April Ryan, Medicare Insurance Broker

Answer: An SOA is not mandatory for a Medicare appointment however some advisors do require them. In my practice, we do not. I’d be happy to answer any questions or discuss your Medicare options with you.

Answer: The short answer is yes. However, if you and/or your spouse are still working and have credible employer-sponsored health insurance, you can defer enrollment. You should, however, go ahead and enroll in Medicare Part A as there is no cost. The penalty for not enrolling when eligible is 10% of your monthly Part B premium for each year that you do not enroll.

Answer: Advantage plans are not governed by the Department of Health and Human Services, specifically the Centers for Medicare and Medicaid Services (CMS). Insurance companies control what advantage plans do and do not cover and they contract with providers. These contracts are not permanent and can change from year to year. Doctors and providers can choose to leave a network if they so choose. That's why I always recommend traditional Medicare and a Medigap policy.

Answer: When you have original Medicare Parts A & B and a Medigap Plan F, you do not have copays for emergency room visits.

Answer: If you have a Medicare Part D Drug Plan, my first advice would be to compare your plan every year during annual enrollment. New drug plans are made available each year. Also, shop pharmacies. You will be amazed at the difference in prices. Ask your doctor to perscribe a generic alternative to a name brand drug and use saving script plans such as Physicians Mutual SaveScript or GoodRX.

Answer: Losing a spouse is devastating in itself, having to figure out insurance and other bills adds to the stress. We try to take away the stress by handling these life qualifying events for our clients. If you lose a spouse and was on their employer coverage, you have 63 days to enroll in Medicare without a penalty. It’s considered a qualifying event, which means you would need to enroll in Medicare Part A & Part B, and we would work with you to determine the best Medigap plan for your needs.

Answer: The one regret that I see over and over is people enrolling in a Medicare Advantage plan and not fully understanding the plan. Advantage plans are not regulated by the Department of Medicare and Medicaid Services. They are owned and regulated by the individual insurance company which means they may not cover everything that Original Medicare would cover. Advantage plans are also zip code specific, so if you travel your advantage plan may not work outside of your coverage area.

Answer: The key difference between Medicare Advantage and Medigap policies is that Advantage plans only pay for in-network providers, while a Medigap plan will allow you to see any doctor, specialist, or hospital that accepts Medicare.

Answer: Medicare DOES NOT fully cover nursing home care or long-term care. It will however cover short term stays for post-hospitalizations or rehab needs. Medicare only covers up to 100 days of skilled care and even a portion of those 100 days will have co-pays.

Answer: New Part D, Prescription Drug Plan laws were established for 2025 that state individuals will pay no more than $2,000 in drug costs for the entire year. You may also set up a payment plan with your drug plan carrier to help with copays and deductibles.

Answer: Selecting the right healthcare company and agent to work with is key when it comes to your Medicare coverage. Look at the company's ratings, how often have they had rate increases in the past and how significant were those increases. What is their turnaround time in paying claims?

Make sure your representative will still be around when you need them in the next one, two, five or ten years. Many people get into this industry for the wrong reasons and find out quickly that it's not the ideal career for them. If your agent has been in the industry five years or more, chances are he or she will be around when you need them.

Answer: Outpatient Mental Health programs will be covered under Medicare Part B. For eligibility, a person would have to be diagnosed with a mental disorder that alters their day-to-day life.

Answer: For me, it's all about the education. So often, individuals turning 65 are not certain what Medicare does and does not cover and what their options are. I spend at minimum two hours educating my Medicare clients so that they are aware and have a better understanding.