Cheryl Lockhart, Medicare Insurance Agent

Answer: If you qualify for both Medicare and Medicaid, you are considered dual eligible. This means you can receive benefits from both programs, helping reduce your healthcare costs and improve access to care.

Medicare is your primary health insurance and generally pays first for covered medical services, including hospital stays, doctor visits, and prescription drug coverage (depending on your plan).

Medicaid works alongside Medicare and may help pay for:

Medicare premiums

Deductibles and copayments

Services Medicare doesn't fully cover, such as certain long-term care services and supports

Many dual-eligible beneficiaries choose a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed specifically for people who qualify for both programs. These plans often provide additional benefits and help coordinate care.

Because Medicaid eligibility and benefits vary by state, it's important to review your options annually to make sure you're receiving all available assistance.

If you think you may qualify for both Medicare and Medicaid, a licensed insurance agent experienced in Medicare can help you understand your choices and determine which coverage best fits your needs.

This information is for educational purposes only and is not a complete description of benefits. Eligibility for Medicare, Medicaid, and D-SNP plans varies. Contact your state Medicaid office for specific eligibility requirements.

Answer: Medicare coverage for physical therapy depends on your plan. If you have Original Medicare (Part B), there’s no set limit on the number of visit as long as your care is medically necessary and properly documented by your provider. This will allow your coverage to continue. However, you will be responsible for the Part B deductible and typically 20% of the cost per visit. If you have a Medicare Advantage (Part C) plan, coverage rules may differ Some plans require prior authorization or limit the number of visits. The best way to find out your exact coverage is to check with your therapy provider, licensed health insurance agent or review your plan details.

Answer: Medicare covers many common cancer screenings under Part B as preventive services, often at no cost when done on schedule with a provider who accepts Medicare. These include screenings like mammograms (once a year for women 40+), colon cancer tests (ranging from yearly stool tests to a colonoscopy every 10 years), Pap smears (every 2 years, or yearly if high risk), lung cancer screenings (yearly for those who qualify), and prostate screenings (yearly for men). The exact timing can vary based on your age, risk factors, and your doctor’s recommendations, so it’s important to follow a screening schedule that fits your individual health needs.

Answer: Moving to a new state can affect your Medicare coverage. If you have Original Medicare, your coverage goes with you nationwide, alhough you may want to update your prescription drug plan based on your new location. However, if you have a Medicare Advantage or Part D plan, these are based on the zip code you live in. You will have a Special Enrollment Period (SEP), which gives you a limited time to make changes. You will need to switch to a new plan in your new state. To avoid gaps in coverage, be sure to contact a licensed agent for support. Notify the Social Security Administration and your current plan if you have Medicare Advantage or a Part D plan. You can also reach out to Medicare (1-800-MEDICARE) for guidance on your options in your new area.

Answer: Switching to a new Medicare Part D plan can sometimes come with surprise like medications suddenly requiring prior authorization. Each plan has its own formulary (drug list) and coverage rules, which can include prior authorizations, step therapy, or quantity limits. Even if your medications were covered without issue before, a new plan may handle them differently.

Many plan comparisons focus on cost and whether a drug is covered, but not always how it’s covered. That’s why this can catch people off guard.

The good news is there are solutions. Your doctor can usually submit a prior authorization, and in some cases request an exception if the medication is medically necessary. Many plans will also allow a temporary supply while this is being reviewed.

The important thing to remember when reviewing Part D plans is look beyond coverage and cost so you understand any restrictions that may apply so there are fewer surprises later.

Answer: Getting diagnosed with a serious illness can make you want more flexibility in your coverag, but unfortunately it does not automatically allow you to switch to a Medigap plan mid-year.

You can leave a Medicare Advantage plan and return to Original Medicare during certain times of the year or if you qualify for a Special Enrollment Period. However, in most cases, Medigap plans require medical underwriting. This means insurance companies can review your health history and may deny coverage or charge more based on your condition.

There are a few situations where you have “guaranteed issue” rights such as when you turn 65 years old when you first try a Medicare Advantage plan or if your plan ends, but outside of those approval is not guaranteed.

While you may be able to change your Medicare coverage, getting a Medigap plan after a serious diagnosis can be challenging. This is why it is important to understand your options early and choose coverage that fits both your current and future needs.

Answer: Medicare Part A provides important hospital coverage, but it usually is not enough by itself. Part A helps pay for inpatient hospital stays, skilled nursing care after a hospital stay, hospice care, and some home health services. However, it does not cover everything.

For each hospital benefit period, you must first pay the Part A deductible, and there are additional daily costs if your stay becomes longer. Part A also does not cover most doctor and specialist services during your hospital stay. Those are typically covered under Medicare Part B.

Because of these gaps, most people choose additional coverage such as Medicare Part B with a Medigap (Supplement) plan or a Medicare Advantage plan to help reduce out-of-pocket costs.

The bottom line is that Medicare Part A is an important foundation for hospital coverage, but most beneficiaries need additional Medicare coverage for more complete protection.

Answer: Here’s how to simplify it:

1. Separate official mail from ads.

Letters from Medicare or Social Security are important. Most other colorful postcards are advertisements.

2. Don’t panic over “urgent” language.

You have a 7-month Initial Enrollment Period. There is time to make a smart decision.

3. Focus on your three main paths.

You’ll generally choose between:

Original Medicare

Original Medicare, a Medicare Supplement and a Drug Plan

Medicare Advantage

Once you understand your options, the mail stops feeling overwhelming.

4. Work with an independent agent who works for you and not one company.

An independent, licensed agent can compare multiple plans, explain everything in plain English, and help you choose what fits your needs. Instead of calling 10 different mailers, you get one clear, personalized conversation.

Turning 65 doesn’t have to be overwhelming. With the right guidance, Medicare can be understood more easily.

Answer: Yes, in most cases, you will have to answer health questions.

During the Annual Enrollment Period (October 15–December 7), you can leave your Medicare Advantage plan and return to Original Medicare. However, enrolling in a Medicare Supplement (Medigap) plan usually requires medical underwriting in most states.

The only time you can get a Medigap plan without health questions is during your Initial Enrollment Period (three months before your 65th birthday, the month of your birthday and three months after your birthday) or if you qualify for a special guaranteed issue situation for example if your current plan is not renewed.

Important: Always apply and get approved for the Medigap plan before dropping your Medicare Advantage plan to avoid coverage gaps.

Answer: In many cases, yes you can use an HSA to pay to pay for certain premiums.

After age 65, you can use your HSA funds tax-free to pay for certain Medicare premiums, including Medicare Part B, Part D, and Medicare Advantage (Part C) plans. If you happen to pay a premium for Part A, that can also qualify. You can also use your HSA for other out-of-pocket medical expenses like deductibles, copays, dental, vision, and hearing care.

However, there’s one important exception. HSA funds cannot be used tax free to pay for Medicare Supplement (Medigap) premiums.

Another key rule to remember is that once you enroll in Medicare, you can no longer contribute to your HSA. But you can still use the money that’s already in the account.

An HSA can be a helpful way to offset healthcare costs in retirement just be sure you’re using it for expenses that qualify under IRS rules.

If you’re approaching Medicare eligibility and want help understanding how it fits into your retirement plan, feel free to reach out.

Answer: Medicare often helps cover recovery after surgery, but what’s covered depends on where your recovery takes place and which parts of Medicare you have. In general, Medicare Part A may cover inpatient hospital stays and medically necessary rehabilitation in a skilled nursing facility after a qualifying hospital stay, while Medicare Part B typically covers follow-up doctor visits, outpatient therapy, and durable medical equipment like walkers or wheelchairs.

If you are recovering at home, Medicare may cover limited home health services when skilled care is required, but it does not pay for long term personal care such as help with bathing or cooking. Prescription medications related to recovery are usually covered under a Medicare Part D plan. Because coverage and out-of-pocket costs can vary based on your plan and recovery needs, it’s important to review your benefits ahead of time to avoid surprises.

Answer: There’s no one “better” choice. It depends on your needs.

Original Medicare offers nationwide access to any doctor that accepts Medicare and works well for people who want flexibility or travel often. You can add drug coverage and a supplement for an extra cost.

Medicare Advantage bundles coverage into one plan, often with drug coverage and extras like dental, vision, and fitness benefits. These plans usually have provider networks and and no extra premiums other than your Medicare Part B premium.

The bottom line is to choose the option that best fits your doctors, budget, and how you prefer to receive care.

Answer: Yes it is real. Starting in 2025, Medicare now caps out-of-pocket prescription drug costs at $2,000 for covered Medicare Part D medications.

Once you hit that amount for the year, you won’t pay more for covered Part D drugs for the rest of the year. This applies to standalone Part D plans and Medicare Advantage plans that include drug coverage. Just keep in mind that premiums are not included, and it only applies to covered Part D medications. Most people do not reach the $2,000 cap, but for people with high prescription costs, this change is a big relief.

The cap increased slightly for 2026 to $2,100 as a cost of living adjustment.

If you’re not sure how this affects your medications or plan, it’s worth taking a quick look. Also consult a licensed agent to help explain your drug coverage.

Answer: It’s very common for Medicare beneficiaries to notice changes in their copays, deductibles, or premiums when January arrives. This usually happens because Medicare plans reset and update each calendar year.

Many Medicare Advantage and Part D plans make annual changes to costs, including monthly premiums, prescription copays, and deductibles. Even if you stayed on the same plan, the benefits and pricing may not be exactly the same as last year. January 1st marks the start of the new plan year, so deductibles reset and cost-sharing often goes back to the beginning.

Another reason your costs may look different is that prescription drug tiers or pharmacy pricing can change. A medication that was inexpensive last year may move to a different tier or your preferred pharmacy status may have changed.

Additionally, Medicare Part B premiums and deductibles are set by Medicare each year and can increase, which may affect your overall costs even if your plan itself didn’t change.

If your January costs catch you by surprise, don’t panic. It doesn’t necessarily mean something is wrong. It does mean it is a good time to review your coverage and make sure your plan still fits your needs.

A licensed, independent Medicare agent can help explain these changes and review your options so you’re not paying more than you should.

Answer: Medicare Part D is prescription drug coverage only. It’s designed to work alongside Original Medicare (Parts A and B). If you choose this route, you’ll have separate coverage for medical care and prescriptions. This option is often a good fit for people who want the freedom to see any doctor who accepts Medicare and may also carry a Medicare Supplement (Medigap) plan.

Medicare Advantage, on the other hand, is an all-in-one plan that replaces Original Medicare. Most Medicare Advantage plans include prescription drug coverage plus additional benefits like dental, vision, hearing, fitness programs, and sometimes over-the-counter allowances. These plans typically have provider networks and set copays, but they also include an annual out-of-pocket maximum to help control costs.

Everyone's Medicare journey is different and the right choice is the one that works best for you.

If you value flexibility and broad access to providers, Original Medicare with a Part D plan may be the better choice.

If you prefer bundled coverage, extra benefits, and predictable costs, Medicare Advantage could be a great option.

Because plans, costs, and benefits vary by location and change each year, it’s important to review your options carefully. A licensed, independent agent can help you compare plans and choose coverage that fits your healthcare needs.

Answer: Don’t panic because losing your Medicare card is more common than you might think and it can be replaced.

If you have an online My Social Security account, you can log in at ssa.gov to request a replacement card or print an official copy right away. If you don’t have an account yet, you can create one in just a few minutes.

You can also call Social Security directly at 1-800-772-1213 (TTY: 1-800-325-0778) to request a new card by mail.

While you’re waiting for your replacement, most doctors and pharmacies can still look up your Medicare coverage using your Social Security number. If you’re enrolled in a Medicare Advantage or Part D plan, you can continue using your plan’s member ID card.

To protect yourself, avoid carrying your Medicare card unless you need it and never share your Medicare number with unsolicited callers.

If you need help accessing your information or have questions about your coverage, a licensed, independent agent can help guide you every step of the way.

Answer: Using my Medicare referral phone number is one of the simplest ways to make sure yo and anyone you refr gets trusted, personalized guidance without the stress of navigating Medicare alone. When someone calls my dedicated number, they reach me directly, not a call center. That means they will get one-on-one support from a licensed, independent agent who takes the time to understand their health needs, budget, and coverage concerns.

You will also have peace of mind knowing your friends and loved ones are in good hands. I compare plans from multiple insurance companies, explain benefits in plain language, and always offer guidance at no cost and with no pressure. Many people discover savings, extra benefits, or better-fitting coverage they didn’t even know they qualified for.

Answer: Beyond your regular doctor visits and prescriptions, many Medicare Advantage plans include extra benefits that people don’t always realize they have. Some plans may cover transportation to medical appointments, meal delivery after a hospital stay, or even over-the-counter (OTC) allowances to help with everyday health items. You might also have access to fitness memberships, telehealth visits, hearing aid discounts, caregiver support, or even in-home safety checks to help you stay independent.

You could also have benefits like expanded dental coverage, vision allowances, podiatry services, accupuncture or special programs for managing chronic condition. These are all designed to support your overall health and well-being.

If you’re not sure what your current plan includes, it’s always worth taking a little time to look it over. A licensed, independent agent can help you sort through those details and make sure you’re taking advantage of everything your plan offers.

Answer: Medicare offers several ways to help lower your prescription costs. First, review your plan each year with a licensed agent to make sure you’re getting the most out of your benefits. Using preferred pharmacies, asking about generic alternatives, and considering 90-day refills or mail-order options can also help you save money each month. You may qualify for Extra Help programs, such as the Low-Income Subsidy (LIS), which significantly reduce out-of-pocket costs. In addition, some nonprofit organizations and drug manufacturers offer financial assistance for certain high-cost medications. A licensed agent can help you navigate these options and find the support that best fits your needs.

Answer: Each carrier such as Humana, Aetna, United Health and more can offer extra benefits with their plans and these benefits may be different in the area you live in. It is always get to get a yearly check with a licensed agent to check on what extra benefits that are available to you in your area that also include your physicians and your medications prescribed to you.

Answer: Medicare Part B covers what is called Durable Medical Equipment for use in the home prescribed by a doctor that meets the criteria of being medically necessary and for the appropriate condition. One example is continuous glucose monitors (CGMs) such as Dexcom G6/G7 and FreeStyle Libre 2/3. You must have a diabetes diagnosis, use insulin or have issues with hypoglycemia. Some other models that could be covered are Medronic Guardian and Senseonics Eversense connected to an insulin pump. You do need a prescription and must get the device from a Medicare approved supplier. For seizure monitoring, coverage could be possible for diagnostic monitoring, but must meet clear durable medical equipment classification and criteria. Again, it would need to be prescribed by a physician and obtained from a Medicare approvied supplier.

Answer: Once you are enrolled in a Medicare Advantage plan, you must show your Medicare Advantage plan card. Medicare pays the private insurance company to manage your benefits. Original Medicare will not pay while you are enrolled in the Advantage plan. It is very important that you work with a license agent, who will make sure your prescriptions and doctors are in the plan you sign up for. During AEP (Oct 15 - Dec 7) or MA OEP (Jan 1 - Mar 31) you can switch back to original Medicare with or without a Medigap plan. There are also special enrollment periods for specific illnesses or natural disasters.

Answer: Medicare covers respite care only if the beneficiary is receiving hospice care with a terminal illness diagnosis and is enrolled in Medicare Part A and Part B. It does not cover at home respite care or general respite care outside of the hospital benefit. If you are on Medicare, it does cover mental health services.

Answer: The advice of a licensed insurance agent who can compare plans across carriers and breakdown costs for you would greatly relieve your stress. Their services are of no cost to you. You can also call your State Health Insurance Assistance Programs (SHIP) who offer free counseling. An Elder law attorney can help to protect assets, power of attorney and planning. A very important thing to remember is to take care of yourself by getting enough rest and support. See if other family members can help you shoulder responsiblities.

Answer: Yes you must meet your Part B deductible of $257.00 for the year 2025 before Medicare starts paying. The deductible is projected to be $288.00 for the year 2026. After you meet the deductible, Medicare pays 80% of the approved amount and you will pay 20% coinsurance.

Answer: While there are advantages to an HMO like extra services of dental, vision and hearing, often some over-the-counter products are covered, they can also have certain limitations. Generally, you are required to stay within the plan's provider network, get referrals to see specialists, and could have less flexibility in choosing providers. There are out of area limits and prior authorization for procedures, tests or medications.

Answer: If you are diagnosed by a doctor with a chronic illness such as diabetes, heart failure, cardiovascular disease, COPD, end stage renal disease and among others listed by insurance carriers, you can change immediately.

Answer: A licensed agent will review your prescriptions, doctors and budget. They can then compare plans that fit your exact needs. Often people enroll in a plan because it appears to be "cheap," but in the long run costs more. An agent can help avoid this pitfall.

Answer: You will be responsible for out of network costs unless a cardologist is not available in your network. Then, you would need to get prior authorization. If you have cardiologist in network, you would need to see a cardiologist in the network and would be responsible for copays.