Kate Spilsbury, Medicare Insurance Broker

Answer: You may qualify for several programs designed to help with medication costs. The first is Extra Help (Low-Income Subsidy) through Social Security, which can lower or eliminate your Part D premium, deductible, and copays. You can also check if you qualify for Medicare Savings Programs through your state, which can help pay your Part B premium and sometimes other costs.

In addition, many drug manufacturers and nonprofit organizations offer patient assistance programs or grants that can help cover expensive prescriptions. My team regularly helps people find these resources, and you can also explore more options and links. Contact me.

Answer: You’re absolutely right to question that advice. The cheapest plan isn’t always the most affordable long-term. A low monthly premium can mean higher copays, limited doctor networks, or poor drug coverage, which can end up costing a lot more when you actually need care.

The best plan depends on your doctors, medications, travel habits, and budget—not just the price tag. My team helps compare the total costs and benefits so you can choose a plan that fits your real needs, not just your wallet today.

Answer: That’s a great question — IRMAA can be tricky when your income swings from year to year. Medicare bases it on your tax return from two years ago, so a one-time spike (like a large investment distribution or property sale) can trigger a temporary surcharge.

Unfortunately, there’s no way to avoid it upfront, but once your income drops again, you can file an appeal using form SSA-44 to request a reassessment based on your current income. You can find that form and others you might need. Contact me.

Answer: Technically, yes — you can apply to change your Medigap (Supplement) plan at any time during the year. However, outside of your initial enrollment window, most insurance companies will require you to go through medical underwriting, meaning they can ask health questions and may deny or rate your application based on your medical history.

There are some exceptions called “guaranteed issue” situations, where you can switch without underwriting. We can review your situation and help determine if one of those applies to you.

Answer: It might seem odd, but sometimes a higher total cost plan actually saves money overall—especially if it offers better coverage for expensive or brand-name medications. A plan with a slightly higher premium might have lower copays, better formularies, or preferred pharmacies that reduce what you pay out of pocket throughout the year.

That’s why it’s important to look at the total annual cost, not just the monthly premium. My team reviews these details with every client to make sure the plan fits their actual medication list and budget.

Answer: Possibly — it depends on your income from two years ago, which Medicare uses to determine if you owe an Income-Related Monthly Adjustment Amount (IRMAA) on top of your regular Part B and Part D premiums. If your income has decreased since then due to retirement, divorce, or another qualifying life event, you can appeal the surcharge by submitting form SSA-44 to Social Security. Contact me.

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Answer: If you’re diagnosed with a rare disease, the first step is making sure your Medicare plan gives you access to the specialists and treatments you need. Check whether your current plan covers those providers—especially if they’re at major research or out-of-state hospitals.

If your current plan doesn’t provide enough flexibility, you might look into a Medigap plan for broader access or a Chronic Condition Special Needs Plan (C-SNP) tailored for specific health needs. Just keep in mind that depending on your diagnosis and timing, you may need to go through medical underwriting to qualify for a Medigap plan, and approval isn’t guaranteed.

Every situation is unique, and my team can help you review your options. You can also learn more about coverage for chronic and complex conditions. Contact me.

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Answer: It can definitely seem confusing, but it’s not random—Medicare plan costs vary by ZIP code, county, and type of coverage. Sometimes when people say they “don’t pay anything,” they’re actually on a $0 premium Medicare Advantage (MAPD) plan, while someone paying around $200/month is likely on a Medigap (Supplement) plan, which works very differently.

Also, keep in mind that everyone with Medicare pays a Part B premium (usually deducted from Social Security before they receive their payment), even if their plan premium is $0. Some people qualify for Extra Help or full Medicare/Medicaid, which can lower or eliminate their costs altogether.

You can read more about how these programs and plan types contact me.

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Answer: Costs can vary a lot depending on your medications, doctors, and where you live. The best place to start is by adding up your Part B premium, prescription costs, and any copays or coinsurance you’d have under your plan. If you have a chronic condition like diabetes, some areas even offer Special Needs Plans (C-SNPs) designed specifically for chronic conditions, which can help lower your overall costs. We talk more about these options. Contact me.

Answer: Yes, when you’re covered under your spouse’s employer insurance, you’ll need to complete a form later to prove you had credible coverage when you’re ready to enroll in Part B. The main forms are CMS-40B (to request Part B) and CMS-L564 (your employer verifies your coverage). You don’t need to submit them now unless you’re ready to add Part B, but keep them handy. When you are ready for help picking out your health plan, we would be happy to guide you.

Answer: Yes, definitely take a look. Moving to a new county can open a Special Enrollment Period, since Medicare Advantage and Part D plans vary by ZIP code. It’s a great time to review your options—sometimes the move gives you access to better networks or lower costs. My team can help you compare what’s available in your new area before you make any changes.

Answer: If you missed your Medicare enrollment because of an exceptional circumstance—like a hospitalization or another situation beyond your control—you may qualify for a Special Enrollment Period (SEP) and, if approved, Medicare can sometimes be made retroactive for up to six months (with limits). If you don’t qualify for an SEP, you’ll need to enroll during the General Enrollment Period, and a late-enrollment penalty may apply.

It’s best to contact us so we can understand exactly what you missed—many people discover they’re actually still within their window once we review the details together. You can also find helpful links and official Medicare forms on our website.

Answer: That “free” label can definitely be misleading. Many Medicare Advantage plans have a $0 monthly premium, but you still pay copays, coinsurance, and your Part B premium, and costs can add up depending on how often you use care. The plan isn’t truly free; it just shifts when and how you pay. My job is to help you see the full picture so there are no surprises later.

Answer: The biggest mistake I see is waiting too long or making a rushed decision without understanding how all the parts of Medicare work together. Many people enroll based on what a friend chose or what sounds cheapest, only to find out later their doctors or medications aren’t covered. Taking a little extra time upfront, and working with an experienced agent, can save a lot of stress and money down the road.

Answer: Medicare Part A does cover hospital stays, but it’s only part of the picture. You’ll still have deductibles, daily copays after a certain number of days, and no out-of-pocket maximum, which can add up quickly. That’s why most people also have Part B and either a Medigap or Medicare Advantage plan to fill in those gaps and protect themselves from big hospital bills.

Answer: if you’re already on Medicare due to disability, you won’t need to reapply when you turn 65. Your coverage will automatically continue, but this milestone does open up a new enrollment window to make changes, like adding a Medigap or switching to a different Medicare Advantage or Part D plan. It’s a great time to review your options, and my team can help you make sure you’re in the best spot going

Answer: Yes, Medicare generally covers emergency care in U.S. territories like Puerto Rico, Guam, and the U.S. Virgin Islands, just as it would anywhere in the U.S. If you need care while there, your benefits apply the same way. And since we also speak Spanish, our team can help you understand your coverage and handle any follow-up or billing questions in the language you’re most comfortable with.

Answer: This is often a frustrating surprise for many people. Medicare covers the standard lens implant after cataract surgery, but if your doctor recommends upgraded lenses (like toric or multifocal), those are considered elective and not medically necessary, so you pay the difference out of pocket. It’s one of those gray areas where what’s “covered” doesn’t always mean “fully paid.”

Answer: That’s a common (and frustrating) experience. Medicare’s call centers can only give general information and often can’t see the full details of your plan. When you work with an independent agent like me, you get direct answers and personalized guidance without the endless hold times, we handle the back-and-forth so you don’t have to.

Answer: Yes, hospice care is covered under Original Medicare, even if you’re enrolled in a Medicare Advantage plan. The hospice benefit includes things like pain management, medical equipment, and emotional and spiritual support for both you and your family. It’s designed to help you focus on comfort and quality of life when a cure is no longer the goal.

Answer: It’s definitely moving that way, with Medicare Advantage plans (run by private insurance companies) growing every year. These “private plan options” are still approved and regulated by Medicare, but they’re administered by insurance carriers instead of the federal government. I don’t think Original Medicare will disappear completely, but more funding and focus keep shifting toward these private plans, so it’s important to work with someone who understands both sides and can guide you through the changes as they happen.

Answer: Yes, it’s possible—but it depends on when you apply. If you apply during your Medigap Open Enrollment Period (the six months after your Part B starts), you can’t be denied for health reasons. After that window closes, companies can ask health questions and may decline your application based on medical history. The good news is there are sometimes guaranteed issue periods or alternative options we can explore to help you get covered.

Answer: I completely understand, that’s one of the most common frustrations I hear. Medicare works as a shared system, which means everyone contributes so that coverage is there when it’s needed most, similar to how homeowners or car insurance works. The good news is we can still look for ways to lower your overall costs, like reviewing your drug plan, Medigap options, or exploring high-deductible or giveback plans—to make sure you’re not overpaying for coverage you rarely use.

Answer: Medicare covers a long list of preventive services at no cost, like your annual wellness visit, many vaccines, and routine screenings for things like cancer, diabetes, and heart disease. However, if your doctor finds something during a preventive visit and orders additional tests or treatments, those follow-up services may have a copay or coinsurance. It’s always smart to ask your provider upfront what’s fully covered and what might lead to extra costs.

Answer: What I love most is the impact we get to make every day. Medicare can be overwhelming, and seeing that relief on someone’s face when they finally understand their options, and know they’re protected, is incredibly rewarding. It’s about helping people feel seen, supported, and confident in one of the most important areas of their lives.

Answer: Discount cards and other savings resources can be a big help, especially for medications your Part D plan doesn’t cover or that still cost too much even after insurance. Just keep in mind that purchases made outside your Part D plan, like with a discount card, don’t count toward your annual $2,100 (in 2026) Medicare out-of-pocket cap. My team helps clients find safe, legal ways to save, including patient assistance programs, grants, discount cards, and reputable international pharmacies when appropriate.

Answer: I completely understand how frustrating that feels—it doesn’t seem fair. The truth is, once you’re past your Medigap Open Enrollment Period, insurance companies can ask health questions and deny coverage based on medical history. It’s one of the few areas of Medicare that isn’t guaranteed. The good news is, we can look at Medicare Advantage plans or see if you qualify for a special enrollment or guaranteed issue option that would let you get coverage without health underwriting.

Answer: If you travel often, Original Medicare with a Medigap (Med Supp) and Part D plan usually gives you the most flexibility. You can see any provider nationwide who accepts Medicare, without worrying about networks or travel restrictions that many Advantage plans have. That said, I never recommend having just Original Medicare alone—it has no cap on your out-of-pocket costs. A Medigap policy helps protect you from those expenses, and my team would love to help you find the right one for your needs.

Answer: That’s a tough spot to be in, and it’s more common than most people realize. Even with great coverage like Plan G, specialty medications can be expensive. You may qualify for Extra Help (Low-Income Subsidy) or manufacturer assistance programs that can dramatically reduce your costs. My team can review your medications, income, and available programs to see what savings might apply—we do this at no cost to you.

Answer: Working with a Medicare agent means you don’t have to navigate all the confusing parts alone. A good agent helps you understand your options, avoid costly mistakes, and make sure your doctors, prescriptions, and budget are all aligned with the right plan. Best of all, our help comes at no cost to you—so really, the question is, why not?