Christopher Boyd, Medicare Insurance Agent

Answer: Over 90% of seniors I have met over the past 13 years, wrongly assume Medicare will financially cover their long term care needs. Thankfully, we offer protection for those needs as seniors become more frail and require care their families are often unable to adequately provide.

Additionally, for those seniors who do not receive federal, state, or VA assistance with their healthcare, Medicare Advantage plans come sometimes become difficult to navigate. Especially relating to network and pharmacy network pricing guidelines. I stand ready to assist anyone with Medicare or retirement planning challenges.

Answer: A recent retiree transitioned from Group health insurance to Medicare Supplement coverage. They have called me a few times with claim or coding problems from the hospital billing their prior coverage after they joined Medicare. After calls to Medicare and the hospital, we were able to correct the billing dispute.

Answer: Those Americans receiving SSDI will automatically be enrolled into Medicare Parts A & B not later than their 25 month after their SSDI started. If an American citizen is receiving SS benefits other than SSDI (at age 62), they will automatically be enrolled into Parts A&B when they turn 65.

Answer: The best discussion tool is the most recent version of the Medicare and You Handbook. If you are enrolled in Medicare and do not receive the Handbook in the mail, simply download it from the www.Medicare.gov website.

Answer: If the senior does not receive federal or state financial assistance, the senior maybe responsible for hospital inpatient deductibles or copays. Medicare Supplements may cover this cost at 100% depending on the supplement chosen. Medicare Advantage or Part C may have daily hospital copays for a limited number of inpatient admission days.

Answer: You need to inquire about Long Term Care planning, as you cannot rely on Medicare funding or the Medicaid Spend Down provisions to be pleasant for you or your family. If you are eligible for credible healthcare coverage from your employer, you will most likely not need to inquire into Medicare enrollment until 90 days before you plan to lose group coverage and enroll into Medicare, assuming you are going to be 65 or older or are not under the SSDI provision of automatic Medicare enrollment.

Answer: Some plans which were in place in 2023 and 2024 have had their Maximum Out Of Pocket (MOOP) increase in 2025.

Answer: Be with your parents when they meet with an insurance agent to discuss Medicare plans/supplements and their various options. Be sure to ask if their desire to travel out of state or out of country (if applicable) will impact or be impacted by their choice of Medicare plan/supplement.

Answer: Life insurance is often an important element of financial and estate planning. In most cases, the death benefit proceeds from a life insurance policy are tax free when paying out to a naturalized citizen. This is very important when discussing the lost income of a spouse.

Answer: You may be penalized in you don't meet certain criteria such a active credible coverage in your state, which may exempt you from enrolling into Medicare while employed and receiving group insurance. Never assume one way or the other. If in doubt, call 1(800)MEDICARE.

Answer: In 2025, Medicare eliminated the Part D Coverage Gap (a.k.a. Donut Hole). This now limits the consumer from spending over $2000 on all covered prescription drugs. However, not all plans may cover all of your medications, so ensure you verify Part D plan options in your zip code at www.Medicare.Gov.

Answer: In most cases, discount cards or pharmaceutical company assistance is not available once a senior enrolls into Medicare Part D or Part C (with drug coverage). There are exceptions to this, but Medicare Part D/Part C can provide significant coverage support for most commonly prescribed medications.

Answer: Two common complaints raised by seniors: 1) the insurance agent (over the phone or in person) did not explain the Maximum Out Of Pocket (MOOP) costs per year and 2) network restrictions or provisions and their implied costs of the Medicare Advantage plan. Will those network restrictions impact my travel across the USA or outside the country?

Another complaint, not as often, but is financially significant, is the senior was unaware that in most cases, after the senior has been enrolled in the MA/MAPD for more than 12 consecutive months, they may not health qualify (Cancer, Stroke, Heart Attack, Dementia, COPD, etc) to go back to a Medicare Supplement and may be limited to MA/MAPD coverage for several years.

Answer: State regulations vary and State Insurance Commissioners are discussing this very issue currently in 2025. In some cases, due to illnesses or medications, a senior may never be able to return to a Medicare Supplement which requires Underwriting and some companies may require a physical exam at time of application. In most cases, the "Turning 65" or "leaving an MAPD/MA after 12 months of enrollment" may be the only time a senior with chronic illness or prescriptions will have guaranteed issue Medicare Supplement enrollment entitlement.

Answer: Current Medicare rules allow a Special Enrollment Period (SEP) when someone loses creditable group coverage and is 65 or over in most states. This entitles the retiree to enroll into Parts A, B, C, and/or D. In most cases, the senior will be required to the pay the entire Part B and/or Part D monthly premiums at that time and for the rest of their retirement.

Answer: From 2006 to 2024, Medicare Part D had various costs sequences throughout the year for a senior, where their out of pocket costs would vary but not have a final stoppage point, until the year ended. In 2025, if their Part D or Part C plan covers all of their prescriptions, the senior is now limited to $2000 out of pocket for all covered medications. For example, they could reach the $2000 limit in August 2025 and they would no longer have any out of pocket costs.

Also, in 2025, Medicare allows seniors to request their share of certain medications to be broken down monthly versus one large deductible in January. This option must be requested by the senior to their respective Part D or Part C plan.

Answer: Cataract surgery and other intraocular eye treatments or eye surgeries are covered standard to plan deductibles and copays and varies between Medicare Supplement and Medicare Advantage. In 2025, Original Medicare will not pay for routine optometry with the exception of one set of glasses following cataract surgery. Medicare Advantage plans can offer some optometry coverage but that coverage and limits are set each year by the private insurance company. Although some MAPD/MA plans cover some glasses coverage, there are limits. Thus, the senior could still pay $200 to $400 or more for higher costs options on their glasses after the MAPD pays some of the costs.

Answer: In most cases, Original Medicare (in 2025) will provide very little or zero coverage for routine dental and vision costs. Most MA/MAPD plans offer some limited dental/vision coverage. Some dentist will recommend a senior purchase a stand alone dental insurance policy accepted by their dental practice. All dental coverage plans (private and MA/MAPD) will have plan limitations and some plans have waiting periods for some treatments/procedures.

Answer: This is not a cookie counter answer for all seniors based on their health and desired premiums, co-pays, deductibles and future rate increases. As of Jan 1, 2020, Medicare Supplements Plan C and Plan F were no longer available to new to Medicare seniors (a.k.a. Turning 65). There are still many others supplements available in most states. Some retirees will opt for Plan G, while others may opt for Plan N or Plan High Deductible G.

Answer: Enhanced coding and billing.

Better diagnostic opportunities to diagnose cancers and other illness sooner, allowing potential lower costs treatments and better survivability.

Less Medicare Fraud, Waste, and Abuse

Better communication from primary care to specialists to ensure unnecessary tests or procedures are not conducted.

Answer: In 2025, some states allow a "Birthday Rule" allowing seniors to change plan to plan at or around their birth month. For example, the senior may be able to change from Medicare Supplement Plan G with company A to Plan G with company B with no health questions during their birth month.

In other states where this provision does not exist, in most cases, a senior with chronic illnesses cannot switch to another Medicare Supplement plan or company without Underwriting (a.k.a. health questions) and some health conditions and/or prescriptions may prohibit the senior from changing plans.

Answer: Some Medicare Supplements have a Foreign Emergency Travel provision which has an 80% coverage after a $250 deductible and a lifetime coverage of up to $50,000 for emergency care if the illness/injury occurred within the first 60 days outside of the USA.

Answer: This is not a cookie answer for either option and if you talk to an agent who pushes one option over the other, go somewhere else.

For some citizens who receive Federal, State, or VA financial assistance, Medicare Advantage may be their only option. For Military Retirees who have TriCare for Life as an example, they currently would not need to pay for a Medicare Supplement.

Know Your Customer, is an Insurance saying which means the agent/broker should explain all options available to the senior.

In most states and zip codes, there are several Medicare Supplements such as Plan G, Plan N, High Deductible G, etc as well as several Medicare Advantage Plans. The senior should spend some time with the agent and gain a thorough understanding of all options available to them based on their unique circumstances.

Answer: Annuities can provide a safe, secure, and guaranteed investment option for retirees. But there are limitations and Best Interest criteria which must be met to protect the senior from financial harm. Insurance companies and regulators are working to ensure all annuity sales are conducted in an ethical, Best Interest process which benefits the senior, their family, and the insurance company.

Answer: In 2025, Medicare Part A is Limited to only 20 days of full Skilled Care and partial co-pay of up to 100 days total, per benefit period, when the senior leaves the inpatient 3-day minimum hospital admission stay. This is limited to Skilled Care Only. Not residential nursing home/long term care stay.

Medicare provides zero Long Term Nursing Home Care funding. Per the 2025 Medicare and You Handbook, there are only TWO Nursing Home coverage options: Medicaid or private Long Term Care Insurance. Further, the Medicare Book recommends seniors plan for their long-term care NOW to ensure they can get the care they want, in the setting they want, in the future. Medicaid Spend Down laws can vary state by state and change each year.

Long Term Care Insurance policies written in 2025 and beyond can provide coverage at home, adult day care, assisted living, hospice, nursing home care, etc, without having to spend down ones assets and keep help control of their money and indepence.

Answer: The newest change for 2025 is No Donut Hole in the Medicare Part D patient maximum. The new limit for out of pocket prescription costs are $2000 limit. Basically, is the medication you require is covered by your Part D plan or MAPD, the new guidelines limit your maximum costs per year. Additionally, there is a new monthly payment plan option to cover high cost Brand Name medications.

Answer: The Covid-19 Global Pandemic led to many healthcare providers and businesses going to online or video-driven healthcare appointments. This technique has been up and going for years (pre-pandemic) in the west and southwestern rural states.

Answer: Currently Medicare cannot afford to cover expenses such as Long Term Care. Dental and Hearing are extremely cost prohibited for "full coverage". Nearly all current Dental plans only cover 50-65%, on average, with a $800 - $3000 maximum benefit (restrictions apply). Leaving the patient to have co-pays and in some cases limited network restrictions.

Answer: This is one of the most dishonest and most-misleading sayings in the business: "zero premium/zero co-pays". Unless an individual has some form of federal, state, local, or hospital financial assistance, he/she will have a co-pay and many circumstances such as chemotherapy, durable medical equipment, inpatient hospital care, ambulance, emergency room, urgent care, etc, co-pays can be quite high. For example, many Advantage Plans in my marketing area cover only 80% of Chemotherapy and Durable Medical Equipment, meaning the patient can be responsible for 20% of the cost until they reach the plan's annual maximum out of pocket (MOOP). The MOOP can range from $3000 to $13000 per year depending on network restrictions and plan allowances. I met a man once who had cancer and maxed out his MOOP of $6,700 two years in a row, and then nearly maxed out again in the third year, when he passed away. He and his family were very angry with the agent who signed him up and never explained the plan rules and restrictions.

Answer: Social Security will automatically enroll you into Medicare Parts A & B if you are not already enrolled due to SSDI Disability.

Answer: If you are turning 65 or have a limited Special Enrollment criteria, consider a Medicare Supplement if it is in your best interest financially. If you are limited to MA/MAPD plans, you must ensure ALL of your specialist are "In Network" to ensure you have the lowest possible co-pays in your plan. Some plans will not cover non-emergency out of network plans, so verify this with your plan Summary of Benefits, do take the insurance agents word of mouth or advice, check the booklet and carrier website to verify network availability of your specialists.

Answer: The AEP period runs from Oct 15 to Dec 7. Medicare books will be sent out before then and the Medicare.Gov website will be updated on 10/01/25 with the new 2026 plan offerings. You can discuss Medicare supplements year around, but Part C and Part D are limited to AEP unless you qualify for a Special Enrollment Period. It doesn't hurt to get an appointment booked now for a date on or after 10/15 with a local agent to ensure you don't fall through thr cracks during the busy fall AEP/Holiday period.

Answer: Under most normal circumstances, she cannot enroll into a Medicare Advantage Plan during this month, unless she is eligible for a Medicare Special Enrollment Period. The Oct 15 - Dec 7 Annual Enrollment Period is typically when most Medicare beneficiaries are able to look at Part C and Part D plans. During that period, Medicare.Gov is a great place to look based on her zip code to find which plans are available in her area and which ones will cover her medications.

She may be entitled to Part B or Part D financial assistance through a variety of Federal, State, and local programs. Some Part D and Part C plans may offer no-cost mail-order prescription home delivery programs based on the medications someone is taking. After a plan is found which will cover all medications, then you can go to that insurance carriers website to verify medical and possibly dental coverage within the plan's network. It is vital to look up every single medication and health care provider to ensure availability and coverage. Last, the biggest difference between the supplement and the Medicare Advantage will be the costs of copays and an annual maximum out of pocket. Some seniors with complicated health conditions, sometimes opt to keep their supplement. While others change and are pleased with their plan. There is no cookie-cutter answer to this question and requires a thorough review of all her needs.

Answer: Many seniors prefer to meet with a local agent, face-to-face to review and medical and prescriptions necessities that require coverage. Be sure to ask a lot of questions and take time to review your Medicare and You Handbook, which is sent out through the mail after you enroll into Medicare Parts A & B. One of the biggest needs, and misunderstandings, which is explained in your Medicare book, is that Long Term Care is NOT covered by Medicare Supplemental or Advantage. A separate policy is required to cover this expensive care requirement.

Answer: This causes a lot of confusion. Medicare and Medicare Advantage Plans generally do not cover any Long Term Care. As written in the 2025 Medicare and You Handbook. Only Skilled Nursing/Skilled Care, post acute hospital care is covered up to 20 days. From Day 21 to 100, the patient will most likely have a co-pay. Beyond Day 100, the patient pays 100%. For example, my mother had a stroke years ago and spent over 60 days in the hospital. Medicare and her Medicare Supplement covered 100 days of skilled care in a nursing home. After Day 100, she was deemed "Long Term" by Medicare and 100% private pay. Her Long Term Care Nursing Home policy covered her care from the time forward.

Answer: Medicare Part B provides 100% for preventive testing such as colon cancer screenings, bone density scans, mammograms, etc.

Answer: Check with .your insurance carrier to update your new address. Some companies base your insurance premiums on your zip code or address.

Answer: This is a case by case basis. Sometimes Original Medicare and supplement coverage, along with Part D could be less costly than group insurance. I have had clients who were involuntary removed from group insurance when they became eligible for Medicare A & B. Please check with your Human Resources to verify coverage options.

Answer: Medicare Advantage plans are thought of as "Medicare replacement plans". Medicare pays and defers your care to your carrier to "manage your care". Some Advantage plans offer out of network care, sometimes with a higher copay. Call your insurance company to inquire about out of network care. They will tell you not to show your Medicare card, only your MA/MAPD card.

Answer: Please call your insurance company to find covered therapists in your area. They will tell you of any required co-pays.

Answer: I advise you seek face to face assistance to ensure all medications and Healthcare providers are reviewed for coverage options. Some clients of mine found out they were eligible for State or Federal assistance with prescription and/or medical care cost sharing. Other clients of mine found out the desired a Medicare Supplement based on their needs. There shouldn't be a cookie cutter answer from agents/brokers. A thorough review in is Your Best Interest.

Answer: This is the very common question and a very confusing issue for retirees. Unfortunately, most retirees do not meet with an insurance agent face to face to discuss their lifestyle when they sign up for a plan. Some Medicare advantage plans, such as some HMO plans, do not allow out-of-network coverage unless it's a Bona Fide, emergency, so unfortunately, some seniors will run into challenges when they travel out of state or out of their network. During the fall enrollment period you may be eligible to qualify for a Medicare supplement based on health screening. And if that's not an option for you, you should be able to change over to another advantage plan that covers out of network care, even with a higher copay.

Answer: There is no cookie cutter answer for this question so it's one of the most confusing, and requires the most amount of interviewing and planning to give someone the most concise answer. For example, I have met with people who were turning 65 that wanted a Medicare supplement. But after meeting with them, we found out that they were eligible for federal and state assistance that would not require them to pay for a Medicare supplement. So they were very relieved to know that they did not have to take out a Medicare, supplement and They were also not going to be required to pay the $185 monthly Medicare, part B premium. Make sure you are meeting with a unbiased Insurance agent face to face l. This can help alleviate a lot of concerns and making sure you're getting the most concise planning for your healthcare as you age.

Answer: The 2025 medicare and you handbook discusses the complications, including outpatient observation status versus an inpatient admission.When considering medicare, covering the cost of part A skilled nursing and a skilled nursing facility. If a person has a medicare advantage plan, they may have to pay a copay for up 100 hundred days in a skilled nursing facility, depending on there are particular guidelines in the medicare advantage plan. If they own a medicare supplement and they meet all the requirements for coverage in a skilled nursing facility under medicare part A, they will be covered for a maximum of 100 days of skilled nursing with no cost on their part.

Answer: Absolutely recommend it. The Department of Health and Human Services (HHS) states that over 70% of all Americans 65 and older will require some type of assisted care, such as long term care do to strokes, dementia, Parkinson's Disease, MS, etc. Also recommended retirees get a long term care policy to cover the expensive costs of long-term care.

Answer: I am so sorry to hear about your situation. Unfortunately, the Joe Namath and countless other Medicare Advantage commercials, brokers, and call centers usually neglect explaining a Medicare beneficiaries ONE TIME "Initial Enrollment Period" when they Turn 65 or drop a Medicare Advantage Plan with 12 months of enrollment back to Original Medicare to get a Medicare Supplement with No Health Questions.

This is explicitly explained in your 2025 Medicare And You Handbook, but again, most brokers and call centers neglect walking someone through their Medicare And You Handbook when they Turn 65, or enroll into Medicare at an older age when leaving Group Health Insurance.

You may be eligible for a very limited Special Enrollment Period in your area. Call 1 (800).Medicare and give them your zip code and plan details to see if you meet one of those very limited periods, such as moving to a different area, natural disaster, Medicare plan termination, etc. For example, if you move from State to State or from one area of your state to another where your current MAPD is not available, you are eligible for a short period of time for a MediGap Plan.

Answer: According to the 2025 Medicare And You Handbook, Long Term Care is not covered by Medicare, Medicare Supplement, or Medicare Advantage Plans. Long term care consist on non-medical Custodial Care performed in your Home, Adult Day Care Centers, Assisted Living, and Nursing Homes. The Medicare Book shows two general or common Nursing Home payment options: Medicaid Eligibility and Private Long Term Care Insurance.

Medicare Part A will pay for up to 20 days of Skilled Nursing with a partial co-pay for up to 100 days. This does not include Custodial Care.