Jeffrey Jon, Medicare Insurance Agent

Answer: You can apply for low income subsidy, apply directly to the pharmaceutical company for their drug programs or ask you pharmacy if there is any program they may be able to help you with. If you haven’t applied for Medicaid, you may consider that depending upon your finances.

Answer: If you have an MAPD plan generally you can change your plan during AEP. If your new condition is a chronic condition, heart/ diabetes, you may be able to change your MAPD plan to a C-SNP Plan related your new chronic condition. You are allowed to make the change to a C-SNP outside of AEP. / If you have a Medicare Supplement, it may effect your ability to change plans since it must go through underwriting. It doesn’t hurt to check with underwriting to see if you can lower your premiums.

Answer: Medicare Supplements allow you to go anywhere in the United States. If you go out of the USA, you can file for up to $50k if you have the details of your travels outside the USA. If you do travel outside of the United States, I would encourage you to obtain travel insurance. MAPD plans offer "nationwide" coverage but not as guaranteed as a Medicare Supplement. Many of the MAPD plans will consider you in network if the plan is in the same state you are traveling in. These plans change every year so it is hard to know what they will do.

Answer: We get paid commission on the sale of an insurance product. If the salesperson represents a company then he will sell for the company. If the salesperson is a broker, then he will represent several companies and not promote one over the other. In either case, the salesperson should be focused on your needs and not the bottom line of the company.

Answer: This is from a google search with the exact wording of the question:

Medicare spending has experienced a significant shift toward private Medicare Advantage (MA) plans, which now cover over half of eligible beneficiaries. MedPAC reports that payments to MA plans consistently exceed traditional Medicare, with 2025 payments estimated to be 20% higher per person—totaling $84 billion in additional spending—driven by coding intensity and favorable selection.

Key shifts and trends include:

Higher Costs: Medicare spends more per beneficiary in MA than in traditional Medicare, with estimates in 2024 showing payments at 122% of traditional Medicare costs.

Rapid Enrollment Growth: More than 50% of beneficiaries are now enrolled in private MA plans.

Profit Drivers: Increased spending is attributed to "coding intensity" (making patients appear sicker to get higher payments) and "favorable selection" (enrolling healthier, less costly individuals).

Benefit Pressures: Despite higher overall spending, some 2025 data suggests plans are scaling back supplementary benefits in response to revenue pressures.

Impact on Solvency: The higher spending in Medicare Advantage compared to traditional Medicare poses challenges to the Medicare Trust Fund's solvency.

Answer: If your current MAPD plan requires prior authorization this year, it does not mean the same for next year. Each year changes. They may require prior authorization or not.

Answer: Manu MAPD plans will offer silver sneakers, and some Medicare supplement plans offer discounts for the plan. It all depends on the coverage you want. Not all plans under Medicare offer the same perks.

Answer: Yes you can. AEP and OEP are only for MAPD and PDP plans Medicare Supplement or GAP plans are not subject to the AEP

Answer: Health Insurance changes all the time. Even with Medicare. There will be price increases, certain services change or some go away. It is the nature of the beast.

Unfortunately with Medicare there is a political nuance to it, as it is a government influenced program. Again, our hands are tied. When the government changes hands, we can worry or just go about our business, go with the flow, and hope for the best.

If you are religious, then you will do your best and leave the rest to the Lord.

Answer: There is no recommendation over another because it is a personal choice as to what your preferences are. With Original Medicare you have no network, and it is accepted in all 50 states. You are responsible for the 20% and there is no ceiling to that 20%. You would have to pick up auxiliaries such as prescription drug plan, dental, vision, and hearing if you wish, as well as a Hospital Indemnity Plan to help with the hospital co pays.

With an MAPD plan you have a network. You would have to ensure your doctors and your medications are covered under that plan. Not every doctor accepts all plans. They may include Dental, Vision, and Hearing, and they offer a ceiling or maximum out of pocket expense.

In either situation you would have co pays or co insurance, unless you pick up a Medicare Supplement policy to go with Original Medicare which can limit co-pays and co-insurance.

Answer: I am not sure about “all types of blood tests,” but Medicare will cover many tests which will include blood testing. Go to Medicare.gov to find specific information.

Answer: As long as you maintain your Medicare Supplement it will increase annually in premiums. To reduce your premiums you could change plans from your current plan, let’s say from a plan F to a plan G, or a plan G to a plan N. If you are in good health, you could have a quote run on your current age with the same plan. If you pass underwriting you may be able to lower your premiums.

Answer: You can go to your summary of benefits or evidence of coverage for specifics , to see if your particular brand is covered, or call customer service to see if your brand is part of your discount .

Answer: A qualified Medicare certified insurance agent can help you understand the Medicare maze. Medicare.gov is also a great place to visit and learn about Medicare.

Answer: The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the U.S. Anywhere else is considered outside the U.S.

Medicare drug plans don't cover prescription drugs you buy outside the U.S.

Medicare supplement insurance (Medigap) policies may cover emergency care when you travel outside the U.S.

Si the answer would be yes

Answer: With any health plan you should notify them of the new address to update their records. If you have an MAPD plan, you would incur a special enrollment period, where you can enroll in a new plan for your new area. You would have 60 or 90 days to make the change. Generally if you know you are moving and where, it is good to let the MAPD plan of your intended move and destination.

Answer: It is a choice. Some may want the security of the Medicare Supplement over the possible lower cost of the MAPD. The MAPD has no underwriting, whereas the MS plans do. If you have health issues that prevent you from lowering your monthly premiums, then you can choose the alternative of the MAPD plans.

Answer: How long do I have to enroll in Medicare after losing employer coverage?

8 months

Your Special Enrollment Period begins when you retire or lose your employer coverage, whichever happens first. You will have up to 8 months to enroll in Parts A and/or B, but only the first two months to enroll in Parts C and/or D.

Answer: Medicare Advantage plans can have high out of pocket costs. if someone has health issues that require lots of maintenance, then they may be paying those high out of pocket costs, and then they can get into the cycle of making payments for past services and accumulating more for current services.

Doctors may change from year to year as to whether they will accept a certain plan or not, and then the patient with the MA / MAPD plan will have to look for another doctor.

You must also remember that the 20% of orginal Medicare has no ceiling, which can also be costly for someone with a lot of medical issues.

Answer: It depends upon the doctors you have and where they are located. A Medicare Supplement will have no network to consider so you can go to any doctor or hospital, in which case you can keep your current doctors, etc. An MAPD plan is a network plan, and you would have to consider whether your doctors are in the network or not.

Answer: That seems to be more of a question to ask your representative. There are many gaps that could be addressed by Medicare and our representatives need to hear from you to seek ways and means to make Medicare better for all.

Answer: Once OEP ends, (January 1st to March 31st) you can no longer change plans. (MA TO MAPD, MAPD TO MAPD) If you have a chronic condition , diabetes, heart condition, you may be able to switch to a chronic plan. You can do so once per year. If you do not qualify for a Chronic Plan, then you would have to wait for the Annual Enrollment Period beginning in October.

Answer: There is a $2000 cap. Once the cost of your drugs meet the $2000 the drug plan will pick up the rest. This is only for your monthly medications not for specialty drugs, like cancer meds , etc.

Answer: I think one of the most important questions to ask is if the plan will allow me to continue to travel anywhere and be covered.

If there is no network, you can travel any where in the United States and be covered. HMO's and PPOs are not universal in their ability to allow you to go anywhere and get coverage.