David Silver, Medicare Insurance Broker

Answer: Today's question is, can my Medigap insurer terminate my policy? The only way your Medigap insurer could terminate your policy is for nonpayment or if they go out of business. That's the only way these policies could be canceled if the company is in business and your premiums are paid in full and are up to date. These policies are not cancelable.

Answer: Today's question is, I'm worried about the donut hole in my Part D plan. How do I manage my medication costs once I enter it? The good news is the donut hole has been eliminated for 2025. You do not have to worry about the donut hole any longer. Just make sure that your medicines are on your plan's formulary and your costs will be capped at $2,000.

Answer: Today's question is, "My pharmacist mentioned the Medicare donut hole is going away in 2025. What does this actually mean for me?" What this means is in 2025, what you pay and what your drug plan contributes, once that number reaches $2,000, you will have no more cost for prescription medication for the rest of the year as long as your medicines are covered under your drug plan. If you compare this to 2024, let's say you're taking a lot of name brand expensive medicines. In 2024, you might have spent $7,000 or $8,000 of your own money. In 2025, that number will be capped at up to $2,000. After $2,000, you will have no more cost the rest of the year. If you have any other questions about your drug coverage or drug coverage costs, feel free to reach out to me. Look forward to hearing from you.

Answer: Today's question is, is Medicare Part A enough for hospital coverage? Under Medicare Part A, you are going to be responsible for a deductible of $1,632 if you are hospitalized, and this covers you from days 1 through 60. After day 60, then you will be responsible for coinsurance. So these are facts and figures that you need to keep in mind and plan accordingly with whatever type of coverage you want to go with in addition to straight Medicare.

Answer: Today's question is, should I keep original Medicare or go with a Part C Medicare Advantage plan? Which is better? There's no real way to answer that question. These are two distinctly different types of coverage. If you go with straight Medicare, you'll never have to worry about network. You can see any doctor in the country that accepts Medicare, and you'll never have to worry about referrals or, for that matter, prior authorizations, which are not very common either. But you will pay a monthly premium whether you get sick or not.

For folks that go with Medicare Advantage, these are people who do not want to pay a monthly premium. These are people looking to get extra benefits that Medicare does not provide, like prescription drug coverage, dental, vision, hearing, and over-the-counter medicine. But with Medicare Advantage plans, there are networks; these are network-driven health plans, meaning some doctors take them and some doctors don't. Prior authorizations are required for most services. So it's a bit more restrictive, but both of these plans can work quite well. It depends on what your needs are.

So if you're looking to distinguish what's going to be a better option for you, feel free to reach out to us, and we'll be more than happy to help you out, steer you through, and make sure you make the right decision for yourself.

Answer: Today's question is, "I've got a Medicare Advantage plan and I'm curious if my upcoming eye surgery is fully covered or if there's extra out of pocket." If you need eye surgery under Medicare Advantage, you can simply look in your summary of benefits and see what your copay is under outpatient surgery. Whatever that number is, that's what you will be responsible for. Thank you, and I look forward to more of your questions.

Answer: So the question is, I'm worried about choosing the wrong plan and being stuck with it. How often can I change my Medicare coverage? Well, very simply, if you have a Medicare supplement or Medigap coverage, they both be the same thing. You could change those plans 12 months a year. So if you think you are overpaying and you want to change to a less expensive plan but the same plan letter, the coverage will be the same. If you do it any month of the year, you are never locked in. If you want to change your Medicare Advantage plan, your Advantage plans are subject to enrollment periods. Typically, most people change their drug plans between October 15th and December 7th. That is the annual election period. You could also make a plan change from January 1st to March 31st, which is called the open enrollment period. And then if you are eligible for any special elections throughout the year, let's say you move to a new area, then you are entitled to a special election. By all means, you can change your plan as well. If you have questions about a plan change, I look forward to hearing from you and answering more of your Medicare-related questions.

Answer: The question is, are Medicare plans and requirements different for every state? Medicare plans, basically from a functionality standpoint, pretty much all work the same way. In Florida, most of the Medicare Advantage plans have zero premium. It's that way throughout the country as well, although some other states have more plans that do have premiums.

One thing that is important to know about a Medicare Advantage plan is you have to live in the service area. So if you move from a state and you move to Florida, for example, you are gonna have to change your Advantage plan because you have to live in the service area. If you are moving to Florida or you are moving out of Florida and you need some insight on what to do, feel free to reach out to me. You could set up an appointment with me and we could talk through it. I have done this thousands of times for clients throughout my 20-year career. I look forward to hearing from you, and I will speak to you soon. Hope to answer some more Medicare questions.

Answer: So the question is, I've been diagnosed with pre-diabetes. What preventative services does Medicare cover to help prevent progression to type 2 diabetes? Here’s the information I found, and I hope you find it useful.

Diabetes screening is covered under Medicare Part B. Eligibility includes having risk factors such as high blood pressure, obesity, or a history of high blood sugar. The frequency is up to two screenings per year, depending on your risk level, and the cost is free. That covers diabetes screening.

Then there’s the Medicare Diabetes Prevention Program. This is a structured program for a proven lifestyle change to help prevent type 2 diabetes. It includes 12 months of group sessions focusing on weight loss, healthy eating, and physical activity, along with ongoing maintenance sessions for eligible participants.

Eligibility includes being diagnosed with pre-diabetes, having a BMI of 25 or higher (23 or higher for Asian individuals), never having had type 1 or type 2 diabetes before, and never having participated in the Medicare Diabetes Prevention Program before. The cost is free for eligible beneficiaries.

There’s also something called Medical Nutrition Therapy (MNT), which is covered under Medicare Part B. Eligibility includes being diagnosed with diabetes or kidney disease, or having had a kidney transplant in the last 36 months. If you progress from diabetes to diabetes, services include nutrition assessment, diet counseling, and follow-up visits with a registered dietitian. The cost is free if the provider accepts Medicare assignments.

Obesity screening and behavioral counseling are also covered under Medicare Part B. Eligibility requires a BMI of 30 or higher. Services include one face-to-face visit every week for the first month, every other week for months two through six, and monthly sessions for months seven through twelve if you meet weight loss goals. The cost is free.

I hope you found this information useful. If you have any other questions about pre-diabetes or any other Medicare coverage options, feel free to reach out. I look forward to hearing from you.

Answer: The question is, I tried calling Medicare and got transferred five times. Is there any way to get straight answers from them? When you call Medicare, it is a mammoth organization. The wait times take forever, and a lot of times, you speak to some people over the phone and may not get the answer you’re looking for. Either they don't understand your question or they don't know the answer.

The best advice I could give you is to work with a Medicare agent who has these answers. He or she could save you an absolute ton of time by you picking up the phone, calling them, and having them answer your questions. For example, when my clients call me, if I can’t answer the question, I let them know that they’re gonna have to call Medicare. However, that’s a very, very rare event. In most cases, I can answer their questions. But when you call these big mammoth organizations, Medicare, Social Security, even large private companies, you get the runaround. Everybody does it; everybody shares the same experience. So if you could avoid it, you want to avoid it.

Answer: The question is, what does Medicare Part B cover and is it enough? Well, typically, Medicare Part B is going to cover your medical or doctor visits. Under Medicare Part B, medical expenses are covered at 80%, and that 20% piece is picked up either by your Medicare supplement, your retirement group health insurance benefits, or if you have TRICARE secondary, that would absorb the 20%.

What I'm going to do is read to you what exactly Medicare Part B covers because I don't have it all committed to memory. So here it goes. Obviously, No. 1, Medicare Part B covers doctor visits, outpatient care, lab testing and imaging, durable medical equipment, mental health services, preventive services, emergency and urgent care, home health, and medication that is prescribed or administered by a doctor at a facility or at a doctor's office. These are medicines that are not purchased at a retail pharmacy. Generally, that is covered under Medicare Part B, not D, as in David.

Here's what's not covered under Medicare Part B: your prescription drugs, routine dental, vision and hearing services, long-term care or custodial care, and most cosmetic procedures or alternative therapies. Hopefully, this answers your question. I do believe that Medicare Part B does cover a substantial amount of services, so I think you'll be very well taken care of in this department.

Answer: The question is, "My husband passed away and now my Medicare premiums went up. Why does losing someone raise your costs?" Well, the only reason your Part B premium would increase is if there was an increase in income. Maybe you're now collecting survivor's benefits from Social Security, which increased your income and put you over the Medicare threshold. Or, upon your spouse's passing, maybe there was some sort of income left to you that caused your income to rise. When Social Security does their look-back, they see that your income went up, and that's why your Part B would be more. That’s the only thing I can think of. You may want to consult with a tax advisor as well. But if it has to do with an increase in income, that's the only reason your Part B would increase. If you have any other questions, feel free to reach out to me, Dave Silver from Dave Silver Insurance. I look forward to hearing from you and talking to you soon.

Answer: One of the most common misconceptions that people have about Medicare is that everybody is concerned about late enrollment penalties. If you're worried about late enrollment penalties, please call me and we can talk it through. Most of the time, late enrollment penalties do not apply, so just give me a call. But everybody's always concerned about penalties. If you have a question, give me a call about those late enrollment penalties, and 95% of the time I will put those fears to rest.

Answer: The worst Medicare decision somebody can make is selecting a Medicare Advantage plan just based on the extra benefits it provides, instead of looking at whether all your doctors are in-network and all your medicines are covered affordably. You should also consider whether you want to deal with referrals or not. These are the things that a lot of people don't look at when they really should. The extra benefits are really just gravy, but the biggest mistake I see with people selecting Medicare Advantage plans is that they are just chasing those extra benefits, which is a really bad idea.

When it comes to Medicare supplement coverage, the worst mistake people can make is overpaying for their Medicare supplements. Your Medicare supplements here in Florida are standardized coverages based on the Medicare supplement plan letter. If you don't believe what I just said, you can look at the Medicare and You book, which is put out by the Department of Health and Human Services, and it simply states the same thing.

For example, if you want to go with a Plan G in Florida, every company that offers a Plan G in Florida provides the same exact coverage. The only difference is the monthly premium. So why would you want to overspend when you're really not getting anything in return? I would say that 90% of the people who call me and already have coverage in place are either with a Medicare Advantage plan that they could do better with or have a Medicare supplement and could save money by switching to another plan without giving up any benefits at all.

The last part is the drug coverage. This year, 14 out of the drug plans are non-commissionable, one is almost close to being non-commissionable, and that's a problem because a lot of times agents are only focusing on putting people in plans that they get commissions on. The folks here at Dave Silver Insurance will put you in the plan that is the most affordable for you when you factor in the premium plus the cost of medicine. So if it's not commissionable to us, we're still going to let you know which plan to sign up with, and you can just do that on your own.

Answer: Why Seniors Delay Enrollment:

1. Lack of Awareness or Understanding

Many seniors aren’t fully aware of their Medicare Initial Enrollment Period (IEP), the penalties for late enrollment, or the options they have. They might assume they’ll automatically be enrolled or think they don’t need to worry until a later time.

2. Fear or Overwhelm

The Medicare system can feel overwhelming with its various parts (A, B, C, D, Medigap). The fear of making the wrong choice often leads to procrastination.

3. Health or Work Factors

If seniors are still working or have employer-provided health insurance, they may think they can delay Medicare enrollment without consequences. However, this can be risky if their employer insurance isn’t considered "creditable" (as good as Medicare).

4. Waiting for a "Perfect" Plan

Some seniors wait until they are sure about which plan is best, hoping to get more information or thinking they’ll figure it out later. However, waiting can often result in missed opportunities or more limited choices.

Answer: What I enjoy most about working with Medicare clients is the opportunity to make a real difference in someone’s life at a time when clarity and trust really matter. Medicare can be confusing, and many people feel overwhelmed or worried about making the wrong choice. I get to step in, simplify things, and help people feel confident and secure about their coverage.

I especially value:

Building long-term relationships — not just helping with enrollment, but being there year after year

Hearing stories and learning from clients — many have lived rich, fascinating lives

Knowing I’ve helped someone save money or find a plan that fits their health needs better.

Answer: 1. Colorectal Cancer Screenings

Fecal Occult Blood Test: Once every 12 months (age 50+)

Flexible Sigmoidoscopy: Every 4 years

Colonoscopy:

Every 10 years (or 4 years after a sigmoidoscopy)

Every 2 years if you're at high risk

Stool DNA test (e.g., Cologuard): Every 3 years (age 50–85, average risk)

2. Breast Cancer Screening (Mammogram)

Screening mammogram: Once every 12 months (for women age 40+)

Diagnostic mammogram: Covered as needed, with coinsurance

3. Cervical & Vaginal Cancer Screening

Pap test and pelvic exam: Every 2 years

Every 12 months if high-risk or had an abnormal Pap in the last 3 years

4. Lung Cancer Screening

Low-dose CT scan: Once per year if:

Age 50–77

History of smoking (20 pack-years)

Currently smoke or quit within the past 15 years

5. Prostate Cancer Screening (for men)

PSA (Prostate-Specific Antigen) blood test: Once every 12 months (age 50+)

Digital Rectal Exam: Covered, but you may pay part of the cost

No Cost If:

You meet age/risk criteria

You go to a provider that accepts Medicare assignment

Answer: Medicare does not directly pay for groceries, but some Medicare Advantage (Part C) plans may offer grocery-related benefits — especially for individuals with certain health conditions or financial needs.

Answer: Original Medicare does not cover hearing aids or routine hearing exams. That means:

You’ll typically need to pay out of pocket for hearing aids, exams, fittings, and maintenance.

This can cost anywhere from $1,000 to $6,000+ per pair, depending on the brand and technology.

Answer: 1. More Red Tape & Prior Authorizations

MA plans often require prior approval for tests, procedures, and even some medications.

This creates extra administrative work for doctors and delays care for patients.

2. Lower and Delayed Reimbursement

Compared to Original Medicare, MA plans may:

Pay lower rates

Take longer to reimburse

Dispute more claims

This can strain smaller or independent practices financially.

3. Limited Networks

Many MA plans have narrow networks, meaning:

Doctors must contract with the plan to see patients

Some patients can't continue with their preferred doctor unless they switch plans

Doctors may choose not to participate in some MA networks to avoid the hassles.

4. Complex Plan Variability

Every MA plan is different — even within the same insurance company.

This creates confusion for both patients and providers when trying to determine what’s covered and how much the patient owes.

5. Care Delays That Affect Patients

Delays from denials or prior auths can negatively affect patient outcomes.

Doctors may feel these plans interfere with clinical decision-making.

To be fair, Medicare Advantage can offer good value for some patients — especially those looking for lower premiums and extra benefits like dental or vision — but from a doctor’s point of view, it can feel like a bureaucratic burden.

Answer: 1. Get Authorization to Speak on His Behalf

Contact Medicare and his insurance providers to get a HIPAA authorization or become an authorized representative. This allows you to call, ask questions, and manage his care legally.

If not already in place, consider a medical power of attorney or durable power of attorney for broader authority.

2. Create a Simple Filing System

Use a binder or accordion folder with labeled sections:

Medicare Summary Notices (MSNs)

Prescription drug coverage (Part D)

Medigap or Medicare Advantage plan

Medical bills

EOBs (Explanation of Benefits)

Consider going digital: scan and store documents in Google Drive or Dropbox.

3. Review Medication Coverage

If he's on many medications, make sure he's enrolled in a Part D plan (or Medicare Advantage with drug coverage) that covers his current list at the best cost.

A Medicare agent can help you run a drug comparison to minimize out-of-pocket costs.

4. Understand the Bills

Medicare Summary Notices (MSNs) arrive quarterly and are not bills — they show what Medicare paid and what you may owe.

Actual bills come from providers. Cross-check them with the MSNs or Explanation of Benefits (EOBs) from the insurance company.

If something looks off, call the provider or insurance — billing errors are common.

5. Get Help — You Don’t Have to Do This Alone

Talk to a local Medicare advisor (I can help) to review his coverage and make sure he’s in the right plan.

Consider contacting a State Health Insurance Assistance Program (SHIP) — they offer free help.

Keep a log of calls and notes from each billing issue.

Answer: Enrollment Period (IEP), which is a 7-month window that includes:

3 months before your 65th birthday month

Your birthday month

3 months after

Here are the first steps you should take:

1. Determine if you need to enroll now

If you're already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B.

If you're not receiving Social Security, you’ll need to manually enroll via the Social Security website or call them.

2. Decide if you want Original Medicare or Medicare Advantage

Original Medicare = Part A (hospital) + Part B (medical), with the option to add:

a Part D drug plan, and

a Medigap supplement (to cover costs Original Medicare doesn’t)

Medicare Advantage (Part C) = All-in-one plan offered by private insurers (includes Part A, Part B, usually Part D, and often extras like dental/vision)

3. Compare plans

Work with a licensed Medicare agent (like me!) who can help you compare plans from multiple companies — based on your doctors, prescriptions, and budget.

4. Enroll on time

Enrolling during your IEP helps you avoid:

Late enrollment penalties (especially for Part B and Part D)

Gaps in coverage

Answer: Medicare may cover certain weight-loss services if you’re classified as obese (BMI of 30 or higher), but coverage is limited. Medicare does not cover commercial weight-loss programs or meal plans. However, it does cover obesity screening and behavioral counseling through your primary care provider, and may cover bariatric surgery (like gastric bypass or sleeve gastrectomy) if you meet specific medical criteria, such as having other health conditions like diabetes or heart disease. Prior authorization and documentation are typically required.

Answer: If you move into a Continuing Care Retirement Community (CCRC), you can keep Original Medicare (Parts A & B) with a Medigap plan and Part D for prescriptions, or choose a Medicare Advantage (Part C) plan that may include drug coverage and extra benefits. While some CCRCs may suggest certain plans or have preferred providers, you are free to select any Medicare option that best fits your needs. It’s important to review your coverage as your healthcare needs evolve over time.

Answer: A client on a MAPD plan was denied coverage for a critical cancer drug her oncologist prescribed, labeled “not medically necessary.” We filed a Level 1 appeal with medical records—it was denied. We escalated to a Level 2 appeal, adding clinical studies, a peer physician letter, and a personal statement from the client. The Independent Review Entity reversed the denial, approving the drug with retroactive coverage. She began treatment within 10 days and saw improvement. This case underscored the power of persistence and strong documentation in the appeals process.

Answer: Make sure you work with some one that will present all your options based on your needs. If the broker/agent is good they will ask you a series of questions that will determine what coverage you will need.

Answer: If you have not reached your Part B deductible it should cost you between $350.00-$400.00

If you have already met your Part B deductible than it should cost between $100-$150.00

Answer: Because you never have to worry about ANY network restrictions. You can use Medicare in all 50 states and US territories. So if you're a frequest traveler or have residences in multiple states, having straight Medicare and a supplement(Medi-Gap)makes getting care much easier.

Most drug plans have very large national retailers in their network. So getting prescriptions in other states is easy with a stand alone Part D drug plan or through a Medicare Advantage plan.

Answer: If you take alot of prescriptions or take some expensive prescriptions, your spending will be capped at $2000.00 (this does not include your monthly premium for the drug plan) This can be a huge savings compared to what you may have paid in 2024.

Answer: If it's an emergency or urgent care situation, your Medicare Advantage HMO and PPO and Medicare supplement will cover you.

If it's non emergency care that you need and you will probably want to have a Medicare Advantage PPO coverage, because you will be covered both in and out of network(out of network will cost more) and you will not need referrals.

Ideally, you should have Medicare Supplement coverage, because with this coverage you get get care from any provider that accepts Medicare. You never have to worry about networks and you can get care in any state.

Answer: Sometimes. It depends on your plan. Medicare Advantage plans can cover acupuncture and other alternative therapies. Medicare Advantage offer additional benefits, such as coverage for acupuncture and other complementary therapies.

Answer: You can save money with Medicare Advantage in most situations. However if you are in need of Part B drug treatment long term, Medicare Advantage can be more expensive than straight Medicare and a supplement. Also if you take expensive prescriptions you need to be careful, as well.

Answer: I keep things simple and explain all options.

I asked a series of questions that insure that I make appropriate recommendations based on how the questions are answered.

Answer: They choose plans based on extra benefits and are not focused on the health and drug coverage components.