Daniel Neale, Medicare Insurance Agent

Answer: Medicare does face long-term financial challenges, but it is not expected to simply “run out” and disappear. Even if the Medicare Hospital Insurance Trust Fund faces funding shortfalls in the future, Medicare would still continue operating, although Congress may make changes over time involving funding, taxes, benefits, or costs to help keep the program sustainable.

Answer: If you have coverage through your spouse’s active employer group health plan, you can usually delay Medicare Part A and/or Part B without penalty if the employer has 20 or more employees. However, many people still enroll in premium-free Part A at 65 because there is typically no monthly cost. One important exception is if you contribute to an HSA — enrolling in any part of Medicare, including Part A, can affect HSA contribution eligibility, and Part A coverage may be retroactive up to 6 months when you enroll later.

Answer: Medicare agents can sell a standalone Part D prescription drug plan during a beneficiary’s valid Medicare enrollment period, such as their Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), or a qualifying Special Enrollment Period (SEP). During the Medicare Advantage Open Enrollment Period (OEP), a beneficiary enrolled in a Medicare Advantage plan can also return to Original Medicare and enroll in a standalone Part D plan.

Answer: Most handheld inhalers that you use at home are typically covered under Medicare Part D or a Medicare Advantage drug plan. Medicare Part B generally covers nebulizers and certain medications used with a nebulizer when they are medically necessary for home use.

Answer: Yes — if you move out of your Medicare Advantage plan’s service area, federal Medicare rules may give you a guaranteed issue right to purchase certain Medigap plans without health questions after returning to Original Medicare. However, the timing rules are very important, and protections can vary somewhat by state, so it’s important to review your options before making any coverage changes.

Answer: You can change your Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (OEP), which runs from January 1 through March 31 each year. During this time, if you already have a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare, with your new coverage typically starting the first day of the following month.

Answer: Social Determinants of Health — things like income, housing, food access, transportation, and social support — can have a major impact on overall health outcomes and access to care. Many Medicare plans now offer benefits and programs designed to help address these challenges, which can improve member health, satisfaction, and overall plan quality.

Answer: At ages 90 and 91, it may make sense to consider moving to a Medicare Advantage Prescription Drug (MAPD) plan if their Medicare Supplement premiums have become unaffordable. Unlike Original Medicare alone, MAPD plans include an annual out-of-pocket maximum, which can help provide more predictable healthcare costs and limit financial exposure from the 20% coinsurance under Part B.

Answer: Yes. Medicare may cover shoulder replacement surgery when it is medically necessary, but how it’s covered depends on the type of Medicare coverage you have.

Medicare Part A helps cover inpatient hospital care if you are formally admitted to the hospital for the surgery. This can include your hospital stay, meals, nursing care, and some rehabilitation services after surgery.

Medicare Part B helps cover outpatient medical services, including doctor visits, imaging, the surgeon’s fees, outpatient surgery centers, durable medical equipment like slings or walkers, and physical therapy. Part B typically covers 80% of approved costs after your deductible, leaving you responsible for the remaining 20% unless you have supplemental coverage.

Medicare Part C (Medicare Advantage) combines Part A and Part B coverage through a private insurance company. These plans must cover everything Original Medicare covers, but costs, prior authorization requirements, hospital networks, copays, and rehabilitation coverage can vary by plan, so it’s important to review your specific benefits carefully.

Answer: A Medicare insurer’s Medical Loss Ratio (MLR) can give you insight into how much of their money is being spent on member healthcare and benefits rather than administrative costs. While a higher MLR may suggest the company is investing more into care and member support, an MLR that is consistently too high could also be a sign the company is under financial pressure, so it’s important to look at overall financial strength and long-term stability as well.

Answer: A good way to look at it is this — you’re not just choosing a plan for this year, you’re choosing a company you may be dealing with for years to come. It’s worth looking at how long the company has been in the Medicare market, their financial strength, customer reviews, provider network stability, and whether they tend to make major benefit changes every year or stay fairly consistent. A strong, established company with a solid reputation for customer service and stability can often make your experience much smoother long-term.

Answer: Yes — beyond just costs and benefits, it’s a good idea to look at the insurance company behind the plan too. Things like customer service, how they handle claims, member satisfaction, financial stability, and their overall reputation can make a big difference in your experience after you enroll.

Answer: Working with a licensed Medicare agent can help make Medicare easier to understand and less overwhelming. An independent agent can compare plans, check your doctors and prescriptions, and help you find coverage that fits your needs — all at no additional cost to you.