Fran Lovelace, Medicare Insurance Agent

Answer: Being able to assist Medicare eligibles navigate the complex Medicare landscape. It is satisfying to know that I have helped someone choose coverage that is the best for their individual situation.

Answer: Many Medicare Advantage plans do not have a monthly premium. However, you share in the costs in the form of copays or coinsurance. This is how you are able to have no or a low monthly premium.

Answer: It can if you find a plan where the medication in on the plan's formulary. If it is on formulary, the maximum out of pocket is $2,000.00 in 2025.

Answer: Abdominal aortic aneurysm screenings

Alcohol misuse screenings & counseling

Blood-based biomarker tests

Bone mass measurements

Cardiovascular disease screenings

Cardiovascular disease (behavioral therapy)

Cervical & vaginal cancer screenings

Colorectal cancer screenings

Multi-target stool DNA tests

Screening barium enemas

Screening colonoscopies

Screening fecal occult blood tests

Screening flexible sigmoidoscopies

Counseling to prevent tobacco use & tobacco-caused disease

Depression screenings

Diabetes screenings

Diabetes self-management training

Glaucoma screenings

Hepatitis B shots

Hepatitis B Virus (HBV) infection screenings

Hepatitis C screening tests

HIV screenings

Lung cancer screenings

Mammograms (screening)

Medical nutrition therapy services

Medicare Diabetes Prevention Program

Obesity behavioral therapy

One-time “Welcome to Medicare” preventive visit

Pre-exposure prophylaxis (PrEP) for HIV prevention

Prostate cancer screenings

Sexually transmitted infections screenings & counseling

Shots:

COVID-19 vaccines

Flu shots

Hepatitis B shots

Pneumococcal shots

Yearly "Wellness" visit

Answer: $0 for most people (because they or a spouse paid Medicare taxes long enough while working - generally at least 10 years). If you get Medicare earlier than age 65, you won’t pay a Part A premium. This is sometimes called “premium-free Part A.”

Do I qualify for premium-free Part A?

If you don’t qualify for premium-free Part A: You might be able to buy it. You’ll pay either $285 or $518 each month for Part A, depending on how long you or your spouse worked and paid Medicare taxes.

Remember:

• You also have to sign up for Part B to buy Part A. Learn more about how Medicare works.

• If you don’t buy Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty. Find out more about how to avoid the Part A penalty.

Deductible $1,676 for each inpatient hospital

benefit period

, before

Original Medicare

starts to pay.

There’s no limit to the number of benefit periods you can have in a year. This means you may pay the deductible more than once in a year. How do benefit periods work?

Inpatient stay • Days 1-60: $0 after you pay your Part A deductible.

• Days 61-90: $419 each day.

• Days 91-150: $838 each day while using your 60

lifetime reserve days

.

• After day 150: You pay all costs.

What's not covered?

What will I pay if I get mental health services as an inpatient?

Skilled nursing facility stay • Days 1-20: $0.

• Days 21-100: $209.50 each day.

• Days 101 and beyond: You pay all costs.

Home health care $0 for covered home health care services.

20% of the

Medicare-approved amount

for durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

Hospice care $0 for covered hospice care services.

You may also pay:

• A copayment of up to $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home.

What if my hospice care doesn't pay for my drug?

• 5% of the

Medicare-approved amount

for inpatient

respite care

.

What's not covered?

Answer: I'm sure there's room for improvement, but things seem to work. Sometimes a little more slowly than I'd like, but it works.

Answer: October of each year. October is when the following year's plans become available for review.

------

Answer: Your plan's website should have the process to file an appeal. Your doctor's office can do it for you.

Answer: Make sure you have Medicare A and B in place. Then talk with a seasoned, reputable Medicare agent to learn the difference between Medicare Supplement and Medicare Advantage. Once you decide which path is best for you, the agent will be able to help you select the plan that gives you the lowest out of pocket for prescriptions, and has your providers in network should you choose the Medicare Advantage path.

Answer: Medicare Advantage plan benefits can differ from county to county, not just state to state. Medicare Supplement plans, however. are the same from state to state with a few exceptions,

Answer: It's possible they changed tiers. Part D plans should be reviewed each October with a seasoned Medicare agent.

Answer: Yes. Anytime you change a plan you should verify that all providers are in network. However, providers can opt out during the year, in which case, you would need to find a plan in the next enrollment period with them in network or change providers.

Answer: Long term custodial care is not provided by Medicare. That would be through a Long Term Care policy or some sort of savings plan on your part.

Answer: Medications are covered by either a stand alone prescription drug plan or a prescription plan embedded in a Medicare Advantage plan. You should check your plan's formulary.