Gary Church, Medicare Insurance Broker

Answer: For 23 years, I have been honored to serve as a health insurance broker, guiding individuals through their Medicare options with expertise and care. As a Medicare member myself for the past seven years, I understand firsthand the complexities of our healthcare system. My greatest privilege is working alongside my clients, helping them navigate their coverage with confidence and ensuring they make informed decisions that best meet their needs.

Answer: When selecting a health insurance plan. It’s very important to work with a Medicare agent, who will take the time to understand your needs to review your options for the year. The cost is important but being able to get the care you need is as important. You’ll have to keep your current plan until the end of the year. Your opportunity to change is October 15 until December 7 for a January 1 start date. I hope this answers your question.

Bay Area Health solutions

Gary

Answer: There are PRO’s and Cons to any Medicare plan. The question is do you want to manage your healthcare or would you like the insurance company to manage your health?

Answer: Not understanding how to use Medicare and the plans available. When selecting a Medicare plan individuals first cus on the cost. The important question is what are your needs today and in the future. The experience of a Medicare agent is key.

Answer: Medicare cover the cost of any medically necessary procedures. Medicare does not cover annual physicals for example. They do cover wellness visits preventative care that’s on your initial wellness visit.

Answer: When it comes to Medicare Medicare plan is important to the person who is choosing their Medicare plan for themselves not what it works for someone else. The most important thing when being on Medicare advantage plan is your doctor participate with that health plan Medicare advantage plans go from January to December with that offer this year may be different the following year so it’s important to be able to work with a Medicare agent who can help you guide through and look at different options each and every year.

Answer: When it comes to Medicare supplement plans or otherwise known as Medicare gap plans there’s two standardized plans, plan G and N our standardized plans. The premium is based on the insurance company is selling their particular supplement or gap plan.

Answer: The commissions are higher on a Medicare advantage plan. For some agents, it’s easier to sell a Medicare advantage plan in most cases. The client getting that Medicare Advantage plan for the most part at a zero premium. It’s important that the client understand all their options so they can choose the right health plan for them.

Answer: I don’t think Medicare is heading for any any crisis pertaining to baby boomers.

The change would come as the federal government sets up Medicare for all.

Answer: Most cases no you can only change during annual enrollment. If you’re on a Medicare advantage plan and you’re diagnosed with a serious illness. The likelihood of you being able to qualify for Medicare supplement is pretty slim to none due to your health issue and pre-existing health condition.

Answer: Your current health condition has no effect on your Medicare itself comes down to the Medicare advantage plan that you have. Does it allow you to see the doctors and specialist that you wanna see

In network.

Answer: No! the rules is you have to be a resident 5 years. Since you don’t have 40quarters of work history you’ll pay premium for part A and part B

Answer: You can save money. Being on a Medicare advantage plan a question is what the cost when you actually have to use your Medicare advantage plan. It is important that you work with a Medicare agent to review your options and determine which plan is the right plan.

Answer: If you’re on Medicare mental health is supported by Medicare as for your spouse with dementia Medicare will provide health care services. But you’d have to look into local caregivers to be able to help you as far as with with that, but not Medicare.

Answer: With that number is, I don’t know personally we all do know how expensive healthcare is and what healthcare options we have.

Answer: Not sure on that question, but with artificial intelligent in some cases can be a benefit, but may be able to make medical decisions. Not sure if I would want to rely on AI to be able to make a judgment for my care.

Answer: Explain Medicare as health coverage. Would you like to control your healthcare or have the insurance company manage it? I go over the three options: Original Medicare, Medicare supplement, or Gap with standalone PDP and Medicare Advantage plans. Any health care plan has pros and cons.

Answer: Medicare Medigap offers true freedom in healthcare choice, allowing you to see any doctor nationwide who accepts Medicare—no referrals, no network restrictions. In contrast, while Medicare Advantage plans may offer zero premiums, they often require referrals and can change annually. Your doctor may be in-network one year but not the next. If you experience a life-changing event and require hospitalization, unexpected medical bills could reach thousands of dollars. With a Medigap plan, your only out-of-pocket cost beyond the monthly premium is the Part B deductible, which is set by Medicare each year—$257 for 2025."

Answer: If you are only on Original Medicare Part A & B, "Yes", you will have medical bills. Medicare is an 80-20 plan. For Medicare services, Medicare picks up 80%, and you are responsible for 20%. Having a Medicare Supplement or GAP plan, the insurance company picks up your 20% minus the Part B deductible. If you have a life-changing event on a Medicare Advantage plan, you would also be responsible for deductibles and co-payments.

Answer: Medicare Advantage plans offer a basic dental plan, usually HMO dental coverage, with a small network of dentists.

Answer: Medicare will usually cover it if it's medically necessary. Medicare says if your doctor indicates that it is medically necessary.

Answer: Not sure with the current administration. What will happen to Medicare plans? It is essential to talk with a Medicare agent at an annual meeting to review changes.

Answer: No, you can not use your HSA to pay your Medicare premiums! HSA is to be used for co-payment for medical expenses. Once you turn 65, you can withdraw your money from your HSA account without penalty. Then if you want to pay your Medicare premium with the money.

Answer: Call Medicare, check their Star ratings, read the fine print, and work with a Medicare agent you feel comfortable with to review information and options for Medicare Advantage plans.

Answer: You can choose any kind care you need, whether it's covered by your Medicare plan or you'll pay out of pocket.

Answer: As of 2025, there are no more donut holes. The deductible is $590, and the max out-of-pocket is $2,000. Depending on your tier level, you may have to meet the deductible.

Answer: An experienced licensed Medicare agent should be able to guide you through the maze and help you to make an informed decision.

Answer: That's not true! Medicare is a health insurance. If you need Life insurance, meet with a licensed agent to review your needs.

Answer: First, Medicare says it has to be medically necessary.

These are some things that Medicare does not cover:

Long Term Care (LTC)

Hearing aids

Cosmetic Surgery

Dental & Vision exams ( If it's medically necessary, like glaucoma)

Adult Daycare

Cosmetic surgery

Answer: Yes! There could be a financial cost that you could face if you needed care. Since Medicare is a 80-20 health plan. (No cap)

Answer: You could! You may end up paying the bill. You have allowed your Medicare Advantage plan to manage your healthcare. If you want to have control over your healthcare, consider going back to Medicare and purchasing a Medicare supplement. Then, you will have control over your healthcare.

Answer: Not sure! The future of healthcare is changing with the current Administration and cuts to social programs will have an effect on healthcare and could on Medicare.

Answer: Depends on whether your company has more than 20 employees; if so, then no, you do not have to enroll. If fewer than 20 employees, then yes, you must enroll in Medicare Part A &B

Answer: Do an annual review during AEP from October 15 to December 7 each year to review your PDP. Work with a Medicare agent or visit Medicare.gov to review all the drug plans. All drug plans are not equal.

Answer: As of now, Medicare does not cover marijuana for treatment. There is a possibility in the future, as marijuana is still a Class 1 drug.

Answer: Dental and vision are basic dental and vision plans. Dental is generally an HMO with a maximum annual coverage of $1500.00. You are limited to a small network.

Answer: Not fully understanding their choices. It's very important that if someone is looking into Medicare, they know all the pros and cons. How is their health is now and in the future?

The question should be based on whether one controls one's own healthcare or the insurance company controls one's care. Budget is also important.

Answer: You can start three months before your Birthday and three months following your Birthday.

You could enroll a little earlier than three months, but sign up within the time frame.

Answer: They should make sure they understand their Medicare health plan, their medications are in the formulary, and their doctors are in-network. They should also know how to use the plan.

Answer: Not necessary! Check with your doctor and the Medical Group to ensure the Medicare Advantage plan is in-network.

Answer: To legally manage your parent's Medicare benefits, you'll need to obtain either a Power of Attorney (POA) or a court-appointed guardianship or conservatorship.

Answer: If you are only on original Medicare, with or without a Gap plan, you can see any doctor, anywhere that accepts Medicare for medical reasons.

Answer: Discount cards do not affect your Medicare or Drug plan. If you're not sure about your Medicare plan or your drug, it's a good idea to speak to a Medicare agent to review your options.

Answer: Yes, open enrollment runs from January 1 to March 31, providing you with a one-time opportunity to switch to another Medicare Advantage (MA) plan. The agent reviewing your plan should have confirmed whether your PCP or medical group is included in the MA network. It's crucial to fully understand how any changes to your MA plan might impact your drug coverage.

Answer: Life insurance serves different purposes depending on when it's purchased. It plays a key role in any financial plan, protecting what matters most. With numerous options available, it's essential to work with a life insurance agent to determine what’s important and take action accordingly.

Answer: There are two types of events: educational and sales & marketing. It's essential to understand the type of event you're attending and what you hope to gain from it. If you have time to research, take the opportunity to review your options and work with a Medicare agent you trust to ensure you're getting accurate information.

Answer: No, nothing is free! It's how they package their plans. If you have little or no health issues, a free MA plan looks great. The insurance company is managing your healthcare. If you experience a life-changing event while on an MA plan, it could result in thousands of dollars in copays and deductibles.

Answer: My calling in life is to help individuals on Medicare or new to Medicare to understand the pros and cons. of Medicare and the difference between supplements GAP insurance and Medicare Advantage

Answer: Medicare covers up to $50,000 lifetime. You pay for medical care abroad, and when you return, submit the claim to Medicare reimbursement for approved Medical services. For Medicare Advantage plans, coverage for emergency care is still up to a $50,000 Lifetime limit.

Answer: Medicare does cover cataract surgery, and the new lens would use the standard mono single lens. If the patient chooses a premium lens, then Medicare would not cover those lenses, but may allow the patient to pay the difference. When in doubt, check with Medicare.

Answer: Explaining the zero premium means stating that you pay for the health plan through co-payments and deductibles. If hospitalized, consider the hospital stay's co-pays and meeting the MOOP. Office visits, outpatient services, and emergency room visits.

Answer: It depends on what the technology is meant to do. To make the process better and more efficient in billing and reducing billing errors. Using AI in medical decisions is questionable.

Answer: Easy, Original Medicare, you manage your healthcare, and with Medicare Advantage, the insurance company manages your healthcare.

Answer: Medicare Plan F has no costs associated with it, whether you visit the emergency room or are admitted to the hospital. You can even see your doctor with zero copays. It’s a great plan, but it comes with higher premiums. You might want to consider Plan G or Plan N, as the only addition is a Part B deductible.

Answer: Your doctors are not in network. Your prescription is not in the formulary with that Medicare Advantage plan. It is essential to review your plan each Annual Enrollment Period (AEP).

Answer: To answer this question: If it is medically necessary, Medicare will cover the surgery, but they may only cover the standard knee replacement. I would advise reaching out to Medicare for clarification.

Answer: Visit ssa.gov on the home page, click on "Medicare," and then select "Apply for Medicare" from the drop-down window. Just follow the instructions. Once you complete the application, you should receive your Medicare card in about two weeks or so. Then look for a licensed agent who can help with your options.

Answer: There are no options for international travel with Medicare. Medicare covers up to $50,000 lifetime. You pay the bill and submit your medical bills for reimbursement. Some MA plans may cover emergencies. You may want to purchase an International health plan separately.

Answer: Choosing a Part D drug plan or a Medicare Advantage plan. It depends on the individual's needs and the options available with Medicare plans. It's best to speak with a licensed Medicare agent to review all your options.

Answer: No, If you're on original Medicare with a Supplement (Med-Gap). Your health plan goes where you go, so you can see any doctor that accepts Original Medicare.

Answer: The reality is that some medications are very expensive. Whether you are on original Medicare with a stand-alone Drug plan or have a Medicare Advantage plan, the issue is that Congress must allow Medicare to negotiate all drug pricing for Medicare patients. Big Pharma needs to be accountable for controlling the cost of its drugs.

Answer: If you're on Original Medicare Part B, you have a deductible that has to be met, which for 2025 is $257.00. Also, if seeing a specialist, does that specialist accept Medicare.

Answer: Medicare Part B covers medically necessary services such as:

* Doctor visits

* Lab work

* Outpatient care

* Lab tests and imaging

* Durable medical equipment

* Mental health services

If you only have Medicare Part A & B, you could have a copay. You also have a current $257.00 Part B deductible for 2025

Answer: One of the biggest frustrations is when clients come in with misinformation or partial knowledge, often from friends, family, or the internet, and are convinced they already know what’s best.

Answer: The disadvantages of Medicare Advantage plans include managing your healthcare. You must stay in-network and get referrals. The plans are not portable, meaning if you move outside your service area, you have to find a new plan.

Answer: Medicare covers skilled nursing facilities for rehab. Medicare does not cover long-term care. Depending on your income level, you may qualify for Medicaid assistance for LTC.

Answer: Medicare will reimburse for medical services in a foreign hospital. You pay, and when you turn to the US, submit your claim to Medicare for reimbursement for medically necessary services. There is a lifetime Max $50,000. I would recommend purchasing Traveler's health insurance.

Answer: Medicare Advantage plans include the annual wellness visit as a free part of preventive care.

Physicals are not covered. Be sure to let your doctor know your coming for the annual wellness.

Answer: If I didn't take Medicare at 65 and am now retiring ? Will if you don't start your Medicare once you are eligible, first, you are responsible for self-insurance for all medical cost. Once you start Medicare, you'll be subject to a penalty for life on your Medicare premiums

Answer: The time to review your drug plan is each year during AEP, which starts on October 15 and ends on December 7. Insulin was capped at $35.00, and that is what you should be paying.

Answer: Yes, you should receive an ANOC from your Medicare insurance company annually. You can contact the agent who helped you with your Medicare planning or reach out directly to your Medicare insurance provider.

Answer: The Medicare Part B premium for 2025 is $185.00 or higher, depending on your income from 2023. We all have to pay.

Answer: You do have coverage under Medicare. Which is important, but the concern is that if you experience a life-changing event, it could be costly because Medicare is an 80-20 plan. Also, do you have a drug plan? If not, you'll be assessed a penalty once you sign up. You do have two options: one is buying a Medicare supplement like Plan G or N, or waiting until AEP from October 15 through December 7, for 2026. I would reach out to a licensed agent to review the right plan.

Answer: A continuous glucose monitor for my diabetes that connects to my smartphone. Will Medicare cover this technology for someone with my condition? As of now, Medicare does not cover glucose metering devices. There is a possibility that a Medicare Advantage plan could. I would recommend finding a licensed agent or broker to review your options. AEP starts on October 15th and runs until December 7. Good luck!

Answer: No, Medicare does not cover Ozempic. IT could be covered under a PDP or MADP. I would recommend talking to a licensed agent or Broker to review.

Answer: It depends on whether you're still working and your employer has 20 or more employees, or if you're covered under your spouse's group health insurance plan with 20 or more employees. Then, no, you do not have to apply for Part B.

Answer: There is fraud, but that does not apply to you unless you file a fraudulent claim or your doctor. Do not share your Medicare information with someone you don't know. Never give to someone on the phone unless you have identified the person who may ask for your Medicare number. I highly recommend meeting with a licensed agent or broker who can assist with your Medicare questions or needs.

Answer: Medicare Advantage HMO has no out-of-network coverage, except for emergency services. So, if you want to see a cardiologist out of network, you'll have to pay the cost.

Answer: Does Medicare Part B handle coverage for preventative screenings like mammograms? Medicare Part B covers mammograms as preventive services.

Answer: There are pros and cons with any health plan. What is the most significant disadvantage of the Medicare Advantage plans? Networks!! Freedom to see the doctors you prefer. Your Medicare Advantage plan manages your care with referrals.

Answer: Medicare Part D changes for 2025: The donut hole has been eliminated and replaced with a deductible and a maximum out-of-pocket limit of $2,000 annually. It should lower your costs for most medications, but this also depends on your drug plan. You should review your drug plan every year to ensure you're getting the best value.

Answer: Part D plans are not created equally. You should review your drug plan annually by visiting the Medicare website or meeting with a licensed agent or broker to evaluate your prescriptions.

Answer: It depends on when you're planning to switch from one supplement to another. This varies by state. If you're in a state with a Birthday rule, you may have the opportunity to change your plan for the same or less, such as switching from Plan G to Plan G or choosing Plan N. Keep in mind that Medicare plans, such as Plan G & N, are standardized plans, which means the premiums you'll pay are the primary consideration.

Answer: Think of it as a pension that provides you with a fixed amount of money for a certain period, such as 10, 20 years, or for life. These payments can be tax-free depending on the money in and distributions.

Answer: Medicare Plan C, also known as a Medicare Advantage plan. Blood work is included as part of your wellness visit, so there should not be a charge. If the blood work is part of tests that are being done, then you are subject to copayments. Best to check with your Medicare Advantage plan.

Answer: Medicare Part B premiums can differ from the base premium for 2025, which is currently $185.00. Medicare IRMAA stands for Income-Related Monthly Adjustment Amount, and an individual whose income was reported back in 2023 will determine the IRMAA currently for individuals earning more than $106,000, who are subject to this. Also the IRMAA also applies to the Drug plans.

Answer: It largely depends on the formulas and the tier level of the medication. If someone is only taking a few generic drugs, a lower-cost PDP is sufficient, but if they are using more expensive or specialty medications, the more costly PDPs tend to be more cost-effective. Reviewing PDP plans each year during AEP is very important.

Answer: Medicare does not cover dental services. They are usually included as an add-on in Medicare Advantage plans, but these are typically HMO dental plans, which may have a smaller network. If you see a specific dentist, I recommend asking your dentist which dental plans they accept and purchasing the plan with which your dentist is contracted.

Answer: The guideline for completing an application to enroll in a Medicare plan is pretty simple. The question should be: do you understand what you are signing up for and how your Medicare plan will work for you today and in the future as your healthcare needs change? I would recommend working with a knowledgeable agent or broker who can help you choose the right plan.

Answer: Is the Medicare Extra Help program expected to change in 2026? Not sure about 2026, but it could be in 2027 and beyond. Extra help is usually available with Medicare Advantage plans, which run from January 1st to December 31st.

Answer: We should be concerned about changes to access the health services we rely on. Changes to Medicare can limit access to doctors who may not accept new Medicare patients. If Medicare cuts what they pay to doctors, yes, this could be a problem for care.

Answer: If you're on Medicare and not working? No, but if you're still working, then yes, through FICA tax for Social Security and Medicare Part A.

Answer: If you work for a company with 20 or more employees, you don't have to enroll in Medicare Part B. You can choose to wait. It might be helpful to compare the costs of your group health plan with Medicare to see which offers better benefits.

Answer: Insurance companies offering Medicare Advantage plans are paid by Medicare to manage your healthcare. As long as you're healthy, they profit. The insurance firm works with a network of doctors who agree to set prices for their services. Medicare agrees to cover care as long as it is medically necessary. Remember, with just Medicare, you're responsible for copayments and 20%.

Answer: To avoid the IRMAA surcharge, your determination for the year Medicare looks back 2 years to assess income. If you want to reduce or eliminate the IRMAA and you're a single filer with income below $106,000, you'll pay the standard rate for 2025, which is $257.00 for the year.

Answer: To report fraud, abuse, or billing issues, call Medicare directly at 800-633-4227. You can also report online: https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse