Jeff LeSourd, Medicare Insurance Agent

Answer: Yes, Medicare has covered my CPAP machine and supplies for years. You will need a prescription script to get the sleep apnea treatment covered by Medicare. Just make sure your CPAP comes from a Medicare approved supplier and the machine is on their approved list

Answer: A Medicare Supplement is definitely worthwhile when you evaluate the potential and probable health costs in the future.

You are responsible for at least 20% of all medical costs that Medicare doesn’t cover.

A hospital stay can be 1000’s of dollars out of pocket costs.

Medical procedures can also run into huge expenses if you require lots of tests Dr. visits etc.

it is a risk management decision and if you look 10-20 years down the road the potential out of pocket costs dwarf the monthly premiums. That doesn’t count the annual costs you might have in the next 5-10 years with unexpected health issues.

Answer: Every year you always have to meet your deductible first for any medical procedure. In 2026 that is $202.90. Once the deductible is met Medicare will cover 80% of all approved PT expenses. If you have a Medigap plan the remaining 20% of all Medicare approved expenses will be covered.

You need to make sure all your PT expenses are Medicare approved with the correct codes. If the PT group uses the wrong codes you will not get reimbursed by Medicare or have them qualify for your deductible.

Answer: One often overlooked fact is when someone turns 65 and keeps working.

If you work for a company that has less than 20 employees you MUST sign up for Medicare when you turn 65 or you will have a Late Enrollment Penalty as Medicare becomes Primary in that situation.

If your company has more than 20 employees you can defer signing up for Medicare until you retire.

Answer: Determining client needs/ requirements for the following items:

Original Medicare (OM) with Medigap allows choice of all Drs that accept Medicare vs. limited Medicare Advantage (MA) plans.

Medical health of patient now and possible future issues.

Concern about future medical issues being delayed or denied by MA plans vs. Not Applicable with Medigap.

Copays and coinsurance costs and billing issues only with MA plans.

MOOP Maximum Out Of Pocket costs/risk with MA plans vs. Monthly premiums and one time annual deductible with Medigap.

Significant changes in the MA market.

If dental and vision services are critical.

Answer: Yes. All Medicare plans are dependent on your zip code at the lowest level. Insurance companies can pick and choose which areas to serve by zip code and county once approved by the state.

Answer: Medicare Advantage (MA) plans can save money in the short term but you need to understand how it could affect you in the medium to long term. You should fully know what MOOP - Maximum out of pocket costs are as well as copays and coinsurance. Understanding the limited Dr and hospital choices for each MA plan is critical to avoid a tragic mistake.

Unless lack of finances completely drive this decision, you need to be really educated on the pros and cons of MA plans vs. Original Medicare.

Answer: Yes, if you feel comfortable that they are VERY knowledgeable about Medicare and its constant changes. I have seen agents that sell Life insurance and other products give wrong and expensive advice to clients due to Medicare being a side part time piece of their business. I personally am on Medicare and know it as a consumer as well as my full time focus. Medicare is too important of a Seniors financial expense to get advice from someone who isn’t extremely knowledgeable about it.

Answer: You can apply for Part B Medicare no earlier than the 3rd month before the month you turn 65.

If you turn 65 in March, you can only apply for Part B on or after Dec 1. You apply online through your Social Security account.

You should apply online ASAP for Part B to avoid admin delays. However, you will start paying to CMS the monthly premium for your Part B benefit. As of Jan 1, the monthly premium for Part B will be $202.90.

Answer: IRMAA is an insidious tax that looks back at your income 2 years and determines your Medicare tax.

Once you get hit with IRMAA you do have a few ways to lower that tax. If you lost your job or have reduced wages from the prior tax years or a couple other situations you can appeal the initial tax.

Once you’ve had an initial IRMAA tax you will have it for 2 years. If your income drops you can appeal to lower the tax. IRMAA is evaluated every year as it looks back 2 years on a rolling basis.

Answer: If you are working for an employer that offers “creditable health insurance” you can delay enrolling in Part B Medicare once you are 65. Your HR dept can advise if your company insurance is creditable. It is very confusing!!

Also the company MUST have 20 or more employees to avoid penalty. If not, then you have to enroll in Medicare Part B to avoid penalty at age 65 as Medicare is primary insurance for people at companies with less than 20 employees.

Once your employment ends you will have a short window to enroll in Part B without penalty.

Answer: Yes that is actually implemented for 2025 for Rx drugs that meet the requirements. The Rx drugs MUST be on the Part D plans formulary for the $2,000 cap to apply. Once you reach the $2,000 level for approved Rx drugs, you will not have to pay anything more for future approved drugs in the same calendar year.

Answer: Once you accept Medicare Part B, the monthly cost of that benefit in 2025 is $185/month. Currently insulin only costs $35/month which is a huge cost savings. There may be other Rx drug costs that can be analyzed and estimated by a Medicare professional. They can help get the least expensive Rx drug plans for your specific Rx costs.

You can also go to medicare.gov and do an analysis of Part D Rx drug plans and get a rough estimate for your zip code.

Answer: Everyone on Medicare Part B must pay the Part B premium to CMS which currently is $185/month.

There may be a no cost monthly premium for most Medicare Advantage plans. However, there are other costs that may apply like copays, coinsurance and Maximum Out of Pocket costs for medical services. Medicare Advantage plans have pros and cons as does Original Medicare with Medigap Supplement plans.

The best suggestion is to talk to a Medicare professional who can fully educate you on the true costs and benefits of MA plans vs. Medigap Supplemental plans. This is a critical decision and seniors need to be completely educated on Medicare to avoid expensive mistakes down the road.

Answer: As a senior I love sharing about the benefits of Medicare to other seniors. I especially love discussing how the $257 annual deductible compares to the typical High Deductible Health Plans I contributed to for over 25 years!!