Cheri Rogers, Medicare Insurance Broker

Answer: 2025 Medicare Part D Maximum-Out-of-Pocket (Part D "MOOP") is what you and "others on your behalf" (the insurance company) pay toward your covered prescriptions. In 2025, it is $2,100. Once you meet the $2,100, your "covered prescriptions" will go to $0. If any of your prescriptions are not covered by your insurance, they do not apply toward the MOOP.

Answer: Disability should automatically enroll you in Medicare A&B after 24 continuous months of Disability.

Answer: If you are going to continue to work and have employer coverage, as long as it is Creditable coverage (as good as Medicare or better), you should definitely apply for Part A. You have paid for Part A through your Social Security payroll deduction if you (or your spouse) have worked 10 years or more (40 Quarters). If you are going to leave employer coverage, you need to enroll in Medicare Part B as well. Please talk to a Medicare Insurance Agent and let him/her guide you through all of your options and allow them to do all the heavy lifting for you. Their services are complimentary, and they are an invaluable resource.

Answer: There is quite a difference between having Original Medicare A&B with a stand-alone Part D plan and a Medicare Advantage plan. I highly advise reaching out to a qualified/licensed Medicare Insurance Agent to have him/her go over your options and find the one that is best for you.

Answer: You won't lose Medicare if you move out of the USA unless you cancel it. However, Medicare does not cover healthcare outside of the USA.

Answer: Many Medicare Advantage plans give you some dental coverage, including but not limited to 2 cleanings per year and one set of X-rays. You will need to use dentists in-network with the specific plan you choose.

Answer: If your employer has less than 20 employees, it has the right to have you enroll in Medicare. Once you turn 65, the cost of insurance to a small group of employees can be unaffordable for a small business.

Answer: Not all doctors or medical facilities take Medicare Advantage Plans. Make certain you use a licensed and knowledgeable local Agent to help you choose a plan that fits all of your needs such as: prescription coverage, doctors, hospitals, clinics, labs, and any ancillary benefits you are interested in (dental, vision, hearing, etc.).

Answer: Medicare Supplement ("MedSup") plans can absolutely be worth the Monthly Premium cost; it all depends on your specific needs. With a MedSup, you have the freedom to see any doctor or medical facility that takes Original Medicare with no referrals. There are many advantages to a MedSup. Contact a local trusted Agent to find out more.

Answer: Having a local agent has many advantages. As you build a rapport with your agent, they are more aware of your needs and can more easily assist you if you are having trouble with your insurance or benefits. A local agent is also much more available to you than an online or 800#, as they do not know you, and you never get the same person twice.

Answer: Medicare Advantage Plans are guaranteed issue if you are using an eligible enrollment period, such as the Annual Enrollment Period (AEP), which is October 15th through December 7th of each year. They are also guaranteed issue if you are turning 65, new to Medicare, or losing employer coverage. Contact a licensed and qualified Agent to assist you so you don't miss out on an election period or important benefits.

Answer: If you used a licensed and qualified Medicare insurance agent, they would have thoroughly covered your benefits, including the dental benefits.

There is a danger of not understanding the many different plans and benefits if you do your own research and enroll yourself into an MA plan.

Answer: Some Medicare Advantage ("MA") plans have a limited amount of dental coverage. Speak to a licensed and trained Medicare Insurance Agent to help you find the best plan for your needs.

Answer: Most Medicare-covered procedures are pre-approved by your provider. If you have questions regarding coverage, you can always call Medicare and ask.

Answer: If you are on Original Medicare and a Medicare Supplement plan, you are covered for any medical service across the United States as long as the facility/doctor takes Medicare.

If you have a Medicare Advantage ("MA") plan, you are covered in the United States in an emergency situation, at an ER or an Urgent Care facility, as if you were in network.

Answer: If you have a Medicare Advantage ("MA") Plan, you don't need to carry your red, white and blue Medicare Card. Your MA plan card is all you need to show to a doctor, clinic, lab, hospital, etc.

Answer: A $0 premium Medicare Advantage ("MA") Plan is typical for many areas. That means that there is not a monthly premium payment for the client. There is no catch. As with all of your insurance plans, you must be diligent in knowing your benefits and adhering to its guidelines. For instance: if your MA is an HMO, you MUST only go to contracted/in-network providers, or you will pay 100% of your costs.

Answer: If your Medicare Advantage ("MA") Plan has a premium, and you fail to make the premium payment, it can cancel your plan. If that happens, you will have to wait until the Annual Enrollment Period to enroll in a new plan, and you may receive a penalty from Medicare for not having a plan.

An MA can leave your service area, and in that instance, you will receive a Special Election Period to enroll in a new MA Plan in your service area as you lost your plan at no fault of your own.

Answer: If you are not going to continue with an employer's group or retirement plan, as early as 3 months before your birth month, enroll in Medicare Part A & B. As soon as you receive your red, white and blue Medicare card, contact a qualified Medicare Insurance Agent to see which options you qualify for and the benefits that fit your specific needs.

Answer: Yes, unless you have a Special Election Period (SEP), such as losing your current Medicare Supplement (MedSup) plan at no fault of your own, you will have to answer medical questions to change MedSup plans or try to lower your monthly premium costs. Contact a qualified Medicare agent to discuss your current situation.

Answer: Never give anyone you don't know, especially on the phone, any of your personal information. There are many scammers who will call you as you near turning 65. It is always advisable to contact a licensed and certified Medicare Agent who is obligated to find you the best plan to suit your needs.

Answer: It is very easy to enroll in Medicare Part A & Part B at www.ssa.gov (Social Security Administration); the process is very well explained. You can call your local SS department and set an appointment for them to help you as well.

Answer: Original Medicare Part A & Part B does not cover a shingles shot without a 20% copay. If you have a Part D prescription drug plan or a Medicare Advantage Plan with drug coverage, many of those cover the shingles shot at no cost to the client.

Answer: An experienced Medicare Insurance Broker (and ethical, I may add) should make certain they are finding you the best fit for all your needs including: financial, medical, prescriptions, your doctors and hospitals, etc. If they don't ask you these pertinent facts before recommending a plan to suit your needs, call someone else.

Answer: Original Medicare Part A & Part B only covers medical. If you need dental or vision benefits, then a Medicare Advantage plan will usually have some benefits, or you can purchase standalone dental and vision insurance.

Answer: Additional benefits such as using your over-the-counter benefits to buy healthy foods or pay your utility bills are generally only available to full Medicaid beneficiaries. Some Dual Special Needs Plans (D-SNP Medicare/Medicaid eligible recipients) may allow partial Medicaid recipients to have such benefits. It depends on the D-SNP plans in your area.

Answer: If you go to the Emergency Room ("ER") and the doctor wants to keep you overnight in "Observation Status" to monitor your condition or run further tests - that is generally covered by the ER visit. If you are "Admitted," make certain you understand your current Medicare Insurance plan as to how many days are covered.

Answer: The answer to this question depends on the Medicare insurance you have. Do you have a Medicare Advantage Plan or Medicare Supplement?

If you are on a Medicare Advantage plan, all surgeries must be pre-authorized. If you are on a Medicare Supplement and the surgery has been approved by Medicare, then the Medicare Supplement will cover it as well.

Answer: It is very rewarding assisting my clients in finding the best Medicare insurance to fit their needs, including financial, medical, prescriptions and the doctors they see. Assisting each client in this endeavor is my only goal.

Answer: Zero Premium means that there is no monthly insurance premium. You will have copays related to many medical services, but the copays are small compared to the actual cost of medical services.

Answer: Medicare may cover medically necessary, part-time or intermittent home health care if you are homebound and your doctor orders a plan of care. You may owe 20%, as Medicare only covers 80% of any medical services. Services must be provided by a registered nurse or a licensed practical nurse. This may cover wound care, IV therapy, physical or occupational therapy, speech therapy, and Durable Medical Equipment (walkers, wheelchairs, oxygen, etc.)

Answer: The Medicare drug payment plan will help if you take expensive prescriptions (i.e., Tier 3, 4 or 5 medications). In 2026, the maximum out-of-pocket for prescriptions is $2,100. Contact a licensed/certified Medicare Insurance Agent to assist you in knowing your plan benefits.

Answer: To answer your question - Yes, Medicare covers hospice. Do not confuse Hospice with Home Health Care or Long Term Care. Medicare covers a Skilled Nursing Facility for the first 20 days, then days 21 forward do incur charges. Medicare does not cover Long Term Care.

Answer: Work with your doctor and insurance company to get the required evaluation and then get reinstated with your oxygen provider. It is imperative you know your insurance policy, benefits and requirements. Always use a licensed/certified Agent to assist you with finding the right coverage for your specific needs.

Answer: One of the biggest misconceptions people have about Medicare is that it covers everything related to medical needs. Medicare only covers medical; it does not cover dental, vision, or prescriptions. Part A is hospitalization, and Part B is medical outside of the hospital, such as doctor appointments, labs, x-rays, the first 3 units of blood, etc. Contact me if you have further questions.

Answer: Medicare insurance Agents/Brokers get paid a commission from the insurance carrier that the client chooses. In general, the insurance companies pay the same commission, so an Agent/Broker does not lead a client to purchase from a company that pays them a higher commission. The goal, and the duty, of a Medicare Insurance Agent is to find the best plan to fit your needs.

Answer: Medicare does not cover long-term care. If you need to go to a nursing facility/skilled nursing facility, Medicare covers the first 20 days. From day 21-100, there are set fees. Then after day 100, you will pay the full cost. There are long-term care insurances you can purchase, but depending on your current age, many of them are unaffordable.

Answer: Medicare Savings Programs are state assistance through Medicaid that may help people with limited income with the cost of Medicare premiums, deductibles, coinsurance, and sometimes copayments. The coverage is based on income and the level of assistance for which you qualify.

Answer: Medicare Part D may deny coverage for a brand-name drug if it is not on their formulary.

If it is denied, you may, and should, file an appeal for coverage.

Answer: Original Medicare Part A & Part B and Medicare Advantage Plans can cover some in-home caregiver services, but only if it is deemed you are homebound by a doctor. In some instances, this could cover skilled nursing, physical therapy, or aide services that are medically necessary.

Medicare does not cover 24-hour care or long-term care.

Answer: Maximum Out-of-Pocket ("MOOP") limits generally change every year. Contact a local Medicare Insurance Agent to find out if your MOOP is changing, or watch your mail for your Annual Notice of Change.

Answer: On a daily basis, I help clients navigate complex Medicare insurance issues. Every one of my clients and prospects have specific and individual needs to navigate to find the best fit for them. Licensed and certified agents are the best bet for the best fit. My services are complimentary, so let me do what I'm trained to do and ease your mind, save you hours of fretful searching and research, and find the insurance for your specific needs.

Answer: Medicare eligibility is based on age (turning 65) and there are some other eligibility criteria based on disability, etc. Medicare eligibility is not income-driven, but if you are a high-income household, there may be additional costs (IRMAA) added to the Medicare Part B and Part D insurance.

Answer: When you move, you may leave the service area for which your current Medicare insurance plan covers. Contact a Medicare Agent in your new area to review your coverage and make any necessary changes.

Answer: When you move into another county, you must make certain your current insurance covers your new area. Contact a licensed Medicare Insurance Agent as they can assist you in verifying that your insurance is covered in your new county and/or assist you in finding the best plan to suit your needs in your new area.

Answer: During your enrollment process, as a trained/licensed Medicare Agent, it is my goal to assist people in finding the best plan available in your area for all of your specific needs, including prescription coverage.

Answer: If your upcoming knee replacement was approved by Medicare, then your Medicare Supplement Plan G will pay the 20% that Medicare does not cover after you have met your Part B annual deductible.

Answer: You need to check with your specific Medicare Insurance Plan by calling the Member Services number on the back of your insurance card or by contacting your agent. There are a multitude of plans, specific to where you live, and each plan will have various differences in benefits.

Answer: It is highly recommended to contact a local licensed Medicare insurance agent. It is our goal to find the best fit for you regarding your needs, your prescriptions, your doctors, and your budget. We are certified, trained and experienced in assisting in this process, and our services are complimentary.

Answer: The act caps some insulin costs at $35 per month for Medicare beneficiaries and set a $2,000 annual out-of-pocket for 2025 and $2,100 for 2026 for prescription drugs (this is based on what you and the insurance company pays for prescriptions). Contact a licensed Medicare insurance agent to make certain you enroll in a plan that covers your drugs. If they are not covered, the costs do not go toward your maximum out of pocket limit.

Answer: There is no discount for healthy individuals in Medicare Advantage (MA) plans; all insurance is based on risk-pooling. If you are on an MA with $0 monthly premium, you don't have any costs unless you utilize the benefits (i.e., go to a doctor, ER, etc.)

Answer: Before enrolling in a Medicare Advantage plan, make certain your doctors/providers are all in-network. If you see a doctor outside of the contracted network, you will likely have higher costs.

Answer: Domestically: you are covered IN AN EMERGENCY SITUATION as in network. If the emergency room refers you to see a doctor post-ER, call your insurance company to make certain that doctor is in network for your post-ER visit or if there can be an exception to cover the doctor.

Internationally: some Medicare plans cover international coverage. If it is important to you, make certain it is included before you enroll. It is always a good idea to buy traveler's insurance when traveling internationally.

Answer: In either Medicare Part B or D, the provider must accept Medicare for vaccines to be covered.

Medicare Part B covers 100% of Flu, Pneumonia, and COVID-19; in cases of high-risk individuals, Hepatitis B.

Medicare Part D (prescription drug coverage), with a $ co-pay, you will need a prescription for Shingles, Tdap (tetanus, diphtheria and pertussis/whooping cough) and RSV.

Vaccines that are "reasonable and necessary" to prevent illness may also be covered by Medicare Part D. Consult your insurance company.

Answer: If you are just on Medicare A and B, you will pay 20% of all Medicare-covered services. Medicare A and B alone has no maximum out-of-pocket limit.

Answer: Go to Medicare.gov or call 1-800-MEDICARE. A Medicare Insurance agent may be able to help you, but as of 2026 we are limited when it comes to prescriptions.

Answer: You need a prescription from your doctor for durable medical equipment (DME). Then your cost will depend on the Medicare Insurance you are enrolled in.

Answer: There is a lot to know and consider before choosing a Medicare Insurance plan to fit you and your personal needs. A Medicare Agent has extensive training and completed many certifications to serve the public at their best interest.

Don’t risk this very important decision to luck. Seek out a Medicare Agent.