Kyle Nystrom, Medicare Insurance Agent

Answer: Only a certain subset of Medicare Advantage Plans have this benefit. That subset are called "Special Needs Plans" (SNP) and you must have a qualifying medical condition in order to be eligible for a SNP. If confirmed eligible, most SNP do offer some sort of "food & home benefit" that varies per plan, and likely per year going forward.

Answer: No, it does not. There are only limited Skilled Nursing Facility and Hospice benefits under Medicare. The alternatives are either 1) self-funding or 2) Extended Care in the form of "Short Term Care", L"ong Term Care", or both.

There are additionally some riders associated with Life Insurance and Annuity products that attempt to fill this gap also, but comparison & initial underwriting is needed to determine what will work for you best.

Answer: We can reasonably assume Medicare Advantage (MA) will continue to strongly emphasize preventative care and benefits as opposed to working with beneficiaries who already have ongoing health concerns.

Answer: Maybe. It might be covered better elsewhere, especially if it's a specialty/exotic medication.

If you're on a Medicare Supplement plan with a separate Prescription Drug Plan (PDP), check how that plan covers your new drug by looking for your plans Formulary document.

If you're on a Medicare Advantage plan that also covers drugs (MAPD), check your Summary of Benefits, the plans Formulary, and/or the Evidence of Coverage documents for your plan.

Also worth checking are services such as mailed prescriptions and/or GoodRx or similar.

An agent will be able to guide you through finding these pieces of documentation and making a choice if better coverage is found.

Answer: Medicare does not cover long-term care (LTC). Once your coverage under Part A is exhausted, you and your family are on your own until Hospice benefits kick in. The solution to this gap in coverage is LTC Insurance offered by private companies. The best time to prepare for this was yesterday, but the next best time is now. Find the top companies selling LTC Insurance in your area and schedule an in-person appointment to gather some info to make sure you understand LTC fully before buying.

Answer: One major reason is Prior Authorizations - the re-checking behind and subversion of the licensed medical doctor's professional, licensed opinions and recommendations. Medicare Advantage plans give authorization to carry out a treatment or procedure prior to covering. If no authorization, no coverage. Doctors converse back and forth with Advantage plans regarding "is this really necessary" and "are we sure this is the correct diagnosis" and "are you sure the patient has done x, y and z" etcetera in efforts to cover as little as possible.

Answer: Yes, definitely. A decision as important as Medicare related coverage should not be able to be sold to you over the phone. Due to the significant amount of advertising companies offering Advantage plans carry out, Medicare Supplement Plans, despite being better coverage, aren't nearly as widely known. Additionally, general positives are advertised with little/no attention to negative aspects of Advantage plans such as prior authorization, yearly plan changes or complete plan withdrawals from an area.

Answer: Medicare "Advantage" Plans are not the only option! Medicare Supplement (Medigap) Plans are superior coverage, but not as often advertised. Advantage Plans work for some, but should be carefully examined for exact coverage and costs.

Answer: Be sure to meet in person. If that's not possible, meet face to face virtually. Don't buy anything over the phone, and don't be pressured into making a purchasing or coverage altering decision without fully understanding how you stand to benefit.

You will be approached/called/marketed to by many. Trust your intuition, do your research and you'll be fine. The more local the agent to you, the better.

Answer: Extended Care/Long Term Care (XTC) is the largest gap in Medicare's coverage. Once you've been discharged from the hospital or skilled nursing facility to head home, but still need further care (such as getting dressed or otherwise caring for yourself without supervision) Medicare offers zero coverage or help. This gap can be addressed by private Long Term Care Insurance.

Another gap in coverage are expensive and/or injectable specialized medications as they are minimally covered by Part B and/or Part D. Critical Illness/Benefit policies can be used to address this gap. This is also an area of focus for Medicare with ongoing price negotiations with drug manufacturers.

Answer: No. Additionally, if you are supplementing Original Medicare (A & B) with a Medicare Supplement (Medigap) plan, no referrals are required. If you supplement A & B with Part C (Medicare Advantage) referrals may be required, depending on your specific Advantage plan.

Answer: Yes, through Part D. There are many plans that satisfy the Part D requirement and they all may cover these types of medications slightly differently. It's worth doing research or talking with an agent if covering these as much as possible is important to you.

Answer: Check with your plan's "Summary of Benefits" and/or "Evidence of Coverage". Additionally, Medicare.gov has a searchable directory of covered procedures and services. Generally, Medicare only covers acupuncture (including dry needling) for chronic low back pain.

Answer: Log in to the website of the provider of your plan or search the internet for a "Summary of Benefits" and/or "Evidence of Coverage" for your plan. Your plan's name can be found on your membership card for the plan.

Answer: Special Needs Plans (SNP) are for people who have specific needs for a specific affliction or illness. They are a variety of Medicare Advantage plan, and as of 2026, the only plans that can offer "benefit cards".

Answer: Medicare can be confusing, and parts of it change yearly. You don't NEED to work with an agent, but if you do, they can make your experience with Medicare smoother and walk you through what's important to you without all the extra or inaccurate info you don't need.