Leslie Kaz, Medicare Insurance Agent

Answer: Medicare can work alongside other insurance, but who pays first (primary) and who pays second (secondary) depends on which type of coverage you have and why you have it.

1. Employer or Union Group Health Plans

If you’re 65+ and still working (or covered by a working spouse’s plan):

Employer has 20+ employees: Employer plan pays first, Medicare pays second.

Employer has fewer than 20 employees: Medicare pays first, employer plan pays second.

Tip: Always confirm with HR whether your coverage is considered creditable for delaying Part B or Part D without penalty.

2. Retiree Coverage

Usually pays after Medicare.

You must enroll in Medicare Parts A & B for retiree coverage to work fully.

Retiree coverage may help pay Medicare’s deductibles and coinsurance, but benefits can change — especially if your former employer changes the plan.

3. Veterans Affairs (VA) Benefits

VA benefits cover care only in VA facilities.

Medicare covers care in non-VA facilities.

You can have both:

Use VA for prescriptions or specialty care.

Use Medicare for civilian doctors/hospitals.

Tip: Many vets keep Part B to avoid penalties and to have access to non-VA care.

4. TRICARE for Life (Military Retirees & Spouses)

You must have Medicare Parts A & B.

Medicare pays first for Medicare-covered services.

TRICARE pays second, often covering what Medicare doesn’t (including some drugs).

For VA or military facilities, TRICARE pays first.

5. Medicaid

Medicaid is always the payer of last resort — it pays after Medicare and any other insurance.

If you have both Medicare and Medicaid (“dual eligible”), you may qualify for a Special Needs Plan (D-SNP) that coordinates both.

6. Workers’ Compensation

Workers’ comp pays first for job-related injuries or illness.

Medicare may pay for unrelated services.

Answer: Yes — you should be alert, but not automatically suspicious. The push toward Medicare Advantage (MA) over Medigap often comes down to money, market rules, and client fit — and sometimes those factors benefit the agent more than the client. Agents should be assessing your specific needs prior to making any sort of recommendation.

Answer: Here’s the no-spin answer — comparing a Medicare Supplement (Medigap) to a Medicare Advantage (MA) plan isn’t apples to apples. One is pay more for freedom and predictability, the other is pay less up front but live with rules and limits. The trick is to run the numbers and the lifestyle test.

Answer: 1. Figure Out if You Need to Enroll Now

Already getting Social Security or Railroad Retirement benefits?

→ You’ll be automatically enrolled in Parts A & B, and your Medicare card will arrive about 3 months before your 65th birthday.

Not getting Social Security yet?

→ You’ll need to actively sign up — Medicare does not enroll you automatically.

2. Know Your Initial Enrollment Period (IEP)

It’s a 7-month window:

Starts 3 months before your birthday month

Includes your birthday month

Ends 3 months after

Enrolling early means your coverage starts on the 1st of your birthday month.

3. Decide on Your Coverage Path

You have two main routes:

Original Medicare (Parts A & B)

Optionally add Part D for prescriptions and/or a Medigap (Supplement) for cost protection.

Medicare Advantage (Part C)

Combines Parts A, B, and usually D, plus extras (dental, vision, hearing).

4. Check Employer or Union Coverage

If you or your spouse are still working and have credible employer coverage, you may be able to delay Part B (and avoid the premium) without penalty.

Get written proof of creditable coverage for both medical and prescription drugs before delaying.

5. Sign Up

Go to SSA.gov/medicare to enroll online (fastest).

Or call Social Security at 1-800-772-1213, or visit a local SSA office.

If choosing Medicare Advantage or Part D, shop plans at Medicare.gov/plan-compare.

6. Review Deadlines & Penalties

Late enrollment in Part B or D (without creditable coverage) = lifetime penalty added to your premium.

Missing your IEP means waiting until the next General Enrollment Period (Jan 1–Mar 31) for coverage to start in July.

Answer: Here’s the straight answer — maybe, but it depends on what you mean by “save” and what kind of dental care you expect beyond cleanings. Original Medicare does not cover dental; however you could purchase a stand alone plan or look at a Medicare Advantage plan that has dental built in.

Answer: Usually, no — switching from Medicare Advantage (MA) to a Medigap (Supplement) plan during the Annual Enrollment Period (AEP, Oct 15–Dec 7) does not automatically give you “guaranteed issue” rights for Medigap.

Answer: It’s not random at all — it’s a mix of where you live, how your plan is funded, and whether your income triggers extra premiums. Here’s the breakdown:

1. Medicare Advantage Plan Premiums = Location + Competition

2. Your Income Might Be Adding to the Cost

3. Different Types of Plans

4. Extra Help & Medicaid

💡 Bottom line:

Premium differences aren’t random — they come from:

The county-level reimbursement rate Medicare pays insurers

Competition (or lack of it) in your area

Your income level and subsidies

The type of plan you choose

Answer: Original Medicare probably not. Medicare Advantage provides some coverage, Medi-gap plans usually for emergencies only, best to purchase a travel medical policy, which is very affordable, contact me directly.

Answer: Go to Medicare.gov or contact me directly and we can review the plans Summary of Benefits (SOB). All plan benefits must be approved by the Centers for Medicare & Medicaid Services (CMS) each year.

If the benefit is in the EOC/SB, it’s CMS-approved. If not — it’s either a “supplemental offer” you pay for, or it’s marketing fluff.

Answer: Medicare’s Extra Help (Low-Income Subsidy, State Pharmaceutical Assistance Programs (SPAPs), Medicaid, Pharmaceutical Manufacturer Patient Assistance Programs (PAPs),

Answer: Not quite — Medicare Part A covers a lot of hospital-related costs, but it’s not “full coverage,” and people are often surprised at the gaps when the first bill arrives. If you are financially well off, maybe you can afford it; however hospital bills can quickly get overwhelming so it's usually a much safer option to have additional coverage, either via a med supp, med advantage or hosp indemnity plan.

Answer: you’re juggling two exhausting battles at once: caring for your dad and navigating the Medicare billing maze. You can’t stop the paperwork from coming, but you can turn the flood into a manageable stream. Get organized create a health file, Understand your EOB's, use a tracking sheet with doc visits dates, times, locations, etc. SHIP and Medicare.gov both have resources for you

Answer: Special Needs Plans are a type of Medicare Advantage plan (Part C) designed for people with specific health, income, or living situations. They work like other Medicare Advantage plans but tailor benefits, provider networks, and drug formularies to meet the needs of the group they serve.

Answer: You may be, depending on your income.

IRMAA stands for Income-Related Monthly Adjustment Amount—it’s an extra charge added to your Medicare Part B and/or Part D premiums if your income from two years ago was above a certain level.

The Social Security Administration (SSA) uses your IRS tax return from two years prior to decide if you owe IRMAA.

If your income is above the threshold, they’ll send you a letter explaining the extra amount and how it was calculated.

If your income has gone down because of a life change—like retirement, marriage, or divorce—you can appeal to have the surcharge reduced or removed.

Answer: Your doctor recommends the care they believe you need, but your insurance company decides what they will cover based on Medicare’s rules and the plan’s guidelines. In most cases, Medicare or your Medicare Advantage plan follows national coverage rules and medical necessity standards. Sometimes the insurance company may require extra steps—like prior authorization—before covering certain services.

The best approach is for your doctor to clearly document why a service is needed and, if there’s a denial, for you or your doctor to appeal. I can also help guide you through that process so you get the care you need with the least hassle.

Answer: If you go without creditable coverage for too long, you could face a late enrollment penalty when you sign up for Medicare Part B or Part D.

Part B (Medical Insurance) – If you don’t have creditable coverage and delay enrolling, your premium may go up 10% for every 12 months you were eligible but didn’t sign up. This penalty is permanent.

Part D (Prescription Drug Coverage) – If you go 63 days or more without creditable drug coverage, you may pay an extra monthly penalty for as long as you have Part D.

Creditable coverage means your existing insurance is at least as good as Medicare’s standard coverage. If you’re ever unsure whether your plan is creditable, ask your insurer for a written notice—keep it in your records in case Medicare ever asks for proof.

Answer: Yes—there are options, but the type of plan matters.

Original Medicare + a Medicare Supplement (Medigap) Plan – You can see any doctor or hospital in the U.S. that accepts Medicare, and many Medigap plans (like Plan G and Plan N) include limited foreign travel emergency coverage.

Medicare Advantage PPO Plans – Many let you see providers outside your home area, sometimes nationwide, but your costs may be higher if they’re out-of-network.

Medicare Advantage HMO Plans – These usually only cover you in-network, except for emergencies or urgent care while traveling.

If you travel often—whether across the U.S. or internationally—we can focus on plans that keep you covered wherever you go, so you don’t have to worry about surprise bills.

Answer: A deductible is the amount you pay first each year before your plan starts helping with costs. For example, if your deductible is $200, you pay the first $200 of covered services yourself.

A copay is a set amount you pay for a service or prescription after your deductible (if any) is met. For example, you might pay $20 each time you see your doctor, no matter the visit cost.

Answer: Check your plan’s website, call your insurance, or ask me—I’ll make sure your new doctor is in-network before you book.

Answer: Your health needs can change over time, and your Medicare plan should be able to change with you. Each year during the Annual Enrollment Period (Oct. 15–Dec. 7), you can review your coverage, compare it to your current doctors, prescriptions, and budget, and switch to a plan that better fits your situation. If you have a major change—like a new diagnosis, new prescriptions, or you move—you may also qualify for a Special Enrollment Period to make changes right away. The key is to review your plan at least once a year, even if you feel healthy, so you’re prepared and protected when life changes.

Answer: Most people can only change their Medicare Advantage or drug plan once a year in the fall, unless you have a special circumstance. Medigap plans can be changed anytime, but you may need to qualify based on your health.

Answer: Quick Summary:

Plan G = Higher premium, fewer surprises.

Plan N = Lower premium, but you pay small copays and possible excess charges.

Answer: Original Medicare generally doesn’t cover you outside the United States, except in very limited situations—like certain emergencies close to the U.S. border. Some Medicare Advantage plans or Medicare Supplement (Medigap) policies may offer emergency coverage abroad, but it’s usually for a limited time and amount. If you plan to live outside the U.S., it’s important to look into private international health insurance or a plan in your country of residence so you’re protected wherever you are.

Answer: You’re not alone—Medicare can feel overwhelming because there are a lot of choices, and the information can be confusing. My advice is to take it one step at a time. Start with your needs—your doctors, your prescriptions, and your budget—then we can narrow down the plans that fit you best. Don’t feel like you have to figure it out all at once; that’s what I’m here for. My job is to explain the options in plain English, compare them side-by-side, and help you feel confident in your decision so you can move forward with peace of mind.

Answer: Your surgery should be covered if it's medically necessary and done in-network. But you’ll still likely pay the Part B deductible, 20% coinsurance, and possible additional fees based on plan structures and any upgrades you choose.

Before You Go Under

Ask your eye surgeon whether they accept Medicare and your Advantage plan.

Confirm if the surgery is medically necessary or elective.

Request a cost estimate by billing code and facility type (clinic vs. hospital).

Call your Medicare Advantage plan to check:

Annual deductible status

What coinsurance or copays apply

Whether your provider and facility are in-network

What vision benefits (if any) are included

Answer: Great question — and a very smart one to ask. If you’re at high risk for heart disease, Medicare offers several preventive services to help catch problems early and support your heart health.

Here’s what Medicare Part B typically covers at no cost to you (if your provider accepts assignment):

✅ 1. Cardiovascular Disease (CVD) Risk Screening

What it is: A screening every 5 years that checks your cholesterol, lipid, and triglyceride levels.

Why it matters: Helps identify high cholesterol and other risk factors early — especially important if heart disease runs in your family.

✅ 2. Cardiovascular Behavioral Therapy

What it is: An annual visit with your primary doctor to assess your diet and provide tips on healthy eating to reduce heart disease risks.

Pro tip: This is often bundled into your Annual Wellness Visit.

✅ 3. Blood Pressure Checks

Done routinely during office visits.

High blood pressure is a silent killer — and a key indicator for heart problems.

✅ 4. Obesity Screening & Counseling

What it is: If your BMI is 30 or higher, Medicare may cover intensive behavioral counseling to help you lose weight.

Excess weight is a major contributor to heart disease.

✅ 5. Diabetes Screenings

What it is: Covered up to 2 times per year if you’re at high risk — and diabetes is a major heart disease risk factor.

If you already have diabetes, Medicare also covers self-management training, nutrition therapy, and supplies.

✅ 6. Smoking Cessation Counseling

Covered even if you haven’t been diagnosed with a smoking-related illness.

Up to 8 face-to-face sessions per year if you’re a smoker — and quitting reduces heart risk immediately.

✅ 7. Annual Wellness Visit

Includes a personalized prevention plan.

You can discuss all your risk factors and build a heart-healthy strategy.

🧠 Bonus Tip:

If you qualify for a Medicare Advantage Plan, some of them offer extra perks like gym memberships (SilverSneakers), meal delivery, or expanded nutrition counseling — which can really h

Answer: You’re not alone — most Medicare beneficiaries feel exactly the same way every fall.

The good news? Yes, you can take the stress out of Medicare.

Here’s how:

1. Work with an independent broker (not the 1-800 number)

We look at all the plans available in your zip code, not just one company, so there are no surprises.

2. Review your plan once a year

Your health, your prescriptions, and the plan benefits change every year.

A 20-minute annual check-in can save you hundreds (sometimes thousands).

3. Focus on more than just premiums

The lowest monthly premium doesn’t always mean the lowest cost. We look at:

Copays for doctors/specialists

Medications

Maximum out-of-pocket

Extra benefits like dental, vision, transportation

4. Ask for a written “Peace of Mind Review”

When you work with us, you’ll get a simple side-by-side comparison with no cost and no pressure. You’ll know exactly what you’re signing up for.

Bottom line: You don’t have to guess. With the right guidance, Medicare doesn’t have to be confusing or stressful.

Answer: Great question!

Yes, Medicare does cover care related to asthma and other chronic respiratory conditions, but what’s covered depends on the type of Medicare plan you have:

Medicare Part B (Original Medicare)

Covers doctor visits, lung function tests, allergy testing, durable medical equipment (like nebulizers and oxygen equipment if medically necessary).

Also covers pulmonary rehab programs if your doctor prescribes them.

Part D (Prescription Drug Coverage)

Covers medications like inhalers or biologic drugs (exact coverage depends on your plan’s formulary).

Medicare Advantage Plans (Part C)

These include everything Original Medicare covers and often add extra benefits like disease management programs, transportation, or reduced copays for inhalers.

Important: Copays, deductibles, and which inhalers/medications are covered can vary widely by plan, so it’s smart to review your options annually.

Answer: If I could change one thing about Medicare, I’d simplify the whole dang system—because right now, it’s like trying to do your taxes in another language while blindfolded.

Here's Why:

Medicare is needlessly complicated:

You've got Part A, B, C, and D—each with different rules.

Then there’s Medigap vs. Medicare Advantage, with very different networks, costs, and coverage.

Enrollment timing alone is a minefield: miss a deadline and you're stuck with penalties for life.

All of this confusion leads to:

Seniors picking the wrong plan.

Doctors not being covered.

Medications being too expensive.

Folks not getting the benefits they deserve.

If we could fix this one thing…

We’d see:

Less confusion and fewer costly mistakes.

More trust in the system.

Better health outcomes because people would actually understand their benefits.

The Bottom Line:

Medicare should work for seniors, not confuse the heck out of them. If we streamlined it—same core benefits, clear choices, easy access—it would truly feel like the safety net it was designed to be.

Answer: Start with the basics.

Clarify penalties and timelines.

Use real-life examples.

Introduce options.

Provide written summaries.

Answer: That really depends on your personal healthcare needs, budget, and priorities—because there’s no one-size-fits-all answer.

Answer: Did you know your Medicare plan might include hidden perks you're not using? From monthly OTC allowances and free gym memberships to dental, vision, hearing, meal delivery, and even rides to the doctor — many Medicare Advantage plans go way beyond basic coverage. Some even offer in-home help, teletherapy, and free smartphones for qualifying members. Don’t leave benefits on the table — check your plan or talk to a licensed agent to unlock everything you’re entitled to!

Answer: 5-Star Special Enrollment Period (SEP)

What it is:

A Special Enrollment Period that allows Medicare beneficiaries to switch to a 5-star Medicare Advantage or Part D plan, even outside of regular enrollment periods.

When:

Once per year, any time between December 8 and November 30 of the following year.

(Right after AEP ends on December 7.)

Who qualifies:

Anyone enrolled in Medicare who lives in an area where a 5-star rated plan is available.

You do not have to currently be in a 5-star plan — this SEP lets you switch into one.

What you can do:

Switch from any Medicare Advantage plan (even another 5-star) to a 5-star Medicare Advantage plan.

Switch from Original Medicare + Part D to a 5-star Medicare Advantage plan.

Switch Part D drug plans if a 5-star Part D plan is available.

Answer: 1. Initial Enrollment Period (IEP)

Who it's for: People turning 65 or newly eligible for Medicare.

When: Begins 3 months before, includes the month of your 65th birthday, and ends 3 months after (7 months total).

What you can do: Enroll in Part A, Part B, and/or a Part D drug plan or a Medicare Advantage (Part C) plan.

2. Annual Enrollment Period (AEP)

When: October 15 to December 7 every year.

What you can do:

Switch from Original Medicare to a Medicare Advantage plan or vice versa.

Change or enroll in a Part D prescription plan.

Switch from one Medicare Advantage or Part D plan to another.

Coverage begins: January 1 of the following year.

3. Medicare Advantage Open Enrollment Period (MA OEP)

When: January 1 to March 31

Who it's for: People already enrolled in a Medicare Advantage plan.

What you can do:

Switch to a different Medicare Advantage plan.

Drop your Advantage plan and return to Original Medicare (and optionally add Part D).

4. General Enrollment Period (GEP)

When: January 1 to March 31

Who it's for: Those who did not sign up for Part B during their Initial Enrollment.

What happens: Coverage starts July 1 and late penalties may apply.

5. Special Enrollment Periods (SEP)

When: Triggered by specific life events, such as:

Losing employer coverage

Moving to a new area

Qualifying for Medicaid or Extra Help

Other significant changes in your life or plan availability

What you can do: Make changes to your Medicare Advantage or Part D plans without waiting for AEP.

Answer: Medicare Area How Late Marriage Affects It

Part A May qualify for premium-free based on new spouse’s record after 1

year of marriage

Part B & D Premiums Joint income may raise costs via IRMAA

Employer Coverage May delay Part B if spouse is still working and has group health

Enrollment Periods SEP applies if you lose spouse's employer coverage

Discounts Some Medigap/Advantage plans offer household discounts

Answer: A Medicare Summary Notice (MSN) is a statement you receive every 3 months if you have Original Medicare. It’s not a bill—it shows the medical services you received, what Medicare paid, and what you may owe. Review it carefully to make sure the information is correct, compare it with your doctor’s bills, and keep it for your records. If you notice any mistakes or charges for services you didn’t receive, report them to Medicare at 1-800-MEDICARE.

Answer: Medicare can cover occupational therapy (OT) for arthritis or mobility issues, but coverage depends on the type of Medicare plan you have, the setting of the therapy, and specific requirements.

Answer: Yes, you can switch from a Medicare Advantage (MA) plan to Original Medicare mid-year if diagnosed with a serious illness, and you may be able to enroll in a Medigap plan, but there are specific rules and considerations:

Answer: When you enter a skilled nursing facility (SNF) for rehab, Medicare Part A typically covers up to 100 days per benefit period, provided you meet eligibility requirements (e.g., a qualifying 3-day hospital stay, skilled care needs, and admission within 30 days of hospital discharge). Here’s how it breaks down:

Days 1–20: Medicare covers the full cost of SNF care (assuming the facility is Medicare-certified and care is medically necessary).

Days 21–100: You pay a daily coinsurance ($204 in 2025), and Medicare covers the rest. Supplemental insurance (like Medigap) may cover this coinsurance.

After 100 days: Medicare Part A stops covering SNF care, regardless of whether you still need rehab or have transitioned to long-term care.

Answer: The worst Medicare-related decision is not enrolling in Medicare Part B when first eligible, without having creditable coverage from an employer or spouse’s plan. This can lead to lifelong premium penalties (10% per year delayed) and gaps in coverage, leaving you vulnerable to high medical costs. Always confirm eligibility and coverage options with Medicare or a trusted advisor to avoid this costly mistake.

Answer: Since you’re already on Medicare due to disability insurance and will turn 65 in October 2025, you do not need to sign up for Medicare again. When you turn 65, your Medicare coverage will continue seamlessly, but your eligibility reason shifts from disability to age. This happens automatically—no need to reapply.

Answer: Yes, it’s time for an overhaul. Medicare’s core structure doesn’t match today’s senior care needs. A system that prioritizes prevention, tech, and comprehensive benefits would better serve an aging, tech-savvy population. But the scale of change required—financially, politically, administratively—means it’ll likely come in fits and starts, not a grand redesign. For now, your best bet is leveraging Advantage plans or advocating for specific reforms like DTx coverage.

Answer: Medicare’s coverage for prescription apps and digital therapeutics (DTx) is limited but evolving, particularly for chronic conditions. Original Medicare (Parts A and B) typically does not cover DTx, as these tools often fall outside defined benefit categories. However, recent developments show some progress; so the answer would depend on what your currently using.

Answer: Medicare generally does not cover dental implants or most dental care, as it considers them non-medically necessary. Original Medicare (Parts A and B) typically only covers dental procedures if they are integral to a covered medical procedure, like jaw reconstruction after an accident. However, some Medicare Advantage (Part C) plans may offer limited dental coverage, including implants, but this varies by plan and often comes with restrictions or additional costs.

Answer: This is a fantastic idea. As research progresses and the results of different modalities become clear, I would be very interested to see this happen.

Currently, insurance companies are generally willing to cover only the "standards of care," which are guidelines developed by the AMA to ensure the public is protected from unproven or ineffective treatments. While there is considerable anecdotal evidence supporting alternative treatments, it is crucial to scientifically validate those that demonstrate positive outcomes and meet rigorous safety standards to safeguard public health.

I hope the new HHS director will approve funding for research into alternative therapies that show promise of beneficial outcomes for everyone. Fingers crossed!

Answer: What I like most about being a Medicare agent is the ability to make a confusing topic simple to understand and even simpler to implement.