Ken Correa, Medicare Insurance Broker

Answer: Original Medicare has a lot of deductible and high out-of-pocket costs and I would not recommend this as a stand alone option for my clients. Medicare Advantage plans have no or low monthly premiums with small co-pays and better much less deductible and co-insurance exposure. It suggest looking closely at what works best for each client as to their budgets. If they want to have a lower monthly cost and pay for services as they occur Medicare Advantage is the better option. If they can afford to pay higher monthly premiums for a Medicare Supplement plus a prescription drug plan you have very little deductible and no co-insurance exposure plus you can go to any provider that accepts Medicare in the country.

Answer: Medicare Advantage rules and funding change annually. You should look to make sure your plan is a consistently highly-rated carrier for the best safeguard against sudden plan withdrawals or benefit reductions. If they have a Star Rating that is a 4 or higher this means they will be receiving additional funds from CMS and provide better financial stability. You should also make sure to check the financial rating from A.M. Best, Moody's and Standard and Poor's and look that your carrier is A rated or higher.

Answer: You can go direct to Medicare.gov and see the pricing with your plans. In the upper right hand corner of the homepage click on compare health and drug plans and enter your zip code.

You can enter your prescriptions and dosages and it will provide the costs for all available plans in your zip code.

Answer: You can lower your Part B premium by filing form SSA-44 with the Social Security Administration. This form allows you to request a recalculation of your income to reflect your current retirement income level and if approved your premium can be changed.

Answer: I have been on Medicare for over 11 years now and have had sleep apnea for over 30 years. My pulmonary specialist have treated my sleep apnea and my CPAP and BiPAP machines and equipment have been covered per the durable medical equipment coverage on my policies. So yes, Medicare does cover CPAP and BiPAP machines and treatment for sleep apnea.

Answer: No, Medicare does not cover medical marijuana for chronic pain, cancer, or any other condition, regardless of state legality. Medicare will not pay for medical cannabis products, including flower, oils, or edibles.

However, There are some exceptions for FDA approved cannabinoid-based drugs. Examples include Epidiolex (for specific epilepsy types), Dronabinol (Marinol) (for cancer-related nausea or AIDS-related weight loss), Syndros (dronabinol solution) and Cesamet (nabilone).

Answer: Generally the answer is NO! But if you have a Medicare Supplement( Medi Gap) or Medicare Advantage plan you may be covered for emergency care and hospitalization. This, of course, depends on the plans.

Contact your Medicare Advantage or Medigap plan provider to understand your coverage limits before leaving. It would be best to get travel insurance to make sure you have coverage while traveling.

Answer: The best time of year to start looking at your Medicare options will vary depending on the type of plan in which you are currently enrolled. If you are new to Medicare you should look at your options at least 3 to 4 months prior to your 65th birthday. If you are already enrolled in a plan and have any major changes in your health, income, doctor(s) or have moved you should look at your options immediately.

If there have been no major changes the Annual Enrollment Period from October 15th to December 7th is when you should review your current plan and see what the other options are for your consideration for the next year. If you are enrolled in a Medicare Advantage plan you have the additional Open Enrollment Period form January 1st to March 31st when you can consider changes and options. Every situation is different and your Medicare agent should be available to guide you through this process and answer any of your questions or concerns.

Answer: Failing to Compare Plans Regularly: Medicare is not a "set it and forget it" system. Skipping the annual review (Oct 15 - Dec 7) can lead to overpaying for drugs or losing coverage for preferred doctors. You need to make sure your plan and coverage take into consideration any life changes that have occurred including moving out of area or regular extended stays out of area.

Answer: Medicare does not pay directly for any mental health treatment for the spouse. They do provide up to 5 days of short-term respite care to give you a break if your spouse is in a Medicare certified hospice program.

There are additional services available to help train family caregivers as well as finding counseling and community resources. Some Medicare Advantage plans provide extra benefits like meal delivery, transport and limited companionship services.

Answer: Several things should be at the top of your list as you move from your Employer's plan to Medicare. Are you currently on a HMO or PPO plan. Is it of prime consideration for you to keep your doctor(s). Will you be doing a lot of traveling or extended stays away from your home area. Can you match or beat your current deductibles and Maximum Out Of Pocket costs. Do you have any drugs that are very expensive.

These are just the beginning of going through the in depth process of getting all your questions and concerns answered. If you are with an experienced professional to guide you on this journey there should be other items that come up for your consideration. Always look to see what options are available and how they compare as you make you decision.

Answer: Yes. Telehealth is covered under Medicare for 2026. In fact, it is covered through 2027. Most of my doctors use telehealth for my follow up appointments. So, if you depend on this service as I do this is very good news.

Answer: If your wife has coverage through her Employer's group plan then you should not have any penalty when you sign up for Part B. That is as long as there are no changes to the current rules. Should you wait until she is no longer on her group plan and you are both looking to sign up for Part B, there is no penalty as long as you sign up within 63 days of losing the group coverage.

Also, you should take the time to see what you have available to you if you opt to sign up for Part B now. You might get equal or better coverage at a lower cost depending how much of her current cost share for her premiums are with her Employer's plan and what the deductibles and Maximum Out Of Pocket costs are on that plan.

Answer: Medicare does not cover long-term care costs. However, if you are in a long-term care facility they will have a Medicare plan that will cover your health care costs, doctors, drugs and hospitalization. The costs for your stay in a long-term care facility will be paid from by you from assets, or long-term care coverage. That is usually through a long-term care policy or a rider on your life insurance policy. If your assets outside of your home are less than $130,000 and you qualify for it Medi-Cal will cover these costs.

Answer: There are a lot of moving parts to Medicare. A Medicare agent can take you through the many and varied options, explain the differences and help you select the option that best meets your needs.