Linda Davies, Medicare Insurance Broker

Answer: Post enrolllment, Medicare brokers have the opportunity to assist seniors with disabilities in managing Medicare insurance business.

Answer: Both Original Medicare and Medicare Advantage plans must cover up to 100 days of skilled nursing facility (SNF) care during a benefit period. 



To qualify for SNF coverage, beneficiaries generally need to have been admitted to the SNF within 30 days of a 3-day hospital stay. 



Both cover skilled nursing services and therapy services that are ordered by a doctor and medically necessary. 



The SNF must be Medicare-approved. 

Answer: It is important to understand that original Medicare (Parts A and B) does not cover prescription drugs, dental, vision, hearing, long-term care, and other out-of-pocket costs like co-pays and co-insurance.

Your health status, financial situation, and additional healthcare needs are all important factors to be considered when enrolling into Medicare.

Answer: When enrolled in a Medicare Advantage plan, you will receive your Part A and Part B benefits through your Medicare Advantage plan except for hospice care which you will continue to receive through Part A.

Answer: Medicare Supplement plans, including Medigap Plan G, typically covers surgeries deemed medically necessary. However, if the surgery was scheduled before you enrolled in the Medigap plan, the coverage may depend on the specific terms of your Medigap plan and the circumstances of the surgery. It is essential to review your Medigap policy details and consult with your insurance provider to understand the coverage for your surgery.

Answer: Guaranteed Issue Rights (GIR) for Medicare Supplement, also known as Medigap protection, allows beneficiaries to purchase a Medigap policy without medical underwriting. This means that the insurers cannot deny coverage or charge higher premiums based on pre-existing health conditions. These rights apply in specific situations, such as losing employer or union coverage, returning to Original Medicare, or moving out of a Medicare Advantage plan service area. They are designed to protect seniors from unfair medical underwriting and ensure they can obtain a Medigap policy without being denied or charged higher premiums due to their health status.

Answer: Yes, you may be eligible for a Special Enrollment Period (SEP) if you lose your employer health coverage. This SEP typically lasts for 8 months following the loss of your coverage, allowing you to enroll in Medicare without facing penalties. It’s important to inform Medicare of your loss of coverage to ensure a smooth enrollment process.

Answer: Yes, you can enroll in Medicare even if you have never paid into Social Security due to working overseas.

Keeping in mind that someone who have never worked or worked for fewer than ten (10) years may have to pay a monthly premium for Part A (hospital coverage).

Answer: When you move to a different state, your Medicare Part A and Part B will not change in terms of medical and hospital coverage, but available plan options and costs will vary based on the state you live in and companies that sell the plans there.

An agent can assist you with important steps to take to avoid a disruption in coverage.

You will also need to find doctors and healthcare professionals that participate in your new plan’s network as well. An agent can help with that too.

To find out how to connect with a local Medicare office once you have moved to a new state, call 800-MEDICARE.

We’ve got you covered on both ends!

Answer: The specific costs can vary depending on the plan. Some plans may offer coverage that is more robust than the standard design, so there is some plan-to-plan variations.

Given the financial implications of the Medicare donut hole, understanding how your plan impacts your drug costs can help you make better decisions.

Having the donut hole conversation is the best approach to maximizing your Medicare benefits and minimizing your costs.

Answer: Yes, you can use an HSA to pay for Medicare premiums and other qualified medical expenses, even after you enroll in Medicare. However, you can no longer contribute to the HSA once you've enrolled in Medicare.

You can use your HSA funds to pay for various Medicare expenses, including premiums for Part B, Part D, and Medicare Advantage (Part C).

You can also use it for qualified medical expenses like copays, coinsurance, and deductibles.

You cannot use HSA funds to pay for Medicare Supplement (Medigap) premiums.

Once you enroll in Medicare, you are no longer eligible to make contributions to your HSA. However, you can still utilize the money already in your account for qualified medical expenses.

After turning 65, you can withdraw money from your HSA for non-medical expenses, but these withdrawals will be taxed as ordinary income.

Answer: Medicare may cover cataract surgery that implants conventional intraicular lenses, depending on where you live. Medicare doesn’t usually doesn’t cover eyeglasses or contact lenses. Medicare Part B (medical insurance) covers one pair of eyeglasses with standard frames (or one set of lenses) after each cataract surgery that implants an intraocular lens.

After you meet the part B deductible, you pay 20% of the Medicare approved amount to both facility and the doctor who performs your surgery.

Therefore, after you meet the part B deductible, you pay 20% of the Medicare approved amount for both intraocular lenses and the surgery to implant it.

If Medicare covers cataract surgery in your area, you can get it using traditional surgical techniques or lasers. Speak with your physician and health plan provider.

Answer: Yes, Medicare Part B covers a colonoscopy every 2 years (24 months) for individuals at high risk of colorectal cancer, such as those with a family history of the disease, inflammatory bowel disease, or polyps.

Answer: You are paying more for your Medicare Part B and Part D premiums due to the Income-Related Monthly Adjustment Amount (IRMAA).

IRMAA is a surcharge added to Part B and Part D premiums for those with higher incomes, based on their Modified Adjusted Gross Income (MAGI) from two years prior.

Answer: An agent can help you understand your options, find the right plan for your needs, and even assist with enrollment and ongoing support.

Answer: The plan you choose will depend on your individual needs, preferences, and priorities. It is important to carefully weigh the pros and cons of each plan and consider factors like provider network, cost, and additional benefits. Consulting with a qualified Medicare expert can provide personalized advice and help with making an informed decision.

Who might consider Original Medicare:

1. Individuals who value flexibility and choice: With Original Medicare, you can choose any doctor, specialist, or hospital in the U.S. that accepts Medicare. This can be attractive for those who have preferred providers or want to avoid network restrictions.

2. Those who prefer a fee-for-service model: Original Medicare operates on a fee-for-service basis, where you pay a portion of the cost of covered services, and Medicare pays the rest. This can be a simple and straightforward approach for some individuals.

3. People who may have a Medigap policy: Many people with Original Medicare also have a Medigap policy (supplemental insurance) to help cover some of the out-of-pocket costs, like deductibles and coinsurance. This can make Original Medicare more financially manageable.

4. Those who may not need extensive additional coverage: Original Medicare provides a good foundation of healthcare coverage, and some individuals may not need or desire the added features and benefits offered by Medicare Advantage plans, such as additional coverage for vision, dental, or hearing.

5. Individuals who want to avoid network restrictions

Who might consider Medicare Advantage:

Individuals who prefer all-in-one coverage with low premiums and copays limited by an out-of-pocket maximum .

Those who live in areas with broad networks and don't mind getting referrals .

Individuals who can't afford a Medicare Supplement (Medigap) plan or who have a lower premium requirement .

Those who prioritize extra benefits like dental, vision, and hearing coverage .

Answer: Yes, Medicare premiums, including those for Parts B, D, and Advantage (Part C) plans, are generally considered tax deductible as a medical expense if you itemize deductions on your tax return. To be eligible, your total unreimbursed medical expenses, including Medicare premiums, must exceed 7.5% of your adjusted gross income (AGI).

Here's a more detailed explanation:

Itemized Deductions:

You can't deduct these premiums if you choose to take the standard deduction instead of itemizing.

Medical Expense Threshold:

Only the portion of your medical expenses that exceeds 7.5% of your AGI is deductible. This includes Medicare premiums, co-payments, deductibles, and other qualified medical expenses.

Self-Employed:

If you are self-employed, you may be able to deduct your Medicare premiums as a self-employed health insurance deduction.

Other Deductible Medical Expenses:

Besides Medicare premiums, you can also deduct other qualified medical expenses, such as hospital bills, doctor visits, prescription costs, dental care, and certain home modifications

Answer: If your doctor deems it medically necessary, they can request prior authorization from your insurance company to get the brand-name drug if it's not readily available in generic form.

Answer: Yes, you will likely be penalized if you don't enroll in Medicare Parts A and B when you are first eligible, which begins three months before your 65th birthday. You'll incur a late enrollment penalty for each part if you don't enroll within your Initial Enrollment Period.

Here's a more detailed explanation:

Part B Late Enrollment Penalty:

If you don't sign up for Part B when you're first eligible, your monthly Part B premium will increase by 10% for each 12-month period you were eligible but didn't enroll. This penalty is added to your premium and continues for as long as you have Part B.

Part A Late Enrollment Penalty:

If you have to purchase Part A (because you don't qualify for it automatically based on your work history) and don't enroll during your Initial Enrollment Period, you'll also face a late enrollment penalty. This penalty is 10% of your monthly premium and you'll have to pay it for twice the number of years you were eligible but didn't enroll.

Exceptions to Late Enrollment Penalties:

There are some exceptions, including if you have qualifying coverage from your employer or spouse's employment. You may also be able to enroll during a Special Enrollment Period if you meet certain conditions. Additionally, if you have limited income and are eligible for a Medicare Savings Program, you may not be penalized.

Part D Late Enrollment Penalty:

If you don't enroll in a Medicare Part D plan (for prescription drug coverage) and don't have creditable drug coverage, you'll also face a late enrollment penalty. This penalty is 1% of the national average premium for each month you were eligible but didn't enroll.

Answer: Yes, Medicare does cover continuous glucose monitors (CGMs) that connect to smartphones, but with specific conditions. Medicare coverage for CGMs is available when the glucose data is displayed on a standalone receiver (a durable medical equipment, or DME) that is also transmitted to a compatible smartphone or other personal device. This means the receiver must be used at least some of the time for Medicare coverage to apply.

Answer: An agent can help seniors better understand a Part D plan formulary and how it aligns with their specific medication needs. It is also important not to overlook coverage restrictions like prior authorization or tiered drug costs, which can lead to unexpected expenses or inability to access necessary medications.

Answer: No, Medicare doesn't pay for all emergency transports. Original Medicare (Parts A and B) generally covers emergency ambulance services, and some non-emergency transports in specific circumstances. Medicare Advantage plans may offer broader transportation coverage.

See your plan’s evidence of coverage to know more about any transportation benefits.

Answer: Seniors may miss their IEP, which is a seven-month period around age 65, or miss a Special Enrollment Period if they continue working past 65.

Some seniors believe they have adequate coverage through a current employer, retiree plan, or other insurance and delay enrolling in Part B, only to find it doesn't qualify as creditable coverage.

Some individuals are simply unaware of the importance of enrolling in Part B when eligible, or don't understand the rules surrounding enrollment deadlines.

If they don't enroll during their Initial Enrollment Period (IEP) or Special Enrollment Period (SEP) and don't have creditable coverage from another source. These penalties are a 10% increase to the Part B premium for each 12-month period they delayed enrollment. The penalty is designed to encourage timely enrollment and maintain a balanced risk pool for Medicare.

Some seniors pay penalties on Medicare Part D, primarily because they either missed their initial enrollment period or didn't maintain continuous coverage through creditable prescription drug coverage. This penalty is a monthly add-on to their Part D premium, calculated as 1% of the national base beneficiary premium for each month they lacked coverage.

The penalty aims to encourage individuals to enroll in Part D when they become eligible to ensure they have consistent coverage for prescription drugs. Without a penalty, some individuals might delay enrolling in Part D until they need costly medications, shifting costs to those who enroll promptly.

The penalty also discourages people from dropping Part D coverage and then re-enrolling later when they need expensive drugs, potentially straining the program.

Answer: Medicare Part B (Medical Insurance) covers medical nutrition therapy services if you have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months. A doctor must refer you for the services.

Initial coverage includes 3 hours of medical nutrition therapy services in the first calendar year. These hours can’t be carried over to the next calendar year. If your doctor decides a change in your medical condition requires a change in your diet, they can give you a referral for more hours beyond the initial coverage. You may get up to 2 hours of follow-up services each calendar year, after the year you got your initial coverage.

Answer: Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don’t pay for long-term care. This type of care (also called “custodial care” or “long-term services and support”) includes medical and non-medical care for people who have a chronic illness or disability.

Most long-term care isn’t medical care. Instead, most long-term care helps with basic personal tasks of everyday life, sometimes called “activities of daily living.” This may include:

Help with personal care assistance (like dressing, bathing, and using the bathroom)

Home-delivered meals

Adult day health care

You might qualify for long-term care through Medicaid, or you can choose to buy private long-term care insurance.

You can get non-medical long-term care services at home, in the community, in an assisted living facility, or in a nursing home. It’s important to start planning for non-medical long-term care now to maintain your independence and make sure you get the care you may need, in the setting you want, now and in the future. If you’re an American Indian or Alaska Native, contact your local Indian health care provider for more information.

Answer: Medicare Part B typically covers 80% of the approved amount for physical therapy services after you meet your annual deductible, which is $257 in 2025. You are responsible for the remaining 20% (coinsurance), any copay, and costs not covered by Medicare.

Answer: The cost of insulin in Medicare Part D could have increased due to a few factors. The Inflation Reduction Act of 2022 capped insulin costs at $35 per month for Medicare beneficiaries, but if your plan doesn't meet this requirement or if your insulin is covered on a higher tier, your out-of-pocket costs could be higher.

Let’s review your Part D plan to find out why your costs might be increasing and what steps you can take.

Answer: If you are already eligible for Medicare (65 or older, or disabled), dialysis coverage begins immediately. If you're under 65 and only eligible due to ESRD, Medicare coverage will usually start on the first day of the fourth month of dialysis treatments.

Answer: If you have premium-free Part A (meaning you or your spouse worked long enough to earn it), you can typically delay enrollment until you are no longer covered by your spouse's employer plan.

You will need to enroll in Medicare Part A within eight months of losing that coverage or your spouse's retirement in order to avoid late enrollment penalties.

Answer: Medigap plans are federally standardized, meaning they offer the same coverage regardless of where you live. This means your basic coverage will continue to apply in Florida.

However, I would check for any price difference for your plan between the states.

Answer: If you are within your Medigap Open Enrollment Period or qualify for guaranteed issue rights, it is illegal for an insurance company to deny you a Medigap policy solely based on your health history.

However, if you apply outside of these protected periods, insurance companies are generally allowed to consider your health history during the underwriting process and could deny your application or charge you higher premiums.

It's highly recommended to apply for a Medigap policy during your Open Enrollment Period or if you have guaranteed issue rights to ensure guaranteed acceptance and potentially lower premiums.

Answer: There's no one-size-fits-all answer to any plan option. The optimal choice depends on individual circumstances, including your health status, budget, and preferences for flexibility in choosing doctors and hospitals.

Let’s explore plan options suitable to your individual needs. Give me a call or message with a good time to talk. And thanks for asking.

Answer: You can choose a Medicare Advantage plan to cover things that Original Medicare doesn’t cover like dental, vision, hearing, chiropractics services, and routine foot care.

Also, Original Medicare or Medicare Advantage will only cover cosmetic surgery if it is deemed medically necessary.

Answer: A caregiver can find help sorting out a client's medical bills through several resources. Let’s try Silverbills.com first. Let me know.

Answer: While Medicare covers certain telehealth services, standard cost-sharing (coinsurance and deductible) may still apply.

The National Rural Health Association (NRHA) supports Medicare and Medicaid reimbursement for telehealth services that demonstrate efficacy and cost-effectiveness.

Medicare coverage and policies are subject to change. For the most up-to-date information, it's recommended to consult the official Medicare website or your healthcare provider.

Answer: To find a dentist who accepts your Medicare plan, start by checking your plan's website for a provider directory. You can also use online tools like Zocdoc, Aetna's provider search, or Humana's dentist finder, specifying your plan and location. If you have a Medicare Advantage plan, check if it includes dental coverage and use their specific provider search tool.

Here's a more detailed breakdown:

1. Check your plan's website:

Many insurance companies, like Aetna, Humana, and Wellcare, have online tools to search for dentists in their network. You'll typically need to enter your plan type, ZIP code, and network name (found on your insurance card).

2. Use online directories:

Websites like Zocdoc allow you to search for dentists by location and filter by those who accept Medicare.

3. Verify coverage with your plan:

Even if a dentist is listed as a network provider, it's a good idea to confirm with your plan directly that they accept your specific plan and what the coverage details are.

4. Consider Medicare Advantage plans:

If you have a Medicare Advantage plan, it might include dental coverage, and you can find participating dentists through your plan's provider directory.

5. Consult the official Medicare website:

The official Medicare website provides general information about dental coverage and can guide you to resources for finding providers.

6. Consider Community Health Centers:

These centers often offer dental services on a sliding scale for those with limited incomes.

7. Contact your State Health Insurance Assistance Program (SHIP):

SHIPs can provide free and unbiased counseling about Medicare benefits and help you find dentists who accept Medicare.

Answer: Even if you don't utilize your Medicare plan extensively, the rising costs of healthcare overall, the increasing number of Medicare beneficiaries, and the program's funding structure contribute to annual premium increases.

If you're concerned about your Medicare costs, here are some recommendations:

1. Review your income and consider strategies to manage it to potentially reduce IRMAA.

2. Contact Medicare or a State Health Insurance Assistance Program (SHIP) for assistance.

3. Explore Medicare Savings Programs (MSPs) if you have limited income and resources.

4. Consider private options like Medicare Advantage plans (Part C) or Medigap plans to help manage out-of-pocket expenses.

Answer: The coverage gap went away for 2025. There is now a $2000 max for prescriptions. As long as your cholesterol medicine is on your prescription drug plan formulary it will count towards the $2000 max. If your prescriptions were to reach/exceed $2000, your prescription

cost over $2000 would be zero dollars for the rest of the calendar year.

Answer: Local agents are more knowlegable about local Medicare plan options and Medicaid programs in your state. They will also be more familiar with local hospitals, pharmacies and doctors in your area.

I work with elderly Medicare recipients who are no longer computer savvy, sometimes just because they don’t care to be, and they have earned that badge. These are also beneficiaries who sometimes prefer home visits rather than enrolling over the phone.

Answer: Yes, Original Medicare, Parts A and B covers many preventative screenings such as mammograms, colonoscopies, Pap smears, and bone mass measurements.

Medicare Advantage (Part C) must cover the same preventative care benefits as Original Medicare, but may have different rules, costs, and coverage restrictions, and additional preventative services beyond what Original Medicare provides.

Please see your Evidence Of Coverage (EOC) for the list of preventative services covered under your plan.

Answer: While various parts of Medicare provide widespread health coverage, these do not always pay 100% of the cost of what it covers. For example, there may be deductibles for:

Part A hospital services

Part B doctor and outpatient services

Part D prescription drugs

After these deductibles are paid, there are often gaps in what Medicare will pay for your covered health care, such as:

Part A of Medicare has expensive copays for people with long stays in hospitals and skilled nursing facilities.

Part B of Medicare pays only 80% of covered expenses for the costs of doctors, durable medical equipment and other outpatient expenses.

Copays and drug costs charged by Part D drug plans can differ among Part D insurers, even for the same drug.

Answer: It is predicted that artificial intelligence AI could help speed up the review process by rapidly analyzing large amounts of data to detect patterns, flag potential fraud, and ensure claims comply with coverage guidelines.