Gary Church, Medicare Insurance Broker

Answer: Medigap plans are sold by insurance companies. They are not part of the ACA and can require underwriting. Due to your health history, insurance companies selling Medicare supplements are not guaranteed issue. Only Medicare Advantage plans.

Answer: Will Medicare cover a specific procedure or treatment? Yes, if it's medically necessary. If in doubt, you can contact Medicare or check with your agent. Also, it would depend on whether you're on original Medicare with a MediGap or on a Medicare Advantage plan.

Answer: The CMS-L564 form is an employment document used to verify employment at the time of Medicare enrollment. It is specifically for individuals aged over 65 who need to demonstrate they had credible coverage to avoid a penalty.

Answer: Medicare agents are non-commissionable on Part D prescription drug plans. Agents could help seniors visit the Medicare website to enroll in a drug plan based on their medications and choose the right one.

Answer: Seniors often misunderstand Medicare's coverage for long-term care. Medicare does not cover long-term care. It will cover the first 20 days of skilled nursing and hospice at the end of life.

Answer: By approaching individuals, whether somebody is new to Medicare or they're currently on Medicare and have questions or want to understand how Medicare works, my approach is to understand what their current situation is and what their future situation may be as far as their health and where they live. That has a key part. But also, do you want to be able to manage your own health care, or do you want the insurance company to manage your health care? There's pros and cons to any health plan, but when it comes to Medicare, Medicare itself, Part B, is a very good health plan. But there are some costs within those plans.

So when it comes down to whether or not you want to be able to control your own health care, staying with original Medicare and buying a Medicare supplement if you're in a rural or metropolitan area, a lot of people are attracted to Medicare Advantage plans because they include Part B, and that also includes the drug plans. The best thing to always do is sit down with a licensed agent who can actually look at your options and help you determine what is the right plan for you. One plan's perfect for everyone. It really comes down to the individual.

As far as what's most important to you when it comes to health care, it's understanding, and you want to control your own health care. Do you want the insurance company to control your health care? A lot of these medical Medicare Advantage plans go from January 1st to December 31st. So whatever they offer this year could be different next year. With being on retail Medicare, the Medicare supplements are guaranteed for life. As long as you can pay those premiums, they do go up. They are guaranteed for six months. So those plans will increase each and every year as long as you can afford to pay them.

The best thing to do is to have the freedom to see the doctors you want to see that accept Medicare. So remember, when it comes to selecting a Medicare plan...

Answer: A senior turning 65 who still works for a company with more than 20 employees does not have to enroll in Medicare. It may be helpful to speak with a licensed Medicare agent to review options. Consider whether the employer's health plan costs less or if Medicare offers better benefits and savings.

Answer: Medicare under Part B covers a nebulizer. Inhalers fall under Part D of the drug plan. Be sure to check which drug plan has the best coverage.

Answer: Questions come in. A friend lives in a different city and has much more detailed Medicare plans. Does it depend on their location? And yes, if you live in a large metropolitan area, you're definitely gonna have more choices because there's a larger population. When you get into smaller rural areas, there's less option when it comes to Medicare plans. So I would sit down with a licensed agent so they can understand your situation and figure out what is the best option for you when it comes to your Medicare plan here. Hopefully, that answers your question. Thank you.

Answer: Questions come in: How much will I pay out of pocket for therapy? It depends on whether or not you're on original Medicare with a Medicare supplement versus a Medicare Advantage plan. Generally, under a Medicare supplement plan, you're only going to pay your deductible, your Part B deductible, within your plan. And if you're on a Medicare Advantage plan, then it's going to depend on the plan that you have. I would recommend if you're not sure, either reach out to the broker that helped you with your Medicare Advantage plan or reach out to the carrier to find out what your options are. Hopefully, that answers your question.

Answer: Tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker: Do you feel comfortable with the answers that you get from the broker, or do you feel that you are being navigated to a Medicare plan that you don't understand? You want to make sure the broker is helping you to make an informed decision.

Answer: Question: I want to switch to Medicare Advantage this year. How do I do this?

Well, during annual enrollment from October 15th to December 7th, you can change your Medicare Advantage plan or go back to return to Medicare. Or, during open enrollment weeks from January 1st to March 31st, you can change from one Medicare Advantage plan to another once during that calendar year or go back to return to Medicare.

But the best thing to do is sit down with a licensed Medicare agent who can advise you and help you look at your options. It's very important to make sure that your doctors, specialists, and the hospital you're going to be using are all in that network with that Medicare Advantage plan, as not all plans are equal. So it's best to be advised by a licensed Medicare agent. Hopefully, that answers your question.

Answer: Question: What happens if I'm unable to provide critical coverage?

Well, you could be faced with a penalty with Medicare. Hopefully, that's what you're referring to. If you're currently working and your employer has at least 20 or more employees that you're working for, you're not required to apply for your Medicare. But if there are less than 20 employees, you are going to be able to provide credible coverage. That's determined by Medicare at the point that you're signing up.

If you're ever in doubt, the best thing to do is either reach out to Medicare directly or sit down with a licensed Medicare agent who can help evaluate your current situation. But you do not want to hesitate. You want to make sure that you're making an informed decision. And that's what's important about sitting down with a licensed Medicare agent who can advise you and help you understand what your options are.

So hopefully, that answers your question.

Answer: Questions, and I'm confused about all the star ratings for Medicare plans. Do they actually mean anything for the care I will receive? That's gonna be based on the plan you have. But the star ratings provided by Medicare are evaluated by a survey that goes out to all Medicare Advantage plans and drug plans for the year to get people's feedback on their experience with their particular carrier that they have their Medicare Advantage plan or drug plan with.

And through that, they're able to rate those companies from one star up to five stars as being the best of that rating. But it's not the only factor when selecting a Medicare Advantage plan. Are your doctors in the plan? Your specialists that you're gonna be seeing, are they in the plan? Is there a hospital that you're gonna perhaps go to? Are they going to be in network with that Medicare Advantage plan?

It's real important to sit down with a licensed agent so that you can evaluate what is the best option for you. There's not one option that's better for one person over another. It really comes down to what's important to you. Again, I would recommend sitting down with a licensed Medicare agent. They can go over all the plans in your location to help you make an informed decision. I hope that answers your question. Thank you.

Answer: The question is, what happens if I delay my Medicare Part enrollment because I'm still on my spouse's employer's health plan? You don't have to do anything. Now, there is an exception to that. If the employer that your spouse works for has less than 20 employees, then you are required to enroll in Medicare. So that would be in first position. But as long as there are 20 or more employees, you're not required to. Now, once your spouse decides to retire, then at that point you need to start the process. I would highly recommend that whenever in doubt, you can either call Medicare directly on their 800 number or sit down with a licensed Medicare agent who can guide you through so that you can make an informed decision. When is the best time to enroll in your Medicare Part A and Part B? I hope that answers your question. Thank you.

Answer: To answer your question, it's not your health plan with Medicare or your supplement. The problem is your drug plan. A few things you can look into are reaching out to your drug plan to see if they can help change the tier level, reaching out to the manufacturer to see what options are available to lower the cost, and talking to your doctor to see if there's an alternative or a generic. I would recommend working with a licensed Medicare agent who can review your current drug plan when AEP comes in October to see if there are changes you should make.

Answer: SNP plan under Medicare Advantage plans is available to individuals with certain health issues, such as diabetes, heart disease, and stroke patients, etc.

Answer: Part D covers Repatha, yes, as a tier 3. Be sure to meet with a licensed Medicare agent to review the drug plan. Not all drug plans cover Repatha in their formulary.

Answer: Here's a question: I'm worried about affording my medications. Even with the 2025 changes, are there additional assistance programs I should know about?

There is. And again, if you work with a licensed Medicare agent, he should be able to help you as far as determining what medications you need and what their classifications are. Under the drug plans, it is a five-year plan, and not all drug plans are equal. So it's very important to know your medications and what's in the formulary with that particular drug company.

But there are assistance programs out there and other resources. So sitting down with a licensed Medicare agent should be able to help you determine a doctor. But yes, when it comes to medications, some medications are very, very expensive. And hopefully, our government will start to do something to help reduce the cost, particularly for seniors who are on a fixed income and can't afford their medications.

So I hope that answers your question.

Answer: Here's a question: If I'm on a Medicare Advantage plan, do I still need authorization for a procedure next year? The problem with next year's Medicare Advantage plans is they go for a calendar year, from January 1st to December 31st. In that current year, whatever authorizations you're looking at for the next year, you're just gonna have to wait till that calendar year starts.

But on a Medicare Advantage plan, for all intents and purposes, you have to get authorization from your carrier in reference to getting a procedure. So again, there are limitations to Medicare Advantage. But I highly recommend that you sit down with a licensed Medicare agent or your agent who helps you with Medicare to figure out what options you have and whether or not you can make any changes.

So hopefully that answers your question.

Answer: The question here is, how does losing a spouse impact my Medicare plan if I was on their employer coverage? Well, it depends on how you're losing coverage. So if you're coming off your spouse's health plan and you're 65 or older, it’s important you go ahead and apply for your Medicare Part A and Part B. Again, I believe the best thing you can do is when you know that you're going to come off your spouse's health insurance and you're over the age of 65, reach out to a licensed Medicare agent in your area to find out what the process is as far as enrolling into Medicare.

And the other thing you can do is call Medicare. They're available 24 hours a day, seven days a week. So whenever in doubt, do your research to find out what you have to do. Because without acting in the timeframe you're supposed to be acting, you're going to be subject to a penalty.

So again, I have my recommendation: sit down with a licensed Medicare agent to help you get prepared and answer some of the questions you may have. So hopefully, this answers the question.

Answer: Questions came in: What Medicare penalties are most common? Probably the most common is somebody who has been working and either retires or gets laid off from their job, and their employer is going to offer them health insurance for the first year. If that employee decides to stay with their Cobra plan and their coverage, they realize that they have to enroll in Medicare. When you're notified by your employer and you know that your employment is ending, it's important that as soon as you know when your end date is, that's when you're going to apply for your Medicare. Now, your arm has already been in place, but it's activating your Part B. This is very important.

Other people will say, "I don't take medications, I don't need a drug plan." Well, you're required to have a drug plan, and a care only covers Part B hospital and your medical services. So if you don't have a drug plan, you are going to get a penalty.

And the other thing is changing your plans. It's important that you understand what you need to do either when you're aging into Medicare at 65 or when you actually have to do your roaming, and also when you're leaving your employer. It's very, very important that when you're leaving your employer, you sit down with a licensed Medicare agent. Don't try to do it on your own unless you know what you're doing. It's important to know when you have a qualifying event. So hopefully that answers your question.

Answer: Question is, can you explain special needs plans for Medicare or special needs plans designed for people with certain health conditions, chronic illness, or due to a heart attack, stroke, or some other debilitating disability that you need extra care with? Medicare is two parts, Part A and Part B, so it's making sure that the kind of care that you need is going to be based on the health plan that you have with Medicare. So as long as it's medically necessary, Medicare is always going to be there to pick up the cost.

Now, there are pros and cons to any health plan, but the best thing to do is actually sit down with a licensed Medicare agent who can review your current situation and determine which is going to be the right option or plan for you. So hopefully that answers your question. Thank you.

Answer: The question has come in: what should people know about Medicare? Medicare is broken up into two categories. Part A is for hospital services, and Part B is for medical services. This is what we're referred to as an 80/20 plan. Medicare covers up to 80% of the cost of your care, and you are responsible for 20% of your care for both A and B.

The problem with just regular Medicare is the cost you would have if you were admitted to the hospital. You can't see your doctor, and there are insurance deductibles. So, the best thing to do is to sit down with a licensed Medicare agent so they can review what your options are with Medicare itself.

This covers Part A for hospital services and Part B for medical services. Again, it's an 80/20 plan, and your responsibility is for 20% of whatever those medical bills are. So, it is highly recommended that you sit down with a licensed Medicare agent to review what your options are when it comes to selecting a plan. I hope that answers your question.

Answer: To answer the question of working with a young licensed Medicare agent. As long as the agent is licensed and you feel comfortable working with the agent. Then you have a choice.

Answer: Question has come in as is: don't you think the Medicare technology systems are outdated and inefficient? Yeah, they could be, but that really doesn't have any effect on your Medicare or how you're gonna be applying. So if it's calling Medicare itself, well, they are available 24 hours, seven days a week to reach out to them.

But when it comes down to understanding what your options are when it comes to Medicare, it's important that you sit down with a licensed Medicare agent so they can help you navigate through and actually help you if you need help enrolling into Medicare. That agent should be able to help you do that.

Yeah, hopefully that answers your question. But when it comes to technology, hopefully, and it can continue to improve their technology. That's all I can say.

Answer: Does moving to a new state affect my Medicare enrollment timeline? Yes, it depends on your Medicare plan. For your original Medicare with a Medicare supplement, while there's Plan F or Plan G, depending on the state you're in, your plan goes with you. If you're on a Medicare Advantage plan and you're transferring to another area, you have anywhere from three to four months. But the sooner you do it, the better. If you're gonna be changing from a Medicare Advantage plan to a Medicare supplement through that move, then that's gonna change that timeline. So if you're looking to do it, I would recommend as soon as you move to start the process. And that's sitting down with a licensed Medicare agent, preferably in person or via Zoom. You want to work with a local agent that understands your situation and the area you're moving to, so you understand what your options are. So again, hopefully this answers the question. Again, it's based on the time that's shown. The sooner you do it, the better it is for you.

Answer: Red flags in a phone call that might be a Medicare scam targeting my personal information? Well, it's kind of tough when you're talking to somebody on the phone to know whether or not you're really talking to a licensed agent. I would highly recommend, depending on what state or the agent you're talking to, not to make a decision right at that moment. If you don't feel comfortable providing personal information, whether it's your name, date of birth, Social Security number, or your Medicare number, it's important to make sure that the agent you're speaking to is actually licensed as a Medicare agent and that you're getting the right questions.

If you have a concern about that, the best thing you can do is look up a local agent in your area. I highly recommend sitting down with a licensed agent in your area. Preferably, if you can, either meet that person in person or have a Zoom call so you can identify them. But again, it's about feeling within yourself whether or not who you're speaking to is legitimate. So, again, you can always check with the state that that agent is licensed in to make sure that he is who he says he is. Hopefully, that answers your question.

Answer: Here's a good question. Somebody says, "I'm scheduled for knee replacement. When I took out my policy, which is a Medicare supplement plan G, will it still pay?" Yes, as long as the procedure you're having is medically necessary, and a knee surgery probably is medically necessary. Medicare is going to cover your supplement. Your plan G is going to cover that 20% that you'd be responsible for. But I understand there is a part B deductible that you will be responsible for that calendar year. So again, yes, it will. Your knee replacement will be covered by Medicare, and your Medicare supplement plan G will pick up that portion. Again, your responsibility is that part B deductible at the time.

Again, the best thing to do is to sit down with your Medicare agent or a licensed Medicare agent to understand what your options are. Hopefully, that answers your question. Thank you.

Answer: A question: I signed up for Part A. I'm still on my husband's insurance and didn't start my Part B. Is there a form I need to fill out stating that I'm still on my husband's insurance? The answer is no, but once you do apply for your Part B, once your husband retires or comes off his health plan or leaves his employer and you're no longer going to be covered under your husband's health insurance, then you do want to enroll each year in Medicare Part B if you're past 65. When you're doing that, Medicare is going to require you to show proof that you were on a qualified health plan. So if you have any questions regarding that, the best thing I can recommend is to sit down with a licensed Medicare agent who can guide you through and make sure that you're making the right choice. Again, it's always very valuable to meet with a licensed Medicare agent because their purpose is to help you navigate through and understand what your options are. When it comes to Medicare, hopefully that answers your question. Thank you.

Answer: A question came in: I'm turning 65 in April. I have full VA coverage and a good hospital and doctor coverage through the VA here in the desert. Does the VA not cover dental care? Do I still need to enroll in Medicare? And if so, which makes sense for my situation?

Well, if you have full VA benefits, you don't necessarily need to enroll in Medicare, but you could be subject to a Medicare penalty for not enrolling in Medicare Part B if you need care outside the VA. You're pretty much going to be paying 100% for your care. So a recommendation would be that you always want to go ahead and enroll in Part B, but you don't have to get a drug plan because you have credible coverage through the VA.

As far as dental, I would recommend just purchasing an individual dental plan in your area. And again, if you work with a Medicare-licensed agent, they can guide you through your options when it comes to dental. But again, work with a licensed Medicare agent who can help navigate and help you understand what your options are.

Answer: There is a question that came in: what Medicare-related items commonly get missed or misunderstood when it comes to doing taxes? Well, it really has nothing to do with the tax, other than if you have an IRMAA, you're gonna pay a higher Part B premium or under your Part D. But mainly, the main thing to understand about Medicare is when to apply for Medicare and when you're eligible for Medicare. That is what's really, really important.

Because again, when it comes to signing up for Medicare, the appropriate time to sign up is crucial. Understanding that it's very important that if you're getting close to eligibility, turning 65, or you're currently working and getting ready to retire, is when you have to activate your Medicare Part A and Part B. Those are key questions.

So I would highly recommend sitting down with a licensed Medicare agent before you're leaving your employer. Your agent can help you understand your options when it comes to signing up for Medicare Part A and Part B. Hopefully, that answers your question. Thank you very much.

Answer: Come in. I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?

Yes. Anything that's medically necessary, then you're on original Medicare. Even maybe even on a Medicare Advantage plan will be covered by Medicare. But it has to be medically necessary.

So when it comes to colonoscopies, if your doctor or the specialist you're seeing recommends a more frequent visit and colonoscopy, yes, Medicare will cover that.

The best thing to do is sit down with a licensed Medicare agent and review your options. Understand what plans are available in your area. I hope this answers your question.

Answer: Your daughter or anyone with written authorization can represent the person on Medicare to help with Medicare enrollment.

Answer: Changing your Medicare plan depends on whether you're on Original Medicare with a Medigap plan or a Medicare Advantage plan. If you're on a Medicare Advantage plan, you generally have two opportunities each year to make changes. During AEP, from October 15th to December 7th, or during OEP, from January 1st to March 31st. There are SEP's. If you need clarification on your options, I would recommend meeting with a licensed Medicare agent who can best understand your situation.

Answer: When it comes to signing up for your Social Security retirement, the decision of whether to start early or at age 70 is up to you. Do you plan to continue working? How is your health? Can you afford to wait until age 70? The situation is based on your current financial situation.

Answer: Hello, my name is Gary Church. My company is Bay Area Health Solutions, where I help individuals planning for their Medicare. One of the things that I understand when it comes to Medicare is that it has two categories: Part A and Part B. Part A is your hospital coverage, and Part B is your medical doctor visits and outpatient services.

You have a choice. When you first start with Medicare, you either stay with original Medicare and buy a Medicare supplement, like a Plan B or Plan M. Those are standardized plans, so it doesn't matter about the company that's on the plan. It's about the plan itself. It's standardized, and with that, you are required to buy a drug plan, which would be your Part D.

If you choose to go with the Medicare Advantage plan, then that combines your Part A, Part B, and the Part D drug plan into one plan, which we call Plan C, a Medicare Advantage plan. There are pros and cons to any health plan, but I always recommend sitting down with a licensed agent so they can go over the options.

Understanding what you're purchasing today is what you're going to have in the future. So it's very, very important to understand the future of your health concerns you might have. When you're navigating through the Medicare planning system, I would sit down with a licensed Medicare agent to answer any questions you have.

So hopefully, this will help guide you through to taking the next step. Thank you.

Answer: Hello, my name is Gary Church. My company is Bay Area Health Solutions. I specialize in helping folks navigate through Medicare. A question just came in asking, "I picked a PPO for flexibility, but now every time I go out of network, I get billed outrageously. What is the point of having a PPO plan?"

Well, it gives you the opportunity to go out of network as long as those specialists are willing to bill your insurance company. Your primary doctor has to always be in network with that carrier you're with. But it gives you the option of being out of network to see specialists that might bill your insurance company. They charge a higher co-payment than the specialists that are in network with that Medicare Advantage plan.

But it's up to you. As long as you stay in network, you're going to pay that negotiated rate. So you're either going to pay a co-payment or not pay any co-payment, but you have the flexibility of coming in at a network as long as that doctor is willing to bill that insurance company.

So again, if you want to save money when you're seeing specialists, then you always want to stay in network with that provider. I hope that answers the question. Thank you.

Answer: Yes, my name is Gary Church. I'm a licensed Medicare agent here in Northern California, and I received a question that says, "Should I be concerned about my income affecting my Medicare eligibility?" Well, the answer is no. As long as you're 65 or older, you become eligible for Medicare. Or if you've been on Social Security disability for 24 months, on the 25th month, you become eligible for Medicare. Medicare does not consider your income. It does as far as IRMAA, but not as far as your eligibility for Medicare. I hope that answers your question. Thank you.

Answer: The question is, is Supplement Part M covering MRIs? Are you gonna be stuck with the bill? The answer is no, as long as it's medically necessary and your doctor says it's medically necessary for that MRI. Medicare is going to cover it. Then your insurance company is gonna pick up your 20%, but under plan M, you are subject to a co-payment.

Now, if you go to the emergency room, you're subject to a co-payment going into the emergency room. But otherwise, it acts just like a Plan G.

So, as far as covering it, yes, it will definitely cover that MRI. Again, I would sit down with a licensed Medicare agent to go over and help you better understand what your options are between the different supplements. Thank you very much. Hopefully, this answers your question.

Answer: First, how long have you been on SSI? If it's longer than 24 months, you should have been enrolled in Medicare. Once you turn 65, you'll have another opportunity to choose a Medigap or a MAPD plan. Your SSI will be replaced with Social Security.

Answer: The question is whether paying for a high-end Medicare supplement is worth the money. Will it come down to paying now or paying later? Are you controlling your healthcare, or are insurance companies managing your care?

Answer: What is the best Medicare Supplement company? It does not matter with Medicgap plans G & N are standard plans, it comes down to the premium that the insurance company set their premiums. It's best to work with a licensed Medicare agent who can show several plans. As for the difference, plans G & N are standard across original Medicare.

Answer: For the most part, Medicare does not cover out-of-the-country health insurance. In some cases, Medicare may cover up to $50,000 lifetime. If you're on a Medicare Advantage plan, check with your plan to see if you're covered. You should consider getting international health insurance.

Answer: Generally not! In some cases, Medicare may cover a lifetime claim of $50,000. If you're on a Medicare Advantage plan, you should check with your health plan to see if there's coverage. I recommend purchasing international health insurance when traveling outside the US.

Answer: That's a good question! Medicare doesn’t exactly “allow” insurance companies to bombard seniors — but it operates within a regulatory framework that permits marketing, with rules that are often pushed to their limits.

Answer: The best thing is to schedule a meeting with a licensed Medicare agent who can guide you through your options. Make sure you understand all your options. Compare MediGap vs Medicare Advantage.

Answer: Catastrophic coverage does not apply anymore. Drug plans have a deductible and an MOOP maximum out of pocket as long as the medication is on the formulary.

Answer: The question came in: can Medicare drop me for health reasons? No, Medicare cannot drop you for health reasons. If you're on a Medicare Advantage plan, those who have it have no underwriting, so you're automatically approved. If you are on Medicare and you're on a Medicare Advantage plan, and you do have health issues, that could prevent you from being able to go back to Original Medicare and buy a Medicare supplement plan because those companies do have underwriting.

So, the long and short of it is Medicare will cover you regardless of what your health conditions are. It's just about what it's going to cost you. So, it's important to understand that if you're on a Medicare Advantage plan, insurance companies manage your care. If you're on Original Medicare, then Medicare is going to pick up their portion. You're responsible for your portion of that bill. It's whether or not you have the right health plan that's there to protect you financially.

So, sit down with a licensed agent. They'll help you understand what your options are. But the most important thing is where the future of our healthcare system is going to be. What kind of quality care are you looking for? Those are key. A licensed Medicare agent can help guide you through that. There are a lot of resources. So hopefully, that answers your question.

Answer: The question is, are Medicare supplement plans the same as Medicare secondary insurance? I think it's really determined by how you're looking at what a supplement is. A Medicare supplement is one that covers 20% of your costs that you would acquire if you were on just regular Medicare Part B. A Medicare supplement 80/20 plan means Medicare for approved services picks up 80%. You're responsible for 20%.

So when you buy a Medicare supplement plan that's designed to pick up that 20%, there is now a Part B deductible, which is set by Medicare each and every year. But the freedom of having a Medicare supplement allows you the freedom to control your own health care. What I mean by that is you're able to see any doctor that accepts Medicare anywhere you go.

And there are pros and cons to any health plan, but the best thing to do is to sit down with a licensed agent and have that agent help guide you through determining what your needs are and what the costs are. Hopefully, that answers your question.

Answer: When can I make a change to my Medicare plan? If you're on a Medicare Advantage plan or drug plan, you're able to make that change in your own Enrollment, which runs from October 15th to December 7th. For the next coming year, once we get into the new year, January through March 31st is what they refer to as open enrollment. That allows folks who signed up for a Medicare Advantage plan to make one change to another Medicare Advantage plan or to go back to original Medicare. I recommend sitting down with a licensed Medicare agent to review your options and understand what your choices are.

Answer: The question is what's the difference between a Medicare Advantage plan and a Medicare supplement plan? Those are managed health care systems controlled by insurance companies to manage your care. You have to make sure that your doctors and the specialists that you're gonna be seeing, not only now but in the future, are going to be within their network. If not, you're not gonna be able to see those doctors.

Medicare supplement or Medicare gap plans fall under which Medicare is designed to allow you to see any doctor anywhere that accepts Medicare. There is no in-network or at a network access. You have the total freedom to control your own health care. There is a cost to that, but it really comes down to how you want to manage your health care. Hopefully, that answers your question.

Answer: I have a question that came in. My Medicare Advantage plan covers dental, but I can't find a dentist that accepts it. Generally, most Medicare Advantage plans have a simple dental plan embedded in those plans, and they're generally an HMO plan, which has a very small network of dentists. That may be a problem. You may want to check with your dentist to see what dental plans they do accept and work with a licensed Medicare agent or an agent that sells dental insurance. Look at what your options are. Because when it comes to dental insurance, it's important to understand what your needs are, not only today but what your needs are in the future, so you can make sure that you have the appropriate coverage in place.

So again, if you're looking for dental insurance, you may want to work with a licensed agent to look at the options as far as the dental plans available. I hope that answers your question.

Answer: Gym membership is not covered by Medicare. As for Medicare Advantage plans, they offer add-ons to make their plans more attractive to other Medicare Advantage plans, enabling them to compete. Nothing is free. If you're on Original Medicare with a Medigap plan, most of them include GYM memberships as part of their coverage. Meet with a licensed Medicare agent who can guide you.

Answer: Medicare covers Skilled nursing services with a three-day hospital stay, not assisted living services. If in doubt, you can call Medicare to confirm your options.

Answer: Those changes depend. The only time to make changes for the upcoming year is during AEP, from October 15 through December 7. There may be other opportunities to change. I recommend meeting with a licensed Medicare agent to review your options.

Answer: No! Medicare does not allow backdating, even for medical reasons. You might qualify for a special enrollment. When in doubt, I recommend reaching out to Medicare if you are unsure.

Answer: The answer is maybe! When choosing a Medicare plan, the key is understanding the differences between the plans. If you are deciding between Plan G or N, that will depend on your current needs. As for which insurance company you choose, that is your decision. The plans are all similar; it's the insurance company's set premium for each plan that makes the difference.

Answer: Yes! Medicare covers you within the U.S., including Puerto Rico, since Puerto Rico is part of the U.S. If you're on a Medicare Advantage plan, you'll only be covered in emergencies. If you're on Original Medicare with a Medigap plan, you're covered as long as the doctors accept Medicare. When in doubt, check with a licensed Medicare agent who can advise you.

Answer: Medicare says that as long as it is medically necessary, it is covered. You may want to check with your Medicare Advantage plan to see what programs are available. You could also check with your local Medicaid office. There are C-SNP plans that could be available in your area. You could check with your Medicare agent to see if they know of programs in your area.

Answer: Medicare and diabetes are covered by Medicare. Work with your doctor and relevant programs to help manage the condition.

Answer: Yes! medicare supplements are sold by private insurance companies, which have underwriting. The best way to see if you are eligible is to talk with a licensed Medicare agent.

Answer: That depends on your specific Medicare Advantage plan and only applies in emergency situations. Make sure to keep your Medicare Part A and B active. You might also consider getting an International health plan.

Answer: Yes, as long as you've been on Social Security disability for 24 months and you're a US citizen or a permanent resident.

Answer: Medicare Part B generally covers routine costs related to qualifying clinical trials. Be approved by CMS or meet CMS criteria. You can contact Medicare to find out if you qualify.

Answer: No, Medicare does not cover home healthcare. However, some Medicare Advantage plans, specifically C-SNP or D-SNP plans, might. I recommend meeting with a licensed Medicare agent who can check what's available in your area.

Answer: If you are referring to Medicare and travel outside your service area, and you want to see doctors or specialists anywhere, you might want to consider a Medigap plan, which does not have networks as long as the doctors or specialists you want to see accept Original Medicare. If you're on a Medicare Advantage plan, then traveling outside your service area will only be covered for emergencies.

Answer: A 5-star Medicare rating signifies excellent performance in areas such as customer service, member experience, and health outcomes. You can use this SEP once each calendar year to switch to a Medicare Advantage or Part D plan with a 5-star rating.

Answer: Smartwatches that monitor health are not covered by Medicare. They might be available through some Medicare Advantage plans. I recommend meeting with a licensed Medicare agent to review those options.

Answer: Medicare Advantage plan denied coverage for a specialist: Is the specialist in the network? The problem with Medicare Advantage plans is those referrals. Keep in mind, the Medicare Advantage plan manages your care and determines your coverage. You can appeal the decision.

Answer: Missing that window by even a day can cause you not to qualify. How's your health? Can you pass underwriting? There are options. I would recommend meeting with a Licensed Medicare agent who can guide you.

Answer: Living in a rural area does limit your options. The telehealth option is included in Medicare plans. You should talk to a Licensed Medicare agent who can guide you.

Answer: What is the financial risk of sticking with Original Medicare without a Medigap plan? The risk depends on your financial capacity—your costs are 20% for both Part A and Part B, with no cap, so a life-changing event could result in thousands of dollars in costs. Medigap covers you financially. You would want to have a drug plan.

Answer: Nothing's free! Annual wellness and preventive services are included in your plan at no cost. To find out what is considered preventive or part of your wellness plan, review your plan documents, check with a licensed Medicare agent, or call Medicare.

Answer: You can visit Medicare.gov and input your medications. The website will show all the available drugs in your area and compare them. You can also meet with a licensed Medicare agent who will help guide you to the right plan.

Answer: Yes! You can return to Original Medicare without penalties. But this can only be done during AEP, OEP, or SEP. Be careful when you're changing. I recommend meeting with a licensed Medicare agent or contacting Medicare directly.

Answer: Yes! If your parents are on a Medicare Advantage plan, they are covered for emergency care anywhere in the U.S. If they are on Original Medicare with a MediGap, they can see any hospital or doctor who accepts Medicare.

Answer: That will depend on which Medicare plan you have. If you're on a Medicare Advantage plan, you'll need to find another specialist that's in network with your current plan.

Answer: Discussing Medicare with your parents should not be an issue. Medicare is a very good health plan. What’s important is to schedule a meeting with a licensed Medicare agent who can meet with you and your parents to review their current plan and ensure it meets their needs.

Answer: Medigap Plan K compared to Plan G. Plan K has deductibles and a MOOP, which Plan G does not, only a Part B deductible.

Answer: Waiting to claim your Social Security at age 70 does not affect your eligibility to start Medicare. If you plan to keep working and your company has 20 or more employees, you're not required to enroll in Medicare; you don't have to enroll. The best option is to meet with a licensed Medicare agent who can guide you.

Answer: That's not enough just to have Medicare Parts A & B. Medicare is an 80-20 plan, which means Medicare covers 80% and you are responsible for 20% with no cap. If you qualify, you should consider a Medicare supplement like Plan G or N, which covers your 20%.

Answer: It's easy! Medicare Advantage plans often require referrals and deny services to their patients. Payment to doctors is affected. The insurance company wants to keep as much of the money given by Medicare.

Answer: Help those going on Medicare understand how it works. Medicare should be more understanding of seniors and people with disabilities, including those who don't have the information to make a decision. Medicare should be more compassionate.

Answer: When it comes to Medicare and all the different Medicare plans, the best approach is to understand how you'll use the plans now and in the future. The best way to do this is to meet with a licensed Medicare agent who can help you understand your options.

Answer: I just got a question that came in. I just started a new Part D drug plan and my new cholesterol medication. Does that count towards my coverage gap? Yes, it does. Any of the medications that you're taking, as long as they are in the formulary with that particular drug plan, will be covered through that deductible and the max out-of-pocket each and every year.

But it is important that each and every year during the annual enrollment, which starts October 15th and runs to December 7th, you reevaluate your drug plan to make sure it's meeting your needs. The best way of doing that is to sit down with a licensed Medicare agent, who will go over and be able to understand what your medications are so you can select the right drug plan for you. I hope this helps.

Answer: Okay, I had a question that came in. I'm really worried about selecting the wrong health plan and being stuck with it. How often can I change my Medicare plan?

When it comes to making any changes to your Medicare plan, whether it's a Medicare Advantage plan or a drug plan, each and every year from October 15th to December 7th is a period of time that you can review your current Medicare plan. You can make any necessary changes during that time.

I would always highly recommend that you sit down with a licensed Medicare agent who will help navigate you through and help you understand what options you have to be able to select and what health plan you have going into the following year. So I would definitely sit down with a licensed Medicare agent who will be able to help advise you on what the right health plan is for you.

Answer: Have a question? Came in about Medicare fraud. Is that something we should be concerned about? Yes, we should all be concerned about fraud within Medicare, whether that's through a Medicare Advantage plan or billing, or somebody abusing the system to take advantage of it. That affects all of us through our premiums. So yes, we should all be concerned about fraud within Medicare. Hopefully, that answers the question.

Answer: I got a question that came in: Can I sign my parents up for Medicare? Well, that depends. But it really comes down to your parents and whether or not you have authorization to speak on their behalf. Then you can. But it's really going to be up to your parents if you want to be part of it when working with a licensed Medicare agent. That would be my recommendation if you want to be there with your parents to understand what their options are. That's fine, but they have to be able to do it on their own and be able to understand what they're learning. So if you have authorization to speak on their behalf, then you certainly can.

Answer: Okay, I got a question that came in. Should I expect any changes from Medicare going into 2026? Yes, there will be some changes you should be receiving here in September. Your notice of annual notice of change that you're going to get from your carrier, whether it's a Medicare Advantage plan or your drug plan, I would definitely go over that. I would recommend when you get to AEP, which starts October 15th and runs through December 7th, you sit down with a licensed Medicare agent to review those options to see which plan is going to work best for you. Again, it's up to you to make sure that you're able to make an informed decision on what's the right plan for you. I hope this answers your question.

Answer: Had a question that came up: how long do Medicare appeals take? Generally, it’s up to about 60 days from receipt of that appeal. So hopefully that answers your question. Thank you.

Answer: Okay, I have a question that came in. What type of Medicare coverage do I need to cover in-home care? Medicare doesn't cover home care. Medicare will cover skilled nursing, which is if you've been in the hospital at least for three days, but not well enough to go home, and you're going to go to a skilled nursing facility where you're going to have rehab. Medicare will pick those days up, at least the first 20 days, depending on which Medicare plan you have. So hopefully that answers your question.

Answer: I have a question that came in: Does Medicare cover chiropractic services? The answer is yes. They will cover up to 12 visits in a calendar year, of this medically necessary. But you may want to check with your chiropractor to make sure that they accept Medicare and also make sure that your Medicare plan does have that coverage in it. As far as what their plan...

Answer: Here's a question that came in: Does everyone over the age of 65 qualify for Medicare? Well, the obvious answer is no. How do you qualify for Medicare Part A and Part B? You had to be working, I've been self-employed at least for ten years and have at least 40 quarters paid into through Medicare taxes to qualify for Medicare Part A and Part B. If you're a non-U.S. citizen, you do not qualify for Medicare. If you're a naturalized citizen or hold a green card, you've been in the country at least five years or longer. You could be eligible for Medicare. The difference is if you haven't paid into Medicare taxes, you would be responsible for paying for Part A and Part B. I hope that answers your question.

Answer: That depends on where you live. If you live in a large metropolitan area, you'll have more choices. Living in a rural area, you'll have limited choices or no choice at all. Medicare Advantage plans do have a Star rating. You can call Medicare to ask about some of the 4 and 5 Star plans. Work with a licensed Medicare agent to review the plans available in your area.

Answer: The donut hole as of 2025 has been replaced with a deductible and a MOOP max out-of-pocket limit $2,000. Now, if you have some very expensive medications that are not on the formulary, they can be very costly and won't be covered by your drug plan.

Answer: Not necessarily! We are coming up to AEP from October 15 to December 7th. I would recommend meeting with a licensed Medicare agent who can help you navigate all the plans available in your area.

Answer: Contact your Licensed Medicare agent, call your Medicare Advantage plan, or visit their website to search for doctors.

Answer: When you receive the Annual Notice of Change (ANOC), get ready for enrollment after

October 15th through to December 7th.

Answer: This should not be a stressful event. If you are on a Medicare Advantage plan and have health issues or your prescriptions change, consider how you are using your Medicare plan. Understand that within your Medicare plan, you share costs through copayments and coinsurance, and be aware of your maximum out-of-pocket (MOOP) each year. Meet with your licensed Medicare agent to review all your options and MOOP for each of the Medicare plans available in your area.

Answer: Not necessary! It would depend on the prescription and the tier level. Is your drug in the MAPD formulary? If it's a PDP, I would recommend reviewing your plan every AEP, from October 15th to December 7th.

Answer: It could be for many reasons. Insurance companies are moving out of rural areas due to low enrollment or Access to healthcare providers. Insurance is losing money.

Answer: That depends! Are you a US citizen? Are you 65 or older? Do you have a spouse or ex-spouse who is or was a U.S. citizen and worked in the US for 10 years or 40 quarters that could qualify you? Reach out to Social Security.

Answer: This will depend on where you live. Choosing the right company comes down to your access to medical services. Do you live in a metropolitan or rural area? Do you want to manage your own health care or leave it to the insurance company? Do you have family or friends on Medicare who can recommend a licensed Medicare agent? How do you feel about the agent you met with?

Answer: Why do you only have Part A? Are you still working, or did you miss your qualifying enrollment for Part B? Just having Part A means that if you're hospitalized, you'll have copayments and co-insurance.

Answer: It all depends on how you perceive or your expectations of the seminar. The seminar gives a group of people the chance to better understand what options are available. Whether it's an education seminar or a marketing/sales seminar. It's always best to meet with a licensed Medicare agent and not be persuaded to choose one plan.

Answer: It's important to understand the pros and cons of each. Do you want to manage your own health care or let Medicare Advantage manage your care? Affordability can influence your choice. You should meet with a licensed Medicare agent who can help you evaluate the best option for you.

Answer: Choice! Managed health care, like Medicare Advantage plans, controls your health care. You must stay within their network of doctors and rely on referrals and denials on MAPD. The freedom to choose your own doctors is available with Original Medicare plus a supplement, which allows you to manage your own health care as long as the doctors accept Medicare.

Answer: The question about eye surgery: if the procedure is medically necessary, such as cataract surgery, it's covered by Medicare. As for Medicare Advantage, there could be an issue or concern.

Answer: There's not one state that has a better Medicare plan. It depends on where you live — in a large metropolitan area or a rural area. It also depends on what Medicare plans are available in the area where you live. Original Medicare has no restrictions on access other than if the doctor accepts Medicare.

Answer: Yes, It depends on whether you are on original Medicare or on a Medicare Advantage plan. If you are on original Medicare Part A & B, you're covered. If you have a Medicare supplement, you need to let the carrier know your new address. If you're on a Medicare Advantage plan, you'll need to find a new Medicare Advantage plan or go back to original Medicare.

Answer: Yes! Original Medicare does not disparity among any minority groups. But depending on where these groups live, the Medicare Advantage plans could.

Answer: You should review your Medicare Advantage plan every year. Also, you should receive your ANOC letter ( Annual notice of change) in September of each year. Review that notice for any changes. I would recommend talking to a licensed Medicare agent, who can guide you to Understanding your options. As for hearing aids, they can differ with every Medicare Advantage plan.

Answer: Yes! as long as it is medically necessary. I would always recommend working with your licensed Medicare agent; they should be able to assist you in looking for the right plan.

Answer: Medicare and some Medicare plans cover emergency overseas care and are reimbursable. The lifetime coverage limit is $50,000. I highly recommend purchasing a standalone international health insurance plan. Check with your insurance broker or your travel agent.

Answer: It depends on whether you're new to Medicare or currently enrolled in a Medicare plan. AEP, which starts on October 15th and runs until December 7th, is the best time to review your options for the upcoming year. I recommend meeting with a licensed Medicare agent to explore your choices.

Answer: No, you should be automatically enrolled in Original Medicare. I would recommend meeting with a licensed Medicare agent to review your options.

Answer: There is no need to let the star rating influence the Medicare Advantage plan you choose. It depends on you, the doctors, and the medical group involved in that plan's claims and denials. As with any insurance company offering Medicare Advantage plans, its members who have had a bad experience with that provider are affected, which reflects the star ratings.

Answer: Choice: if you want the insurance company to manage your care, then a Medicare Advantage plan works for you. If you are on a fixed income, then a Medicare Advantage plan also works for you. If you want to manage your own healthcare, then a Medicare Advantage plan does not work for you. There are pros and cons to any health plan; it ultimately comes down to your choice. Work with a licensed Medicare agent who can guide you and help you choose the right plan.

Answer: Yes, not every Medicare plan works for everyone. We all have different needs. With Medicare, it's about selecting the right plan for you.

Answer: The best relationship is with a local agent. There is nothing wrong with working with a licensed Medicare agent remotely by phone. It's about building a relationship. Buying a Medicare plan should not be a transaction but an ongoing connection as things change in life.

Answer: Because they ignore the advice or talk to someone else who may have given misinformation, it's important to feel comfortable with the licensed Medicare agent and be clear about your options.

Answer: IRMAA means Income-Related Monthly Adjustment Amount, which applies to individuals based on the income reported for 2023. If your income was above $106,000, you will pay the IRMAA based on the higher income. You can appeal the IRMAA based on your current income with Social Security, which is going to be lower in 2025 than what you earned in 2023.

Answer: Simple Medicare did away with the donut hole and replaced it with a deductible and a $2,000 MOOP. What's important is that 2026 will have changes. I would recommend that during AEP, which runs from October 15th through December 7th. To review your drug plan with a licensed Medicare agent.

Answer: There is no cheapest plan. Understand, we all want to save money, but when it comes to having a Medicare plan, it's about how you'll use the Medicare today and in the future.

Answer: Research and avoid calls about Medicare plans from so-called agents. Recommend meeting a licensed Medicare agent who can understand your needs. Ask a friend who's on Medicare if they have an agent that helped them with their Medicare plan. If you're not sure, call Medicare.

Answer: That depends on how the individual uses their Medicare Advantage plan and which plan they have. Also, consider the deductibles, co-insurance, and the MOOP.

Answer: I recommend waiting until AEP, which runs from October 15th through December 7th. Any time during that period is a good opportunity to review your current plan and the new plans for 2026.

Answer: Choice! Do you want to have full control of your healthcare or let the insurance company manage your care? Affordability is also very important when deciding which way to lean. I would recommend meeting with a licensed Medicare agent to review all your options.

Answer: Yes! If you are not going to continue working for an employer with 20 or more employees, then yes, you'll need to sign up for your Medicare Part A & B. Make sure you fully understand your options. Work with a licensed Medicare agent who can explain your options.

Answer: Good question; as of now, in 2025, hospitals do accept Medicare. Generally, hospitals should accept Medicare for medical reasons. The concern in the future with all the projected cuts to Medicare could have an effect on private hospitals not accepting Medicare.

Answer: Great question. It's not based on your health as an individual, but rather on the risk pool of everyone in the group.

Answer: Depend on which Medicare plan you have. Are you on original Medicare with a Med-Gap plan or a Medicare Advantage plan? If you have a Medicare Advantage, yes, you'll need to change. If you have a standalone Drug plan, you'll need to make changes.

Answer: First of all, sorry for your husband's passing. There could be several factors. Did your income increase? You could appeal the increase by reaching out to Medicare.

Answer: No, control means you have full authority over your health care, rather than letting the insurance company dictate your health care. Regarding traveling within the US, you can take your health plan and see any doctor that accepts Medicare. As long as you can afford to keep your current Med-Gap plan, I would highly recommend that. You can pay now or pay a lot later.

Answer: I want to answer that question: If you have original Medicare, then it's just you and your doctor. If you have a Medicare Advantage plan, then it's the insurance company’s decision.

Answer: It depends on which Medicare plan you have. If you're on original Medicare Part A & B, and hopefully have a Medigap policy, your plan covers where you go. If you have a Medicare Advantage plan, then you'll need to switch to another Medicare Advantage plan as long as there is one available where you are moving to. Check with a license agent for guidance.

Answer: It all comes down to the service area. If you live in a metropolitan area, it can have a lot to do with plans. Rural areas with fewer healthcare options can affect the cost of plans. Working with a local licensed agent can help you better understand your options.

Answer: Yes! The Part B premium is subject to change each year. As for the Medicare Part B deductible, it changes every year.

Answer: If you have been on Social Security disability for 24 months, Social Security should automatically enroll you in Medicare A & B. If not, you may want to contact Social Security.

Answer: Medicare does not cover dental. Check with your dentist to see which dental plans they accept, and then work with a licensed agent in your area to find the right dental plan. As for Vision, check with your Eye doctor or your local Vision store. The two large insurance companies VSP and Eyemed.

Answer: Generally, MOOP applies to Medicare Advantage plans. When choosing a plan based on the MOOP, consider the network and the doctors where you live. It is essential to review all the plans in your area. Look use the star ratings issued by Medicare as a guide. Work with an agent that has your best interest in mind.

Answer: Medicare looks back every two years to determine if you'll have an IRMAA. They are currently reviewing 2023. If you believe that the IRMAA should be lower based on your current income, you can appeal to Medicare.

Answer: I would stay with original Medicare along with a Med Supp. Purchase an individual dental plan. Check with your dentist about which dental plans they accept. Medicare Advantage plans offer a basic dental coverage, usually as an HMO, which may have a limited network.

Answer: The most important question should be about how you'll use Medicare throughout your lifetime, what health concerns you may have in the future, where you will live, and your access to doctors and hospitals—both today and if you move in the future.

Answer: Protective screening during the annual wellness visit is covered by Medicare. Be mindful of what you request, as it will depend on how your doctor codes the screening.

Answer: Great question. What are the chances of significant changes in the next few years? Who will be managing Medicare, insurance companies responsible for patient care, or shareholder value? We need to ensure Medicare remains a government agency beholden to all Medicare beneficiaries, not the insurance companies aiming to control their bottom line.

Answer: Yes! there should be advertising on TV focusing on the local community where the Medicare Advantage plans are being sold. Celebrities should not endorse plans for money. Be honest about their endorsements. Nothing's for free; it's baked into the plan.

Answer: One piece of advice every senior should know before picking a Medicare plan? What is your health now? What will be in the future. There are PROS and CONS to any Medicare plan. But do you want to have control over your healthcare decisions or let the insurance company make their decision on your healthcare? Pay now or consider how much you'll pay later and what options you'll have.

Answer: Yes! For non-payment, If lose your Part B with Medicare. Keep in mind that you are on original Medicare and purchase a Medigap plan.

Answer: Why you should work with a Medicare agent or broker is that they should review all the plans that are available in your area. I would recommend meeting with the broker and reviewing all your options.

Answer: The likelihood of Medicare covering gene therapy as it becomes a reality will depend on the current Administration. There could be changes in 2026 and beyond. It will also depend on the insurance company, usually Medicare Advantage plans.

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

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

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

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

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

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

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

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

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

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

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

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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: What I like about being a Medicare licensed agent is I truly love what I do. My purpose is to help educate and inform people about health care and understanding individuals' needs and wants when it comes to their health care. It's important for people to be able to make informed decisions, particularly when it comes to Medicare and how confusing Medicare can be. But if you work with a licensed agent, they can actually guide you through it. I take great pride in helping people make informed decisions about their care. Not only today, but where your health is gonna be in the future. Because whatever decisions you're making today can have an impact on you in the future.

To me, it's about the relationship I have with my clients that helps me get through this. I say if I'm digging ditches and climbing roofs at 72 years old, I'm not gonna be able to do that. But my heart and passion is helping people understand our health care system, which I've been doing for 23 years, and I truly love what I do.

So when it comes down to helping people navigate through our health care system, whether that's Medicare or any health plan, it's about understanding what people's needs are, not only today, but what our future needs are. So for me, I'm truly honored to be able to help folks make informed decisions when it comes to their health care.