Christopher Boyd, Medicare Insurance Agent

Answer: There are many: in/out of network costs, inpatient admissions costs, chemotherapy, skilled nursing costs and network restrictions, possible travel/network restrictions, just to name a few. Each plan has a lengthy summary of benefits which is required to list required co-pays/cost of care within the parameters of the plan.

Answer: Hospital Indemnity plans are not always available for all applicants due to health qualification questions. They are also not necessary if a person has both Medicaid and Medicare Advantage assuming they are seeing providers which accept both plans. But yes, if you have a hospital indemnity plan and are hospitalized, the plan should provide coverage per hospital stay. Each policy will have guidelines and limitations on how it pays per hospital stay.

Answer: Best to call 1 (800) Medicare to get clarification when you are getting conflicting information. There are rules and restrictions with HSA.

Answer: Here is the current Medicare guidance for standard lenses for Cataract Surgery. Always feel free to call 1 (800) Medicare with specific questions or procedures prior to surgery.

Cataract surgery

Medicare Part B (Medical Insurance) may cover cataract surgery that implants conventional intraocular lenses, depending on where you live.

Covered by Part B

Cataract surgery removes a cloudy natural lens from your eye and, in most cases, replaces it with a clear artificial lens.

Coverage details

Medicare doesn’t usually cover eyeglasses or contact lenses. However, Medicare Part B (Medical Insurance) covers one pair of eyeglasses with standard frames (or one set of contact lenses) after each cataract surgery that implants an intraocular lens.

Costs

For covered cataract surgery in a hospital outpatient setting or ambulatory surgical center: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount to both the facility and the doctor who performs your surgery.

For covered cataract surgery you get in a doctor’s office: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for both the intraocular lens and the surgery to implant it.

Answer: Here are the current 2026 Medicare guidelines:

Medicare Part B (Medical Insurance)

Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Covers counseling to help you stop smoking or using tobacco

Up to 8 sessions every 12 months

You pay nothing if your provider accepts assignment

Also:

Description

Lung cancer screenings check for early signs of lung cancer in adults who are at risk of getting the disease.

Who's eligible

Part B covers lung cancer screenings with low dose computed tomography (also known as "CT scans") if you meet all these conditions:

You’re between 50-77.

You don’t have signs or symptoms of lung cancer (you're asymptomatic).

You’re either a current smoker or you quit smoking within the last 15 years.

You have a tobacco smoking history of at least 20 “pack years” (an average of one pack (20 cigarettes) per day for 20 years).

You get an order from your health care provider.

Answer: If you are receiving Social Security monthly benefits, Social Security will automatically enroll you into Medicare Parts A & B and send your Medicare Card to your address on file. However, if you are employed or covered by group insurance from your spouse who is still employed, you may not be required to enroll into Parts A & B. Please ask the HR department to verify your coverage at age 65 and beyond.

If you are deferring your Social Security at or after your 65th birthday, you must enroll into Parts A and B within 90 days of your 65th birthday. You will be required to pay the monthly Medicare Part B Premium, currently $202.90 for most retirees. You can enroll at the SSA.GOV website or go to your local Social Security office.

Answer: According to the 2026 Medicare and You Handbook, there are only a few, very limited circumstance which will allow a person to enroll into a Medicare Advantage Plan and return to Original Medicare and obtain a Medicare Supplement with no health underwriting (answer health questions, height/weight, pharmacy check, etc) within a 12-month period. The only other guaranteed enrollment without medical underwriting is if the Medicare Advantage Plan was involuntarily terminated from the person. Meaning the plan was cancelled by the company. The person receives a letter from the company which states the plan is ended and they are then allowed to select a Medicare Supplement for a limited time with no health questions.

In most cases not listed above, if a person has an Advantage Plan and experiences poor health and desires to get a Medicare Supplement, they may not be able to obtain the Supplement at that time, or most likely, not in the future.

However, if a person is Dual Eligible (eligible for both Medicare and Medicaid) and maintain their Medicaid eligibility, they may keep their Advantage Plan because if they follow the plan guidelines, their medical care costs should be covered by Medicaid and their Advantage Plan.

Answer: The most recommended and concise Long Term Care planning, is to follow Medicare's advise (found in your 2026 Medicare and You Handbook). Get a Long Term Care insurance policy that includes facility care (skilled, intermediate, assisted living, and nursing home), Home Health Care, Adult Day Care, & Hospice. These policies can be Tax-Qualified which is what we offer at Bankers Life and Casualty Insurance Company. Feed free to reach out for assistance.

This insurance allowed my mother to get around the clock care in a wonderful nursing home after a catastrophic stroke. Although I had over three decades of nursing and healthcare experience, her needs could not fully be met at home by me and my family.

Answer: Yes, most certainly out of guaranteed enrollment limitations. When Turning 65 and leaving Part C (under time frame limitations), Health questions and height and weight will be asked outside of the above limited circumstances.

Answer: Each year, Medicare Part D and Part C, commonly changes formulary, pharmacy network, and annual deductible.

Answer: While Medicare allows for certain Special Enrollment Periods, contact your CO Department of Insurance as states vary on some criteria which may or may not impact your situation. You can also call 1 (800) Medicare 24 hours a day to speak to them and get specific information as well at the federal level.

Answer: Some people are eligible for some form of State(Medicaid or Medicare Savings Program) or Federal government assistance such as VA or Tricare For Life. These individuals do not require a Medicare Supplement and are eligible to sign up for a Medicare Advantage plan in their local area, these plans offer benefits in addition to Tricare or the VA.

Other Medicare enrollees with a low limited income who are above State Assistance program levels, are often able to receive local or regional Hospital Financial Assistance. These folks also do not require a Medicare Supplement and may benefit from additional benefits of a Medicare Advantage plan in their local area.

Other retirees will desire to pay for a Medicare Supplement plan to cover medical costs above a small annual deductible and possible office visit or ER co-pays (Plan N) or no office/ER co-pays (Plan G).

The financial situation is unique for each enrollee and their are NO canned answers for all enrollees as some folks need a Medicare Supplement while others can benefit from a Medicare Advantage Plan without the risk of high out of pocket annual copays.

Answer: Yes, I understand your question. I have been helping seniors for 14 years with retirement planning and investments, and Medicare is not easily understood. Ensure you have your employer sign proper Medicare paperwork to ensure you do not pay a Late Enrollment Penalty for Parts B and D.

Answer: An insurance agent or financial advisor will require a Durable or General Power of Attorney (depending on your state) before they can discuss options for your parents. If they don't require to see this in writing, go somewhere else immediately.

Answer: Apply to your state for Medicaid assistance with the Medicare Savings Program. Some Medicare Advantage plans provide a Part B Giveback to cover a portion of the Part B premium for those folks who are not eligible for State Assistance.

Answer: If you have a Medicare Advantage plan, you must ensure each year that 1: your providers are in network, 2) prescriptions are covered by the plan, and 3) review mental health co-pays and limitations.

If you have Original Medicare with a supplement, not much other than ensure providers accept Medicare Assignment to limit any out of pocket co-pays. And check the Part D plan each year to ensure the medications are covered.

Answer: Medicare Part B has a very concise list of Preventive Services such as annual mammogram, cervical pap smear, and every other year bone density scan, etc. These are listed on the Medicare.gov website

Answer: Medicare Advantage commissions are set by Medicare each year. Medicare Supplement companies set their commission rates for agents. As a Fudiciary Advisor, I sign my clients up for the plan which best meets their needs.

Answer: Biggest mistake is to Not take a Long Term Care policy. Long term care will be required for over 70% of all retirees as they age. These costs are NOT covered by Medicare and many folks end up on Medicaid.

Answer: First and foremost, ask your Healthcare provider if a generic option is available. If not, Medicare offers the Prescription Payment program, where the beneficiary can spread the costs of their brand name prescriptions over a 12 month payment plan.

Answer: Although many advertisements reference Medicare Advantage plans, most of my clients 65 and over sign up for a Medicare Supplement.

Answer: The Summary of Benefits and Evidence of Coverage, which is mailed to the enrollee reviews all coverages. From Jan 1 to March 31, you can make one plan to plan change if a different plan better meets your needs.

Answer: Currently, Part A covers inpatient hospice at 100%.Part B covers in home Hospice equipment and nurse visits.

Answer: Medicare Part D covers this medication. Many Part D plans have a $615 brand name drug deductible. After this cost, the patient has a copay and the 2026 maximum medications costs is $2100, after this cost is met, covered medications have zero co-pays.

Answer: 1. Meet with a certified Elder Law Attorney in your local area to ensure all legal POA's, will/trust, etc, and other paperwork is updated.

2. While it takes time, call 1(800) Medicare, they are open 24/7 to inquire about his coverage. Ensure his coverage is paid up to date.

3. Call the insurance companies, after providing them with the General/Durable POA, and get up to date evidence of coverage, costs, premiums, etc. Does he have Long Term Care Insurance? Does he have VA or TriCare For Life benefits?

4. Make an appointment with his family doctor and neurologist to update his diagnosis's and medication.

5. Get other siblings involved (if applicable)

6. Go to your local State, city, or county Council on Aging for resources.

7. Contact your local Alzheimer's Chapter for support

Answer: Yes, contact your insurance company and change your address if you have a Medicare Supplement. For Part C (Medicare Advantage) and Part D (Medicare Drug Coverage) notify the company and you will have a new Special Enrollment Period in your new address. I you have an Advantage Plan, your involuntary plan termination will allow you to sign up for a Medicare Supplement under a Guaranteed Issue status.

Answer: No, unfortunately, nor is there an SEP for when doctors or hospital decide to leave a network in a Medicare Advantage plan (HMO or PPO).

Answer: With original medicare, you are free to go to any hospital or doctor in America that accepts Medicare. If you have a part d prescription drug plan and walmart or sam's club or CVS (etc) pharmacy are your preferred pharmacy, you can use any of those same pharmacies anywhere in the country.

Answer: Original Medicare will cover telehealth visits. Medicare Advantage plans may not cover telehealth visits for out-of-network providers.

Answer: If you have a medicare supplement, medicare part d will cover your diabetes drugs, and you will not have to deal with the network restrictions of a medicare advantage plan. Additionally, if you've had a medicare vantage plan for more than one year, you may not be able to get back to a medicare supplement with pre-existing conditions under most circumstances. If you are eligible for the extra help savings program through the Social Security Administration, or medicaid, or pharmaceutical assistance through your state. You may be able to get assistance that way.

Answer: No, Generally standard Annual Enrollment Period rule restrictions prevent switching mid year. However, if you have a supplement and switch to MAPD, you have a one time, limited, 12 month trial period to switch back to the supplement with no health questions.

Answer: Helping them and their children prepare for retirement, long term care, and estate planning. Most folks do not consider long term care and estate planning when they retire and don't want to think about it.

Answer: Yes, if you stop paying your Medicare Part B. And providers or hospitals can drop Medicare Advantage plans at any time.

Answer: Will all of my doctors, pharmacies, and hospitals accept the plan I am signing up for. If so, what are the co-pays?.

Answer: Check with your employer HR department to see if they will cover you and, if applicable, your partner or spouse when you/they turn 65. If so, you will not need Medicare until you lose credible health/drug coverage.

Answer: Except for a few limited circumstances, if someone has pre-existing medical conditions, they may not be able to leave the MAPD and get a new Medicare supplement. This can become very expensive over time when sick patients max out their Maximum Out Of Pocket. The last possible inconvenience is network restrictions on some plans.

Answer: Update your plan every year as networks, formularies, prescriptions, pharmacies, hospitals, and providers will drop or add Advantage plans.

Answer: Yes, be a skeptical and ensure you review Medicare.Gov with the agent. Medicare.Gov will show all medical providers, prescriptions, network costs, and pharmacies. NEVER sign up for a plan until you review Medicare.Gov. While Medicare Supplements cover most Medicare approved care, they require medical approval outside of a limited enrollment period. Therefore, some brokers will simply switch folks from one Advantage Plan to another.

Answer: If your medication is covered by your prescription plan, the maximum out of pocket in 2026 is $2100.

Answer: No, While Medicare Advantages plans are managed by private insurance companies, they are required to cover basic Medicare approved care (per networks and co-pay restrictions). They are approved by Medicare, but payments and co-pays may differ from one plan to another.

Answer: Most over the counter, vitamins, and herbs are not currently covered by Medicare Parts B and D, in most cases.

Answer: If Medicare Part B covers your outpatient treatments, a traditional supplement will cover the remaining 20% after the annual Part B Deductible.

Answer: Telemedicine is covered per Medicare deductibles and co-pays. However, Medicare Advantage plans may or maynot cover any medical providers, always verify all providers are in the plan networks as applicable.

Answer: Here are a few issues to be discussed:

1. If an agent is recommending an Advantage Plan or Prescription drug plan, are they showing YOU the non-biased recommendations from Medicare.gov?

2. If they are recommending Medicare Advantage, are they verifying all your doctors, networks, and prescription drug formulary verification?

3. If they are recommending Medicare Advantage, are they fully reviewing the entire Summary of Benefits, co-pays, and Maximum Out of Pocket, both in and out of network with YOU, before you sign up for the plan?

4. If they are recommending Medicare Supplements, are they showing you Plan G, Plan G High Deductible, and Plan N, as a minimum to ensure you can find a supplement that meets your needs?

5. If they recommend a supplement, are they giving you the option to pay annually (to save you 3% to 7% per year) over monthly bank drafts?

Answer: An insurance agent can help. But the most effective way is to start with the provider and see which plans they accept. And then look for those plans in your local area.

Answer: Retirees are bombarded with Call Center Sales agents everyday. Even if they signed up for a plan on or after Oct 15, they could unintentionally sign up for a new plan (change plans) and be unaware of the change. Check in with your parents periodically throughout the AEP Oct 15 - Dec 7th to ensure they receive any "new enrollment forms" or paperwork. Make one more check with them to ensure they didn't change any plans on Dec 7th.

Lastly, help them to set up a spam call blocker on their phones and tell them to ignore any phone numbers they do not know. If their doctor or other official call comes in, a voicemail will be left for them to return.

Answer: Most likely, you will come out ahead compared to paying Medicare Advantage co-pays. Additionally, you will not have to negotiate Networks on an Advantage Plans when you have Original Medicare.

Answer: Yes, always must pay the deductible on post 2020 Medicare Supplements (not enrolled in Plan F or Plan C). However, you must verify the therapy practice accepts Medicare Assignment.

Answer: After you pay the Annual Part B (Outpatient) deductible, you will pay 20% of the Medicare Approved amount. Medicare will pay the first 80% in this case.

Answer: MEDICARE. GOV is the best unbiased resource. If you have Part C or Part D, the insurance company is required to mail your new evidence of coverage with listed monthly premiums, co-pays, deductibles etc. ALWAYS verify via Medicare for the drug coverage and preferred pharmacy or mail order to ensure your lowest drug costs. I have already saved a few clients over $1000 for 2026 by making plan changes via Medicare guidance.

Answer: 2926, the Donut Hole has been abolished, new guidelines limit Part D co-pays to $2100 if your drugs are in the plans formulary and your pharmacy preference are in the plan network.

Answer: First and foremost, are they showing you Medicare.gov and letting that be the unbiased source of their recommendations? If not, leave immediately.

Answer: 1. Not getting Long Term Care Insurance.

2. Not getting Part D Drug coverage (unless exempt from Part D by current Medicare rules). Most folks are not eligible for the exemptions.

3. Not meeting with an agent every fall to review your plan(s).

Answer: Medicare and Medicare Supplements will pay for all traditional outpatient medical treatments as long as the provider accepts Medicare Assignment. The patients responsibility is the Annual Part B Deductible before Medicare will cover the remaining charges for Plan G.

Answer: Absolutely. Plans can change co-pays, max out of pocket costs, network providers and pharmacies. Check your plan every year and make changes accordingly.

Answer: When you move, your current plan may not be offered in the new zip code/service area. If this is the case, your plan will send you a mandatory disenrollment letter. In most states, that letter explains your ability to switch to a Medicare Supplement with a Guaranteed Issue requirement. As long as the rural area providers except Medicare you will have no trouble if you chose the Medicare Supplement. You will need to get a Part D plan and ensure it covers all of your medications and network pharmacies.

If you chose to sign up for a new Medicare Advantage plan, you will need to ensure the local and/or regional Healthcare providers and pharmacies are in the new plan's network. Also ensure all of your medications are covered by the new plan.

Answer: There are no "Medicare Agents". I am a insurance agent and financial advisor. I enjoy teaching my clients about the various benefits and charges of Medicare Supplements and Medicare Advantage plan.

I have had various members of my family who had strokes and dementia that required Long Term Care. Thankfully when my mother had a massive stroke and required Long Term Care, she had previously purchased a Long Term Care insurance policy from me which allowed me to place her in a top notch nursing home for her specialized long term care. I had family members who went to the nursing home and lost everything they owned and ended up on Medicaid. This is the most satisfying part of my job, is protecting my clients and their families from the burden of Long Term Care.

Answer: Commercials, letters, or postcards that mention $0 co-pays and grocery cards are the most common misleading type of advertising. They are usually limited to Dual Eligible Medicare and Medicaid enrollees. A traditional Medicare Advantage Plan with no associated government or other financial assistance, will have co-pays for most chronic illnesses, hospital stays, specialized care, chemotherapy, etc.

When I sign someone up for a plan, we review every page of the summary of benefits which outlines ALL mandatory co-pays and network related restrictions.

Answer: Contact Social Security, either in your local area or by calling the 1800 number, and make an appointment to enroll in Medicare or enroll via your SSA.Gov account. Social Security personnel will assist you, and Medicare is available 24/7 to answer your questions over the phone (1800) MEDICARE or on Medicare.Gov.

Answer: Not all clients sign up for Medicare Advantage plans and have difficulties. For example, Dual Eligible (Medicare & Medicaid) beneficiaries are able to gain additional benefits from the correct Medicare Advantage Plans. Other groups such as military retirees, like myself with Tricare, can gain additional benefits from a Medicare Advantage plan as long as they follow all of the guidelines of both Tricare For Life and the Advantage Plans. Additionally, some Veterans who chose the VA exclusively for their healthcare, may gain additional benefits from an Advantage plan, again, as long as they follow all plan guidelines.

However, for those beneficiaries (the majority) who do not have some form of government assistance (medical or financial), Advantage Plans can create large out of pocket costs for those members who become ill and require more than average medical care. Those who leave Original Medicare often switch to Medicare Advantage for the lower premiums and additional benefits such as gym memberships, dental coverage, over-the-counter benefits, etc. A diligent insurance agent will provide a thorough review (summary of benefits) of all Advantage Plan network(s) and copays, if the client decides to switch to the Advantage Plan, they can do so with the full knowledge of the plan limitations and potential out of pocket costs.

For the many clients of mine or those I have been referred to, whom chose Medicare Advantage and later regretted it due to paying much larger out of pocket costs than their supplement, did so because they were lied to by the broker. Most of these were via a telephone call, a few were face to face. The biggest lie was "no payments, no copays", which is not true for folks who have large medical costs with no form of government or hospital financial assistance.

Answer: Unfortunately, many seniors assume Medicare will cover long term care and custodial care, which is not the case. Medicare and Medicare Advantage Plans provide limited post-hospital skilled care in a skilled nursing facility. The Medical Advantage Plan may have an additional network restrictions for the facility and a daily co-pay for the patient up to a limit of 100 days, per the plan guidelines. Medicare recommends a stand alone long term care policy in the 2025 Medicare and You Handbook. Very few insurance companies offer long term care insurance, so applying is best done while you are in good health. I am grateful the company I work offers long term care insurance, as my mother required the use of long term care after a debilitating stroke required specialized long term care. That policy provided for her special care needs.

Answer: Medicare will not cover the concierge or convenience fee charged by the providers office. Medicare will cover all wellness and preventative care items outlined in 2025 Medicare and You Handbook. After the Annual Part B Deductible Medicare will cover 80% of the Medicare Approved charges for medical treatments. The remaining 20% will be billed to an applicable Medicare Supplement with any applicable co-pays.

Answer: There are several cost share differences between the Medical Supplement and the Medicare Advantage Plan. Under the Part B, you most likely have a $257 Part B Deductible in 2025 and then outpatient copays go to the supplement 100%, whereas the Medicare Advantage Plan may have a 20% co-pay for Chemotherapy and set co-pays for outpatient procedures, MRI scans, etc.

Under the Part A Deductible, your Supplement most likely covers these charges 100%:

-The Medicare Part A inpatient hospital deductible is $1,676 for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.

-skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $209.50 in 2025.

The Medicare Advantage Plan shares these costs with the patient, the daily hospital inpatient stay co-pay varies by Advantage Plan as does the Skilled Nursing daily co-pay.

Unfortunately, many people signup for Medicare Advantage and were not aware of their plan $ copays and network requirements and possible preauthorizations.

Answer: This is the biggest difference of opinion among retirees. If a retiree is on Medicare AND eligible for Federal, State or Local government financial assistance programs or hospital charity programs, Medicare Advantage plans are available with very limited or no out of pocket co-pays. I have helped many of my clients qualify for some form of financial assistance, so they will not need a Medicare Supplement and can use a Medicare Advantage plan and enjoy the over the counter benefits.

A non-assistance based Medicare Advantage Plan can create very large expenses if a person has multiple hospital admissions, chemotherapy, chronic health conditions, etc along with some possible network restrictions. If a retirree has no health problems, then they will not spend much or no money for basic annual wellness visits or check ups. It all depends on their health.

In most circumstances, if a retiree has an Advantage Plan and is ill, they will most likely NOT be able to switch to a Medicare Supplement due to pre-existing health conditions. I have healthy clients in their 70's and 80's who love their Advantage Plans. While others who are sick and can't get a Medicare Supplement and regret their plans.

Some retirees prefer to be safe and pay for a Medicare Supplement to allow for stress free Healthcare as they age. This will cost over $100 a month with most insurance companies. But allows Healthcare with no network restrictions or hospital co-pays at most hospitals in the USA.

Answer: This is a common question. Under the age of 65, you may be enrolled in a Medicare Advantage Plan or your State Medicaid Program. Some states allow Medicare beneficiaries under 65 to sign up for a Medicare Supplement, while many states do not allow this. When you turn 65, if you are still entitled to your State Medicaid Program, that plan will continue to cover your expenses. If you were never eligible, or will no longer be eligible for Medicaid when you turn 65, you will be eligible to join a Medicare Part D Drug Plan and a Medicare Supplement and leave the Medicare Advantage Plan. Many disabled Medicare beneficiaries chose to get a Medicare Supplement for much lower out-of-pocket costs and the removal of network restrictions for healthcare providers and hospitals.

Answer: What is easiest and most convenient today, most likely will not be in the future. I highly recommend you find a local agent you and your children can meet with every year as you age through retirement.

Medicare sometimes makes big changes as do Part D Drug plans and/or Medicare Advantage Plams: such as networks, formularies, cost sharing, deductibles, etc. I have met many clients who made the mistake of getting insurance over the phone (Medicare Advantage, Medicare Supplement, Life insurance, etc) and later learned they did not have what they were told they were buying over the phone.

Good, old-fashioned face-to-face, is the best way to negotiate your retirement planning. Do not think your children are too busy to sit with you and the agent, make time for everyone. That may mean an evening or Saturday appointment with your insurance agent and children.

Unfortunately, when a senior falls sick with strokes, hip fractures, heart attacks, etc, their children are forced to get involved and often have NO idea which plan their parents have and which doctors or hospitals are in the network. This also frequently happens while traveling out of state, again, networks can become problematic in these instances.

Answer: The Medicare Annual Enrollment period runs from Oct 15 to Dec 7th. If you are leaving a Medicare Supplement, make sure the agent you are working with explains your one-time, 12 month MAPD Trial Disenrollment rights.

Answer: Absolutely, I recommend it. Children can become beleaguered when negotiating their parents Medicare Advantage plan network when their parent suddenly falls sick and requires specialized care or treatments or when looking for a specific physician or hospital. Also they can become exasperated when helping their sick parent pay their Maximum Out Of Pocket when covering large expenses such as chemotherapy or complications requiring on going care. This is often further complicated when the parent and adult children live in different states.

Answer: Your Medicare Supplement should contain the following disclosure: Guaranteed Renewable For Life. This means the insurance company cannot place any restrictions on your policy or refuse to renew it. This is not common to property or casualty insurance such as car or home owners insurance. Those type of policies may have the right to drop you.

Answer: There is no such thing as the "best" MAPD in any zip code. Many factors such as hospital and provider networks and prescription drug coverage must be taken into account. Additionally in and out of network maximum out of pocket (MOOP) varies significantly among plans: HMO's, PFFS's & PPO's. For example, there may be six HMO's available in a zip code and the MOOP can vary by $1000's per year. As well as the requirement for pre-authorizations and referral approvals before care can begin.

Answer: Many retirees wrongly assume Medicare will cover all of their retirement-aged healthcare expenses. Expensive portfolio destroyers such as Long Term Care costs has ZERO Medicare coverage. Unfortunately, Medicaid is the main funding program in the USA for Nursing Home Care. The Medicaid spend-down process can wipe out someone's nest egg.

Additionally, Original Medicare currently does not cover hearing aids, glasses, dentures, and most dental care. Current Medicare enrollees can chose a Medicare Supplement which can cover most or all of their outpatient Medicare Part B expenses after a yearly Part B Deductible is met. Medicare Advantage Plans may offer some limited coverage for dental, vision, and hearing aids, but many carry large annual out of pocket costs some retirees are not willing to risk. While other retirees fully embrace their Advantage Plans and keep their plans for year.

Answer: Unfortunately, this has been a problem. Sometimes the insurance carrier is 100% honest with their provider list during the AEP enrollment period and then providers (hospitals, doctors, dentist, etc) drop the carrier from their accepted plans during the first few months of the year. The insurance carrier is not in control when this happens and tries to mend the relationship with the hospital. In some cases, the carrier and provider fix the issues and everything goes well from then on. In other cases, the enrollee is forced to change plans (i.e., HMO to PPO) or carriers (Aetna to Anthem).

Medicare allows ONE change during the OEP from 01JAN to 31MAR for the individual to change their plan from one plan to another or one carrier to another. When the hospital or provide drops the plan or carrier after 31MAR, in most cases, the enrollee cannot change their plan until AEP. The new plan takes effective on 1JAN of the following year.

Your most comprehensive solution is during the open enrollment, meet with an agent who takes the time to review all of your current and prospective providers (medical and dental). This is a two-step process, look up the carrier website to verify the providers, and then call them to see if they are 1) still accepting that plans and 2) accepting new patients (if applicable).

Answer: Clever but misleading marketing in some instances:

A compliant insurance agent/broker is forbidden from using the words "free" or "this is the best plan for you". If someone is Dual Eligible (Full Dual Eligible Medicaid and Medicare) and they see providers who accept both Medicare and Medicaid, they should have 100% no-copays or financial responsibility for their medical expenses. This does not apply to all medications, there can still be a partial co-pay for name-brand drugs for Dual Eligible Medicare/Medicaid beneficiaries.

Unfortunately, many brokers, especially call centers will not review the Summary of Benefits with the person explaining applicable co-pays (for Non Dual Eligible enrollees) such as emergency room, specialist appointments, inpatient hospital admissions, chemotherapy, durable medical equipment, etc. Many insurance carriers offer some Medicare Advantage Plans with Over The Counter (OTC) benefits and gym memberships at no cost to the enrollee. Some plans also offer partial, limited coverage for glasses and dental as well (as applicable). These benefits are listed in your Summary of Benefits (as applicable).

The bottom line, if someone has no eligibility for any Federal, State, Tribal, local, or hospital financial assistance programs, they should be 100% accountable for any applicable co-pays in their Summary of Benefits or Evidence of Coverage- printed guidelines. These guidelines may change from year to year. Check with your Medicare Advantage Plan Carrier website to review your current Summary of Benefits or Evidence of Coverage to verify your current plan.

Answer: According to the 2025 Medicare And You Handbook, Original Medicare Parts A & B do not currently cover hearing aids, most dental coverage, Long Term Care, annual physical exams and several other issues retirees deal with as they age. If you are a Veteran, you may be eligible for hearing aids at the VA.

Answer: I am Retired Military and have Tri-Care. When I turn 65, I must enroll into Medicare Parts A & B. Medicare will be Primary and TriCare For Life will be secondary. I am also 100% Service-Connected Disabled through the VA. I will also need Medicare Parts A & B for providers and care outside of the VA and VA Network. The VA Network is no different than any other networks (Optum, Humana, Anthem, etc) in that it changes Network Providers from time to time and the patient has no control over the network care restrictions. If a Veteran gets all of their prescriptions from the VA or TriCare For Life, Medicare exempts them from enrolling into Medicare Part D. If a case ever arose requiring the Veteran to enroll in Medicare Part D, they will be required to fill out paperwork from Medicare which will exclude them from paying a Medicare Part D Late Enrollment Penalty.

When a retiree 65 or over leaves their company, the vast majority of the time they will have no employer health coverage exclusive of Medicare Parts A & B. Therefore, the retiree must enroll into Parts A, B, & C (Medicare Advantage with Drug Coverage) or A,B, & D with a Medicare Supplement.

This may sound convoluted and confusing, but is better accomplished when talking to an agent face to face who has a clear understanding of the VA and Tricare systems and their respective relationships to Medicare (based on current guidelines)

Answer: Home health care/ home therapy visits are allowed post operative if ordered by a physician. The Discharge Planner or hospital Social Worker should be familiar with the process. Long term care is NOT covered by Medicare.

Answer: Each insurance carrier sets and controls their respective plans. Refer to your 2025 Evidence of Coverage for the most recent guidelines. If you can't find yours, the carrier should list your plan on their website.

Plan guidelines and co-pays often change from year to year.

Answer: I always recommend a Certified Elder Law Attorney. Most states allow the purchase of a pre-paid Irrevocable Funeral Trust, this will be Medicaid exempt. The Elder Law Attorney knows the options for Medicaid eligibility. If a person has whole life insurance, it is often possible to change the ownership of the policy to a family member before the Medicaid application to allow the family member to control the policy as not to lose the accumulated cash value and use that money for the future funeral. Proceeds from life insurance are generally tax free when going to a family member, but not when going to an estate, in most states. Again, consult the certified Elder Law Attorney.

Answer: Yes, some carriers such as Aetna work at CVS. Several stores accept the cards based on the insurance carrier. About half of my clients prefer to order online, for example, Centerwell mail order with Humana. The online option allows the convenience of seeing the inventory of items, and then take advantage of free shipping.

Answer: If you are receiving SSDI benefits, then Social Security will automatically enroll you into Medicare Parts A and B upon the 25th month of receiving benefits. If you are under 65 at that time, you must ensure you enroll into a Part D drug plan or a Medicare Advantage plan with Presciption coverage (MAPD) to alleviate the Part D Late Enrollment Penalty.

If you are Turning 65 at that same time, you will need the Part D plan with a Medicare Supplement or a Medicare Advantage plan (MAPD). Don't take this decision too lightly as it determines Medicare co-pays coverage as you age. While the Medicare Supplement costs more than the majority of MAPD's, the coverage is more robust and the potential out of pocket costs are considerably lower.

Answer: Medicare sets the Part B Deductible each year. This must be paid out for your covered outpatient medical costs before Medicare sends remaining charges to your supplement.

On Plan N, the premium is lower because the patient eventually gets a bill for 20% of the Medicare Approved amount for Office Visits, with a cap of $20 per visit and an Emergency Room visit capped at $50. These bills can take several weeks or months before they are fully processed and you are sent the final bill.

Plan G does not contain the $20 office visit copay or ER $50 copay. You simply pay out the Part B Deductible for the year, then the supplement covers the remainder of your covered medical expenses. Plan G has a higher premium than Plan N.

For some folks on Plan N, a few visits a year at $20 are less than the premium difference for Plan G.

Answer: This is not a cookie cutter answer. If a person is eligible for Federal or State Government Assistance, they should be able to get Part D with a $0 or reduced monthly premium. Medicare Advantage Plans for Dual Eligible (Medicare & Medicaid) provide additional coverage above that of Original Medicare. If a Veteran uses the VA for prescriptions, Medicare can exempt them from enrolling into Part D. Military Retirees with Tricare For Life already have prescription coverage and are also exempt from Medicare for Part D Coverage.

Medicare Part D or Part C(Medicare Advantage) should be understood as traditionally not overlapping coverage in most areas. Each Part D and C plan will have different deductibles, co-pays, and network requirements.

Answer: If you have been on SSSI for 24 months, Social security will automatically enroll into Medicare Parts A&B on the 1st day of the 25th month. If you are on Medicare A & B and Turning 65, you can enroll into a Medicare Supplement and Part D Plan if you prefer.

Answer: I sit down with then and review their 2025 Medicare and You Handbook. This is the most concise and NON biased resource for retirees. Medicare.gov is best for reviewing Part D drug coverage.

Answer: Call 1 800 Medicare to get the comprehensive answer to this question. Never assume coverage to unusual questions.

Answer: If you are covered by what Medicare considers "Credible Coverage", which generally applies to Group Health insurance, you are ok to enroll into Medicare Parts A,B, & D without a late enrollment penalty if your group insurance meets this requirement. Easiest to ask your HR department to ensure you can remain on Group Insurance until you or your spouse retires or is moved to part time with no Group Coverage.

Answer: In my years of experience three main regrets are common: **Usually, the person was not told these below restrictions will be part of their respective MA/MAPD plan

1) inability to switch back to a Medicare supplement with preexisting conditions (unless a guaranteed issue special enrollment criteria is met)--not a common option for very sick folks. Meaning most sick folks can change from one MAPD to another in the fall AEP, but not back to Original Medicare with a Medicare Supplement in most circumstances (cancer, stroke, COPD, heart attack, nitroglycerin, insulin, dementia, etc).

2) large yearly maximum out of pocket (MOOP) charges: such as 20% co-pays for chemotherapy, DME, etc. Some PPO plans have a smaller in network MOOP (i.e. $4900) and out of network MOOP ($10,000).

3) network restrictions of some HMO plans and large co-pays for out of network PPO plans.

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.

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: 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: The 2025 Medicare and your 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: 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: 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: 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: Please call your insurance company to find covered therapists in your area. They will tell you of any required co-pays.

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

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

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: 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: Under most normal circumstances, she cannot enroll in 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 that will cover all medications, you can go to that insurance carrier's 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 supplements. While others change and are pleased with their plan. There is no cookie-cutter answer to this question, and it requires a thorough review of all her needs.

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 cracks during the busy fall AEP/Holiday period.

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

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

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: 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: 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: 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: 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: 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.