Joel Hill, Medicare Insurance Broker

Answer: It depends on what type of coverage you have.

If you have a Medicare Supplement (Medigap) plan, most of them will cover your Part A hospital deductible. When it comes to the Part B deductible, only certain older plans like Plan F or Plan C cover it. If you became eligible for Medicare after 2020, your plan will not cover the Part B deductible. For example, Plan G covers everything except that Part B deductible.

If you just have secondary insurance, like from an employer or retirement plan, it may cover some or all of your deductibles, but every plan is different so you would need to check the details of that specific coverage.

The simple way to think about it is this: most Medicare Supplement plans cover the big costs, but you may still have a small out-of-pocket amount depending on your plan.

Answer: One Medicare rule many seniors find outdated is the late enrollment penalty for Medicare Part B and Part D. If someone delays enrolling when first eligible at 65, they can face a permanent increase in monthly premiums.

The issue is that many seniors don’t intentionally delay coverage. Some are still working with employer insurance, while others simply don’t get clear guidance on deadlines. As a result, a small mistake can turn into a lifelong financial penalty.

Another commonly criticized rule is hospital “observation status.” A patient may stay in the hospital for days but still not be classified as formally admitted, which can affect what services Medicare covers after discharge, including skilled nursing care.

Answer: Yes, Medicare does pay for pulmonary rehab when it’s medically necessary—usually covering up to 36 sessions, with the possibility for more if your doctor approves.

Answer: Not necessarily. The 2025 Medicare changes don’t automatically mean you should switch plans. If your doctors, medications, and costs are still working well for you, staying with your current plan may make sense.

However, plans can still change their premiums, drug lists, and provider networks each year. Because of that, it’s always a good idea to review your coverage

Answer: Yes. If someone enrolls in a MAPD C-SNP and is disenrolled because the plan did not receive the Chronic Condition Verification (CCV) form within the required timeframe (usually 60 days), that is considered a loss of SNP eligibility, which triggers a Special Enrollment Period (SEP).

Answer: When someone has cataract surgery, Original Medicare typically covers the surgery itself and a standard monofocal intraocular lens. That basic lens is considered medically necessary.

But if you choose upgraded lenses, such as:

• Toric lenses for astigmatism

• Multifocal lenses

• Extended depth of focus lenses

• Other “premium” lens upgrades

Medicare considers those elective, not medically necessary. So the surgery is covered, but the upgraded portion of the lens cost is not.

That is why it feels like “they covered the surgery but not what I actually needed.”

From Medicare’s perspective, they covered what restores basic vision. Anything that reduces the need for glasses or corrects additional issues beyond that is considered optional.

Now depending on the plan:

• Some Medicare Advantage plans offer extra vision benefits that may help

• Some supplemental policies may reduce other out of pocket costs

• But premium lens upgrades are usually still the patient’s responsibility

It is not that they are “getting away with something.” It is how Medicare defines medical necessity versus elective upgrades.

If someone is facing this situation, it is always smart to:

1. Ask the surgeon for a breakdown of what is covered versus what is considered an upgrade

2. Check the Evidence of Coverage for their specific plan

3. Verify in writing what the out of pocket cost will be before surgery

This is a great example of why reviewing coverage before a procedure matters.

Answer: Medicare isn’t facing an immediate crisis, even with so many baby boomers aging in. While enrollment is growing and there are long term funding challenges, Medicare is not going away. Parts B and D are funded differently, and even Part A would continue paying benefits from incoming revenue. For today’s seniors and those turning 65 soon, Medicare benefits are safe. This is a long term sustainability issue, not a collapse.

Answer: Original Medicare doesn’t cover routine vision exams, glasses, or contacts. It only covers vision when it’s medically necessary like cataract surgery, glaucoma testing for high-risk patients, or eye exams related to diabetes.

If you want routine eye exams or help paying for glasses, Medicare Advantage plans often include vision benefits. Or, a stand alone vision plan if you don’t have Medicare advantage.

Answer: Unfortunately, it can happen because doctors and insurance companies have contracts that can change at any time. A doctor might decide not to renew their contract, or the insurance company might make changes to its network. Medicare Advantage plans are required to keep their provider directories updated, but sometimes there’s a delay between when a doctor leaves the network and when that information gets updated. The best thing to do is call your plan to confirm your doctor’s status and ask if they’ll cover your visit at the in-network rate since the doctor was listed when you enrolled. If not, you can look at switching plans during the next enrollment period or, in some cases, use a special enrollment option if your provider’s change affects your care.

Answer: When you’re taking a brand-name medication without a generic version, the best approach is to compare Medicare Part D plans carefully. Each plan has its own formulary (a list of covered drugs), and the cost for the same medication can vary widely between plans.

You can work with a licensed Medicare agent (like me) who can compare plans for you and help you find one that offers the best balance of coverage and cost.

Answer: Great question!

It’s not a physical exam, but it’s really important. During the visit, your provider will:

• Review your medical and family history

• Check your height, weight, and blood pressure

• Update your list of medications and doctors

• Screen for depression, memory, and fall risks

• Go over any preventive services you may need

• Help you make a personalized plan to stay healthy

Answer: Starting a new prescription doesn’t always mean you have to change your Medicare plan—but it’s a good reason to review your coverage.

• Every Medicare Advantage and Part D drug plan has its own formulary (list of covered drugs).

• If your new prescription is covered and affordable under your current plan, you may not need to make any changes.

• If it’s not covered, requires high copays, or has restrictions (like prior authorization), then reviewing other plan options could save you money.

Answer: When someone is brand new to Medicare, I make sure to keep things simple and build from the basics:

1. Start with the Foundation – I explain what Medicare is, who qualifies, and the difference between Original Medicare (Parts A & B), Medicare Advantage (Part C), and Prescription Drug Plans (Part D).

2. Break Down the Options – I walk through how each part works, what it covers, and what it doesn’t. I also explain the role of Medigap (Supplement) plans to help cover out-of-pocket costs.

3. Use Easy-to-Understand Language – Instead of using government or insurance jargon, I explain it in plain English with real-world examples so they can connect the information to their life.

4. Focus on Their Needs – I ask about doctors, medications, budget, and lifestyle. Then I tailor the explanation to show how certain plan types might fit their situation better than others.

5. Provide Visuals & Resources – Handouts, comparison charts, and step-by-step guides make it easier for them to remember the information.

6. Encourage Questions – I remind clients there are no “bad” questions. I want them to feel comfortable and confident before making decisions.

7. Follow Up – Medicare isn’t “one and done.” I check in as needs change and plans update each year, so they always stay in the right coverage.

Answer: Some clients ignore good Medicare advice for a variety of reasons:

1. Information Overload – Medicare is complex. With so many commercials, mailers, and opinions from friends or family, it’s easy for people to feel overwhelmed and make quick decisions without fully understanding the consequences.

2. Trust Issues – Some may have had bad experiences with salespeople in the past, making them hesitant to believe an agent has their best interest at heart.

3. Influence of Advertising – National TV ads and celebrity endorsements can be persuasive, even when the plans being pushed don’t fit someone’s specific needs.

4. Fear of Change – Seniors often stick with what feels comfortable, even if it’s not the best option financially or medically. Change can feel risky.

5. Focus on “Perks” Over Coverage – Many get attracted to extra benefits (like dental, vision, or gym memberships) without realizing that provider networks, drug coverage, and out-of-pocket costs matter more in the long run.

6. Misinformation From Friends/Family – Well-meaning loved ones often give advice based on their own plan or situation, which may not apply at all.

Answer: That’s a great question, and this is going to be a bit of a long answer because there’s a lot to think about with it.

I’m guessing you’re talking about the over the counter cards or the healthy foods benefit cards. The grocery cards you’ve heard about are not incentives to enroll, they’re actually benefits included in certain Medicare Advantage plans. These cards are typically part of what’s called an ‘over-the-counter (OTC) or healthy foods benefit,’ and they’re meant to help members afford nutritious food, which supports better health outcomes.

As far as gift cards, Medicare has strict rules that prohibit offering gifts over a certain value to influence enrollment decisions. What you typically see are small, government-approved tokens, usually under $15, used to encourage people to attend educational events or complete health assessments after they’re already enrolled. These are designed to promote preventive care and overall wellness, not to sway anyone’s plan choice.

The grocery cards or Flex Cards you see advertised, especially with dual-eligible Medicare Advantage plans, are not sign-up incentives. They’re actually approved supplemental benefits offered to people who qualify for both Medicare and Medicaid.

These benefits are designed to support low-income individuals with things like groceries, over-the-counter items, or utilities, depending on the plan. The government allows Medicare Advantage plans to provide these extra benefits to improve health outcomes and help members manage chronic conditions.

So, it’s not about getting a gift for enrolling, it’s about providing real, ongoing support to those who qualify.

Providing the best healthcare plan for each individual should be the focus of any agent when helping a client with a healthcare plan.

Answer: Medicare Part A does not cover outpatient surgery — that falls under Medicare Part B.

Here’s a quick breakdown:

• Medicare Part A covers:

• Inpatient hospital care (when you’re formally admitted)

• Skilled nursing facility care (post-hospital stay)

• Hospice care

• Some home health care (under certain conditions)

• Medicare Part B covers:

• Outpatient surgery

• Doctor visits

• Preventive services

• Durable medical equipment (like walkers or wheelchairs)

• Outpatient diagnostic tests and lab work

• Emergency room services (unless admitted)

So if someone has outpatient surgery (not admitted as an inpatient), Part B is the part that pays — and it usually covers 80% after the deductible is met.

Answer: Yes, Medicare deductibles are not fixed for life. They are reviewed and often adjusted annually either by Medicare for part A&B or your private plan (part C&D).

Answer: I enjoy helping others and solving problems. I’ve been in law enforcement for nearly two decades so problem solving is in my nature. Being a Medicare Agent is a different road but giving the same help I’ve given for the past 20 years.