Françoise Mueller, Medicare Insurance Broker

Answer: In most cases, a Medicare Advantage plan cannot simply drop you because you have health problems or because you are using your benefits. However, there are certain situations where your coverage can end:

* You move outside the plan’s service area.

* You lose eligibility for Medicare Parts A or B.

* You fail to pay any required plan premiums.

* The plan terminates its contract with Medicare.

* The insurance company decides to discontinue the plan. (medicare.gov⁠)

What Happens If Your Plan Ends?

If your Medicare Advantage plan is discontinued or its contract with Medicare is not renewed, you will receive advance notice and typically have a Special Enrollment Period to choose another Medicare Advantage plan or return to Original Medicare. Depending on your circumstances and state, you may also have certain protections when applying for a Medicare Supplement (Medigap) policy. (medicare.gov⁠)

The Bottom Line

A Medicare Advantage plan cannot drop you simply because you become sick, develop a chronic condition, or use expensive healthcare services. If your plan does leave the market or you become ineligible, Medicare provides opportunities to choose new coverage so you’re not left without healthcare benefits.

Have questions about Medicare Advantage plans, prescription coverage, dental benefits, or other healthcare concerns? Visit Ohana Medicare⁠. We offer concise clarity to important Medicare questions, helping you understand and manage your healthcare benefits with your best interests in mind. Explore our resources and educational content designed to help you make informed healthcare decisions with confidence

Answer: Yes. Most Medicare Advantage plans include some level of dental coverage, while Original Medicare generally does not cover routine dental care. In recent years, about 98% of Medicare Advantage plans have offered dental benefits, but the amount and type of coverage vary significantly by plan and location.

Common dental benefits may include:

* Routine exams

* Teeth cleanings

* Dental X-rays

* Fillings

* Extractions

* Crowns

* Root canals

* Dentures

* Sometimes implants (depending on the specific plan)

However, there are important limitations:

* Annual maximum benefit amounts often apply.

* Many plans require you to use network dentists.

* Major services may have copays or coinsurance.

* Benefits can change from year to year.

When speaking with Medicare beneficiaries, I would explain it this way:

“Many Medicare Advantage plans do offer dental coverage, but not all dental benefits are the same. One plan may only cover cleanings and exams, while another may also help pay for crowns, dentures, root canals, or even implants. That’s why it’s important to review the specific plan’s dental benefits rather than assuming all Medicare Advantage plans provide the same coverage.”

As an independent Medicare agent, this is also a good opportunity to remind clients that dental coverage should be just one factor in choosing a plan. Their doctors, hospitals, prescriptions, copays, and maximum out-of-pocket costs are often even more important considerations than the dental benefit alone.

We take the extra step to go through a thorough needs analysis to make sure we’re addressing all of your needs, including Dental vision, hearing, doctors, medications, hospitals, and essential needs to give you the clarity and transparency. You deserve a qualified Medicare agent with the aloha spirit. Contact us for non-Medicare assistance.

Answer: “It is completely understandable that you almost fell for that call. These scammers are very convincing, and they make the call sound official.

The truth is that Medicare will not call you out of the blue to offer free groceries, gift cards, spending cards, or other special benefits. Medicare also will not call and ask for your Medicare number, Social Security number, bank account information, or credit card information.

Many of these calls start with a small grain of truth. There are some legitimate programs that help certain low-income individuals with food and other expenses. Scammers take that information, twist it, and then call thousands of seniors pretending everyone qualifies for free benefits.

Their real goal is usually to obtain your Medicare number, Social Security number, or other personal information that can be used for fraud.

To stay safe, remember these three simple rules:

1. Hang up immediately if someone calls unexpectedly offering free gifts, grocery cards, or Medicare benefits.

2. Never give your Medicare number or personal information to someone who called you.

3. If you’re unsure whether a call is legitimate, hang up and call Medicare directly at 1-800-MEDICARE or speak with a trusted licensed Medicare agent.

If you’d like, I’d be happy to help you find legitimate programs and benefits that may be available in your area.”

Mahalo,

Francoise Mueller

Contact me.

Answer: You only get “guaranteed acceptance” during certain periods

These include:

Your Initial Enrollment Period at 65

Losing employer coverage

Your Medicare Advantage plan leaving the area

Certain trial rights

If you apply outside these windows, underwriting kicks in.

Medigap companies are private insurers

They’re not required to accept everyone year‑round.

Outside your guaranteed issue window, they can:

deny you

charge more

impose waiting periods

This is written into federal law.

Medicare Advantage plans cannot deny you

This is why so many people end up choosing Medicare Advantage after being denied a Medigap plan.

Advantage plans:

don’t use underwriting

accept all health conditions (except ESRD in some states)

cap your yearly out‑of‑pocket costs

often include dental, vision, hearing, and drug coverage

For many people, it becomes the only realistic option.

Answer: Medicare covers a Wellness Visit at 100%, but it is not the same as a traditional physical exam. If your doctor performed anything beyond the Wellness Visit checklist, they can (and usually will) bill you.

Here’s the difference:

Medicare Annual Wellness Visit (free)

Covered at 100%

Includes:

Health history review

Medication review

Height, weight, blood pressure

Cognitive screening

Preventive planning

No hands‑on exam. No labs. No tests.

Annual Physical (not free under Medicare)

Medicare does not cover this.

If your doctor:

Listened to your heart/lungs

Checked reflexes

Ordered labs

Addressed new symptoms

Managed chronic conditions

…that becomes a billed service, and you may owe a copay or coinsurance.

You didn’t do anything wrong; Medicare’s terminology is confusing.

This is exactly why I walk clients through what’s covered, what isn’t, and how to avoid surprise bills. Having your own Medicare agent who really clarifies these details can make all the difference.

Answer: One of the biggest Medicare expenses people overlook (it’s not hidden it’s just hard to grasp until you see the numbers) is the 20% coinsurance Medicare doesn’t cover. If you ever needed something major like open‑heart surgery, your 20% share could easily reach $60,000. Most people on Medicare simply don’t have that kind of money available.

That’s exactly where Medicare Advantage plans can make a huge difference.

Instead of leaving you responsible for unlimited 20%, Advantage plans typically reduce big procedures to a flat, predictable copay often just a few hundred dollars and cap your total out‑of‑pocket costs for the year.

It’s one of the most important protections people don’t realize they’re missing until it’s too late. And this is exactly why I take the time to go over everything with you to educate, simplify, and make sure you understand every moving part of how Medicare really works. When you know the mechanics, you can make decisions that protect your health and your wallet.

Answer: Yes, even with the 2025 Medicare drug‑cost changes, there are several additional programs that can help you afford your medications. Most people don’t realize how many layers of assistance exist, and many qualify without knowing it. If someone’s income is moderate or low, Extra Help can reduce drug costs to just a few dollars and eliminate the Part D premium and deductible.

In 2025, Extra Help becomes even more generous — many people who didn’t qualify before will now qualify. Medicare Savings Programs or Medicaid automatically get Extra Help for medications.

There are Manufacturer Patient Assistance Programs. State Pharmaceutical Assistance Programs and the MP3 program that will help you spread your payments out over the year so you can budget your finances and once you hit the $2,100 limit for 2026 then you pay nothing for the remainder of the year. This limit did increase by $100 between 2025 and 2026 so it may go up again in 2027.

However, I go over all of those options with you to ensure we leave no stone unturned.

Answer: Seniors are losing Medicare Advantage plans mainly because insurance companies are pulling out of certain counties, reducing plan options, or changing networks and benefits in ways that force members to switch. It’s not the senior’s fault, it’s the result of carriers adjusting costs, contracts, and reimbursements behind the scenes.

If a carrier decides a plan is no longer profitable or sustainable, they can discontinue it.

When that happens, every member is automatically disenrolled for the next year.

If a senior’s doctor or specialist stops accepting the plan, the member may feel like they “lost” their plan, even though the plan technically still exists.

If a plan performs poorly, CMS may restrict enrollment or force changes that impact members.

That's why I always remind my customer to think of your Medicare Advantage plan like a physical and get it checked once a year in October, November or December. But remember the Annual Enrollment Period is only open from October 15th to December 7th. If you miss that window, you may be able to still enroll in January through March however, it depends on your circumstances.

Answer: Original Medicare does not cover routine care outside the United States, so it won’t work for doctor visits or hospital care while you’re traveling in Europe. But depending on the type of Medicare plan you have, there are ways to stay protected. You’d need travel medical insurance or a Medigap plan with foreign travel benefits.

If you have a Medicare Advantage plan (Part C):

Coverage varies by plan.

Some MA plans offer limited worldwide emergency coverage, but not routine care.

You’ll want to check the plan’s Evidence of Coverage to see what they pay for overseas.

I will typically go over that with you so that You’re not stuck, you just need the right kind of coverage before you go. I can look at your exact plan and tell you in minutes whether you’re protected in Europe or if you need a simple add‑on like travel medical insurance.

Answer: Seniors end up with lifelong penalties for Part B or Part D when they go without creditable coverage and don’t realize they were supposed to enroll. Medicare charges these penalties to discourage people from waiting until they get sick to sign up — but most penalties happen simply because no one explained the rules to them.

Here’s why it happens so often:

They didn’t know their employer coverage wasn’t “creditable.”

They missed their Initial Enrollment Period at 65.

They thought “I’m healthy, I don’t need it yet.”

They relied on misinformation.

These penalties are permanent they last for as long as the person has Medicare.

That’s why I believe in Medicare guidance and educating on Medicare basics, it really matters so much. I help people avoid mistakes they didn’t even know were possible.

Answer: You’re right! Original Medicare doesn’t cover hearing aids, but there are ways to get help. Many Medicare Advantage (Part C) plans include hearing benefits, and some will cover part or even most of the cost of hearing aids depending on the plan and your needs. Some plans offer $500–$3,000+ in hearing aid benefits depending on the county and carrier.

If someone has Medicaid + Medicare, they may qualify for even stronger hearing benefits.

Answer: The biggest frustration Medicare agents have is trying to explain complex rules in a way clients can understand while racing against the clock, especially when every person’s situation is different. Between deadlines, plan changes, drug formularies, networks, and eligibility rules, agents often feel like they’re translating a foreign language while also trying to calm someone who’s overwhelmed or scared.

A few things agents consistently struggle with:

Clients getting conflicting information from TV ads, friends, or call centers.

There's also a lot of explanation that goes into the difference between Original Medicare, Medicare Advantage Plans and Supplemental Plans.

I like to go at your pace and slow things down, break it into simple steps, and make you feel safe, heard, and taken care of. Making sure that you can make an informed decision is most important for you and me.

Answer: With a Medicare Advantage HMO, you generally cannot see an out‑of‑network cardiologist unless it’s an emergency and if you go anyway, you’ll usually pay the full cost yourself. HMOs are Health Maintenance Organizations and require you to stay in‑network and get referrals, so the safest way to see a cardiologist is to choose one who’s contracted with your plan. If staying with your current cardiologist is important, we can look at PPO or HMO‑POS plans that allow out‑of‑network visits at a lower cost.

Answer: If you delay Medicare Part A because you’re still covered under your spouse’s active employer plan, nothing bad happens, you won’t owe a penalty, and their job‑based insurance keeps you fully protected. When that employer coverage ends, you’ll simply enroll in Parts A, B, and D during your Special Enrollment Period with no late fees and no gaps in coverage.

And then your natural follow‑through:

From there, we can also look at Medicare Advantage (Part C) options to help you save on out‑of‑pocket costs and pick up benefits Medicare doesn’t cover like Dental, Vision, and Hearing. Some plans even offer a monthly spending allowance for over‑the‑counter items such as multivitamins, cold and flu medicine, and other pharmacy essentials, which can really add up in savings.

Answer: Medicare cannot be canceled because of bankruptcy. If your income dropped because of the bankruptcy, you may now qualify for Medicaid, LIS/Extra Help, or QMB/SLMB/QI, which could reduce or eliminate premiums, deductibles, and drug costs. If debt caused you to skip care, you could safely resume appointments — Medicare still covers you. I can go over all of that with you and help you apply for these extra benefits if it looks like you would meet the low-income guidelines.

Answer: Not necessarily you didn’t “make a mistake,” but you did choose a plan that traded a low monthly premium for higher copays when you actually use your benefits. Many Medicare Advantage plans keep premiums low by shifting more of the cost to doctor visits, tests, hospital stays, and medications, so it’s very common to feel the pinch once you start using the plan.

What I do is help you look at the whole picture your doctors, prescriptions, health needs, and budget and see whether your current plan still makes sense or if there’s a better fit with lower out‑of‑pocket costs. I also help you apply for Medicaid and LIS if we can determine that you may qualify. That would greatly reduce your out of pocket costs.

Answer: No, you will not owe a Part B penalty as long as you’re covered under your wife’s active employer group plan. When she retires and that coverage ends, you’ll get a Special Enrollment Period to sign up for Part B with no late‑enrollment penalty at all. As long as you enroll during that Special Enrollment Period, you’re fully protected from penalties.

Answer: Yes, something did change, and you’re not imagining it. Many Part D plans update their drug formularies every year, and sometimes a generic gets moved to a higher tier or requires prior authorization, which can make your usual prescriptions suddenly cost more. I help you review your plan and check whether your medications were re‑tiered, dropped, or if there’s a cheaper pharmacy or plan option available for you.

Answer: Medicare itself doesn’t pay for groceries, but some Medicare Advantage plans do offer grocery allowances if you qualify based on your health conditions or income. I walk you through a quick set of questions to see if you’re eligible, because most people only qualify if they have both Medicare and Medicaid or if they have a chronic condition like diabetes or a heart condition.

Answer: Yes, Medicare does cover mammograms. It's called preventive care screenings. You get one free screening mammogram every 12 months, and if your doctor needs a diagnostic mammogram, Medicare covers that too, though you may have a small copay depending on your plan. Medicare covers a whole list of preventive screenings — things like colonoscopies, lung cancer screenings, diabetes screenings, bone density tests, and many more — all designed to catch issues early. Each screening has its own timing rules, but most are covered every 12–24 months, and I help you figure out exactly what you qualify for based on your age and health needs.

Answer: You can avoid IRMAA by keeping your income below the IRS limits, which often just means being mindful of things like withdrawals, tax planning, or avoiding big one‑time income jumps. And if Social Security is using an old tax return and your income has gone down because of a life change, I help you file the appeal so they can remove that IRMAA surcharge.

Answer: Yes, the flex cards and grocery allowance cards you see on TV are real but they’re not for everyone. You have to qualify first, and I walk you through a quick set of questions to see exactly which benefits you may be eligible for.

Answer: I can't speak for all agents, but I personally take pride in educating my clients on Medicare and how it works and providing you with the options available to you. As an independent agent, I can take the time you need to get the whole picture so you can make an informed decision.

Answer: Typically, you will be automatically recognized by the system according to your income level, and the system will automatically implement it. However, if for some reason you are not automatically enrolled, we can help with that process.