Karen Murray, Medicare Insurance Broker

Answer: It’s a good idea to review your coverage at least once a year, especially during Medicare’s Annual Enrollment Period (October 15 – December 7). Plans can change their provider networks, therapy coverage, and costs each year.

You should also review your plan anytime your health needs change or if your therapist or provider tells you they may no longer be in your plan’s network.

Answer: The main “trap” of Medicare Advantage plans is that they can look inexpensive up front but come with hidden limitations that many people don’t realize until they’re sick or need major care.

Here are the key pitfalls:

Network restrictions – You must use doctors and hospitals in the plan’s network (often local). If you travel or need a specialist out of area, coverage can be limited or denied.

Prior authorizations – Many services require plan approval first, which can delay or even block needed care.

Changing benefits each year – Premiums, copays, drug coverage, and provider networks can change annually, so what works this year might not next year.

Difficult to switch back – If you want to move from Medicare Advantage to Original Medicare later, you may have to pass medical underwriting to get a Medigap plan for supplemental coverage. Many people don’t realize this until it’s too late.

In short, Medicare Advantage can work well for healthy individuals who stay in-network—but for those with chronic or complex health needs, Original Medicare with a Medigap plan often provides more freedom and predictable costs.

Answer: Usually, you can’t switch mid-year just because of a new illness—you’re limited to certain times like the Jan–Mar Medicare Advantage Open Enrollment Period or a Special Enrollment Period (SEP).

If you move back to Original Medicare and want a Medigap plan, you’ll typically need to health qualify through medical underwriting, unless you have a guaranteed issue right.

Starting July 1, 2025, however, Virginia’s new Birthday Rule gives current Medigap policyholders a 60-day window beginning on their birthday each year to switch to another Medigap plan with equal or lesser benefits without medical underwriting.

Answer: One positive trend improving Medicare affordability is the Medicare prescription drug cost reforms under the Inflation Reduction Act.

Starting in 2025, there is a $2,000 annual cap on out-of-pocket prescription drug costs for Part D plans — a first in Medicare’s history. This change will make medications far more affordable for seniors who currently spend thousands per year on prescriptions.

In addition, insulin costs are capped at $35 per month, and recommended vaccines (like shingles) are now free under Part D. These reforms are already helping beneficiaries better manage costs and stay consistent with their care — improving both financial stability and health outcomes.

Answer: My goal is to help you find the plan that truly fits your needs, not to push a product. Here’s how I approach it:

Education first. I take time to explain how each option works — what’s covered, what’s not, and what to watch out for — so you can make an informed decision.

All carriers, not one. I represent multiple insurance companies, which allows me to compare plans side by side and recommend what best fits you, not the company.

Ongoing support. My help doesn’t stop after enrollment. I review your plan each year to be sure it still makes sense as your health or income changes.

Transparency. There’s never a cost to meet.

You’ll never be pressured — my job is to make Medicare clear and give you confidence in your choice. Would you like to schedule a quick call or meeting so I can walk you through your options and show you how I work?

Answer: Yes — if your dad’s income changes, his Medicare costs can change too.

Medicare premiums, especially for Part B (medical) are based on income. If his income goes up, he may pay an Income-Related Monthly Adjustment Amount (IRMAA). If his income drops, he may qualify for lower premiums or extra help with drug costs.

He should report income changes to Social Security as soon as possible so they can adjust his Medicare costs accurately.

Answer: If the government shutdown continues and Congress doesn’t act, Medicare payments remain safe short-term, but ripple effects could follow:

Telehealth gaps: Expired waivers mean some virtual visits may go unpaid unless Congress restores authority.

Payment delays: Claims tied to affected services could be held or slowed.

Reduced oversight: CMS surveys, certifications, and new program approvals may pause.

Provider strain: Smaller practices could face cash-flow issues.

Access issues: Seniors may lose some telehealth or home-based options.

If prolonged, the shutdown could create disruptions in access, reimbursement, and provider stability until funding and policy authority are restored.

Answer: Medicare generally does not cover long-term in-home dementia or custodial care, but some plans may help with limited skilled or medical services. There are additional options through Medicaid or state programs that may assist.

Please contact me for further details—I’d be happy to review each unique situation and explore the best coverage options for such care.

Answer: If you notice something wrong on your Medicare statement, start by reviewing your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) carefully. Then:

Contact your provider or supplier first – Many billing errors are simple mistakes that can be corrected quickly.

If it’s not resolved, call 1-800-MEDICARE to report the issue.

Keep detailed notes – Record dates, names, and what was discussed.

If you suspect fraud, contact the Medicare Fraud Hotline or your State Health Insurance Assistance Program (SHIP) for help.

👉 Always keep copies of your bills and statements until the issue is resolved.

Answer: It’s best to find a Medicare plan that fits your long-term needs—but also review it every year during the Annual Enrollment Period. Plans, premiums, and prescription drug coverage can change annually, so even if your plan worked well before, a quick yearly review during AEP ensures it still meets your health and financial needs for the upcoming year.

Answer: One of the most common misconceptions about Medicare is that it’s completely free and covers all healthcare costs. In reality, beneficiaries still pay premiums, deductibles, and copayments, and some services—like dental, vision, or long-term care—aren’t covered under Original Medicare.

Answer: A Medigap “birthday rule” provides current Medigap enrollees with a short, guaranteed-issue window each year around their birthday to switch plans without undergoing medical underwriting (usually to the same or lesser benefits; exact rules vary by state).

States with birthday rules (as of Sept 2025):

CA: 60 days from the first day of your birth month; equal or lesser benefits; can change carriers.

California Department of Insurance

OR: 30 days from the first day of your birth month; equal or less; can change carriers.

Oregon SHIBA

ID: 63 days after your birthday; equal or less; can change carriers.

Idaho Department of Insurance

IL: 45 days after your birthday (ages 65–75); equal or less; same carrier or affiliate.

MD: 30 days after your birthday; equal or less benefits.

NV: 60 days from the first day of your birth month; equal or less; can change carriers.

Nevada Division of Insurance

LA: 63 days after your birthday; equal or lesser; generally same carrier/affiliates.

OK: 60 days after your birthday; similar/equal or lesser; can change companies.

Oklahoma Insurance Dept.

KY: 60 days after your birthday; same benefits; can change carriers.

UT (effective May 7, 2025): 60 days after your birthday; equal or lesser; same insurer only.

Utah Legislature

+1

VA (effective July 1, 2025): 60 days after your birthday; same letter plan with any insurer.

Virginia SCC

WY (effective June 4, 2025): 63 days after your birthday; equal or less; can change plan/carrier.

Wyoming DOI

IN (effective Jan 1, 2026): 60 days after your birthday; same letter plan with any insurer.

LegiScan

+1

Related protections: Missouri has an anniversary rule (60-day window around your policy anniversary to switch to a same-letter plan, often with a new carrier); Washington lets you switch anytime to equal/lesser benefits with the same insurer; CT & NY have year-round Medigap guarantee

Answer: Yes. Part D plans cover drugs based on their formulary, so a brand-name drug can be non-covered even if no generic exists (they may prefer a different brand or therapeutic alternative, or require prior auth/step therapy).

Lack of a generic doesn’t guarantee coverage—it just means the plan can’t force you to take a generic of that exact drug.

If your prescriber says the brand is medically necessary and alternatives won’t work, you can request a coverage exception/appeal with supporting clinical notes.

There are also transition fills for new members and special protections for certain “protected classes” of drugs, which can help in the short term.

Answer: Short answer: no, not fully.

Under Original Medicare, most outpatient therapy is covered by Part B—you pay the Part B deductible (if not yet met) and typically 20% coinsurance of the Medicare-approved amount; a Medigap plan can cover some/all of that.

Preventive screenings (e.g., annual depression screening) are generally $0 when you see a Medicare-enrolled provider.

Inpatient psychiatric care falls under Part A with its own deductible and day limits (including a 190-day lifetime cap in psychiatric hospitals).

Make sure your therapist is Medicare-enrolled and accepts assignment to avoid extra charges.

Answer: With Original Medicare + Medigap Plan F, emergency room care is typically billed under Part B (unless you’re admitted as an inpatient, then it shifts to Part A). Plan F pays both the Part B deductible/coinsurance and the Part A deductible/coinsurance, so for Medicare-approved ER services you generally have no copay or out-of-pocket.

Exceptions: costs for non-covered items (often self-administered drugs given in the ER—submit receipts to your Part D plan), care from opt-out providers, foreign travel emergencies (Plan F pays 80% after a $250 deductible, up to a lifetime cap), and SELECT versions of Plan F (must use network hospitals). If you’re unsure whether you have a standard or SELECT Plan F, check your card or call the insurer.

Answer: No—Original Medicare (A & B) works nationwide, so you don’t need to change that.

You can usually keep your New York Medigap (if it’s not a Medicare SELECT policy), but notify the insurer of your new Florida address and ask about any premium/residency changes.

If it is Medicare SELECT, moving out of area gives you a 63-day guaranteed-issue right to switch to a standard Florida Medigap.

Your Part D drug plan (and any Medicare Advantage plan) is region-specific, so your move triggers a Special Enrollment Period to choose a Florida plan.

Answer: Annuities convert a portion of your savings into contractually guaranteed income you can’t outlive—essentially a private pension.

They help manage longevity and sequence-of-returns risk by creating an income floor alongside Social Security (and any pension).

Deferred annuities also offer tax-deferred growth and optional riders—like lifetime withdrawal benefits, inflation adjustments, or long-term-care features—to match specific goals.

Trade-offs include limited liquidity, surrender charges and fees, insurer credit risk, and potential inflation drag, so use strong carriers and annuitize only what’s needed for essential expenses.

Answer: Great question—here’s how an agent helps (at no extra cost to you):

Personalized plan match: I compare carriers side-by-side to fit your doctors, prescriptions, budget, and travel needs.

Avoid penalties & deadlines: Guidance on enrollment windows (AEP, SEP, IRMAA) so you don’t overpay or miss dates.

Drug & doctor checks: We verify formularies, tiers, and networks—before you enroll.

Ongoing support: Annual reviews if plans change, plus a real person to call for issues or appeals.

Time & money saver: You get curated options quickly, often uncovering lower total cost of care—not just low premiums.

Local insight, national carriers: What actually works well in our area, with transparent pros/cons.

Answer: Medicare covers short-term skilled care, not long-term custodial care in nursing homes or assisted living, so don’t rely on it for those costs. Instead, consider long-term care insurance or a hybrid life/LTC policy, earmarked savings or annuities, and early Medicaid/asset-protection planning with an elder-law attorney (mind the five-year lookback), plus check VA benefits if eligible.