Evan Agona, Medicare Insurance Broker

Answer: Here’s an updated version with that note included:

Medicare generally covers cataract surgery under Part B when the procedure is considered medically necessary due to vision problems affecting daily activities like driving, reading, or ability to work. Coverage typically includes the surgery itself, the surgeon and facility fees, anesthesia, a standard lens, and follow-up care. After the Part B deductible is met, Medicare usually pays 80% of the approved amount, leaving the beneficiary responsible for the remaining 20% unless they have supplemental coverage.

Medicare also covers one pair of standard eyeglasses or contact lenses after cataract surgery with an implanted lens. However, premium upgrades or certain laser-assisted procedures are often not fully covered and may result in additional out-of-pocket costs. Individuals with a Medicare Supplement plan may have little to no cost-sharing, while those enrolled in a Medicare Advantage plan may have specific copays, coinsurance, and network requirements depending on the plan.

Overall, cataract procedures are generally covered pretty well for Medicare beneficiaries, however, it is important to review each plan’s Summary of Benefits and Evidence of Coverage to understand how cataract surgery, outpatient procedures, and lens upgrades are covered under that specific plan.

Answer: If Medicare premiums or healthcare costs are difficult to afford, there are programs available that may help reduce or even eliminate some of those expenses.

Medicare Savings Programs are state-run programs that may help pay for Medicare costs depending on income and financial eligibility. These programs can help cover Part B premiums, and in some cases may also help with deductibles, coinsurance, and co-pays.

There is also a program called Extra Help, which helps reduce the cost of prescription drug coverage. Individuals who qualify may pay lower premiums, lower deductibles, and reduced co-pays for medications.

In some situations, individuals with very limited income may also qualify for Medicaid in addition to Medicare. When someone has both Medicare and Medicaid, it may help cover premiums and additional out-of-pocket healthcare costs. These are often referred to as dual-plans.

Additionally, it may be as simple as meeting with a Medicare Broker to review your plan annually and switch to a plan the better suits your budget, needs and coverage. Reviews are free of charge and often times a broke can find a plan to save you money.

Answer: Medicare only covers chiropractic adjustments when they’re treating a specific spinal problem that’s expected to improve. Medicare Part B only covers manual adjustments when it’s medically necessary. The patient typically pays 20% after the Part B deductible. Services like routine maintenance adjustments, X-rays ordered by the chiropractor, massage, and other therapies are not covered under Original Medicare. Once it becomes routine maintenance, Medicare stops paying.

Some Medicare Advantage plans offer additional chiropractic benefits, often including a set number of visits per year with a copay.

Answer: Medicare Part B is the medical insurance part of Medicare. It covers care you usually get outside the hospital, items such as; doctor visits, outpatient services, preventive care, durable medical equipment, mental health services and some home health care.

For your Part B, you pay a monthly premium. There is a yearly deductible which is 2026 is $283 before Medicare starts paying it's share. After that, you usually pay 20% coinsurance for approved services. There is, no out-of-pocket maximum unless you add a Medicare Supplement or Medicare Advantage plan.

Answer: Medicare Plans run on the 12-month calendar and reset each year on January 1.

If you are on Original Medicare, when the deductible resets each January, you’ll temporarily cover the 80% of outpatient service costs that your insurance usually pays until you’ve met the $283 deductible rate for 2026. While you’re paying to meet that deductible, 20% of your total payment will still be used to cover your coinsurance for each service. These costs will show up in your first few medical bills of the year and could be from your primary care provider, specialists you see, or remote patient care programs.

If you are on a Medicare Advantage Plan or Prescription Drug Plan that has a deductible, those also reset at the beginning of the calendar year. You will be responsible for meeting any deductible prior to the coverage applying.

Answer: If a spouse passes away the surviving spouse may be eligible for up to 100% of the deceased benefits. However, if you are already getting your own social security benefits you will not receive both you will receive the larger of the two amounts. Additionally, the surviving spouse is eligible for a one-time $255 death benefit.

Answer: The best way to compare to compare any type of Medicare plans is to speak with a licensed brokers. Licensed brokers typically have access to most major carriers in your market and are experienced to evaluate and help clients best understand the key differences between plans.

Typically, the biggest differences between Supplement Plans and Advantage Plans is the up front premium costs and the accessibility to doctor/hospital networks. Many Advantage Plans are available at $0 monthly premiums or low monthly premiums, but have higher out of pocket costs compared to the Supplement Plans that have more significant up front premium costs, but much lower out of pocket costs. Additionally, because Supplement Plans keep clients in Original Medicare benefits, beneficiaries can see doctors anywhere in the country and are not required to stay in a local network like most Advantage Plans. Lastly, Supplement Plans do not include drug coverage with most Advantage Plans do.

Again, it is recommended to meet with an experienced professional to evaluate what plan best suits your needs and budget.

Answer: The best part about being a Medicare agent is helping people. Each day is different and each client creates new challenges. I enjoy talking with people and helping them navigate what can me a complex process. Personally, working in this role it provides me the flexibility to set calls and meeting around my schedule to be involved in all the sports and activities that my family are participating in.

Answer: The best part about working in this industry is truly trying to help people that need assistance. The Medicare industry is complex and can be overwhelming to many, but that is where we can help. Is rewarding to help individuals to safe money and find plans that are better aligned with their needs as they change from year to year.

Answer: Both routes have pros and cons, it is really about preferences and the right fit for each individual. One of the biggest advantages to a Medigap policy is that they do not have networks. So if an individual travels a lot or splits time between different residences (Ex. Snowbirds) this may be a better option as most Advantage Plans work with a set network of doctors and facilities. One other big difference is that many Advantage Plans have no monthly premiums, whereas Medigap policies have some significant premiums, but often little to no out of pocket expenses. While there are some other differences between the two, the other significant difference is that a Medigap policy will require a beneficiary to also purchase a prescription drug plan, while most Advantage plans they are included.

Answer: That if you change plans you have to change your doctors. On the contrary when shopping for plan options we are able to using comparison tools to find plans that will allow beneficiaries to maintain their current doctors and hospitals. Many times a beneficiaries current doctors and hospitals are considered to be in-network with multiple carriers, however, a new carrier may provide additional items that better align with their needs.

Answer: Medicare will not directly pay for you groceries, but on certain plans there are funds that can help individuals with the cost of groceries and other over-the-counter type items. Many advantage plan programs provide a monthly or quarterly card that is loaded to be used similar to a pre-paid debit card.

Answer: Original Medicare (Parts A & B) do not cover hearing aids. However, most Medicare Advantage Plans (Part C) do offer varying amounts of coverage levels.

Answer: Yes beneficiaries should receive an ANOC by early October each year via mail or email. If you do not receive one it is important to contact your carrier. These documents while lengthy are important as the outline potential adjustments to your plan from the previous year such as change in premiums, prescription costs or providers coming in or leaving the network.

Answer: If you call the carrier they are only going to look at plans that they offer. Working through an agent/broker they have the ability to shop and compare multiple plans to see what plan may best fits your needs. Different carriers will cover things such as certain drugs are at different rates as well and have varying extra benefits such as OTC allowances, etc that may be beneficial.

Answer: The cost of Medicare plans are determined by a number of factors beyond just your zip code. The primary factors of cost determination are deductables, co-payments, co-insurance, prescriptions and extra benefits such as OTC cards, Fitness Programs, etc.

Answer: Medicare agents are trained and certificated to help beneficiaries make the best decision on selected a plan. With so many changes to plans each year it is difficult for the average person to stay up to speed, while agents are required to study the various changes year to year to assist beneficiaries. Additionally, if you work with an independent agent or broker they have access to multiple plans to shop around for the best fit versus contacting one particular carrier directly.

Answer: Once you are a Medicare beneficiary, the benefits themselves are generally not subject to federal income tax.

However, you may have to pay income tax on your Social Security benefits, which often cover your Medicare premiums, depending on your income level.