Deborah Webster, Medicare Insurance Broker

Answer: I strongly encourage you to work with a reputable local agent. Many rules and scenarios that can happen. I have seen people incur penalties because they did their enrollment themselves and did not understand all the rules. Plans can change year after year, so understanding those changes is important as well. Insurance agents spend many hours studying those changes year over year and are extremely beneficial in making sure you are protected.

Answer: Yes, the SEP would be an involuntary loss of coverage, which would allow you to go into a different medicare advantage plan

Answer: Medicare Advantage plans are contracted with Medicare and allow a private company to manage your A and B (original Medicare). These plans have network benefits, and therefore, you should be aware of the network benefits and differences before you join a plan.

Answer: Medicare Insurance agents are paid commission based on all Medicare plans. Like plans typically

pay agents the same regardless of the insurance carrier. Medicare Advantage will pay differently than a drug plan, for example, because they are not the same type of plan.

Answer: Medicare does not cover any Medications unless they fall under Part B. Drug plans cover your medications. You will need to contact your Part D provider to determine if that drug is on the formulary. If it is not, you may request (through your doctor) an exception request to have a medication covered that is not on the formulary.

Answer: You have 2 choices for coverage beyond original Medicare. Medigap is also commonly referred to as a Medicare supplement. Medigap plans do not have networks. Advantage plans do have networks. On Medigap, as long as your doctor is willing to bill Medicare, they will accept your Medigap plan and will lower costs like the Part A deductible. It will cover co-pays that you are currently paying on original Medicare. Work with a local reputable agent who can help guide you to appropriate plans and coverage.

Answer: IRMMA is an income-related monthly adjustment that you pay on your part B and D coverage if your income is over a certain amount, based on how you file your taxes. The 2026 IRMMA rates and allowable amounts are available on the Social Security website. SSA.gov. If you are over the income threshold you will pay more for your part B or D, as it is relates.

Answer: Mental health is covered under original Medicare. Your supplement or advantage plan will give you coverage for your mental health doctors as well.

Answer: No, there is no form necessary to report. You may delay your part B as long as you are covered under a group health plan; you will have no penalty and may add your B later when your group health plan is ending.

Answer: Advantage plans do have some dental benefits, but this may or may not be enough to cover your issues. Also, dental coverage will only cover allowable amounts set by the carrier, so if your dentist is not in network with your carrier, you can be "balanced billed" the difference between allowable amounts established by your carrier and what the dentist you are seeing is charging.

Original Medicare does not cover any dental, so the carriers are not required to cover any dental at all.

Answer: Part A was paid for when you worked aka the Medicare deduction taken off your paycheck before taxes, and as long as you worked 10 years, it costs nothing when you take your A.

Part B has NOT been paid for; this will cost you a premium each month off your social security check or direct bill if you are not yet drawing social security. Part B premium is 185.00 this year and usually increases yearly by about 3%. The Part B premium is set by CMS (the center for Medicare and Medicaid Services). If your income is high enough this may be an even higher amount called IRMMA. You can refer to IRMMA on the Social Security website SSA.gov.

Answer: Original Medicare does not cover dental, vision or hearing. There are plans that supplement, and you can purchase Vision plans that will give you coverage for eye exams and eyeglasses or contact lenses.

Answer: IRMMA is reported when you file taxes and has a 2-year look-back period. You can contact the Social Security office to report and ask income-related questions.

Answer: Moop is a $ amount on the advantage plans to give you a maximum amount of $'s that you could potentially have to pay in a given year on your medical co-pays. Once you have reached that threshold in a given year, you no longer have to pay any more out-of-pocket on medical expenses that year. This threshold resets every January and is subject to change from one year to another.

Answer: This will depend on what plan option you chose. You will need to check your evidence of coverage on your plan to see if and what coverage you have for acupuncture.

Answer: If you are already on Medicare, then the open enrollment period is October 15th to December 7th. If you are getting ready to turn 65, you have 7 months to decide on plan options. 3 months before your birthday month, the month you were born, and 3 months after the month you were born.

Answer: you will need to discuss with the Social Security office as to whether you have any eligibility for Medicare and what the cost will be for Part A or Part B

Answer: When you either have a guaranteed issue (first turning 65 or enrolling in Part B) or pass the underwriting questions for a supplement, pre-existing conditions do not factor into your coverage. You will have no issue with the supplement company covering the cost of your surgery once you have met your deductible.

Answer: Medicare will only cover 100 continuous days in Skilled nursing. If you are in a skilled nursing facility longer than 100 days, you would need a long-term care plan to kick in to pay for any additional days. Typically, you would be spent down to Medicaid (state insurance) if you have no long-term care insurance.

Answer: I do not know for sure what you are on versus the plan your friend is on. Based on what you are saying, "cost" is, I would say you are on a Medicare Supplement, and your friend is on a Medicare Advantage plan. You will need to meet with a ship counselor or licensed agent to fully understand the difference between these 2 very different plans.

Answer: Agents can be crucial in making decisions on Medicare. Licensed agents know the plans and can help you sort through the noise of all the different plans and help you navigate to a plan that fits your specific needs.

Answer: You cannot use your original Medicare card if your Medicare plan is on an Advantage plan, then that is who is managing your benefits. You must go to a provider who is covered by your Medicare Advantage carrier.

Answer: Yes, you will need to update your address change with Medicare and your plan carrier. Depending on what plan you are on, you may need to make a change. Plans may not be available in some states. You will have a 60-day special election period to get moved into an appropriate plan based on your new state and location.

Answer: YES, MEDIGAP PLANS DO NOT HAVE AN ANNUAL ENROLLMENT. YOU MUST, HOWEVER, BE ABLE TO PASS THE UNDERWRITING GUIDELINES OF THE MEDIGAP PLAN YOU WISH TO ENROLL IN.

Answer: MOST OF THE CARRIERS SEND THESE OUT AT THE END OF SEPTEMBER.

THEY MUST BE POSTMARKED BY THE END OF SEPTEMBER. THIS WILL ENSURE THAT THE MEMBERS HAVE THE INFORMATION BEFORE ANNUAL OPEN ENROLLMENT BEGINS ON OCTOBER 15TH.

Answer: Medigap doesn't have networks. As long as your doctor or facility takes Medicare assignment (willing to bill Medicare), you are covered. Medicare Advantage plans do follow networks. You will need to be sure your doctors and facilities take your plan on Medicare Part C (Advantage)

Answer: You must have delayed your B at age 65, so you will need to contact Social Security or go to the website to apply for your B. This will open another open enrollment period for you to get on Medicare plans. Give yourself about 3 months before full retirement so that you have time to pick your plans.

Answer: Sometimes, there are fewer plans available in a rural community. Another thing to consider is that your doctor's networks can be smaller as well.

Answer: Reporting suspicious activity is kept strictly confidential for the individual who reports it.

You can report suspicious activity by simply calling 1800-MEDICARE or calling the customer service number on your insurance carrier's card.

Answer: That is a complicated question because I don't have all the details. Mostly, if it comes in as income, it is reported to the IRS; therefore, if you cross the IRMAA thresholds, you will pay more on your Medicare.

Answer: I don't know why a timeshare pitch would coincide with a Medicare 101. These educational events can be very helpful (when done correctly) for learning the parts of Medicare and things to look out for when entering Medicare. Information on how to avoid penalties and learning about the general ins and outs of Medicare.

Answer: This could be a number of different things, perhaps you are not on the same plan as your friend. You're on just original Medicare, not a supplement or a Medicare Advantage. Without knowing more details, this is not a question I can fully answer.

Answer: You can call directly to a carrier to get enrolled in a plan. The difference is that you do not have someone local to speak to or meet with. There will not be a personal touch in having the same person you are working with each time you call.

Answer: Work with a ship office or work with a local agent who can help you sort through all the options available to you.

Answer: You cannot turn Medicare on and off, so if you are going to be living in the states at all you will need to continue to pay your part B

Answer: In my professional opinion, no. You need to pick a drug plan to avoid paying a penalty that lasts the rest of your life. Also, there are gaps in original Medicare (A& B).

Answer: In 2025, Medicare changed the stages of the drug plans and eliminated the donut hole.

There are only 3 stages: Deductible, initial coverage, and catastrophic. Members enter a catastrophic stage where they pay $ 0 for medications once they have crossed the $2,000 mark.

Answer: On October 1st all Medicare changes will be announced. Agents are not allowed to discuss changes for 2026 before October 1, 2025.

Answer: Call Medicare directly to report your lost card, and they will re-issue a new one and mail it out to your home address. Phone number is 1-800-Medicare.

Answer: The cost of Medicare can be different for people in higher income brackets. This is called IRRMA.

You can find IRRMA brackets by visiting ssa.gov.

Answer: Life insurance can be used in many different ways to help. Some products can help cover funeral expenses, grow cash value, and also assist with long-term care and more. Working with an agent to discover your needs can make a big difference in your financial situation in retirement.

Answer: I would never recommend just being on Original Medicare. So, the answer is yes, Medicare Advantage would lower your out-of-pocket costs that you could potentially incur with original Medicare.

Answer: Drug coverage options all have formularies. They may deny any drug not on the formulary.

Your doctor can ask for an exception request to have a non-covered medication covered under the plan, however, this does not mean the company has to cover the medication.

Answer: Coverage on Medigap plans is the same from one carrier to the other. In other words, a G plan is the same medical coverage regardless of the carrier you choose. There are some carriers that offer some extra benefits, such as a gym membership that may give you a little perk; however, the medical coverage is identical. The cost will vary from one carrier to another, as well as the increases they take annually.

Answer: The best way to determine if your insurance covers your medication is to look on the drug formulary. This is sent to you when you join a plan. You may also call the customer service number on your card to have them assist you in looking into the formulary to determine that your medication is covered and at what cost to you.

Answer: Star ratings determine how Medicare (CMS) ranks Medicare plans. Low star ratings can be a warning sign that beneficiaries have been unsatisfied with a plan. Medicare may not allow the plan to continue offering benefits if star ratings stay below a certain score. Work with an independent agent who can offer multiple carriers and plans to help you choose a plan that is going to work for your particular concerns.

Answer: Your medication costs go to 0 regardless of the tier of medication you are taking.

Once you cross the 2,000 max out-of-pocket thresholds, you incur no more cost for the rest of the year.

Answer: Medicare can be primary or secondary insurance depending on your situation. You can work with an agent to determine how this would work. The ship office is another place you can schedule an appointment to speak with a licensed agent.

Answer: What you choose to do for your plan should be 100% your choice. No agents should be steering a beneficiary one way or the other. Insurance is supposed to make you sleep at night. If, for any reason, you don't feel comfortable with Medicare Advantage, then it isn't for you.

Answer: Yes, open enrollment is the time to review changes with your current plan and allows you to look at other options. If you work with an agent, they should be reviewing your doctors, preferred facilities, and prescriptions to ensure that you have proper coverage within your plan.

Answer: Yes, there are special enrollment periods created for someone who may have continued working past age 65 and is now losing their employer-sponsored benefits.

Answer: My favorite is getting to know my clients on a personal level and helping them navigate Medicare in this special time of retirement.

Answer: Yes, this is the current maximum out-of-pocket for all Medicare beneficiaries. If your plan has a deductible, this also counts towards your maximum out-of-pocket.

Answer: Prescription savings are available both through the state and Federal Programs.

You can apply on the DHS website for the state pharmaceutical program. The Federal program is called LIS (low income subsidy) and this is available to apply online or contact your social security office for a paper version or sign up over the phone.

Answer: I sit down with each prospect and give them a Medicare 101 that includes many different things. Discussion on the parts of Medicare and how they function: Discussion of Medications, doctors, and overall areas of concern for each individual. Expected costs and plans that can help cover gaps in Medicare coverage. I also do group settings in a public location that is free to the public to listen and learn all the aspects of Medicare.

Answer: I have not heard of any Medicare Advantage giving gift cards to enroll. This practice would not be permissible by Medicare. They have Advantage plans available that may give you a card to purchase over-the-counter medications after enrollment, or gift card rewards you may earn for doing healthy activities during the year. This is not the same as an incentive to buy.

Answer: you will automatically get your A and B (original Medicare) without having to sign up. Your effective date will be the 1st of the month that you are born in unless your birthday is on the 1st of the month: in that case your effective date will be the 1st of the month before the month you were born.

Answer: Original Medicare does have gaps; this is why it is important to purchase supplemental plans that can help fill those gaps. You can contact a ship office or a local agent to discuss what those plans consist of and what they cost. Whether it was designed well or not, it is the healthcare option that seniors must work with as of now.

Answer: No, original Medicare does not cover groceries. There are plans (Medicare Advantage) that do give a grocery allowance. These are private insurance companies contracted with Medicare that manage your Parts A and B and can give you additional coverage above and beyond what original Medicare offers. Contact a local insurance agent or talk to a local ship office about what options may be available to you.

Answer: It is not a requirement for taking part B when you are covered under a group health plan with your employer. Most people will delay B while still working if they are allowed to stay on employer coverage (check with your HR on policy rules). They will take B at a later date when they fully retire and quit working. Ship offices will help with information about this, as well as local agents you may work with to help explain your options for Medicare.

Answer: Unfortunately, Medicare is not free. When you worked, the Medicare you paid for out of your paychecks is going toward your Part A. This covers inpatient stays like a hospital or skilled nursing facility. Part B premiums start when you turn 65 or take your Part B. This section covers doctors and outpatient services. This is still, however, never fully paid for; there is still an out-of-pocket expense you will incur when you use your Part B.

Answer: Yes, you are eligible for guaranteed issue when you are first eligible to take your Part B or when leaving creditable group health care coverage after your initial enrollment period.

Answer: I believe you are referring to a rule with Medicare Advantage plans that requires a 3-day stay in the hospital before the plan will pay for skilled nursing care. This is the 3 midnight or after stay.

You can refer to your plan's evidence of coverage to see if this rule applies to your plan.

Answer: There are often local educational events that will help you understand the Medicare process.

These are registered with Medicare, you can contact 1800Medicare to inquire about dates and times for your area.

There is always the ship office that will schedule a time to visit with you about Medicare.

Contact a local agent to set up an individual appointment to review how Medicare parts work.

Answer: SOA is a scope of appointment. It defines what products your agent is going to discuss in relation to Medicare coverage. It is required for all agents, including telemarketers. The rule in 2025 requires all agents to have this signed by the medicare beneficiary 48 hours prior to a Medicare meeting. There are a few exceptions to this rule. It is Medicare's requirement, and all agents licensed to sell Medicare must comply.

Answer: Answering phone calls from telemarketers who call constantly can be a little scary.

It is recommended that if you didn't ask for the call or didn't give permission to call, it is best to disconnect.

Medicare will not call you; instead, they will mail any correspondence relevant to your account.

Do not give out your Medicare number over the phone unless you are sure about the company or agent that you are speaking with.

Answer: If your income is over a certain threshold you may pay more for part B. IRRMA is figured on single or joint household income. For IRRMA thresholds visit ssa.gov. social security site.

Answer: This information is in your evidence of coverage. If you worked with a broker to sign up for your part D plan, the agent should have covered that when you signed up. This information is also available on Medicare.gov

Answer: Yes, the max in 2025 is 2,000 while the max in 2024 was 8,000. There may be deductibles on your plan if you are on brand-name medications. Work with your agent to determine whether the deductible will apply on your medications.

Answer: Medicare is a straight 80/20 plan with deductibles on A & B. Medigap plans lower that potential out-of-pocket and eliminate the A deductible. If you're eligible for a plan F medigap, you also eliminate the part B deductible.

Answer: People may leave a Medicare Advantage plan to go to another one during open enrollment.

Some people may try a Medicare Advantage plan and then decide to go back to a Medicare Supplement plan. As far as how many are on Medicare Advantage vs supplement, there are now more Medicare beneficiaries on Medicare Advantage than supplement plans across the US.

Answer: Specified disease plans such as heart attack, Cancer and Stroke are additional policies one can buy that will give extra help to pay for costs for treatment; additionally can be set up to cover travel expenses as well.

Answer: Yes, you can pay part A& B, and D premiums are eligible. Medicare Advantage premiums would

also qualify. Medicare supplement or Medigap policy premiums do not qualify for pretax HSA.

Note: Contribution to your HSA account must cease at this time.

Answer: I personally think they are trying to give seniors access to choices.

As an agent, I think they are more hindering than helpful.

Medicare.gov shows seniors all choices online, and they offer a ship office

for those who don't have access to the internet.

Medicare also welcomes feedback from seniors on Medicare.

Answer: You can contact your insurance agent to help you file an appeal if you like. If you don't have an agent, you can contact customer service on your health plan and they can help you with the appeal process.

Answer: Medigap plans are a supplement to Medicare A and B ( Original Medicare). Medical plans do have health underwriting. The only time you do not have to pass underwriting is when you are first eligible for B outside of that you must be able to pass underwriting. Medigap companies do not all have the same health questions. It's important to work with an agent who has multiple options to look at underwriting and find a carrier who may take your current pre-existing conditions.

Answer: No, you should be able to access the dentist who are participating by calling member services or go on your member website to look up the dentist who are participating with your Medicare advantage carrier.

Answer: You may purchase stand-alone plans available in your state. Medicare Advantage plans often have some Dental and Vision coverage as well.

Answer: Contact the carrier you have for your Medical coverage, or refer to your evidence of coverage on your policy. If all you have is original Medicare, you may call 1-800-Medicare for more information.

Answer: Medicare does not cover any of the above. Whether or not they should is irrelevant because it's not covered. Sending feedback to your congressmen or to Medicare would be a way to let them know what the public wants or needs. Medical costs are increasing, so the expense to consumers will continue to rise regardless of whether they cover any extras.

Answer: Most generally, there are already apps in place with Medicare Advantage plans. If you did not receive the information on how to sign up by mail or email, you can call the customer service number on your Advantage plan card.

Answer: You are eligible for A& B when you turn 65. You can call Social Security about any of your benefits questions. You may also access everything online through the social security website ssa.gov

Answer: You may be eligible for a federal retirement group retiree plan. This will not affect your Medicare eligibility but may offer you better plan options than someone who is only eligible for individual Medicare plans.

Answer: PPO's allow you to go to out-of-network doctors. (at a higher cost sharing) PPO's however, can still require a referral to see a specialist. To find out whether your company requires this, you should check this information in your evidence of coverage document.

Answer: Medicare seminars are designed to educate people turning 65 about how Medicare works. Compliance does not allow agents to talk about any specific carriers or any benefits at those seminars. So no these are not " sales pitches".

Answer: You can call your drug carrier and have them apply for a payment plan to spread the cost of your medications over the whole year.

Answer: We would need to look at what plan your on and compare. I am independent and work with lots of carriers and plan options

Answer: Drug plans do cover many weight loss drugs such as Ozempic. Be sure to look at your drug formulary to determine which medications they cover as well as any deductibles or co-pays that may apply to this medication, to determine what your out-of-pocket costs may be.

Answer: Your plan may offer smoking cessation coverage. Typically, the Medicare Advantage or Part C plans offer smoking cessation. You can look it up in the insurance company's evidence of coverage or call customer service, or your agent if you are unable to find the information in the evidence of coverage.

Answer: Original Medicare is the same regardless of what state you reside in. Your supplemental plans will have to change to what is offered in the state you reside in. You will want to contact your agent or your plan to find out what is provided in the state you are relocating to.

Answer: Either way insulin are now capped at 35 per month you do need to make sure the insulin you are taking is on the formulary of the plan. That is where an agent like myself can help guide you through the plans.

Answer: this is concerning that you don't have your preferred hospital in the network. Are you on a Medicare Advantage PPO plan? This would still allow you to go to that hospital (although you may pay a higher co pay), If it is an emergency situation, your plan would still cover an out-of-network hospital.

Answer: Most of the Medicare Advantage plans will cover diabetic counseling. This counseling is covered at no cost to the member. Diabetic testing supplies are also covered on these plans at no cost to the member.

Answer: Traditional Medicare does not cover eyewear. I cannot really answer this question in detail because I do not have enough information about what plan she was enrolled in. I would need more details about the circumstances in this situation.

Answer: Medicare Advantage and Medicare Supplements are the only two options available to lower the gap left with traditional Medicare. We are currently seeing a strong trend toward Medicare Advantage plans with our seniors. Neither option is wrong, it's about making sure that the coverage you choose fits your situation. The system is designed the way it is; we can only maneuver within what systems we have to work with.

Answer: Contact an Elderly Care Attorney to help with full Power of Attorney. They assist with setting up a Medical or full power of attorney status. This way, you can have full control of what is happening with your loved one. Typically, not a very expensive investment to have the authority to make decisions on behalf of a family member who can no longer make those decisions on their own.

Answer: Medicare coverage is set up by CMS (center for Medicare and Medicaid services) If regulations are changed in the future, that we cannot predict but an illness such as heat stroke are covered by Medicare.

Answer: They are not "free" plans, these plans are a pay-as-you-go plan. They do offer benefits that original Medicare does not offer, such as coverage for Dental, Vision, and hearing.

Answer: I enjoy helping seniors navigate the Medicare space. I offer after-sales customer service to assist them as they use their Medicare plans and also offer ancillary products to improve their coverage.