Dominic Javier, Medicare Insurance Broker

Answer: The IRMAA (Income-Related Monthly Adjustment Amount) surcharge is not permanent, but it isn't necessarily a "one-time" fee either. It is an annual determination. It will change based on your income determination last year and year after.

Answer: Under the Affordable Care Act and subsequent updates, Medicare Advantage plans are guaranteed issue. They cannot deny you coverage based on your medical history. They cannot charge you a higher premium because you are sick. They must cover your pre-existing conditions from day one (no waiting periods).

Answer: Supplemental insurance is a specific product you buy (Medigap) in addition to Medicare Original. Whereas, secondary insurance is a role any insurance plan plays when it isn't the first one to pay the hospital bill.

Answer: Yes, you can absolutely get Medicare without receiving Social Security benefits. In fact, many people delay Social Security until age 70 to maximize their monthly checks while still enrolling in Medicare at 65 to ensure they have health coverage.

Answer: Medicare Part B covers most of what happens outside of a hospital bed—think doctor visits, blood work, and MRIs. Most people add either a Medigap plan or a Medicare Advantage plan to cap their potential losses.

Answer: Switch to another specialist included in your Medicare advantage plan. That is why, review the coverages before signing an Medicare Advantage plan. If you're satisfied with your Original Medicare and need to just improve co-pay/co-insurance, consider Medigap or Medicare Supplement.

Answer: Yes, you should be skeptical about it. Since Medigap supplements Original Medicare (Parts A and B), its premium is way lower than Medicare Advantage. It is lower because it simply lays on top of your Original Medicare. Therefore, agents, specially the captured ones, will push Medicare Advantage since it has higher premiums, thus higher commissions.

Answer: It is perfectly fine to work with a Medicare agent from another state, provided they hold a non-resident license for the state where you live. Many agents are licensed in multiple states and help clients across the country using phone, email, and video calls.

Answer: Ask about the Medicare Prescription Payment Plan. This is a new feature that allows you to spread your out-of-pocket costs (like that $2,100 cap) into monthly installments throughout the year instead of paying a massive sum the first time you fill your specialty drug in January.

Answer: Moving to U.S. territories will allow you to retain your Original Medicare coverages. However, Medicare Advantage is geographic specific, that is, certain territories where you are moving in may have limited or no coverage at all.

Answer: Medicare's chiropractic benefit is very narrow. It only covers manual manipulation of the spine. It does not cover: Maintenance Care, X-rays, Massage & Physical Therapy and Orthotics or Supplements.

Answer: Yes, caregivers and home health aides can be included in dementia care, especially when skilled care is needed. Medicare may cover home health aide services if they are part of a broader home health care plan that includes skilled nursing or therapy services.

Answer: Medicare covers several cancer screenings at no cost if you receive them from a provider who accepts Medicare. These include screenings for breast cancer (mammograms), cervical cancer (Pap tests), colorectal cancer (various tests), and lung cancer (for eligible individuals) among others.

Answer: To budget for Medicare costs with expected health decline, start by estimating your potential healthcare expenses, including premiums, deductibles, and out-of-pocket costs. Consider setting aside funds in a health savings account and explore Medicare Advantage plans that may offer additional coverage options to help manage costs.

Answer: When selecting a Medicare Advantage plan, it is crucial to review the specific dental benefits outlined in the plan's Summary of Benefits. This document will detail what services are covered, any associated costs, and whether there are annual limits on coverage.

Answer: The monthly premium for Medicare Part B in 2026 will be $202.90, an increase of 9.7% from 2025. This change is primarily driven by projected price changes and increased utilization of services.

Answer: Yes, occupational therapy is covered under Medicare Advantage plans, including those offered by UnitedHealthcare (UHC). Coverage is generally aligned with Medicare Part A and Part B services, which include medically necessary outpatient occupational therapy.

Answer: Medicare Part D provides prescription drug coverage through private insurance plans, and these plans often have a tiered pricing system for medications. The tier structure can significantly affect your out-of-pocket costs for prescriptions.

Answer: The Extra Help program is a federal initiative designed to assist people with limited income and resources in paying for their prescription drug costs under Medicare Part D. This program can significantly reduce the expenses related to medications for those who qualify.

Answer: If you are already receiving Social Security benefits at age 65, you will be automatically enrolled in Medicare Parts A and B. However, since you're delaying Social Security, you will need to take the initiative to enroll yourself.

Answer: Traditional Medicare remains favored by many for its simplicity and broad acceptance among healthcare providers. The future of Medicare will likely depend on political decisions and public sentiment regarding privatization and the balance between cost and care quality.

Answer: If you find yourself paying more for Medicare Part B and D than your friends, it’s likely due to the Income-Related Monthly Adjustment Amount (IRMAA). This adjustment affects the premiums of those with higher incomes.

Answer: Yes, Medicare does cover the shingles vaccine as a preventive service. Specifically, the coverage falls under Medicare Part D, which pertains to prescription drug plans.

Answer: One Medicare decision that many people regret later is delaying enrollment in Medicare Part B when they first become eligible. This can lead to significant consequences for beneficiaries, both financially and in terms of healthcare access.

Answer: One significant trend improving Medicare affordability is the implementation of an annual out-of-pocket cap of $2,000 on prescription drug costs under Medicare Part D, which took effect in January 2025. This landmark change represents the first time beneficiaries have a limit on total out-of-pocket spending for medications.

Answer: Consider these factors - Health Care Usage, Prescription Drugs, Additional Benefits, Travel Considerations, Chronic Conditions and Hospitalizations.

Answer: Consider these questions: Do you visit doctors frequently or require specialist care, Are you taking medications, Do you have specific providers you want to continue seeing, and re you living with a chronic condition that may require more frequent medical care?

Answer: Assess Your Needs - consider your health status, budget and preferred healthcare providers. Compare Plan Options - look at the benefits, costs and coverage details of available plans.

Answer: You may choose to delay enrolling in Medicare if you are provided a health insurance by your employer. However, to avoid late enrollment penalties, it's generally advisable to enroll in Medicare Part A since it is usually premium-free and can provide additional coverage alongside employer insurance.

Answer: With chronic conditions like diabetes or heart disease, you can estimate your Medicare costs by knowing your monthly premiums in Part A (which is normally $0.00) and Part B (which is $185.00 or more), deductibles and co-insurance in Part A (Hospital) and Part B(Doctor's fees), plus cost of medications like insulin currently capped at $35.00 per month, and cost of 24/7 chronic care management.

Answer: No, Medicare does not cover everything that your current employer plan does. Depending on the benefits of your employer, Medicare however covers Part A and B, and D if you have enrolled, and there may be differences in benefits and costs between the two plans.

Answer: The main components that affect the premium you pay periodically are deductible and coinsurance. Now, if you are healthy and strong at 65 or more, you may apply for a policy with larger deductible and larger coinsurance to decrease your premium. In that manner, you’ll address cost efficiency with lower premiums but higher copays since your frequency of checkups will be minimal to nil.

Answer: Yes, through the cognitive assessment and care plan services that will look for signs of dementia, including Alzheimer's disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, or making decisions about your everyday life. Your doctor should check on you and give you are care plan, including supervision 24/7 if indeed needed.

Answer: PACE - Program of All-inclusive Care for the Elderly (PACE) should be an option. PACE is a Medicare and Medicaid program offered in many states that allows people who need a nursing home-level of care to remain in the community, like home, apartment, or other appropriate setting. PACE covers all Medicare and Medicaid -covered care and services the team of healthcare professionals decides are necessary to improve and maintain your health.

Answer: Among the federal entities that are under review, The Health Care System and Education System are one of the top tiered entity the current and even the past government never failed to fund. The health care system nowadays is focused on taking good care of our senior citizens and improve the booming side of our population. With JFk Jr. Medicare is here to grow and innovate MAHA.

Answer: Yes, they are terminologies referring to same nature. In the Medicare industry, it is know as Medicare Supplement Plan or Medigap sold by private insurance companies to augment your Medicare plan.

Answer: Medicare covers E-visits or telehealth using an online patient portal. To get an E-visit, you must request one with your doctor. You will 20% of the approved Medicare amount for your doctor's or other provider's services. The Part B deductible applies.

Answer: The premiums are the periodic payments (monthly, quarterly or annual) the beneficiary pays without fail to maintain an ongoing Medicare plan. The deductibles are the maximum payment the benficiary have to pay initially per benefit period before Medicare benefits starts. And, copay synonymous to coinsurance are additiinal payments you'll have to make usually after enjoying the benefit. These cost components play along with the type of plan you have and will vary based on each amount of the cost element.

Answer: To get an E-visit, Telehealth, you must request one with your doctor or other provider. You will pay the 20% of the Medicare-approved amount for your doctor's or other provider services. The Part B deductible applies. The E-visits allow you to talk with your provider using an online patient portal.

Answer: Lab tests are usually prescribed by your doctor (in-network) and coverage of tests should be thereby indicated. You can call and ask the laboratory prior to the test so you'll know your benefits and the net cost, out of your pocket.

Answer: As we know, PPO has in-network and out of network and the latter will cost you more. Annual wellness is usually covered and should be in-plan - free of cost within your PPO network. Check the plan with your PPO if indeed annual wellness is part of the program.

Answer: Medicare plans that have Coordinated Care Plans have a network of preferred providers such as Health Maintenace Organization (HMO), Preferred Provider Organization (PPO) and Private Fee for Service (PFS). Check well if the area of coverage of your plan covers your home area.

Answer: Issuance and sales of Medigap (Medicare Supplement Insurance) plans are regulated by States, which have varying laws 'bluesky' like guaranteed issue rights, marketing, commissions, etc. And, depends on the medigap plan (A to F) you are subscribed with. For instance, the foreign travel benefit pays 80% of charges after the $250.00 deductible, up to a $50,000.00 lifetime maximum. Your premium depends on the plan you acquired.

Answer: Because Medicare (Advantage and Supplement) involves complicated rules and procedures, lest updates and revisions from time to time, most beneficiaries get confused, eventually frustrated. You will need to understand Medicare/Medigap benefits, coinsurance, deductibles, copayment, hospital benefits, blood pints, hospice, skilled nursing care, etc.

You will need a licensed, AHIP certified person who knowledgeable and experienced to guide you through the rules and procedures that will clearly give you practical options and solutions.

Answer: Medicare covers home health services under Part A and/or Part B. Medicare covers durable medical equipment, in your case, heart monitoring device, and medical supplies for use at home. You will pay nothing for home health services. However, for Medicare-covered durable medical equipment, you will pay 20% of the Medicare approved amount. The Part B deductible applies.

Answer: The Medicare process can be overwhelming. A licensed Medicare broker will listen to you and give you information about your coverage options that is based on your needs and preferences. Working with a trained broker can help you save time and money, ultimately helping you find the right health plan.

The Medicare process can be overwhelming. A Medicare broker is an independent adviser who represents multiple insurance companies and can help you evaluate plan options, along with helping you enroll into a plan.

Please note, I used 'broker' instead of 'agent' because I am here to represent the needs of the clients with a fiduciary obligation, whereas the later is an employee whose obligation is with an employing nsurance company.