John Becker, Medicare Insurance Agent

Answer: Medicare Part D plans group covered medications into "tiers," and the tier your drug is in directly determines your out-of-pocket cost. Lower tiers mean lower costs. Plans typically use a 5-tier system, though some use 3, 4, or 6 tiers to structure their pricing.

TYPICAL PART D DRUG TIER STRUCTURE

TIER 1 (Lowest Copayment): Preferred Generic Drugs. These are usually the most affordable medications, offering the lowest copays.

TIER 2 (Low Copayment): Generic Drugs. Standard or non-preferred generic medications that cost slightly more than Tier 1.

TIER 3 (Medium Copayment): Preferred Brand-Name Drugs. These are specific brand-name medications that the plan has negotiated a better price for.

TIER 4 (High Copayment): Non-Preferred Brand-Name Drugs. These brands cost more and may have alternatives in lower tiers.

TIER 5 (Highest Cost-Sharing): Specialty Drugs. These include very high-cost, complex, or unique medications. You generally pay a percentage of the retail cost (coinsurance) rather than a flat copay.

Note: Some plans include a Tier 6 specifically for select insulins or low-cost diabetes medications. How They Affect What You Pay Every Medicare Part D plan has its own formulary (a list of covered drugs and their tiers). Even if a medication is covered, its tier can dictate:

COPAY VS COINSURANCE: Lower tiers usually offer a flat, predictable copayment (e.g., $10), while higher tiers often use coinsurance (e.g., 25% of the drug's retail price).

DEDUCTIBLES: Some plans apply their deductible only to drugs in higher tiers (like Tiers 3–5), meaning you may not have to meet a deductible to get your Tier 1 or 2 prescriptions.

COVERAGE RULES: If your doctor prescribes a drug in a high tier, the plan may require prior authorization or ask you to try a similar, lower-tier drug first (step therapy).

Answer: The federal government sets mandatory caps on out-of-pocket expenses for Medicare Advantage (Part C) plans. Once you reach this limit, your plan pays 100% of covered medical costs for the remainder of the year.

Specific limits vary by plan, but federal guidelines enforce the following thresholds:

* IN-NETWORK SERVICES: The maximum limit is $9,250.

* COMBINED IN-NETWORK AND OUT OF NETWORK SERVICES: The maximum limit is $13,900.

Keep in mind these important details about the maximum out-of-pocket (MOOP) limit:

* LOWER LIMITS ARE COMMON: While $9,250 is the maximum allowed by the government, many individual plans voluntarily set much lower caps.

* AVERAGES: The average out-of-pocket cap is $5,421 for in-network services, and $9,825 for combined in-network and out-of-network services.

* WHAT COUNTS: Deductibles, copayments, and coinsurance for Part A and Part B covered services count towards this limit.

* WHAT DOES NOT COUNT: Your monthly plan premiums, prescription drug (Part D) costs, and extra supplemental benefits (such as dental, vision, or hearing) do not count toward your medical MOOP.

* PRESCRIPTION DRUGS: Part D prescription drug costs have a separate, dedicated annual out-of-pocket cap of $2,100.

To find out the specific MOOP limit for a plan you are considering, you can review its Summary of Benefits or compare options using the Medicare Plan Finder.

Answer: Yes, disenrollment from a C-SNP for failing to provide the Chronic Condition Verification (CCV) form within 60 days is classified as a loss of SNP eligibility. This qualifies the individual for a Special Enrollment Period (SEP) to enroll in another MAPD plan.

SEP DETSAILS & RULES TIMELINE: The SEP begins the month you are notified of disenrollment and lasts for two full calendar months after the notification date.

OPTIONS: You can switch to another Medicare Advantage plan (MAPD) that you are eligible for, or switch back to Original Medicare with a standalone Prescription Drug Plan (PDP).

COVERAGE: Your new coverage will typically begin the first day of the month after you submit a completed application.

Answer: Medicare Advantage (Part C) star ratings (rated 1 to 5) directly reflect a plan’s proven ability to deliver quality care, preventive services, and customer satisfaction. Enrolling in a 4- or 5-star plan significantly increases the likelihood of smoother care coordination, better chronic condition management, and fewer hassles.

What High Ratings (4 to 5 Stars) Mean for You

Better Health Outcomes: Highly rated plans show superior performance in preventive screenings (e.g., cancer, flu shots) and the management of chronic conditions like diabetes and heart disease.

Superior Customer Service: Ratings heavily weigh member experience. Higher scores indicate shorter wait times, responsive customer service, and fewer coverage disputes.

Enhanced Benefits: Medicare rewards plans that score 4 stars or higher with bonus payments. These plans typically reinvest this money into enrollees through extra benefits like dental, vision, or lower out-of-pocket limits.

Year-Round Enrollment Perks: If you find a 5-star Medicare Advantage plan in your area, you can use a one-time Special Enrollment Period to switch to it at any point between December 8 and November 30, bypassing traditional enrollment windows.

Answer: Just for clarity purposes.... we are referring to a Medicare Advantage plan and not a Medicare Supplement.

No, you cannot be turned down for a Medicare Advantage plan (Part C) because of your health status or pre-existing conditions. Private insurance companies are legally required to accept you, regardless of illness or pre-existing conditions, as long as you are eligible for Medicare, live in the plan's service area, and apply during a valid enrollment period.

KEY HEALTH AND ENROLLMENT RULES:

No Pre-existing Condition Exclusions: You cannot be denied coverage or charged higher premiums due to pre-existing conditions.

Exceptions to Enrollment: While they cannot deny you due to health, you can be denied enrollment if you try to join outside of approved enrollment periods, or if you live outside the plan's service area.

Answer: Drug tiers in Medicare Part D are levels within a plan's drug list (formulary) that determine how much you pay for a prescription; drugs in lower tiers generally have the lowest copayments or coinsurance, while those in higher tiers cost more.

HOW DRUG TIERS WORK

Each Medicare Part D plan assigns its covered drugs to different tiers. While plans typically use a 5-tier structure, the specific placement of a drug can vary from one plan to another. Tier 1 (Lowest Cost): Usually includes preferred generic drugs. Tier 2 (Low Cost): Often includes generic drugs that cost slightly more than Tier 1. Tier 3 (Medium Cost): Generally includes preferred brand-name drugs. Tier 4 (High Cost): Typically includes non-preferred brand-name or generic drugs. Tier 5 (Highest Cost / Specialty Tier): Reserved for very high-cost specialty drugs used to treat complex conditions.

Answer: Original Medicare (Part A and Part B) is generally not enough coverage for most, as it typically leaves you with 20% coinsurance, high deductibles, and no maximum out-of-pocket limit. Supplemental insurance—such as Medigap or a Medicare Advantage plan—is usually required to cover these gaps and protect against high, unpredictable medical costs.

Answer: You did say a MEDIGAP plan, so i am taking that into consideration and not addressing a Medicare Advantage plan.

Dependent on what state you live in ....Medigap plans C, D, F, G, M, and N are the currently available or common plans that provide coverage for foreign travel emergencies.(WI AND MN WE DO NOT HAVE ALL THESE PLAN OPTIONS.) These plans typically pay 80% of billed charges for medically necessary emergency care after you meet a $250 annual deductible. There is a $50,000 lifetime limit on this benefit.

KEY DETAILS OF FOREIGN TRAVEL COVERAGE

* Eligibility Period: Coverage applies only if the emergency care begins during the first 60 days of your trip.

* Conditions: The care must be considered medically necessary and must not be otherwise covered by Original Medicare.

* What is Not Covered: Medigap plans do not cover medical evacuation or repatriation.

* Availability Note: While Plans C and F are no longer available to new Medicare beneficiaries (those who became eligible for Part B on or after January 1, 2020), individuals who already have them may retain their coverage.

IMPORTANT CONSIDERATIONS

* Because Medigap plans have a lifetime limit and do not cover medical evacuation, many travelers choose to purchase separate travel insurance for more comprehensive protection. Always confirm the specific benefits with your insurance company before traveling outside the U.S.

Answer: Medicare Part B covers both psychiatrists (medication management) and therapists (talk therapy) as outpatient services, typically paying 80% of the Medicare-approved amount after the deductible is met. No referrals are needed for Original Medicare; they coordinate by allowing concurrent, medically necessary treatment from both types of providers.

KEY COVERAGE and COORDINATION DETAILS:

* Providers: Coverage applies to services from psychiatrists, clinical psychologists, clinical social workers, and as of 2024, licensed mental health counselors and marriage/family therapists.

* Cost-Sharing: After the yearly Part B deductible, you usually pay a 20% coinsurance for visits.

* Medication Management: Psychiatrists and other doctors covered under Part B manage medications, with prescriptions typically covered by Part D.

* Talk Therapy: Unlimited sessions are allowed if deemed medically necessary by the provider.

Medicare Advantage: If you have a Medicare Advantage plan (Part C), you may need referrals and must use network providers.

CORRDINATION TIPS:

* Ensure both providers accept Medicare assignment to minimize costs.

* If using Medicare Advantage, check with your plan, as Medicare.gov rules can vary, and pre-authorization might be required.

Answer: As of January 1, 2025, Medicare covers select FDA-cleared prescription digital therapeutics (PDTs) for treating chronic conditions like depression, anxiety, and insomnia. These, often called Digital Mental Health Tools (DMHTs), require a doctor's prescription and must be designed for specific, evidence-based treatment, not general wellness.

Key details on Medicare's coverage for digital tools:

What is Covered: Coverage includes the app itself, necessary accessories, and the associated provider fees for monitoring. Specific examples include tools for chronic pain or mental health.

Payment Model: The new policy allows providers to buy and then bill Medicare for these tools.

Action Needed: You must have your healthcare provider submit a claim, as they must be the ones to "procure" or prescribe the product.

Alternative Coverage: While not direct device coverage, you may be able to have monitoring services covered under Medicare's Chronic Care Management services.

To confirm coverage for your specific apps, you should check with your doctor to see if they are considered "FDA-approved digital therapeutics" and are eligible for billing codes introduced in the 2025 Medicare Physician Fee Schedule.

Answer: That is a tough question to answer with out knowing intangibles and dynamics of your relationship with you parents, etc. With that being said, try and create a comfortable environment for discussing Medicare by choosing a quiet, private, and relaxed setting, such as a home setting, rather than rushing the conversation during a stressful time. Approach the discussion with patience, empathy, and respect, positioning it as a partnership to support their independence rather than a, confrontational, high-pressure, event.

Here are specific ways to ensure a comfortable discussion and prepare yourself for a heathy discussion:

:

Prepare in Advance: Research the basics of Medicare Parts A, B, C, and D, and use Medicare.gov to understand their current needs.

Use "We" Language: Frame it as a team effort, using phrases like "How can we make sure you have the best coverage?" to make them feel supported rather than losing control.

Listen Actively: Focus on their concerns about finances and healthcare needs. Let them take their time and express their fears without interruption.

Start Early: Discuss Medicare before a crisis forces quick decisions, allowing them to feel more comfortable and in control.

Appoint a Representative: If necessary, help them fill out an appointment of representative form to allow you to talk to Medicare on their behalf.

Be Patient and Gentle: Start conversations with low-pressure, casual comments, such as, "I've been reviewing my own health coverage and wanted to share what I've learned," to initiate the topic com

Answer: Yes, Medicare Part B covers many preventive screenings, often with no out-of-pocket cost IF the doctor accepts assignment. While they can be scheduled together, coverage depends on Medicare’s frequency limits (e.g., annual vs. every 5 years) and medical necessity, rather than the number of tests performed at once.

Key details on coverage for multiple screenings:

Cost: Many screenings are free, but some may require a 20% coinsurance or deductible.

Limitations: Screenings must meet age, risk factor, and frequency guidelines.

Doctor's Assignment: Ensure your doctor accepts Medicare assignment to avoid higher costs.

Preventive vs. Diagnostic: If a screening becomes diagnostic (treating a condition found), you may have to pay coinsurance.

Answer: Here is a breakdown of some of the reasons mentioned in why some people avoid Medicare Advantage:

Restricted Networks: Unlike Original Medicare, which is accepted by 90% of U.S. doctors, MA plans use networks. You may be forced to change doctors or pay heavily to see specialists outside the plan.

Prior Authorization Delays: Plans often require pre-approval for tests, procedures, and specialist visits. This adds administrative hurdles and can lead to denied care.

High Out-of-Pocket Risk: While premiums are low ($0), if you become severely ill or need extended hospital stays, costs can exceed those of Original Medicare with a Medigap policy.

Geographical Limitations: Coverage often does not exist outside your specific plan area, making it difficult for those who travel, according to Investopedia.

Annual Changes: Plans can change benefits, formulary (drug coverage), and cost-sharing every year, or drop doctors mid-year, notes The Motley Fool and Investopedia.

Difficult to Switch Back: If you join an MA plan and later want to return to Original Medicare + Medigap, you may face medical underwriting. This means you could be denied coverage for a Medigap plan due to pre-existing conditions if you are outside your initial enrollment period.

Profit Motive: Because these are private, for-profit insurance plans, critics argue they have incentives to deny care.

These plans can be a good fit for individuals on a tight budget seeking low premiums and added benefits like dental or vision, but are often viewed as risky for those expecting complex medical needs.

Answer: Your Medicare deductible resets in January because most Medicare plans (Part B, Part C/Advantage, and Part D) operate on a calendar year basis, running from January 1 to December 31. As a new year begins, the previous year's out-of-pocket spending is cleared, and you are responsible for the new year’s deductible amount.

Answer: In my opinion it seems to be a lack of a Long-Term Care Plan: Medicare does not cover custodial care (help with daily living) in nursing homes or assisted living, which can cost over

annually,

Answer: For 2026, you can access additional medication assistance through Medicare’s "Extra Help" (Part D LIS) for low-income seniors, manufacturer patient assistance programs (PAPs), nonprofit co-pay foundations, and state-level pharmaceutical programs. These programs can significantly reduce costs for premiums, deductibles, and high-priced specialty drugs.

Key additional assistance options:

Medicare Extra Help (Part D Low-Income Subsidy): If you have limited income and resources, you may qualify for help with premiums, deductibles, and co-pays. In 2026, eligibility includes incomes up to 150% of the Federal Poverty Level.

Manufacturer Patient Assistance Programs (PAPs): Many pharmaceutical companies offer free or low-cost medications, especially for brand-name or specialty drugs. Search for your drug manufacturer's website for "patient assistance" or "copay card".

Nonprofit Copay Foundations: Organizations like NeedyMeds, RxHope, and Patient Advocate Foundation can help with out-of-pocket costs and provide emergency aid.

State-Level Programs: Some states offer their own programs, such as Wisconsin's SeniorCare Program, that provide extra savings.

Discount Cards: Utilize tools like SingleCare or NeedyMeds for lower prices, even if you have insurance.

Health Savings Accounts (HSAs): If eligible, using an HSA allows you to pay for medications with tax-free dollars.

Contact your local State Health Insurance Assistance Program (SHIP) for free, personalized counseling to apply for these programs.

Answer: I would say that the one i here most is: Regretting choosing a Medicare Advantage plan based on low premiums without realizing it restricts doctor networks and requires prior authorization for care. Many regret not opting for Original Medicare with a Medigap plan, which allows nationwide access to any doctor who accepts Medicare.

Other regretted decisions include:

Restricted Networks: Switching to a Medicare Advantage plan and realizing their preferred specialists are out-of-network, leading to higher costs or inability to see them.

Forgoing Medigap Initial Enrollment: Skipping a Medicare Supplement (Medigap) plan at 65. If you do not buy one during your Initial Enrollment Period, you may have to pass medical underwriting later, meaning you can be denied coverage due to pre-existing conditions.

Assuming Medicare Covers Everything: Assuming standard Medicare covers long-term care, dental, or vision, leading to unexpected, massive out-of-pocket expenses.

Missing Part B Enrollment: Failing to enroll in Part B when first eligible, resulting in lifetime late-enrollment penalties and coverage gaps.

"Set it and Forget it" Drug Coverage: Not re-evaluating Part D drug plans annually,

Answer: I am not sure exactly what you are asking… but I will assume you are asking what happens with Medicare in that event?

I’m that case: If you are retired and collecting Social Security when you turn 65, you will be automatically enrolled in Medicare Parts A and B. Your Part B premiums will generally be automatically deducted from your monthly Social Security payments.

You will need to take separate action to enroll in Medicare Part D for prescription drug coverage.

Medicare Enrollment: Because you are already receiving Social Security, the Centers for Medicare & Medicaid Services will send you a welcome package about 3 months before your 65th birthday.

Part B Premiums: Medicare Part B premiums will be deducted directly from your Social Security benefits.

Continued Benefits: Your Social Security retirement benefit amount will not change just because you turn 65, as the reduction for early filing (if applicable) is already locked in.

Answer: Evaluate plans by calculating the total estimated annual cost—combining monthly premiums, deductibles, and co-pays for your specific prescriptions and providers—rather than choosing based on the lowest premium alone. This ensures your specific needs are covered while avoiding high, unexpected out-of-pocket expenses.

Key actions to balance cost and care:

Answer: It will depend on your particular Medicare Advantage plan. Check the specific plan’s Evidence of Coverage (EOC) or call the provider to confirm coverage for specific treatments.

many Medicare Advantage (Part C) plans cover acupuncture and some alternative therapies, often offering broader coverage than Original Medicare. While Medicare only covers acupuncture for chronic low back pain (up to 20 visits/year), some Advantage plans include coverage for other conditions like nausea, migraines, or other pain types.

Answer: Special Needs Plans (SNPs) are a type of Medicare Advantage plan (Part C) designed for individuals with specific severe/chronic conditions, those eligible for both Medicare and Medicaid, or those in institutions. These plans tailor benefits, provider networks, and drug formularies to the specialized needs of their members, offering coordinated care and often extra benefits like dental, vision, or hearing.

Answer: I am a little curious with your question. Are you referring to 2026 or legitimately asking about 2025? If you are truly speaking about the changes that went in to effect in 2025, dependent on your drug usage, there could have been a significantly lower prescription costs for many by adding a $2,000 annual out-of-pocket cap, eliminating the "donut hole," and offering monthly payment options for drug costs, though some patients with lower drug needs might see slightly higher percentage costs as plans shift, but overall, major savings are expected for those with high drug expenses.

Some beneficiaries with lower drug needs might see their share of costs (coinsurance) increase slightly as plans adjust, but this is offset by the new cap for those with high costs. (Cost shifting)

Answer: Yes, Medicare generally covers asthma and other breathing conditions like COPD, covering doctor visits, tests, and treatments, primarily through Part B for durable equipment (nebulizers) and services, and Part D (or Medicare Advantage with drug coverage) for most prescription inhalers and medications, though you'll have copays/coinsurance and need to check plan formularies for specific drugs.

Answer: Yes, Medicare covers hip, knee, and shoulder replacement surgeries, but only if they are deemed medically necessary by your doctor, covering common procedures like these joint replacements, plus related therapy (PT) and equipment, with costs depending on if you're in Original Medicare (Parts A & B) or a Medicare Advantage (Part C) plan, and whether it's inpatient (Part A) or outpatient (Part B).

Answer: Reasons for choosing a high-cost Part D plan:

Lower Drug Costs (Copays/Coinsurance): A plan with higher premiums might have much lower copays or coinsurance for your specific, costly medications, leading to significant savings compared to a cheap plan where those drugs cost a fortune.

Comprehensive Drug Lists (Formulary): High-premium plans often cover more drugs, especially specialty or brand-name medications, with fewer restrictions (like tier placement) than budget plans.

$0 Deductible Plans: Some higher-premium plans waive the deductible, meaning you pay less upfront and start getting lower drug costs immediately, rather than paying full price for drugs until a deductible is met.

Preferred Pharmacy Networks: They might offer lower costs at preferred pharmacies, which is crucial if your preferred pharmacy isn't in a cheaper plan's network.

Predictable Costs: For people with chronic conditions (like diabetes or cancer) needing many expensive drugs, a higher-premium plan provides more stability, ensuring costs don't skyrocket, especially with the new out-of-pocket cap.

Smoothing Costs: The Inflation Reduction Act allows spreading drug costs over the year (Medicare Prescription Payment Plan), which benefits those who hit the annual $2,000 (soon $2,100) out-of-pocket limit early in the year, making higher premium plans more attractive for predictable monthly payments.

In essence, it's a trade-off: You pay more monthly (premium) to potentially save much more throughout the year on your actual prescriptions.

Answer: If you're working past 65 with employer coverage (company has 20+ employees...), you can likely delay Part B without penalty, using your employer plan as primary; however, signing up for premium-free Part A is usually smart as it acts as secondary insurance, and you can delay Part B until you stop working to avoid penalties, using a Special Enrollment Period (SEP). If your employer has fewer than 20 employees, you generally must enroll in Medicare Parts A & B to avoid gaps/denials, as Medicare becomes primary

Answer: For basic hospital care with minimal cost, a $0 premium Medicare Advantage plan is often the winner if you qualify and don't mind networks and there is one in your area.

Answer: It's legal because Medicare Supplement (Medigap) plans are sold by private companies, and outside your initial 6-month Medicare Part B enrollment period, they can use medical underwriting (health questions) to deny coverage or charge more, even if you paid into Original Medicare, which is separate. However, federal law guarantees acceptance during that special enrollment window and certain Guaranteed Issue (GI) situations, but if you missed those, insurers can use your health history to decline you.

What You Can Do

Check for GI Rights: See if you qualify for a Guaranteed Issue situation (e.g., moving out of a Medicare Advantage Plan) where you can't be denied.

Explore Other Options: Look into Medicare Advantage (Part C) plans, which have different enrollment rules, or see if your state offers extra protections.

Appeal the Decision: You can file an appeal with the insurer if you believe the denial was an error or if you have supporting information from your doctor.

Contact SHIPS: Your State Health Insurance Assistance Program (SHIP) offers free, unbiased advice to help you understand your options.

Answer: Yes, there are potential disadvantages to working with a Medicare broker/agent, primarily concerning potential bias due to how they are compensated. While their services are free to you, they are paid commissions by the insurance companies, which may influence their recommendations. Find a Medicare advisor who will spend the time to educate you on both Medigap plans vs Medicare Advantage plans.

Answer: Medicare Part A covers inpatient hospital care, while Medicare Part B strictly covers outpatient surgery, including doctor's services, anesthesia, and related outpatient hospital or clinic services, with you typically paying the Part B deductible and 20% coinsurance. Part A only applies if you're formally admitted to the hospital for an overnight stay; if you're treated as an outpatient (even in a hospital), Part B is responsible.

Answer: The answer to that is probably above my pay grade and I assume would have to be very political in nature. Therefore I won't express an opinion at this time. Sorry! :)

Answer: No, not everyone over 65 automatically qualifies; you generally need to be a U.S. citizen/permanent resident for 5 years and have worked (or have a spouse who worked) paying Medicare taxes for about 10 years for premium-free Part A, though you can buy coverage if you don't, and others under 65 with disabilities also qualify. Eligibility hinges on citizenship, age, residency, and work history, with options to enroll (and pay premiums) if you don't meet the free Part A criteria, or delay enrollment if you have other group coverage.

Key Eligibility

Answer: I find that most gripes with advantage plans are due to misunderstandings on how the plan works.. Education in the difference between a Medigap plan and a Medicare Advantage plan is crucial. Call "time out" on anyone telling you that a Medicare Advantage plan is the best option with out spending the time to properly educate you on the pros and cons of each.

People dislike Medicare Advantage (MA) plans due to restrictive provider networks, complex authorization processes causing care denials, annual changes in costs and networks, and potential for higher out-of-pocket expenses when sick, despite low initial premiums, making them unreliable for ongoing health needs compared to Original Medicare. Issues like misleading marketing and difficulty switching back to Original Medicare with a Medigap plan also fuel frustration.

Key Criticisms of Medicare Advantage:

Network Restrictions: MA plans use HMO/PPO networks, limiting choices for doctors, specialists, and hospitals, unlike Original Medicare's broad network.

Prior Authorizations & Denials: Plans often require pre-approval for services (like chemo or rehab), which can delay or deny necessary care, creating a "bureaucratic maze".

Annual Changes: Benefits, provider lists, and costs (premiums, copays) can change yearly, disrupting care and making plans unaffordable

Higher Out-of-Pocket Costs When Sick: While low-premium plans attract people, high copays, deductibles, and an annual maximum out-of-pocket (MOOP) can make them very expensive for those with chronic conditions.

Provider Disincentives: Lower reimbursement rates can lead some doctors to avoid MA networks, further shrinking patient choices.

Difficulty Switching Back: Leaving an MA plan to get a Medigap (supplement) plan later can be difficult or costly due to enrollment rules, trapping beneficiaries.

Misleading Marketing: Ads can focus on low premiums and extra benefits (dental/vision) while downplaying restrictions and potential costs, leading

Answer: Medicare covers medically necessary, short-term home health care like intermittent skilled nursing, physical/occupational/speech therapy, medical social services, and some supplies/equipment, but only if you're homebound and under a doctor's care. It doesn't cover 24/7 care, custodial care (like bathing if it's the only need), or long-term help with daily activities; aide care is covered only if you're also getting skilled nursing or therapy.

Answer: Medicare Supplement (Medigap) Guaranteed Issue (GI) rights allow you to buy a Medigap policy without medical underwriting or health questions, meaning insurers can't deny coverage or charge more due to pre-existing conditions, typically triggered when losing specific health coverage (like an employer plan or certain Medicare Advantage plans) outside your initial enrollment period. These rights provide a crucial window (usually 63 days) to get coverage if you lose other insurance involuntarily, such as your MA plan leaving your area or an employer plan ending.

WHAT IS IT:

No Underwriting: Insurers must sell you a policy without asking health questions or denying you based on your health.

NO HEALTH BASED PREMIUMS: You get the best available rate, not a higher one due to health issues.

WHEN IT APPLIES: (Common Situations):

LOSING EMPLOYER COVERAGE: Your group health plan (with Medicare Parts A & B) ends.

LOSING MEDICARE ADVANTAGE (MA): Coverage: Your MA plan leaves your service area, goes bankrupt, or you drop it within the first year of joining.

TRIAL RIGHT: You dropped a Medigap plan within the first year to try an MA plan but want to return.

PLAN ISSUES: Your private insurer goes bankrupt or misleads you.

KEY TIMELINES:

You generally have a 63-day window to apply for a GI Medigap policy after losing your prior coverage.

IMPORTANT NOTE:

State Laws Vary: Some states (like NY, CT) offer more generous, even year-round, GI rights; always check with your State Health Insurance Assistance Program (SHIP).

Answer: With a standard Medicare Advantage HMO plan, you will generally have to pay the full cost for an out-of-network cardiologist unless it is an emergency or you have specific plan features.

HMO plans typically require you to receive all non-emergency care within a specific network of doctors and facilities. If you choose to go outside the network, the plan usually will not cover any of the cost, leaving you responsible for the entire bill

Network Exception/Prior Authorization. If your plan does not have an in-network cardiologist who can provide the necessary treatment, your primary care physician (PCP) can request a "network exception" or "prior authorization" from the plan. If the plan approves the request before you receive care, the service may be covered at the in-network rate.

Answer: Yes.. absolutely! Agents often push Medicare Advantage (MA) plans because they typically earn higher commissions and bonuses for these sales compared to Medigap policies. This financial incentive can create a conflict of interest, meaning you should be skeptical and carefully evaluate if the recommended plan truly fits your healthcare needs. Make sure the advisor you are working with spends the time to EDUCATE you on the differences of MA and Medi-gap plans.

Answer: Moving to a rural area can limit your Medicare Advantage plan options because there are fewer insurance companies willing to offer plans in areas with lower population density and limited healthcare provider networks. This often results in fewer plan choices, potentially smaller networks of doctors and hospitals, and possibly higher premiums. When you move, you will likely need to enroll in a new plan specific to your new location during a special enrollment period.

Answer: "Creditable coverage" is health insurance that is as good as or better than the standard Medicare Part D prescription drug plan, or a general health plan that provides essential benefits. It applies when you are enrolling in Medicare or another health plan and can help you avoid a late enrollment penalty if you are on a prescription drug plan.

When does it apply?

Avoiding Medicare late enrollment penalties: If you have creditable prescription drug coverage from another source (like an employer plan), you can delay enrolling in Medicare Part D without a penalty.

Avoiding a gap in coverage: Having prior creditable coverage can reduce or eliminate pre-existing condition exclusion periods when you switch to a new job-based plan.

Meeting state requirements: In states with an Affordable Care Act individual mandate, like Massachusetts, "Minimum Creditable Coverage" refers to coverage that meets the state's essential health benefits and avoids a tax penalty.

For employers: Employers with prescription drug plans must determine if their plan is creditable and notify employees of the status each year.

Answer: I will assume that from your statement that $3000 is your MOOP on your Advantage Plan?

If that is the case.... No, you will not have any copays or fees for covered services for the rest of the year after you reach your plan's annual out-of-pocket maximum. Once this limit is met, the Medicare Advantage plan pays 100% of the costs for covered services for the remainder of the calendar year.

Answer: 1. Original Medicare Pays First: First, Medicare determines if the knee replacement is medically necessary. If approved, Medicare pays its share of the Medicare-approved amount for the costs.

2 .Part A or Part B Coverage:

If the surgery is an inpatient procedure (requires an overnight hospital stay), Medicare Part A covers the hospital costs. Plan G will cover your Part A deductible and any coinsurance.

If the surgery is an outpatient procedure (most knee replacements are now outpatient), Medicare Part B covers the surgeon's fees, facility charges, and other related services. You are responsible for meeting the annual Part B deductible.

3. Medigap Plan G Pays Second: After Medicare pays its portion, your Medigap Plan G policy kicks in to cover the remaining costs (the "gaps"). Plan G covers the 20% coinsurance that Original Medicare leaves you responsible for once you meet the Part B deductible.

4. Minimal Out-of-Pocket Costs: Once you've paid your annual Part B deductible (which is $257 in 2025), Plan G covers 100% of all remaining Medicare-approved Part B charges and all Part A deductibles and coinsurance. This means your additional out-of-pocket expenses for the surgery and recovery should be minimal or non-existent, aside from your monthly Medigap premiums.

Answer: No, Original Medicare (Parts A and B) does not cover routine vision exams, eyeglasses, or contact lenses, but it does cover certain medical eye exams and treatments for conditions like glaucoma, diabetic retinopathy, and macular degeneration. For routine vision care, you can get coverage through a Medicare Advantage (Part C) plan, which often includes exams, glasses, and contacts, or you can purchase a private vision plan to supplement your Medicare coverage.

What Original Medicare covers:

Medical eye exams: Covers annual eye exams for people with diabetes to check for diabetic retinopathy and annual eye exams for those at high risk of glaucoma.

Diagnostic tests and treatments: Covers diagnostic tests and treatments for conditions like macular degeneration.

Cataract surgery: Covers the surgery to remove a cloudy lens and one pair of corrective eyeglasses or contact lenses after surgery.

What Original Medicare does not cover

Routine eye exams: For the purpose of fitting eyeglasses or contacts.

Eyeglasses and contact lenses: The cost of the frames, lenses, or contacts themselves.

Answer: You and your friend are likely paying for different types of Medicare plans: she is on a Medicare Advantage (Part C) plan or a Medigap plan that includes SilverSneakers, while you may have Original Medicare (Parts A and B). Original Medicare does not cover gym memberships, but some Part C and Medigap plans include SilverSneakers as a benefit.

Medigap (Medicare Supplement): There are SOME private plans that can supplement Original Medicare. Some Medigap plans also offer SilverSneakers or a similar fitness benefit.

Answer: There is no charge to help clients enroll. Agents are paid by the different companies that they help the client enroll in.

Answer: You will only get a ANOC letter if you have a Medicare Advantage Plan or a part D Plan. Not a Medicare supplement.

Your provider should have sent your Annual Notice of Change (ANOC) by September 30 each year to inform you of changes to your coverage, costs, and more for the following January. You should receive it in the mail or by email, depending on your plan's preference.

If you have not received it yet, contact your insurance provider for a replacement copy.

Answer: Medicare Part B covers intensive outpatient programs (IOPs) for seniors with severe mental health conditions, but patients pay a coinsurance after meeting the Part B deductible. Coverage applies to services received from a participating provider, which can include individual and group therapy, medication management, and other therapies at facilities like hospitals or community mental health centers. As of January 2024, IOPs are specifically covered under Part B as a level of care between traditional therapy and inpatient treatment.

Answer: The key difference is that Medigap plans offer the freedom to see any doctor who accepts Medicare, with no network restrictions, while Medicare Advantage plans typically require you to use providers within a specific network for non-emergency care.

Answer: What happens when you turn 65

Automatic enrollment: You will be automatically enrolled in Medicare Part A and Part B. If your birthday is on the first of the month, your coverage will start the first day of the previous month.

New options: You can now enroll in a Medigap (Medicare Supplement Insurance) plan or a Medicare Advantage plan if you choose to. You may also want to enroll in a Part D prescription drug plan.

Important decisions: You will need to decide on your coverage for prescription drugs and whether you want to switch from your current Medicare coverage to a Medicare Advantage plan.

Important considerations

Review your options: Even though you don't have to re-enroll, it's a good idea to review your current Medicare coverage and see if there are better options available as you approach your 65th birthday.

Enrollment period: Your 65th birthday marks the beginning of a new Initial Enrollment Period (IEP) for your age, which lasts for seven months. This is your opportunity to make changes or additions to your coverage without penalty.

Answer: A Medicare "professional" is genuinely looking out for your best interests, focus on their transparency, their approach to your specific needs, and the range of options they offer. A trustworthy agent acts as an advisor, not just a salesperson, and should provide clear, unbiased information.

A good agent will ask detailed questions about your health, medications, doctors, lifestyle, and budget before recommending any plans. They should never try to fit you into a pre-determined plan. Trustworthy agents or brokers are usually independent and represent multiple insurance companies. They will explain the pros and cons of different plan types (Medicare Advantage vs. Medicare Supplement/Medigap) and help you compare plans side-by-side, rather than pushing a single, specific plan.

Answer: It is almost impossible to answer that question without knowing what type of plan you selected...a Medicare Supplement or a Medicare Advantage Plan? My guess is a Medicare Advantage plan. If you could confirm that i can answer more intelligently.

Answer: You can likely keep your Original Medicare and Medigap coverage, but you must update your address with Medicare and your Medigap insurance company. Your premiums may change, and you should review your options in Florida, though switching plans could involve medical underwriting.

Answer: Medicare Part B covers many preventive services at 100% with no deductible or copayment if you meet the eligibility criteria and the provider accepts Medicare assignment. However, some services may still have cost-sharing (20% coinsurance) depending on specific conditions or if a screening turns diagnostic.

What is Free (No Cost)

The following preventive services are generally covered with no out-of-pocket costs when performed by a Medicare-approved provider:

• "Welcome to Medicare" preventive visit: A one-time visit within the first 12 months of enrolling in Part B.

• Annual Wellness Visit (AWV): A yearly visit to develop or update a personalized prevention plan (not a physical exam).

• Vaccinations: Flu shots, pneumococcal shots, COVID-19 vaccines, and Hepatitis B shots for intermediate/high-risk individuals.

• Screenings:

o Abdominal aortic aneurysm screening (one-time for qualifying individuals).

o Alcohol misuse screening and counseling.

o Bone mass measurements (for qualifying individuals).

o Cardiovascular disease screenings (cholesterol, lipid, and triglyceride levels) once every 5 years.

o Cervical and vaginal cancer screenings (Pap tests and pelvic exams).

o Colorectal cancer screenings (fecal occult blood tests, flexible sigmoidoscopies, colonoscopies, etc., at set intervals).

o Depression screenings.

o Diabetes screenings (for those at risk).

o Hepatitis C screening (for qualifying individuals).

o HIV screening (for qualifying individuals).

o Lung cancer screening (for qualifying individuals at high risk).

o Mammograms (screening) once every 12 months.

o Obesity screening and behavioral therapy.

o Prostate cancer screening (digital rectal exam is free, but the associated blood test has a 20% coinsurance).

o Sexually transmitted infections (STI) screenings and counseling.

• Counseling & Therapy:

o Cardiovascular disease behavioral therapy.

o Counseling to prevent tobacco use.

o Medical nutrition therapy services (for those with diabetes or kidney dise

Answer: Medicare covers several preventive services for individuals with high cardiovascular risk factors, such as a family history of heart disease. These include a cardiovascular risk assessment, annual cardiovascular behavioral therapy, and various screenings like blood pressure and cholesterol checks. Other covered services include smoking cessation and weight loss counseling, diabetes screenings, and programs for self-management, medical nutrition therapy, and wellness.

Answer: The "Extra Help" program, also known as the Low-Income Subsidy, is a federal program to help people with Medicare Part D pay for prescription drug costs like premiums, deductibles, and copayments. Eligibility is based on your income and financial resources, such as savings and assets. You can apply online at ssa.gov/extrahelp or contact your State Health Insurance Assistance Program (SHIP) for free counseling and help with the application.

Eligibility requirements (for 2025)

Income: Your annual income must be below \(23,475\) for an individual or \(31,725\) for a married couple living together. These limits are higher in Alaska and Hawaii.

Resources: Your total resources (like bank accounts, stocks, and bonds) must be at or below \(17,600\) for an individual or \(35,130\) for a married couple.

Automatic qualification: You automatically qualify if you are enrolled in both Medicaid and Medicare ("dual-eligible") or receive Supplemental Security Income (SSI). 

How to apply 

Online: The quickest way is to apply online through the Social Security Administration at ssa.gov/extrahelp.

Through SHIP: You can also contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased counseling and help with the application process

Answer: No, IRMAA (Income-Related Monthly Adjustment Amount) does not go away automatically if your income drops. You must report the change to the Social Security Administration (SSA) to request a reduction or elimination of the surcharge.

Key Points:

IRMAA is based on tax returns from 2 years prior

SSA uses your Modified Adjusted Gross Income (MAGI) from your IRS tax return two years earlier.

Example: 2026 IRMAA → based on 2024 tax return.

A drop in current income won’t trigger an automatic adjustment

Even if your income falls significantly this year, SSA won’t know unless you tell them.

You must file Form SSA-44 ("Medicare Income-Related Monthly Adjustment Amount Life-Changing Event")

This form is used to report a "life-changing event" that reduced your income, such as:

Retirement

Reduction in work hours

Divorce, death of a spouse, or loss of pension

Other significant income drops

What to do:

Call SSA at 1-800-772-1213 or visit a local office.

Request Form SSA-44.

Provide proof (e.g., pay stubs, retirement letter, tax estimates).

SSA will recalculate your IRMAA using a more recent estimate of your income.

Timing matters

File as soon as the income drop occurs.

If approved, the reduction can be retroactive to the month of the life-changing event (or up to the prior January, if later).

Bottom Line:

Report the change yourself using Form SSA-44. SSA will not adjust IRMAA automatically based on a future lower tax return — you must act proactively.

Answer: No, you are probably not the only one, as this is a common misunderstanding, and many people are surprised to learn about their financial responsibility for ambulance rides. Medicare Part B covers 80% of a "medically necessary" ambulance service after you've met your deductible, leaving you responsible for the remaining 20% and any costs exceeding the Medicare-approved amount. A medical necessity is determined by whether transport in another vehicle could endanger your health

Answer: Medicare covers most recommended adult vaccines for free with no out-of-pocket costs (no copayments or deductibles), though which part of Medicare covers them depends on the specific vaccine.

Vaccines Covered by Medicare Part B (Medical Insurance)

You pay nothing for these vaccines as long as your healthcare provider accepts Medicare assignment:

Flu shot: One annual shot.

Pneumococcal shots: For pneumonia prevention. This typically involves two different shots given a certain time apart.

COVID-19 vaccines: Includes primary series and all recommended boosters.

Hepatitis B shots: For people at medium or high risk of contracting the virus.

Vaccines related to injury or exposure: Such as a tetanus shot if you step on a rusty nail or rabies shots after an animal bite.

Vaccines Covered by Medicare Part D (Prescription Drug Plans)

If you have a Medicare Part D plan (either a stand-alone plan or through a Medicare Advantage plan that includes drug coverage), you also pay nothing out-of-pocket for all other adult vaccines recommended by the CDC's Advisory Committee on Immunization Practices (ACIP).

These include, but are not limited to:

Shingles vaccine (Shingrix): A two-dose series recommended for adults 50 and older.

RSV vaccine (Respiratory Syncytial Virus): Recommended for adults 60 and older (based on shared decision-making with a doctor).

Tdap vaccine: Protects against tetanus, diphtheria, and whooping cough (pertussis).

Hepatitis A vaccine.

MMR vaccine: Measles, mumps, and rubella.

Important Tip: Ensure you go to a pharmacy or provider within your plan's network to avoid potential issues where you might have to pay upfront and seek reimbursement later. It's always a good idea to confirm coverage details with your specific plan or provider beforehand

Answer: Yes, Medicare Part B covers chiropractic care only for manual manipulation of the spine to correct a subluxation. It does not cover maintenance care, X-rays, massage, or other services. You are responsible for the Part B deductible and a 20% coinsurance after that, but if you have a Medigap policy, it may cover these costs.

Answer: Yes, Medicare can cover a home health aide after surgery if you meet specific criteria, including being homebound and requiring part-time or intermittent skilled care such as nursing or therapy services. A home health aide's assistance is covered only when it's part of a care plan that includes skilled care, and they are there to help maintain your health or treat your injury.

Answer: 1. Contact Your Plan Provider Directly (Most Definitive)

• Call the customer service number on your Medicare card or plan ID card (usually 24/7).

• Provide: Your plan name/ID, drug name, dosage, and pharmacy.

• They’ll confirm: Coverage, copay, tier, restrictions, and alternatives. This is binding—they process claims.

• Bonus: Ask about prior authorization, quantity limits, or step therapy (trying cheaper drugs first).

Answer: Yes, but it is extremely rare. as Medigap (not Medicare Advantage) policy are generally guaranteed renewable as long as you pay your premiums. An insurer can only cancel your policy if you fail to pay premiums, commit fraud or misrepresentation on your application, or if the company goes bankrupt. They cannot cancel your policy simply because you are filing a lot of claims.

Here would be the circumstances that an insurer can cancel a Medigap policy.

*Non-payment of premium: Failing to pay your premiums is the most common reason for cancellation.

*Material misrepresentation or fraud: If you are found to have provided false information on your application, especially related to your health, the insurer can cancel the policy.

*Insolvency or bankruptcy: If the insurance company goes out of business, it can lead to the termination of your policy. In this case, you may have a guaranteed issue right to enroll in another Medigap policy without medical underwriting.

Answer: That is an almost impossible question to answer without knowing what type of Medicare Plan you have? Do you have a Medicare Supplement or a Medicare Advantage plan?

Answer: An experienced broker will demonstrate a deep understanding of the nuances of Medicare plans, ask detailed questions about your specific needs, work with multiple insurance companies, and provide long-term support beyond initial enrollment.

Answer: Scope of Appointment forms are required by Medicare to have a client sign. It specifies what the agent is going to talk about with the client. Call centers are not exempt. If they’re getting around that, they should be reported.

Answer: You can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering the questions can help you and your doctor develop or update a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

Routine measurements (like height, weight, and blood pressure)

Health advice

A review of your medical and family history

A review of your current prescriptions

Personalized health advice

Advance care planning

A screening schedule (like a checklist) for appropriate preventive services

An optional “Social Determinants of Health Risk Assessment” to help your provider understand your social needs and their impact on your treatment

Answer: Medicare appeal time lines are strictly regulated by CMS. There are 5 levels of appeals that all have a realistic timeline. If you are more specific with the level, i could give you a better estimate. Usually with an expedited 9Fast) appeal you will get and decision in 24-72 hrs.

Answer: You would have to be much more specific about your circumstances. There is not enough information here to answer it. I assume what you might be referring to may have to do with you now filing as and individual where as before you were filing as a couple… but would need way more information to answer that question.

Answer: While Original Medicare (Part A and B) does not offer incentives for regular exercise or a healthy lifestyle, many Medicare Advantage (Part C) plans provide additional benefits that cover fitness programs, rewards, and other wellness resources.

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurance companies and are required to cover all the same services as Original Medicare. They often include extra benefits for wellness and prevention.

Fitness programs: Many Medicare Advantage plans offer free or discounted memberships to fitness programs designed for seniors, such as SilverSneakers, Renew Active, or Silver&Fit.

Incentive and rewards programs: A growing number of Medicare Advantage plans provide incentives for completing healthy activities. These rewards are often gift cards for things like:

Completing an Annual Wellness Visit

Getting a flu shot or other vaccinations

Participating in certain fitness activities

Answer: Yes, Medicare does cover emergency care in U.S. territories like Puerto Rico. You will also find that coverage is the same as it is in the mainland U.S. If you have a Medicare Advantage plan, it is also required to cover "emergencies" in all U.S. territories as well.

Answer: I am assuming you are 65 or older.

Yes, losing your employer-sponsored health coverage is a common reason for a guaranteed issue right for a Medigap plan. This means you can buy a Medigap policy without medical underwriting, regardless of your health, and you must apply within a specific timeframe, usually 63 days after losing your coverage.

When you lose your coverage, sign up for Medicare Part B immediately to avoid late penalties. Then, apply for a Medigap plan within 63 days of your employer coverage ending.

Answer: I am not quite sure I understand your question? Could you give me more details? Are you asking what type of Medicare options one has?

Answer: Do you mean 2025 or 2026? Has you probably know in 2025 Medicare part D prescrittions drugs were capped at $2000 out of pocket. This will change to $2100 in 2026.

However, no knowing what drug you take... if it is not on formulary, your costs will not be capped at $2000 in 2025 or $2100 in 2026. The cap for Medicare Part D only apples to to prescription drugs that are on your plan's formulary (list of covered drugs). For a non-formulary drug, you will likely have to pay the full retail price, which will not count toward the annual cap.

Answer: Purely speculative.... but it is more than likely that it will put a strain on the Medicare Part A's hospital fund, leading to the hospitals and providers getting reduced payments, which will need to be made up somewhere?

Answer: Original Medicare does not cover hearing aids or exams.

If you mean can i get coverage for those with a Medicare plan then that would depend on what type of plan do you have. A Medigap Supplement plan or Medicare Advantage (Part C) plan.

You will not get coverage with a Medigap plans but many Medicare Advantage (Part C) plans include hearing benefits that can help pay for hearing aids.

Answer: You can typically change your Medicare plan during the Fall Open Enrollment Period (October 15–December 7) each year, or during the Medicare Advantage Open Enrollment Period (January 1–March 31) if you are enrolled in a Medicare Advantage plan. Additionally, you may qualify for a Special Enrollment Period (SEP) and be able to switch plans at other times of the year due to certain life events, such as moving or losing other coverage.

You can always attempt to make a change with your Medicare Supplement plan or switch from MA to Medicare supplement, but unless there are some special circumstances, and you are no longer in your initial enrollment period, you will have to get underwritten in order to be accepted by a new company.

Answer: Sounds like you are not comparing Apples to Apples? Do you both have Medicare Advantage plans or do you have a Medicare Supplement? If you do both have advantage plans, I assume i the parameters (MOOP, coinsurances, etc) are much different. I would speak with a Medicare Advisor and get the facts based on the plans by each.

Answer: You can qualify for Medicare under 65 if you have a qualifying disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS). Individuals who have received Social Security Disability Insurance (SSDI) benefits for 24 months usually become eligible, while those with ESRD or ALS can get Medicare without a waiting period.

Answer: Yes certainly!

But not sure that would be a question any of us can answer. Maybe a better question for a politician?

Answer: Briefly. if your parents are turning 65 and no automatically enrolled in Medicare, the best time to enroll them will be during their Initial Enrollment period. 3 months before their 65th birthday or 3 months after.

f you are signing up your parent on their behalf, and they are not able to make their own decisions, you may need a Power of Attorney (POA) or legal guardianship documentation to act as their representative. If they are able, they can simply enroll themselves and then authorize you to access their information later.

Answer: You have about a 30 minute conversation here if I were to try and answer all questions. Yes I would definitely seek out and INDEPENDENT Medicare Insurance Advisor. I would make sure they are Independent so that they have no bias between a Medicare Supplement and a Medicare Advantage Plan.

Medicare is very confusing for most people. A trained advisor will walk you through the pros and cons of both options. Typically there is no best or worst option. Someone's choice is most of the time dependent upon a person's health, budget and family situation.

Answer: I would say some of the top companies that stand out would be Blue Cross/Blue Shield, Humana and United Health Care. While no single company is the best, these 3 would stand out for their longevity, consistency, competitive rates and financial strength. I would tell you all 3 of them have very good customer support as well.

Answer: Yes.. Medigap open enrollment rules and plans can vary by state? ” Although the basics of Medicare are the same across the US, some states have different rules than others regarding open enrollment periods and which plans are available.

Answer: I would recommend that they first get the details from the provider to exactly what the basis for the denial was. Get the facts. Then contact your advisor and get him involved i assisting from there. He or she should know the next steps in which you will need to make to appeal the denial.

Answer: Medicare agents can help make the very complex subject of Medicare seem easy. They can help clearly explain your options so that you can understand them. Choose someone who is and INDEPENDENT Medicare advisor that works with all the top companies and does not just have a bias towards one or two companies.