Cynthia Allen, Medicare Insurance Agent

Answer: Yes you will generally need to go through medical underwriting but there are exceptions. Such as the Birthday rule, which only a few states offer, by which you can change your Medicare Supplement Plan each year in the designated timeframe of when your birthday is and another 60 days — depending upon the rules of each state. Best thing to do before making a switch is to talk with an insurance agent so they can cover all your options.

Answer: Insurance companies have scaled back to exit unprofitable markets - so carriers pulled out of certain counties. However, all beneficiary recipients who were affected by this change can get another Medicare Advantage plan or do nothing and be automatically enrolled in Original Medicare Parts A and B. if you choose this route you can secure a Medicare Supplement plan because you will now have “guaranteed issue rights” — meaning you will be eligible regardless of any health condition.

Answer: I will best answer this based upon what information is in the question. If you changed to another medicare advantage plan during AEP and you found out after that you can’t see your specialist—out of network I’m guessing, then you can always change an MA Plan during the Medicare Advantage Open Enrollment period of January 1st - March 31st. But if that timeline has passed then you can see if you qualify for a SEP (Special Enrollment period) so that you can change your plan. This SEP would be based upon that you received inaccurate information. You can call 1-800-Medicare to explain your situation and ask about a SEP.

Answer: It depends on what plan you have. If you have a Medicare Advantage plan then yes you would need to change that because these plans are county / region specific…If you only have Part A/B - Original Medicare you don’t need to do anything and if you have a Medicare Supplement plan you don’t need to do anything either since these are not county specific. If you don’t have a Medicare Advantage plan then you would need to let Medicare know your change of address. A switch from one Medicare Advantage Plan to another would be considered a Special Enrollment period that lasts 60 days from the time the move - event occurred.

Answer: MOOP in Medicare Advantage Plans is designed to let you know exactly how much you might be responsible for so you won’t have unexpected costs. As an agent I always try to obtain a Medicare Advantage Plan that has the least amount for out-of-pocket costs while at the same time comparing the benefits that each plan offers. Everyone likes to make sure they get what they really need, for example, to have their physician they like be a part of the plan’s network, coverage for surgeries, a hospital stay, dental, vision, etc. while at the same time weighing the possible out of pocket costs. It’s an individual decision based upon where your medical needs are at any given time. Remember, you can change your plan each year at Annual Enrollment period to help fit your needs and costs. AEP-October 15th to December 7th. Keep in mind that all your copays, co-insurance and deductibles count towards your MOOP. Although some plans have higher MOOP’s - it can be less costs to someone who goes to a lot of doctors or has a serious health condition, and as opposed to just having Part A and B where a Medicare beneficiary would be responsible for 20% of all costs - thus, the out-of-pocket costs could be significant. The MOOP set in Medicare Advantage plans could be considered a financial safety-net.

Answer: Medicare Part B covers ambulance rides when medically necessary. If you only have Original Medicare Part A&B, then Medicare pays 80% of costs, while you would be responsible for 20% after the annual deductible which is now for 2026 - $283, was $257 in 2025. If you have a Medicare Advantage Plan (Part C) instead of paying the 20% you typically pay a fixed copay - the cost depends upon each plan…In addition, if you have a Medicare Supplement Plan (Medigap) you generally would be responsible for Part B’s deductible, and Medigap would fill the gap of what would be left that Original Medicare did not pay - essentially ensuring significant or full coverage for an ambulance ride.

Answer: Yes, Medicare Part B covers cataract surgery, but if you don’t have a Medicare Supplement Plan or a Medicare Advantage Plan to help with out-of-pocket costs, then you would be responsible for 20% coinsurance after the deductible with having only Original Medicare -Part A and Part B.

Answer: When you turn 65 you will be automatically enrolled into Original Medicare Part A and B- which provides you with health insurance. Your Part A premium is generally free as long as you or your spouse paid Medicare taxes while working. There will be a premium for Part B, and that premium will be based upon your income. You will have the options of getting a Prescription Drug Plan and or a Medicare Supplement plan or a Medicare Advantage plan in addition to Original Medicare Part A/B.. Original Medicare Part A/B will only cover 80% of any medicare costs, so it might be a good choice to have the other 20% covered through additional coverage. It would be best to talk with a Medicare insurance agent to go over your options. Medicare coverage will begin on the 1st day of your birthday month.

Answer: You could look on medicare.gov and put in your zip code and drugs if you have any, and take a look at the information that will populate. MAPD plans are area specific, and the best MAPD plan depends upon your needs and the costs involved. If the information is too confusing, then I would suggest you looking into getting a Medicare insurance agent to help you.

Answer: Yes, an agent does not have to be local, an agent, as long as they have a license in your state, they can do business and assist you with medicare. Many agents have licenses in various states in the US.

Answer: Declaring bankruptcy does not affect your Medicare Benefits, so therefore the scope of your coverage remains the same. Without knowing what Medicare plan you have presently you might want to look at a plan that is going to give you the maximum benefits with the least out-of-pocket costs. Going forward this would be the best thing to do to avoid future medical bills.

You will have to continue paying for Part B, and any other premiums you do have. This will need to be done in order to keep your coverage current and to avoid any penalties.

Answer: A Medicare Advantage 5-Star Special Enrollment period (SEP) is only for changing to a 5 Star rated plan, if it is in your area, between December 8 and November 30. AEP - is for other changes such as enrolling or switching, or dropping a MA or PDP plan, or switching between original medicare (A&B) and a MA plan. This can be done between October 15 through December 7. OEP — is from January 1 to March 31st, where you can revisit your MA Plan and decide whether you want to switch to a different MA Plan or drop your MA Plan and go back to Original Medicare. All 3 periods offer different options.

Answer: If you have any high cost specialty drugs you can: 1. Compare costs with other prescription drug plans, 2. Enroll in the Medicare Prescription Payment plan, which enables you to spread out the costs of your drugs over the year— keep in mind the out-of-pocket costs for all beneficiaries is now $2000, so if your drugs go beyond that you do not pay. 3. Apply for Extra Help if you are low-income, 4. Ask your doctor to see if there is a less expensive generic or brand name drug that you can substitute, 5. Contact the drug manufacturer to see if they offer their own assistance program to help pay, or see if your state may have programs -State Pharmaceutical Assistance Program.

Answer: Well, they could be helpful if they answer any questions you might have and that might help you decide which direction you would like to go — or you also could possibly obtain a contact to call to ask questions to clarify information. These generally are people who are agents who want to educate people about their choices…and hopefully they accomplish that.

Answer: As you might know Original Medicare only pays 80% for any services rendered so you would then be responsible for the remaining 20%, which could be a lot depending upon what you needed to have done medically. Medicare Advantage would certainly help with the additional 20% costs but those plans do have copays, co-insurance and deductibles. They do offer additional benefits like drug coverage, hearing and dental. You can change from Original Medicare to a Medicare Advantage Plan during the Annual Enrollment Period October 15th to December 7th, and the plan will become effective January 1.

Answer: Medicare Part D, which is your drug plan, covers blood thinners, such as: Eliquis (apixaban), Xarelto Warfarin, and Heparin. Whatever drug plan you have you will need to take a look at the formulary or call your plan to get the exact cost.

Some plans may require a copay or deductible for blood thinners.

Certain blood thinners, such as Xarelto, may have manufacturer coupons or patient assistance programs available to help reduce costs.

If you are in the hospital, Medicare Part A may cover some of the cost of blood thinners administered during your stay.

If you need blood thinners for a long-term care facility, you may be eligible for coverage through Medicaid or private insurance.

If you have questions, contact the member services of your plan or if you have an insurance agent call them to see if they can help answer your questions.

Answer: Both the agent and the medicare beneficiary must complete and sign the SOA….the licensed agent is responsible for completing the SOA form and that it is signed properly by both the agent and beneficiary.

Admin staff may assist with completing or submitting the SOA form but they cannot act as the agent or have the client’s permission to discuss products without the agent present.

The agent has the conversation with the beneficiary to determine the SOA details, and ensure that the form is filled out correctly.

Answer: As long as you have Part B preventative services such as mammograms will be covered.

To avoid any unexpected costs you must use a medicare-participating provider who accepts assignment.

Also, there is criteria to meet such as age, frequency and risk-factor. When you meet the criteria for a preventative service you can often receive it at no out-of-pocket cost.

Answer: Medicare Part D (your prescription drug plan) covers most vaccines and immunizations for adults, including shingles, hepatitis A, Tdap.

Part B covers a few specific vaccinations for condition such as the flu, pneumonia, hepatitis B, and COVID-19.

Medicare Advantage and Medicaid also cover vaccines.

There are usually no out-of-pocket costs for vaccines that the ACIP recommends. This includes some travel vaccines.

Answer: Not sure what age you are…..best thing is to type into google - how does going on dialysis affect my medicare coverage….you need to read that and/or go onto medicare.gov it will explain what you need to know.

Answer: Medicare does not pay for groceries. However, there are some Medicare Advantage Plans

That offer a health food benefit or grocery allowance. You have to qualify by being a part of a Medicare Advantage plan that offers this benefit, — example would be a Special Needs Plan which is for individuals with chronic conditions. If you qualify you will receive a pre-paid card with an allowance that ranges from 25 to 200 dollars. The plan does specify where you can buy food and which items you can purchase.

Answer: One of the best ways to figure it out is to have a Medicare Agent help you because they have been trained in the knowledge and will help make it less confusing and help narrow down information for you so that you make a good decision for your Medicare plan. If people try to figure it out on their own I think it would be difficult because you don’t have all the access to plans and the knowledge an agent has acquired.

Also, there is no charge for a Medicare Agents service, if you would like to talk about your options you could call me or any other agent of your choice.

Answer: To avoid any surprise lab bills you need to know what your plan covers which you can get that information through your plan’s Summary of Benefits. If you do not have that you should contact your plan to get a copy of it so you always have it on hand. Also, if after you have gone through the summary of benefits and you are not sure if a test is covered, then contact your plan for verification. In addition, talk to your doctor to make sure the tests being ordered are in-network.

If possible, get a good faith estimate of the costs before the tests are performed.

If you should receive a surprise bill, check for its accuracy, and if the bill seems incorrect or includes an out-of-network charge, you can dispute the bill by calling your plan and filing a grievance…they will explain the process.

There is a “No Surprise Act’ in effect which does provide additional safeguards, particularly for certain out-of-network care in emergency situations and at in-network facilities.

This Act requires providers and facilities to give you certain information about balance billing protection and out-of-network care costs.

Answer: Medicare Part D - which is your prescription drug plan will pay for the shingles shot. However, if you have a Medicare Advantage plan you will need to check with that plan to make sure it is covered. Part D covers all adult vaccines that the Advisory Committee on Immunization Practices recommends.

Answer: Costs in Medicare go up every year so if you have a medicare advantage plan those specialists costs are going to increase also and you will need to pay a co-pay or co-insurance that was more than the year before, it does not matter how much you have paid into medicare — it is the same for everyone. If you were to have a Medicare Supplement plan you would more than likely just need to cover the Part B deductible which is $257.00 for 2025, and then not have to pay anything further once that is met. Keeping in mind that Medicare Supplement plans have a premium every month but no other out of pocket expense except the Part B deductible. You can also look into other Medicare Advantage plans to see if your out of pocket costs could be less.

Please note that if you have had a medicare advantage plan for years and wanted to switch to a medicare supplement you will more than likely have to pass underwriting…therefore insurance companies could deny you or charge a higher premium.

Answer: Of course I do not know who you spoke with, but if you did speak with someone like an agent they should have gone over what the dental plan covered via the Summary of Benefits. As agents we know that all plans are not the same and that we need to review the summary to determine whether you will have comprehensive coverage or only preventative services which only includes cleanings, exams and X-rays. More comprehensive coverage should include fillings, root canals, dentures, etc. All plans vary and with most dental plans you will more than likely have out-of-pocket costs such as a deductible, copays or coinsurance.

If you want more dental coverage you can certainly change your Medicare Advantage plan to something that is more beneficial to you during the Annual Enrollment Period which starts October 15th and runs till December 7, 2025, which is only 3 months away.

Answer: Yes, Medicare generally covers emergency care for individuals traveling in Puerto Rico, as it is considered a U.S. territory. Original Medicare (Part A and Part B) provides coverage for services like hospital care and doctor visits in all 50 states and U.S. territories.

Here's a more detailed explanation:

Original Medicare (Part A and Part B):

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If you have Original Medicare, you are covered for emergency care and other necessary medical services when traveling in Puerto Rico, just as you would be in any other part of the United States.

Medicare Advantage:

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If you have a Medicare Advantage plan, it's crucial to check with your specific plan regarding their coverage for emergency care in Puerto Rico. Some plans may offer additional benefits for emergency and urgent care services during foreign travel, but it's best to verify the details with your plan provider.

Foreign Travel Emergencies:

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While Medicare generally doesn't cover care received outside the U.S. (except in specific, limited circumstances like being closer to a foreign hospital in a medical emergency than the nearest U.S. hospital), Puerto Rico, as a U.S. territory, is an exception.

Medigap:

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Some Medigap plans (like C, D, F, G, M, and N) may offer some coverage for foreign travel emergencies, but they often come with deductibles and co-insurance requirements.

Answer: I would think that because some people feel that they can figure it out for themselves or they just don’t trust the agent has their best interest at hand, they decide to go their own route. As a result, sometimes the plan they have chosen, while not knowing information that primarily agents know, they might experience a plan they thought would be the best for them but turns out not to be….there really aren't any “bad plans” — but agents help with selecting plans that accommodate a person’s needs. That said, I make sure that the client knows all their choices and gear towards the least out of pocket costs but also getting what they need in coverage.

Answer: If you have had creditable medical coverage, i.e. a medical plan from your employer, then you would need a letter from your employer stating that you have had coverage along with the starting date of coverage and when it will end. You will need that to sign up for Medicare Part A and B within 8 months of you leaving your employment to avoid any penalties. You would need to contact Social Security if you plan on taking those benefits, and then you could have the Part B premium taking out of Social Security as an option. It all depends upon when you want to take social security. You can go to medicare.gov to find out information or contact an agent to help explain things further to you which is best since every situation can be different.

Answer: Go onto google and search - does medicare cover home health care after surgery and it will bring up the information that you need,