Keith McCarthy, Medicare Insurance Agent

Answer: The best way to avoid surprise bills for lab tests under Medicare Advantage:

1. If a lab test is scheduled, always ask whoever scheduled it, "who is paying for this?"

2. Services such as lab tests may be handled in a variety of ways by each Medicare provider - even within their own plans. Therefore, it is helpful to read the enrollment booklet for your plan when you enroll.

3. If you are dissatisfied with your plan, this time of year is the "Annual Enrollment Period": between October 15 and December 7 you can select a different Medicare Advantage plan, if you choose to do so. (You're not required to change, unless your insurer is discontinuing your plan). These changes take effect on January 1 of the coming year.

I hope this is helpful for you.

Answer: Yes, there are Medicare plans that address chronic conditions. In most cases, these are Medicare Advantage plans that are focused on chronic special needs, often referred to as C-SNP.

Answer: You've come to the right place. Simply put, the best way for you to do this is to directly contact a licensed Medicare insurance agent. He or she can provide clear options for you.

Answer: Yes, but... not every private hospital will accept every Medicare plan. First, you need to identify whether your current Medicare coverage is Part C "Medicare Advantage", or Part A and Part B with a Medicare Supplement Plan.

If you have Medicare Advantage, each plan will have a number of different hospitals that are within their network. This could vary even within the brand name of the insurer, since most offer a variety of Medicare Advantage plans.

If you have a Medicare Supplement plan (or "Medigap"), most hospitals (about 98%) across the nation will accept your Medicare coverage. These plans generally cost more than a Medicare Advantage plan, but they offer you greater freedom of choice for not only hospitals, but also for doctors and specialists.

Answer: There is no clear answer for this, but here are a few related points:

1. "Silver Sneakers" or any other free gym membership is not automatically part of Medicare Part A and Part B coverage.

2. Some Medicare plans, both Medicare Supplement and Medicare Advantage, do offer free gym membership. You might check on your plan - in the past, "Silver Sneakers" was the "go-to" system for many Medicare insurers. Now, there are a variety of plans offered that are similar to Silver Sneakers, but have a different name.

3. Many plans do not offer any gym membership, as it is not required by Medicare.

Answer: That's certainly worth finding out. However, your question is very general. I'll answer the best I can. One question: did it increase $100 over 4 years, or only in the last year?

1. At the beginning of every calendar year, Medicare adjusts their rates for Parts A, B and D. While it is possible that the rates could decrease in a given year (like once in a blue moon), like most things, the rates creep up each year. That may be one explanation.

2. If your income increased for some reason within the last 2 years, Medicare may be adding an IRMAA surcharge ("income-related monthly adjustment amount"); it may be due to that.

Feel free to reach out if you'd like to get more specific information.

Answer: No, it is not enough.

Medicare Part B provides partial coverage for payments for visits to doctors and specialists (not a hospital - that's Part A); most, but not all lab work (like x-rays, blood tests, etc.); outpatient surgery; chemotherapy, and ambulance.

However: Medicare Part B (1) pays 80% of costs; you pay the remainder. (2) Medicare Part B has an annual deductible for which you are responsible, which is $283 in 2026.

This complexity is a very good reason for you to speak with an independent agent who, at no cost to you, can work with you to assess your needs and budget and provide additional insurance that can address most of these costs.

Answer: Great question! Every person should scrutinize their ANOC—but not many are even aware that they receive it, let alone, review it.

I discovered that my deductible for Tier 4 drugs (like Eliquis!) went from $0 last year to $250 this year! The ANOC is a perfect example of "the devil is in the details".

It may also be the opportunity to change plans. For example, in California, when your insurer makes changes that exceed a certain percentage, you may be able to move from a Medicare Advantage plan to a Medicare Supplemental plan without going through the medical questions in underwriting.

Answer: Much of Medicare is confusing once the veneer is peeled back! Star ratings are issued by the Centers for Medicare & Medicaid Services (cms.gov), the federal government's department in charge of Medicare. Plans are reviewed annually, and the star-ratings are updated every calendar year.

Star ratings do not apply to Medicare Supplement plans. They apply only to Part C (Medicare Advantage) plans, and Part D (Prescription Drug) plans.

Yes, the star ratings can be helpful in choosing a plan. Star ratings are part of a matrix of considerations you have which include cost, and the choice of doctors and facilities.

Answer: This is a good question, but a very general question. There is a great amount of information to sift through - for example, your parents’ age, location (ZIP code), health condition, prescription lists, and so on. The best way to compare Medicare plans is to contact an agent and have that person carefully walk through the issues with you.

Answer: Good question - this is a difficult question that many seniors may face. Generally speaking, Medicare does not cover long-term care.

If specific medical coverage is needed, Medicare should cover that - but long-term care is a separate expense.

Separate insurance exists for long-term care, and it is quite expensive. In fact, if you're already in need of long-term care, probably no insurer will cover that. The possibility of long-term care is something that all people need to consider in planning for the future.

Answer: At first glance, Medicare appears to be quite simple and easy to enroll. While there is some truth to that idea, in fact, you have an array of choices - and consequences - in selecting your (Medicare) health insurance. There are many insurers available, many plans available, and different time periods that may allow you to make changes (or not).

This is why using a licensed, independent health insurance agent whom you can trust is extremely helpful.

Amazingly, you pay nothing to your agent for his/her assistance. Agents are compensated by the insurers, based upon the enrollments. An agent has your best interests in mind. Agents have volumes of information about Medicare plans and their subtleties available to them, in order to benefit you.