Edward Smith, ChFC, CRPS, AIF, Medicare Insurance Broker

Answer: As a financial advisor, I am used to this question. There are different strategies. One of the most common is to move taxable assets to tax deferred or tax-free assets. This will reduce your taxable income and possibly reduce or remove your IRMAA surcharge. Also, remember the IRS looks back 2 years to access IRMMA. If you simply had one year of higher-than-normal income due to a capital gain or something like that, you can always and should always appeal the IRMMA decision.

Answer: You will not lose your Medicare benefits just because you get married, but marriage can affect your premiums, eligibility for certain low-income programs, and a few special situations. Medicare is individual coverage, not a family policy, so your own Medicare eligibility and basic coverage do not stop when you marry.

Answer: I think some people would say, it's the fact that you have to use a doctor in Network. Where with a Medicare Supplement policy you can go to any doctor that accepts original Medicare. I believe it is simply the higher out of pocket maximum medical cost in a plan year. With a Medicare supplement you only have your premium plus the Medicare part B deductible ($283.00) in 2026 to be responsible for. With a Medicare Advantage plan, you could have a potential $5,000 or more maximum of pocket in any plan year.

Furthermore, a lot of agents do not explain the potential benefits of a High-Deductible Plan G. In 2026 the deductible is $2,950. But that is the maximum out of pocket you will pay plus the part B deductible. The difference in the monthly premium for a 65-year-old could be as low as around $40 per month.

Answer: If you have Original Medicare only or Original Medicare with a Medi Gap (Supplement policy) no. However, if you have a Stand-Alone Prescription drug plan or a Medicare Advantage plan, yes.

You will need to find a plan for your new zip code. You have a special enrollment period that allows you to change plans.

Answer: Medicare brokers are paid commission by the insurance carriers. For Medicare Advantage plans, CMS controls what we are allowed to receive as commission. Medicare Supplements generally pay less up-front commission than Medicare Advantage but can pay more in subsequent years called renewal commission. To me the amount of commission is so close it shouldn't matter, but it may to other agents. I am going to do what is in the best interest of my client either way. Keeping customers on the books is how one succeeds in this business.

Answer: Medicare does not pay for room, board, or long‑term “custodial” care in a memory care facility. It can, however, cover many medical services a person in memory care needs (doctor visits, skilled nursing, drugs, hospice, etc.).

Answer: If you already have Medicare because of disability, you generally stay on Medicare when you turn 65; your entitlement simply changes from “disability‑based” to “age‑based,” and you get a new window to review and change your coverage (called IEP). You do not have to reapply for Medicare Parts A and B, but you should treat 65 as a new planning opportunity.

Answer: An HMO‑POS Medicare Advantage plan is an HMO that adds a limited “point‑of‑service” option to use certain out‑of‑network providers at a higher cost. It sits in between a straight HMO and a PPO in terms of flexibility and cost. Most of the ones I have dealt with allow out of network coverage for dental benefits.

HMO: With rare exceptions (emergencies, urgent care, out of area dialysis), you must use in network providers for coverage.

HMO POS: You can go out‑of‑network for some services, but at higher cost.

PPO: Covers in‑ and out‑of‑network care, and you can see specialists and out‑of‑network providers without referrals.

I hope this helps.

Answer: It is not absolutely necessary to change things every year, but it is good to stay up on any changes that are taking place. If you have a Medicare Advantage plan, you should receive an "ANOC" (Annual Notice of Change) each year (Usually around September) for any changes effective January 1st.

of the following year. If there are significant changes then by all means look at your options. Your agent should be contacting you if there are significant changes by the way. If you have a Medicare Supplement (Medigap), and your rates have gone up, you could always see if you are able to great through the Medical Underwriting to change companies. If you are on a plan G, you could consider going to plan N, or even eliminating the monthly premiums altogether by switching to a Medicare Advantage plan. Remember, once you go from a Medigap plan to a Medicare Advantage plan you may not being able to go back to a Medigap due to pre-existing conditions.

Answer: Agents and companies are allowed to offer up to a $15 gas card, gift card etc. for marketing purposes not to enroll you. It's just to get the opportunity to speak with you about your needs.

Answer: The part B deductible is reset based on inflation. It is indexed to inflation just as the part B premium and your Social Security benefits are.

Answer: You might consider a Medicare Supplement plan N or High Deductible G instead of a regular plan G. The plan N has a small co-pay for doctor visits (no more than $20) and a $50 co-pay for the emergency room (waived if admitted within 24 hours). It doesn't cover excess billing on part B services but some states like Ohio do not allow this anyway.

Answer: Well, you can make a change to Medicare Advantage plans every year, so I would have to say, not going with a Medicare Supplement instead during their Initial Election Period. Once you are past the guaranteed issue phase you have to be able to pass underwriting and many people cannot.

Answer: If you are not receiving monthly Social Security benefits you will need to enroll in Medicare parts A & B by going here. -->  Sign up for Medicare | SSA.

If you are already receiving Social Security benefits you will be automatically enrolled into Medicare parts A & B. Once parts A & B are effective you can choose a Medicare Supplement or a Medicare Advantage plan.

It is best if you work with an independent Medicare Broker to develope a plan that meets your needs.

Answer: If you have a Medicare Advantage plan, you can change every year during AEP, although I do not suggest this. If you move, or your Medicare plan cancels your coverage (due to no fault of your own) you will have a Special enrollment Period to change plans also.

If you are enrolled in original Medicare and also enrolled in a Medicare supplement, you can change anytime but will be subject to medical underwriting and possibly a declination.

Answer: Yes, you can enroll in Medicare even if you've never paid into Social Security due to working overseas. However, your eligibility and costs will depend on your residency status and work history.

To qualify for Medicare, you must be either a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five continuous years before applying. Part A (Hospital Insurance) is generally premium-free if you've worked and paid Medicare taxes for at least 10 years (40 quarters). If you have fewer than 30 work credits, you'll pay the full premium for Part A. For 2025, the standard Part B premium is $185 per month.

If you haven't paid into the system, you may still qualify for premium-free Part A by paying a premium for both Part A and B. It's crucial to contact Social Security to verify your eligibility and to purchase Part A and B if necessary.

Answer: Most nursing home care is custodial care, which helps you with activities of daily living (like bathing, dressing, using the bathroom, and eating) or personal needs that could be done safely and reasonably without professional skills or training.  Medicare does not cover this type of care.

Medicare Part A (Hospital Insurance) may cover skilled nursing care in a nursing home. It must be medically necessary for you to get skilled nursing care (like if you need help changing sterile dressings). There are limitations.

If you're in a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan, check with your plan to see if it covers nursing home care. Usually, plans don't help pay for this care unless the nursing home has a contract with the plan. Ask your plan about nursing home coverage and check the facility’s quality ratings before you make any arrangements to enter a nursing home.

Answer: Not all people are unhappy with Medicare Advantage plans. The people that are unhappy with these plans are those that do not want to have to go to a doctor in network or have to pre-certify a medical procedure. They hear from their friends and or medical billing people that dealing with a Medicare Advantage plan is harder than dealing with original Medicare and a supplement company. In a lot of cases, it is. But there are always tradeoffs with every decision. If you want to be able to go to any doctor and never have to worry about having a procedure approved or pre-certified, then you will have to pay a monthly premium for a plan that offers that. A lot of people are on a fixed income and cannot afford the premiums going up every year.

Having a Medicare Advantage plan is like having a commercial Group health plan with no or low monthly cost and having original Medicare with a supplement gives you more control and freedom but there is a price connected to that.

My job as an independent Medicare broker is to educate and let the client decide. Either way, I am here to help them.

Answer: Guaranteed Issue is available for up to 6 months after your Part B becomes effective, and it doesn't have to coincide with the Medicare Open Enrollment Period. There are also other Special Enrollment Period situations in which Guaranteed Issue applies such as your carrier canceled your plan, you moved out of the carrier's service area, etc. Always consult an independent agent before making a decision.

Answer: Yes. There are a lot of honest, independent agents like me trying to make a living by doing the right thing for our clients. There are always bad apples trying to make a quick buck. You should never talk to anyone you have not given prior permission to contact you.

I will add, check them out with a platform like Medicare Agents Hub, etc. before doing business with them. Ask your friends and family for referrals.

Answer: Yes, occupational therapy is generally covered under Medicare Advantage plans provided it is considered Medically necessary. They must cover at least what original Medicare part B does. However, you will probably need to have these services preauthorized. Always consult your plans Explanation of Coverage.

Answer: There are tradeoffs with every decision we make in life, and this is no different. If you can afford the monthly premium for a Medicare Supplement and keep original Medicare, this will allow you to go to any doctor that accepts original Medicare. There are no networks to worry about, normally no pre-certifications and you have essentially 100% coverage (Less a small part B annual deductible, $283 in 2026) If you do this you will also need a standalone PDP plan (Medicare.gov has some inexpensive plans).

If you choose a Medicare Advantage plan, in most cases you will have no monthly premium and these plans can include prescription drug coverage. There will be co-pays and co-insurance amounts you are responsible for each year when you use your plan. There is a pre-determined maximum out-of-pocket each plan year. You will have to use certain doctors that are in network or you will pay more for your services. With an HMO you are responsible for all cost outside of network and with a PPO, you will be charged more but there are out of network benefits.

The Medicare Advantage will offer some other ancillary benefits that original Medicare does not.

Questions to consider.

Do you travel lot?

Do you want to be able to go to any doctor, when you want to?

Can you afford the extra monthly cost of a Supplement premium?

Answer: For 2026 here are your responsibilities (out of pocket cost).

Part A deductible: There is a $1,736 deductible for inpatient hospital care.

Then Medicare part A pays 80% and you are responsible for 20% for 60 days. If you are still hospitalized on the 61st day, you start paying a $434.00 per day coinsurance. If you get out of the hospital a then get re-admitted after a 60-day gap of not being hospitalized, these charges can start over.

Part B Deductible: The annual deductible for part B services is $283. Then Medicare pays 80% ad you are responsible for 20%.

There is not an out-of-pocket maximum. You are responsible for 20% of Whatever unless you have a Medicare Advantage plan which caps the maximum or a Medicare supplement which pays all medical expenses except the $283 part B deductible.

Answer: Yes, once you are approved and your policy is in force, there should be no limitations on something like that.

Answer: That all depends on whether you feel your current plan still meets your needs. Medicare Advantage plans can change every year. Sometimes it is small changes like a slight increase in a co-pay versus other times they may eliminate a benefit like reducing the OTC benefits, eliminating Silver Sneakers, reducing dental benefits etc. There is no one size fits all. It is important to find an independent Medicare Broker, like me that will work with you find what works for you.

Answer: Original Medicare (Part A and Part B) covers the diagnosis and treatment of cataracts, including laser surgery. However, Original Medicare only covers 80% of the diagnosis and treatment. If you have a Medicare Supplement (Medigap) plan, it should cover the other 20% minus any part be deductible (up to $283 for 2026). If you have a Medicare Advantage plan, more than likely you will pay the 20% yourself out of pocket up to your plan maximum out of pocket. Keep in mind there is usually $0 monthly premium for the Medicare Advantage plan where there is a monthly premium for the Medigap plan.

I hope this helps.

Answer: There is no one size fits all for Medicare. It depends on income, travel expectations, health conditions, desire to have no network or have to be subject to a network, etc.

With a Medicare Supplement plan G for instance, you can go to any doctor that accepts original Medicare. There is a small part B deductible (2026 is $283) Other than that the only out of pocket a person should experience is the yearly premium for your coverage. It offers the lowest out of pocket for a Medicare eligible person. However, if a person is in fairly good health and doesn't want to pay a monthly premium, he/she can enroll in a Medicare Advantage plan that operates more like a person's previous group healthcare coverage. There are co-pays and co-insurances that are payable at the time of service rendered and there is an out-of-pocket maximum. Once that out of maximum is hit all coverage from that point for the rest of the calendar year is covered in full. The difference is that with a Medicare Advantage Prescription Drug plan (MAPD), everything is included in one plan, there is usually no monthly premium for the plan, no deductible for medical coverage and a zero co-pay for your primary care provider visits. It is an individual choice but choose wisely, if you choose a Medicare Advantage plan first and then want to go to a Medicare supplement after one year, you will be subject to medical underwriting.

Answer: Contact myself or any independent licensed Medicare agent and we/ they can assist you in the application process.

Answer: There are two ways this can happen: one, you are present and simply want her opinion and approval on health decisions made and two, your daughter has a POA and can speak on your behalf.

Answer: Yes, some Medicare Advantage plans do cover acupuncture and other alternative therapies. However, the coverage can vary significantly depending on the specific plan. Original Medicare (Part B) covers acupuncture for chronic low back pain, but only under certain conditions. Medicare Advantage plans, offered by private insurance companies, are required to cover everything Original Medicare does, but many go further and include extra benefits. Some plans may offer more extensive acupuncture coverage or even cover treatments for conditions besides back pain. It's essential to check the Summary of Benefits and contact the plan directly to inquire about specific coverage details.

Answer: We can help but would need to have another person who has POA to be able to do so. The Medicare beneficiary would not be able to speak on their own behalf.

Answer: You would have to check and see if you qualify for one of the Medicaid levels (state program) that assist in paying those premiums. Depending on your health, you may also look at one of the insurance carriers that offer what is called a "part B Giveback". These plans most of the time have a higher out of pocket maximum in medical cost (when you use them) but if you are relatively healthy it could be an option. They are called give back programs because they put money back into your social Security check and this essentially reduces your part B premium.

Answer: It is for your prescription drugs to be covered that are not considered Medicare part B expenses. (Like some chemotherapy drugs, etc.) In 2026, there can be a prescription deductible as high as $615 and a total out of pocket maximum of $2,100.00. Some companies have no deductibles or low deductibles but the highest they can have according to CMS is $615. No matter what an insurance company chooses to make their prescription deductible, that amount counts toward the $2,100.00 out of pocket maximum.

Answer: Because when a Medicare beneficiary decides to go onto a Medicare Advantage plan, they are no longer on original Medicare. The money that would have been used by Original Medicare to pay your medical bills will now be sent to the carrier you choose. You continue to pay your required Medicare part B premiums and these funds along with other monies is funded to the private insurance carrier to administer your health care plan.

Answer: Working with a reputable Medicare Insurance Broker is the start. Make sure you give the name, dosage and frequency of all your prescription drugs, your doctors and even your preferred pharmacy to your agent. They can make sure that the companies you are considering covers all and that the cost is reasonable.

Answer: It speeds up the process of getting someone care in a time of need. It also can save you hard earned dollars by reducing travel and wait times.

Answer: No, Medicare Advantage plans are no different than most people's previous employer coverage. There are always tradeoffs in life. I feel the vast majority of MAPD plans are well run and will take care of their Medicare Beneficiaries.

Answer: Yes, improper health care planning could derail the rest of your financial planning. You've worked hard to retire, let's make sure you are properly insured in order to protect your nest egg.

Answer: Every company that offers a Medicare Advantage plan is funded through CMS and the MAPD plans must be actuarily the same as original Medicare. However, some companies may decide to put the money funded by CMS toward benefits they feel are more heavily utilized than others.

Answer: That shots and infusions done in a medical facility are covered under Medicare part B and not D. If they have an ongoing medical condition, that require expensive drugs, they should consider going on a Medicare Supplement during their IEP.

Answer: Thankfully, the law changed and the Donut Hole is gone bye, bye! We now have just 3 phases, The deductible phase, initial phase and the catastrophic phase.

***2026***

Carriers are allowed to have up to a $615 deductible, but not all do, the second phase is where you, the manufacturer, the insurance carrier and Medicare share in the cost of drugs included on the carrier's formulary list. There are a few tiers and co-pays and coinsurances vary between carriers.

However, once you and all parties on your behalf have paid $2,000.00 in a year for your covered drugs, they will be covered at 100% for the remainder of that plan year.

Answer: It will not affect your Medicare eligibility. As long as you continue to pay your Medicare part B premium, you will keep original Medicare. If you are on a Medicare Supplement or Medicare Advantage plan and you continue to pay your premium (if there is one), you will maintain your coverage.

However, if any of your medical providers are included in the bankruptcy, they could in the future require payment up front for any services rendered.

I hope that helps.

Answer: It depends if you are past your Initial Enrollment period and whether you are on a Medicare Supplement or Medicare Advantage plan. You will want to seek advice from a Medicare Agent that can make sure your doctors are in network, your prescriptions are in the formulary and whether or not you qualify for a C-Snp, D-Snp, or at least (LIS) Extra Health with prescriptions.

Answer: A person would have to be considered homebound based on the Centers for Medicare & Medicaid (CMS) criteria, require skilled care on a part-time or intermittent basis to improve, maintain, prevent, or further slow your health condition and be under the care of a nurse practitioner, clinical nurse specialist, physician’s assistant, or doctor, who completes and documents an in-person visit with you either: three months before the start of home health care, or within one month after the home health care benefit has begun and receive home health care from a Medicare-approved home health agency.

You aren’t typically eligible for Medicare home health benefits if you need full-time skilled nursing care for an extended time period. Medicare covers specific services. These services include physical therapy, occupational therapy, speech-language pathology services, medical social services, medical supplies, and other services provided in your home. Recent changes to the law may allow for the increased ability to use telehealth.

If there are any home-based services that Medicare will not cover, your home health agency must advise you in writing through something called an Advance Beneficiary Notice of Noncoverage (ABN). If you disagree with Medicare’s decision to not provide coverage, you may be able to file an appeal.

Answer: You should always look at each prescription, doctor, pharmacy and facility you use to make sure they are covered by the plans you compare. That advice is too simple. I suggest using an independent insurance agent that focuses on Medicare benefits. Someone willing to take the time and educate you on all potential pitfalls.

Answer: Not necessarily, however some dental networks seem to be better than others. You could call your provider and see if they offer out of network benefits. Usually, the carriers that do this offer less benefits, but it is still something. You may have to pay first and then get a partial re-imbursement based on the allowed fee for a particular service. You could always purchase a stand-alone dental insurance plan.

Answer: If you are already on Disability benefits, Medicare will automatically enroll you in Medicare parts A and B when you reach your 24th month of disability benefits. You shouldn't have to do anything. At this time, you can decide to add a Medicare Supplement and stand-alone prescription drug plan or enroll in a Medicare Advantage plan.

Answer: They absolutely can. However, they do have co-pays and co-insurance that you as a Medicare beneficiary have to share in. They can have no monthly premium, no deductible, no co-pay for seeing your primary care physician, but they do have a per day cost for each day in the hospital (usually up to 5 or 7 days) as well as other co-pays for see specialist, getting lab work, etc.

There is a yearly predictable maximum out of pocket for most Medicare Advantage plans. It is important to review your prescriptions, potential doctor visits in a year and compare the potential total out of pocket medical cost between going with a Medicare Advantage vs. a Medicare Supplement.

Answer: Medicare does not cover routine eye exams for eyeglasses or contact lenses. However, it does cover certain eye exams and treatments related to specific conditions such as glaucoma, diabetic eye disease, and macular degeneration. Medicare Part B covers diabetic retinopathy eye exams once a year for patients with diabetes and provides an annual glaucoma eye exam for those at high risk. Additionally, Medicare Part B covers certain diagnostic tests and treatments for age-related macular degeneration. For cataract surgery, Medicare Part B covers one pair of eyeglasses or contact lenses.

Seniors who have Medicare Advantage plans may have additional coverage for routine vision care, including annual eye exams and eyewear. However, the coverage and limits are set by the private insurance companies that offer these plans. It is essential for seniors to review their specific Medicare Advantage plan details to understand the extent of their vision coverage

Answer: It may, however, it is important to review each prescription against any plan you are considering and make sure that each drug is on the carriers Formulary list, what tier it falls under and whether or not you would benefit from CMS' new M3P plan.

Answer: They absolutely can, however, you need to know what state your provider's contract is being judged and whether or not those ratings pertain so much to where you are located. Sometimes if a carrier is new to your area, or new to the business in general, it can take a little while for the ratings to mature and settle to a more accurate rating. This is my opinion.

Answer: It does not offer incentives for things like that, but it does pay for many preventative services to help you stay healthy. Some Medicare Addvantage plans offer financial incentives for preventative health behaviors. Some plans pay you incentives for things like going to the gym, annual wellness visits, different types of screenings, etc. It is important to review several plans and types of coverage before making a decision concerning your Medicare health care plan.

Answer: Medicare does not cover home modifications like stairlifts for safety reasons. These modifications are considered non-medical or home improvement expenses and fall outside Medicare’s standard coverage. However, if a medical prescription justifies the need for a stairlift, it may be purchased without paying sales tax, provided it is used in the home.

Medicaid, VA Benefits, State Assistance programs or even local Non-Profits may have grant programs to help with things like this.

Answer: If an individual is disenrolled from a Medicare Advantage C-SNP for not qualifying due to not providing a required Chronic Condition Verification (CCV) form within 60 days, they may qualify for a Special Enrollment Period (SEP) to enroll in another Medicare Advantage plan. This SEP typically begins when the individual is notified of their disenrollment and lasts for two months.

It is important to make sure you qualify before enrolling, to avoid the hassle of having to change plans twice.

Answer: You cannot be denied, if you are enrolling during a period of time that would be considered a guaranteed issue time period. For example, the best time to enroll in a Medicare Supplement would be your (OEP) Open Enrollment Period, which is the 6-month period that begins the first month you are 65 or older and enrolled in Medicare Part B.

The other exception would be during guaranteed issue rights. This could be if you lose employer coverage, your Medicare Advantage plan is leaving the service area or if you decide to go from a Medicare Advantage to a Medicare Supplement within the first 12 months of being enrolled into that Medicare Advantage plan. (This is only available one time).

Outside of these instances, Medicare supplements require a person to go through medical underwriting and therefore, you can be denied coverage.

Answer: It depends on what plan you have. Some plans offer limited international coverage. You would still be required to pay it and then have the insurance company reimburse you. There is very limited coverage though. I think anyone traveling internationally, one should consider a standalone international healthcare plan. These are plans that cover international travel for a selected period of time for a one time premium.

Answer: I always use the example of pay now or pay later. With a Medicare Advantage plan you do not have a monthly premium as with a Medicare Supplement, but you do have co-pays and co-insurance cost if and when you use the plan. The max out of pocket with a Medicare Supplement Plan G for instance is the total of all monthly premiums plus the Part B deductible (currently $258 in 2025), where the out-of-pocket maximum with a Medicare advantage is going to be the co-pays and co-insurance amounts added together up to the maximum out of pocket or (MOOP) for the particular plan you have chosen.

Answer: The answer to that question is yes, Medicare and everything else is becoming more expensive. Just like in the stock market, corrections are necessary to bring prices more in line with the reality of earnings, I believe changes in coverage, reduction in expenses, waste, fraud and abuse will have to be dealt with in order to maintain these programs. We deal with it as it comes. The answer is to live within your means, try and eat right and stay as healthy as possible, and lastly, try not to worry about things that aren't a reality yet.

Answer: No, it is not. Although there maybe plans available in your area that has ancillary benefits like this, no agents are permitted to call you without having your express consent to do so before the call. I would report the number to the Department of Insurance in your state and the FTC for calling you when not allowed.

Answer: Anytime, the government pays for more benefits it will make taxes and cost go up. Not everyone wants dental, vision and hearing benefits, therefore I believe it should be up to the individual whether or not to add that coverage. I hope that helps.

Answer: Most of the time, all I see is slightly higher co-pays and slightly less extra benefits than HMO plans. The biggest reason to go with a PPO is if you are planning on traveling a lot or have a plethora of medical professionals you see for several different reasons. I hope this helps.

Answer: Start reading and preparing late September or early October. Agents are allowed to tell you about the new plans coming for the next year starting 10/01 but cannot submit an application until 10/15. I hope this helps.

Answer: Mostly the limitations of only having coverage for in network services, except for emergencies and some offer limited situations.

Answer: There are Medicare Advantage plans that use PPO Networks and HMO networks. PPO networks are larger and offer in and out of network coverage, although you will incur a higher out of pocket cost for out of network services. HMO plans offer in network coverage only except in the case of emergency care and some other limited situations. In some states there are PFFS (Private Fee for Service) plans. These plans allow you to go to any doctor that accepts original Medicare and is willing to accept the PFFS plans terms and conditions. I hope this helps.

Answer: Since Medicare Advantage plans use networks, this can happen. If you are concerned about this, you could do one of two things. You could make sure you go with a PPO plan, so that even if the facility were to drop out of the carrier's network, there would still be some out of network coverage. Secondly, you could consider purchasing a Medicare Supplement plan. These plans do not use network and allow you to see any doctor or go to any facility that accepts original Medicare. I hope this helps.

Answer: Yes, they can deny coverage. However, there is an appeal process you can use to see if the insurance company will make an exception. It may require an explanation from your physician as well as supporting documentation, but it can be done. I hope this helps.

Answer: It should cover everything that is considered medically necessary. You have your part B deductible, and it should cover the 20% that original Medicare doesn't cover. Check and see if your state allows for balance billing. My state does not. Balance billing is when the doctor or facility charges more than is allowed by Medicare.

Answer: Yes, once your initial enrollment period is past you will have to go through underwriting. The only exception to this I know of is, if you enroll in a Medicare Advantage plan and then change your mind, you can change to a Medicare supplement within the first 12 months of enrolling in your Medicare Advantage plan. This is an SEP call Trial Right SEP.

Answer: Not necessarily. I think you must look at, what is the chance I am going to have ongoing health issues? Are you going to have to pay these co-pays every year? And also, even if you do, Will these copays equal more than the monthly premium, I would have paid for a Medicare supplement and a standalone PDP plan? You may consider buying a hospital indemnity plan. These policies help with out-of-pocket copays and still cost less than Medicare supplements. You can use them in conjunction with your Medicare Advantage plan.

Answer: Are my doctors in network, How are my prescriptions covered by the insurance companies formulary list, will I be traveling a lot, Does the plan I am considering pay for charges outside of their primary network.

Answer: You have a guarantee issue enrollment period when you first become eligible, due to turning 65 or coming off of a group health plan after age 65. Once you pass this initial enrollment period and want to change plans you may be required to go through underwriting to see if the insurance company deems you insurable. The only exception I know of is, if you enroll in a Medicare Advantage plan and then decide you want to go to a Medigap (Supplement plan), You can, during the first year of coverage. This is called a Special Enrollment Period ( SEP). It is called your Trial right SEP. You can always go back to a Medicare Advantage plan, as there is no underwriting with these products. However, if you want to change from one company Medigap to another you would be subject to underwriting.

Answer: You will have 60 days from the time you come off your group coverage to enroll in a supplement or Medicare Advantage plan. The Social Security Administration will tell you that you have 8 months to enroll in part B from your last day of coverage. While this is true for part B, it is not true for a supplement or a Medicare Advantage. If you miss this deadline, you may have to wait until the next Open Enrollment to enroll in a plan.

Answer: There are resources for folks that have limited resources. Medicaid and local support services. Low income subsidies as well as dual-eligible plans.

Answer: Annuities can provide a dependable income that can not be outlived. They also can allow you to take money that has taxable interest income and move it into a tax deferred account. This could possibly lower your income enough to reduce part B premiums and more. There are also, no-load fee-only annuities which do not have surrender penalties or fees.

Answer: As an agent, I do both but I always offer in-home consultations. I think people appreciate being able to put a face to a name. It is comforting to know your agent cares enough to meet with you from time to time to help you.

Answer: The OTC benefits may be used to cover things like, minerals, vitamins and other needs. Not all plans other these benefits and the amount allotted is different from plan to plan.

Answer: You can use a discount card to use toward prescriptions not covered by your plan. You have to remember though, that these purchases will not count towards your deductible or your out of pocket maximum.

Answer: Yes, but there are stipulations. If you have been enrolled for more than a year in the Medicare Advantage plan, you may have to qualify health wise by answering a few underwriting questions. If you have been enrolled in your Medicare Advantage plan less that 12 months, you can use an SEP called, the Trial Right SEP any month during that first year of MAPD enrollment. This is a once in a lifetime SEP.

Answer: It is always good to have an advocate. If you work with an independent agent, you have a small business owner that needs and wants your business. If that person is worth their salt, they will always put your interest before their own. The thing that benefits the independent agent more than anything, is what I call shelf-life. The longer you stay with an independent agent the more they make and are able to grow their business. Also, buying from an independent agent doesn't cost you anything. The price and benefits are the same. However, as your needs change, or benefits change from year to year and from company to company, that agent can always steer you to the plan and company that best fits your needs through the years. Relations matter, 800 numbers can't do that.

Answer: I walk them through a presentation that explains original Medicare basics, what is covered and what is not. Then, I explain how to cover what original Medicare does not and the pros and cons of each solution. This allows the client to make an informed decision as to what they think works best for them. I educate and the client decides.

Answer: There are several things to consider. #1 You could be opening yourself up to multiple deductibles due to the fact that a new Part A deductible could be assessed each benefit period (60) days. #2 there is no maximum out of pocket expense on the 20% you would be responsible for. Original Medicare only covers 80%, you are responsible for the 20% with no cap, each and every year.

Answer: Not necessarily. It covers a large percentage (80%) of covered expenses but the 20% the Medicare beneficiary is responsible for has not cap and medical expenses can add up quickley.

Answer: Being involved in the decision-making process. Offering support but giving them the power to decide.

Answer: Because there are many seniors that have extremely high-cost drugs. The lower out of pocket maximum could very well be the difference in life or death for some people.

Answer: I was able to explain to a person who wanted to enroll into a Medicare Advantage plan, that since he had very expensive infusions every 3 months, he would max out his out-of-pocket expenses with the MAPD plan due to the infusions being given in the medical facility. They would have been covered under Part B (20% co-insurance). Instead, I enrolled him in a Medicare supplement that covers all part B except the small part B deductible each year. It has saved him approximately $5,000 every year.

Answer: I just love seeing them have that ah ha moment. It makes me feel good knowing that they have peace of mind because of something I have had a small part in.