Katheryn Evans, Medicare Insurance Agent

Answer: Each October or November it is wise to meet with your Medicare insurance broker and review the next year's plans.

There are quite a few changes each year and we anticipate changes you will want to be aware of for 2026.

The best way to stay on top of these changes is to meet with an experienced broker who is familiar either the new changes and the various plans that are available.

If you already have a MedAdv plan in addition to meeting with a broker October 1 through December 7th you are also meet in January, February or March. You are also able to switch to another MedAdv plan or return to original Medicare January through March.

Answer: When someone with a disability turns 65, their Medicare eligibility shifts from being based on their disability to their age. This means they get a new Initial Enrollment Period (IEP) starting three months before their 65th birthday, the month of their birthday, and ending three months after.(7 months) .

This will allow them to change plans effective the first day of the month they turn 65 or the first day of the following three months. A plan becomes effective the first of the month following their application date night unless they apply the first two months of the 7 month period. If the apply for a plan in the first two months of the 7 month period the new plan will become effective the first day of the month they turn 65.

If they have been receiving Social Security Disability Insurance (SSDI) benefits, their benefits will automatically convert to retirement benefits at their full retirement age, which may be between 66 and 67. (Some people’s monthly cash benefit ends up decreasing).

If they have been receiving Supplemental Security Income (SSI) benefits for disability, those benefits can continue as long as they still meet the program's financial requirements.

Answer: Medicare allows an annual preventive care mammogram once a year for those over 40 years old.

Diagnostic mammograms, if medically necessary, may be covered more than once a year.

This is the link to all Medicare covered Preventative benefits. https://www.medicare.gov/coverage/preventive-screening-services

Answer: Some Medicare Advantage plans cover non-Medicare acupuncture treatments and/or alternative therapies. Otherwise, these are not covered by Medicare.

Acupuncture to treat chronic low back pain is covered by Medicare.

Answer: Call the number listed on the practitioner's bill and ask questions so you understand why they are asking for that specific dollar amount to be paid.

If you are not satisfied, call your insurance company and share your concern.

If you are still not satisfied call your state insurance commissioner and CMS and file a complaint.

Answer: First of all, Physical Therapy must be considered Medically Necessary. Usually not more than 10 visit are approved unless there is additional documentation and a written treatment plan with performance tracking by the physical therapist to justify the need. There is also a cap on the overall dollar amount that can be spent.

Answer: The legislation granting the $2,000. out-of-pocket maximum for drug costs was put into effect this year (2025). It limits the amount any one person will pay out of pocket for the prescription drugs that are covered by their Medicare Insurance plan.

It is important to note that if a drug is not In Formulary (included in the plans list of covered drugs) then its cost is not counted towards the $2000. maximum. If a client has a prescription they must take that is not in their plans formulary, then they will want to ask for a Formulary Exception. If the Formulary Exception is approved, then the cost of that drug will count towards the $2000.

When a drug is approved through the Formulary Exception process it is typically placed in a higher or more expensive Tier. At that time, the client is able to ask for a Tier Exception. This could possibly lower the cost of that particular drug.

Answer: Artificial Intelligence can be a wonderful tool. However, it is important that we do not lose the human touch. Perhaps Artificial Intelligence will do the initial screenings and then a medical professional will look more closely at certain claims.

Answer: Medicare does not cover Long Term Care. 24/7 Supervision of a dementia patient is Long Term Care. There are strategies that can be employed. It is a good idea to talk to a broker about options available.

Answer: I have historically set clients up with a fairly even mix of Medicare Advantage and Medicare Supplement Plans.

I'm finding that I am getting more phone calls lately from people who have had Medicare Supplement plans for many years and want to change to a Medicare Advantage plan.

I think if we, as brokers, educate clients properly then they are able to make a clear, well thought out decision on which direction they want to go with their Medicare coverage; traditional Medicare and a Medicare Supplement or a Medicare Advantage Plan. There are benefits to both and there is a right answer for each person.

If we, as brokers, educate our clients well and then allow them to select the coverage that fits their personal financial situation and their personal value system then we will see a fairly even split between Medicare Supplements and Medicare Advantage plans.

Answer: Sometimes clients do not realize that they must pay the Part B premium. There are certain circumstances (based on income) where the Part B premium is waived but most people do need to pay it.

Answer: I love getting to know clients, listening to their hearts desires and helping them find the right solution for their Medicare needs. It is such a good feeling to see clients express satisfaction and relief after we meet. I also enjoy seeing their excitement as they look forward to using the extra benefits in their new plan.