April Burke, Medicare Insurance Broker

Answer: Depends on if you have credible prescription coverage with your employer group plan if you do, then you can analyze whether it’s best for you to drop your employer plan and enroll in part B and pick a Medicare supplement or a Medicare advantage plan depending on your details of the benefit benefits of your employer group plan compared to your Medicare options.

Answer: Dental, vision, hearing, Plastic Surgery, certain upgraded lenses for cataract surgery,Massage therapy, long term care/custodial services.

Answer: If their work furnishes them with credible coverage, they can choose to stay on their employer group plan and delay enrolling in Medicare part B. if they lose their employer Group plan, they can enroll in a special enrollment, Called loss of employer group plan, and enroll in part B of Medicare effective for the first of the month following the end of their employer plan.

Answer: There are certain situations where you can change your plan if you move to a different service area, however if you’re in a Medicare advantage plan & you can change to another Medicare advantage plan after annual enrollment (10-15 to 12-07) from January to March 31, but if you’re in a standalone prescription drug plan you will have to wait till the annual enrollment. Which is October 15 through December 7 for a January effective date.

Answer: Well again, it depends on your situation that you’re in and if you can answer no to the medical questions on a Medicare supplement if you currently don’t have a guarantee issue right. if you’re already in a Medicare Advantage plan, my suggestion is to go with a Medicare supplement if you’re able to afford it and want to go anywhere you want in the nation to see providers who take Medicare assignment without prior authorization and not have to deal with network restrictions and plan changes every year like you have to with those Medicare Advantage plans.

Answer: If that particular drug is listed on the formulary, yes it will help you, if it is not you need to ask your doctor to submit a formulary exception as to why that you need that particular drug instead of a lower cost drug that is on your drug Plans formulary currently, and why you cannot take it and why it is medically necessary. If the exception is granted, yes it will be included in the maximum amount of pocket for that year.

Answer: If your prescription drug plan is listed on the drug plan companies formulary then yes it will be included in the maximum out-of-pocket for 2026 of $2100.

Answer: Depending on the current plan that you are enrolled in if it’s a Medicare advantage plan sometime there are network disruptions and plan cancellations and plan changes every October for the next year. It is advised to analyze your situation with your Broker and see if staying in your plan or switching plans would be better for you or not.

Answer: If all of your drugs are listed on the formulary of the particular drug plan that you are enrolled in in 2025 yes that is correct and 2026 it’s $2100 if all your coverage drugs are listed if they are not, you must get a formulary exception note written by your doctor to have it covered and be included.

Answer: Everybody has a different personal situation, lifestyle, different prescription, drugs, and doctors and health situation. It is recommended to have a Broker that writes many plans to assess your particular situation and finances to see what is better for your situation, not your neighbors!

Answer: There are two different types of plants Medicare advantage that takes the place of the Medicare card and subject to networks and limitations. Then there’s Medicare supplement where you pay a premium that picks up some of Medicare part an and B that is not covered. It’s all aThere are two different types of plants Medicare advantage that takes the place of the Medicare card and subject to networks and limitations. Then there’s Medicare supplement where you pay a premium that picks up some of Medicare part a and B that is not covered. It’s all a personal situation and based on different states and ZIP Code that you live in.

Answer: Yes, Medicare covers Ventolin (and its active ingredient, albuterol), but the exact coverage and out-of-pocket costs depend on your specific Medicare plan.

Answer: Whether you keep paying for Medicare depends on which part of the program you have and whether you plan to return to the U.S. for healthcare. Because Medicare almost never covers medical care outside the U.S., paying for coverage while living overseas can feel unnecessary, but dropping it carries serious financial risks.

| Medicare Component | Premium Required? | What Happens If You Spend Part of the Year Abroad

**Part A (Hospital)** | Usually **$0** | Remains active automatically at no cost as long as you qualify for premium-free Part A (10+ years of U.S. work history).

**Part B (Doctor / Outpatient)**Yes** (monthly premium) | You must continue paying the monthly premium to keep your U.S. coverage active. If you drop it, you avoid the monthly fee, but you incur a **lifetime penalty** when re-enrolling.

**Part D (Prescriptions) **Yes** (monthly premium),Requires a U.S. home address in the plan's service area. Dropping it may lead to Part D late-enrollment penalties if you re-enroll later without creditable coverage. |

**Medigap (Supplement)**Yes** (monthly premium) | Many plans (e.g., Plan G or N) cover **80% of emergency medical care** during the first 60 days of a foreign trip. |

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### The Hidden Costs of Dropping Part B

If you spend part of the year abroad and drop Part B to save money, returning to the U.S. health system gets complicated quickly:

* **Lifetime Late-Enrollment Penalty:** Medicare adds a **10% premium penalty for every 12-month period** you were eligible for Part B but dropped it. Foreign health insurance or foreign national healthcare generally does **not** count as creditable coverage to waive this fee.

* **Coverage Gaps:** You cannot re-enroll anytime you choose. You must wait for the **General Enrollment Period (Jan 1 – Mar 31)**, and coverage will take effect the following month, leaving you uninsured in the U.S. in the interim.

If you maintain a primary residence in the U.S. and return

Answer: Medicare continues to pay for your standard medical care, labs, and visits, while your private membership fee covers advanced labs, personalized care plan, in depth screenings, You pay this out-of-pocket directly to the doctor. Medicare never covers or reimburses for this fee.