Cody Biggs, Medicare Insurance Broker

Answer: When you move to a different county, Medicare plan availability can change quite a bit, especially with Medicare Advantage plans. Networks, premiums, and benefits are all based on your new ZIP code, so there may be better options available — or we may need to make a change to keep your coverage aligned.

The good news is your move gives you a Special Enrollment Period, so we can review everything and make adjustments if needed without waiting for the annual enrollment window.

Answer: What usually surprises people is that Original Medicare isn’t designed to cover everything—it’s more of a cost-sharing setup.

Under Part B, you generally pay:

• The annual deductible

• Then 20% coinsurance for specialist visits, tests, and procedures

• And there’s no cap on what you could spend out of pocket

So if your specialist bills $300, you’re on the hook for about $60 every visit—and that adds up quickly.

What most people are “missing” is that Medicare was built to be paired with either:

• A Medigap (supplement) to cover that 20%, or

• A Medicare Advantage plan that replaces the 20% with set copays and includes a max out-of-pocket

If you only have Original Medicare by itself, what you’re experiencing is exactly how it’s structured to work.

Answer: No—Original Medicare does not require referrals to see a specialist. As long as the doctor accepts Medicare, you can go directly without needing approval from a primary care physician.

Many Medicare Advantage plans also don't require referrals, but they do have network restrictions.

Answer: If you missed the Medicare Open Enrollment Period (Oct 15–Dec 7), you typically can’t make changes until the next one—unless you qualify for a Special Enrollment Period (SEP) due to something like moving, losing other coverage, or qualifying for Medicaid. In some states a broker may have access to SEP codes that can be used outside of the above.

If you’re already in a Medicare Advantage plan, there’s also the Medicare Advantage Open Enrollment Period, where you can make a one-time switch to another Advantage plan or go back to Original Medicare (with or without Part D). If none of those apply, you’ll need to stay put for now and plan ahead for the next enrollment window.

Answer: No—you don’t have to change anything. With Original Medicare and a Medigap plan, you can see any provider nationwide that accepts Medicare, so your coverage works the same in Florida as it did in New York.

That said, it’s still worth reviewing your options. Florida may have Medigap plans priced lower than what you’re paying now, but depending on your situation, switching could require underwriting—so you don’t want to move plans without comparing first.

Answer: Yes, you can drop Medicare Part B if you move abroad, since it generally doesn’t cover care outside the U.S. Just be careful—if you come back later and want Part B again, you may have to wait for the General Enrollment Period and could face a lifetime late enrollment penalty.

Answer: The right answer depends on your exact medications, not the plan type.

Both standalone Part D and Medicare Advantage plans can either cover your drugs well or poorly—it varies by plan formulary, dosage, and pharmacy.

For diabetes specifically, some plans cover insulin well but don’t cover newer or brand-name drugs as favorably.

Best approach: work though a broker and run your exact medication list through both options and compare total annual cost (premiums + copays). That’s how you avoid the “horror stories.”

Answer: There’s not a one-size-fits-all answer here—it really depends on how advanced the kidney disease is and what doctors and facilities you need access to. In most cases, you’re looking at either staying on Original Medicare and adding a supplement, or going with a Medicare Advantage plan that’s built to manage more complex conditions.

If you can get a Medicare supplement, that’s usually the strongest overall setup. It gives you the flexibility to see any doctor or specialist in the country that accepts Medicare, which is a big deal if you need a specific nephrologist, dialysis center, or transplant team. It also keeps your out-of-pocket costs predictable, which matters when care is ongoing.

On the other hand, some Medicare Advantage plans—especially the ones designed for chronic conditions like kidney disease—can be a good fit from a cost standpoint. They often have lower premiums and include extra support, but you’ve got to be comfortable working within a network. The key is making sure your doctors, dialysis center, and any potential transplant hospital are all covered.

At the end of the day, it really comes down to your doctors, medications, and how you want to balance cost versus flexibility. That’s where I’d focus before making a decision.

Answer: If you’re on Original Medicare only with no supplement, Part B typically covers ambulance transportation when it’s medically necessary, but you’re responsible for 20% of the Medicare-approved amount after your deductible. In most cases, that can still leave you with a few hundred dollars—or more—out of pocket depending on the distance and level of care provided.

Answer: Yes, potentially. Medicare premiums can count as medical expenses for federal tax purposes, so a retiree may be able to deduct them if they itemize deductions and their total unreimbursed medical expenses exceed 7.5% of adjusted gross income. This can include premiums for Medicare Part B, Part D, Medicare Advantage, and Medigap in the appropriate circumstances. 

There can also be a separate benefit for some self-employed retirees. If you have self-employment income, you may be able to claim the self-employed health insurance deduction for eligible Medicare premiums instead of relying only on Schedule A itemizing rules. 

The main limitation is that not everyone gets a tax break. If you take the standard deduction, or your total medical expenses do not get above the 7.5%-of-AGI threshold, the Medicare premiums may not produce any federal tax benefit.

Answer: Yes—there is a strong case for stricter enforcement and, in some areas, tighter rules. CMS has already strengthened Medicare Advantage marketing rules, including limits on compensation structures that can steer agents toward certain plans and updated marketing requirements for third-party materials, which suggests regulators already saw real problems that needed correction. 

The main reason is that Medicare is complicated, and many beneficiaries are vulnerable to confusing or misleading sales tactics. KFF has documented beneficiary concerns about aggressive marketing and the difficulty people have understanding their options, especially during enrollment season. 

That said, the goal should not be to shut down legitimate education or ethical sales conversations. The better approach is stricter oversight of misleading ads, stronger disclosure requirements, clearer distinctions between educational events and sales events, and tougher penalties for brokers or organizations that misrepresent benefits, provider access, or plan costs.

Answer: Some are helpful, but a lot of them are really lead-generation events dressed up as education. The useful ones focus on explaining Medicare basics, enrollment timelines, penalties, Medigap vs. Medicare Advantage, Part D, and how to compare options; the less useful ones spend most of the time steering people toward one plan, one carrier, or setting a one-on-one appointment. A good rule is this: if the event feels balanced and educational, it may be worth attending, but if it relies on pressure, fear, “limited-time” language, or pushes you to enroll before you’ve had time to compare your choices, treat it like a sales pitch.

Answer: It depends. Medicare Advantage plans can save some seniors money, but not automatically and not in every case. They often look cheaper up front because many plans have low or $0 premiums, include drug coverage, add extras like dental/vision/hearing, and have a built-in annual out-of-pocket maximum for Part A and Part B services.

Answer: Medicare generally does not cover treatment in a foreign hospital, but there are a few exceptions. It may pay if you have a medical emergency in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat you, if you’re traveling through Canada between Alaska and another state without unreasonable delay and the Canadian hospital is closer, or if you live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital able to treat your condition. Even then, Medicare only pays for Medicare-covered services, not routine care received outside the U.S.

Answer: A PPO gives you permission, not price protection, to go out of network. When you do, the insurer only pays a “reasonable” amount, and the provider can bill you the rest—so costs can explode fast. The real value of a PPO is access to specific doctors, travel flexibility, or second opinions, not routine care outside the network. If you use out-of-network providers often, a PPO usually ends up being an expensive illusion of flexibility.

Answer: I recommend you to contact me so I can simplify things, explain your options, and help you create a burn pile for all the advertisements.

Answer: Yes—and unfortunately, that experience is very common.

Medicare’s 1-800 number is a general call center. The representatives are following scripts, and when your question gets even slightly nuanced, you end up being transferred from department to department. That’s not a reflection on you—it’s just how the system is built.

The most reliable way to get clear, consistent answers is to work with a licensed Medicare broker who deals with these rules every day. My role is to cut through the runaround, explain how Medicare actually applies to your situation, and make sure nothing gets missed or misunderstood—without you spending hours on the phone.

Answer: Medicare covers cataract surgery — but only the “standard” part of it.

That includes:

• the surgeon

• the facility

• removal of the cloudy lens

• and one basic monofocal intraocular lens (IOL)

That standard lens usually corrects vision at one distance only (typically far), which means most people still need glasses afterward.

What Medicare does not cover are the premium lens upgrades, such as:

• multifocal lenses

• toric lenses for astigmatism

• lenses designed to reduce the need for glasses at multiple distances

Those upgrades are considered elective, not medically necessary — so the patient pays the difference out of pocket.

So your friend didn’t get “denied” surgery.

She got the surgery covered, but chose a lens above and beyond what Medicare pays for.

I always explain it this way to clients:

Medicare restores basic vision — anything beyond that is a personal upgrade.

Answer: Yes — but only in a very specific situation, and this is where people get tripped up.

Original Medicare (Part B) only covers acupuncture for chronic low back pain, and it has to meet all of these criteria:

• The pain has lasted 12 weeks or longer

• It’s not associated with surgery, pregnancy, infection, or cancer

• The acupuncture is provided by a qualified practitioner (MD, DO, NP, PA, or an auxiliary provider under their supervision)

If you qualify, Medicare will cover:

• Up to 12 sessions in 90 days

• An additional 8 sessions if you’re improving - 20 visits max per year

What Medicare does not cover:

• Acupuncture for neck pain, migraines, arthritis, sciatica, or general pain

• “Wellness” or maintenance acupuncture

• Most stand-alone acupuncture clinics unless they meet Medicare’s provider rules

Also important: Medicare Advantage plans may offer broader acupuncture benefits, sometimes covering more conditions or visits than Original Medicare.

Bottom line:

If this is chronic low back pain, there’s a good chance some of it is covered. If it’s for anything else, you should assume Medicare won’t pay unless you’re on a Medicare Advantage plan with extra benefits.

Answer: Hands down, the most frustrating misconception I have to clear up every single year is this:

“If I do nothing, my Medicare plan just stays the same.”

Technically, yes—you’ll stay enrolled. But the plan itself almost never stays the same.

Every year carriers can (and do) change:

• premiums

• deductibles

• copays and coinsurance

• drug formularies

• provider networks

So people assume they’re “all set,” then January hits and suddenly their doctor is out of network, their prescription moved tiers, or their out-of-pocket costs jumped.

I tell clients this all the time: Medicare doesn’t require you to review your plan annually—but your wallet absolutely should. Even a 10-minute review during Annual Enrollment can save a lot of money and frustration later.

Answer: Short answer: sometimes — but don’t count on it.

In general, Medicare does not cover routine medical care on a cruise ship because you’re outside the United States. There are a few narrow exceptions — for example, if the ship is within six hours of a U.S. port and the care is medically necessary — but those situations are pretty limited.

That’s why I always recommend travel medical coverage (or a Medicare Supplement that includes foreign travel emergency benefits) if you’re cruising. Medical care at sea can be extremely expensive, and evacuation alone can run into the tens of thousands of dollars.

Bottom line: assume Medicare won’t cover you on a cruise, and plan accordingly. If you want, I’m happy to help make sure you’re properly protected before you sail 🚢

Answer: What I enjoy most is the relief people feel once everything finally makes sense.

Medicare can feel overwhelming—too many letters, too many ads, too many opinions—and a lot of people come to me worried they’re about to make a costly mistake. I really enjoy slowing it all down, explaining things in plain English, and helping them realize, “Okay… I’ve got this.”

I also love the relationships. Medicare clients tend to be loyal, appreciative, and genuinely grateful when you look out for them year after year—not just during enrollment season. There’s something very satisfying about being the person they trust to call when a bill doesn’t look right, a prescription changes, or they just want reassurance they’re still on the right plan.

And honestly, I enjoy being able to say, “You’re already on the best plan—don’t change a thing.” That kind of honesty builds real trust, and that’s what makes this work meaningful to me.

Answer: A Medicare agent is usually appointed with one insurance company (or sometimes just a couple).

• They can only show you plans from the carrier(s) they represent

• If that company doesn’t have the best option for you, they still can’t show you others

• This isn’t necessarily bad—it just means the view is limited

Think of it like walking into a Ford dealership. You might get a great truck… but you’re only seeing Fords.

A Medicare broker is appointed with multiple insurance companies.

• They can compare plans across many carriers

• They’re not tied to pushing one specific product

• They can help you switch plans in future years if something better comes along

• The cost to you is the same as going directly to a carrier

Think of this as an independent car shopper who can show you Ford, Chevy, Toyota, Lexus—whatever actually fits your needs.

You don’t pay more to work with a broker.

Medicare plans pay the same commission whether you enroll:

• online

• through the carrier

• through an agent

• or through a broker

So the real question is:

Do you want one option—or a comparison?

My Philosophy

I believe people deserve:

• honest comparisons

• plain-language explanations

• and someone who will tell them “you’re already on the best plan” when that’s the truth

That’s why I operate as a broker.

If you ever want a second opinion—or just want to sanity-check what you already have—I’m always happy to do that. No pressure, no cost, and no sales games.

Answer: Original Medicare (Parts A & B) does not include routine dental or vision. So if you want coverage for things like cleanings, fillings, crowns, eye exams, glasses, or contacts, you have three main options:

Option 1: Medicare Advantage (Part C)

Many Medicare Advantage plans bundle dental and vision right into the plan at no additional cost beyond your monthly premium (sometimes $0).

• Dental often includes cleanings, X-rays, and an annual allowance for major work

• Vision usually includes routine eye exams and an allowance for glasses or contacts

• Coverage amounts and networks vary a lot by plan and location

This is the most common route for people who want everything packaged together.

Option 2: Stand-Alone Dental & Vision Plans

If you’re happy with your current Medicare setup (like Original Medicare + a Supplement), you can add separate dental and vision policies.

• Typically no networks as restrictive as Advantage plans

• Often better for people who know they’ll need more extensive dental work

• Premiums are separate, but coverage can be more predictable

Answer: Yes—something did change, and it’s catching a lot of people off guard.

Starting in 2025, Medicare Part D was redesigned. While this overhaul added some big wins (like a $2,000 annual cap on out-of-pocket drug costs), it also changed how deductibles, copays, and coverage phases work. As a result, many people are seeing higher costs on generic medications, especially early in the year or when they hit a new phase of the plan.

A few common reasons this happens:

• The drug may have moved to a different tier, even though it’s still generic

• Your plan’s pharmacy pricing or copay structure changed

• You entered a new coverage phase where cost-sharing looks different

The key thing to know is this isn’t a mistake—and it’s not just you. The Part D rules and plan designs shifted, and some plans passed more cost upfront instead of spreading it out.

Answer: The short answer is: it’s allowed because of loopholes, gray areas, and poor enforcement — not because it’s ethical. Some marketers technically follow the letter of the law while completely violating the spirit of it. They’ll advertise “free groceries,” “food cards,” or “Medicare benefits you’re missing,” then bury the fine print that says you have to qualify for a very specific plan in a very specific area. The goal isn’t education — it’s to get you on the phone so they can flip you into a plan.

What really bothers me is that they often blur the line between Medicare and private insurance, use scare tactics, or imply they’re connected to Medicare itself — which they are not. And once your number is in one system, it gets sold and resold, which is why the calls never stop.

This is exactly why I tell people: Medicare doesn’t call you, and legitimate agents don’t lead with giveaways. If groceries, cash cards, or “extra benefits” are the hook, that’s a red flag. Real Medicare planning starts with your doctors, your prescriptions, and your costs — not gimmicks.

If anyone ever wants a second opinion, I’m always happy to take a look and tell them straight up whether something is real, exaggerated, or just marketing fluff. No pressure, no scare tactics, and no free-grocery bait.

Answer: Medicare can reduce certain financial risks, especially medical bills, but it doesn’t replace life insurance. It doesn’t pay off a mortgage, replace income for a spouse, cover final expenses, or leave anything behind for family. So if your life insurance was mainly there to protect against catastrophic medical costs, then yes, the need may be lower once Medicare kicks in.

That said, I often see the opposite. For many people, Medicare actually highlights gaps — like funeral costs, income protection for a younger spouse, or legacy planning — where life insurance still plays an important role. And if someone is using life insurance for tax-advantaged savings, estate planning, or as a financial safety net, Medicare doesn’t change that at all.

Bottom line: Medicare covers healthcare — life insurance covers the people you love.

Answer: Absolutely—yes. Your ANOC (Annual Notice of Change) tells you exactly what’s changing with your Medicare plan for next year, and reviewing it with your Medicare agent helps make sure higher premiums, drug changes, or provider network changes don’t catch you by surprise. Even if you’re happy with your plan, a quick review can confirm you’re still in the best option or uncover a better one for your needs.

Answer: If you’re turning 65 next month, the first step is to confirm whether you should enroll in Medicare Part A and Part B right away or if you can delay Part B because you’re still covered under an employer plan. From there, we look at whether a Medicare Supplement with a Part D plan or a Medicare Advantage plan makes the most sense for you, and we time everything so your coverage starts seamlessly with no gaps or penalties.

Answer: The biggest disadvantage of Medicare Advantage is loss of control. You’re in a managed-care system with networks, just like your pre-Medicare coverage has.

Answer: Yes — the $2,000 cap on out-of-pocket prescription drug costs is real, and it started in 2025 for people with Medicare Part D drug coverage (whether through a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage). Once you hit that $2,000 threshold in a year, you pay $0 for covered Part D drugs for the rest of the calendar year. 

It increases slightly in 2026: The cap moves to $2,100 in 2026 to account for inflation. 

Answer: I hear that a lot—and I usually say this: Medicare Advantage isn’t really free; it just has a different cost structure. You’re trading a low or $0 premium for copays, networks, and a higher risk of large out-of-pocket costs if you get seriously sick in limited situations, whereas a Medigap plan is about predictability, freedom to see any doctor that takes Medicare, and peace of mind. Neither is “right” for everyone—but paying for Medigap is a deliberate choice to control risk, not a crazy one.

Answer: The best time to start looking at Medicare options is a few months before you turn 65 or before your current coverage ends, so you’re not rushed into a decision. For most people already on Medicare, the fall Annual Enrollment Period (October 15–December 7) is the key window to review and make changes for the next year.

Answer: Yes, Medicare Advantage plans can work in rural areas, but it really depends on the specific plan’s provider network. Some plans have limited doctors and hospitals outside metro areas, so it’s important to confirm your local providers are in-network before enrolling.

Answer: Yes, UnitedHealthcare Medicare Advantage plans do cover occupational therapy as long as it’s medically necessary and ordered by your doctor. Most plans charge a simple copay per visit, and OT is treated just like any other covered outpatient therapy.

Answer: It depends on whether your current doctors are in the network for the Medicare Advantage plan you’re considering. Unlike Original Medicare plus a supplement, Medicare Advantage plans use managed-care networks—so some doctors will be in-network, some out-of-network, and some not accept the plan at all.

If your doctors are in-network, you can keep seeing them with standard copays. But if they’re not, you may pay much more or may not be able to see them under the plan. The safest move is to check each doctor before you enroll so you know exactly what your access will look like.

Answer: Medicare won’t cover you for care you receive while living abroad, even if you’re a U.S. citizen or permanent resident. The program is designed to work only inside the United States (and a few very limited situations near the border or on a cruise ship).

Most people in your situation either keep Medicare active for when they visit the U.S. or in case they eventually move back, or they rely on local health coverage in the country where they actually reside.

Answer: Yes—if you want to keep your Medicare Part B active, you still have to pay the monthly premium even when you’re living abroad and not using the coverage. Medicare generally doesn’t pay for care received outside the U.S., but dropping Part B to save money can backfire because you’ll face a permanent late-enrollment penalty and limited enrollment windows if you ever move back and want it again.

Most people who spend part of the year overseas keep their Medicare in place as “insurance for the future,” since re-establishing it later can be costly and difficult.

Answer: If you’re already receiving disability benefits, the Medicare enrollment process is much simpler because most of it happens automatically. After you’ve received disability benefits for 24 months, Medicare enrolls you in Part A and Part B without you needing to apply, and your card arrives in the mail about three months before your coverage starts.

From there, your only real decisions involve whether to keep Part B, whether to add a Part D drug plan, and whether you want a Medigap or Medicare Advantage plan to round out your coverage. So instead of “signing up” from scratch, you’re mainly choosing how to structure your benefits once Medicare becomes active.

Answer: To minimize costs when you take a mix of generics and specialty drugs, the key is to compare Part D plans based on your exact medication list, not just premiums. Start by running your drugs through a plan finder so you can see each plan’s total annual cost, including deductibles, copays, and the plan’s handling of specialty tiers.

Pay special attention to formulary placement, prior authorization rules, and whether your specialty medications fall into a tier with percentage-based coinsurance—those differences can create thousands of dollars of variation between plans. Also look at each plan’s preferred pharmacy network, since using the right pharmacy can dramatically lower your out-of-pocket costs. In short, the best plan isn’t the cheapest monthly premium—it’s the one that prices your prescriptions most efficiently across the entire year.

Answer: Some clients ignore good advice because Medicare feels overwhelming, and when people are stressed, they often default to whatever seems quickest or most familiar—even if it’s not in their best interest. Others get swayed by flashy advertisements, misleading offers, or friends’ experiences that don’t actually apply to their own situation.

There’s also a natural resistance to change; if someone has been on a plan for years, switching can feel risky, even when the facts clearly show it would help them. And sometimes people misunderstand the details and think all Medicare plans are basically the same, so they underestimate the consequences of a poor choice.

Answer: If Medicare approves and covers the bloodwork under Part B—which most routine lab tests do—then your Medigap Plan C will pick up the remaining costs that Medicare doesn’t cover. Plan C is one of the more generous supplements, and it pays the Part B coinsurance and even the Part B deductible, so you typically shouldn’t see a bill for approved lab work. The only time you’d need to budget extra is if the test wasn’t Medicare-approved or was done outside of Medicare’s rules.

Answer: Not necessarily. Medicare is excellent coverage, but it doesn’t work exactly like an employer plan. Your employer plan may bundle medical, drug coverage, dental, vision, and sometimes even extras under one umbrella, while Medicare separates these into different parts and may require you to add a supplement or Medicare Advantage plan to match what you currently have. Many people find Medicare to be more cost-effective overall, but it usually isn’t a one-to-one replacement for every benefit offered by an employer plan.

Answer: No—there is no late-enrollment penalty for Medicare Part A or Part B until the person actually becomes eligible to enroll.

A 65-year-old green card holder who has not yet met the five-year U.S. residency requirement is not eligible for Medicare, so the clock for penalties hasn’t started.

Once they reach five years of continuous lawful residency, they can enroll during their Initial Enrollment Period, and as long as they sign up at that time, there is no penalty for not having had other insurance before then.

Answer: Working with a Medicare agent makes the whole process easier because you don’t have to guess your way through dozens of plans, changing rules, or confusing enrollment periods. A good agent listens to your situation, compares every option available to you, and helps you avoid costly mistakes—ensuring you end up on the plan that actually fits your doctors, prescriptions, and budget.