Anna Davis CIC-RSSA, Medicare Insurance Broker

Answer: Discount cards and prescription savings programs can help lower the price you pay at the pharmacy, but it’s important to understand that they do not coordinate with your Medicare Part D plan. When you use a discount card like GoodRx or a manufacturer coupon instead of your Part D insurance, those payments won’t count toward your Medicare drug plan’s deductible or annual out-of-pocket maximum. While the donut hole is no longer a coverage gap, Medicare Part D still has different cost phases, and what you spend using discounts outside of the plan does not move you through those phases. Discount cards can be helpful if a drug isn’t covered or if the discounted price is cheaper than your copay—but relying on them long-term can affect your true out-of-pocket tracking with Medicare. If you're consistently facing high drug costs, it’s a good idea to talk to a licensed agent and compare plans during the Annual Enrollment Period to find coverage that better meets your needs.

Answer: To stay up to date with changes in Medicare policies and plan options each year, be sure to review your Annual Notice of Change (ANOC), which is sent to you by your Medicare Advantage or stand-alone Part D drug plan. This important document typically arrives in September and outlines all updates to your plan for the upcoming year—such as changes to premiums, copays, drug coverage, or provider networks. It's essential to read it carefully. If you're happy with the changes, no action is needed—your plan will automatically renew. But if something doesn’t work for you, don’t wait. Contact a local licensed Medicare agent during the Annual Enrollment Period (October 15–December 7) to review other options that may better fit your needs. Staying informed each year ensures you're not caught off guard and that your plan continues to match your health and financial situation.

Answer: One of the most common misconceptions people have about Medicare is that it covers everything—but it doesn’t. Original Medicare (Parts A and B) leaves you responsible for deductibles, 20% coinsurance, and—most importantly—there is no annual out-of-pocket maximum. That means if you face a major illness or need ongoing care, your costs can add up quickly. To protect yourself financially, it’s important to enroll in either a Medicare Supplement (Medigap) plan or a Medicare Advantage (Part C) plan, unless you have qualifying employer coverage. These options help limit your out-of-pocket expenses and provide extra benefits that Original Medicare doesn’t include.

Answer: Call 1-800-Medicare they are open 24/7, they will send you another one, or you can print one on Medicare.gov

Answer: Yes, and sometimes they are called Medigaps. They usually have a monthly premium and they allow you to go to any doctor that accepts Medicare.

Answer: We are local, you have a person to talk to if you have a question or a problem, we will also simplify Medicare concepts, make sure you are covered well. And because we work for you, we will do our best to get you the best coverage avaible.

Answer: If your income fluctuates year to year due to investment distributions, and you have a spike that causes IRMAA (Income-Related Monthly Adjustment Amount) surcharges on your Medicare Part B and Part D premiums, there is a way to potentially reduce or eliminate those extra charges. Medicare bases IRMAA on your Modified Adjusted Gross Income (MAGI) from two years prior, but if your current income is significantly lower due to a qualifying life event, you can file a “Request for Reconsideration” using Form SSA-44.

While investment income itself isn’t a qualifying event, you can strategically plan around it. One approach is income smoothing, where you work with a financial advisor or tax planner to spread out large distributions over multiple years, use Roth conversions carefully, or consider Qualified Charitable Distributions (QCDs) if you're over 70½ to reduce taxable income. Another tactic is to plan large capital gains or trust payouts in years when you don’t need to renew IRMAA calculations—like after age 63 if you're claiming Medicare at 65.

IRMAA planning takes some foresight, but with proper tax and financial coordination, it is possible to minimize or avoid surcharges even with variable income. Working with a tax professional and a Medicare expert together can help you build a strategy that protects your benefits and your budget.

Answer: f you're not yet receiving Social Security benefits, you’ll receive a quarterly bill for Medicare Part B premiums by mail. Once you begin collecting your Social Security income, Medicare will automatically switch to monthly deductions from your check instead. It’s very important to pay your quarterly bill on time—missing payments can lead to a cancellation of your Part B coverage, which could leave you with gaps in care and future penalties. If you're having trouble affording the premiums, don’t wait—reach out to your local county office or Medi-Cal office to see if you qualify for help through programs like the Medicare Savings Program (MSP). These programs can help pay your Part B premium and even eliminate your late enrollment penalties if you qualify.

Answer: The easiest way to solve this, is call your plan and ask them for a list of dentist that you can go to. Otherwise, you will be going in circles calling each dentist and asking them do you take this insurance?!!

Answer: If you're turning 65 next month, the first step in your Medicare journey is to decide whether you'll keep your employer coverage (if you're still working) or rely on VA benefits (if you're eligible). If you don’t have either, you’ll need to enroll in Medicare Part A and Part B through the Social Security Administration. You can apply in person, over the phone, or online at ssa.gov. Once you receive your red, white, and blue Medicare card, the next step is to get help choosing the rest of your coverage. Even if you don’t take any medications, you’ll want to sign up for a Part D drug plan to avoid lifelong penalties. You’ll also need protection for the 20% that Medicare doesn’t cover, either through a Medicare Supplement or a Medicare Advantage plan. Working with a local licensed agent costs you nothing extra and ensures your plan covers your doctors, prescriptions, and healthcare needs properly from day one.

Answer: They are both insurance licensed professionals but a broker might be contracted with multiple plans and can offer multiple options vs. a company agent might be working for one company offering only their plans.

Answer: If you live abroad for extended periods of time, you technically have the option to drop Medicare Part B to avoid paying the monthly premium while you're not using the coverage. However, when you return to the U.S., you’ll need to provide proof to the Social Security Administration that you were living outside the country the entire time to qualify for a Special Enrollment Period and avoid the late enrollment penalty. Even then, you may have to wait for Part B to be reactivated, which could delay access to care. For many people, it’s actually a smart move to keep Part B active and enroll in a $0 premium Medicare Advantage plan, especially one that includes worldwide emergency coverage. These plans won’t cost you extra each month, but they can give you some peace of mind in case of a medical emergency overseas—coverage that Original Medicare does not offer. While you won’t be using the plan regularly abroad, having it in place preserves your Medicare enrollment and provides a safety net both at home and overseas.

Answer: No, with an HMO you can't do that, you will need to see providers in your plan network usually with a referral from your primary care doctor or your insurance will not pay and you will be responsible to pay all charges out of pocket.

Answer: f Medicare or your Medicare Advantage or Part D plan denies coverage for a procedure or medication you believe is necessary, you have the right to file an appeal. The first step is to carefully read the denial notice you received—it should explain why the service was denied and provide instructions on how to appeal. For Original Medicare, you’ll use the Redetermination Request Form or write a letter to the Medicare Administrative Contractor listed on your MSN (Medicare Summary Notice). If you're enrolled in a Medicare Advantage or Part D plan, you’ll need to follow your plan’s specific appeal process, which typically begins with requesting a reconsideration from the plan within 60 days of the denial. You can also request an expedited (fast) appeal if waiting could seriously harm your health. Supporting your appeal with a letter from your doctor explaining why the service or drug is medically necessary can increase your chances of approval. If the appeal is denied again, you may continue to escalate it through up to five levels of appeal, including a hearing with an Administrative Law Judge. Always keep copies of all communications and deadlines in mind to protect your rights.

Answer: One Medicare decision that many people regret later is not enrolling in a Medicare Supplement (Medigap) plan and a stand-alone Part D drug plan when they’re first eligible during their Guaranteed Issue (GI) window. This is especially true for individuals with multiple or chronic health conditions. During that initial period—typically the six months after you turn 65 and enroll in Part B—you have a unique opportunity to get a Medigap plan without medical underwriting, meaning you can’t be denied coverage due to pre-existing conditions. If you miss that window and try to enroll later, you may be declined or charged more. Medicare Supplements offer the freedom to see any doctor nationwide who accepts Medicare, with minimal out-of-pocket costs for services. In my experience, if someone can afford the premiums and they need frequent medical care, starting with a Medigap plan from the beginning is a decision they’re far less likely to regret.

Answer: Yes and no, if you have super expensive medications that used to throw you in the donut whole every year, then yes, 2025 changes limits your out of pocket costs to $2,000 in 2025 and $2,100 in 2026 and the donut whole. if you take regular inexpensive generic drugs you might not notice any difference.

Answer: Medicare contracts with multiple companies to provide drug coverage, each has their own formulary list of medications that they cover, you could confirm the easy way or the hard way, the hard way is to call or visit each company's website and review their formulary list. or the easy way is to go to medicare.gov , enter the medication names in question, and Medicare's website will tell you which companies cover this medication and which one covers it best.

Answer: Yes, if you need hospice care in the future, Medicare will cover it, including if you're enrolled in a Medicare Advantage plan. Under federal law, hospice services are always covered by Original Medicare (Part A), even if you are currently enrolled in a Medicare Advantage (MAPD) plan. This means that when you elect the Medicare hospice benefit, your hospice care—including pain management, symptom control, nursing, and support services—will be coordinated through Medicare Part A, not your Medicare Advantage plan. However, your MAPD plan will still continue to cover services unrelated to your terminal condition, such as dental, vision, or other supplemental benefits. It's important to ensure your providers are Medicare-certified for hospice care. Hopefully you will never need it, but if you do, it is there through part A

Answer: Technically, no—you can go to Medicare.gov and compare plans on your own. But here's why working with a licensed local agent (like us at Peace & Grace Insurance Services) can make a big difference: Working with an agent for personalized advise, it also a local agent will be familiar with the local doctors, what doctor takes what and since Medicare can be confusing, choosing an agent can avoid you many costly mistakes.

Answer: Yes, occupational therapy (OT) is generally covered under UnitedHealthcare Medicare Advantage (MA) plans as part of their required benefits. All Medicare Advantage plans must provide at least the same level of outpatient OT services covered under Original Medicare Part B. just keep in mind, prior authorization might be required.

Answer: Yes. If you're disenrolled from a Medicare Advantage C-SNP (Chronic Special Needs Plan) because you didn’t return the Chronic Condition Verification (CCV) form within 60 days, you may qualify for a Special Enrollment Period (SEP) to join another MAPD plan.

According to CMS guidelines, being disenrolled due to not verifying your chronic condition qualifies as a loss of SNP eligibility, which opens a time-limited SEP. This allows you to enroll in another Medicare Advantage plan that you're eligible for, even if it’s not a SNP.

To prevent losing your C-SNP coverage, do not wait for your provider’s office to handle the CCV form.

Here's what you should do:

• Call your plan directly and ask for the Chronic Condition Verification (CCV) form.

• Personally take the form to your doctor’s office to be filled out and returned.

• Busy provider offices may overlook or delay insurance paperwork—following up yourself can save you from losing your coverage

Answer: Yes and no.

If you travel for extended periods, like snowbirds who spend six months in Michigan and six months in Florida, then a Medigap plan is a great option. It allows you to see doctors in both states without worrying about networks or referrals.

However, if you’re only traveling for a week or two at a time, your Medicare Advantage plan should work just fine—since you're still regularly seeing your primary care doctor in your hometown. And remember, if an emergency happens, you're covered anywhere in the U.S. regardless of network.

Also, many Advantage plans now offer telemedicine, so you can consult with a doctor by phone or video no matter where you are.

Answer: Ambulance Ride — Don’t Fall Into the Trap!

You know those situations—you're sitting at a restaurant, suddenly feel dizzy or faint, and someone calls 911. By the time the ambulance shows up, you're feeling better and decide not to go to the ER?

Big mistake.

If you don’t take the ride, your insurance will likely deny the claim, and you’ll be stuck with the full bill—sometimes hundreds or even thousands of dollars.

That’s why I always tell people:

Get on the ambulance.

Go get checked out.

Pay the copayment—not the entire bill.

Better safe (and covered) than sorry.

Answer: Yes, that’s definitely suspicious—and illegal. No one is allowed to offer you any incentive to enroll in a Medicare plan. That’s a major red flag and a violation of CMS rules.

Some plans can offer small gift cards or incentives after enrollment, but only for things like getting a routine mammogram or prostate cancer screening—to encourage preventive care and help you stay healthy.

But if someone is offering you something to enroll?

Run!

Answer: Here’s the sad truth:

Medicare only guarantees your Medicare Supplement (Medigap) enrollment during the first six months after you enroll in Part B—or in a few other very limited situations.

On day 181, your application is subject to medical underwriting, and the insurance company is not required to accept you. If you're denied, your only option may be a Medicare Advantage plan available in your area.

Either way, you should get some form of coverage—because relying on Original Medicare alone exposes you to unlimited financial risk, especially in the case of major surgery, cancer treatment, or emergency transport.

Trust me—you do not want to be stuck paying 20% of a helicopter ride out of pocket.

Answer: Quick Medicare Breakdown:

Part A – Hospital stays, hospice care

Part B – Doctor visits, outpatient care, surgeries

Part D – Prescription medications

Part C – Also known as Medicare Advantage = A + B + (usually) D

Medicare Supplement Plans:

Plan F – (Only available to those eligible before 2020)

Plan G – Most comprehensive for new enrollees

Plan N – Lower premiums, with some copays

Want the simple route? Talk to a licensed agent. there are many good ones here, We spend hours studying this stuff so you don’t have to.

Or... you can read the Medicare & You handbook from the Social Security Administration—about 150 pages long. Either way, a trusted local agent can save you time, money, and headaches.

Answer: The Part A deductible is due to the hospital on the first day of your inpatient visit. However, Medicare Advantage Plans (Part C) are designed to ease that burden on the member. Instead of one large deductible, these plans often charge a daily copayment based on the number of days you're hospitalized.

For example, if you're admitted for only 2 days, you might pay around $700 total instead of the full $1,676 Part A deductible.

That’s why it’s so important to compare plan benefits—not just the brand name. You may have had a great experience with XYZ Insurance while working, but once enrolled in their Medicare Advantage plan, the copayments and hospital costs could be much less favorable.

Shop by coverage, benefits, and star ratings—not by brand loyalty.

Answer: No worries at all—and congratulations on reaching retirement! Many of us look forward to that day :O)

To get started, you’ll need your employer to complete CMS Form L564, which verifies to the Social Security office that you had creditable coverage through your job. This helps you avoid a late enrollment penalty for Medicare.

This form will also include your current coverage end date, which determines when your Medicare will begin. For example, if your employer coverage ends on 07/31, your Medicare coverage should begin on 08/01, ensuring there’s no gap in coverage.

It’s also a good idea to speak with a licensed local agent to explore your options for covering:

*The 20% coinsurance for Medicare Part B

*Part A deductibles

*Prescription drug coverage

Remember: Medicare does not cover everything. That 20% coinsurance under Part B has no out-of-pocket limit, which could expose you to unexpected financial risk.

So be careful—get the right coverage, and enjoy peace of mind as you enter this exciting new chapter of your life!

Answer: You should apply for Part A anyway—especially if you’ve worked and paid Medicare taxes for at least 10 years (40 quarters), as it’s usually premium-free.

Turning 65 is considered a qualifying life event, which means you have the right to leave your employer health plan if you choose to.

So what should you do?

Speak with a licensed Medicare agent in your area.

Compare the Medicare plans available in your ZIP code. Compare those plans to your current employer coverage.

Look at:

Monthly premium costs - Doctor network access - Out-of-pocket costs (deductibles, copays, and max limits)

If Medicare offers better value—and in many cases it does—you can add Part B to your application and drop your employer coverage.

If not, you can keep your employer plan and Part A only until you retire. Later on, you can always enroll in Part B with no penalty, as long as you had creditable coverage.

Answer: Medicare Supplement plans (also known as Medigap) help you maintain your freedom to see any doctor, any hospital, and any facility in the U.S. that accepts Medicare—with no network restrictions and no referral requirements. They also offer more predictable out-of-pocket costs, which typically don’t change much from year to year.

On the other hand, Medicare Advantage plans usually have lower or even $0 monthly premiums, but they come with trade-offs. Even PPO Advantage plans have networks of providers, so you must do your due diligence every time you see a doctor to verify if they’re in-network—otherwise, you could end up with a surprise bill.

In many HMO Advantage plans, you’ll need a referral from your primary care doctor to see a specialist, and that specialist must also be in-network and contracted with the plan.

That said, Medicare Advantage plans often include extra benefits that Original Medicare and Supplements don’t cover—such as dental, vision, hearing aids, and gym memberships.

In short:

A Medicare Supplement will cost more monthly but offers greater freedom and predictability.

A Medicare Advantage plan may cost less and offer extra perks, but your provider access is limited by network rules.

Answer: I had a client who was on a Covered California plan with a certain carrier. When he aged into Medicare, I helped him enroll in a Medicare plan. Two years after being on Medicare, he received a $6,000+ ambulance bill from the time he was still on the Covered California plan. The carrier had denied the claim, stating that the ambulance provider was out of network—even though it was an emergency situation.

In reality, he was only responsible for a $250 copayment per his Covered California policy. But the ambulance company was demanding he pay the full amount—over $6,000—and had turned the bill over to collections.

By the time he contacted me, he was being harassed by a collection agency. He was facing additional charges, late fees, interest, and constant threatening phone calls. We called the carrier and were transferred from one department to another for hours, just trying to file a grievance and get them to pay what they were supposed to cover.

The man was Portuguese and had a speech impediment, so he had to come to my office every time we needed to call or fill out forms. He didn’t speak much English, so we handled the communication and paperwork for him.

After doing some digging online, I found the Department of Managed Health Care Services—and they were lifesavers. We filed a complaint with them, and magically, within a few days, the bill was paid. The client never heard from the collection agency again.

Answer: I personally like Plan N. It’s usually reasonably priced compared to Plan F (which is grandfathered) and Plan G. It has three things to consider:

A $20 copayment when visiting the doctor—any doctor.

A $50 copayment for emergency room visits, usually waived if you're admitted to the hospital.

The Part B deductible, which is $257 in 2025.

Plan N does not cover excess charges. However, in my many years selling Medicare, I’ve found that excess charges have not been an issue. Most doctors and facilities accept Medicare and the supplements as they are. While excess charges can occur, they are very rare.

Answer: What I love most about being a Medicare agent is that I get to treat every client like I would my own parents — with care, patience, and respect. I enjoy seeing the look of relief on their faces once we’ve sorted through the confusion and found the right solution. But my greatest reward isn’t a commission — it’s when a client prays for me on their way out and says, “You’re God-sent.” That’s when I know I’m walking in my purpose.