Kathleen Gonzales-Byrd, Medicare Insurance Agent

Answer: All Medicare insurance agents who conduct an enrollment have to follow CMS Guidelines (Center for Medicare and Medicaid). A agent should provide complete information regarding a Medicare Advantage plan so the potential enrollee is fully informed and should not favor one plan over another but should understand the client's needs so they can assist the client in making a decision that best aligns with their needs. The potential client needs to assess if this process is occurring and should not feel "pushed" into any plan. An agent should explain the differences between a Medicare Advantage plan versus a Supplemental plan (also known as Medigap) not make sure the potential enrollee understands the differences so they can decide what plan best fits their medical needs and budget needs.

Answer: It DID happen in 2025 and continues in 2026. Out of pocket expenses such as co-pays, deductibles, payments for prescription payments at the pharmacy are capped at $2,000. Once you reach $2,000 you will not incur any additional out of pocket costs (this EXCLUDEs your premium payments) - In 2026 out of pocket costs are capped at $2,100

Answer: I want to minimize my out of pocket costs and have access to quality medical provider so please tell me which plan is best for me based on my current medical status

Answer: Yes, Medicare does pay for telehealth visits for specialty care visits. Your specialty provider will let you know if they offer televisits

Answer: You will incur permanent penalties if you have delayed enrollment for Part A, B, and D. The penalty fees vary for each part of Medicare. You should enroll in each of these Medicare groups as soon as possible to minimize enrollment delay.

Answer: Medigap Plan F (also known as a Medicare Supplement Plan F) has no co-pays or out of pocket costs for Medicare-approved Emergency Room visits. You should not expect a co-pay with your current plan.

Answer: Based on when you selected this MA plan, you can change to a different plan during January, February or March (Open Enrollment Period) or you can wait until the Annual Enrollment Period (October 15 to December 7) and select a more appropriate plan.

Depending on the frequency of co-pays, the lower premium may still be a better option. Speaking to a Medicare Agent at any time, may help you navigate through this process.

Answer: Yes - you need to do something with Medicare IF you are (or will be) 65 or older, you have been receiving employer coverage, and you have delayed Medicare Part B. You will have a Special Enrollment Period (SEP) to sign up for Medicare A and B without any penalties once you leave your employer sponsored "credible" coverage (health care coverage). You also have to sign up for Part D (Drug Plan, required even if no prescription medication) and Part C (Medicare Advantage, if you chose to go this route) within two months. A Medicare Supplement plan is also another coverage option. You will be contacting the Social Security Administration (SSA) to handle enrollment.

Answer: A senior would pick a plan with a high total cost if the prescription drugs they take are also high cost drugs. Often, they must incur a highly monthly Plan D cost. They should research available plans to ensure the lowest monthly cost. It should be remembered that each Medicare beneficiary has a cap on total out of pockets costs of $2000 per year. And Medicare beneficiaries can spread this cost out over a 12 month period each calendar year.

Answer: It greatly depends on the senior's plan. Is it a Medicare Advantage Plan? is there a Supplement? It is also dependent on the time of year - has the senior met his or her deductibles for the year?

If the senior only has Original Medicare, he or she will incur a deductible, co-pays, and 20% of the providers charges (if there is no Supplement)

Answer: 1) They ask you alot of questions regarding your medical status, costs, goals

2) They listen to you and remember what you say and understand what is important to you

3) Understand your budget

4) They begin to look at plans that fit with what you have communicated

5) They are not in a hurry to enroll you; they are patient

6) It does not appear that they are pushing one plan over another

7) You become more knowledgeable about Medicare because of their education

8) They offer you various options based on the information you have provided

9) You feel comfortable and knowledgeable about your options to make a decision

10) Your stress level about the complexities of Medicare have been greatly reduced because of the agent

Answer: The Guaranteed Issue (GI) for Medicare Supplement plans allows for enrollment into a Supplement plan (also known as Medigap) without any Underwriting. This means that the insurer cannot deny coverage for health status such as pre-existing conditions. The Guaranteed Issue period is typically for initial enrollments into a Medicare Supplement plan (when you turn 65). There are other GI periods such as loss of Medicare Advantage or Supplement plan coverage, Trial Rights, or loss of employer coverage. Additionally, there are some states (e.g., New York) that do not require underwriting if you choose to change Medicare Supplement plans.

Answer: The PPO of a Medicare Advantage plan does allow you to go out of network but there is still a cost associated with going out of network. Typically, the PPO out of network cost represents approximately 40% of the provider (doctor) cost. This percentage can vary by PPO plan. The point of having a PPO is so you can visit a doctor you prefer even if he or she is out of network. But, you must be willing to incur additional cost - versus if you chose to stay IN network. The PPO is intended to allow visits to out of network providers but with additional cost to the member. Comparatively, a Medicare Advantage HMO does not offer any shared cost if you choose to go out of network. It might be in your best interests to locate providers who are in your PPO network.

Answer: In 2025, there was an estimated $5.3 trillion spent on healthcare, about $15,500 per person. This national expenditure represents almost 20% of the US Gross National Product (GDP). The 2024 expenditures represent a 7% increase from the previous measured year (2023)

Answer: As a priority, you should continue to identify any mail from: the Social Security Administration (SSA) or the Center for Medicare and Medicaid (CMS), both federal government agencies associated with Medicare. Correspondence from both these federal agencies are typically easy to identify. Next, I would recommend you establish a trusting relationship with a Medicare Agent who can provide you with a thorough review of your Medicare options and assist you in your decision making enrollment process. Once you have conducted these two steps, you ignore and dispose of any commercial Medicare mail you are receiving.

Answer: In 2025, there is a maximum out of pocket cap of $2000. Once you hit this maximum amount with your medication costs you will not incur any additional out of pocket costs. Further, you can spread this cost ($2000) over 12 months (approximately $167 per month) if you choose to not pay the greater amounts in full when incurred. This monthly option is called a Monthly Payment Plan (MPP). The MPP is a voluntary program.

Answer: The federal government requires that you register for Medicare when you become 65. You must enroll in Part B and Part D during this time (unless you have employer coverage). If you do not enroll during the required times you will incur a lifelong penalty. Also, if you have employer coverage at age 65 but leave employer coverage at a later date, you are required to notify the federal government regarding Part B and Part D at this later time.

Answer: A geographic area (thus, zip codes) are one factor that determine the member cost determined by the insurance company offering the Medicare Advantage plan. As such, it is not a random decision but one based on measurements that include, but are not limited to, overall population, health status of a population, and population medical costs. Going forward, research the various plans offered in your zip code to ensure you are receiving complete cost information from multiple insurance carriers.

Answer: I would recommend that you contact your Medicare Advantage plan to inquire about the coverage that is included for breast cancer medical care. If you have a concern or question regarding breast cancer care it would be advisable to refine your question to the multiple areas associated with breast cancer care such as: surgery, diagnostic studies (mamorgram, ultrasound), radiation or chemotherapy, or and other medications required for successful treatment. And with regard to your question, what would be "extra coverage" since most of the care required is typically covered in a plan (less the costs associated with deductibles, co-payments, and out of network care)

Answer: Medicare Advantage (MA) plans are structured such that they offer members medical care to a defined set of Providers (doctors and hospitals), which is referred to as a Provider Network Thus, a Medicare Advantage plan member is typically restricted to the Network Providers. Members can become unhappy if a doctor they want to visit is not in their MA Provider Network. If they do visit a doctor outside their Provider Network they will have to incur some or all of the cost associated with a visit to that Out of Network Provider. HMO MA Plans are more restrictive than MA PPO plans. It would be wise to research the network providers in each of these plans to ensure you can access certain providers with little cost for you.

Answer: You should understand the coverage that is provided for the different Medicare coverage plans which are: a Medicare Advantage plan, or a Medicare Supplement, or Original Medicare only. It is important to understand the deductibles, co-payments, and maximum out of pocket costs that you would incur with each of these plans. If you understand the coverage details of each of these plans you will understand what is the maximum amount of out of pocket cost you would incur per year for each of these plans.

Answer: For a Medicare Advantage plan, Maximum Out of Pocket can change per year. However, this decision is dependent on each insurance company and each Medicare Advantage Plan within each insurance company. For Original Medicare, there are usually annual percentage changes that occur each year. These increases typically are less than a 5% per year increase.

Answer: All Medicare Advantage plans are dependent on where you live. As an example, if you live in Harrisburg, PA and enroll in a Medicare Advantage plan serving Harrisburg, and later move to Richmond, Virginia, you will need to change your Medicare Advantage plan to one that services Richmond. If this occurs there is a Special Enrollment Period (SEP) that begins and gives you time to conduct the Plan transition so you maintain adequate medical coverage.

Answer: TRICARE focuses on current active duty service members and retired military, as well as their family and survivors. A Veteran Affair (VA) benefit is associated with a service connected disability, sometimes income levels, and discharge status. Additionally, a VA benefit is typically for the veteran only and not for their dependents or survivors.

Answer: If you qualify for both Medicare and Medicaid you may be offered additional dollars to cover the Part B Premium that is withdrawn from your Social Security check each month. This is typically referred to as a "give back" where you could receive part or all of the monthly Part B premium (a dollar "give back" would present as an increase in your Social Security monthly deposit)

Answer: You can file your SSA-44 now so you can report your income for 2025 and projected 2026. If your 2025 and projected 2026 income takes you out of the additional IRMAA $, these years (2025 and 2026) will also be adjusted to reflect your income.

Answer: This question is asking almost the same as: Are some doctors (providers) better than others? And the answer to that question would be Yes because some doctors are better than others. A Medicare Advantage (MA) plan typically is offered within a geographic area - so there will be a grouping of doctors who are contracted to offer their services for that MA Plan. And generally speaking, doctors (Providers) are going to have varying levels of quality. However, a Medicare Advantage plan is very focused on the quality of care that their Plan doctors offer and there are standards that a doctor must meet in order to participate in the MA Plan contract. Generally speaking, we can say that MA plans (which are insurance companies) work to maintain quality, cost and patient satisfaction. Like anything, some people or organizations will excel among others and ensure that the highest quality is maintained. It is important that you take a look at the ratings of each plan in your enrollment decision making process.

Answer: The federal government (Center for Medicare and Medicaid = CMS) establish contracts with each healthcare insurance company to manage the medical care for their Medicare population. The federal contracts ensure that the insurance company efficiently manages the costs of the patients it enrolls with the aim of managing the costs ultimately incurred by CMS. Typically, healthcare insurance companies will receive a contracted dollar rate from CMS for each person they enroll. Depending on the contract, insurance companies will determine what they can afford to charge the Medicare member, which in many cases it is $0 and in some cases it will be a specific dollar amount. This is dependent on the contract and also the geographic region.

Answer: We would need your zip code and date of birth to look at available plans in your geographic area. Please feel free to give me a call if you’d like to review (at no cost or obligation to you

Answer: A Medicare Advantage plan (one of your other options instead of medigap) allows for emergency care. If you are traveling, and had a Medicare Advantage plan, your medical emergency care would be covered during your travels. If you only took the medigap plan because you travel a lot the Medicare Advantage plan would cover emergency care even if you’re away from your geographic area.