John Zentner, Medicare Insurance Agent

Answer: Plan G and Plan N are both comprehensive Medigap (Medicare Supplement) policies. Plan G offers maximum coverage with no unexpected out-of-pocket costs, while Plan N offers lower monthly premiums but requires small copays for doctor and ER visits and excludes Part B excess charges.

Both plans cover all of your major medical cost-sharing gaps, meaning you get excellent financial security and no network restrictions (you can use any doctor accepting Original Medicare).

Answer: The biggest coverage gap most people miss with Medicare Advantage (MA) is restricted access to specialized care and out-of-network providers. Because most MA plans are HMOs or regional PPOs, you are generally locked into localized networks. If you need a certain specialist or travel frequently, you could face denied coverage or huge staggering out-of-pocket costs.

Answer: Yes, Medicare covers post-surgery recovery, including follow-up doctor visits, physical or occupational therapy, skilled nursing, and necessary medical equipment.

Coverage and costs depend on where you recover and your specific Medicare plan (Original Medicare or Medicare Advantage).

If you require an extended hospital stay or are transferred to a care facility, Medicare Part A handles the costs. If you recover at home or visit a clinic, coverage falls under Medicare Part B or Home Health Services.

Answer: If you qualify for both, you are considered "dually eligible". The two programs work together with Medicare acting as your primary insurance (paying first) and Medicaid acting as your secondary insurance (paying last to cover your out-of-pocket costs).

Being dually eligible reduces or entirely eliminates your out-of-pocket healthcare costs.

Your specific benefits and level of Medicaid coverage can vary depending on exactly which state you live in. To explore your D-SNP options or coordinate your benefits, you can explore plans using the Medicare Plan Finder or contact your local state Medicaid office for details.

Answer: You are not permanently locked into a Medicare plan; you can change your coverage every year during the Annual Enrollment Period (Oct. 15 – Dec. 7), with changes taking effect Jan. 1.

Additionally, you can switch plans during a Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) or if you qualify for special circumstances.

Special Enrollment Periods (SEPs):

Life changes may allow you to change plans outside of standard times.

- Moving: If you move out of your plan's service area.

- Loss of Coverage: If you lose employer or Medicaid coverage.

- Plan Changes: If your plan leaves Medicare, or changes its contract.

- Nursing Home: Moving into, out of, or living in a skilled nursing facility.

Answer: Yes, Medicare Part B covers wheelchairs and power-operated vehicles (scooters) as Durable Medical Equipment (DME).

For Manual Wheelchairs: You generally do not need "prior authorization," but you must have a doctor's prescription and a face-to-face evaluation. For Power Wheelchairs/Scooters: Yes, you may need "prior authorization" (prior approval) for certain power-operated vehicles and power wheelchairs. Your doctor and the supplier handle this paperwork, which must be approved by Medicare before they deliver the chair.

Answer: Yes, Medicare Part B covers medically necessary physical therapy (PT), but you must meet your annual Part B deductible first. Once met, Part B generally pays 80% of the Medicare-approved amount, leaving you with 20% coinsurance.

Answer: Seniors pay lifelong Medicare Part B and D penalties, often exceeding 30% of their premium, due to missing enrollment deadlines, lacking "creditable" coverage, or misunderstanding rules while working past 65. Penalties are added for not signing up during the initial 7-month window and remain for life. One of the main reasons is failing to enroll in Part B or D during the 7-month Initial Enrollment Period (three months before, the month of, and three months after the 65th birthday).

Answer: The 6 key areas not covered by Original Medicare are Long-Term Care (Custodial Care), most dental care (such as routine dental cleanings, fillings, tooth extractions, and dentures), routine vision care, hearing aids and exams, cosmetic surgery and routine foot care. Also other things excluded are generally Concierge Care, International Coverage, and Alternative Medicine.

Answer: Whether you can keep your current doctors when switching to a Medicare Advantage plan depends on whether they are in the plan's network. If your doctors are in the network, you can continue seeing them. If they are not in the network, you will need to find new doctors who are part of the plan's network.

Some Medicare Advantage plans are PPO which allow you to see out of network doctors. It is important to note that costs on seeing out of network doctors in this situation can be much more expensive.

Answer: Yes, you may be penalized if you do not enroll in Medicare Part B when you turn 65 and don't have other qualifying health coverage. This penalty is a surcharge added to your monthly premium and can last for as long as you have Part B.

When you turn 65, you have a 7-month Initial Enrollment Period to sign up for Medicare (3 months before, the month of, and 3 months after your 65th birthday).

The penalty is usually 10% of the standard monthly premium for each full 12-month period you delayed enrollment.

If you have creditable coverage (like through your employer) when you turn 65, you can delay enrollment without penalty and enroll later during a Special Enrollment Period, which is triggered when your other coverage ends.

Answer: Yes, Medicare has comprehensive coverage for asthma and other breathing conditions, including medications, equipment, and treatments. Medicare Part D (Prescription Drug Coverage) covers inhalers, including both quick-relief (like albuterol) and long-acting medications for asthma and COPD.

Answer: A Medicare agent usually will only represent and work with one insurance company or possibly a select few, limiting benefit options. A Medicare broker, on the other hand, works for the consumer, comparing plans from multiple insurance companies to find the best fit for their needs and budget.

Answer: In most areas, there are many excellent Medicare plans to choose from. You can compare plans using tools like the Medicare Plan Finder on Medicare.gov. It is important to consider cost, coverage, benefits and provider network.

It is always a good idea to seek advice from a Medicare-certified professional, such as an insurance agent specializing in Medicare, or an independent Medicare consultant. Reviewing agents online reviews such as Google Reviews is always a good idea to make sure the individual is experienced and professional.

Answer: Medicare will give you 60 lifetime reserve days for inpatient hospital care beyond the initial 90 days in a benefit period. These reserve days are used to cover some of the costs after the first 90 days of inpatient care have been used. After using all 60 lifetime reserve days, the individual is responsible for all costs.

Answer: Medicare can cover genetic testing to assess cancer risk based on family history, especially for individuals with a known issues in their family or who meet specific criteria for hereditary cancer risk assessment. However, Medicare generally doesn't cover genetic testing for pre-symptomatic screening or to simply determine an individual's risk of developing an inherited condition. It is always best to check your plan first to make sure there are no hidden cost surprises.

Answer: While many Medicare Advantage plans have "Zero Premium", they are not "free" in that they do come with certain copays and out of pocket expenses that require some costs in most cases. While for many, they are the best way to go for coverage and protection, I like to always educate my clients on all options that could best be of benefit for their unique circumstances and needs.

Answer: Medicare can be very complicated and frustrating for consumers trying to figure it all out on their own. I very much enjoy assisting people navigating these complexities and simplifying the process for my clients. I love that using my many years of experience, we together can find the very best option for someones needs and budget concerns.