Ashley King, Medicare Insurance Broker

Answer: To start the appeal process, you first have 120 days from the time coverage was denied to file for a redetermination of coverage. I recommend you start by reaching out to your doctor to provide more details as to why home health care is medically necessary for you after surgery. If coverage is still denied you can move on to the next step of the appeals process which is for reconsideration and allows for an independent review which all details will be provided for that if redetermination is denied.

Answer: You have three different options to request a replacement card. You can contact 1-800-MEDICARE (1-800-633-4227), and if you receive benefits through the Railroad Retirement Board. You can also go to Medicare.gov and log in, then select "replace your Medicare card" and follow the instructions. You can also print an official copy from there as well. Lastly, you may go to your local Social Security Administration office to request a replacement card.

Answer: There are several changes that may occur that could affect the cost of your prescriptions. Pharmacies can change their pricing and increase the price of the current prescriptions. In addition, the Part D plan you have may have updated their formulary which can change the tier level co-pay you are responsible for. I would recommend looking at the medications and your plans formulary to see what has changed.

Answer: Enrollment in a Medicare Advantage Plan may be denied if the beneficiary does not live in the plan service area, don't have both Parts A and B, or don't meet Medicaid level requirements for certain plans.

Answer: No, income does not affect your Medicare eligibility. Medicare eligibility is based on age, disability, or certain medical conditions.

Answer: Guaranteed issue for a Medicare Supplement plan allows an individual to enroll in a supplement plan without medical underwriting. That means there is no risk you would be denied for any health conditions. Everyone gets a 6‑month Medigap Open Enrollment Period when they turn 65 and enroll in Part B, that rule applies in every state. There are also certain life events where this applies like losing Medicare Advantage coverage, moving out of your plan’s service area, losing employer coverage, or switching back to Medicare within your first year on an Advantage plan. Each state also has its own Medigap rules on top of the federal protections, so your options and timing can look different depending on where you live.

Answer: Yes, it will work the same as if you travel in any of the U.S. and that applies to Part A & B. You can see any provider that accepts Medicare.

Answer: If you do not accept Medicare, the BCBS Massachusetts Medicare supplement plan will not pay for your services. The client will need to pay you directly and they will not allow any billing or reimbursement. The BCBS-MA Medex covers therapy for providers who accept original Medicare.

Answer: Medicare Part B covers outpatient surgery after the Part B deductible has been met. Once that is met you would be responsible for 20% and Medicare Part B will cover 80% of the outpatient surgery.

Answer: Your first option is to file an appeal, as many denials get overturned after additional medical documentation is provided to the Medicare Advantage carrier during the appeal process. You can also ask your doctor to request a reconsideration or provide additional notes to why the specialist was needed. They may grant an exception or offer coverage for a different provider under the same specialty in-network.

Answer: One thing I see often is that people new to Medicare focus mainly on premiums or extra perks, but the long‑term impact of their choices is just as important. Many also never learn about their early Medigap opportunities, like their Guaranteed Issue window, state GI protections, or birthday rules until those options have already passed. These rules can make a huge difference in long‑term flexibility and affordability, which is why I focus on educating people upfront about both their immediate choices and how those decisions can affect them 5–10 years down the road.

Answer: Since Medicare Supplement plans are standardized, it's really now one company being "better" than the other. It really comes down to pricing, rate increase history, and their customer service ratings available in a client's area based on their zip code. I focus on comparing those factors to help clients choose the most stable and cost-effective option available to fit their situation.

Answer: Since they have not met the 5-year U.S. residency requirement they would not be subject to any penalties. However, as soon as they reach the 5-year requirement the clock starts on their initial enrollment period. If they do not enroll during the initial enrollment period window of time which is a total of 7 months, they will be subject to penalties.

Answer: You have 12 months after joining a Medicare Advantage plan to switch back to original Medicare and during that time you can purchase a Medicare Supplement policy without medical underwriting. If you are notified your Medicare Advantage Plan is leaving your covered area you would also be eligible to enroll in a Medicare Supplement policy without medical underwriting. In addition, if you move out of the area where your Medicare Advantage plan is offered you may be eligible for a special election period to enroll in a Medicare Supplement plan without underwriting. Some states also have special rights regarding medical underwriting that may apply. A licensed insurance broker can help review your options, or visit your local SHIP department, call 1-800- Medicare or visit Medicare.gov.

Answer: Medicare Part B does cover medical nutrition therapy services if you are eligible. Diabetes is one of the qualifying conditions in addition to chronic kidney disease or if you have had a kidney transplant in the last 36 months. You will also need a referral from your doctor for nutrition therapy for a registered dietician.

Answer: If you are admitted to the hospital Part A will kick in after you meet your Part A deductible which is $1676.00 currently for 2025, but it will be going up to $1,736 for 2026. That covers up to 60 days. If you are admitted beyond that there are daily charges. If you’re not admitted, then you’re overnight stay for observation for example in an emergency room visit would fall under your part B coverage. Now, if you do have any other coverages, such as a Medicare supplement plan or a Medicare advantage plan.

Answer: I can completely understand how overwhelming all the mailers can be as you're approaching 65. Just keep in mind the truly important notices come from Social Security directly. Independent brokers like me are not tied to one insurance company. This allows us to compare plans across multiple carriers, explain the differences and guide you to coverage that truly fits your need and budget.

Answer: You will want to to complete a form that proves you had credible coverage when you do go to enroll in Part B. The form is called CMS-L564 which is a request for employment information. You will need to fill this out with yours and your spouses information. You will also need to have your spouses employer fill out section B of the form. You will submit this with your CMS-40B form which is your application for Part B. You can find these forms at CMS.gov. I also recommend obtaining a written statement from your spouses employer stating the coverage is credible for Part B and Part D.

Answer: Licensed insurance agents and brokers, like me are prohibited from charging you for help with Medicare insurance education or enrollment. This is to ensure that every Medicare beneficiary has equal. no cost access to professional Medicare education and guidance.

Answer: Medicare Part B does provide coverage for preventative screenings such as mammograms at no cost when performed by a provider who accepts Medicare. Other appointments such as diagnostic follow- ups may be subject to your Part B deductible and coinsurance.

Answer: You chose a plan to fit your budget at the time; you didn't make a mistake doing that.

Medicare Advantage plans often trade low premiums for higher copays, which can feel frustrating later. You can have options to review your plan and look for one that may be available with lower co-pays.

Answer: Medicare may help with trials if it is normally covered under Part B. This would be the typical 80% of costs after you meet your deductible. If you incur an inpatient hospital stay for the trial, Part A may cover those costs after your deductible. Any treatment that is consider experimental and not FDA approved would not be covered. It is best to discuss the trial with your doctor to enroll and understand eligibility.

Answer: Once you enroll in Medicare you cannot keep contributing to an HSA account, but you can still use the funds you have for Medicare Advantage premiums, Part D premiums and even Part B premiums. However, Medigap policy premiums are not HSA eligible.

Answer: Depending on what type of Medicare coverage you have, for example Original Medicare, Medicare Advantage, or a Medicare Supplement Plan. It is important to know that you will have a 2-month window to make changes if your plan is not available in your new location or if you lose coverage as a result of the move. You may qualify for guaranteed issue rights to buy a new Medigap plan if your current one isn’t offered in your new state. You will want to notify the Social Security administration of your address change and if you have a current plan contact them as well to notify you will be moving.

Answer: There are a few options you can explore to help dealing with those high costs. You can apply for Extra Help which is a federal subsidy that can lower drug costs along with exploring other Part D plans that may be available offering to cover more of those drug costs. Your state may also have assistance programs you can apply for along with checking with the drug manufacture to see if they offer any discount programs. Lastly, you could explore other options such as Medicare Advantage plans that include prescription drug coverage.

Answer: There are gaps in coverage with Original Medicare Parts A&B, such as they do not offer prescription drug coverage, routine dental, vision and hearing, and there is no out of pocket maximum. In addition, Original Medicare does not cover long-term care and may have higher deductibles. There are options to help fill the coverage gap such as Medigap plans, Medicare Advantage and prescription drug plans.

Answer: After years in automotive service, I saw how often clients felt overwhelmed and unsure. What I love about Medicare is that I get to offer something more stable and personal. I’m guiding people through coverage that protects them, not pressures them—and that’s why I do this

Answer: No, Medicare cannot drop you for medical reasons. Even if your health changes or you develop a serious condition Medicare coverage will remain in place.

Answer: To save money it’s best to compare rates across carriers, choose the plan letter based on your needs, and definitely enrolling at the right time. A licensed Medicare agent can assist with this to tailor coverage to your needs.

Answer: When turning 65 you have a seven month window to enroll in Medicare. This initial enrollment period begins three months prior to your birthday month and extends three months after your birthday month. for example, if your birthday is in June, your initial enrollment period. Begins March 1 and would end September 30.

Answer: Yes, losing employer coverage can make you eligible for a special enrollment period. I can help navigate timing, explain options and avoid penalties.

Answer: Navigating Medicare can be overwhelming as it is not one-size-fits-all, and going at it alone could mean costly mistakes. Working with a Medicare agent is no obligation to you and they have the knowledge and carrier experience to bring clarity to the planning process.

Answer: When turning 65 you have an initial enrollment period that begins three months before the month you turn 65, and it’s the time to sign up for Medicare Part A and Part B if you're not automatically enrolled. From there, you’ll want to compare options like Medicare Advantage, Part D drug coverage, or supplemental plans based on your health needs and budget.

Answer: The use of certified health apps and wearables to track vitals, set reminders for medications, and alert of any changes that could be early signs of new illnesses.

Answer: A licensed agent not only helps you compare options, but they can also help you avoid costly mistakes while finding coverage that fits. All at no obligation to you!

Answer: Some Medicare Advantage (Part C) plans may offer supplemental chiropractic benefits. A Medicare broker can help you explore what is available based on your region, carrier and plans.