Hannah Skinner, Medicare Insurance Agent

Answer: The answer is yes and no. There are two types of Medicare plans, and the way that they are accepted by insurance companies are very different. The first option is Original Medicare with a Medigap plan. On these plans, you do not have a network, so you can go to any doctor or hospital (around 97% of providers in the US accept Medicare). The second option is Medicare Advantage. On these plans, you have a network, so some providers will not accept your plan if you are not in the network or if they don't accept Medicare Advantage at all.

Answer: No worries! You can order a new card on your Medicare.gov account or call Medicare to order a new card. You will need your Medicare number or Social Security number to do this.

Answer: Providers can dislike Advantage plans for a few reasons, but the two biggest reasons are likely dealing with authorizations and the declines. Doctors and hospitals are the ones who have to submit appeals and prior authorization requests which can be very frustrating and time-consuming. On top of being frustrating, if a request is denied then they do not get paid by the insurance company.

Answer: Special Needs Plans are Medicare Advantage plans that are for people who have Medicaid (low income subsidy) or a Chronic Illness. They can give you more benefits, depending on your situation, than a "regular" Medicare Advantage plan would.

Answer: If you are not in your Initial Enroll Period (the 6 month period before and after your Part B effective date) then you will likely have to health qualify for a Medicare Supplement. They can decline you based on health conditions. Many companies have different underwriting guidelines, so it can be helpful to meet with an agent to see what your options are.

Answer: Yes, you do. Unless you take up residency in another country and disenroll from Medicare, you will have to pay the premiums.

Answer: Your friend likely has a $0 Medicare Advantage plan whereas you pay for a Medigap plan. Plans can differ by zipcode, but they also differ in coverage. Although your friend pays $0 for coverage, he likely has higher copays and deductibles than you.

I would recommend speaking with an agent to explain the difference and compare plans with you.

Answer: The answer to this is no for two reasons.

1. You cannot leave your advantage plan in the middle of the year. You can only change from advantage to Original Medicare during the Annual Election Period (October 15th-December 7th), Medicare Advantage Open Enrollment Period (January 1st - March 31st) or under special circumstances such as moving to a new service area.

2. In most states, you have to be able to health qualify for a Medigap plan. This means that having a serious illness would likely disqualify you.

If you are contemplating moving to Original Medicare with a Supplement, I would recommend speaking with an agent now instead of waiting. Trying to change your plan once you are sick will be too late.

Answer: The only disadvantage would be working with an agent that does not have your best interest in mind. Agent are paid by insurance companies so that you do not have to pay us, but this can lead to agents having financial incentives to put you in a plan that might not be your best option. It is important to work with an agent that you know you can trust because having an agent can make the Medicare process 1000% times easier for you.

Answer: Medicare Part A covers skilled nursing facility care for the first 20 days in a benefit period. If you have a Medicare supplement this could be more. Medicare does not cover long-term care. You will still have Medicare during the period that you require long-term care, but a Long-Term Care Plan would be what you needed to cover the cost.

Answer: The qualifications for the Extra Help Program change yearly. Although, we do not know what the income limits will be yet for 2026. you can find this information (when it is released) on www.ssa.gov.

Answer: Once you hit the maximum out of pocket, you will be in the catastrophic coverage phase. In the catastrophic coverage phase, you will not be responsible for any copays or coinsurances. Medicare, your Part D drug plan, and the prescription companies will pay this cost.

Answer: You likely live in one of the six states where the WISeR program was implemented.

The WISeR program is a government performance model that's goal is to reduce Medicare fraud and waste. It will run from January 1st, 2026 to December 31st, 2031 in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.

You can learn more by going to CMS.gov and looking under Innovation models.

Answer: If you used an agent to enroll in this new Part D drug plan, they should have informed you of the prior authorization or step therapy associated with any medications you are taking.

If you enrolled on your own through Medicare.gov or a carrier website then prior authorization or step therapy would have been listed. This would have been your responsibility to read through before enrolling.

Answer: Heat stroke would be covered by Medicare depending on the treatment. There is really no correlation between climate change and Medicare. If you are injured or become ill, whether it is because of climate related issue or not, you will be treated and covered by Medicare as long as it is medically necessary.

Answer: If your preferred hospital is not in network you will likely pay more to go there or have to pay the whole cost depending on your plan. You can review your plan, and try to find a plan that has your hospital in the network during the Annual Election Period. Your other choice would be to choose a new hospital that is in your current plans network.

Answer: You can apply though Social Security for "Extra Help". This program can help get prescription costs down to a limited amount. You can find the application on Medicare.gov by searching "Extra Help".

Answer: Original Medicare does not typically cover smart watches as they are not considered durable medical equipment. There are some Medicare Advantage companies that will offer discounts on these devices as part of their benefits. I would recommend speaking with your physician to see if their are any devices that would monitor your heart rate that are covered by Medicare.

Answer: It is very common for providers to leave the network of advantage plans. Provider contracts with insurance companies can end in the middle of the year where as you are bound to your Medicare Advantage plan from January 1st- December 31st in most cases. If you are in a PPO you can likely still see that provider if they go out of network, but you will pay more. If you are in a HMO, seeing an out of network provider will not be covered by the plan.

Answer: To save money on your Medicare Supplement you can review options with an insurance broker. Brokers are able to share multiple options with you (most of the time with identical coverage to what you have) for less money.

Answer: I would suggest getting your parents set up with an agent who is able to offer insight and support. You can help them find videos on YouTube that will help them to better understand their options.

Answer: I would say that the biggest mistake seniors make when enrolling Medicare would be not getting help from a broker. Many people will go straight to one company or just try to enroll themselves on a company site. I think this is a mistake because it drastically limits the options you have when choosing a plan.

Answer: You will continue to receive Social Security. You will be automatically enrolled in Medicare at age 65, and you should receive your Medicare card in the mail 3-4 months before your birthday.

Answer: SSDI does not switch to SSI when you turn 65. It will however convert to Social Security Retirement benefits, but your monthly amount will likely stay the same aside from the Part B & D premium deductions.

Answer: A hospital indemnity plan is a great way to cover some of the gaps in your Medicare Advantage plan. Hospital copays can reach up to $3000/stay. If you area discharged and go back the next week, this number will reset.

Most hospital indemnity plans reset after a 30-60 benefit period. This means that it can be used upwards of 6 times a year.

Answer: If you are retiring and would like to take Medicare, you will need to go to www.ssa.gov to apply for Medicare Part B. In order to avoid the late enrollment penalty, you will need to get your employer benefits/HR person to fill out an employee benefits verification form (CMS-L564) and submit it with your Part B application.

Answer: You can qualify for Medicare under age 65 if you have End-Stage Renal Disease, or have received Social Security Disability benefits for at least two years. To see if you qualify for Social Security Disability Income, please refer to www.ssa.gov.

Answer: Medigap Plan N is the most cost-effective for seniors that do not frequent the doctor's office more than 15-20 times a year. Medigap Plan G is the best value for seniors that tend to have more than 20 visits to a provider per year. This is because Plan N has up to a $20 copay at the doctor's office, but it offers a lower premium. Plan G has a higher premium, but it covers all copays after you meet your Part B deductible.

Answer: Yes, Medicare does cover asthma and other breathing conditions. Any medications or nebulizers will be covered under Part D. Any durable medical equipment (such as oxygen tank) will be covered under Part B.

Answer: Medicare supplements or "Medigap" plans are secondary to Medicare. Medicare Advantage plans are considered an "alternative" to Medicare.

Answer: Medigap policies are guaranteed renewable. This means that your plan has to renew your policy every year as long as your pay your premiums even if you are filing a lot of costly claims.

There have been Medigap carrier become insolvent and pull out of the market, however, you are protected in this situation. If this happened to you, you would have guaranteed issue rights to get another plan with no underwriting. The guaranteed issue plan is a Plan G or Plan F depending on when you became eligible for Medicare.

Answer: Providers will typically send your Annual Notice of Change within 60 days of the Annual Election Period. Look for it in the mail between August and October 1st.

Answer: Palliative care and hospice care are extremely similar, but hospice refers specifically to people who have a prognosis of 6 or less months to live. Palliative care can be provided at any point of an illness.

Medicare covers palliative care when it is medically necessary. Typically it will be covered both in- and outside of hospice care.

Answer: You can switch to Original Medicare during the Annual Election Period, but you have to answer health questions unless you are in your Initial Enrollment Period. The only exceptions are New York, Massachusetts, and Connecticut where open enrollment is allowed year round.

Answer: The donut hole has been replaced with a maximum out of pocket. For 2025, this Maximum out of pocket is $2000 for the year. This means that as long as your medications are covered under a plan's formulary, you will never pay more than $2000 for those medications in one year. This change has resulted in some plans raising their premiums and changing their formularies.

Answer: It helps to start with some "homework". Watching videos, reading the "Medicare and Me" handbook, and doing research online is a great way to prep your learning experience. It is really important to understand the basics of Medicare before jumping into learning about secondary plans like Medigap or Advantage. What do Part A, B, C, and D cover? What are the copays and deductibles associated with these parts? Once you have that foundation, it makes it so much easier to add on to it.

Answer: There are many steps you can take to avoid Medicare fraud. Keep your Medicare card/number in a safe place out of the public eye. Only share this number with medical providers or an insurance agent who YOU have contacted. Never give your Medicare number to anyone who contacts you first. Insurance agents will require this information to help you make changes to your plan, but you can schedule an appointment with an agent who you trust.

In most cases Medicare fraud affects the medical providers and insurance carriers more than the insured, but it is always good to be diligent in keeping your information safe.

Answer: I would start by having them watch some videos explaining the topic. There are many great YouTube channels that explain the ins and outs of Medicare. Setting up a 3-way call with an insurance agent can also be a great way to comfortably discuss Medicare. Medicare can be a very confusing topic, so it can be helpful to have a professional to guide your parents through it.

Answer: Losing creditable employer coverage does give you a Special Election Period. You have 8 months from the day you lose coverage to enroll in Part B. You have 63 days from the day you lose coverage to enroll in a Part D or Medicare Advantage plan.

Answer: The cheapest Medicare plan is not always the best. For example, Medicare Advantage plans can have a $0 premium, but your out of pocket expenses could total upwards of $10,000 a year. Whereas Medigap plans have a premium that is typically between $50-$300/month. Medigap plans, however, have little to no out of pocket costs in comparison to Medicare Advantage.

Your friend might be referring to Medigap plans. Medigap plans are federally standardized, so a plan letter (for example Plan N) has to have the same coverage no matter which company is offering it. If Company A is offering Plan N for $100, but Company B is offering Plan N for $200, you might be inclined to go with Company A since they are offering the same coverage for a lower price.

Answer: Medicare Part A covers inpatient hospital stays, skilled nursing facility stays, and hospice among other things. There is a $1676 deductible that resets every 60 days. This means you could have this deductible up to 6 times a year which could total over $10,000 in a year. There is also a limited amount of days that Medicare will cover in the hospital/skilled nursing facility. I would recommend looking at some type of secondary coverage to avoid this large out of pocket cost such as a Medigap plan, Medicare Advantage plan, or a Hospital Indemnity plan.

Answer: If you are over 65 and have previously deferred your Part B then you will want to apply for Part B to start when your employer coverage ends. When applying you will need to have your employer benefits person fill out an employer benefits verification form to prove that you had creditable coverage since you turned 65. If you are under 65, then you will want to look at other coverage options until you turn 65.

Answer: A PPO allows you to go out of the network if you choose to, but you will likely have a higher cost than if you were to go in network. An HMO typically does not allow you to get care outside of the network except in the case of an emergency. HMOs can be more restrictive especially because doctors can leave the network in the middle of the year. Your doctor leaving the network does not give you an opportunity to change your plan.

Answer: There is a common misconception that Medicare covers long term care or nursing home care. Unfortunately, Medicare does not cover long term care or a stay at a nursing home. I would recommend a long or short term care policy to cover this expense.

Answer: If your employer coverage is creditable towards Medicare (meaning your employer has 20 or more employees) then you should be able to defer Part B. When you are ready to take Part B when you retire, you will need to prove that you have creditable coverage, or you will receive a late enrollment penalty.

Answer: Medigap plans are great for people who travel a lot because they do not have networks. You might face higher costs by going with an Advantage plan with networks if you are trying to receive treatment out of the service area. It is never a bad idea to meet with an agent and review your Medigap plan. You could be paying too much for it and could get the same coverage for much less.

Answer: Yes, you can change your Medigap plan at any time of the year. You must be able to health qualify to change unless you live in a state that has rules that say differently. Although, you can change at any time, you typically get your yearly rate increase on your policy's renewal date. This can be a good time to review your plan because you have the most accurate rate information.

Answer: I love getting to work with seniors to help them get the coverage they need and deserve. Medicare can be very confusing and everchanging, so it's nice to have someone on your side that can keep up with these things for you. I love being that person for my clients.

Answer: Although Medicare does cover an abundance of services, there is not a guarantee that Medicare will cover everything that your employer coverage does. It would be wise to do a side by side comparison of your current plan versus Medicare plans. Meeting with a Medicare agent to discuss your options can make comparing plans less overwhelming.