Julie Thompson, Medicare Insurance Agent

Answer: There are certain diagnoses that will allow you to make a qualify and make a change with your Medicare Advantage plan. This is not the case with Medicare Supplement plans.

Answer: Unfortunately, a change in your prescription is not a qualifying event to change your Medicare plan outside of an enrollment period.

Answer: Yes, Medicare Part B covers chiropractic services but with limited coverage.

Part B covers the manual manipulation, also called an adjustment, of the spine when it’s considered medically necessary to correct a subluxation. Medicare advantage plans as well as some med supplement plans also have additional benefits available, i.e. acupuncture but they may limit how many visits you can get per year.

Answer: Yes, We have already seen lower cost on many prescriptions like insulin as well as the maximum out of pocket cost has been reduced.

Answer: Medicare does not pay for it but some of the Medicare Advantage or Medicare Supplement plans does cover the cost of medical alert systems. They are listed as Personal Response Systems.

Answer: Your best options would be to consult an agent and give them a list of ALL your medications, so they can compare which stand alone Prescription Drug plan would be best for you. You only have until March 31st to make a change without a qualifying special enrollment event.

Answer: The summary of benefits for each plan is the ideal way to do so. But you also need to check on all doctors you need and be sure they are in the same network and/or medical group. Its best to consult an agent for this comparison.

Answer: Once an individual has been disabled for 24 months they can apply for Medicare coverage. They will have to provide doctor information proving the disability.

Answer: Its not that simple. You need to be sure the plan you pick is contracted with your doctor. Most Advantage plans are just the cost of your Part B premium which makes most Advantages plan all the same cost which will be $202.90 in 2026. Some Advantage plans have an added monthly premium so be sure to check on that before selecting a plan.

Answer: There are several Medicare Advantage plans that offer incentives and reward you for maintaining a health lifestyle even for volunteering. Many of the Medicare Advantage plans will sponsor a basic gym membership via OnePass or Silver Sneakers and a few of the Medicare Supplement plans will as well. Contact an agent for help understanding the best option for you.

Answer: Its possible to continue seeing the same doctors if the medical group for your current doctor accepts your new plan. It may also be possible because your doctor may be in multiple medical groups. Always a good time to consult with an agent to make sure.

Answer: If you have a Medicare Advantage plan or a Stand Alone Part D it will cover the drugs. You will need a prescription from a doctor.

Answer: It will depend on what your current insurance coverage and situation. If you have none yes it could cause yiu to have a penalty. You initially have 3 months before you turn 65, the month you turn 65 and 3 months after you turn 65 a total of 7 months to enroll without penalty. If you have other creditable coverage then you may be eligible to enroll at a later date under a special enrollment period without penalty.

Answer: Out-of pocket expense for physical therapy will depend on which type of plan you have. Some plans will have set copays, some have deductible first then co-insurance and some plans may only be a $0 copay/co-insurance. This is a great time to ask your agent.

Answer: Now is the time to make a change if you want your hospital in-network. If you are unable to make this change before Dec 7th during Annual Enrollment Period (AEP). You will have one more opportunity to change starting Jan 1st. Contact an agent to be sure you choose the best plan for you and your future needs.

Answer: If you turn 65 between now and then or have already you will most likely need to apply for Part B. I strongly suggest you contact an agent now so you will be prepared in advance of your retirement. Some people pay more than the average for Part B and this will be good to know in advance an experienced agent can help you figure this out.

Answer: It will depend on the situation requiring the creditable coverage. I woild need more details. A good time to get with an agent for assistance.

Answer: There is no longer a coverage gap on Part D. Some plans have a deductible up to $615 and the maximum out of pocket of $2000 for 2025 and $2100 for 2026. It will depend on your plan whether the cost of the drug will go towards your deductible (if applicable) or straight to your maximum out of pocket cost. It's best to call your agent or carrier for clarification.

Answer: No, Original Medicare nor Advantage or Supplement plans will cover in-home Dementia or Alzheimer. This type of care is covered by a long-term care policy. Unfortunately if they are already diagnosed you will not find any carrier who will cover them at this time.

Answer: Original Parts A and Part B do not cover vision. Many Medicare Advantage plans will cover vision as well as dental, hearing and other extra benefits. A few of the Medicare supplement plans are also starting to cover dental and vision.

Answer: Take a vested interest in the decision making of choosing a plan. Ask questions let them answer. Be sure to hear them out on what they feel they need.

Answer: If your advantage plan is an HMO the decline is most likely because specialist is not in the same medical group as your primary care physician (PCP). 1) You can check to see if that specialist may be in another medical group as your PCP and change medical groups. 2) You can change to the medical group the specialist you want to see is in, but it may mean changing your PCP. 3) Because this is Annual Enrollment Period, you have the opportunity to change plans altogether to a plan that allows access to this specialist. Some plans will allow you to self-refer without needing permission. This is a great time to consult your agent or find an agent to assist you.

Answer: The purpose of the Annual Notice Of Change (ANOC) is to notify you of any plan changes for the upcoming plan year. It's possible if your plan has no changes you would not, but in my experience there is generally a change or even a change in verbiage of the contracts.

Answer: Some plans will give you free FitBit. Others will give you money towards one with the Over The Counter (OTC) benefit where you can purchase one with the money they give you.

Answer: When to take Social Security will depend on each individuals situation. You may need to consult your financial advisor for that. Some Medicare agents are not equipped to help with this decision if they do not know your financial situation.

Answer: An experienced agent will ask you a ton of questions and not just about prescriptions and doctors but things like do you need transportation doctor appointments, do you need dental insurance, do you go to the gym or would you if you had a free membership. But more importantly they will keep in contact with you throughout the year.

Answer: Insulin is generally not more than $35 but it may be the particular brand you are being prescribed. I suggest calling the customer service number of your carrier or your agent to help you understand why its increasing cost.

Answer: They can save you money because many of the plans have $0 copay for many of the services including inpatient hospital stays. Also many of the plans have no additional monthly premium other than your Part B premium. The Part B premium for 2026 will ne increasing to $202.90 from $185 for 2025.

Answer: With a specific surgery call your carrier the number on the back of your card or ask your agent to help you find out if you will have any out-of-pocket expenses. You want to make sure if you need follow-up thats covered too.

Answer: Yes you can have someone assist you with Medicare decisions. If you want to have them sign forms for you, you will need to get a formal power of attorney so they can legally sign documents on your behalf.

Answer: Yes, its covered by original Medicare. Depending on the plan it may have a limited number of visits.

Answer: Honestly consult a local agent to assist you. If you want the most flexible plan without a lot of extras go with a medicare supplement and a stand alone Drug plan. Keep in mind the premiums of these plans will most likely increase each year. If she is on a fixed income there are many advantage plans to choose from with added benefits like dental, gym, transportation, OTC etc. Long Term Care is a definite conversation with an agent and has a lot to do with the persons current health.

Answer: All plans have a formulary list showing the drugs they cover and what the copay is for it. It will also let you know if there is a deductible. An insurance agent can help assist you as well. Plans now have a maximum out of pocket as well and there is a new payment method to pay for expensive drugs overtime.

Answer: Many of the Medicare Advantage plans will cover Hearing Aids. Yes, there generally is a copay depending on the type of hearing aid you get. Some plans have two or three different levels to choose from. The better the hearing aid the more expensive the copay.

Answer: There are other PPO options if you can not qualify for a Medicare Supplement/Medigap plan that are guarantee issue. This means they will take you regardless of your current health situation, but it is only a certain times of the year i.e. AEP Oct 15th to Dec 7th.

Answer: A deductible is your portion to pay before the plan will pay and once its be paid for the year its done. Example $257 deductible for Part B means you pay that before the plan pays towards your doctor services. Once the deductible has been met your are done for the year. A co-pay is an amount you pay each time you go in for services unlike a deductible it generally is paid each time.

Answer: Medicare Advantage plans can work in rural areas. It is best to consult an agent and have the agent research plans and networks for you before enrolling into a plan.

Answer: The best way is to consult your summary of benefit and call the carrier/plan customer service number and inquiry. You can always call your agent for assistance too, but they may need to have you on the line to get more detailed information for you as well. The main thing is to be sure the facility you go is in-network. Sometimes the doctors office sends you to a facility that is not contacted on your plan and ultimately its your responsibility to be sure its contracted with your current plan. So I recommend calling your carrier/plan to confirm.

Answer: Original Medicare is Part A generally referred to as Hospital Coverage and Part B, generally referred to as Medical and Doctor coverage. Original Medicare consists of deductibles, co-pays and co-insurance depending on the service/care received. Most will only have to pay the Part B premium to receive this coverage. There are various Medicare Supplement plans you can purchase to help pay for some of the deductibles, co-pays and co-insurance. It does NOT include Prescription Drugs coverage. There are separate Stand-Alone Drug plans you can also purchase to help with these costs. A Medicare Advantage plan is a plan that generally includes all Medicare Covered services which can greatly reduce or eliminate your out-of-pocket expenses for deductibles, co-pays and co-insurance and many times it includes prescription drug coverage. In most cases, the cost is just the Part B premium. As for recommendation of which plan, that varies on the individuals income, health preferences, doctors & hospitals they want access to and travel just to name a few. Some plans offer a limited time of guarantee issue meaning regardless of your health they will accept you. At a later date, your health may change and certain plans i.e. Medicare Supplements may not accept you or may no longer be available to you.

Answer: The cost of your Medicare cost may change if you have a combined income that exceeds a certain amount. This is referred to as IRMMA or Income Related Monthly Adjustment Amounts and it’s based on Modified Adjusted Gross Income (MAGI) from two years ago. For Example: Year 2025 will use 2023 tax return to calculate IRMMA. There are ranges of income and different amounts base on the income level. This chart can be found at www.Medicare.gov. This increase could be applied to your Part B and/or Part D premium. This is based on filing jointly as a married couple, but his may be avoided by filing married but separate tax returns. This would be a great time to consult a tax person to see what is best because each situation can vary.

Answer: If your employer offers you group health insurance, then no you do not have to. You will have an opportunity to do so when you leave that employer. This would be considered a special enrollment period (SEP). Be sure to ask if the prescription drug portion (known as Part D) of your employer plan is considered Creditable Coverage. You should receive a notice stating this every year. Should it loose creditability this would be an SEP and an opportunity to enroll in another plan.

Answer: Medicare for the most part does not cover in-home caregiving. Medicare will cover training for your caregiver if your type of care requires training. You would pay 20% of the Medicare approved amount and your Part B deductible would apply. There is some limited caregiver care in some Medicare Advantage plans. The best policy to get to cover in-home care is a Long Term Care policy. Unfortunately, generally if a person does not have this type of policy prior to needing this in-home care they most likely will not qualify for this coverage.

Answer: Generally a PPO would not require a referral, but in order to confirm I would need to know your exact plan.

Answer: Critical Illness policies can help pay for deductibles, copays or co-insurance when you have a critical illness that qualifies.

Answer: I would need specifics about which treatment of Medicare you are inquiring about i.e. a surgery, or physical therapy.

Answer: Many times its their stories. I just love hearing them talk of younger days and simpler times, but I enjoy making sure they understand what their plan offers them and the additional benefits they get too.

Answer: Telemedicine allows for people who are unable to travel to get care from their home. People are seeking care sooner because now the nurse is only a phone call away.

Answer: You will need to enroll in Part B. If you had coverage with your employer, no penalty will apply and you have 8 months from end of coverage or end of job whichever happens first to enroll in Part B. Be aware you need to allow time for the enrollment process. Don't wait to the last minute.

Answer: I feel some people regret going straight to a MAPD plan without truly considering their future health. The advantage of the Medicare Supp is that true freedom to go to any doctor/hospital that accepts Medicare even if it costs more.

Answer: Unfortunately, I feel it would make it more expensive if they cover all three. I think the options offered in the MAPD plans and even with some of the Med Supp plans are doing a great job of getting coverage to beneficiary. There are stand-alone plans available for purchase too that I offer to clients.

Answer: If you are only on Medicare Part B without another plan, then yes Part B deductible applies then you will pay 20% of the Medicare approved cost. But if you have an Advantage plan generally its a co-pay and Supplements its subject to the Part B deductible and will depend on what Med Supp plan you have to determine if additional costs after the deductible.

Answer: Not choosing a Medicare Advantage (Part C) plan is simply a preference. Medicare Advantage plans are generally less expensive because most only require your Part B premium to be the cost of it and most plans include prescription drug coverage (Part D) too. A Medicare Supplement has its own premium in addition to the Part B premium. Most times a Med Supp will increase each year and it does not include prescriptions drug (Part D). You will have 3 different plans to pay for, Part B, Med Supp and Stand Alone Rx Plan.

Answer: If you have Parts A & B only, you are allowing yourself to be expose to additional deductibles, co-insurance and full cost of prescriptions drugs. Without enrolling in Part D when you are eligible you are also exposing yourself to a late penalty if you enroll at a later date and the full cost of the drug.

Answer: First, I would need to know your medication and check it against each of the carriers formulary list. Yes, the out-of-pocket maximum has been reduced to $2000 for 2025 and $2100 for 2026 this will help reduce your monetary exposure. You may be subject to a deductible, but you wont pay more than the out-of-pocket maximum for that calendar year.

Answer: Generally Medicare will not cover hospitalization in a foreign country. Some Medicare Advantage and Medicare Supplement policies have limited coverage. Generally you have to pay and be reimbursed. Some policies do have access to a network in other countries. I always recommend a travel policy when traveling outside the US.

Answer: What additional benefits does my plan offer? Can I get rewards for my healthy activities? Do I have OTC benefits? Does my plan cover dental, vision and hearing? Are all my drugs covered on this plan?

Answer: Everyone's Medicare needs are different, what's good for one is not necessary for another. An agent, has the ability to review your situation including health, social and home needs to help you determine the best plan for you. There are many additional benefits built into the plans that a beneficiary may not be aware of.

Answer: You should review your ANOC (annual notice of Changes) which tells you what will change for 2026 and always double check your current Rx list to the new drug formulary list.