Hector Vazquez, Medicare Insurance Broker

Answer: Yes, Medicare covers MRI’s CAT scans pet scans and many other diagnostic imaging services and aome preventive.

The cost share will vary depending on your choice of coverage to deal with those costs.

Answer: Your friend may have a Mesicare Advantage plan and more than likely you have a Supplement.

There are many factors to consider but that’s one logical explanation from experience.

Answer: Hello everybody, Hector Vazquez here. I want to answer the question regarding the Extra Help program and if there are going to be changes in 2026. The answer is yes, there are going to be some changes taking place in 2026. For those of you that are in the Extra Help program, otherwise known as the LIS program, Low Income Subsidy, which helps people with the cost of their medications.

The first thing is that the government is changing the cap to $2,100. If you're in the Extra Help program and you take tier one or tier two medications, which are generics, you probably never hit this number. But if you're on high-cost or tier three, tier four medications, or specialty drugs, you may at some point hit this number. And $2,100 is that ceiling. After that, you're going to catastrophic.

Now, for those of you that are concerned because you take high-cost medications, very important in 2026. And this ties up to the first answer. The government is going to start negotiating with pharmaceutical companies directly to get the prices of those high-cost medications down. This means that the price is going to go down because the government is now going to demand or put a little muscle into them to get those prices down. So that should impact you positively.

The third thing is that some states are going to see changes regarding prior authorizations. They should speed up a little because the government for six states is going to start a pilot program for taking care of prior authorizations. Very interesting. If you are, and by the way, very important to note that that program is only for six states and it's for those on original Medicare only. If you're on an Advantage plan, you do not need to worry about that. That has nothing to do with you.

Okay, any questions? Please feel free to reach out here in the Medicare Agents Hub. I would love to hear your questions. Take care. Peace.

Answer: The best way to create a comfortable environment with your parents to talk about Medicare, in my personal opinion and my professional experience, is by coming into this conversation with three things in mind.

Number one, you need to be empathetic when you're talking to Mom and Dad or Grandma and Grandpa. If they don't feel like you're empathetic, like you do not relate, like you do not feel their pain or that they may be in trouble, they're not going to want to talk to you. They're not going to feel comfortable.

Number two, I suggest you use real-life examples. Go to forums like Medicare Agent Hub, go to Facebook or YouTube, or other places, even Reddit. You'll find real-life people talking about their issues with Medicare, their troubles, and some agents also giving their experiences and how they have worked to fix them.

And number three, I would say ask a lot of questions. If you want someone to open up, ask them questions. Ask them how they feel about this. How do you think they would feel if a situation arose? What do they have planned? Imagine this, imagine that. Those things would put someone more in a receptive mindset than a wall or protected mindset.

I would suggest you use those three things to create a perfect environment to talk about Medicare.

Answer: Ai is already helping enhance protocols and treatment plans plus Ai will help claims processing and reduce a lot of the administrative expense and overhead for the carriers which should translate in more efficient operations, HOPEFULLY it will also translate into savings.

Doctors are using AI to help diagnose complex conditions and interpret lab results data. Preventive medicine will probably turn proactive with AI in the next 5 or 10 years.

Answer: If the Advantage plan has Zero deductible instead and a $350.00 per day copay for in-patient hospital admissions, the member pays $350.00 times the amount of days spent as an admitted patient until the max days are covered, which in this case is 7.

If the stay is more than 7 days all the member pays is for the 7 days. This is different for observation or emergency room stays.

Answer: You are not crazy, every person has different needs, priorities and budgets. Free doesn't mean best or always better. Free is actually never "Free" because we all have been paying Medicare taxes from the very first moment we started working in the US.

It is wise to consider an Advantage but never make your decision based on someone else's perspective or ideology.

Answer: While Medicare Part A is automatic for most people turning 65 who have enough work credits, enrollment in Part B is not automatic. If you do not have other creditable health coverage, you must actively apply for Part B to avoid late enrollment penalties.

If you will continue to have employer coverage or another form of insurance when you turn 65, confirm that it is considered "creditable coverage" by Medicare standards. Having creditable coverage allows you to delay enrolling in Part B without incurring a late enrollment penalty once your other coverage ends.

Answer: Not choosing a Medicare Supplement during the guaranteed issue period and wanting to join later to find out they don't meet the underwriting criteria.

Answer: Individuals receiving social security disability insurance benefits or some railroad retirement board (RRB) disability benefits recipients for at least 24 months, individuals with end-stage renal disease (eligibility based on situation) and people with ALS after 24 months of disability benefits.

Answer: if you won't have creditable coverage starting at age 65, you need to enroll in Medicare.

At this point you should have received a Medicare card if you are automatic or should have had a meeting with Social Security to enroll in Medicare if not automatic.

You then should evaluate your needs and decide how you will cover all the gaps present in Medicare or in the plan you will have.

Answer: Trap is such a negative question that I don't use it, but there are gaps in Medicare Advantage like less access to providers and the need for referrals in some HMO's and other things that make advantage plans less appealing to some people.

Answer: Do I know all the gaps present in Original Medicare and am I prepared to face them with my choice of plan?

Answer: Yes, a lot of Medicare Advantage plans cover therapies like acupuncture and some cover alternative therapies but not all. Speak to a licensed agent before making a choice.

Answer: Depends on what coverage you have, if on Original Medicare with a supplement all you need to do is find a professional that accepts medicare and talk therapy should be covered by Part B. While psychiatric appointments will be covered by Part B, meds will be covered by Part D.

So there is no need to choose meds over therapy or viceversa.

If on Medicare advantage, all the care and treatments have to be coordinated thru the primary care provider in most cases, unless on a PPO.

Answer: Medicare and every other government and corporate entity can and should always do more to address disparities among all seniors.

Answer: In no specific order, Mutual of Omaha, United Health Care/AARP, Humana, Blue cross blue shield, etc. But in my professional opinion as long as the company has a good rating there is very little difference since most plans are standardized.

Answer: The likelihood is high as the FDA approves more procedures and Medicare updates their policies to include more treatments and protocols while increasing reimbursements.

Answer: The answer is "yes but It depends". Compared to Original Medicare alone the savings are HUGE! In average advantage members save due to most plans having zero or low premiums and zero or low deductibles with a max annual out of pocket amount something Original medicare doesn't have.

Some people compare Medicare Advantage to Medicare Supplements but the comparison is not apples to apples. The big disadvantage Medicare Advantage when compared to med supps is not financial, is the accessibility to providers due to network restrictions. Med supps are standardized mostly while Medicare Advantage plans are designed in many shapes and forms to accommodate different populations, incomes and in some cases even specific medical conditions.

The answer is Yes they could save people a lot of money. Speak to a licensed and objective agent before making a decision on a plan.