Celeste McGrath, Medicare Insurance Broker

Answer: Once you reach your out of pocket maximum on dog costs for the year, all co-pays for medications that are covered on your drug plan become zero. So they become covered 100%.

Answer: A new person called me recently because he had just received his citizenship status but when he applied for Medicare (at the age of 70) he was hit with a high late enrollment penalty for not enrolling in Medicare at 65. Together we called the SS office and explained that due to his citizenship status he was not eligible for Medicare at 65 so he should not have a late enrollment penalty. They had to escalate the issue and finally they agreed that our math was correct and they dropped the penalty.

Answer: This is a question that agents are not going to be allowed to answer outright. For Supplemental (Medigap) policies, there is 1 company in particular I will not write a Supplement plan through but I love them for a different line of coverage. Talk to a licensed agent and you can get some good recommendations for companies as well as estimates on cost.

Answer: My advise to my clients is simple. Get a trusted Medicare Specialist Agent that you can call and ask questions. Any time you answer the phone and someone mentions Medicare, hang up and call your agent.

Answer: Medicare is very confusing. The best way to figure it out is by speaking with a Licensed Medicare Specialist who can put everything in simplified terms for you.

Answer: The taxes you've paid into Medicare for years enables you to get Part A with no monthly premium. That is all. A Medigap plan is through a private insurance company and completely separate from the Federal Medicare program so that company has the ability to deny based on medical history. It's not a perfect system but working with a Licensed Medicare Specialist can help you go through all of your options to find the best plan option for you and your situation.

Answer: That is purely personal choice. With a local agent, the only real benefit is that you can sit down face to face with them.

You can build a great relationship with a remote agent just like you can with a local agent.

Answer: Your Summary of Benefits document will spell out the benefit for that service. If you struggle to understand that document, your Medicare Broker can help as well.

Answer: The quick answer is to log into your Social Security or Medicare account online and request a new card to be mailed out to you. From there, you can also print a temporary card until the new one arrives.

Or you can call Medicare to request one be mailed.

That being said, a lot of seniors do not feel comfortable making these calls by themselves. A trusted Medicare Specialist would be able to make this call WITH you so that you have guidance and someone who can assist directly.

Answer: If you have just Original Medicare, with or without a Supplement plan, then no. No referral is required. If you are on a Medicare Advantage plan, the answer would friend on the plan as some plans do require them and some do not.

Answer: Great question. Yes, you will still need to enroll in Parts A & B of Medicare. If you would like to add Dental coverage, you can do so through a trusted agent/broker who can shop plan options for you. Many Medicare recipients opt for a Medicare Advantage plan that has Dental build into it with a zero dollar premium so no extra cost, and you get extra coverage.

Answer: Your Supplement Plan N MAY require a copay of roughly $20 (if any copay at all) but that should be it. Your Supplement is designed to pick up the 20% that Parts A & B leave behind for you shouldn't get billed for anything with it. If you do, you should reach out to your Broker to assist with talking to the insurance company and Dr office. Your Broker should be your liaison so you don't have to navigate that by yourself.

Answer: If you qualify for low income subsidy, that helps by reducing drug costs, or you can apply for assistance through the manufacturer. During certain times of the year, you may be able to change your plan to one that covers your specifics medications at lower costs. Speak with a licensed agent to get an estimate on your drug costs on different plans.

Answer: If you have a trusted agent that you work with, you can reach out to that agent. He/She can check the network for the plan you are on and supply a list of in-network doctors for whatever specialty you are looking for.

Answer: Great question!! Read the reviews for the agent that is contacting you. A good agent will not be pushy, will have a heart for service, and work in the best interest of you. If this is true, the reviews on that agent's website will reflect it.

Answer: This generally comes down to affordability. A Medigap plan has a monthly premium where in general, most Advantage plans do not so that is usually the number 1 reason people choose Advantage over Medigap. Medigap plans are fantastic coverage, but the premium increases every year and sometimes twice a year.

The second part is that it can only supplement your A & B. Nothing more, nothing less. So you are still required to get another policy for your Part D (Drug coverage). Which adds more cost on the monthly premium side.

Advantage plans are more of a bundled structure so you have medical, dental, vision, hearing and drug coverage (in most cases) all in one plan without a monthly premium (in most cases). But there are copays as you use the coverage so each structure has it's pros and cons.

Answer: You should always consult with a licensed Medicare broker on this. A good broker can check your Drs on networks for Advantage plans and advise on whether a plan has any/all of your Drs in network.

Answer: There are penalties that you should be aware of if you did not take Medicare when you turned 65 AND did not have creditable coverage from an employer plan. If you DID have creditable coverage, there is a form that your employer HR dept will need to fill out showing that you did have coverage so you do not incur Late Enrollment Penalties. You can generally get this form from a licensed Medicare broker.

Answer: IRMAA is determined based on your income taxes from 2 years prior and will automatically adjust as time goes on. However, if you retire and your income drops drastically, there is a form that you can submit to have a 12 month reprieve. You can generally get this form from a licensed Medicare broker.

Answer: As a licensed Medicare broker, I have a Medicare 101 presentation that I have put together that goes over all of the basics of Medicare and the plan types available that also showcase the pros and cons of each without steering into one plan type or the other. I listen to you on what you want and need. Most people will know after a Medicare 101 which type of coverage they would prefer. And if not, we can delve a little deeper into them.

Answer: If you are on SSDI, then after 24 months, you should be automatically enrolled with Medicare. At that point, you will want to contact a licensed Medicare broker to go over the plan options available that fit your needs.

Answer: Your income does not affect your eligibility, however, it does affect the amount of your Part B premium. For the most up to date information on these amounts, it is best to contact a licensed Medicare broker who can explain the brackets and timeframes that Medicare looks at for this.

Answer: This has been both a good and bad thing for different people. The 2025 Part D out of pocket cap got rid of the Doughnut Hole. This, plus the Max out of pocket on drug costs, reduced the yearly cost of medications for many many seniors on very expensive medications.

It does come with it's drawbacks though. It is done on a sliding scale from Jan to Dec so when seniors fill their medications for the first time or 2, the cost is really high. Then as the year goes on, the cost each month (or 3 months, however you fill your medications) goes down each fill. Many people find that their last several months of medications don't have a cost at the pharmacy.

Answer: The point of having a PPO is that when you go out of network, instead of having 0% coverage, you have "some" coverage (percentages and benefits vary from plan to plan). So while you do get bills for those visits, the total cost is less than if you had an HMO and no coverage out of network.

Answer: There isn't really a best way to compare Advantage to Supplement. They are very different coverages and plan types. However, I have found that going over those types of options with a licensed broker that is well versed in both can help you figure out which type is best for your specific needs.

Answer: If the company you work for has more than 20 employees, generally that means your coverage is considered creditable so you could stay on your employer coverage and delay Medicare. However, there are caveats to it so it's best to ask your HR dept if it is creditable coverage and speak with a licensed Broker to go over the implications of doing so.

Answer: It depends on your plan, but many plans do cover both a skilled nurse and a home health aid to assist after a surgery.

Answer: A licensed agent/broker has completed hours of training and education and we know the ins and outs of Medicare. We know how it works with your situation, which options would be the right fit for you, and how different decisions may impact you in the future.