Lillian Hill, Medicare Insurance Broker

Answer: The research used to answer this question indicates that the new Medicare Advantage audits are designed to protect beneficiaries—not take away nursing home benefits.

Nursing home coverage is NOT being cut

Benefits — like skilled nursing care after a hospital stay — should stay the same.

The audits are about plan's behavior, not care.

Medicare is making sure insurance companies:

- Follow the rules

- Don’t overcharge

- Don’t deny care they should approve

The goal is fairness — not taking anything away.

These changes may actually HELP seniors

By double‑checking the insurance companies to make sure they treat patients fairly, beneficiaries may see...

- Fewer unfair denials

- Faster approvals

- Less hassle getting the care needed

- More consistent rules that match Medicare

This is especially important for people who need skilled nursing or rehab.

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Answer: Medicare generally pays up to 80% of all medically necessary treatments, services, and devices—including many heart‑related medications and implantable cardiac devices—when they are ordered by a licensed medical provider and meet Medicare’s medical‑necessity criteria. Because every situation is different, I always recommend that the best starting point should begin with your health care team to confirm what is clinically appropriate for your condition. After that, you can verify how Medicare classifies and covers the service by contacting the Centers for Medicare & Medicaid Services (CMS) directly at 1‑800‑MEDICARE (1‑800‑633‑4227), or by reviewing your coverage at Medicare.gov.

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Answer: What a great question — let’s explore it together.

On the contrary. Medicare takes care of your health‑care exposures, but it doesn’t replace the financial protection or legacy planning that life insurance provides. And after almost twenty years walking seniors and families through these decisions, I’ve seen a clear pattern: life insurance is always most affordable and easiest to secure when you’re younger and generally healthier. By the time folks reach Medicare age, the conversation shifts from “Do I want it?” to “Can I still qualify, and does it still serve my goals?”

I’ve sat with families who were grateful they put coverage in place early, and I’ve sat with families who wished they had. Those moments stay with you. They shape how I guide people today — with honesty, compassion, and a focus on protecting the story you’ve built and the people who will carry it forward.

A simple needs analysis brings everything into focus. It helps you look at:

What you want covered at the end of life

How a spouse or loved one would be affected financially

Any debts or medical balances that could fall to your family

The legacy or gifts you want to leave

Long‑term wealth or generational goals

Whether your current age and health still support the coverage you want

Medicare covers your health.

Life insurance helps cover your impact — the part of your life that continues for the people who will carry it forward.

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Answer: Thank you for your question.

It does not matter whether your disability was caused by an accident, an injury, a chronic condition, or a sudden medical event. To qualify for Medicare through disability, the key requirement is the 24‑month SSDI waiting period.

Once approved by Social Security for Social Security Disability Insurance (SSDI), your 24‑month clock begins as soon as your SSDI benefits start.

After you have received 24 months of SSDI, you automatically qualify for:

Medicare Part A (Hospital Insurance)

Medicare Part B (Medical Insurance)

Once you reach the 24‑month mark, your Medicare card should be mailed to you, showing the date your coverage begins.

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Answer: A little background information that ties into this question—before I became a licensed insurance agent, I worked as a third‑party debt collector on unpaid medical bills. I heard the same line again and again: “My insurance is responsible for that bill.” 😱

Today, the wording has changed, but the frustration remains:

“I have Medicare. Why am I being billed?”

Many people assume that once they enroll in a health plan—whether over 65 or under 65—their costs should end. I understand why it feels that way, but most health plans, including Medicare, will have out‑of‑pocket costs.

Here’s the simple truth:

Medicare is not full coverage.

It typically pays up to 80% of medically necessary services.

So, beneficiaries may still face deductibles, copays, coinsurance, and costs for services Medicare doesn’t cover, such as dental, vision, and hearing.

After a major “tsunami” moment concurred in my personal life, I shifted careers—and I now see how necessary both paths were. My work in medical debt collections showed me how often people struggled to understand their coverage and financial responsibilities. That experience prepared me for the work I do today, helping individuals navigate their benefits and build long‑term security while easing some of the frustrations that comes from trying to understand a system that can be complex.

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Answer: What a great question! Working with an independent insurance broker is my first recommendation. An independent broker can guide you, compare companies, answer your questions, and enroll you in new options that may save you money.

You may also choose to use Medicare’s official tools to compare prices.

Go to Medicare.gov and click “Find Plans.”

Type in your ZIP code

Add your prescriptions (if you have any)

Compare plans by total yearly cost, not just the monthly premium

This shows you which plans give you the best price for the same benefits.

You can also contact Medicare for help:

1‑800‑MEDICARE (1‑800‑633‑4227)

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Answer: What a great question. Whether a memory check or neurologist visit is covered can depend on whether the service is considered preventive or diagnostic, and that can vary from person to person.

Because everyone’s health needs are different, and Medicare plans can work differently, it’s important to talk with your medical team about what services are appropriate for you.

You can also contact the Centers for Medicare & Medicaid Services (CMS) at 1‑800‑633‑4227 (TTY 1‑877‑486‑2048) to get official information about what Medicare may cover in your situation.

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Answer: Hi, thanks for your question!

Typically offered by the State's Medicaid, assistance program, and depending on what an individual qualifies for whether QMB, SLMB, QI, QDWI, can receive help to pay Medicare premiums for Part A, Part B, as well as Deductibles and Coinsurance costs. Anyone in need should contact their local state office.

Programs:

QMB — Qualified Medicare Beneficiary

SLMB — Specified Low‑Income Medicare Beneficiary

QI — Qualified Individual

QDWI — Qualified Disabled & Working Individuals

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Answer: Answering medical questions to qualify for a health care policy is called underwriting, and highly routine. The only times you do not have to answer these questions are when you have a protected Special Enrollment Period (SEP) that gives you guaranteed‑issue rights.

The Annual Enrollment Period (AEP)—October 15 to December 7 each year—is not a protected time for Medigap. You can switch your plan during AEP, but you may have to prove your insurability by answering health questions unless your plan change is caused by a situation that gives you guaranteed‑issue rights, such as:

- Moving out of your Medicare Advantage plan’s service area

- Your plan ending, terminating, or reducing its contract

- Other qualifying involuntary losses of coverage

In these situations, you are protected by a guaranteed‑issue SEP and can enroll in a Medigap plan without answering health questions.

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Answer: Specific data points on the disadvantages of Medicare Advantage Prescription Drug (MAPD) plans — not opinions — should come directly from the Centers for Medicare & Medicaid Services (CMS). CMS publishes the scientific, numbers‑based information that explains what these plans do well and where they fall short. You can look this up on CMS.gov, use the CMS Data Explorer for more detailed reports, or call Medicare and they will help walk you through the information.”

Medicare (CMS) phone number: 1‑800‑MEDICARE (1‑800‑633‑4227)

TTY: 1‑877‑486‑2048

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Answer: As a rule, Medicare will not drop you because of your health, and your coverage stays in place as long as you remain eligible and keep your Part B premium paid while also being required to meet an annual deductible.

The exception on what can change are the private plans that work with Medicare—such as Medicare Advantage, Medigap, or Part D—because insurance companies can adjust benefits, raise premiums, or discontinue a plan.

When or if that occurs, you, or the plan itself may be changing, and Medicare simply requires you to choose a new option. If you move out of a plan’s service area or a private plan ends its contract, you may need to select a new plan, but your right to Medicare coverage does not end. 🦉

Answer: Terminations, non‑renewals, or reductions in the service area of any Medicare Advantage Prescription Drug (MAPD) plan can happen for several reasons. That may include rising costs, new requirements or regulatory changes from CMS, or the plan no longer being financially sustainable for the insurance company to continue offering.

If your plan is discontinuing the most accurate information about why your plan is ending will be in the letter your insurance company will mail you. Medicare can also confirm whether the plan was ended by the company or by CMS, and the next steps available for you.

Answer: AEP is the once‑a‑year window for anyone with a Medicare Advantage Prescription Drug Plan (MAPD) or a stand‑alone Part D drug plan to look at what they have and decide whether it still fits. It’s not a requirement to change. It’s simply the period when changes are allowed.

Most seniors only need to act if something in their plan, health, or medications has shifted. Think of this as a time to go Medicare shopping, should you choose.

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Answer: Medicare Advantage plans use competitive marketing — including gift card incentives — to get your attention. While these can feel like gimmicks, the OTC benefits can genuinely help your budget.

What matters most is choosing a plan that truly fits your needs. If multiple plans are available in your ZIP code, you’re not limited to one. Compare your options and choose the plan that supports your health now and protects you in the future. Confirm your doctors, drug formulary, pharmacies, hospitals, and out‑of‑pocket costs all align with your needs and budget.

If a plan doesn’t meet those basics, it’s appropriate to choose another carrier. Supplemental perks may add value, but the right plan is the one that fits you or your family member — not the one with the flashiest promotion.

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Answer: As someone who once served as the official caregiver for my beloved mother, I know how important it is to make sure our parents receive the care — and the cost savings — they deserve. When it comes to evaluating Medicare drug costs, here are two effective ways to compare plans for overall value:

1. Contact a licensed Medicare agent or broker:

A licensed agent can simplify the process by reviewing your parent’s prescriptions, check each plan’s formulary, compare costs across multiple companies, and give a clear picture of the total annual cost.

2. Use the Medicare.gov Plan Finder:

The Plan Finder tool on Medicare.gov allows you to enter your parent’s prescriptions, choose preferred pharmacies, and compare plans by total yearly cost, not just premiums. It’s one of the ways to see which plan offers the best overall savings.

For additional verification or questions, you can contact Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227).

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Answer: I advise my clients to understand that a Medicare plan should take good care of you today and still be there for you if your health ever takes a major—or heaven forbid, catastrophic—turn tomorrow.

Answer: Often, when I think about Health Maintenance Organization Plans (HMOs) from a personal standpoint, the out‑of‑pocket costs, network rules, and limits on seeing specialists or certain hospitals can feel like disadvantages — but that really depends on who you ask. Many people actually view the structure of having all their medical services bundled into one coordinated package as an advantage.

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Answer: Be sure to check with your medical providers to confirm coverage, acceptance, and that services are coded correctly. This helps prevent unexpected bills and ensures your benefits are applied the way Medicare intends.

You can also verify your coverage directly through Medicare.gov or by calling 1‑800‑MEDICARE (1‑800‑633‑4227), TTY 1‑877‑486‑2048, for confirmation of how a service should be covered.

Answer: Many people assume that $0‑premium Medicare Advantage plans are “free,” but they’re not. Out‑of‑pocket (OOP) costs can catch beneficiaries off guard. These costs are disclosed during enrollment, but until someone actually needs care, they often feel hypothetical. In reality, co‑pays, deductibles, and coinsurance can add up quickly — and while plans do have a Maximum Out‑of‑Pocket (MOOP) limit, that cap can still reach several thousand dollars.

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Answer: MAPD plans are being reduced in some areas, so it’s smart to stay alert. If keeping your current doctors is important, check with their offices to see whether they expect any network changes. You can also review your carrier’s financial stability and talk with your agent about other plan options in your area in case you ever need to switch or replace your existing coverage.

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Answer: Subjectively: it depends on individual preferences of time and convenience.

Objectively: there are obvious distinctions of observations one can make on body language, social skills, area knowledge, logistics and vibes.

Ultimately: both options can work well depending on what is valued most.

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Answer: Sales, marketing, educational, let's classify them as navigational steps with clear goals: To inform, advise and enroll in the best plan options for Medicare beneficiaries. Remember there are...

-No obligations

-No pressure

-Yes opportunities to meet and network with licensed representatives .

Attend. Enjoy!

Answer: It can all seem overwhelming at times. The Centers for Medicare and Medicaid Services (CMS) only regulates the content of information that is being heavily disseminated, to ensure that the offers are accurate and not misleading. CMS does not regulate the amount of tv, and mail ads permitted. Federal advertising laws allows advertiser's a wide, broad spectrum to promote their products.

The confusion is likely due to industry terminology and the vast number of plan options that are being offered. If you are in the market for a plan, be sure to contact a licensed insurance agent-broker for clarification and helpful navigation of the choices with confidence.

Answer: It may be advisable to reach out to a qualified medical support team to help you to build a routine of techniques and exercises to be implemented to de-stress whenever situations begin to feel threatening and overwhelming.

May you truly enjoy retirement! 💯Or perhaps you may consider going back to work?

Answer: Delaying your Social Security benefits until age 70 may be a smart financial choice. However, if you are not receiving Social Security checks when you turn 65, you will not be automatically enrolled in Medicare.

You can sign up for Medicare through the Social Security Administration (SSA) by calling 800‑772‑1213 (TTY 800‑325‑0778). They can walk you through the steps to avoid Medicare late‑enrollment penalties. This includes reviewing any creditable health or drug coverage you may already have—such as insurance from continuing to work, staying on an employer plan, or being covered under a spouse’s plan. To avoid processing delays, contact SSA in as much advance as possible.

In anticipation of an awesome 65th! 🎉

Answer: Start by reviewing your current Medicare coverage. If you have Original Medicare with a Medigap (Supplement) plan, access to specialists is generally straightforward with minimal barriers. However, if you’re enrolled in a Medicare Advantage Prescription Drug Plan (MAPD), you may encounter a more complex process. MAPD plans use networks, may require prior authorizations, can deny certain services, and often involve additional out‑of‑pocket costs through co‑pays, deductibles, and coinsurance. Even so, your Primary Care Team will work to guide you toward the best available care.

The best to you! 💯

Answer: I salute you for your enrollment in a Medicare Supplement (Medigap) Plan F. In the insurance industry this plan has long been hailed as the "Cadillac" of Medigap coverage—here is why: after you pay your premiums (monthly, semi-annually, or annually), there are no additional out of pocket costs to you. That's right no co-pays, no-deductibles, and no-coinsurance.

Bottom Line:

With Plan F, emergency room visits are fully covered as long as the treatments are Medicare approved and/or medically necessary.

Congratulations on a wise choice🦉

Answer: My recommendation regarding this question is for you to speak with you tax preparer or contact the Centers for Medicare and Medicaid Services (CMS) to ensure that your particular set of medical circumstances and eligibilities for Tax related purposes and credits are not missed.

All the best!

Answer: Available options for dental, vision and hearing (DVH) benefits can be purchased from a stand-alone plan, or you may choose to enroll in a Medicare Advantage Prescription Drug (MAPD) that will include these additional benefits.

Option 1 scenario: You currently have Original Medicare with parts A, B and D. A stand-alone for dental, vision and hearing (DVH) will complete your basic medical needs.

Best for:

Option 2 scenario: You currently have a Medicare Advantage Prescription Drug (MAPD) which is also your Medicare part C. This plan will provide options to cover all or most of your basic medical needs.

Such a noteworthy inquiry! 😀

Answer: Several factors to be considered.

What phase of Medicare are you in?

For example:

If your plan enrollment in Part B is to take place during the guaranteed period of turning 65, then you will not be disqualified as having a pre-existing condition. During this enrollment period, no health questions (underwriting) are to be asked.

If you can prove having credible health care that did not include a break in coverage longer than 63 days, the pre-existing waiting period may be waived.

If outside of the guaranteed issue window, you are approved by underwriting, and a Medigap policy is issued, then pre-existing conditions may impact your plan G coverage by stipulating a waiting period before benefits will pay.

Answer: A good rule of thumb to follow is that if it is medically necessary and ordered by a primary care provider, Medicare will most likely approve it. If it is cosmetic or elective, it is unlikely to be approved. However, be sure to discuss it with your medical team whenever you have questions.

Good question.

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Answer: That is easy, peasy, breezy. $0 premiums do not mean free.

Easy: Original Medicare outsources or contracts with private insurance companies to manage the beneficiary's Parts A and B services. For each member who enrolls into a Medicare Advantage (MA, or MAPD) plan, the government pays the insurance company a fee.

Peasy: The member will also pay fees called out-of-pocket costs (OOP) up to an annual maximum amount known as deductibles, co-pays, and coinsurance.

Breezy: The amounts paid to insurance companies by the government are generally adequate to cover all the basics; therefore $0.00 premiums can be offered to the members.

What a great question.

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Answer: Plan changes are ongoing from one year to the next. Plan redesigns—changes in formularies—reduction in annual out-of-pocket maximums, and the elimination of the coverage gap (Donut-Hole) could be some of the reasons for higher costs. Always compare your plan benefits with a licensed agent during AEP.

Answer: Yes. Below are some examples:

Part A. If you are an inpatient in the hospital.

Part B. If you are receiving an outpatient procedure.

Part C. Through your Medicare Advantage Prescription Drug Plan (MAPD).

Part D. Stand-alone prescription drug plan.

*Costs may vary by plans and drug tier formularies.

Wishing you the best!

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Answer: The impact of changes to Medicare on beneficiaries for the upcoming year, are not yet clearly defined. Many on Medicare are adopting a wait-and-see approach; however, those who are practical and proactive may want to start laying the groundwork of preparedness.

This could mean higher out of pocket costs, so be sure to compare plan benefits.

Sign up with an advocacy group in your area.

Work closely with your licensed agent-broker.

Thank you for asking such a great question. I hope my response has been helpful.

Extending my best...

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Answer: The time is now as the Medicare Annual Enrollment Period is ongoing, from October 15, through December 7, 2025. During this time, you may switch your Medicare Advantage Prescription Drug plan (MAPD) from one plan to another. This is why it is highly recommended to compare the benefits of what is being offered from the different insurance companies for the upcoming plan year of 2026. This and so much more.

You may also have additional opportunities to change your plan throughout the year by qualifying for one or more special enrollment periods (SEP) which range from a "move" "plan closure" "delayed part B., "change in Medicaid" among others. Contact your agent ASAP!

Seize your moment!

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Answer: Beginning with a needs analysis to establish priorities of each individual that I counsel and represent. During these processes my client details what matters most to them in areas such as budget, medical providers, pharmaceuticals, travel, dental, vision, hearing, over the counter benefits (OTC), wellness-lifestyle benefits and most especially pre-existing health issues and underwriting qualifications. We figure it out together.

This is a great question, and I am glad you brought it up!

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Answer: Do you define Medicare advisors as licensed Insurance agents and brokers? If so, allow me to speak for the procedure of my insurance practice: My instructions are to only work with the adjudicated Power of Attorney (POA). My training advises me to discontinue engagement once any cognitive condition or issue becomes apparent, as legally this person may no longer be qualified to act as their own decision maker.

Thank you for your great question!

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Answer: There may be a few exceptions:

Nearly all hospitals and medical facilities do accept Original Medicare.

You can receive medical services at all hospitals and facilities that participates in Medicare.

In the case of a medical emergency, you are allowed to be transported to the nearest hospital.

...Exceptions are:

Private facilities such as the VA and Military hospitals for anyone who are not current or former active-duty members will not be accessible.

Public or private hospitals that do not accept Medicare assignments or payments.

If you have a Medicare Advantage plan (MAPD) you may incur additional costs if you are treated out of network.

If this does not adequately answer all of your concerns, feel free to reach out again. Your questions are always welcomed.

Take care!

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Answer: After your first 24 months on Disability, you should already have Medicare Parts A and B.

For original Medicare, age 65 is that magic (key milestone) number. At this time, your disability-based Medicare benefits will automatically transition to those managed through the Centers for Medicare and Medicaid Services (CMS). Feel free to verify your status with the Social Security Administration (SSA).

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Answer: Strongly recommended! A hospital admission can tally up into a sizeable amount in out-of-pocket costs with Co-pays, coinsurance and deductibles. The right Hospital Indemnity plan can ensure that these costs can be managed more comfortably and predictably. Hospital Indemnity plans can be a great way to add more protection and financial safeguards for peace of mind.

Answer: Insurance is for the "in case if, or when the unthinkable, or catastrophic" occurs, you are protected. The time to purchase insurance is when you are healthy. Another aspect of insurance pricing is that risks are shared so that healthy members share the cost of paying for members who are less healthy, and as we age is also becomes a factor in cost.

Options for you maybe to change your coverage type. You may want to try a high-deductible plan. Some plans offer a household discount, and you most assuredly want to compare plans annually for a plan with a lower premium, but same benefits.

With good health you are already a winner!

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Answer: Hi!

Congratulations that you have been grandfathered into Medigap Plan C, an oldie and a goodie.

Things to consider...

1. Ordered by a Medicare participating Dr.

2. Performed by an approved Medical Lab

3. Is Medicare Approved

If yes, to all above then reasonable and customary indicates that under ordinary circumstances you should not have any out-of-pocket costs. Your Medigap C should take care of any remaining costs after claims are filed and paid under Medicare Part B.

*To ensure this procedure is medically necessary, always check with your medical provider.

Best wishes,

xoxo

Answer: It is most unfortunate for you to feel that there are disparities in your demographics regarding your Medicare health benefits. Contact Medicare toll-free, 24/7. Exceptions may be given on certain holidays.

My best,

xoxo

Answer: After a qualified diagnosis is provided by a member of the Medicare beneficiary's medical team, the therapeutic actions, prognosis, and prescribed treatments deemed medically necessary will be covered by up to 80%. Some network plans may require a referral.

Answer: If you have Part D. Benefits the best place to find that information is on your plan's formulary. However, further research indicates that you should check with your PCP, and if this medication is administered by their office, it may be covered under Part B. Let me know if you decide to consider the latter option.

My best to you,

Have a great day!

Answer: In order for a medication to be covered the beneficiary of Medicare, must either have a Part D prescription drug plan, or a Medicare Advantage Prescription Drug Plan (MAPD). Coverage and cost may vary by plans. Some restrictions may apply.

Answer: Did you know that Medicare Supplement and Medicare Advantage plans are both healthcare selections, however they provide benefits to members in a different way? That is where a licensed, certified agent-broker can help you navigate the sometimes-confusing landscape of your new healthcare options. With personalized attention, and current year plan comparisons. It is important to have guided support (at no additional cost) to help ensure that you are making the best choices available.

Answer: Absolutely! You always want to be aware of any changes to your plan such as premium costs, out of pocket costs, increases or reductions or if any changes occur to your plan itself. Reviewing your ANOC is the barometer by which you evaluate and compare benefits for the upcoming plan year.

Have you evaluated your recent ANOC? Have you any concerns? Are you satisfied, but may wish to explore additional options that you may qualify for?