Casey Graves, Medicare Insurance Broker

Answer: Yes, several Part D plans have Repatha covered on their formulary. This doesn't mean the plan pays 100% for the drug. It is likely you will owe a percentage or copay at the pharmacy for a brand name drug like Repatha! It is all dependent on what drug plan you are enrolled into.

Answer: The Part D plans can change every year. It is important to look at it every year during the Annual Enrollment Period to make sure your prescriptions are still covered as desired. I always tell my clients to just touch base with me during AEP with an updated list of prescriptions and I can check on it!

Answer: You would want a PPO Medicare Advantage plan, a nationwide HMO Medicare Advantage plan, or a Medicare Supplement. You are covered on any plan in case of emergency, but I would look into one of these three plans if you have a routine doctor in FL that you might see outside of an emergency.

Answer: Oh my goodness I love this question! I meet with all of my clients face-to-face and really get to know them outside of a quick transaction. I love hearing about my clients' kids, grandkids, pets, jobs, vacations, marriage and parenting advice, and so much more. As a young professional, I gain so much wisdom from so many that have gone before me!

Answer: "Guaranteed Issue" basically means that if you want to enroll, you are GUARANTEED to be enrolled regardless of your health or any pre-existing conditions you have. The most popular GI is 6 months from when your Medicare Part B begins, however, that is not the only GI!

Answer: Medicare does not pay for long term care. You can prepare now by enrolling into a long term care policy. Other ways to get LTC covered would be through the state Medicaid program.

Answer: 1. See if you qualify for low income subsidy (LIS) also known as Extra Help.

2. See if the manufacturer of your prescription offers a patient assistance program. If approved, they could very well mail your prescription to you for free.

3. Ask your provider for samples.

4. Speak to an agent local to you. Local agents are often familiar with how the plans in your area differ in deductibles and copays on your drugs. Some plans in my area have a $615 deductible on brand name drugs while other plan only have a $200 deductible.

5. Try a coupon such as GoodRx or SingleCare to see if they give you a better rate than your insurance!

Answer: There are two ways to do Medicare. It could be that your friend is on a completely different type of plan than you. Maybe you are on a Medicare Supplement and your friend is on Medicare Advantage?

Answer: Yes. Medicare covers chiropractor visits, but only the manipulation of the spine. So your adjustment would be covered, but anything "extra" is not. This is assuming that your chiropractor is a Medicare or Medicare Advantage provider.

Answer: Unless you have a Medicare Supplement, you would be extremely financially exposed with Original Medicare. With Medicare Advantage, you are protected financially by a max-out-of-pocket. This question does not have a "one size fits all" answer. Part C is a great and often budget friendly option for several beneficiaries but some of the cons include networks and more prior authorizations than Original Medicare. Lets get together and I'd be happy to assess what type of plan might serve you best.

Answer: Yes, Medicare Advantage and standalone Prescription Drug Plan benefits vary depending on what county you live in!

Answer: Not necessarily! It depends on how often you are going to the doctor. We would want to do the math to see if paying the higher premium (and subsequently having lower copays) makes financial sense than your current plan.

Answer: I think this is a reason why its beneficial to use an agent from the start. We can make sure you aren't missing any important enrollment periods or guaranteed issue periods! CMS sends out a "Medicare and You" book every year that explains this rule.

Answer: Medicare Advantage plans often pay higher commissions to agents than Medigap policies, however, sometimes Medicare Advantage plans are truly the better option depending on your health needs. I wouldn't be skeptical as long as the agent is offering both Medicare Advantage and Medigap's and has educated you on the differences!

Answer: Ask your agent! If you don't have an agent, you can call the customer service number on the back of your insurance card. If you want to figure it out on your own, you can locate the "Summary of Benefits" or "Evidence of Coverage" documents which will outline any hearing aid benefits included in your plan!

Answer: Yes, you may change your Medicare Supplement at any time throughout the year. The only drawback is that you will have to go through medical underwriting.

Answer: In comparison to Original Medicare, Medicare Advantage plans can certainly save money because you are financially protected by a max-out-of-pocket which is something you don't have with original Medicare!

Answer: If the surgery is performed in an outpatient setting, you have to meet the Part B annual deductible ($283 in 2026). Once your deductible is met, Medicare pays 80% and your Plan G will cover the remaining 20%.

Answer: If by "overhaul" you mean examine or reform, I think there is always room for improvement in any federal program. It seems the only way to answer this question would be based on opinions!

Answer: No. Medicare does not "fully cover" nursing home care. Care in a skilled nursing facility is only covered for the first 100 days. After 100 days, it becomes long term care, which is not covered by Medicare. Alternatives would be a long term care policy or reaching out to the state Medicaid program!

Answer: No, original Medicare does not require referrals to see a specialist. It is important to note that sometimes a specialist may require a referral from your Primary Care Provider, however, it is not required by the insurance.

Answer: We simply complete the appeal form and submit it along with any supporting documentation! Often times the appeal forms require your provider to explain why you need the procedure or medication. If the appeal is not granted, you can climb the "appeal ladder" and eventually get a hearing from a judge.

Answer: Yes, acupuncture is covered for chronic lower back pain. Depending on your Medicare plan, you might need prior authorization and/or be limited to a certain number of visits.

Answer: Dental and vision coverage is included in several Medicare Advantage plans, otherwise you have to buy them separately.

Answer: Working with a Medicare agent is beneficial because we are highly educated on the plan benefits, networks, enrollment periods, penalties, rate increases, and more. While you could certainly figure these things out on your own, you might save a lot of time and energy by letting a professional guide you. Not to mention, our services are free! There are no disadvantages of using an agent.

Answer: Yes, visits with psychologists and psychiatrists are included in Medicare coverage! If you are enrolled into a Medicare Advantage plan, you will be responsible for the specialist copay or coinsurance. Out-of-pocket expenses can vary depending on if you see a provider in your plan's network or out of network.

If you are enrolled into Original Medicare, you are responsible to meet a $283 deductible (in 2026) and then Medicare pays 80% of the Medicare Allowable Charge, given that the provider is a Medicare provider. Hope this helps!