Carly Cusack, Medicare Insurance Broker

Answer: I'm sorry to hear that anyone is experiencing back pain. Medicare covers "medically necessary" chiropractic. This refers to manipulations of the spine for medically necessary reasons. Bascally, Medicare will cover manipulations of the spine as long as they are medically necessary. Chiropractors usually get prior authorization for a certain number of appointments in a certain amount of time. It's generally not just open ended for ongoing care.

Answer: Medicare.gov answers this question like this:

Original Medicare generally does not cover healthcare services outside the 50 states, DC, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. It does not offer long-term or comprehensive coverage for residents abroad, except in rare emergencies, such as certain Canadian/Mexican hospitalizations.

Basically Medicare states that you don't have any coverage when you're outside of the country whether traveling or living.

Answer: Medicare covers medically necessary eye exams. They are usually listed in an EOC as Medicare Covered eye exam and they usually have a copy associated with them. If you only have Original Medicare you are responsible for 20% of the cost of the visit. That is why people usually add a Medigap plan to their Original Medicare or a MAPD.

Answer: If your dad's income goes down past the poverty level, he may eligible for Medicaid. This is a state program that can help with health care costs and othe costs associated with daily living. If his income goes up due to the selling of a house or inheritance, then his Part B premium can increase. This is called an income related monthly adjustment amount or IRMAA.

Generally an income change doesn't impact the premium of a Medicare Advantage plan or a Medicare Supplement plan that they are enrolled in. Those premiums are not income driven.

Answer: Medicare brokers get paid by insurance companies based on the plan that you choose to enroll in. Due to current commission restructuring, Medicare brokers are now paid commissions for enrolling people in certain Medicare Advantage plans and not others.

Answer: There are certain supports that Medicare does cover in terms of services if someone is experiencing or has been diagnosed with memory loss. However, Medicare does not cover any type of long-term care facility.

Answer: The HMO-POS that I am familiar with, is a plan that has HMO coverage for medical, and dental coverage is a PPO. That means that if a dentist can bill an out of network PPO, then you can still see that dentist and get coverage even if they are out of network. However; this can include more out of pocket costs to you.

Answer: Smoking cessation is covered under most Medicare Advantage plans. There may be a copay associated with the service.

Answer: If you have effective Part A and Part B coverage and you pay all your premiums, you can't be denied a Medicare Advantage Plan.

Answer: I would trust your intuition. When people talk at you rather to you, that's usually a red flag for me. I also like people that educate me on options versus trying to push on certain plan.

Answer: You can change your Medicare plan during AEP from October 15th-December 7th. If you have a Medicare Advantage plan starting January 1st of the new year, you can change once from 01/01/2026-03/31/2026. This is called OEP and occurs every year. Then there are also SEP's which stand for Special Election Periods which take place when someone leaves group coverage, they move counties, get divorced, and more.

Answer: Medicare Advantage is private insurance that is offered by insurance companies. You have to be Medicare eligible and have both your Part A and Part B in place. Once enrolled in a Medicare Advantage plan, it acts as your Primary insurance and covers your Part A, Part B, Part D, and usually includes extra benefits outside of Original Medicare like vision, dental and hearing.

Answer: You will not fall into the donut hole because it doesn't exist anymore. Under the Biden administration they eliminated the donut hole. In 2026 your max out of pocket for prescription drugs is $2,100.00.

Answer: I would tell them to find a Medicare agent that can help them find a plan that meets their lifestyle needs while keeping doctors in-network.

Answer: You can find a local agent that can help you find a plan that has her doctor's in-network and covers her prescriptions. The agent can search for you or you can go to Medicare.gov.

Answer: The advice I would give is, use a Medicare agent to help you find the plan that meets your lifestyle needs and works with your budget.

Answer: When you sign up for Original Medicare it covers 80% of your medical costs. This leaves 20% of your medical costs coming from your pocket. People might consider this a gap in coverage but I consider it a financial risk. Also, Original Medicare only covers your Part A and Part B. You don't have dental, vision or hearing coverage with Origninal Medicare.

Answer: There is no way to say what is “best” for someone when it comes to health care because everyone’s needs are different. If you go to Medicare.gov, you can see all the plans available in your county. Then you can enter your medications and doctors to make sure everything is covered at the cost that works for you. After that, look for a plan that covers your medical needs at the lowest copays, coinsurance, and premiums. That way you’re paying the lowest cost for what you need. Any money you save due to lower premiums or copays, you can put towards the extras you need like dental and vision.

Answer: Medicare supplement plans act as a secondary insurance. When you're on Original Medicare and you also have a Medicare Supplement plan, Medicare is your primary and your Supplement plan is your secondary insurance. While it is the secondary insurance, I've never heard it referred as that.

Answer: The first thing to do is apply for Medicare Part A and Part B. If you didn't enroll when you turned 65, you may have a late enrollment penalty. If you worked past the age of 65 and had insurance coverage from an employer that is deemed credible, then you won't have a late enrollment penalty. You apply for Medicare Part A and Part B through Social Security. You can enroll online at ssa.gov, or contact them, or go to a Social Security office for help.

Answer: Better is not the correct term to use when trying to decide between a Medicare Supplement plan and a Medicare Advantage plan. It's about chosing a plan that meets your health needs and budget needs while also addressing the amount of personal risk an individual feels comfortable taking on.

Answer: It's not that one is better, they are different ways to receive coverage. Original Medicare covers Part A (hospital coverage) and Part B ( doctors and outpatient services). If you only have Original Medicare it covers 80% of services needed. This creates a financial risk for people. In order to close that financial risk, people will add a Medicare Advantage plan. That plan then becomes their primary insurance and covers their Part A and Part B along with benefits outside of Original Medicare like dental, hearing and vision.

Answer: If you’re already on a Medicare Advantage plan, once you get your current plan’s ANOC. Otherwise, October 1st is a good time to start.

Answer: Yes, there are some plans that cover Accupuncture and alternative therapies. If you are curious about whether or not a plan covers those benefits you can look in the plan's Evidence of Coverage.

Answer: Some Medicare Advantage Plans have coverage for hearing aids and a yearly hearing exam as long as you use their in-network providers. There are also companies that offer stand alone hearing coverage. However, Original Medicare doesn’t offer hearing aid coverage.

Answer: Due to the fact that Part B premiums are income driven, filing for bankruptcy could potentially impact your premiums if you have been impacted by Income Related Adjustment Amounts. If you have any outstanding medical bills, filing for bankruptcy can erase that debt. It would be wise to explore any Medicaid or Extra Help options through your State.

Answer: I would include services such as mental health, dental, vision, and hearing coverage in the Medicare program. If we want to keep people healthy, we need to serve the entire person.

Answer: I think hospital indemnity policies can offer people strong coverage and peace of mind. I would advise you to shop around and even reach out to an agent for help.

Answer: First, I would like to address how frustrating that is for you and anyone else in that situation. This can happen for a variety of reasons. If carrier’s search tools aren’t up to date then they can reflect doctors in-network that aren’t. Agents can make errors when checking. Also, contracts expire between carriers and doctors throughout the year and either side can decide not to renew the contract. Therefore, people can find themselves in a health care plan where the network can change mid-year.

Answer: Medicare plans differ from county to county and state to state. The best way to understand your plan is to talk to a local agent or read through your plan’s Explanation of Benefits.

Answer: Insurance carriers are required to notify members of policy changes for the upcoming year. Feel free to reach out to an agent any time after October 1st to go over your policy’s changes for 2026.

Answer: You can order a new card by going to Medicare.gov. You can also call Medicare to order a new card.

Answer: Medicare is a Federal healthcare program. You have to pay premiums for part B coverage and most people are entitled to Part A through working 10 years full time or longer.

Answer: You can find the Medicare covered services by going to Medicare.gov. If you’re on a MAPD you can find a list of covered preventive services in your plan’s Summary of Benefits.

Answer: There are payment programs available through insurance carriers. They are called M3P programs. You can also look into help from your state.

Answer: Expanding Medicare and analyzing the impact would take a lot of data and time to accurately assess.

Answer: I'm so sorry to hear that. First, call your insurance carrier and check to see if the specialist is in-network. If they are, inquire as to why your visit was denied. If the specialist isn't in-network, ask them to help you find a specialist that is.

Answer: You will need to pay the Part B medical deductible which is $257 in 2025 before the MRI is covered. If there are Part B excess charges you may need to pay those as well.

Answer: Many different insurance companies offer stand alone dental plans and some Medicare Advantage plans have dental and vision embedded in the plan.