Kevin Chaikin, Medicare Insurance Broker

Answer: If you have a qualifying life event such as retirement, reduction of work, divorce, annulment, death of a spouse, etc. you should use Form SSA-44 to appeal the IRMAA decision. If that life event reduces your Modified Adjusted Gross Income to a lower level or completely removes you from IRMAA charges, it is well worth your time to submit that form. You may need documentation depending on the life changing event. Expect up to 8 weeks for the appeal to be processed.

Answer: It all depends on what type of eye exam you're talking about. If we assume you mean a refraction exam to check on your vision then generally no. Diabetic eye exams or an exam to address a medical issue of the eye would then typically be covered by Medicare. Seniors can wind up paying 100% out of pocket for basic eye exams and glasses or you may get vision coverage as a standalone plan or part of a Medicare Advantage plan to help cover out of pocket costs associated with vision needs.

Answer: Yes, Medicare increasingly covers AI-powered diagnostic tools for early detection of disease. Expansions are underway in 2026 and some coverage already includes cardiac exams, stroke detection, retinal imaging for diabetes, cancer detection, etc. More to come!

Answer: Premiums are what you pay monthly for policies like Part B, Part C (med Advantage), Part D (Rx), Medigap, and any other ancillary coverage you may add. That is your monthly fixed cost to own the policy. Deductibles are what you pay before the plan pays anything. For instance, on Medicare Part B that is $283 for the year in 2026 and $615 for Part D. Once those deductibles are met, the respective plans start to pay their share. Copays and coinsurance are your cost sharing responsibility after the plan pays. This could be for hospital/medical on Parts A/B or Medicare Advantage as well as Part D and Medigap. Deductibles + Copays + Coinsurance generally add up to your maximum out of pocket if your plan has one. Ultimately, there are so many different combinations of policies and plan types, it is best to review plan specifics to really understand how all these things work and estimate your costs.

Answer: We start at the beginning with Medicare 101. Review A, B, C, D. Medicare supplement vs. Medicare advantage. Pros/cons of each. Enrollment availability of each type. Ultimately, providing enough education for you to make decisions that are best for yourself based on our recommendations.

Answer: Whether you're on a Med supp or Med Advantage, constantly changing your plan is not recommended. Especially if you are changing plans just to chase ancillary benefits. With Medicare supplement, you should set that up with plans to change very infrequently. Rate will rise so every few years (3-5+) you can look to shop rates and your access to change will vary by state. In that scenario you can shop your Part D (Rx) plan annually but that doesn't mean a change every year makes sense - it usually doesn't. On Medicare Advantage, if your doctors and Rx list are covered and the plan meets your needs (low MOOP, etc.) then don't mess with it. Don't get drawn in by freebies like extra dental, vision, hearing, over-the-counter allowance, Part B givebacks, etc. All that said, updating often isn't necessarily recommended but REVIEWING coverage annually is worthwhile. Just to be sure.

Answer: Medicare Part B covers urgent care. That is "outpatient" and outpatient services are covered by Part B. If you have a Medicare Advantage plan (Part C) urgent care will be covered by the plan as part of the Part B services that the plan is required to offer.

Answer: You have options here depending on which Medicare product you select. Original Medicare is not going to offer dental or basic vision coverage so if you stick with OM and get a Medicare supplement, you can buy separate dental and/or vision insurance which are non-Medicare specific plans. Some Medicare supplement plans may have dental/vision/hearing benefits but they are not insurance, more of discount programs. If your Medicare path is Medicare Advantage, many of those plans will provide a basic level of dental, vision and/or hearing though they vary significantly by plan with some being preventive only and others being more robust. Keep in mind, when it comes to vision, Medicare is going to cover MEDICAL vision (i.e., cataracts, glaucoma, macular degen, etc.) so if you are looking for vision insurance it is going to be specifically for an eye exam and glasses/contacts.

Answer: Yes you can be denied for a Medicare supplement in most states which is why it is so important to look at your Medicare decisions as a long-term journey. You have 6 months from your 65th birthday or Medicare Part B start date (if enrolling in Medicare later) to enroll in a Medicare Supplement plan with no chance for denial. Any plan from any company has to accept you. Changes to that med supp beyond that point often require medical underwriting which can be denied. Some states have special legislation that could allow you to change plans without underwriting. If you aren't already in a Medicare supplement plan and want to add one later, most states will require underwriting. Very few will allow enrollment without the possibility of denial if not done when first eligible for open enrollment (6 mos. window).

Answer: Medigap has no network so as long as the provider accepts original Medicare they are considered "in network." Any Medigap plan will then pay what Medicare approves without question. The vast majority of non-pediatric providers still take original Medicare. Medicare Advantage is managed care so you will have network based care, usually an HMO or PPO. In an HMO you do not have out of network coverage except in cases of emergency or if your plan is an HMO-POS which MAY provide out of network cost sharing. In a PPO you have more flexibility to go out of network but typically pay higher costs and have higher total exposure for out of network care.

Answer: The most important question you should ask about Medicare is what option between Medicare supplement and Medicare advantage is better for me now AND in the future. And can I change from one to the other down the road? This decision when starting Medicare can have lifelong implications.

Answer: Your Medicare plan may not still meet your health needs if your health changes so it is important to review your coverage every year to check on prescriptions, doctors and if the costs and coverage meet your needs. Especially true for your Medicare Advantage and Part D plans. On a Medicare supplement your changing health needs are probably going to have less of an impact on your plan so it will probably work well for you as needs change. It's important to research additional copay/coinsurance protection plans for things like hospitalization, home health/skilled nursing, cancer, etc. so that you can secure these additional umbrella coverages before your health needs change.

Answer: That's a great question. Your parents are going to receive a lot of information in the mail that appear to be official government business, see many confusing TV ads and possibly be solicited on the phone by agents/companies trying to sell them a plan to benefit themselves. it is important to ensure your parents are working with a trusted agent and made a choice based on their needs, not what someone may have pushed them into.

Answer: Your daughter can be involved to help you but can only work with an agent on your behalf if she has Power of Attorney. Otherwise, you need to be involved every step of the way and she can assist you.

Answer: Start by reviewing differences in monthly premiums, deductibles and out of pocket maximums. Also look at your current Rx premium and estimated copays vs. Rx estimates on Medicare Advantage plans in your area. Finally, make sure your doctors who take Medicare are also taking the advantage plan you are looking at. Don't move to Medicare Advantage just because it is cheaper only to find out you can't see certain doctors and/or your meds aren't covered. Find a good agent and have them review with you!

Answer: Simply, Medicare doesn't cover Long Term care. After 100 days of skilled nursing, Medicare nor a supplement or Advantage plan pays anything for days 101+. Other than self insuring or securing a long-term care policy, beneficiaries can look into short-term recovery policies which are cash products that could add additional funding to help out with a portion of what could be come a long-term care stay. This would not be a catch-all but could help lessen the blow for those that can't pay out of pocket.

Answer: In short, no, you don't HAVE to sign up for Medicare. If you are not making HSA contributions you should probably get Part A ($0/mo) for secondary hospital coverage. However, if you work for an employer with less than 20 employees, Medicare is viewed as your primary payor and enrollment in Medicare and possibly supplemental/Part C coverage would be required. If you are able to keep employer coverage beyond age 65 then do not enroll in Part B and address it 3-6 months before retirement.

Answer: It's not universally the better option but in summary it usually comes down to cost. If you are short sighted about finances, you may focus on the monthly premium instead of the financial exposure.

Answer: The point is exactly what you stated - you chose it for the flexibility. This is not unusual for a PPO, to pay higher rates when you go out of network. Its in exchange for having that flexibility whereas an HMO is going to cost you less but restrict you more.

Answer: It depends who your carrier is in NY. Generally you just need to call that company and update your address and your rate will change, probably for the better from NY to FL. If your NY company is not in FL talk to the carrier about your options and look to find a broker to help you. Part D you will need to submit a new application even if with the same company/plan in FL.

Answer: In many cases yes you do need to answer health questions but this depends where you live as some states have more flexible rules for consumers than others and you may find you can make this change at certain times of year without going through underwriting. As with most Medicare questions, it depends on your specific situation and location.

Answer: Sometimes marketers will highlight that the plan has a PPO network leading you to believe you can see any doctor when in reality that doctor still has to take Medicare and agree to bill the plan. Even if those are true, you are likely to have higher out of pocket costs and exposure when out of network which is not always the story that is told. Marketers focus on $0 premiums and extra "freebies" to distract from certain limitations you may face with restrictions/provider choice. That said, Medicare Advantage plans work much like whatever insurance you had before Medicare so this is not a foreign concept to anyone who has had US based health insurance prior to Medicare.

Answer: It all really depends on what your situation is both from a financial perspective and health needs as well as what options are available to you in your zip code. Part D is a standalone which requires an extra premium whereas Medicare Advantage does not typically require additional premium. Sometimes you'll find drug coverage on Medicare Advantage plans to be better due to lower deductibles and better coverage but that is such a case-by-case thing that it is impossible to make that blanket statement. Start with figuring out whether Medicare supplement or Medicare Advantage is better for your medical needs and then start figuring out Part D once you've made that decision.

Answer: Not opting for guaranteed coverage when eligible and then facing underwriting later. Don't make decisions that are short-sighted.

Answer: Of course some are but it sounds like you went to one that was really just a sales pitch. Every seminar held by an agent/agency is intended to generate leads but some do better than others at making it more educational vs. a hard sell. Seek education and trust and figure which agent/agency is the right fit for you. We are all providing the same products. Who is offering the best service?

Answer: Yes but when meeting certain criteria. Medicare already covers an annual wellness visit as a preventive service and since Medicare Advantage plans must also cover the same preventive visits at no cost, your PPO will also cover it IF you have been on Medicare Part B for 12+ months AND the wellness visit is at least 11-12 months after your welcome to Medicare visit. You should also check your plan's summary of benefits as it MAY also cover an annual physical, which is not the same as the wellness visit.

Answer: Yes Medicare covers many preventative screenings at no cost. Things such as bone mass measurements, cardiovascular screenings, colonoscopies, mammograms, depression screenings, diabetes screenings, some vaccinations, amongst others.

Answer: There are plenty of mistakes seniors can make when enrolling in Medicare but the biggest would be not considering future medical needs. Just because you're healthy today doesn't mean you won't need more care in the future. Failing to look ahead and make a coverage decision that is in your best interest 10-20 years from now could lead to an inability to get the coverage you really want when you need it due to underwriting requirements. Think long-term with all Medicare decisions.

Answer: If you are spending winters in another state you will be best served by original Medicare with a supplement. This provides you the same coverage anywhere in the United States with any doctor who takes Medicare (no networks). Your supplement will work exactly the same way it does in your home state and pay for most of your out of pocket expenses leftover by Medicare A&B.

Answer: It depends but in most cases, probably not. First, you would need to find a valid enrollment period to switch from Medicare Advantage to Part D (standalone) and then you would likely need to qualify for the Medigap plan via medical underwriting. There are exceptions to every rule however so it could depend where you live, how long you've been on Medicare Advantage or other factors that may plan into your situation. It is important to make your initial enrollment decision for the long-term however since you may not be able to get a Medigap plan after you first enroll in Part B.

Answer: Yes, whether you have traditional Medicare with a supplement or Medicare Advantage, hospice will be covered.

Answer: You should talk to a broker about your specific situation. While that is important to know about the bipolar disorder, you should look at your entire health picture to understand the best coverage for you. If you are on medications for bipolar disorder then shopping all plans in your market is important to understand how to lower your Rx costs. As far as medical goes, original Medicare with a supplement is generally going to cover more mental health providers than Medicare Advantage and can reduce copays if you see a therapist regularly. Like with everyone, Medicare is highly personalized so there is no "one-size-fits-all" solution.

Answer: First of all, it depends if the drug is covered by a Medicare Part D plan. Not all drugs are covered by all plans and formularies vary plan-to-plan. However, it if it IS covered, you will not spend more than $2,000 this year for all covered medications.

Answer: It is possible that Medicare won't cover this and you could be 100% out of pocket. This is why we always recommend umbrella Cancer coverage for those on Medicare. Of course, the exact details depend on the individual's situation.

Answer: Yes on traditional Part B you would need to pay your deductible first. Then, depending on your supplemental coverage you may have additional copays and as little as $0 extra cost for Physical Therapy.

Answer: Buying the "cheapest" coverage isn't something we would ever recommend though someone could opt for Part A only and most people pay $0/mo for that. It does however come with variable out of pocket costs with NO cap on total spending. A hospital indemnity policy could be added to that to pick-up more of the hospital costs along the way. What is still missing however is Medical (outpatient) and Prescription coverage. One should always assume they will pay at least the part B premium and perhaps could get by with a $0 Medicare Advantage plan to reduce total exposure but that would not be our advice for most people.

Answer: In both cases we are reviewing Medicare 101 because even someone currently on a plan doesn't speak Medicare everyday. We make sure to cover the ABC's again and Medicare Supplement vs. Medicare Advantage and do a full needs assessment. We then are making a formal recommendation based on their new to Medicare needs or their current coverage needs. There's no reason to assume a current Medicare beneficiary won't benefit from the re-education - they may have been mis-educated in the first place!

Answer: Because they pay more commission and lifetime commissions. Plus some companies incentivize MA sales for the agents.

Answer: Medicare does not provide an annual physical but rather a wellness exam. If the doctor billed it as a physical then you will pay 100%. If you have a Medicare advantage plan the plan MAY cover an annual physical.

Answer: If you choose a PPO for flexibility you are usually exchanging that flexibility for potentially higher out of pocket costs (copays, coinsurance, MOOPs) and less "extra" benefits. On an HMO, for having to stay in network, you are typically rewarded with lower out of pocket costs and sometimes more extra benefits.

Answer: I love the opportunity to provide a valuable service to my parents' generation which provided so much to me. It feels good to help people. I also always dreamed about owning my own business and the Medicare insurance industry has been a blessing to start and continue growing a business.