Edward Givens, Medicare Insurance Broker

Answer: Medicare plans can change yearly. Not reviewing coverage during the Annual Enrollment Period (Oct 15–Dec 7) can mean staying in a plan that no longer fits your needs or budget. Some people who continue to work past 65 assume their employer coverage is sufficient and delay Medicare enrollment, not realizing this could lead to penalties or coordination of benefits issues.

Answer: Medicare covers everything.”

People are often surprised to learn that Medicare doesn't cover dental, vision, hearing aids, or long-term care. These gaps can lead to major out-of-pocket expenses if not planned for. “Medicare is free.”

Many believe that once they turn 65, Medicare won’t cost anything. While Part A is usually premium-free, Parts B, D, and supplemental plans come with monthly premiums, deductibles, and co-pays.

Answer: Limited Provider Networks

Unlike Original Medicare, many Medicare Advantage plans have restrictive networks. You may not be able to see your preferred doctors or go to certain hospitals unless they’re in-network.

Prior Authorization Requirements

Many Advantage plans require prior approval for services or procedures, which can delay care and add extra administrative hassle.

Unexpected Out-of-Pocket Costs

While premiums may be lower, Medicare Advantage plans often have higher copays and coinsurance for certain services, and the cost can add up—especially if you have chronic conditions.

Answer: Medicare provides coverage for both psychiatric medication management and talk therapy through its Part B (Medical Insurance) and Part D (Prescription Drug Coverage) plans.

Psychiatric Medication Management

Medicare Part B covers outpatient mental health services, including visits with psychiatrists or other qualified healthcare providers for psychiatric evaluations and medication management. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount for these services if your provider accepts assignment. Provider Acceptance: Not all mental health providers accept Medicare. It's important to confirm with your psychiatrist and therapist that they accept Medicare assignment to ensure coverage.​ Medicare Advantage Plans: If you're enrolled in a Medicare Advantage Plan (Part C), your plan may offer additional mental health benefits beyond Original Medicare. However, provider networks can be more limited, so verify that your preferred providers are in-network

Answer: If you've missed the Medicare Open Enrollment period (October 15 to December 7) and wish to change your plan, you may still have options through Special Enrollment Periods (SEPs).​

Verywell Health

+8

Cal Dept of Health Care Services

+8

Kiplinger.com

+8

Special Enrollment Periods (SEPs): SEPs allow you to make changes to your Medicare Advantage or Part D prescription drug coverage outside the standard enrollment periods if you experience certain life events. Qualifying events include:​

Cal Dept of Health Care Services

+7

UHC

+7

Investopedia

+7

Moving out of your plan's service area.​

Cal Dept of Health Care Services

+3

UHC

+3

Medicare

+3

Losing other credible health coverage.​

National Council on Aging

+6

Investopedia

+6

Medicare

+6

Gaining or losing eligibility for Medicaid or Extra Help.​

UHC

+1

Medicare Interactive

+1

Your plan changes its contract with Medicare.

Answer: Yes, Medicare can cover home health aide services after your surgery, but certain conditions must be met.​

Eligibility Criteria:

To qualify for Medicare-covered home health services, you must:

Be under the care of a doctor who certifies that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy.​

Be homebound, meaning it's difficult for you to leave your home without assistance due to your medical condition.​

Boost Home Healthcare

Receive services from a Medicare-certified home health agency. ​

Services Covered:

If you meet these criteria, Medicare may cover:

Part-time or intermittent skilled nursing care (e.g., wound care, injections).​

Therapy services, such as physical, occupational, or speech-language therapy.​

Home health aide services, which provide personal care like bathing and dressing, but only if you're also receiving skilled care as mentioned above.​

Medical social services to help with social and emotional concerns related to your illness.​

Certain medical supplies and durable medical equipment (e.g., walkers, wheelchairs). ​

Limitations:

Medicare does not cover:​

24-hour-a-day care at home.

Meals delivered to your home.

Homemaker services like shopping, cleaning, and laundry when these are the only services you need.​

Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need.

Answer: I totally get why you're worried—Medicare can feel overwhelming, and no one wants to get stuck with a plan that doesn't fit. But here’s the good news, friend to friend: you’re not stuck forever.

You can make changes to your Medicare coverage every year during Open Enrollment, which runs from October 15 to December 7. That’s your chance to switch between Medicare Advantage and Original Medicare, or to change your drug plan if something better comes along.

And if you do have a Medicare Advantage plan, there's even a second window—January 1 to March 31—called the Medicare Advantage Open Enrollment Period, where you can make a one-time switch to another Advantage plan or go back to Original Medicare.

Plus, there are some special situations (like moving, losing coverage, or other life changes) that can give you an extra opportunity to switch—those are called Special Enrollment Periods.

Bottom line: You’ve got options, and I’ve got your back

Answer: I know this stuff can get confusing, but I don’t want you to ever get stuck with one of those surprise bills for lab work. So here’s how we can stay ahead of it, step by step — think of it like a little checklist before getting any lab tests done under your Medicare Advantage plan:

Make sure the lab is “in-network” – This is a big one. Your plan has a list of labs they work with. If your doctor sends you somewhere else, even by accident, you could get a big bill. So always double-check that the lab is covered under your plan before any tests are done.

Ask if the lab test is “covered” or “medically necessary” – Not all tests are automatically approved. Ask the doctor, “Is this covered by my plan?” and “Do you need to get prior authorization for it?” If they say yes, great. If they’re unsure, we can call the plan and ask.

Get everything in writing if you can – If the doctor says it’s covered, ask for something simple in writing or a copy of the order that shows they’re sending it to a network lab.

Check your plan’s Evidence of Coverage (EOC) – I know it’s a thick book, but I can help look it up for you. It will show exactly which lab services are included and what you might owe.

Don’t be afraid to say “wait” – If a lab tech or someone says “we’re not sure if this is covered,” don’t feel pressured. Just say you’d like to check first. It’s always better to take five minutes to call than to deal with a $300 surprise bill later.

And if anything ever seems fishy or confusing, just call me first — or better yet, let’s talk to your plan together. We’re going to keep you protected and make sure every dollar counts.

Answer: Here's the Pro Move:

If you know you’ll be living abroad for an extended time and want to pause coverage, let’s talk through your options before you make a move. I can help you weigh the savings vs. potential penalties and make a game plan that fits your lifestyle.

Bottom line: Medicare doesn’t follow you outside the U.S., but your premiums don’t automatically stop just because you’re not using it. Let's protect your long-term coverage while also respecting your current lifestyle.

Answer: Medicare fraud is real, and staying sharp is key. Here’s your quick defense plan from a seasoned Medicare agent:

Protect your Medicare number like it’s a credit card — don’t share it unless you’re sure who you’re talking to.

Be skeptical of “free” offers — if someone calls or shows up offering free braces, tests, or supplies in exchange for your Medicare info, it’s likely a scam.

Check your statements — review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for anything you didn’t receive.

Hang up on unsolicited calls — Medicare will never call you to sell you anything or ask for your number out of the blue.

Report suspicious activity — call 1-800-MEDICARE or your agent (like me) if something seems off.

Simple rule: If it feels fishy, don’t bite. Let’s keep your benefits safe and your peace of mind intact.

Answer: Great question — and here's the simple breakdown from a seasoned Medicare agent’s point of view:

If the U.S. ever moved toward universal healthcare — meaning everyone gets health coverage from the government — it could majorly shift how Medicare works. Here’s how:

Medicare could expand to cover everyone — This is the “Medicare for All” idea. Instead of just covering people 65+ or those with disabilities, Medicare could become the national health insurance program for all Americans.

Private Medicare Advantage plans might shrink or go away — If the government runs everything, private insurers might play a smaller role. Or, they could shift to offering optional add-on coverage, kind of like how dental or vision works now.

Benefits could change — Depending on the model, we could see more services covered (like dental, vision, long-term care), or there could be stricter cost controls to make the system affordable for everyone.

Taxes might replace premiums — Instead of paying monthly Medicare premiums, people might see higher payroll or income taxes to fund the system — but with fewer out-of-pocket costs at the doctor or hospital.

Bottom line: If universal healthcare becomes reality, Medicare could grow into a much bigger program — but with big changes to how it’s funded, who it covers, and what it looks like. No one knows for sure yet, but as always, I’ll be here to help you adjust if and when it happens.

Answer: When you turn 65, Uncle Sam gives you a gift. It’s called Medicare—and it covers a lot. Hospital stays. Doctor visits. Some preventive care.

But what many folks don’t realize is this: Medicare doesn’t pay for everything.

In fact… it only covers about 80% of your approved healthcare costs.

And so… you have a choice to make.

On one hand, there’s something called a Medigap plan—also known as Medicare Supplement Insurance. These plans work with Original Medicare. They’re simple, straightforward. You go to any doctor or hospital that takes Medicare, anywhere in the country. And when Medicare pays its share… your Medigap plan picks up the rest.

No networks. No referrals. No surprises.

That’s freedom.

But there’s another option. One that’s been heavily marketed in shiny brochures and flashy commercials. It’s called Medicare Advantage.

Now here’s the twist:

Medicare Advantage plans are run by private insurance companies—not the government. You’re still in Medicare, yes, but you’ve handed the reins over to a company. They decide what’s covered, what’s not, and where you can go for care.

You may get extra perks like dental or vision… but you may also face restricted networks, prior authorizations, and unexpected out-of-pocket costs.

So which one’s better?

That… depends on you.

Do you travel? Want the freedom to choose any doctor who takes Medicare? Medigap might be your match.

Prefer a lower monthly premium and are okay with networks and co-pays? Medicare Advantage could work.

But this isn’t a decision to make with a coin toss or a TV commercial.

It’s a decision to make with someone who knows your health, your budget, and all the options available.

Someone like a non-captive Medicare agent—who works for you, not the insurance companies.

Because when it comes to your health, there’s no one-size-fits-all plan.

Answer: Great question—and one I hear all the time.

Suppose you’re looking at Medicare Supplement plans (also called Medigap). In that case, you’ve probably noticed that plans like Plan G (and the legacy Plan F, if you were eligible for Medicare before 2020) come with some pretty impressive coverage… and a higher price tag. So the real question becomes:

Is it worth the money?

Let’s break it down.

According to the 2025 Medicare & You guide, high-end Medigap plans help pay for almost all the out-of-pocket costs that Original Medicare doesn’t cover—like the 20% coinsurance for doctor visits, hospital stays, and skilled nursing.

Plan F covers everything, including the Medicare Part B deductible. But it’s only available to people who were eligible for Medicare before January 1, 2020.

Plan G is the next best thing—it covers everything except the annual Part B deductible (which is $257 in 2025).

High-Deductible versions of Plan F or G are available too. These plans have a lower monthly premium, but you have to pay the first $2,870 out of pocket in 2025 before the plan starts covering your costs.

Here’s who it’s worth it for:

You want predictable costs and maximum peace of mind.

You see doctors often, expect surgeries or specialist care, or just want to avoid surprise bills.

You can afford the premiums and don’t want to worry about “what if” scenarios.

If you want the "set it and forget it" option—no guessing, no worrying—then yes, a high-end Medigap plan like Plan G is absolutely worth it. You’ll pay a bit more each month, but you’ll have rock-solid coverage and very few surprise expenses.

But if you’re healthy, budget-conscious, and okay with a little financial exposure? There are other Medigap options that may fit your needs better.

Still not sure what’s right for you? That’s what I’m here for.

Let’s talk through your options and figure out the best plan for your life, not just your wallet.