Brian Moore, Medicare Insurance Broker

Healthcare Wars: The 2023 CMS Expenditure Report, Congressional Budget Blunders, and the Fight for Health Information Transparency

November 8, 2024

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A Closer Look At Medicare Eligibility For Those Under 65 With Disabilities

June 13, 2024

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Who qualifies for Medicare coverage if they are under 65?

Answer: If you’re under the age of 65 and have a disability, you may qualify for Medicare coverage. A qualifying disability is almost any health condition that prevents you from being able to work enough to access employer-sponsored health care benefits. Before you can enroll in Medicare, you must receive Social Security Disability Insurance for two years. If you have end-stage renal disease or amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, that 24-month waiting period is waived.

How do Social Security and Medicare work together for people with disabilities?

Answer: When considering Social Security versus Medicare, it’s important to recognize that these are two separate benefit programs from the federal government. Social Security provides financial support, whereas Medicare is health insurance coverage. These two safety net programs work together to support people with disabilities to remain as healthy as possible. As mentioned, for someone looking to gain health insurance coverage via Medicare because of a disability, they must first apply for disability benefits from Social Security.

What imbalance exists in prescription drug spending, and how has it impacted overall costs?

Answer: A recent report highlighted a stark imbalance where generic drugs, despite being 91.5% of prescriptions, only represent 12.9% of the drug spending, while brand-name drugs, at 8.5%, account for 87.1% of costs. This disparity contributed to an 11.4% increase in drug spending, reaching $450 billion, primarily due to rising costs for treatments of diabetes and obesity.

What shift has been observed in Medicare spending, particularly regarding Medicare Advantage plans?

Answer: Medicare spending crossed the $1 trillion threshold, with a significant 52% of this now going towards Medicare Advantage plans, up from 39% in 2019, indicating a shift in how care delivery and financing are evolving.

How much is spent on healthcare per year the U.S., and what does this amount represent per person?

Answer: The 2023 CMS Healthcare Expenditure Report revealed an eye-opening total of $4.9 trillion spent on healthcare, averaging about $14,570 per person.

If a senior is turning 65 but still working, should they enroll in Medicare or delay it?

Answer: Hitting 65 while still working means you’re automatically getting Medicare Part A—it’s free for everyone, no opting out, and it’s a solid backup to your employer’s coverage. From my experience, signing up for Part B makes sense too; it’s usually way cheaper than what you’d pay monthly through a job’s plan, often has no annual deductible, and throws in extra perks you won’t find in most group benefits. Delaying Part B is an option if your work insurance is top-notch, but I’ve seen Part B save folks money and headaches, so I’d lean toward enrolling now!

If I move to a rural area, how might that limit my Medicare Advantage plan options?

Answer: Moving to a rural area could mean fewer Medicare Advantage plans to pick from, since these areas often have lower enrollment and less competition among providers. You might also face narrower networks, making it tougher to find in-network doctors or specialists without traveling farther. In my experience, some rural spots even lack plans with the extra bells and whistles—like dental or vision—that you’d see more of in heavier populated counties.

I'm turning 65 soon, when can I enroll in Medicare?

Answer: When clients ask about enrolling in Medicare at 65, I explain the Initial Enrollment Period (IEP) covers three months before their birthday month, the month itself, and three months after. It’s a straightforward seven-month window.

Can you describe a time when you helped a client navigate a complex Medicare issue?

Answer: A few months back, I worked with a couple who’d been on Medicare supplement plans for years, paying high premiums with little extra benefit. They were hesitant to switch, so I walked them through their options, showing how a Medicare Advantage plan could cut costs and add perks like dental, vision, hearing, over-the-counter items, and transportation. By breaking down the numbers and network details, they confidently made the switch and saved hundreds monthly.

What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?

Answer: When clients ask about Guaranteed Issue for Medicare Supplement plans, I explain it’s a right that stops insurers from denying coverage or raising rates due to pre-existing conditions. It applies during your initial enrollment at 65—starting the first day of your birthday month and lasting six months—or within 63 days of losing qualifying coverage, like an employer plan, or during your 12-month trial period if you’re new to Medicare Advantage and switch back to Original Medicare. For folks under 65 with disabilities, federal law doesn’t guarantee it, but many states offer a similar six-month window when you enroll in Part B. Missing these windows usually means facing medical underwriting.

What is the biggest mistake seniors make when enrolling in Medicare?

Answer: The biggest mistake seniors make when enrolling in Medicare is relying on advice from neighbors, friends, or family who think they understand the program’s details. Medicare’s ins and outs are complex, and misinformation can lead to costly errors. Seeking professional consultation is always the smartest move to get it right.

What is one of the the most common misconceptions people have about Medicare?

Answer: When I talk to clients, one of the biggest misconceptions I hear is that Medicare covers long-term care or even burial insurance, which it doesn’t. Medicare’s a living benefit only, so I often have to clarify that it’s built for medical needs excluding nursing homes down the road or final expenses.

How might climate change-related health issues (like heat stroke) influence Medicare policies?

Answer: In my 25 years working with Medicare, climate change-related health issues like heat stroke have never come up in discussions or policy updates—not once. Honestly, it’s not something I’ve ever thought about either, but I’d assume it wouldn’t shift Medicare coverage much since conditions tied to it are already baked into what’s covered. Any impact would likely stay minor, handled within existing frameworks.

What's one piece of advice you wish every senior knew before picking a Medicare plan?

Answer: Throughout my career advising seniors, I’ve noticed many overestimate their grasp of Medicare Advantage versus supplement plans. The key difference lies in a fixed versus variable cost structure, so I provide a detailed, numbers-driven consultation to project outcomes, ensuring they make an informed choice both financially and in understanding benefit distinctions. This approach gives them clarity on both costs and benefits coverage.

How is Medicare Advantage expected to evolve in the future?

Answer: It sure has been interesting to watch Medicare Advantage plans take the lead, now outnumbering supplements in enrollments nationwide. I expect they’ll keep growing, thanks to added benefits like dental and vision that supplements don’t offer. Their straightforward cost limits appeal to seniors, and that practical edge should continue to drive their popularity moving forward.

Why is the new $2,000 out-of-pocket maximum for drug costs important?

Answer: The new $2,000 out-of-pocket max for drug costs is key because it eliminates the donut hole and slashes financial exposure for seniors. It’s a relief for clients knowing their costs are capped, but they’re also seeing drawbacks like stricter formularies or rising premiums. It’s a big win with some trade-offs they’re starting to notice.

Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?

Answer: I believe buying the best Medicare Supplement plan available is the smart move. It costs more upfront, but the lower financial exposure and stronger benefits outweigh the savings from cheaper plans with weaker coverage. Most clients I’ve guided find the trade-off worth it when they need serious care. You’re not overpaying—you’re securing peace of mind.

What benefits are there to working with a Medicare Agent near me vs remote/virtual?

Answer: As Ohio Medicare Plan, I stick to Ohio’s 88 counties because I believe local agents like me bring far more value with our deep experience in local networks and plan features—details call centers or virtual agents often miss or don’t fully grasp. I’m not licensed outside Ohio, and that’s by design; it lets me stay dialed into what matters most for my clients here. Plus, some clients prefer meeting face-to-face to build trust and get that personal touch, which I’ve seen makes a real difference.

For Medicare Part D, why would someone pick a plan with a high total cost?

Answer: When I’m helping someone with Medicare Part D, they might pick a plan with a higher total cost if it covers their specific meds at a lower out-of-pocket rate—especially pricier ones that’d hurt more under a cheaper plan. It’s a choice I’ve seen work for clients with chronic conditions needing brand-name drugs, where the broader formulary and lower copays justify the premium. Now, with the Inflation Reduction Act’s $2,000 cap, that strategy’s less critical and not used as much since the max exposure’s locked in either way.

What's one Medicare decision that too many people regret later?

Answer: From what I’ve observed, many people later regret choosing Medicare Supplement plans, paying steady premiums in their healthier, younger years regardless of whether they use medical services. They often say they’d rather have that money back—typically far exceeding what they’d spend on Medicare Advantage copays down the line—since those early costs feel wasted when they’re not tapping into care. It’s a common frustration, especially for those who stay active and well into their 70s, realizing they overcommitted financially too soon.

What is the biggest disadvantage of Medicare Advantage?

Answer: The debate over Medicare Advantage’s biggest disadvantage sparks varied opinions among clients and advisors alike. In my view, the traditional concern about restrictive networks is overstated and largely a relic of the past, as access has improved significantly. I firmly believe the advantages—cost savings, added benefits—far outpace any downsides, and that edge only grows as these plans continue to advance.

Does Medicare cover eye exams, or are seniors left paying too much?

Answer: Medicare doesn’t cover routine eye exams for glasses or contacts under Original Medicare—seniors pay 100% out of pocket for those, and I’ve seen plenty frustrated by the cost when they just need a basic checkup. Part B does cover exams for specific conditions like glaucoma or diabetic retinopathy if you’re at risk, but that’s it unless you’ve got a Medicare Advantage plan with vision benefits tacked on. A major snag with Advantage plans, though, is that even with vision, dental, and hearing perks, the networks for those extras can be limited, making access trickier than people expect.

What role do you think technology will play in the future of Medicare?

Answer: As a Medicare expert, I believe technology will simplify processes like enrollment and plan selection, but I’m genuinely concerned that AI could soon replicate the expertise I offer clients. My biggest fear is that within a decade, it might crunch numbers and match plans better than I can, cutting into the personal guidance I provide. I just hope there’s still room for the human judgment and connection I bring to the table.

Will I be penalized if I do not enroll in Medicare when I turn 65?

Answer: If you don’t enroll in Medicare at 65 without qualifying employer coverage, you’ll face a 10% Part B premium penalty per year delayed, and it’s permanent. It’s unfortunate that Medicare doesn’t do more to clarify these consequences or provide better access to this info, leaving it to folks like me in the industry to educate clients. Without an active group plan, that Initial Enrollment Period is your window to avoid the hit.

What's the key difference in how Medicare Advantage and Medigap handle out-of-network providers?

Answer: Medicare Advantage often ties you to a network—go out-of-network, and you’re either paying more or not covered at all, unless it’s an emergency, which I’ve seen trip up clients who didn’t check their plan’s rules. Medigap, paired with Original Medicare, doesn’t care about networks; any provider accepting Medicare works, giving you flexibility I’ve found folks appreciate when they travel or need specialists. It’s a clear-cut distinction that hits home when you’re picking between the two.

How does losing a spouse impact my Medicare plan if I was on their employer coverage?

Answer: When a client loses a spouse and was on their employer coverage, I explain they have 63 days to enroll in Medicare or adjust their plan without facing a penalty. It’s a qualifying event, so they’d need to switch to their own Part B if they’re 65, and I’d urge them to do it promptly to avoid any cost hikes or coverage lapses. The rules give them a clear path forward, but timing is critical.

Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?

Answer: When clients ask me about switching Medigap plans, I point out that in Ohio, once you’re past the 6-month window after starting Part B at 65, insurers typically require health questions and can deny or adjust premiums through medical underwriting. Ohio follows standard federal guidelines with no added state safeguards, so unless you qualify for a guaranteed-issue event—like losing prior coverage—you’ll face that review. I’ve noticed people often don’t expect this hurdle, so I make sure they understand it upfront.

What demographic challenges will Medicare face in the coming years?

Answer: When I look at Medicare’s future demographic challenges, I see an aging population hitting the system hard, but I think recent shifts—like better access to healthier foods and advances in medicine and tech—could offset some pressure. In my view, these improvements might stabilize costs or even make coverage more cost-effective while boosting benefits. It’s a real chance to handle the growing demand without breaking the bank.

Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?

Answer: When clients ask why their Medicare Part B and D premiums exceed others’, I attribute it to IRMAA, the Income-Related Monthly Adjustment Amount, which increases costs based on higher income reported on their tax return from two years prior. Medicare discourages advisors like me from quoting specific thresholds, instead directing individuals to consult the official income brackets and resources to determine their financial responsibility two years hence. The calculation uses modified adjusted gross income, and significant income events—such as a large asset sale—can elevate the surcharge, often unexpectedly impacting their total premium obligation.

If you had to pick just one, what's the worst Medicare-related decision someone can make?

Answer: In my professional opinion, the worst Medicare-related decision is choosing a plan without assessing one’s individual circumstances and relying instead on unsolicited advice from others. I frequently encounter clients who select coverage based on someone else’s experience, only to discover it doesn’t align with their specific healthcare or financial needs. This misstep often leads to unnecessary complications or expenses that a tailored evaluation could prevent.

What are some ways to ensure your parents feel supported during the Medicare decision-making process?

Answer: Children rarely assist during initial Medicare enrollments around age 65, but they often step in later when parents are switching between Medicare Advantage plans or modifying Part D coverage. Their involvement in those later years aids in understanding plan benefits, changes, and features, ensuring parents fully comprehend their choices. I recommend they collaborate with a well-respected, trusted advisor whose expertise brings clarity and reliability to the decision-making process.

I've been on a Part D plan for a while, and I'm wondering why my generic prescriptions suddenly cost more. Did something change?

Answer: Your generic prescription costs might be rising because Part D plans update their formularies, premiums, and copays each year, and I’ve seen many people overlook the need to review these changes annually. In my view, it’s a frequent mistake—failing to reassess coverage as costs and policies can shift significantly, especially this past year with the Biden-Harris Inflation Reduction Act taking effect. The Act introduced a $2,000 out-of-pocket cap for 2025, but it also altered how plans and manufacturers share costs, which can increase generic prices depending on your specific plan’s structure.

What do you enjoy most about working with Medicare clients?

Answer: I absolutely love working with Medicare clients because I get to unravel a topic that’s often daunting—turning confusion into clarity by educating them step-by-step, which feels like lifting a weight off their shoulders. There’s nothing better than seeing someone go from intimidated to empowered, knowing I’ve made this complex system approachable and straightforward for them. What drives me most is doing this in a highly regulated field where I don’t charge them directly—I’m right there with them, on their side, fighting for the best benefits possible without any financial agenda pushing me one way or another. Unlike so many other industries where money can cloud judgment, this is pure, unfiltered advocacy, and I’ve never once felt like Medicare is just a career or a job—it’s a passion I’m deeply grateful for every day.

Can Medicare pay for my groceries?

Answer: Medicare itself doesn’t pay for groceries—Original Medicare sticks to medical coverage and doesn’t touch stuff like food benefits. But I’ve noticed more Medicare Advantage plans stepping up with ancillary extras, like grocery allowances, built into many options now, especially for folks with specific health needs. It’s not universal, though—depends on the plan and if you qualify, so you’d need to check what’s offered where you are.

How might artificial intelligence change how Medicare approves claims in the future?

Answer: AI could transform Medicare claims approval by speeding up the process, spotting patterns, and flagging errors faster than today’s manual reviews—I see it analyzing data in real time to cut delays. My hope is to drive this change to curb fraud, waste, and abuse, boosting efficiencies throughout, which is practical if the tech’s designed to verify claims against solid benchmarks and provider records. With the right system, I’d work to ensure approvals are tighter and taxpayer money goes further.

I just started on Medicare Part D, and I'm confused about whether my new cholesterol medication counts toward my coverage gap. Can you explain?

Answer: Figuring out how your new cholesterol medication fits into Medicare Part D’s coverage gap can be confusing—it does count toward that limit, depending on your plan’s formulary and annual drug spending. In 2025, once your total costs hit the gap, you’ll reach catastrophic coverage after $2,000 out-of-pocket, lowering your costs to zero for covered meds, and Medicare now sends a statement detailing these expenses to keep you informed. Check that statement or your plan’s formulary for a clear snapshot of your progress!

How will the Inflation Reduction Act's Medicare drug pricing changes really affect seniors?

Answer: The Inflation Reduction Act (IRA) brings real relief to seniors by capping your annual Part D out-of-pocket drug costs at $2,000 starting in 2025, eliminating the coverage gap and making prescription expenses much more predictable. What’s less obvious is how temporary premium stabilization credits are keeping Part D premiums low in 2025—once these fade, premiums could climb higher than they might have without the law, possibly offsetting some of your savings down the line. While drug companies now pay penalties for steep price hikes, which helps lower certain copays, I genuinely recommend watching your plan’s premium changes since these credit details weren’t fully emphasized when the law took effect.

Why do some clients ignore your advice and end up in bad Medicare plans-what makes them resistant?

Answer: Some clients hesitate to follow my advice because of a common misconception that Medicare advisors like me drive up their premiums or costs due to commissions, when in reality, our guidance doesn’t change what you pay—plans and pricing are set by insurers and Medicare, not us. There’s also a false narrative that we can push you into specific plans for higher payouts, but the truth is, we earn the same regardless of the provider or product, so my focus is purely on what fits your needs best. Ignoring tailored advice can lead to picking the wrong plan, missing out on key benefits, and facing unexpected costs that hit both your health and wallet hard.

Can I backdate my Medicare enrollment if I missed my initial window due to a medical emergency?

Answer: If you missed your initial Medicare enrollment window because of a medical emergency, I’m sorry you had to go through that—unfortunately, Medicare doesn’t typically allow backdating for missed deadlines unless you qualify for a Special Enrollment Period (SEP), like if you were hospitalized or incapacitated during your sign-up time. The rules are strict, but if you can show proof—like hospital records or a doctor’s note—explaining how the emergency prevented you from enrolling, you might appeal to CMS for a retroactive adjustment, though approvals are rare and case-by-case. Without that, you’d face a late penalty on Part B premiums—10% per year missed, added for life.

Is Medicare becoming more expensive over time, and will it ever be unsustainable?

Answer: Medicare costs have certainly risen over time—Part B premiums went from $144.60 in 2020 to $185 in 2025, and I’ve noticed Part D premiums spiking too, largely due to the Inflation Reduction Act shifting some expenses around—though recent crackdowns on waste, fraud, and abuse, like overpayments and non-qualified services, might temper future hikes compared to past jumps. The program’s sustainability gets questioned as more folks age into it, but I’m optimistic that sharper oversight and drug price caps from the IRA could keep things manageable moving forward.

Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?

Answer: Some seniors face lifelong penalties for Medicare Part B or Part D because they miss their initial enrollment period—typically the seven months surrounding their 65th birthday—and lack qualifying coverage, such as an employer plan, to justify delaying enrollment. For every year they’re late, Part B adds a 10% premium penalty, while Part D increases by roughly 1% per month missed, and these extra costs stay with you permanently since Medicare enforces timely sign-ups to maintain its structure. I’ve seen this catch people by surprise, especially when they overestimate their existing coverage, making it a costly oversight to avoid.

What's the deal with Medicare covering medical equipment like wheelchairs- do I need a special approval?

Answer: Medicare Part B covers durable medical equipment (DME) like wheelchairs when deemed medically necessary, but you must have a doctor’s prescription and obtain prior approval from Medicare to confirm it meets their criteria, such as being essential for use within your home. This includes items supplied by Medicare-approved DME providers, though many beneficiaries don’t realize this until a need arises, often prompting a last-minute call to advisors for clarification. Without proper approval, coverage won’t apply, and you’d face full costs, so verifying these requirements early is key.

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.

Answer: With your Medicare Supplement Plan N, your recent MRI is covered under Medicare Part B as long as it’s deemed medically necessary, but you’ll need to meet the 2025 Part B deductible of $257 first, and then Plan N picks up the 20% coinsurance—though you might face a small copay, up to $20, if it’s done in a doctor’s office. Unlike Plan G, which also covers the Part B coinsurance but skips those copays and fully handles excess charges if a provider bills above Medicare’s rate, Plan N leaves you responsible for any excess, though that’s rare with MRIs since most imaging centers stick to Medicare-approved amounts. I’ve seen beneficiaries caught off guard by these details, so double-check your provider’s billing with your Explanation of Benefits to avoid surprises—either way, your bill should stay manageable compared to having no supplement at all.

What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?

Answer: This is a perfect question, and a great one especially in today’s time, as Medicare Advantage plans are introducing more creative and innovative benefits to differentiate themselves. You might find lesser-known Medicare Advantage perks like quarterly allowances for rent, utilities, groceries, over-the-counter items like pain relievers, or even transportation to medical appointments and gym memberships for wellness programs. Meanwhile, Medicare Supplement plans, such as G or N, often include a valuable international travel benefit for emergency care abroad, which can be crucial if you’re overseas and need treatment unexpectedly.

If you could change one thing about the Medicare system, what would it be and why?

Answer: If I could change one thing about the Medicare system, it would be to tighten the oversight and regulations around soliciting and advertising to beneficiaries, because even with recent efforts to curb misleading tactics, I still see folks overwhelmed by confusing ads and high-pressure pitches that don’t always prioritize their best interests. The rules have gotten stricter—like requiring Medicare Advantage plans to get prior approval for TV ads in 2025 and holding plans accountable for third-party marketers—but beneficiaries are still bombarded with mailers, calls, and promises of “free” benefits that gloss over limitations like narrow networks or copays. Stronger enforcement, clearer standards, and maybe even a centralized opt-out system could cut through the noise, giving people a fair shot at choosing what’s right for them without the clutter of persuasive gimmicks.

I'm retiring next year - do I need to do anything with my Medicare?

Answer: Since you’re retiring next year, you’ll need to enroll in Medicare during your Initial Enrollment Period, which spans the three months before, the month of, and the three months after your 65th birthday—assuming you’re not already on it—but my advice is to start reviewing your options now rather than waiting until the last minute. Get familiar with Medicare Parts A, B, and possibly D or a Supplement plan, and jot down questions for a professional you trust, because diving into this complex process without preparation can leave you rushed and short on time to pick what fits your health and budget. I’ve seen too many folks scramble as retirement hits, so giving yourself a head start ensures you’re set up with confidence when the time comes.

Which Medicare Supplement plan (Medigap) offers the best value for most seniors, and why?

Answer: Medicare Supplement Plan G is my top pick for most seniors in 2025, covering all gaps in Original Medicare—like the Part B 20% coinsurance and the $257 deductible—delivering robust protection without surprise costs, which I’ve always valued from my years in this field. When Plan F was still open to new enrollees before January 1, 2020, it was my go-to because it handled every expense, including that Part B deductible, but now Plan G steps in with nearly identical coverage at a more affordable premium—averaging $130 to $150 monthly for a 65-year-old, depending on your area and insurer. I prefer G over options like N because it avoids copays and keeps your expenses steady, making it a practical, comprehensive choice for the long haul.

I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?

Answer: Changing your Medicare plan depends on specific enrollment periods, and knowing them can save you headaches down the line. Your Initial Enrollment Period (IEP) spans seven months around your 65th birthday to join Parts A, B, D, or Medicare Advantage; miss it without other coverage, and penalties loom—10% per year for Part B and 1% per month for Part D, both lifelong. The Annual Enrollment Period (AEP), October 15 to December 7, lets you switch between Original Medicare, Advantage plans, or Part D options for the next year, while the Medicare Advantage Open Enrollment (January 1 to March 31) offers one tweak if you’re already in Advantage. Special Enrollment Periods (SEPs) kick in for life events like losing a job’s coverage, typically giving you two months to adjust penalty-free, and the General Enrollment Period (January 1 to March 31) is for late Part A or B sign-ups if you missed IEP. For Medigap, you get a six-month window starting when you’re 65 and on Part B to enroll without health-based denials—outside that, it’s possible but trickier—something I’ve watched folks overlook until it’s urgent over my years in this field.

What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?

Answer: If your preferred hospital isn’t in-network with your Medicare Advantage plan, it’s a significant issue—over 25 years, I’ve found most people won’t abandon the trust they’ve built with their doctors and hospitals due to insurance limitations, making it essential to work with a professional to confirm network coverage upfront. You can switch plans during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment (January 1 to March 31) to align with your hospital, and with today’s wide range of competitive plans, we can typically find one that includes your providers without much trouble. If you’re caught mid-year, a Special Enrollment Period might apply—like after a move or loss of other coverage—or you’ll face higher out-of-network costs, which vary by plan and can add up quickly.

What if I missed my window to sign up?

Answer: If you missed your Medicare sign-up window—typically the seven-month Initial Enrollment Period around your 65th birthday—you’re not alone, and I’ve seen this trip up plenty of folks over the years, but you’ve got options to fix it depending on your situation. Without qualifying coverage like an employer plan, you’ll enroll during the General Enrollment Period (January 1 to March 31), with coverage starting the first of the next month, though you’ll face lifelong penalties—10% per year missed for Part B and about 1% per month for Part D—unless a Special Enrollment Period applies, like if you just lost job-based insurance, giving you two months to sign up penalty-free. CMS has been pushing harder lately to educate future beneficiaries about these deadlines and consequences, which I think is a smart move, so fewer people end up blindsided by costs they could’ve avoided with better knowledge upfront.

In what situations will Medicare pay for medical services in a foreign hospital?

Answer: This is a great question—and one many folks don’t think about when enrolling in Medicare—since Medicare is a U.S.-based benefit and doesn’t typically cover medical services abroad, though there are a few narrow exceptions worth knowing. Original Medicare (Parts A and B) will pay for a foreign hospital only if you’re traveling through Canada between Alaska and another state and the nearest hospital is Canadian during an emergency, if you live in the U.S. and the closest hospital for an emergency is foreign (like near the Mexican border), or if you’re on a U.S.-based cruise ship within six hours of a U.S. port when an emergency hits—verified exceptions straight from Medicare’s rules. Some Medicare Advantage plans offer limited international emergency coverage—often up to $50,000 per trip, depending on the plan—but Medigap plans like G or N can cover 80% of emergency care costs abroad (up to a $50,000 lifetime limit) during the first 60 days of travel after a $250 deductible. From my experience, I always tell seniors heading overseas to grab a standalone travel health insurance package—it’s affordable, usually $50-$150 for a two-week trip—and it’s the safest way to avoid big bills Medicare won’t touch.

Can Medicare Part D deny coverage for a brand-name drug if a generic isn't available?

Answer: Medicare Part D can’t deny coverage for a brand-name drug just because a generic isn’t available—plans must cover it if it’s on their formulary and medically necessary, based on your doctor’s prescription, though they might require prior authorization or step therapy to justify it over other options. Upon enrollment, I always encourage my clients to call me if their medication regimen changes during the year so we can verify coverage details with the carrier and avoid surprises. I’ve dealt with this plenty, and as long as the drug’s listed and no generic exists, your plan has to honor it under CMS rules, but check your formulary or call your provider to confirm it’s not excluded or restricted. If it’s off-formulary, you’d need an exception, which can be a hassle but doable with your doctor’s help.

What role do annuities play in retirement planning?

Answer: Annuities can be a steady piece of retirement planning, a perspective I picked up back when I started as an investment advisor and stockbroker, but these days, I stay in my lane, focusing solely on Medicare expertise. I don’t dive into annuities or retirement planning advice myself anymore—instead, I’ve built partnerships with trusted pros who handle that side, bringing added value for my clients while I stick to being your go-to expert for all things Medicare. If you want to explore annuities, we’d set up a separate discussion per scope of appointment rules, ensuring my focus here stays on your Medicare coverage.

What do you like most about being a Medicare agent?

Answer: What I truly enjoy most about being a Medicare agent is not just helping people through a process that often feels overwhelming, but also teaching them about their options so they’re confident they’ve made the right call and know what’s ahead. I love the educational side of it—arming them with solid info—and then seeing the gratitude in my clients’ eyes once we’ve tackled this intimidating Medicare transition together. That sense of making a real difference for them beats any paycheck I could earn, and it’s what keeps me passionate about this work after all these years.

Is Medicare Part A enough for hospital coverage?

Answer: Medicare Part A covers a lot for hospital stays—like inpatient care, skilled nursing, and hospice—but it’s not always enough on its own since it comes with costs like a $1,632 deductible per benefit period in 2025 and no cap on how many times that could hit if you’re in and out of the hospital. It also doesn’t cover outpatient services or extras like private rooms unless medically necessary, which is why I’ve seen folks pair it with Part B and either a Supplement like Plan G or a Medicare Advantage plan to close those gaps. From my experience, sticking with just Part A can leave you facing some steep bills if your health takes a turn, so it’s smart to consider what additional coverage fits your needs.

How does life insurance contribute to financial planning?

Answer: Life insurance can be a key piece of financial planning, offering a payout to cover debts or support loved ones after you’re gone—something I understand well since I am licensed and have a ton of experience in that area—but now, I choose to focus solely on being a Medicare expert. I’ve built strong relationships with trusted life insurance pros who stay on top of that industry’s changes, and I find it’s better to refer these questions to them since they’re more dialed into the latest details. My passion and knowledge are strongest in Medicare, so I stick to guiding folks there and leave the life insurance planning to those specialists I trust.

Is it true that Medicare pays for dental implants?

Answer: Original Medicare—Parts A and B—does not cover dental implants or routine dental care like cleanings or fillings, limiting its scope to hospital and medical services, which leaves those costs entirely on you unless you have other coverage. This limitation is a big reason more seniors are turning to Medicare Advantage plans, many of which—around 70% in 2025—include dental benefits that can cover implants, depending on the specific plan and provider. I’ve noticed clients often assume Medicare handles more than it does, so if implants are something you need, you’d either pay out of pocket with Original Medicare or look into an Advantage plan that lists them in its benefits.