encephalitis.

Any other vaccine approved by the CDC and commercially available.

Answer: Yes, many of my clients also use over-the-counter drug cards. They typically compare the discount with the card, Good RX, for example with what the cost would be, using their insurance and choose the most affordable option.

Answer: Medicare Advantage plans differ by zip code. If a zip code has Medicare Advantage Plans available, and doctors/pharmacies partnered with those plans... yes, they work.

However, in many rural communities, there simply aren't any Medicare Advantage Plans available.

Answer: I've had the privilege of helping many clients with complex issues and supporting the resolution. Below are a few examples.

1) Discovered that a client was inadvertently enrolled in a MAPD plan and was paying for a Medicare Supplement.

2) Helped a Veteran navigate the world of VA benefits and making decisions about what parts of Medicare they need to engage with.

3) Supported multiple clients in understanding how their annual income affects their Part B premium, and when appropriate, helping them make retirement plans to maximize their assets and minimize their out-of-pocket expenses.

Answer: The premium cost for Medigap Plan's is based on how the state manages premiums. Many states offer a consistent price regardless of age. Other companies grow their Medicare premium costs based actual age. Medigap companies also can petition the state insurance commissioner to increase their premium price if they have an actual documentable cost increase.

Answer: This is a vicious rumor. Medicare doesn't replace life insurance or cover final expenses. Life insurance should be part of the consideration as everyone works with retirement and final expense planning.

Answer: Both Medicare Advantage and Medigap can be the right choice depending on your individual situation.

From my perspective, Medigap policies provide better overall protection for significant medical/hospital bills. This will be the choice I make in nine years. They allow you to know for certain what your out-of-pocket obligations will be.

Medicare Advantage plans are limited by zip code for available, in network, providers. Medicare Advantage plans also have a MOOP (Maximum Out Of Pocket) which is significant. This unpredictability coupled with co-pays and other out of pocket liabilities makes me see these plans as less favorable, even though the monthly cost will most likely be less than the Medigap plan premium.

Answer: Yes! If it is your first time exploring/trying a Medicare Advantage plan you have a one-year window that you can return to original Medicare with Medicare supplemental insurance. If you are on the Medicare Advantage plan longer than a year, you'll have to answer all the health questions and aren't guaranteed a return to the Medicare supplemental insurance.

Answer: if you have your red/white/blue Medicare card, I'd reached out to a licensed agent who can help you with either Original Medicare with a Medicare Supplement or Medicare Advantage. Working with an agent who can do both truly allows you to choose.

If you don't have your red/white/blue card, you need to either visit your local social security office and ask them to start your Medicare or you can do it online if you have good technology skills.

Answer: Experienced brokers are going to be able to describe all parts of Medicare, confidently, and answer any questions that you may have. I also think it's helpful to work with a broker who knows and understands both Medicare Advantage and Original Medicare, so they can adequately explain the pros/cons of both options. A good broker is going to give you the information and empower you to make the best choice for you, as the client, as opposed to trying to "sell" you something.

Answer: I love serving other people and making, what some people feel is complex, simple. I support potential clients with either Original Medicare or Medicare Advantage, whatever makes the most sense for them. Helping seniors make the best choice for them is very rewarding!

Answer: Unfortunately, if people don't sign up for their Part B/D when they lose credible coverage or turn 65, there is a penalty to pay. Even though this may feel punitive, it's Medicare's effort to ensure that as many healthy participants can be in the Medicare pool as possible.

Answer: During the annual enrollment period check to see what Medicare Advantage plans your preferred hospital is in, and consider changing to that other MAPD plan.

Answer: It depends. Each state has different rules. In Washington, there is a RCW that allows seniors to change from one supplement to another at any time with no health questions. In Oregon, you generally DO need to respond to health questions; with one exception, your birthday month. Oregon allows you to move without health questions 30 days before and 30 days after your birthday. These are the two states that I'm licensed in. I'm certain that other states may handle it both similar and differently.

Answer: Yes, bone density tests are covered under Medicare as preventative care, once every two years. Your doctor may have to document/state that it's medically necessary.

Answer: Original Medicare, part A and B do not cover hearing aids. Many Medicare Advantage plans do offer a benefit every two years ($1000.) That said, each Medicare client should weigh the pros/cons of Original Medicare with supplemental insurance to Medicare Advantage Plans. One really needs to consider all the benefits and liabilities.

Answer: No-most Medicare agents genuinely want to help support the transition onto Medicare for the seniors they serve. Medicare seminars are one way to get the information. My company tends to meet in person with potential clients and serve 1:1 but there are many ways to learn the information.

Answer: It depends. If you have a Medicare Supplement, in addition to Parts A and B, once your Part B annual deductible is met, you should have no other out-of-pocket costs. If you have a Medicare Advantage plan you likely will have out-of-pocket costs, both in terms of co-pays and your MOP (maximum out of pocket).

Answer: MOP or Maximum Out of Pocket, only applies to Medicare Advantage Plans. They can be significant and need to be considered when weighing the type of Medicare that one will pursue in retirement. Conversely, Original Medicare customers, with a Medigap Supplement are not subject to MOP out of pocket expenditures.

Answer: There are so many considerations in addition to the premium. Many people don't realize the high copays or the MOP (Maximum Out of Pocket) annual expense which can run from $7000 to $10000, annually for many Medicare Advantage Plans. I recommend sitting down with a knowledgeable agent who deals with both Original Medicare/Supplement and Medicare Advantage Plans and do a side-by-side comparison of the monthly premiums, and also the unpaid possibilities that exist with Medicare Advantage Plans.

Answer: Yes. Losing your employer coverage creates a SEP (Special Enrollment Period) and you will be able to choose the Medigap policy that works best for you and your family.

Answer: Medicare Advantage plans typically have a small or no monthly cost. That said, there can be significant co-pays, and the MOP (maximum out of pocket) can be between $6000 and $10000. This translates into a big out of pocket liability should you have a significant medical event. Many clients prefer Original Medicare because the out-of-pocket costs are known and can be budgeted for with absolute certainty. It's all about flexibility and meeting your individual needs.

Answer: Yes. The only way to "turn off" your Medicare is to have other credible insurance. Plus, if you have Original Medicare with a supplement (G, N) that supplement will reimburse for up to 80% of emergency medical care out of the country. The safest bet is to keep your coverage intact and enjoy your time out of the USA.

Answer: Yes! When you turn 65, you'll be able to choose Original Medicare with a Medicare Supplement or a Medicare Advantage Plan, based on your individual needs and preferences.

Answer: Part A will fully cover your hospital stay, after you pay the $1676 Part A, per benefit period deductible.

The best way to ensure full coverage is to have your Part A and B engaged and purchase a Medicare Supplement plan. Then you're good!

Answer: A wise man once said: "The cheapest isn't necessarily the best." Typically, Medicare Advantage Plans are less expensive than the monthly cost of Medicare Supplements. That said, they have a large "maximum annual out of pocket expense," that catches people by surprise if they have a big medical issue to solve. My recommendation is to have a conversation with a licensed Medicare professional who can share the pros/cons of both and help you make an informed decision.

Answer: Medigap plans ensure that you know "exactly" what your out-of-pocket costs will be each year, and you get to see any doctor in America who accepts Medicare. Medicare Advantage may have a zero-premium plan, but they also are likely to have a significant "maximum annual out of pocket expense" that could range from $7000 to $10000. There are pros/cons to both approaches, but many clients prefer the security and flexibility of their Medigap plan

Answer: If you just have part A and Part B with no Medicare Supplemental Insurance or Medicare Advantage you will have a tremendous liability for out-of-pocket expenses. I highly recommend meeting with a Medicare specialist to review exactly what Part A covers and what it does NOT cover.

Answer: Yes. Many mental health services are covered under Part B. You must meet your annual Part B deductible and either pay the remaining 20% unless you have a Medigap plan, which in that case, care may be fully taken care of.

Answer: You will continue to get Medicare Part A and Part B. You have the opportunity, if you choose to change to a different/new Medicare Advantage Plan or you could choose to shift to "Original Medicare" with a Medigap supplement. I would encourage you to meet with a licensed professional and review all your options.

Answer: Technology, and in particular AI, will play a significant role in the future of Medicare. Possible advances include:

1) Enhancing diagnostics and treatment

2) Preventative care and chronic disease management

3) Administrative efficiency and fraud reduction

4) Improving access and patient engagement

5) Policy and population health analytics

There also are several concerns and challenges that will need to be thoughtfully considered as technology plays a larger role for each of us in many areas of our lives.

Answer: Nothing really :-) But there is no reason to delay because there is no out of pocket expense at 65 to start your Part A. I encourage clients to start their Part A and just have it as back up to their spouses' insurance.

Answer: From my perspective, the "N" plan offers the best value for most seniors. The only significant difference between the "N" and "G" plan is a $20 co-pay at the doctor and $50 co-pay at the ER if you're not admitted, with the "N" plan. The difference in monthly cost typically makes the "N" make the most sense for many of my clients.

Answer: I'm happy to help! It makes things so much easier to sit down with an agent who specializes in Medicare. I work with both Original Medicare and Medicare Advantage and am committed to helping you find the policy and coverage that best meets your needs and the needs of your family!

Answer: The Medigap Birthday Rule is a regulation in certain U.S. states that allows Medicare beneficiaries to switch their Medigap (Medicare Supplement) insurance plans without medical underwriting around their birthday. This gives people a chance each year to change plans without worrying about being denied or charged more due to health conditions.

States with a Medigap Birthday Rule (as of 2025):

California

Oregon

Idaho

Illinois (similar rule, but not called the Birthday Rule)

Answer: Since Medicare Supplements are guided by Federal Expectations, the most important question relates to the agent who sells and manages the supplement, as well as provides Part D coaching on an annual basis. I work with Bankers Life and pride myself in offering the very best customer service possible to my clients.

Answer: Many people leave Medicare Advantage plans because they don't like the restrictions regarding "in network" doctors. Many seniors also like the stability of knowing 100% what their out-of-pocket medical expenses will be. With the "Maximum Annual out of Pocket" in MA plans the out of pocket can actually be significantly more than with original Medicare and a supplement.

Answer: Doctor's have to, annually, engage with the various Medicare Advantage plans. I'd suggest double-checking with your doctor to see if they are connected with your MAPD provider. If they are, you're good to go! If they are not, I'd reach out to your MA plan and question the initial sign up communication. If your MA provider used to be in network and now is not... they have created a "special enrollment period" and you should be able to try and move to a new MA plan that your doctor is enrolled.

Answer: A shrinking workforce in the U.S. over the next 20 years is likely to increase financial pressure on Medicare, leading to higher costs, potential funding shortfalls, and challenges in providing adequate care to the aging population. Policymakers will need to make difficult decisions about how to balance the needs of an older population with the realities of a smaller tax base, possibly through increased taxes, reduced benefits, or other reforms. Ensuring the sustainability of Medicare in the coming decades will require a combination of strategies, including workforce policies, healthcare reforms, and fiscal adjustments.

Answer: You should seek out a plan that hits the "sweet spot" between monthly premium and potential "out of pocket liability."

Answer: Medicare Advantage plans may have a zero premium each month, but they will also have a annual "out of pocket" maximum. This amount may be significant and certainly may be equal or greater than the premiums that you might have paid for a Medicare Supplement with Original Medicare. It's important to review the pros/cons of both and to choose the plan that best meets your individual needs.

Answer: What are the measurable differences between "Original Medicare" and "Medicare Advantage? (The pros/cons of both)