Bob Callahan, Medicare Insurance Broker

Answer: Your Medigap plan can only terminate your policy under three scenarios:

1. Non-payment of premium

2. Fraud or material misrepresentation (i.e. lying about health history, smoking, etc..)

3. the carrier goes out of business (i.e. bankruptcy, etc..)

If the third scenario occurs, you have the right to move to another carrier w/out underwriting (i.e. you are guaranteed issuance)

Answer: Repatha would be covered under a stand-alone Part D prescription plan, or the Part D component of a Medicare Advantage plan. However, it depends on the plan. Repatha is common and so most plans do cover it. If they don't cover it, you may be able to submit a request that they do cover it for you, though.

Answer: Two things to note:

1.) if you are losing creditable employer-sponsored group coverage and are just now enrolling in Part B, then you have a Special Enrollment period to get an Rx plan within 62 days of creditable group coverage stopping. You also have the right to enroll in a supplement without underwriting for 6 months after enrolling in Part B.

2) If, however, you have been enrolled in Part B AND have participated in a creditable employer-sponsored group plan simultaneously (i.e. maintaining double coverage), you can enroll in a supplement without underwriting (i.e. Guaranteed Issuance, also called GI) if you can demonstrate that you've been covered under a group plan since turning 65.

My only disclaimer is that I have successfully used such strategy many times, but I don't know if every carrier would accept it as GI. I can only say that some would.

Answer: If you remain on and employer sponsored plan after turning 65 and such plan is deemed "creditable" then you have the right to defer enrollment without incurring any penalties.

(see definition of Creditable at https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/downloads/whatiscreditablecoverage.pdf)

You should also save the annual Notice of Creditable Coverage from the employer to prove it was creditable.

You can confirm such rights at:

https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65

All sites shared are government sites.

Answer: IRMAA is a surchage that people w/ higher income pay on top of the base rate for Part B ($202.90 in 2026) and Part D ($0 in 2026). Income levels and respective surcharges can be found at:

https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles.

IRMAA is based on your modified adjusted gross income (MAGI) from 2 years prior. To calculate, I default to your accountant. However, to get a good idea, add your AGI (line 11 on 1040) to your tax-exempt interest income (line 2a on 1040).

It's important to note that if your circumstances have changed from 2 years prior, and such prior income is not representative of current income then you can file form SSA-44 to lower your premiums. You should speak w/ an experienced Medicare broker or your accountant to assist.

Answer: If you have a Medigap (supplement) plan, you'll want to notify the insurer. Assuming it isn't a "Select" plan, you don't have to do anything for your supplement. However, you may want to see if costs are lower in your new zip code. If so, you should ask if the insurer would adjust your pricing to the new zip. Alternatively, if you're healthy, you could shop for another less expensive supplement w/ the new zip.

For your Rx plan, you have a Special Enrollment Period that allows you to change to a plan for the new zip code.

If you have a Medicare Advantage plan and you are moving out of your coverage area, you must either change to another Med Advantage available in your new area or you have the right to change to a Medigap plan w/out underwriting.

Answer: The short answer is that you should reevaluate your health coverage if your health condition has changed. A more personal reply is challenging, as it's uncertain as to a) what Medicare plan you currently have, b) what condition has changed, and c) whether you are within a special enrollment period that might allow you to make a change... The bottom line is that it would be wise to engage with a licensed, experienced, and independent agent to review your situation with you.

Answer: SOA is a Scope of Appointment, and is a requirement for Medicare Agents to get from prospects before a sales meeting/call/etc.. It is normal, and has been required for years. Since 2024/2025, it became mandatory to get an SOA 48 hours before speaking/meeting w/ someone about Medicare. Although there are some exceptions to the 48hr rule, an SOA must be obtained. Medicare call centers are not exempt from the practice, but they are exempt from the 48-hr rule for inbound calls initiated by a prospect. The form does NOT lock you into any enrollment, etc... It simply states that you agree to speak about the products cited in the SOA.

Answer: For Medicare Advantage (Part C) plans, the answer is 'yes'. In 2026, such plans have a maximum out-of-pocket limit of $9,250 for in-network services, with a $13,900 combined limit for in-network and out-of-network services.

Original Medicare has no out-of-pocket maximum.

Part D prescription drugs have a $2,100 cap for medications on the plan's formulary (note: there are a few exceptions to medicines, such as for Viagra used for ED).

Answer: Generally speaking, if it is deemed medically necessary by your physician, Medicare will cover it. How much you'd have to pay as well as whether pre-authorization is required, however, is dependent upon your plan (i.e. Medigap versus Med Advantage, etc...).. Medicare would cover the surgery, the actual robotic knee, and post-surgery rehab...

Answer: Different states provide different options. However, consistent among all states, you have the right to change plans if you can answer some basic underwriting questions. In fact, it's best practice to periodically shop your supplement around to ensure its pricing remains competitive. I'd add that some carriers in some states may also allow you to step down to another lettered supplement (i.e. Plan G to Plan N) w/out underwriting.

Answer: Generally speaking, Medicare will cover the routine costs associated with qualifying for a clinical trial (i.e. lab tests, dr visits, etc...), but will NOT cover the trials whether it be for a drug, device, or service/procedure. There are very rare exceptions for slightly greater coverage (i.e. if part of a CED or IDE Study), but those situations are truly exceptional.

Answer: The Part A inpatient deductible effectively goes away when you have Part C. The Part C Medicare Advantage Prescription Drug (MAPD) plan is an umbrella under which the MAPD carrier is responsible for providing Parts A , B, and D. In this case, you are assigned over to the MAPD carrier and they are responsible for providing A, B and D. They are providing terms of your hospital stay per day as opposed to a deductible.