Gary Henderson

What's the most important question I should be asking about Medicare that I probably haven't thought of yet?

Answer: Medicare supplement plans vs Medicare advantage plans.

Insurance companies want you to buy advantage plans. They make more money and cost you more

Are Medicare Advantage plans really "free," or is that just clever marketing?

Answer: It's just clever marketing. They can bankrupt you if you have a long illness like cancer. They have high max out of pocket costs per year

My doctor mentioned something about Medicare not covering my procedure. How do I find out for sure before I get stuck with a bill?

Answer: Have a predetermination submitted to see if it is covered.

You can find many answers for Medicare supplement plans in the Medicare guide and website

Medicare advantage plans require you to be contact your insurance company

I'm considering a smartwatch that monitors my heart rhythm for atrial fibrillation. Will Medicare help cover this type of wearable technology?

Answer: +5

Generally, Medicare (Parts A and B) doesn't cover smartwatches for atrial fibrillation (AFib) detection, as they are not considered medically necessary durable medical equipment (DME). However, some Medicare Advantage plans or other options might help cover or offset the cost.

Shouldn't Medicare do more to address health disparities among minority seniors?

Answer: Yes, Medicare should do more to address health disparities among minority seniors, as research indicates that disparities in access to care and health outcomes persist even within the Medicare program, and that expanding coverage and addressing social determinants of health can help reduce these inequities.

What is the biggest disadvantage of the Medicare Advantage plans?

Answer: YearlyMax out of pocket costs are high

The more perks they offer, the higher the max out of pocket costs

My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?

Answer: It varies by insurance company. You would need to get an answer from them. You don't need a referral for supplement plans.

What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?

Answer: Guaranteed issue is a time period where you cannot be denied coverage for a Medicare supplement plan due to illnesses. There's a number of special periods that this can occur and it varies by state. If you'd like to have a conversation to fully understand your situation and how this works for you, please feel free to contact me.

I'm healthy and barely use my coverage, but I'm still paying more every year. Why isn't there a discount for people like me?

Answer: Insurance companies set pricing and they typically do it based on where you live. It's based on your ZIP code and your age. Way you can offset this is by looking at other alternative plans that are lower cost for supplement plans which I can help you with. And as long as you're healthy enough to pass the underwriting, you'll be able to get another plan. If you live in a state that has special rules where they cannot deny you coverage, we can look at that also

Give me a call at 737-530 -4626 pick option two. That is my direct number and if I'm busy leave a message and I'll call you back

How can I estimate my total Medicare costs if I have a chronic condition like diabetes?

Answer: If you have a Medicare supplement plan, you'll have an annual deductible for all your doctor visits this year. It's $257. Once you've met your deductible, you're covered at 100% for the rest of the year, then includes hospitalization also

Your prescription drug coverage depends on your prescription drug plan and the type of medication you take. Generic medications are usually $0 to $5 for one month's supply insulin if you take, that is capped at $35

If you'd like to have this discussion in more detail, give me a call at 737-530-4626 pick option two. That's my direct line. If I'm busy, just leave a message and I'll call you back

What's the projected impact of an aging population on Medicare Part A hospital funds?

Answer: That is a question for Medicare. They are the ones that control that insurance agents would have no knowledge of Medicare decisions by the government in this particular situation

I've heard Medicare covers an annual wellness visit. What exactly is included in this visit?

Answer: This is a usual physical type doctor visit where you get general checkup and he may request a blood and urine test also

My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?

Answer: If a doctor builds you always question it. Check your explanation of benefits before you pay any bill. Often doctors will bill you because they haven't been paid yet and it's lagging or something like that by the insurance company or Medicare. And also depends on whether you have a Medicare advantage plan or a Medicare supplement plan. If it's a supplement plan, Medicare pays first and then your plan pay-c remaining 20%. You do have an annual deductible for doctor visits of $257 this year. Once that's been met you would not have any further charges for the rest of the year. If you'd like to go over this in more detail, give me a call at 737-530-4626 pick option 2. That's my direct line. If it's busy, just leave a message and I'll call you back

My husband passed away and now my Medicare premiums went up. Why does losing someone raise your costs?

Answer: It depends on what premiums you're talking about

If you're talking about your Medicare supplement plan premiums, if you had a discount because you both had the same policy with the same company that would eliminate that and raise it somewhat but not too much

So again, I would need to understand your situation. If you'd like to talk about it give me a call.

Don't you think Medicare will eventually be privatized completely?

Answer: There has been no known discussion as far as I know about Medicare, but with the current administration changing everything, only time will tell so we'll watch for that

I've heard Medicare covers home health care, but what exactly does that include?

Answer: Home health care includes getting a medical professional to help you with medical needs that is part of the Medicare supplement plans

If you have Medicare advantage plan that might be different

But basically you could have someone come into your home and help you with your medical needs 365 days a year and that would be cover under your Medicare part b and your Medicare supplement plan at no cost after you paid your annual deductible which this year is $257

If you'd like to discuss this in more detail, give me a call. My phone number is 737-530-4626 pick option two. If I'm busy just leave a message and I'll call you back

I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?

Answer: Yes, Medicare Part B covers smoking cessation counseling, and Part D may cover certain prescription medications to help with quitting, with a focus on a combination of counseling and medication for optimal results

How do you stay up to date with changes in Medicare policies and plan options each year?

Answer: I'm required to stay current Medicare publishes changes that they're going to make every year so we just review the bulletins and applied the changes. Most of the changes are pretty nominal. There might be an introduction or something here or there. Last year there was big changes to drugs plans which was very good. Dropped the max out of pocket down to $2,000 which it previously was $8,000 .

If you'd like to discuss this in more detail, contact me.

I'm caring for my spouse with dementia and experiencing caregiver burnout. Will Medicare cover any mental health support for me?

Answer: Outpatient Mental Health Care (Part B):

Covers individual and group psychotherapy with licensed professionals.

Includes annual depression screenings.

Covers psychiatric evaluations and diagnostic tests.

Covers medication management and injections received at a provider's office.

Covers partial hospitalization programs (PHPs).

Covers intensive outpatient programs (IOPs).

Covers other mental health services like substance abuse treatment, occupational therapy, and more.

I'm confused about preventive services under Medicare. Which screenings are actually free?

Answer: Many Medicare Part B preventive services, including various cancer screenings, vaccinations, and wellness visits, are no cost to beneficiaries, as long as the service is provided by a provider who accepts assignment. For example, colorectal cancer screenings like colonoscopies, mammograms, and Prostate cancer screenings are covered without cost. Additionally, the Welcome to Medicare and yearly wellness visits are also no cost.

I'm at high risk for heart disease based on my family history. What additional preventive services might Medicare cover for someone with my risk factors?

Answer: Medicare Part B covers several preventive services for heart disease, including cardiovascular screenings and behavioral therapy. Cardiovascular screenings check cholesterol, lipid, and triglyceride levels every five years, helping to detect conditions that may lead to heart attack or stroke. Additionally, individuals can receive a yearly cardiovascular behavioral therapy visit with their primary care physician to help lower their risk for cardiovascular disease.

My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?

Answer: Medicare covers medically necessary cataract surgery, including the implantation of a standard monofocal intraocular lens (IOL), but typically does not cover more advanced lens options like toric or multifocal lenses.

You would have out-of-pocket cost for those

What's the key difference in how Medicare Advantage and Medigap handle out-of-network providers?

Answer: Medicap really has an auto network provider because they don't care what the insurance is. It's whether the doctor takes original Medicare or not. Whatever the medigap plan and doesn't matter they have to take it so it is extremely difficult to be out of network with medigap plans

On the other hand, Medicare advantage plans work exactly like your corporate plan did when you were working and you have to stay in network dentist. If you go out of network, you get charged additional monies. If it's a PPO or POS plan HMO plans, you must stay in network or you don't have any other coverage

Why are hospitals not taking Medicare Advantage plans?

Answer: That is a contractual issue between the hospital and the insurance carrier. If they're not taking a Medicare advantage plan, they have their reasons for it. Typically if you stay with major brands you don't have that problem. It's when you get these small off-brand companies that are the ones that tend to Make it harder to find in-network hospitals

Get a Medicaid plan. You don't have to worry about any of that because because you're on regional Medicare and your Medicaid plan just pays the difference. If they take original Medicare they must take your Medicare supplement or medigap plan

Will Medicare cover asthma and other breathing conditions?

Answer: Yes

And to clarify, I'm talking about Medicare supplement plans for Medicaid plans

Medicare advantage plans probably will also, but it depends on the plan and the insurance company and what the condition is

Medicare advantage plans can turn down different types of ailments for coverage, whereas Medicare supplement plans typically have very, very wide range of coverage which makes them much better

How might climate change-related health issues (like heat stroke) influence Medicare policies?

Answer: That is a question for the United States government That manage Medicare

Contact your congressman

I doubt if a typical customer service operator would know the answer to that question

I use a continuous glucose monitor for my diabetes that connects to my smartphone. Will Medicare cover this technology for someone with my condition?

Answer: Yes, Medicare Part B covers high-tech glucose monitoring devices like continuous glucose monitors (CGMs) as durable medical equipment (DME). This includes both non-adjunctive and adjunctive CGMs. Medicare will cover CGMs for individuals with diabetes who are treated with insulin or have hypoglycemia, and who meet specific criteria.

I'm participating in a clinical trial for a new cancer treatment that uses personalized medicine based on my genetic profile. How does Medicare coverage work in this situation?

Answer: First of all, since you're doing it for a drug company, I would expect them to cover that

In general, Medicare does not directly cover the cost of the medications themselves used in clinical trials. However, Medicare may cover certain routine costs and complications related to participation in qualifying clinical trials if they are otherwise covered services.

I'm in the donut hole and can't afford my medications. What are my options right now before the 2025 changes?

Answer: This question is out of date. The maximum coverage started in 2025 was no more than $2,000 max out of pocket for any prescriptions in the course of one calendar year. So this is no longer a relevant question

I just moved from New York to Florida and have Original Medicare with a New York Medigap plan. Do I need to change my coverage?

Answer: No, you just notify your plan with your new address and they will give you a new rate where you live in Florida. As long as the company is Nationwide and has approval to sell products in Florida and New York, there should be no difference in your coverage. There may be a difference in your monthly premium

I signed up for a Medicare Advantage HMO, and I'm wondering if I can see a cardiologist out of network without paying everything myself.

Answer: Only if it's an HMO POS plan if it's a pure HMO you Cannot see anyone outside the network without having to pay for it yourself

I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?

Answer: Give me a call and we will over everything with you. This is not a simple one or two sentence answer sadly

My work phone number is 737-530-4626 pick option 2. I cover every state except New York and Massachusetts

My name is Gary Henderson

What do seniors often misunderstand about Medicare's coverage for long-term care?

Answer: There is no long-term care provision

Long-Term care policies are purchased separately. The older you are the more expensive they are

Should there be stricter regulations on Medicare Advantage marketing and sales practices?

Answer: There are very strict rules regarding Medicare advantage sales practices. The one rule I wish they would force agents to do, which is what I regularly do is explain all your options which are other plans such as Medicare supplement, also known as medigap plans. These actually have much better coverage. But in the event that they are not affordable to you, that's why there's Medicare advantage plans

So with all these 2025 Medicare changes, should I be switching plans or staying put?

Answer: The biggest change was to prescription drug plans and you can only change those during the open enrollment. October 15th through December 7th

It's a good idea to look at those cuz a lot of companies drop their lower cost plans and switch people to the higher plans. And if you did not notice that in time for the ability to switch policies, then you're stuck with it for the entire 2025 year. So watch for those annual notice of change letters that come out in September or October each year and then you'll know what to expect

I need help at home after my surgery. Will Medicare cover a home health aide or am I on my own?

Answer: All answers depend on whether you have a Medicare supplement plan in addition to your original Medicare or Medicare advantage plan

If you have original Medicare, yes it will cover at home care. Medical care not washing dishes, making food things like that it'll be covered at 80% and you pay the other 20%. If you have a Medicare supplement plan, it'll be covered at 100%. If you have a Medicare advantage plan, it's going to depend on each insurance company and if you have an HMO you may have a lot of problems with that. Contact your Medicare advantage insurance company for more details with them

How does losing a spouse impact my Medicare plan if I was on their employer coverage?

Answer: Well you need to explain this. Are you also losing your spouse's coverage? The answer depends on a lot more detail. Sorry, I can't explicitly answer this one, but if you do lose your spouse's coverage and you're on Medicare, you're still always covered by Medicare. That doesn't change unless you stop paying your Medicare part b payment and you lose part b

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

Answer: Yes, Original Medicare typically covers colonoscopies needed for colorectal cancer, including surveillance and follow-up procedures. Medicare Part B covers colonoscopies as preventive care. For those at high risk for colorectal cancer, Medicare covers colonoscopies every 24 months. If you've had colon cancer, Medicare will cover a colonoscopy one year after treatment and then every three years.

How do Medicare Savings Programs help with Medicare costs?

Answer: Medicare savings programs do not work with Medicare plans. They only work with under 65 medical healthcare plans

I'm considering genetic testing to assess my cancer risk based on family history. Will Medicare cover this preventive approach in my situation?

Answer: Medicare typically covers genetic testing that's used to diagnose or guide treatment for a specific health problem, but not to predict risk or detect undiagnosed conditions.

Does Medicare pay for telehealth visits with specialists, or is it limited to primary care?

Answer: Yes, Medicare does cover telehealth visits, both through Original Medicare (Parts A and B) and Medicare Advantage plans. Medicare Part B covers a range of telehealth services, including routine office visits, consultations, and certain mental health services

I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?

Answer: Yes, Medicare generally covers robotic knee replacement if it's deemed medically necessary and performed at a Medicare-approved facility

How might artificial intelligence change how Medicare approves claims in the future?

Answer: You would need to contact Medicare for that one. If it doesn't exist, we cannot presume how it's going to work

How do I report a suspicious Medicare billing error without getting in trouble myself?

Answer: Call Medicare

Anytime you see something that doesn't look correct and you've researched it with your doctor or hospital and determine it wasn't made an error, then you can contact Medicare and report it

Does Medicare Advantage cover home health care?

Answer: Typically yes but it depends on the plan. Oftentimes HMO plans only work with specific service providers and if you can't find a service provider then you won't get the health care. I do not recommend Medicare advantage appliance at all. Medicare supplement plans are worry-free. You don't have these kinds of issues.

I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?

Answer: There are several reasons. First of all, if you first sign up for Medicare parts a and then b. Even if b is later, you have a 6-month period where you cannot be denied coverage.

After that, most insurance companies can deny you coverage when you're first signing up for Medicare plan.

If you already have a Medicare plan and want to change it, there are a few states that have special consumer Medicare laws that allow you to change them, for example, for a period around your birthday

People often think that with the ACA plans often called Obamacare that you couldn't be denied coverage that does not apply to Medicare. It applies to insurance in the ACA plans for people 65 and under only

What's a red flag in a phone call that it might be a Medicare scam targeting my personal info?

Answer: Never give out your Medicare ID number and your dates

The only time you ever need to provide that information is if you are at your doctor's office or you're getting something done at a hospital or you're buying Medicare related insurance

Initially to get a quote even with insurance as an agent I only ask for the A&b dates because I don't need the number until I actually enroll a person

So guard that one with your life. Scammers are trying to get that information so they can file false claims and get paid by Medicare

I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?

Answer: No

You must live and work here a minimum of 5 years to qualify for Medicare and social security

To get part A for no charge you must have 10 years in the United States working

If you have 5 years you can still get part A but you have to pay a monthly premium for that and it's quite expensive typically

If you're married and your spouse has qualified credits for the 10 years, then you can piggyback off of your spouse and get Medicare benefits

This is based on often spouses. Don't work for whatever reason. Just one does and therefore they are eligible to use their spouse's benefits to get Medicare

Aren't those Medicare seminars just sales pitches in disguise?

Answer: Yes, sales people are going to try to provide education and then follow up with potential sales opportunity.

That's just business

But they are very restricted in terms of what they can do. So they can't hand out a bunch of freebies that cost more than $15. I think it is. They can only call you if you've signed up to be called, etc. There many laws protecting consumers about this but seminars or just go online and watch YouTube videos to learn about Medicare or call me. I can answer your questions

I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?

Answer: Your doctor must provide you a letter AKA a prescription for any durable medical equipment. Contact your primary care physician

I've heard that once you're on Medicare, you might not need life insurance as much. Is that true?

Answer: 0 Medicare does not have any life insurance provisions at all

You can purchase individual life insurance. Of course you need to be healthy enough. You can be denied coverage for serious health issues

It is best to get life insurance while you're young and healthy. So if that is not you and you have children tell them to do that often people use the life insurance provided by their jobs. Then they retire and they ignore the offer to pick up the life insurance that they had at work and they're too ill to qualify for it later and are denied

Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?

Answer: This is a long story, but in short, if you get a Medicare supplement plan, you have much better coverage. You're covered at 100% in the hospital. You're covered at 100% outside the hospital after you pay your annual deductible for that

Medicare advantage plans are similar to what you had working. They look very familiar in terms of the coverage the government gives them your part b payment which this year is $185 so they offer it to you for free

They have the same limitations that you had before with doctors, hospitals and coverages off an expensive coverages like cancer are not covered as well

So if you can afford it, get a Medicare supplement plan. If you need assistance understanding all your options give me a call

Can I backdate my Medicare enrollment if I missed my initial window due to a medical emergency?

Answer: Well, there's a lot of details to that situation that would need to be answered. Typically no, they do provide national disaster type of adjustments for your start date but if it was just you failed to sign up when you were supposed to and then you got sick. And now you want the insurance to cover the bill that is not going to happen

When my husband dies, do I get his Social Security and mine?

Answer: No

The sad part about social security is you do not get your spouse's benefits and yours

What you can do is get the higher of the two, so if you've got more money through your spouse's benefits, the social security administration would be assign that to you

The sad part of all of this people can work all their lives. Retire at 62 die the next day and all that money that was paid into it reverts back to the government and that is just very wrong in my opinion

How well does Medicare support seniors who need assisted living, or does it fall short?

Answer: No, Medicare does not cover the costs of assisted living facilities. Medicare primarily covers medical services like doctor visits, hospital stays, and skilled nursing care, but not the general costs associated with living in an assisted living facility, such as room and board, housekeeping, or assistance with daily activities

What's the deal with Medicare covering medical equipment like wheelchairs- do I need a special approval?

Answer: Yes, it needs to be medically necessary. See your family physician. They can help you provide a letter so that you can get any durable medical equipment that is covered by Medicare. And yes that would include wheelchairs and even motorized wheelchairs

I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?

Answer: Preventative screenings are covered under Medicare and no charge. They want you to stay healthy! So your annual wellness visit mammograms pap smears colonoscopies things of that nature that would help prevent disease are covered

Why did I receive a Medicare Summary Notice, and what should I do with it?

Answer: If you're referring to a claim as a summary notice that tells you what the doctor or hospital builds, what Medicare paid and what you owe. If anything, if you are just on original Medicare that would mean you would owe the 20% that Medicare didn't cover

It would be different if you're on a Medicare supplement plan or Medicare advantage plan according to the plan coverage and I'm referring to the advantage plan. Supplement plan would be covered at 100% after the annual part b deductible if that applied

I called to ask about a knee replacement and suddenly they said I need prior authorization. I thought my plan was supposed to be good-what's going on?

Answer: All medical procedures require a doctor provide information that makes it medically necessary

For example, if you decide you want a knee replacement, you just can't get one because you want it. You're not a medical professional

What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?

Answer: Well that's a long list

First of all, they're not as good coverage as Medicare supplement plans not even close

People love them because they have $0 monthly premiums but once they become seriously ill they can spend anywhere from $4 to $10,000 a year out of pocket

They offer freebies. Beware of freebies, the more they give you the higher your maximum out of pocket is each year

The dental plans are terrible. They have so many restrictions that they are almost of no value except to get your teeth cleaned and it's often more and more difficult to find a dentist that will take them

The vision plan coverages okay

Hearing plan coverage is okay

If they start offering you like $50 a quarter towards pharmacy and items like bandages, cough syrup etc. Beware that's a trap. The more they give you the higher your max out of pocket. What you want is the least of perks and the lowest Max out of pocket because once you get sick that max out of pocket is the maximum you have to spend before your insurance kicks in at 100% too. So if it's 5'8 $10,000 a year and you have a long-term illness, you're going to be paying that every year and and you'll go broke. That is one of the leading causes of bankruptcy today and their poor coverage

Medicare supplements you don't have that issue

What's the biggest frustration Medicare agents have when helping clients enroll?

Answer: I don't have frustrations actually. I appreciate that people don't understand this. It's complicated. I try to boil it down to simple terms determine based on their income if they can afford a Medicare supplement plan, which I always recommend typically a Medicare supplement plan N.

If their income is low and they can't afford it, then a Medicare advantage plan is their better choice.

However, I feel compelled to explain the risks with Medicare advantage plans. A lot of agents. Just try to sell them on. You get this for free. You get that for free. Well, there's nothing for free. You're paying for it somewhere

I'm getting conflicting information about whether Medicare covers my specific medication. How can I get a definitive answer?

Answer: Sign onto medicare.gov follow the steps for prescription drug plans. Enter in the medication you're taking and it will tell you what the coverage is for that particular medication

There are many Medicare plans for prescriptions out there. Most of them will cover the majority of drugs

There's also a annual $2,000 limit now out of pocket so you cannot exceed that with any company that you work with

I just started on Medicare Part D, and I'm confused about whether my new cholesterol medication counts toward my coverage gap. Can you explain?

Answer: Most cholesterol medications are generics and very low cost. Majority of prescription drug plans, they're either going to be a preferred generic or generic drug. Therefore, they will typically not go towards your deductible

Also plans were revised this year. The Gap has been removed

The maximum you can spend on Total drug costs for the year is $2,000

How does the Part D "catastrophic coverage" phase work once I hit the out-of-pocket max?

Answer: Once you hit the $2,000 out-of-pocket Max, your drugs are no cost to you for the rest of the year

This law started in January of 2025 and so far the current administration hasn't figured out how to revoke it and thank God

What happens if I delay Medicare Part A enrollment because I'm still on my spouse's employer plan?

Answer: Nothing happens. However, it is to your advantage to enroll in part A because it's free

Part A is for hospitalizations so the way it would work is if you went to the hospital. Typically your employer plan pays first and then Medicare will pay next. It will reduce your hospital bill. There is no downside to signing up for part A

And you should also talk to a professional as to whether you'd be better off being on a Medicare supplement plan

Oftentimes it's cheaper. If your employer makes you pay a lot of money for your health care for having a spouse on it, it can be better coverage at a lower cost to go on a Medicare supplement plan

I need home health care after my surgery, but Medicare denied coverage. What are my appeal rights?

Answer: Did Medicare deny coverage or did your Medicare advantage plan deny covers? There is a big difference you've been turned over to an insurance company if you bought a Medicare advantage plan

Coverage can vary from Aboriginal Medicare

Yes, you can appeal any decision. They have to respond quickly by law

If it was denied by Medicare itself, contact Medicare or go on to medicare.gov for information on how to file for an exception

Gary Henderson, Medicare Insurance Agent

Contact Details

Location

LinkedIn

Gary Can Help With:

About Me

Get in touch with Gary using this form

Q&A with Gary Henderson

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website