Annelies Van Schie, Medicare Insurance Broker

Answer: Unfortunately, to avoid a late enrollment penalty fee for life in the future; No. The minimum you need to add to Part A & B is a Part D - Drug plan. If you do not take any prescription drugs, select the plan with the lowest monthly premium. If you do take prescription drugs, check on www.medicare.gov website with your drug list and a variety of pharmacy options what the plan is with the lowest total cost. A Medigap plan is options.

OR you can you get a Medicare Advantage plan with drug prescription coverage. Then you can also avoid a late enrollment penalty fee.

The reasons why people do select a Part C - Medicare Advantage plans or a Medigap plan wth their Part D - Drug plan, is because Medicare Part A & B does not have a maximum out of pocket cost that limits you cost annually. Hope this clarifies this matter.

Answer: Yes, Medicare Part B (Medical Insurance) covers mammograms. What cost they cover depends on the type of mammogram you get. For those 40 years and older, Medicare covers one preventive screening mammogram every 12 months. When you have medically necessary reasons for diagnostic mammograms to investigate or follow-up on an abnormal finding, Medicare could also covers those mammograms.

Answer: Great question. You can definitely enroll in Medicare at 65 while waiting until 70 for Social Security! Just keep in mind that since you aren't receiving a check yet, enrollment isn't automatic—you’ll need to sign up manually via the SSA website during your 65th birthday enrollment period, and you will simply have to pay the Medicare premiums direct until your Social Security Benefits start.

Answer: In short: Yes/ The Medicare Advantage plans you are able to choose from are based on your residential address. You cannot apply to plans that are not offered in your area.

Answer: Yes. Losing employers insurance qualifies as a Special Enrollment Period, which means you can apply for Medicare Part A & B, or for Part B only after your initial enrollment period at age 65.

Most people also would not have a late enrollment penalty fee due to having employer coverage after 65 till getting on full Medicare.

Answer: That's a great question. Unfortunately the HMO Medicare Advantage plans do not have out-of-network benefits. This means you would have to pay 100% out-of-pocket for the cardiologist visit. When reviewing your next year Medicare Advantage plan, you want to look for a plan that either the cardiologist is in-network with to have coverage (and all your other doctors), or change to a PPO Medicare Advantage plan because those plans do have out-of-network benefits so that you don't have to pay a 100% yourself.

Answer: Congratulations that you are already retired.

You would automatically receive your Medicare ID card in the mail about 3 to 4 months before the effective date. You would not have to apply for it.

Your Medicare insurance would start on the first day of your 65th birthday month.

If your birthday is on the 1st of the month, your Medicare will start the month before your 65th birthday month.

I would advise you to start learning about Medicare and exploring your additional Medicare plans about 4-5 months prior to your Medicare start date. Find a Medicare agent you can trust.

Answer: With the changes made to the prescription drug coverage, you're out of pocket maximum for all your drugs is $ 2,000. You would not have to pay more than that, or anything for any other prescription drug for the remainder of 2025. Now, that only applies to all drugs that are on your drug formulary, which is the covered drug list. Any drugs taken that are not covered by your drug plan would be additional out-of-pocket cost to you.

It is crucial to have the right plan that has your drug on their covered drug list / drug formulary!

Answer: It really depends on your insurance company. Not all dentists want to contract with every insurance carrier. Especially when it takes them a long time to get paid for the dental services they have provided.

Answer: I get this question all the time.

You would not get penalized if you continue to have a qualified health insurance plan through your employer.

You could get a Lifetime Enrollment Penalty fee (LEP) if you have individual insurance (a marketplace or private health insurance plan) or COBRA at the time you turn 65.

I would recommend you to apply for Medicare Part A at time of turning 65. Often times, whenever you do retire, the Part B application could be processed faster than applying for Part A & B at the same time.

Answer: When you have a Medicare Advantage plan, your insurance carrier has taken over the health insurance admin from Medicare. You would not be covered if you show your Original Medicare Card unfortunately.

You can change to another Advantage plan during the calendar year in the first quarter of the year (January through March) or at other times under certain circumstances. I recommend that you talk to a Medicare agent to understand your options, or find your answer on medicare.gov.

Answer: In my experience, people start to dislike a Medicare Advantage plan for one or more of the following reasons:

a. When they need more medical care and they have selected an HMO plan requiring a referral from a Primary Care Physician to see a Specialist.

b. Their doctors and hospitals do not accept their Medicare Advantage plan.

Just note that if you want to change to Traditional Medicare with a Medigap plan, you often need to pass a health questionnaire to qualify for a Medigap plan. This applies when you have Medicare Part B for longer than 6 months or have your Medicare Advantage plan for longer than 12 months. Other situations may require that as well.

Talk to a Medicare agent to understand your options.

Answer: Unfortunately, I do not have an answer for this questions.

Medicare, and all other health insurance programs, cover for medically necessary services. I am not sure if gene therapy would fall into this category.

Answer: You can look into applying to the following programs:

1) Extra help through Social Security. Those programs have the potential to lower your drug cost, and potentially also pay for your Medicare Part B premium.

And

2) Apply for state Medicaid benefits which potentially could cover for all your medical expenses that Medicare does not cover.

Answer: Yes, you should take into account that your Medicare deductible changes every year, just like the cost of groceries changes all the time. Often times though, the deductible does not change too much annually.

Answer: A Medicare Supplement plan (Medigap) plan medical benefits are the save, regardless with which insurance company you buy the plan from. Most people who want comprehensive coverage purchase a Plan G, while a Plan N is also worth exploring. Some insurance companies provides extra benefits such as a free gym membership and discounts on dental and vision services.

When you work with an agent who is contract with multiple insurance companies can help you figuring out the right plan for you.

Answer: For Medical services and procedures, doctors need to bill the Insurance company you have your Medicare Advantage plan with. For certain services/procedures, pre-authorization is needed which takes longer with dealing with an insurance company.

If you have a Medicare Supplement Plan (also called a Medigap plan) such as Plan F, G, or N then the billing and medical services pre-authorization request goes to Medicare direct, which is a simpler process.

Both billing and pre-authorization might just be simpler and quicker for the doctors to deal with. The administration with a Medicare Advantage insurance company might be more work for the doctors' administrative office.

Hope this helps ...

Answer: If you missed your window to sign-up for Medicare you could qualify for a Special Enrollment Period (SEP) , such as when you loose employers insurance (or other reasons). If you do not qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the Open Enrollment Period which runs from January 1 through March 31 each year. Check the medicare.gov website or talk to a Medicare Insurance agent to find out what applies for you and how to go about the application process.