Jack Mayer, Medicare Insurance Agent

Answer: In short no because it is guaranteed renewable. However if the carrier goes out of business then you will be able to get a new replacement policy of equal or lesser value then the one you have now.

Answer: It shows proof of Group Employee Health Coverage and you an obtain the form through Medicare.gov or from the SSA in person or online.

Answer: Yes of course and most of them do not have a monthly premium. There is no catch however in the future there may be more carriers offering plans with premiums due to claims loss ratio.

Answer: Regarding Plan C, there is an SEP for those who have been diagnosed with Diabetes, Chronic Heart Failure, Cardiovascular disorders. The qualifier varies with carriers but you can do a one time SEP if diagnosed with a qualifying health condition including HIV/AIDs ESRD and Chronic lung disorders.

Answer: Its a different health care model and it is a managed health care model where you choose a Primary Care Physician and you go to him first and he refers you to specialist and other providers within the same network and its typically under a Medical Group where you go to. With Traditional Medicare A & B and a Medi-Gap and Prescription Drug Plan you have the freedom to see any doctor in any place that excepts Medicare in the US and you the insured manages your own healthcare and you have the freedom to go anywhere.

Answer: SEP, a special election period is all year around for those who may be dual eligible, turning 65, those coming off an employee group health plan and when there is a disaster in your area such as fire or flooding and if a medical group leaves your health plan. The other enrollment periods are AEP, Annual Enrollment Period where you can change plans from Oct 15 through December 7th and then there is an open enrollment period for those who want to change again from Jan 1-March.

Answer: Personally used it today, sitting at home worried about my blood pressure readings and the nurse on the phone had my records in front of her and was able to help me through the issues I was dealing with. Better than getting in the care and driving to Urgent Care or waiting to speak to my doctor after leaving a message.

Answer: IF you have a plan F and you want to save some money then a Plan G is a good option, Plan F is no longer offered and the pool of insured is diminishing which leads to higher premiums to cover the claims loss. Plan N is also another way to cut back on expenses. Talk to me.

Answer: Routine physicals, Dental, Vision, cosmetic procedures, Hearing aids and long term nursing care. These are some of the items Medicare will not cover.

Answer: The answer is Long Term Care, Skilled Care, Intermediate Care and Custodial Care. Medicare is very limited on what they pay for and there are financial losses when it comes to this type of care. I do provide LTC Plans and if you have assets you want to keep including savings you may want to do some homework and contact me.

Answer: To be safe I would keep them until the end of the year. Most people just toss them but I always ask my clients to hold on to them until the following year.

Answer: Part B excess charges are above and beyond what Medicare says is fair price, but if you ask the provider to except what Medicare says is fair and reasonable then you would be asking for an assignment to avoid the excess charges. If you have a Plan G for example (Medi-Gap policy) then the excess charges are paid in full.

Answer: Go with a local agent because a local agent will scare you into the right plan based on your needs and choose the best PCP and medical group to handle your personal health care needs

Answer: That Medicare will cover routine physical exams, dental, hearing and vision. As well as prescription medications and that Medicare covers long-term care.

Answer: I think a person in that situation may want to make sure they have a managed Care model that is part of their healthcare assuming that they can qualify for that type of plan which is basically a Medicare Advantage plan with managed Care for those that qualify.

Answer: Yes you can get a medigap plan with a guarantee issue if you're coming off a credible employee group health plan and you have two months to get it done without penalty once you come off the group plan

Answer: Yes Medicare will pay for most heart medications under Part D and Part B for those medications that have to do with infusions. As long as Medicare approves a device such as a pacemaker it is covered under Part A when admitted but it is an outpatient implant procedure that comes under Part B

Answer: All Medicare Advantage Plans have a PCP and you must have prior authorization unlike original Medicare, also many plans have done away with PPO's where you can see a specialist in network without a referral but due to heavy utilization most plans only offer HMO and therefore you need prior authorization

Answer: If you have a credible health plan , once you retire and lose your plan you have 8 months to enroll in Part B and into a health plan without penalty

Answer: Too much utilization and Medicare will only pay so much yet healthcare rises every year so all Medicare Advantage plans re negotiate with providers yearly and sometimes they can't come to an agreement. You will never worry about that when you have original Medicare and a Med-Supp that said if you lose your provider you would need to find a new PCP or health plan with a special election period if needed, so if there is no provider available you can change plans outside of AEP and OEP

Answer: Your free to make things complicated when you choose to work with multiple agents verses one person handling everything for you.

Answer: Do not depend on Medicare to pay for your nursing home coverage. Big mistake because first you need to be hospitalized at least 3 days and your physician must approve your stay and will if he/she thinks you will improve. You pay nothing the first 20 days and thereafter 60 more days and your MAPD plan should cover the very expensive daily co payments. After that your on your own. Medicare only covers skilled care not intermediate or custodial care.

Answer: Hospital deductible each hospital stay separated by 2 months, daily hospital co payments after the 20th day and 20% of all your outpatient medical and any excess charges beyond what Medicare approves and allows

Answer: The freedom to choose their health care providers and how the cost is contained because each year you know exactly what your potential out of pocket is as opposed to part C Medicare Advantage

Answer: I would lower the part B premiums by more than half and I would like to see dental that goes with original Medicare

Answer: You need to sign up for Medicare part B and if you are coming off an employee group health plan, could be your spouses, you have 8 months to enroll without penalty

Answer: Tribal members on IHS don't need to enroll in Medicare but there would be serious long term consequences since IHS may not cover everything and can be underfunded. Many Tribal members take Medicare and enjoy coverage off the res. If you don't take Medicare and decide to later there will be late enrollment penalties for life

Answer: To create a comfortable environment I would suggest a meeting with a professional agent who is seasoned, one who can make things easy to understand and be a go to person to help with the healthcare choices.

Answer: It doesn't affect you but you need to avoid penalties by enrolling on time. 3 months before your birthday, your birthday month and 3 months after without penalty. Coming of an Employee Group Health Plan, you have 63 days to enroll without penalty and these are lifetime penalties you want to avoid.

Answer: Depends if you have a Medicare Supplement along with original Medicare or a Medicare Advantage Plan. There is nothing to do if you have a Med Supp but if you have a Medicare Advantage Plan or Plan C then you need to be aware of the changes that are made each year in October and things do change so in my professional opinion you should talk to your agent each year so that he can advise.

Answer: If you mean an EOMB or EOB which is an Explanation of Medicare Benefits, its a statement sent to you by Medicare showing what was approved by Medicare, Paid and what your insurance paid.

Answer: After you leave your Employee Group Health Plan you will have 63 days to get on Medicare and enroll in a plan without penalty.

Answer: It depends. Some prefer a truck and others prefer a car. Original Medicare = Medicare Supplement + Prescription drug plan and freedom to see any provider anywhere who accepts Medicare in any state you go too. Medicare Advantage is the in-network healthcare model that is an HMO and you are assigned a primary doctor. Typically unlike a Medicare Supplement and a Part D plan there are no premiums with a Medicare Advantage Plan and you just have a share of cost and that figure depends on the plan you go with.

Answer: Yes it will help those who have expensive medications because there is an annual maximum out of pocket for prescribed medications. The maximum per year is $2100 including your deductible.

Answer: Original Medicare is A, B and D this is a supplement to Medicare and you would pay a monthly premium for both the supplement and for Part D. There is no network and you manage your own healthcare. Medicare Advantage is A, B and D but called Part C and the is the managed healthcare model where you are assigned a primary doctor and you are part if an in network HMO health plan. Typically there are no premiums.

Answer: 4 parts to Medicare. A =when you are admitted into a hospital. Part B = All your medical and doctors. Part C = combines A, B and C and Part C is called Medicare Advantage Plans. Part D is your prescriptions.

Answer: People would pick a more expensive plan because they stand to save more on their prescriptions because their medications may be too expensive and in the higher tiers and not all PDP plans are equal. When you have little to know meds or they are in the lowest tier then a cheaper plan is in line.

Answer: The STAR ratings for Carriers and Physicians let us know how well they are performing, the level of services provided and all this is monitored by the Centers of Medicare and Medicaid Services. It is a big deal because carriers and providers want to receive a high rating because they strive to be compliant and handle complaints fairly and expeditiously.

Answer: A broker like myself would compare with many different carriers and share that information with you. You can also contact SSA and see about qualifying for extra help on the cost of your medications

Answer: Yes, Medicare Part B covers a wide range of outpatient mental health services, including therapy, counseling, and psychiatric evaluations. You typically pay 20% of the Medicare-approved amount for these services and with insurance that gap is covered but you will typically have a co pay with a Medicare Advantage plan

Answer: Part D which is Prescriptions drugs is where Medicare covers and helps with the out of pocket expense associated with some medications and the good thing is that there is a cap on how much a Medicare enrollee pays on their maximum annual out of pocket for their drugs. For 2026 its $2100 and for some people who need tier 4 and 5 meds it really helps.

Answer: You can only get a Medicare Supplement without answering specific health questions only when you are turning 65 and enrolling for the first time. You have 3 months before your birthday month, your birthday month and 3 months after. Its a bit different when coming off a Group Employee Health plan.

Answer: When you partner with an experienced agent who knows Medicare and makes things simple, there really is not much you need to worry about. I like others will take very good care of you. Every person's health care needs are unique so don't just go with anything or the plan your buddy has because it may not be what is best for you. Call me :)

Answer: My quick answer is if any service is covered under Medicare or is an approved service under Medicare then yes it is covered.

Answer: Many carriers have done away with the PPO side on their Medicare Advantage Plans and its true that if you do have a PPO, your out of pocket is greater than your share of cost in network under the HMO model.

Answer: Medicare covers preventative health services under Part B and in most cases there is little to no out of pocket and when you couple that with your health plan it's covered services.

Answer: Typically if Medicare doesn't cover a procedure then you are out of luck but I would go to Medicare.gov to see if there can be any acceptations

Answer: Go with a local agent!! Someone you can meet in person. A dedicated agent will guide you through Medicare, answer all your questions and help you decide what is best for you based of your particular healthcare needs.

Answer: In my experience I have found that it just depends on where you are, where you live. Some rural areas in various states have a very small foot print and if you live in one of those areas where the network is small then you may not be too happy with a Medicare Advantage Plan which are typically HMO's because there may not be too many providers or medical groups to choose from.

Answer: Medicare by itself doesn't cover dental. You would be well suited if you picked up a stand alone dental plan. I provide that information when called upon

Answer: You have no out of pocket expenses on a plan F supplement if you go to any provider or facility that excepts Medicare. Plan F has no deductible or co pays.

Answer: Not so, one has nothing to do with the other

Life insurance provides needed protection on many levels. Many need it to pay for final expenses, funeral cost, mortgage protection, to pay off outstanding loans, to leave a small nest egg for the surviving spouse and for many other reasons. Need life insurance, contact me.

Answer: At any time you can review your plan by contacting your agent. It's important to review during the Annual Enrollment Period, October 15 through December 7th because carriers make changes to the plans consumers have and they need to stay informed.

Answer: Higher risk: Your doctor will recommend a more frequent schedule based on your specific situation. This can include:

Every 2-5 years for those with certain polyps, a history of inflammatory bowel disease, or a family history of colorectal cancer.

Every 7-10 years if you have no symptoms and no family history, starting at age 45.

Answer: The quick answer is no and beyond your Initial Coverage Period, turning 65 , one year later, at that point you must answer health questions to qualify for a Medicare Supplement. They can turn you down for health reasons. Also, you would need to wait until AEP to apply.

Answer: Part B covers out patient medical care, doctors and specialist. The question is is it enough? Not really because after your annual Part B deductible is met you are responsible for 20% of all medical expenses and any excess medical expenses beyond the reasonable and customary charges.

Answer: I think its good to have the option of choosing original Medicare and a supplement policy if you can afford to do so. Many people prefer to choose their own providers and some travel so therefore a MAPD may not be in their best interest. If insurance companies can control cost and keep premiums down, privatizing Medicare won't happen anytime soon, plus we want checks and balances along with health insurance options

Answer: If someone is being taken care of and the agent has their best interest at heart there should be no problems but some people's kids lol

Answer: Original Medicare is the way to go if freedom to choose where you go and who you want to see us what you want. There again Medicare Advantage plans are also good for those who want no premiums and want to yo pay as they go, in network

Answer: Get a trusted agent and only work with them, we always put the client first. We are compliant and well trained. Others just want to take ppl for a ride

Answer: It's actually $2,100 and there is a $610 annual part D deductible which is included in the max out of pocket. This is better than what it was with the donut hole.

Answer: You may be eligible for extra help, contact SSA for more information and if you meet the requirements they may be able to help or you could search for a modest give back through some carriers like United Healthcare but typically you can have a higher annual out of pocket. They give you something but it's never free, you may have a greater share of cost annually if you buy into a give back plan.

Answer: Original Medicare does not cover holistic care. Some Medicare Advantage plans have limited coverage for chiropractic and acupuncture but typically holistic care is not covered

Answer: It's really beneficial because it helps my clients make informed healthcare decisions and it's about time

Answer: Medicare does have deductibles and co-payments along with coinsurance and when you supplement Medicare but the health plan to take care of all those out of pocket expenses depending on the plan you choose. They are all standardized Plan g is the best other than that you can go with a Medicare Advantage plan and these are network base plans most of them are all HMO and you will have copay and deductibles

Answer: Do not take what your friends say to heart, everybody's situation is different and many people prefer a Medicare supplement policy because there's no network associated with these plans and you know up front what your cost will be. A plan g will allow you to see any provider that accepts Medicare and cover 100% of your hospital and medical bills and the only out-of-pocket would be your part B deductible which is nominal

Answer: After the first month switching if the prescription drug plan does not cover the drugs you need that are on their formulary they will have other standard like similar medications to use that have like similar benefits

Answer: I would advise you to consult with your cardiologist to implement a plan and if Medicare covers it you will be covered.

Answer: Medicare does cover standard implant lenses, so it depends on the lenses. Medicare only covers certain lenses.

Answer: Medicare does not pay for dental implants, I have a terrific plan for all ages that will cover implants to a point which is typically 60% if you own the policy for a couple years, the benefit is lower in the first year and gradually increases.

Answer: Only Medicare Supplements can afford you the luxury of being fully covered wherever you go where they except Medicare because these are not network based plans like the Advantage Plans however you are covered for ER and Urgent Care outside your area with the Advantage plan.

Answer: Your policy limits are spelled out and you should check to determine what if any out of pocket expenses will be incurred. Not so with a Supplement, you know what your cost will be but with an Advantage plan you will pay a co-pay for 70% of health services rendered

Answer: You will be responsible for the Part D and Part B premiums based on your annual income or combined income if you file jointly. Over a certain amount you pay more.

Answer: Every insurance carrier who offers a Medicare Advantage Plan has a Look-up a Doctor in my network option found on their online website or call the number on your healthcare card and they can assist you and you can always check with your agent too.

Answer: On TV there is much marketing to get people to enroll into certain plans with certain carriers because of the over emphasized ancillary benefits like dental, hearing and vision which is not always the primary reason for choosing a health plan and some overlook the benefits of a Supplement which may be more suitable for the enrollee.

Answer: Medicare is stable right now. What is going up is the Part B monthly premium in 2026 to roughly $205.00, the Hospital deductible, in-hospital daily co-pay after the first 60 days will go up too.

Answer: Telehealth is available through a Medicare Advantage Plan. If you have a Supplement, some of the Healthcare Providers provide that service too.

Answer: That is a question only you can answer. Take time to evaluate your decisions because if you wait you will earn more and if you don't perhaps its best if you are struggling financially.

Answer: During AEP you may pick you a health plan and if you are on Medi-Cal then you can opt for a Dual Special Needs Plan or possibly a Chronic Condition Needs plan. At this point you have a gap in coverage. Not sure what you mean regarding what you noted at the end of your question. Reach out to me and we will work with you to take care of it.

Answer: If you will be eligible for Medicare with earnings over a certain threshold then you will pay more for Part B of Medicare, if you would like more information reach out to me.

Answer: Not taking Part D because it's a lifetime penalty that will add up over time so therefore even if you don't take any meds you should opt in and avoid penalties if you don't have credible coverage through an employer group health plan assuming you are Medicare eligible. Consult a professional like myself to make sure you are doing the right thing

Answer: In most cases these are In Network based plans that typically requires a referral by their primary care physician and you are covered only in your area except for urgent care and ER. Also, the plans can change each year.

Answer: Those under 65 who qualify and become eligible for Medi-Cal and Medicare and typically have a disability and on low income subsidies

Answer: IRMAA, or the Income-Related Monthly Adjustment Amount, is an additional fee that some Medicare beneficiaries must pay on top of their standard Part B and Part D premiums if their income exceeds certain thresholds. For 2025, individuals with an income over $106,000 and couples filing jointly with an income over $212,000 will incur this surcharge, which is determined based on income from two years prior.

Answer: Yes you need to contact SSA and your employer of your intentions so that there is a smooth transition with no late penallties

Answer: The answer is yes. For example plans available in one area can be totally different in another. I wrote a Medicare Advantage plan for a couple who are dual eligible in one State and in another none of those plans are offered, same experience from one county or city to the next.

Answer: Contact us and we can shop out your PDP plan and find the best offer on the right formulary for your meds or compare what you have to a MAPD

Answer: Donut hole is over as of 2025, there is a deductible of 610.00 annually for medications and a copay or coinsurance for certain tiers and a true out of pocket of as much as 2,000

Answer: Not necessarily Medicare butI think Social Security could be reduced or eliminated, some say however it would be suicide to do so politically

Answer: The answer would be no, however many Medicare Advantage plans offer an allowance for hearing aids. Contact me if you would like more information.

Answer: Medicare does not work with VA Benefits, it is totally independent of the VA Health Plan. Most active employees with group coverage enroll in Part A because it is premium-free if you have worked for at least ten years. Part A can coordinate to lower your costs if you have a hospital stay. For example, let’s say your employer health plan has a $3,000 deductible. The Medicare Part A hospital deductible is $1,676 in 2025. So if you have both your employer insurance and Part A, and you incur a bill for a hospital stay, you will only be out $1,676 for your inpatient hospital services. Medicare pays the rest of any Part A services.

Answer: Outside of the Annual enrollment period and the open enrollment period you may be eligible for a special enrollment period.

Answer: I would not suggest going without expert advice, a well-qualified agent will be your guide, listen to your story, help you make sense of everything and then find the best outcome for your personal insurance needs. With a Medicare Advantage client, the agent will make sure your doctors and specialist are in network and that your medications are covered on that plan. It's not one size fits all, there are variable factors. When it comes to Medigap insurance there are different options and its best to go over all that with an expert. The goal is to get it done right the first time... one and done.

Answer: Check with SSA and see if you can qualify for some help through a low income subsidies program or LIS

Answer: Part A Hospital by itself is not enough to take care of the hospital bills. Medicare Hospital Part A has huge gaps and frankly with out a health plan, a supplement or medigap plan to cover the deductible and daily co-pays, by itself will add up quickly and it would not be advised to go with just Medicare Part A without a health plan to cover the gaps.

Answer: Medicare will not cover dental, vision and hearing. It is an ancillary benefit offered by insurance carriers who offer Medicare Advantage Plans. Medicare was only intended to help with Hospital and Medical care. My guess is that if these perks were added on to Medicare, a Federal Program it would drive cost through the roof.

Answer: The in Network providers and hospitals renegotiate contracts with carriers overseen by CMS Centers of Medicare & Medicaid Services each year and sometimes deadlines and negotiations are not met especially in some of the small rural areas where the networks are small. You will need to contact your carrier and request a new primary care physician. Also, you can check other carriers to see if your doctor is in their networks and switch during the Annual enrollment period October 15 - December 7th.

Answer: You can wait with no penalty until you decide to go off the group. You will have Part A hospital but you get the Part B once you decide to go off the group plan and apply for Part B with Social Security or the Dept of SSI You have 8 months to make the transition before you are penalized

Answer: Depends on the plan you choose but for the most part most carriers will offer a maximum annual benefit of $1500 on all procedures however depending on the procedure, you will still have out of pocket expenses. With a Medicare Advantage plan you can pick up a second stand alone Dental plan to cover the lion share but these plans are very limited on what they will allow for implants. Some of my friends go to Mexico and pay much less without insurance.

Answer: I think for the most part it really comes down to the carrier, the available plans in your area that have the largest network of providers and going with a flagship carrier like United Healthcare for example. Also, Medicare Advantage PPO plans can offer less restrictions because there is no referral needed by your Primary Care Physician but the PPO plans are still network based and you will have more out of pocket! On the flip side a Medigap plan has no network and you are free to see any doctor, provider anywhere that accepts Medicare.

Answer: Talk to me in person to go over the landscape because you have choices to keep cost down by choosing the right Medigap plan that fits your lifestyle, budget and needs.

Answer: For 2025 you will have an annual deductible of $590.00 then your maximum out of pocket will be $2000 but in most cases its much less because you are credited at times beyond the cost of the prescription.

Answer: Original Medicare can be used in all 50 states, as well as in the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands. The same isn’t true for Medicare Advantage plans. These plans have defined service areas and may not cover out-of-state care, with the exception of emergency and urgent care situations.

Answer: If Medicare covers it and these clinical trials are available in your area network then it's covered by your health plan, your chances of getting that covered are greater when you have the flexibility that a Medigap plan offers.

Answer: No need to change because Med Supps or Medigap plans are not network based plans like Medicare Advantage Plans are and therefore you go to any provider or hospital anywhere that accepts Medicare.

Answer: Each year the insurance carriers that offer Medicare Advantage Plans re-negotiate contracts with providers and hospitals under CMS rulings and if the deadline is not met for one reason or another, it is possible to lose those providers and hospitals. I have some information and can expand on that if interested. The main thing is to go with a flagship carrier that has huge networks such as United Healthcare for example. Just a note of confidence, 9 our of 10 people stay with UHC once they enroll.

Answer: Most Medicare Advantage Plans have no monthly premiums however there are deductibles, co-pays and co-insurance so it is important to understand that with Medicare Advantage Plans there will be some out of pocket or share of cost. Medicare Advantage Plans are Network plans so if the policyholder stays in Network their is minimal out of pocket.

Answer: Simply put, since 1984 I've been actively helping Medicare enrollees who need someone to guide them through the Medicare landscape and their health care choices. I love what I do because I add value to the lives of those I work with. I am blessed to be able meet so many nice people throughout my professional career.