Calvin Fritz, Medicare Insurance Broker

Answer: How will my current health needs and medications be covered under the different Medicare plans?

Medicare has multiple parts (A, B, C, and D), and understanding how each part covers your specific needs—especially if you have ongoing health conditions or take regular medications—can save you a lot of time, money, and stress.

Answer: The idea that Medicare Advantage plans are “free” is generally more of a marketing strategy than a literal truth. While many Medicare Advantage plans have low or even $0 premiums, this doesn’t mean they are free in the overall sense.

Out-of-Pocket Costs: Even if the premium is $0, there are still costs like co-pays, deductibles, and co-insurance for doctor visits, hospital stays, prescription drugs, and other services. The out-of-pocket costs can add up, depending on the plan and the services you use.

Network Limitations: Many Medicare Advantage plans are HMO or PPO plans, meaning they have network restrictions. You might have to stay within a network of doctors and hospitals, and if you go outside that network, you'll pay more or your care may not be covered at all.

Answer: The main reasons are:

Limited provider network, higher out of pocket costs, referrals and authorizations, plan changes year to year, traveling in and out of state.

Because these issues often only become apparent after someone enrolls, many people don’t realize the limitations until they need care that isn’t covered or are faced with high out-of-pocket costs. It's essential to compare all your options carefully to ensure the plan you choose aligns with your health needs and preferences.

Answer: It sounds like you're experiencing one of the potential downsides of Medicare Advantage plans, where low premiums can be offset by high copays and other out-of-pocket costs. This can definitely feel like a mistake, especially if you expected more predictable costs.

Think Long-Term. Medicare Advantage plans can work well for some people, but if you expect to need frequent care or have specific providers in mind, it might be worth reconsidering whether Original Medicare with supplemental coverage might have been a better option. The key is finding a balance between premium, copays, and your healthcare needs.

Answer: When transitioning from your employer's health plan to Medicare, consider your eligibility for Medicare Part A and Part B, potential special enrollment periods, COBRA options, and the costs and benefits of Medicare compared to your employer's plan.

Answer: While bankruptcy can be a challenging experience, it shouldn't directly affect your Medicare coverage. Medicare is a federal program, and being on Medicare isn't contingent on your financial situation, including bankruptcy.

Answer: If you're under 65 and have end-stage renal disease (ESRD), which requires dialysis or a kidney transplant, you’ll become eligible for Medicare when you begin dialysis. This applies regardless of age, and you don’t need to wait until you're 65 to apply.

If you're over 65 and already on Medicare, there’s no change to your eligibility for Medicare; your coverage will continue as normal. However, starting dialysis might mean that you’ll need to adjust your plan choices to accommodate the new medical needs.

Answer: The new $2,000 out-of-pocket maximum for drug costs is important because it provides significant financial relief and protection for Medicare Part D beneficiaries. Here’s why it matters:

1. Caps Drug Spending for Seniors

Before this cap, there was no limit on how much someone could spend on prescription drugs under Medicare Part D in a year. Some patients—especially those with chronic or serious illnesses like cancer or multiple sclerosis—could end up paying tens of thousands of dollars annually for their medications.

With the $2,000 cap:

Once a person has paid $2,000 out-of-pocket in a year for covered drugs, they owe nothing more for the rest of that year.

This makes drug costs predictable and manageable.

2. Protects Vulnerable Populations

Older adults and people with disabilities often live on fixed incomes. High drug costs can force people to:

Skip doses

Not fill prescriptions

Cut back on essentials like food or utilities

The new cap reduces this risk by limiting how much they can be asked to pay.

3. Part of Broader Drug Pricing Reform

This cap is part of the Inflation Reduction Act (IRA), which also includes:

Allowing Medicare to negotiate drug prices

Penalties for drug companies that raise prices faster than inflation

Together, these reforms aim to lower prescription drug prices overall and increase affordability and access.

4. Implementation Timeline

The $2,000 cap goes into effect in 2025, giving time for Part D plans and pharmacies to prepare systems and communicate with patients.

In summary:

This change marks a historic shift in Medicare by giving beneficiaries clear financial protection against runaway drug costs, which improves health equity and access to needed medications.

Answer: Yes, Medicare allows multiple preventive screenings in the same year, depending on:

The specific screening

The recommended frequency (some are every year, others every 2+ years)

Whether you meet eligibility criteria for each test

Example:

You could potentially receive a mammogram, diabetes screening, and an annual wellness visit all in the same calendar year—and all could be covered at no cost.

Exceptions & Notes

Some screenings (like colonoscopies with polyp removal) might lead to coinsurance or costs if something is found during the test.

If your doctor orders tests not classified as preventive or performed more frequently than Medicare allows, you may have to pay.

Answer: 1. Nationwide Coverage

Choose a plan that allows you to get care anywhere in the U.S.

Original Medicare (Part A & B):

You can see any doctor or hospital that accepts Medicare—nationwide.

Great for domestic travel.

Medicare Advantage (Part C):

Many plans have networks (HMOs or PPOs).

Look for:

PPO plans (more flexibility to see out-of-network providers)

Plans with nationwide networks or travel benefits

Confirm how coverage works outside your home area.

2. International Travel Coverage

Original Medicare typically does NOT cover care outside the U.S., except in very limited situations. To get global coverage:

Option 1: Medigap (Medicare Supplement)

Plans F, G, and N offer some foreign travel emergency coverage:

Covers 80% of emergency care abroad (up to plan limits)

Limited to the first 60 days of a trip

$250 annual deductible; $50,000 lifetime limit

Answer: The short answer is yes, you will be covered—however, there are a few important conditions you'll want to be aware of.

Original Medicare (Part B) pays 80% of the approved cost. Plan N typically covers the remaining 20% coinsurance, except:

You may have to pay a copay of up to $20 for a doctor visit or $50 for an emergency room visit (if not admitted).

You are responsible for the Part B deductible (which is $257 in 2025).

Plan N does not cover Part B excess charges, which occur if a provider doesn’t accept Medicare assignment and bills up to 15% more. (Most providers do accept assignment, so this is often avoidable.)

Answer: 1. Outpatient Mental Health Services (Part B)

This includes:

Psychotherapy or counseling (individual and group)

Psychiatric evaluations

Medication management

Depression screenings

Family counseling (if it helps with your treatment)

✅ Medicare pays 80% of the approved amount after you meet your Part B deductible ($257 in 2025).

❌ You pay 20% of the Medicare-approved amount (unless you have a supplement plan).

Answer: Some seniors end up paying lifelong penalties for Medicare Part B or Part D because they didn’t enroll when they were first eligible and didn’t have other qualifying coverage during that time. Medicare imposes these penalties to encourage timely enrollment and to keep costs down overall.

Part B:

If you don’t enroll in Part B (medical insurance) when you're first eligible and don’t have other creditable coverage (like employer insurance), you may face a permanent penalty.

Part D:

If you go without creditable prescription drug coverage (like from an employer or union plan) for 63 days or more after your Initial Enrollment Period, you’ll pay a penalty when you do enroll in Part D.

How to Avoid the Penalties:

Enroll on time: During your Initial Enrollment Period (IEP)—a 7-month window around your 65th birthday.

If you have employer coverage, enroll during a Special Enrollment Period (SEP) when that coverage ends.

Always maintain creditable coverage to avoid gaps.