Javier Salguero, Medicare Insurance Broker

Answer: Sticking with Original Medicare without a Medigap (Medicare Supplement) plan exposes you to significant, potentially unlimited financial risk, primarily because there is no annual out-of-pocket maximum. Without a supplemental plan, you are responsible for 20% of all Part B (outpatient) services, with no cap on your total exposure.

Answer: You will not owe a Part B penalty if your wife is actively working and her employer has 20 or more employees. You can use a "Special Enrollment Period" (SEP) to sign up for Part B without penalties within 8 months of her retirement or losing coverage.

Answer: No, Original Medicare (Parts A & B) generally does not cover routine vision care like eye exams for glasses, eyeglasses, or contact lenses, but it does cover medically necessary vision services, such as exams for diabetic retinopathy, glaucoma, or macular degeneration, and one pair of glasses after cataract surgery. For comprehensive vision benefits, many people enroll in a Medicare Advantage Plan (Part C), which often includes routine eye exams, glasses, and contacts.

Answer: Neither Original Medicare nor Medicare Advantage is inherently "better"; the best choice depends on your health, budget, and preference for provider choice vs. bundled benefits, with Original Medicare offering nationwide doctor freedom but needing Medigap for extras/limits, while Medicare Advantage provides all-in-one plans (often with $0 premiums, dental/vision, drug coverage) but uses provider networks and requires an out-of-pocket max (MOOP) for protection. Recommend Original Medicare for travel/provider choice, and Medicare Advantage for lower premiums/extra benefits if you're okay with networks.

Answer: You can change your Medicare plan at different times, including annually during the Open Enrollment Period (October 15–December 7) and the Medicare Advantage Open Enrollment Period (January 1–March 31). There are also Special Enrollment Periods (SEPs) that allow you to switch plans outside of these times due to qualifying life events, such as moving or losing other coverage.

Answer: You have to weigh the pros and cons.

Original Medicare allows you to see any doctor who accepts Medicare without a referral. However, you’ll need to purchase a separate drug plan. One drawback some people don’t like is that the 20% you’re responsible for has no maximum out-of-pocket limit—unlike Medicare Advantage or Supplement plans. If you prefer the flexibility of Original Medicare but want more financial protection, I recommend pairing it with a Medicare Supplement plan.

Medicare Advantage plans are usually HMOs. Many people like that most services are covered at 100%, and these plans often include dental, vision, and other added benefits at no additional cost. They also include prescription drug coverage, so there’s no need to buy a separate plan. Most Medicare Advantage plans have no monthly premium—you just continue paying your Medicare Part B premium.

Answer: A Medicare broker is independent and works with multiple insurance companies to compare plans, while a Medicare agent typically represents just one insurance company or a limited network of them. This means a broker can offer a wider selection of plans, whereas an agent's recommendations are limited to the plans from their affiliated company.

Answer: Your friend has a private Medicare Advantage plan (Part C) or a specific Medicare Supplement plan (Medigap) that includes SilverSneakers, while you either have Original Medicare (Parts A and B) or a different private plan that does not offer this gym membership. Original Medicare does not include SilverSneakers or other gym memberships.

Answer: For a healthy 65-year-old, a cost-effective approach is to compare Original Medicare (Parts A & B) with a Medigap plan and a separate Part D drug plan vs. a Medicare Advantage (Part C) plan, considering your budget, preferred doctors, and any prescription needs. Medicare Advantage plans may offer lower monthly premiums and include extras like vision and dental, but often have network restrictions.

Answer: To compare your Medicare Supplement (Medigap) plan to a Medicare Advantage plan, focus on costs, provider networks, and benefits. Evaluate your current healthcare usage and needs to determine if higher premiums with a Medigap plan's freedom of choice is better than lower premiums with an Advantage plan's potential network restrictions and added benefits like dental and vision. Or you can contact me if you're in California or Nevada.

Answer: Once every 24 months if you’re at high risk for colorectal cancer. If you aren’t at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy

Answer: Working with a Medicare broker can save you time, money, and stress. A broker:

Explains your options – Medicare can be confusing, with Original Medicare, Medicare Advantage, Part D, and supplement plans. A broker makes the differences clear.

Shops all carriers – Instead of calling each insurance company yourself, a broker compares plans from multiple carriers to find one that fits your needs and budget.

Personalized guidance – A broker helps you match your doctors, prescriptions, and health priorities with the right plan.

Year-round support – Beyond enrollment, a broker is there to help with claims, billing questions, or coverage changes.

No cost to you – Brokers are paid by the insurance companies, so their services come at no additional cost.

Answer: Original Medicare does not fully cover mental health services such as therapy. After meeting your Part B deductible ($257 in 2025), you are responsible for 20% coinsurance for outpatient care. If you choose a Medicare Advantage plan, mental health services may be covered at little to no cost, depending on the plan.