David Quintal, Medicare Insurance Broker

Answer: Medicare plans are available based upon zip code but there are many types of plans available. Basically, there are three type of products that people can enroll in addition to Original Medicare. The three type of plans that are available are Medicare Supplement plans (also referred to as Medigap plans), Prescription Drug Plans, and Medicare Advantage Prescription Drug plans. Medicare Supplement plans do carry a premium whereas some Medicare Advantage Prescription Drug Plans may not carry a premium. Most likely, you are enrolled in a Medicare Supplement and your friend is enrolled in a Medicare Advantage Prescription Drug plan. It is, however, quite possible to be enrolled in a Medicare Advantage Prescription Drug plan that does carry a high premium. In order to best understand what coverage you have always reach out to a local broker for a quick review. Lastly, it is also possible to be enrolled in a zero premium Prescription Drug plan or a plan with a very high premium. Always check your cards and always reach out to a local broker for assistance.

Answer: In 2025, Medicare Part D has several changes. The changes include a $2,000 annual out-of-pocket limit for prescription drug costs, the elimination of the coverage gap (aka "donut hole) and new options for spreading drug costs throughout the year.

Answer: No, a green card holder would need 5 years residency in the USA to be eligible for Medicare.

This rule applies even if an individual is turning 65.

Answer: Star ratings are used by the Centers for Medicare and Medicaid (CMS) to evaluate Medicare Advantage plans (part C) and Prescription Drug plans (part D). Star ratings range from one star to five stars. Star ratings assist individuals by allowing them to compare plans and choose the best one for their needs. The higher the star rating, in most cases, indicates better performance and may include additional benefits or programs.

Answer: Based on the 2025 changes, once an individual hits the out-of-pocket max they pay nothing for the rest of the calendar year. The out-of-pocket max is $2000 for 2025. Once you hit $2000 you enter the "catastrophic phase" and pay nothing more than $2000 for covered medications.

Answer: Whether an individual chooses a Part D plan or a MAPD, in each case a thorough review of the relative costs associated with each option should be done prior to enrolling into a plan. Sitting with a local and knowledgeable broker is one way to ensure that when a decision has to be made the Medicare beneficiary is aware of the plans premiums, deductibles, copays and formularies. All of these can impact prescription costs.

Answer: Generally speaking, yes Medicare covers all medically necessary blood tests ordered by your healthcare providers.

Covering these blood test allows your healthcare professional to track your health and even screen for disease prevention.

Medicare Advantage plans (Part C) may cover more blood tests than original Medicare (Part a and Part B). Under original Medicare, there is no separate fee for blood tests.

Answer: Simply put, Medicare does not cover costs related to long-term custodial care or assisted living facility. There are options that one can do to prepare for these costs. Options like Medicaid, long term care insurance, or private funding are ways to cover these potential costs. Always speak to a local Medicare broker to assist you with these options.

Answer: Yes, an annual wellness visit is covered by Medicare. This would include a PPO Medicare Advantage plan.

Answer: A large portion of the American population lives well beyond retirement age. As a result, the total cost of providing healthcare will also grow. Based on information provided by Center for Medicare Services (CMS), growth in Medicare spending will average nearly 8% per year until 2030. The result of these factors may lead to an 11% shortfall in payments for medical services by 2036.

Answer: The MRI must be deemed medically necessary by either Medicare or your supplemental plan. You may be responsible for 20% of the original amount, as well as any applicable deductibles, until your deductible is met. Currently, the part B deductible for a Plan N is $257.00

Answer: Yes, you can use a Health Savings Account (HSA) to pay for Medicare premiums and other qualified medical expenses after you retire and enroll in Medicare. However, you can no longer contribute to the HSA once you enroll in Medicare.

Answer: Yes, Medicare will cover the shingles vaccine through Medicare Part D which is prescription drug coverage. This would be in a stand alone prescription Drug Plan (PDP) or in Part C which is a Medicare Advantage Prescription Drug Plan (MAPD). If the shingles vaccine is considered medically necessary, Part D covers the vaccine and Medicare beneficiaries usually pay nothing out of pocket. The same applies with MAPD plans. The Shingrix vaccine is usually given in two doses and is covered under Part D.

Answer: Typically, if someone is trying to scam an individual they lie and say that they are representing Medicare and begin to ask for personal information. This would include asking for a Medicare number, social security number or other sensitive information.

Answer: Turning 65 means that you are eligible to enroll into Medicare. It is generally understood to be your Initial Enrollment Period (IEP). IEP is the 7 month period around your 65th birthday. This period includes the 3 month period before, the month of, and the 3 month period after your 65th birthday. You can sign up for Medicare during this time, and it is generally recommended to do so to avoid late enrollment penalties and potential gaps in coverage. Consult with a local broker to assist you with this process. Another good resource is ssa.gov