James Stang, Medicare Insurance Agent

Answer: Anyone turning 65 but continuing to receive healthcare benefits from an employer should enroll in Part A but not Part B. Part A can work in conjunction with an employer plan in some instances and is already paid for from your paycheck withholding. Part B is not able to work with any other insurance plan and has a monthly premium. When you know when you will be stopping your employer coverage you can call social security and have Part B start at that time.

Answer: There aren't any out of network providers for Medigap plans in most circumstances. If you are enrolled in a medicare Advantage PPO you can go out of network but might incur additional charges. With a Medicare Advantage HMO, there is no out of network coverage.

Answer: I only represent UnitedHealthcare so I can only speak about our PPO plans. For 2026, our PPO plans seem to have higher premiums as well as higher costs for the benefits. The ability to see providers out of network usually is out weighed by the additional costs.

My recommendation is to enroll in a HMO plan your provider accepts as opposed to a PPO, especially if it's your PCP that is out of network.

Answer: Part A is paid for with the contributions from your paycheck while you were working. As long as you worked for four quarters you qualify. Part B is paid for via a monthly premium paid directly to the government. Unless you qualify for certain levels of Medicaid, you have to pay the Part B premium.

Answer: That depends. If you are in a Guarantee Issue period then no. If you are outside a Guarantee Issue period then yes.

Answer: Although I am not sure what you mean by "structure", if you want to pay the absolute lowest amount of money and still stay out of possible penalties from Medicare in the future, a $0 premium MA plan that has $0 copay for primary doctor office visits would be what I advise.

Answer: Your daughter can gather the information and help you make a decision but cannot complete an enrollment for you unless they have power of attorney. I always invite anyone that would help you make a decision to any meetings.

Answer: That depends on how much you paid. There is a max out of pocket expense on $2100, up from $2000 last year, for medications purchased through a Medicare drug plan or MA plan. That does not include premium costs, just medication costs. If your medications do not cost more than $2100, you will not see a lower cost.

Answer: Medicare Agents should verify all medications, ask you about which ancillary benefits are most important to you and find out how often you go to the doctor/specialists. Then they should check your providers to ensure they are in network if you don't want to change. They can then make a recommendation. I have never "pushed" one MA plan over another or tried to convince someone to enroll in a Medicare Supplement or Medicare Advantage Plan, those decisions should be made by the client.

Answer: Yes, you can pay Medicare premiums, out of pocket expenses like copays, and even Medicare Advantage premiums with HSA money tax-free. You cannot continue to contribute to your HSA after retirement, however.

Answer: Depends on what your friend means by "cheapest". There are $0 premium Medicare Advantage plans that could be the cheapest if you are pretty healthy and only go to the doctor for your annual checkups. But if you do have multiple specialists or frequent stays at the hospital, that $0 premium plan could be more expensive than a Medicare Supplement.

You should always talk with a licensed Medicare agent about your specific situation to find something that will fit you.

Answer: It's not. The person that called you is in violation of multiple contact rules, the first is cold calling, which is absolutely forbidden. You should never speak with someone about your Medicare that you do not know or did not contact first.

Answer: You need to find someone that can explain the options to you while considering your health and enrollment period eligibility. For instance, if you are experiencing health issues and are in a Guaranteed Issue period, a Medicare Supplement may be the right choice but if you are very healthy and only go to the doctor for a regular check-up you might be able to save money with a Medicare Advantage Plan.

Answer: If your agent is "pushing" one type of policy over another, find a new agent. Your agent should listen to your individual situation and recommend a few solutions, going over the potential costs of each. I will offer my opinion when asked, but always with reasons.

Answer: There are Medicare Advantage plans that have a $0 monthly premium but you will pay co-pays for things like specialist visits or hospital stays. So while they aren't "free", if you are healthy and do not need regular medical services outside you normal check-ups with your PCP, a $0 premium MA plan can save you money.

Answer: That depends on if you have Original Medicare and a Supplement or if you have an Advantage Plan. If you have an Advantage plan and move outside the plan's coverage area you will have to enroll in a plan that covers you new address. If you have Original Medicare and a Supplement nothing will change.

Answer: Medicare's coverage outside the US is very limited. If you want to be able to see any doctor that accepts Medicare, a Medicare Supplement with your A&B will be easiest. There are national networks for some Medicare Advantage plans as well.

Answer: You can sit with an agent and go over medication costs, premium expenses, specialist visit costs and monitoring supply costs. it's something I do with every new client when deciding which coverage option fits their individual situation best.

Answer: The donut hole was eliminated last year. If you are unable to pay your deductible ask your carrier to put you on a payment plan. The nice the cost of your medication reaches $2000, you will not pay and more copays.

Answer: Medicare will provide for 100 days of LTC, in total. If you have an issue and need to spend a week in a rehab center, that counts toward the 100 days.

As to how you should be planning, there are Long Term Care policies available and I would also suggest speaking with an estate planner.

Answer: Yes, Medicare provides for doctor ordered in-home therapy, wound care and medication management.

Medicare does not cover:

24-hour home care.

Personal care services if they are the only type of care needed.

Services like meal delivery or homemaker services unrelated to your care plan.

Answer: Original Medicare is Parts A&B and it is required you keep them active to be enrolled in a Medicare Advantage Plan. If you were talking about enrolling in a Medicare Supplement or a Medicare Advantage Plan, that is something you would want to discuss with a Medicare Agent. Every person is different and your needs are different than the needs of others. One is not necessarily better than the other for everyone.

Answer: If you did, the Annual Open Enrollment period starts in October. The policies I represent have $0 copay for primary care visits and the copays for specialists vary by $10 to $20. If you see multiple specialists each month the extra cost could certainly add up.

Answer: Yes. You can apply for Extra Help, called LIS (low-income subsidy) on the Social Security website. If you are accepted into the program, you will have your Rx costs reduced to nominal amounts.

Answer: No, as long as you have credible coverage after you are eligible for Medicare you do not have to enroll. But you may want to enroll in Part A anyway. In most cases it does not have a premium, you have already paid for it by working 40 quarters and paying payroll tax, and it could help reduce your costs if you have a inpatient hospital stay.

You can apply for Part B when you are ready to drop your Employer Group Health Plan.

Answer: You shouldn't be too worried. It can happen under certain circumstances but the carriers will usually find a way to retain the providers in the network until the end of the year so their clients can find other policies that would allow them to continue to see their preferred providers.

Answer: There are a few different types of special needs plans in Medicare coverage, Dual Special Needs Plans, or DSNP's, that include some level of Medicaid coverage, and Chronic Special Needs Plans, or CSNP's. CSNP's do not require Medicaid enrollment but do require verification from your provider of one of the conditions of the plan. You may qualify for a CSNP if you are diabetic or have cardiovascular or heart issues. These plans offer benefits tailored to the needs of the condition.

Answer: Medicare Parts A and B only cover 80% of your medical costs. You can purchase a Medicare Supplement or enroll in a Medicare Advantage Plan to mitigate the risk of having to pay 20% of your medical bills.

Medicare does not provide for prescriptions, dental vision or hearing issues. All can be covered by buying additional coverage if you choose.

Answer: You would have to be more specific. Medicare Part B premiums can change annually but are individual so that would not be effected by losing your spouse. If you were covered by a Medicare Supplement policy that had a discount for two people in the household being covered, you would lose the discount when your spouse passes.

Answer: Medicare eliminated the coverage gap in 2025, capping the max out of pocket at $2000. If you are taking expensive medications you could hit the max in the first part of the year and pay nothing for the rest of the year.

Answer: You can apply for Low Income Subsidy assistance (LIS), also called Extra Help, from the Social Security website. LIS gives you assistance with co-pays for medications.

Answer: I won't say it's impossible but to change from a MA plan to a Medicare Supplement would necessitate going through medical underwriting unless you are in a Guarantee Issue period, which is rare outside of your Initial Election period. If you are diagnosed with a serious illness it would be difficult to pass through medical underwriting.

Answer: The costs of Medicare coverage are pretty straight forward. I always explain all the costs, from Part B premiums to plan premiums and copays. I would rather my clients be prepared for the worst and be surprised by not paying that amount.

Answer: In most cases I would say no. However, there are times when those types of policies can help. It's a personal choice as to if the premium for those types of plans gives you enough benefit to make them worth it.

Answer: You need to go through a cost analysis with a licensed agent. That will help you understand the costs of the different types of Medicare coverage in relation to your health. The best time to buy is when you are in your Guarantee Issue period.

Answer: Medicare Advantage Plans have a network you have to use where Original Medicare with a Medicare Supplement do not. The MOOP (max out of pocket) could also be higher than the annual premium for a Medicare Supplement, meaning in a year where you have multiple hospital stays a Medicare Advantage could cost more.

Answer: Medicare is based on paying in via working for 40 quarters. Unless you can qualify through a spouse, you need to speak with someone at Social Security to check on qualification.

Answer: Guarantee Issue means there is no medical underwriting when applying. For Medicare Supplement plans, the most popular time to enroll with Guarantee Issue is three months before your 65th birthday, the month of your 65th birthday and the three months after your 65th birthday. If you delay enrolling in Medicare Part B, you have another window around the start date of your Plan B.

Answer: It depends. A Medicare Supplement gives you freedom to go to any provider that accepts Medicare with no networks but can be a lot more expensive than a Medicare Advantage plan. You should talk to a licensed agent to see how each would work for you specifically before making a decision.

Answer: There are different types of events a Medicare agent can run. .What you are talking about is probably a formal sales event, where an agent/broker can discuss plan specific information. I frequently offer Medicare Made Clear educational events to people interested in the nuts and bolts of Medicare coverage. By law, we are not allowed to discuss plan-specific information at an educational meeting.

Answer: A scope of appointment is a government required document. It is designed to make sure unscrupulous sales agents don't use Medicare as a way to get their foot in the door to pressure you into buying other products. I am not familiar with the regulations for call centers, but it is absolutely normal for field agents.

Answer: You need to be enrolled in Medicare when eligible or have credible coverage to not be penalized. Credible coverage is normally an employer plan or other group health plan.

Answer: You need to be covered by a MA plan with a national network or by Medicare A & B with a Supplement. It sounds like you are covered by a Medicare Advantage plan with a local network.

Answer: Medigap plans offer the ability to see any doctor that accepts Medicare without any networks. You also have no co-pays when you access services. Medigap plans might not be right for everyone but they do have advantages.

Answer: That depends on your plan and your provider. If you enroll in a HMO, your provider would need to be in network in most cases. A PPO plan would allow you to see non-network providers if they are willing to bill the carrier and there is sometimes a higher cost.

Answer: I agree, the different lettered parts and plans can be confusing. I host Medicare education events for UnitedHealthcare and would be happy to help you understand the different parts of Medicare to find the option that suits your individual situation.

Answer: I absolutely think it should but that is a question for Congress. I'm sure any of the carriers would support alternative treatments that are proven to be effective.

Answer: Co tact Socisl Security to enroll in Part A and Part B. That is the first step for everyone! Once you have your MBI number you can contact an agent to enroll in a plan that fits you!

Answer: That everyone should be in one type of plan. Different people might get more benefits from different plans, no Medicare plan is one size fits all.

Answer: Explaining the different parts of Medicare, how they differ and the costs. Then ask questions about their health, if they have any issues they are currently treating and then explain how the different options would look moving forward.

Answer: It depends on the policy you enrolled in but normally out of network doctors will not be covered by an HMO. There are exceptions based on someone’s individual situation and you should ask your carrier if you could get one.