Erick Vallarino, Medicare Insurance Agent

Answer: The Medigap plans that cover emergency care outside the US are C, D, F, G, M and N. Plans A, B, K and L do not. For an emergency during the first 60 days of a trip, the plan pays 80% after a $250 deductible each year, up to $50,000 over your lifetime. Original Medicare by itself almost never pays for care outside the country, so if you travel frequently or even if you take a long trip, I recommend at least looking into travel insurance.

Answer: Hello! It's paid once a year, not once per tier. The plan has one drug deductible, and whatever you pay toward any drug, tiers 2-5, in your plan count toward the same total. Make sure that your plan applies the deductible starting on tier 2 drugs, since a lot of plans only apply the deductible to tiers 3 through 5. Once you meet it, it's met for the rest of the year and resets January 1.

Answer: Yes, all three medications are covered by Medicare, but under different parts, depending on how the drug is taken. Veletri is usually covered under Part B, with the pump covered as medical equipment. Under Original Medicare you pay 20%, but a Medigap plan can help cover that 20%, and under an Advantage plan you pay the plan’s copay instead.

Ventavis is also usually covered under Part B, along with the nebulizer. And just like with Veletri, you may pay 20% or an Advantage plan’s copay.

Since ambrisentan is a pill, it is covered under Part D, and it’s usually on the specialty tier of a plan’s formulary. The good news is that Part D has a yearly out-of-pocket cap: $2,100 for 2026 and $2,400 for 2027.

As your Medicare agent, I can always help you check which plan covers your PAH drugs and what each one would cost for the year.

Answer: Things like your yearly wellness visit, flu and COVID shots, mammograms, colon cancer screenings, and diabetes and heart screenings are free when your doctor takes Medicare. Where people get surprised is when the visit turns into more than a screening. If you bring up a new problem or the doctor finds something and orders tests, that part can have a copay or coinsurance. Also, the yearly wellness visit isn't a full physical, so ask your doctor's office what they're billing it as.

Answer: Good news, the donut hole is gone. Since 2025 there's no coverage gap anymore, and for 2026 the most you'll pay out of pocket for covered drugs in a year is $2,100 and $2,400 in 2027. If big costs hit early in the year, I can help you can help you plan about the Medicare Prescription Payment Plan. It splits your copays into monthly payments instead of paying hundreds at the pharmacy in the early months of your plan. It's also worth checking if you qualify for Extra Help, because that can lower your copays a lot.

Answer: Put your zip code in the search on this site and you'll see agents licensed in Ohio near you. I'd look for an independent agent, because they can compare all the different plans in your area, which usually are available from several companies. Have your doctors' names and your medicine list handy when you call, and try to get it done before December 7, since that's the last day to change your plan for 2027.

Answer: Yes, Medicare still covers them after 65. You can get a Pap test and pelvic exam once every 2 years, or every year if your doctor says you're high risk or you've had an abnormal Pap in the last 3 years. If your doctor takes Medicare, you shouldn't pay anything for the screening itself.

Answer: In most cases you can keep your Plan G when you move, even if that company doesn't sell in your new state, because Medigap policies are guaranteed renewable. The rate may change based on your new address. If you choose to switch to another company's Plan G, they can usually ask health questions, unless you have a guaranteed issue right (for example, a Medicare SELECT policy whose area you're leaving) or your new state has a special rule like a birthday or anniversary rule. Before canceling anything, give your agent a call. If that’s me, I’ll check your options and help you find the best rate.

Answer: A drug lands on the specialty tier mainly because of its price. Medicare lets plans put drugs there when they cost more than a set monthly amount. You can ask for a tier exception, but plans are allowed to say no for specialty drugs, so the better moves are comparing plans during open enrollment, asking about manufacturer help or Extra Help, and remembering that out-of-pocket drug costs are capped at $2,100 for 2026 and $2,400 for 2027. As your agent, I can help you reach out to your plan to sign up for the Medicare Prescription Payment Plan, which allows you to spread the cost of your medication copays over the year. That way you pay a set amount each month instead of having to pay hefty amounts during the early months of your plan.

Answer: If you are below the poverty level, I can help you call each hospital's billing office and ask for their financial assistance or charity care application. Nonprofit hospitals are required to have one, and many will reduce or wipe out bills for people near the poverty level.

Most importantly, I help my clients apply for Medicaid and the Medicare Savings Programs all the time, FREE of charge! If you qualify for QMB, doctors and hospitals can't bill you for Medicare deductibles and copays going forward. The income limits change every year, and they count your Social Security and pension together, so apply even if you think you're a little over.

Answer: Having access to an independent Medicare agent gives you a plethora of benefits. First of all, my service is ALWAYS free to you, and whether you are entering Medicare for the first time or have had Medicare for a while, I will help you select the option that is best for you based on your doctors, medications, and the extra benefits you may be looking for, such as dental, vision, OTC, and more!

I am contracted with most of the carriers in the area that offer Medicare Advantage plans, and I am also contracted with the carriers that offer the most competitive prices for Medicare Supplement plans. This means I can help you select the plan that best fits your particular situation based on your needs, not the needs of the insurance companies, or the plan you may have been placed in years ago whose prices and benefits may have changed since you started with it. Another important fact: insurance companies pay me, not you, and the plan I help you with will not cost you a penny more than if you had gotten it yourself. The difference is that I will help you find the plan that fits your situation out of the dozens of options available in our area. And the best part of signing up with me is that you have a real person to call about bills, letters and questions instead of a 1-800 number, and I will always do my best to help you.

Other things I do:

Help with Medicaid applications, free of charge

Recommend doctors in your network

Find out what your plan covers

Year-round help with anything insurance related