Ben Washington, Medicare Insurance Broker

Answer: Can I be denied for a Medicare Supplement plan? yes you can, if you don't guarantee issue rights, you have it when you first turn 65 or you sign up for part B : you 6 months window to signup for Medicare supplement plan

Answer: I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare? Will you be taking social security if not you need to signup up your part B,

Learn about original Medicare in comparison to to your company plan. Also learn about the different option like medigap and part C (meicare advantage plans) and part D (prescription drugs plan)

Answer: I'm planning to delay Social Security until age 70, but I'm turning 65 soon. How does this affect my Medicare enrollment? Does not affect your Medicare enrollment but how you pay your part B premium since they cannot take out your social security check you may require paying quarterly

Answer: Do I qualify for SEP if my health dramatically gets worse out of nowhere? yes may qualify for a chronic special need plan. if you have change in health that fit c snp requirements -condition

Answer: Can I drop my employer health insurance and switch to Medicare instead? yes , you have two months from time your coverage to enroll MA or part D plan

Answer: Medicare generally covers standard monofocal intraocular lenses (IOLs) used during cataract surgery for monovision, but it does not cover the costs associated with achieving or refining monovision with premium IOLs. If your eye center is recommending premium lenses, you would be responsible for the difference in cost, which could be around $2,500 per eye.

Answer: Will I be penalized if I do not enroll in Medicare when I turn 65? yes if don't have creditable coverage.

Enroll during your Initial Enrollment Period (IEP): This is the 7-month window around your 65th birthday (3 months before, your birth month, and 3 months after).

Have "Creditable Coverage": If you're still working and have health insurance through an employer (yours or your spouse's), you can often delay Part B and Part D without penalty.

Use a Special Enrollment Period (SEP): If you are still working, you have an eight-month window to sign up for Part B and a 63-day window for Part D after your employer coverage ends.

Answer: I just got a $300 bill for an ambulance ride I thought was covered. Am I the only one who didn't know Medicare doesn't pay for all emergency transport? No, most people do not know they do cover nonemergency transportation. Medicare Part B (Medical Insurance) covers ground ambulance transportation when traveling in any other vehicle could endanger your health, and you need medically necessary services from one of the following:

A hospital

A critical access hospital

A rural emergency hospital

A skilled nursing facility

Answer: Will Medicare cover asthma and other breathing conditions? Yes, Medicare covers it with Medicare Part B

Answer: How does Medicare handle coverage for experimental treatments or clinical trials? Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover some costs, like office visits and tests.

Answer: Are there any exceptions for medical nutrition therapy or therapeutic supplements under Medicare? You must have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months. A doctor must refer you for the services.

Answer: Will I get an Annual Notice of Change (ANOC) every year? yes, the plan should give an ANOC before the AEP

Answer: I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage? yes, depending if changes in medication or doctors covrage in your current plan, if have enrollment period, you can change a plan

Answer: Can Medicare drop me for health reasons? No, you are covered by original Medicare regardless of your health.

Answer: How does Medicare cover outpatient mental health intensive programs for seniors with severe conditions? Medicare Part B services cover: Intensive outpatient programs offer a level of care for mental health conditions (including substance use disorders) between traditional once-weekly therapy or counseling, and inpatient or partial hospitalization. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for visits to your health care provider to diagnose or treat your condition. With MA you pay copays. Also Mental Hospital stay is covered

Answer: What's the best time of year to change my Medicare plan if I develop a new diagnosis? You can only change your Medicare plan like a Medicare Advantage MA or Prescription Drug Plan PDP unless you have a enrollment period like AEP or Special Enrollment Period. If have Medigap plan

you can change anytime but if you have underwriting you wait six months before they pay out of cost that you are responsible for.

Answer: I switched to a new Part D plan and now half my meds require prior authorization. Why didn't anyone warn me this could happen? Sorry your agent should have reviewed that the plan can have prior authorization (PA) need approval from the plan Step Therapy (ST) plan can require you to try other drug be they approve it or can have quantity (QA) limits on medication the number plils can be prescribe in 30 day period. If any these limitations applies to your medications.

Answer: Is it ok to work with a younger Medicare Advisor? yes, Medicare Advisor are certified each year on Medicare by each carrier. as well as trained on product knowledge.

Answer: How can I make sure my Medicare plan will cover future treatments for my illness? Ma plans has cover everything that original medicare cover. It cover more but not less

Answer: Do your clients use Medicare Advantage over-the-counter drug cards? How does that work? Yes

Depending on carrier cashier scan barcode on the card or some use debit like card in the store. Also they have apps

Answer: Part A Inpatient Hospital deductible $1,676 but if I have Part C Advantage Plan, the hospital $350 copay per day 1-7 so how does this work? When you are under Part C (Medicare Advantage) your cost that you are responsible are in accordance the MA plan not original Medicare like Part A deductible, but copays as defined by the MA plan for services.

Answer: Who can help me figure out this Medicare "maze and alphabet soup" it's so confusing. A license Broker can help you. They are certified each year on Medicare.

Answer: Does Medicare fully cover nursing home care, and are there alternatives? No only skilled nursing

not for custodial care. You can short term nursing or home heathcare plan or long term care plan.

Answer: What's one Medicare decision that too many people regret later? Paying for part B when they did have too because they covered by spouse or retirement plan.

Answer: I have Medicare Advantage with a PPO, and I'm curious if my annual wellness visit is free or if I'll owe something for it. Your annual wellness visit is free. preventive is no cost to you.

Answer: I'm on a supplemental Plan N, and I'm curious if my recent MRI is covered or if I'll get stuck with a big bill. Medicare covers MRI for medical reason, after you meet the part B deductible and 20 copay

Answer: Will Medicare Advantage plans start offering more digital health tools like apps by 2030? I can say because carriers do not reveal their changes head of time, but most try to improve the customer experience.

Answer: My friend lives in a different city and has a much more detailed Medicare plan. Is their plan dependent on their location? Yes it may depend on the county that you live in. carriers

may have different benefits depend on counties not just the city.

Answer: Am I responsible for an IRMAA surcharge? depend on your income: If you have Medicare Part B and/or Medicare Part D prescription drug coverage, you could owe a monthly surcharge based on an income-related monthly adjustment amount

Answer: Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare? Medicare Advantage plans covers parts A and B and includes extra Dental, Vision , and Hearing , can also include prescription drug

Answer: Can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones? Medicare plans are network base but should be able to find a plan with your doctor in the network. you can see a doctor out of network, but you pay a higher cost.

Answer: What do I need to do if I didn't take Medicare at 65 and am now retiring? All need to do is go SSA.gov or go to your nearest Social Security Office (make appointment) to sign up for part B, you should already have gotten Part A if work 40 quarters or ten years. You will have up 8 Months to apply for part B from losing group coverage without getting a penalty.

Answer: I have Medicare Part A and B since 06/01/2006 because of disability. My husband retired on 4/1/2024, and I now have no other coverage except for Medicare Parts A and B because I missed open enrollment for insurance coverage. Note: SS dropped SSI and changed it to straight SS. Please help. You get a Medigap plan to help with the out pocket cost.

Answer: What is the main benefit of Medicare Part D? Allows you to get prescriptions at pharmacy and help with out of pocket costs. Medicare on for medication only administered by doctors or on Part B formulary.

Answer: What benefits are there to working with a Medicare Agent near me vs remote/virtual? You can talk and enroll in person only benefit. but has access to same plan or you can get more options.

Answer: What happens if I am already retired and collecting Social Security when I turn 65? you will be automatically enrolled in part A and elected Part B

Answer: Can I change my Supplemental/Medigap plan at any time? Yes you can change it at anytime of the year no enrollment periods.

Answer: What are the types of Medicare Advantage plans? Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), HMO-POS(point of Service), Medicare Saving Plan MSA, Chronic Special Need Plan(SNP) C-SNP, Dual Eligible D-SNP

Answer: Can you explain what "creditable coverage" means and when it applies? Creditable coverage refers to health insurance or prescription drug coverage that meets or exceeds the coverage that they would get Medicare.

Answer: I've been paying into Medicare for years, and I'm not sure why my specialist visits still cost me so much. What am I missing here? Medicare-approved amount for medically necessary services, which includes specialist visits. Medicare covers the remaining 80%. So cost is more specialist service is typically higher

Answer: Does Medicare Advantage cover home health care? yes, same as original Medicare with limitations -You won't qualify for the home health benefit if you need more than part-time or "intermittent" skilled care.

Answer: Why not just call the insurance carrier directly? calling carrier first will get access to train customer service agent and customer service driven by star ratings and can call broker because it personal response and relationship with you.

Answer: I lost my Medicare Card. What do I do? you can go to medicare.gov or call 1-800-MEDICARE to report card a lost card and get a replacement

Answer: How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility by securing a long term care (LTC) or short term home healthcare plan.

Answer: What do you like most about being a Medicare agent that I can help people get healthcare plan that will meet their needs and budget. I can find plan that will encourage them to go to doctor because, they have plan that cover the cost.

Answer: I picked a Medicare Advantage plan last year, and I'm not sure if my hearing aids are covered. How do I figure this out? You can look plan summary benefits or evidence of coverage documents. You can ask your broker or customer service.

Answer: Is it better to get Medicare Part D or Medicare Advantage? Well part D help lower your cost, and Medicare Advantage can include Part D as well. Also include extra benefits like vision, dental, and hearing. It also includes routine physical exam. Medicare Advantage are care management plan.

Answer: I went with Medigap because I travel a lot, but now I'm paying a fortune in premiums. Did I make a mistake? The Medigap does allow go to any doctor in the United States that accept Medicare without worrying about networks and they include foreign travel. So it does give you flexibility which mean you pay more. Most Medicare Advantage has worldwide travel benefits and depending on the MA you go to doctors in/out network (PPO) and any doctor in emergency at in network. Depending on your medigap it does cover more out-pocket cost.

Answer: What are the reasons why I should work with a Medicare agent? As agent I am certified each year on Medicare. I am also certified by each carrier that I sale. I am trained by each carrier on their plans.

Answer: Medicare doesn't cover hearing aids or exams for fitting hearing aids. Your costs in Original Medicare You pay 100% of the cost for hearing aids and exams, but most Medicare Advantage plans cover hearing exam and copays for hearing aids.

Answer: I'm living solely on Social Security of $1,400 monthly and can't afford my Medicare premiums and copays. What assistance programs might help someone in my situation? You might be eligible for medicaid which can qualify for Medicare Saving Programs(MSP) like Qualified Medicare Beneficiary (QMB) Program or other MSP which can with premiums and other cost sharing

Answer: I have Original Medicare, a Medigap Plan G, and a Part D plan, but I'm still facing high costs for my specialty medication. What options exist for someone in my situation? Since original medicare only covers prescription medication taken in doctors office; Supplemental plan want help reduce your cost for specialty medication ,but you request Formulary Exception: 
A request to get a specific medication at a lower cost or tier or
Tiering Exception a request to have a drug placed in a lower tier, which would result in a lower copay. or drug manufacturer for help or SSA for special help or LIS low income subsidy which help with drug cost.

Answer: How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits? by using your part b outpatient services. There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.

Answer: I'm on Medicare Part B, and I'm wondering how my physical therapy visits are covered. Do I have to hit my deductible first? Yes medicare has part B deductible of 257 then you will pay 20% of the cost. under original medicare. With a medicare Advantage plan you don't have me et a deductible under most plans.

Answer: I signed up for a Medicare Advantage HMO, and I'm wondering if I can see a cardiologist out of network without paying everything myself. You can not go out of the network, if you do you will always pay the full cost unless it is emergency.

Answer: What advice would you give to seniors who are feeling overwhelmed by all the Medicare options available? Well I would say don't be because a good broker can help. They should focus on their needs will eliminate most of the options.

Answer: What's the best way to avoid surprise bills for lab tests under Medicare Advantage? To go in network or go to lab in the office

Answer: Why are seniors losing Medicare Advantage plans? A company can choose no longer offer MA in area, or Non payment or they enrolled in a part D Plan will disenrolled from a MA or they travel away from plan area for over 6 months

Answer: Why am I paying more for Medicare Part B and D than my friends? because premiums based on your income.

The IRMAA (Income-Related Monthly Adjustment Amount) the premiums for Medicare Part B and Part D based on those with higher Modified Adjusted Gross Income (MAGI). It based on MAGI 2 years prior

Answer: You get qualified by your state to help individuals with limited means cover some or all of their out-of-pocket Medicare expenses. like your Medicare Premium Payment Programs, offer financial assistance to pay your Part B Premium as well.

Answer: Yes , It is true in 2025 the limit is $2,000. A Medicare Part D has different phase : deductible phase you pay retail cost of your medication until you meet deductible limit ( some plans has deductible only on some tiers) or the plan does not then you and plan pay cost of the medication initial coverage level until $2,000 has been reached then you pay nothing for your medication.

Answer: Donut hole going away means that your cost will be less that last if your drugs cost was higher enough for you to get into the donut hole.

Answer: so many coverage gaps, and is it designed that way on purpose? Medicare Coverage Gap for Medicare Part D has been eliminated. The coverage gap was to help reduce cost carrier and shift to the senior and the Part. D manufacturer.

Answer: The 2025 Medicare Part D out-of-pocket cap means the cost lower, because the donut hole has been eliminated. After $2k has spent by senior and Part D carrier the senior cost will be zero. Also because of the part D payment plan the monthly cost will be less.

Answer: you avoid or reduce IRMAA charges on my Medicare premiums? By lowering your taxable in prior to taking medicare two years before 65 or submit Monthly Adjustment Amount form (life-changing event)

Answer: If you are turning 65 next month; You should go to SSA.gov website, learn and sign up for part A and enroll in Part B or go to your Social Security office. if you getting Social Security you should by automatically enrolled in Medicare part A/B unless you opt-out of part B.

Answer: In 2025 there is an imbalance exists in prescription drug spending, because it uses to be four cost stages on a drug plan now it is only three cost stages. The deductible, initial coverage and catastrophic which comes when over 2000 has been spent on drug by client and plan. This means the client pay 0 dollars for rest of year which should be less than previous years.

Answer: I had client paying out over 3,000 for premium for a Medicare Supplemental plan but was not sure about getting into a Medicare Advantage Plan. I explain to the client that even though he has had a Medicare supplemental plan for over ten years. He still has a one-year trial period to enroll in a Medicare Advantage plan and get back into Medicare Supplemental plan without having to answer any medical questions. (Called guarantee issued right)

Answer: The biggest mistake seniors make when enrolling in Medicare is not understanding their Medicare options. What difference between original Medicare and Medicare Advantage plans. Also enrolling into Medicare Part B (paying a premium for part B) when they still have coverage through their company or through their spouse.