Gary Burroughs, Medicare Insurance Broker

Answer: That’s a thoughtful question, and the short answer is: yes, Medicare’s gaps are largely by design.

When Medicare was created in 1965, it was never intended to cover everything. The structure was built to:

• Share costs between you and the program (deductibles, 20% coinsurance) to help control overall spending

• Focus on medical care, not things like dental, vision, or hearing, which were considered outside core coverage at the time

• Leave room for private insurance—that’s why Supplement (Medigap) and later Medicare Advantage plans exist to fill in those gaps

Over time, healthcare has evolved, but the basic framework hasn’t fully kept up—so those gaps are still there today.

Bottom line:

Medicare gives you a strong foundation, but it was intentionally designed to be paired with additional coverage if you want more complete protection.

Answer: Great question, and it’s an important distinction:

Medicare Agent:

Typically represents one insurance company (or a limited number), so they can only show you the plans from those carriers.

Medicare Broker:

Works with multiple insurance companies, so they can compare a range of plans and help you find one that fits your needs.

Bottom line:

A broker generally offers more choice and side-by-side comparisons, while an agent may be limited to a smaller set of options.

Either way, there’s no extra cost to you—they’re compensated by the insurance companies.

Answer: One of the most common misconceptions about Medicare is this:

“Medicare covers everything.”

In reality, it doesn’t. For example:

• There’s no cap on out-of-pocket costs with Original Medicare by itself

• It generally doesn’t cover dental, vision, or hearing aids

• You’re still responsible for deductibles, copays, and coinsurance

That’s why many people add a Supplement or choose a Medicare Advantage plan—to help fill in those gaps.

Answer: The good news is Medicare does cover telehealth, and right now the rules are more flexible than they used to be.

Here’s how it works:

• You can usually do visits from home—including with primary care and many specialists. Congress has extended these expanded telehealth benefits through 2027, so rural location is actually less of a barrier right now.

• Common services covered: routine checkups, follow-ups, mental health visits, and some chronic care management.

• Your cost: same as an in-person visit under Part B (generally about 20% after your deductible), unless your plan offers lower copays.

• Medicare Advantage plans: often go a step further and may include expanded telehealth options or lower copays—but it depends on your specific plan.

One important caveat:

Not every doctor offers telehealth, so availability can depend on the provider—not just Medicare coverage.

Bottom line:

Even in a rural area, Medicare currently makes telehealth widely accessible—often right from your home—but the exact access and cost will depend on your plan and your doctor.

Answer: If I had to pick just one, the worst Medicare mistake is this:

Delaying Part B (and not having other creditable coverage).

Why it matters:

• You can face a lifetime late enrollment penalty

• You may have to wait months for coverage to start

• And you could be left without outpatient/doctor coverage when you need it most

This one decision can create permanent, compounding costs—so it’s critical to get the timing right. If you’re unsure about your situation, I’m happy to take a quick look with you.

Answer: Great question, hearing aid coverage can vary quite a bit by plan.

To find out if yours are covered, here are the quickest steps:

• Check your plan’s Evidence of Coverage (EOC) or Summary of Benefits—look under “Hearing Services” or “Hearing Aids.”

• Look for details like coverage limits (for example, an allowance every year or every few years), approved providers, and any copays.

• You can also call the member services number on the back of your card and ask them directly.

Answer: If your specialist leaves your plan mid-year, what happens depends on your coverage.

• Medicare Advantage (HMO/PPO):

You may need to switch doctors. HMO plans usually won’t cover out-of-network care, while PPO plans may—but at a higher cost. In some cases, you can request a temporary “continuity of care” exception if you’re in active treatment.

• Original Medicare + Supplement:

No networks—so you can keep seeing your doctor as long as they accept Medicare.

Answer: The Medigap “birthday rule” is a state law that gives Medicare Supplement policyholders a window around their birthday to switch to another Medigap plan without going through medical underwriting. In most states with this rule, you can move to a plan with equal or lesser benefits, often with a different insurance company, even if you have health conditions. The enrollment window is usually between 30 and 63 days, depending on the state. States that currently have some version of the birthday rule include: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Utah, Virginia, and Wyoming.

Answer: Yes. Many people are experiencing higher costs for generic drugs in 2025 due to changes in Part D plans, which have adjusted their deductibles, copays, and drug tiers. Some plans now require you to pay more up front before coverage begins. Some plans are also placing fewer generic drugs on traditional low-cost generic tiers than in past years.

Answer: Beginning in 2025, Medicare Part D will include a new $2,000 annual out-of-pocket cap on covered prescription drugs, which means that once a senior has spent $2,000 on covered Part D medications during the calendar year, they will pay nothing more for those covered drugs for the rest of the year. This is especially important for seniors who take expensive medications, because it can save them thousands of dollars compared with previous years when there was no true cap on prescription drug spending. However, the cap does not include monthly plan premiums or medications not covered by the plan’s formulary, so it is still important to compare Part D plans.

Answer: Generally, people are short-sighted. At 65, life is good, and they feel they are healthy, and the monthly cost of -0- is very appealing. As time goes on, the node starts falling, the deductible starts building, and they are not able to qualify. With Medigap carriers so they must stay with an Advantage plan.

Answer: Free is a very good price! Let’s step back as the devils in the details. When it comes to adding Medigap coverage with an Advantage plan the adage to remember is “Pay me Now, or Pay me Later”. There is no Free Lunch.

Answer: I’ve helped individuals and families for the past 40 years in the ares of finance, retirement, taxes and retirement planning. My medicare benefits planning focuses on seniors healthcare and affordability.