Lynn C Shurtleff, Medicare Insurance Broker

Answer: Yes it could be and our government is wanting to change and/or privatize it which would not be a good thing. Please make sure your representatives know they need to keep hands off Medicare and Social Security.

Answer: The donut hole no longer exists. Part D plans changed completely in 2025. I would advise reviewing these changes on Medicare.gov.

Answer: No Medicare will not cover these things. Some medicare advantage plans MAY cover these as a plan benefit but many do not.

Answer: This will depend on which Medigap plan you have. If you have a plan F, yes they will be covered. If you have a plan G, the Part B deductible will not be covered but Part A will be. Other plans vary as well.

Answer: I have had to contact Medicare to find this out myself. Medicare will only answer "If it's medically necessary." Unless it is something specifically mentioned in Medicare's coverage, it depends on it being medically necessary. The doctor or provider scheduling should know if it will be covered as well. There are some disclaimers though of things not covered such as an experimental treatment.

Answer: You can, but you will be subject to the Medicare deductibles which for 2026 is over $1700 for hospitalization and can happen multiple times per year. Your 20% for some things can be much higher than if on a Medicare Advantage plan as well. Original Medicare also has no Max out of pocket so your costs just keep going all year. Medicare Advantage plans at least have a cap or a max out of pocket so you know what your worst case scenario is for treatments like Chemo or infusions. You can have just A and B but the coverage may not be as good or predictable.

Answer: A broker can but I would not base your plan choice on that alone. Most MAPD plans are similar in coverage for Medicare covered Chiropractic and many Chiropractors don't participate in the plans networks but offer discounts to those on Medicare.

Answer: They should not without a family member or POA present. Sadly too many do and take advantage of the person.

Answer: Yes but you will have to pay for both part A and B. Part B this year was about $185 per month but A is over $500 a month. If you haven’t at least paid in 40 quarters you can enroll but at a cost.

Answer: The rule of thumb is the less you pay per month the more you pay when you use the services and vice versa. If you pay $0 per month for a plan, you will pay somewhere and usually that is higher copays for things like out patient surgeries and in patient hospitalization. The Annual Enrollment Period and the Open Enrollment Period January through March offer you the opportunity to change your plan which might be recommended in your situation.

Answer: Yes you should be skeptical. Agents are paid much more for Medicare Advantage plans and most supplements stop paying commissions for Medicare Supplements after year 6, or they are drastically cut to a minute percentage. Steer clear of an agent that pushes anything. Find an agent that will do what's best for you and not what will pay them the most. They are out there but not plentiful.

Answer: Medicare will only cover nursing home for rehab, it must be an improving situation. Once the care becomes custodial, Medicare will no longer pay. At that point the options are either Medicaid if one qualifies or private pay. You can also purchase Long Term Care insurance but that must be purchased when you're healthy and not when you need it. There is underwriting as well for LTC insurance and you can be turned down.

Answer: Medicare is separate from any secondary plan someone signs up for. She has either a Medicare Advantage plan or one of the few Medicare Supplement plans that include this benefit. If you also wanted this benefit you would have to sign up on a plan that offers it, Original Medicare does not.

Answer: Insulin is still capped at $35. The carrier for your part D or Medicare Advantage may no longer cover that particular insulin which in that case you would be responsible for the entire cost. Check with your carrier and review your options for 2026 as well. There may be a plan that will offer lower costs for that insulin.

Answer: No, Medicare rarely pays for dental procedures. Some Medicare Advantage plans may offer coverage for dental and include implants but in the area I live few do cover them.

Answer: Medigap plans are private secondary insurance to your Medicare which cannot be denied. You received Medicare by working and paying into it but that has nothing to do with obtaining secondary insurance. Medigap plans are guaranteed issue when you first go on Medicare part B for a 6 month window but once that window closes there is underwriting unless you live in a Birthday rule state. There also may be certain circumstances that may be GI as well. In general, there is underwriting outside of your initial enrollment into Medicare and you can be denied.

Answer: This must be an old question because the donut hole went away for 2025. We are now looking at 2026 and there is no more donut hole.

Answer: Medicare will not cover hearing aids but some Medicare Advantage plans do offer coverage. You usually will have a copay or co-insurance on most plans. Some Medicare Supplements also offer discounts for hearing aids as well.

Answer: Part D and Medicare Advantage plans change every year. That is why during the Annual Enrollment Period it is advisable to review those changes and your medications and see if it is still going to be the right plan for you in the coming year. You should have received an Annual Notice of Change in September from your current carrier informing you of the changes.

Answer: No the program is not expected to change any more than it does every year. The amounts the beneficiary pays for medications will go up as it does every year.

Answer: Is it okay to work with any age advisor but a younger one may not be as experienced or understanding and very well may be more commission oriented. I have been doing this for over 16 years, worked for my state before that and am on Medicare myself. I understand exactly what others are going through and am not only after the commissions. Insurance agencies promote how much money you can make selling Medicare products to entice agents to sign on with them, but if it's all about the money, I say you are not doing your job. Note too, always investigate someone wanting to do something with your finances, see what their portfolio and debt looks like.

Answer: I the 16+ years I have been an independent agent, I have never heard of or come across a Medigap that has a non-increasing premium. I doubt this is the case in your area because over time it would be cost prohibited for the company to continue such a plan. Rising medical costs and an aging population using the coverage is what dictates the increases.

Answer: You would need to check the service area for the plan you are on. It could include the new county so you would not have a special enrollment period for moving outside the service area for a part D plan or a Medicare Advantage plan. If the new county is outside the current service area, you will have to look for a new plan.

Answer: Definitely a heavy accent is a red flag but also ANY mention of Medicare or Medical coverage, changes etc. Medicare will never call you.

Answer: The rule of thumb is the less you pay per month for a plan, the more you pay when you use the services and vice versa. You will pay somewhere. Plans are all different and lowest price is not always the best choice.

Answer: No, there will be underwriting or medical questions. Once you are outside your initial enrollment period in most states there is underwriting except for a few instances.

Answer: You will be covered 100% with a plan F as long as the hospital accepts Medicare assignment. The ER is no different than any other part B service

Answer: Most part D plans no longer have agents so your best bet is to go to Medicare.gov or call 1800 medicare. If a Medicare advantage client, call your agent or find a good, honest, local agent to work with.

Answer: Medicare won’t pay for home health of this type. There are some Medicare advantage plans that have some non-medical home care included. Medicare will only pay for medically necessary and pt and ot.

Answer: Find an honest one, not one that acts and sounds like a salesman. There are a few of us out here. Talk to your friends and family too and ask who they use.

Answer: It all depends on your situation. Everyone is different so for some a Medicare Advantage may be a better fit and for others original Medicare with a supplement and a stand alone PDP. Almost never is just Medicare a better fit.

Answer: Are they turning 65? If so they may already be signed up. This is not an easily answered question because there are factors involved and if they are of Medicare age they are probably already on Medicare. If they are not yet old enough, it is not an option.

Answer: The best way is to contact your agent. If you don't have an agent you can contact your carrier directly by calling or going to their website and search. Most carriers allow you to set up an account on the website and you can search through that source as well.

Answer: Yes, is the short answer. There are some variables though so it does depend on the situation, but yes you will have a SEP for losing employer coverage.

Answer: There isn't really an definitive answer to this question, no one knows. It all depends on what Congress and our governing bodies do.

Answer: No you didn't make a mistake, but that is usually how Medicare Supplements work. Many agents low ball and go with the lowest premium but I learned that is not the best choice in the long term. I don't know what carrier you have but many that have the lowest premiums in the beginning tend to have the higher percentage rate increases. I stick with the more rate stable companies. You can reset down to a lower rate IF you can pass underwriting, or there is another tool that can be used as well if the conditions are right and depending on the state you live in and state laws.

Answer: It depends on the type of appeal. You can find all of this information on the Medicare website: https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals

Answer: They should be covered as long as they are screenings covered under the preventive listing for Medicare and according to Medicare timelines. Check to be sure.

Answer: No, they actually do not and I have come across this before. If you don't qualify for part A there is a monthly cost of over $500 a month. It all depends on qualifying for Social Security by paying into the system for the required amount of time.

Answer: Medicare will cover some chiropractic appointments but not routine visits. Some Medicare Advantage plans may cover routine but your best bet is to check with the chiropractor to see what is covered and what is not.

Answer: You would need to check with Medicaid for custodial care, Medicare does not cover this type of care and most plans don't either. Medicaid through your state is where to start but it will be income based. Also if you have some long term care insurance, that should cover it too. There are some plans that may cover very limited care after a hospital or inpatient rehab stay, but they are very limited. Medicare also does not cover custodial care in a facility as well, again that would be Medicaid and after resources are exhausted.

Answer: Many but not all Medicare Advantage plans have hearing aid coverage. The best way to find out is to call the customer service number on your card and ask. If you go through a local agent, they should and should have gone over this with you when you signed up. That's the bonus of working with someone locally and in person. Never talk to the people cold calling or over the phone.

Answer: YES! There should be. These TPMO, Third Party Marketing Organizations, have figured out how to get around the laws already in place. The calls come from overseas using fake or non-working phone numbers and the beneficiary is required to attest that the transfer to the agent is an incoming call. This is how the agents are getting around the illegal cold calls but the laws were expanded to the TPMO as well. But you can't catch them if you don't have a working return phone number or a full name. Some even require you to attest that they can share your information so you get more calls. Permission to contact according to the law must be given in writing, not verbal. COLD CALLS ARE ILLEGAL, so never talk to these people. Simply hang up and never, ever give them your information. I had 4 people last month have their plans flipped and they all told me they told the agent they did not want to change anything, BUT they had already given all of their information. The only way to stop this illegal harassment is to make it illegal for agents to sell over the phone, change the laws back. Contact your Congress members and request this.

Answer: No. They might be covered by your states medicaid if the person qualifies, but Medicare does not cover these things.

Answer: Plans can differ state to state, county to county and even by zip code. If the two of you have different plans that could be the reason also. Different plans, types of plans, carriers, locations, ages, etc. all play a part. It is difficult to completely answer without specifics.

Answer: I would actually recommend a Medicare Supplement with a Part D if you are a frequent travelers, especially if you travel outside the country. Original Medicare has gaps and no coverage outside the US. Medicare Advantage plans are network based so you may not have coverage at all when traveling outside of a true emergency or urgent care.

Answer: The best thing to do is throw it all away and find a good, honest local agent to help you make the right choices. Not all local agents are honest either but try to find one that has YOUR best interest as the focus and not what their commission will be.

Answer: For sure food cards which are not available in all areas or on all plans. The cold callers and advertisements use this benefit to "bait" you to call or contact them or even listen furture during an illegal cold call, then they use the oops, you don't qualify for that, and proceed to flip your plan to any other plan even if your doctor is not in network. Never trust these people and always be wary of anyone calling you and especially saying they are with a certain carrier or with Medicare, they are breaking the law.

Answer: When a carrier's plan or plans achieve a 5-star rating from Medicare, one of the perks is a Special Enrollment Period (SEP) all year. A Medicare beneficiary can upgrade to a 5-star plan, join a plan, or move laterally one time during the year using this SEP. It is outside the AEP and OEP, starting Dec. 8 and running through Nov. 30. New plan enrollments will go into effect the first of the following month. This is similar to the OEP which runs from Jan. 1 through March 31 where you can change a Medicare Advantage plan 1 time or return to original Medicare and a Part D. But, during the OEP if you are not on a Medicare Advantage plan you cannot get on one which you can do during the 5-star SEP. For both the OEP and the 5-Star SEP, you may only make 1 change. During the AEP, which runs from Oct. 15 through Dec. 7, you can make as many choices and changes as you like and the last one before midnight on Dec. 7 is the one that goes into effect on Jan. 1 of the next year.

Answer: This is a tricky answer. Medicare usually does not coordinate at all with Medicare, you have your VA coverage for the VA and Medicare for outside the VA. There are times where the VA may file to Medicare if you have only original Medicare and/or a supplement. As for employer plans, that depends on the employer benefits and plan design. I have seen where the two will work great together and the person will have no out of pocket cost, and I have also found instances where they do not coordinate at all and it is best to only have the employer's plan until retirement. Everyone and every situation is different.

Answer: Extra help is a program through Social Security to help those with a qualifying income pay for their medications. There is an income limit to qualify so it is not based on amount of medications or cost.

Answer: It is a form that says you agreed to the appointment to discuss certain products. It is not only normal but is a requirement by Medicare and except for walk ins, should be obtained 48 hours prior to the appointment. Call centers are not exempt and should do a virtual/electronic SOA. Remember anyone calling you without you giving written prior permission is breaking the law and you should never talk to these people.

Answer: We will have to wait and see. It's possible and some already do. It's difficult to predict what will be happening 4 or 5 years from now.

Answer: A local agent is always a better fit. They know, or should know, the network, the doctors, the pharmacies and can really get to know you. I consider my clients my friends and am here to help them. Often with a remote agent, once they sign you up you may never be able to find them again so you're on your own if you need help.

Answer: The biggest mistake is not actually running your medications on Medicare.gov or having an agent run them. Medicare.gov is an unbiased comparison. But there can be errors on Medicare.gov so be careful. Using the Medicare and You book is never a good way to choose a plan.

Answer: If you're already on Medicare the best time is after Oct. 1. Agents are not allowed to discuss plan changes for the next year before Oct. 1. Agents cannot assist in filling out or submit and application prior to Oct. 15 if making an Annual Enrollment election, Oct. 15 to Dec. 7. If you're new to Medicare, 3 months prior to your birth month or adding part B.

Answer: You actually had a 60 day window after losing your husbands coverage through his job. There could be a possibility you may have an option to get signed up on a plan now but if not you will have to wait until the Annual Enrollment Period. Have you recently turned 65? Without particulars it's difficult to give concrete answers.

Answer: PPO's give you the flexibility to go out of network provided the provider agrees to accept it as out of network, they are not required to. But most of the time the out of network copays and coinsurance will be higher, often much higher, than using network providers. That's the trade off for the flexibility of having the out of network option.

Answer: Do not talk to anyone cold calling you about your Medicare, Social Security, Medicaid or any benefits. Either do not answer the phone or hand up, do not be polite to these people because they are breaking the law by calling you unless you have given written prior permission to call you. Never call those phone numbers on the TV, on your phone or on the internet. These ads are designed to trick you and bait you to call.

Answer: If you delay signing up for Medicare Part B or D you will pay a penalty based on the length of time you delayed signing up. These penalties last a lifetime unless you qualify for help due to income. It is not recommended to delay signing up because depending on the period of time these penalties can become cost prohibitive over time.

Answer: The plans vary and it depends on the area as to what is available. In the area I live, we have many rural areas but most of our plans cover a large area in this part of the 2 states. That may not be the case where you are.

Answer: They won't work together but they could save you money on some medications. If there is a medication that's not covered on your Part D plan, you may be able to get a lower cost with a discount card or a program that the pharmacy offers. Always ask the pharmacy to check for you to see what gives you the lowest cost.

Answer: It's not allowed. Cold calling for Medicare Advantage plans and Part D plans is 100% illegal but unless you can obtain the actual name of the agent and a working phone number it is impossible to catch them. Many calls originate outside the country as well. I recommend contacting your Congress members and tell them to change the law back and make it illegal for agents to sell over the phone. The laws keep getting amended but these scammers find ways to get around them and create loopholes.

Answer: Social Security will need a form from your employer showing you've had coverage at least since turning 65. Check with your HR department they should be familiar with this. You can also start the initial sign up at ssa.gov https://www.ssa.gov/medicare/sign-up/part-b-only

Answer: Medicare covers some preventative screenings. You can find the list of covered screenings at Medicare.gov. https://www.medicare.gov/coverage/preventive-screening-services

Answer: Medicare was designed decades ago and really has not changed much per original Medicare. It covers basics but not 100% and was not designed to cover 100%. That is why there are supplemental plans you can pick up to help cover some of those gaps and give you predictability for costs.

Answer: That is a very complicated question and cannot be answered in generalities. So much depends on what plans are available in your area, what your needs are, who your doctors are and possibly what you medications are.

Answer: If your income drops below the amount to have your state pay the Part B premium through the Medicare Savings program that could help, but it depends on your income AND assets. There are Medicare Advantage plans that giveback or rebate a portion of the Part B premium but it depends on what plans are available in your area and if your doctors are in network for these carriers and plans. If you are paying a higher amount for your Part B premium due to higher income, once the income drops contact Social Security and let them know and ask to appeal the higher amount due to a drop in income.

Answer: Medicare Advantage plans are mostly network based plans so the physicians and facilities available could be limited. This is going to depend on the carriers and the networks where you live. These can vary greatly so you want to be sure to check all of your providers and not be misled. I hear from beneficiaries that an agent told them with a PPO they could see anyone and just pay the higher copay, I just was told this a few days ago by someone referred to me. This is not true, the provider has to agree to accept and bill the PPO plan and they are not required to. Network based plans is the biggest disadvantage.

Answer: Yes, Medicare Advantage and Part D plans vary from state to state, county to county and possibly city to city. The plan your friend has may not be available in the location where you live.

Answer: If you have not enrolled in Parts A and B, you will want to do so right away. If you are already collecting Social Security you should have been automatically enrolled and received a Medicare card. If you are not collecting you must enroll either online, on the phone or at possibly at a Social Security office. That is the first step. If you are already enrolled, the next step is to look over the types and available supplemental plans in your area and see what will best fit YOUR needs, they are not one size fits all.

Answer: Original Medicare does not cover routine eye or hearing exams, nor does it cover eye wear except after cataract surgery or hearing aids. It also does not cover dental except in very limited instances or custodial care in a nursing facility, only rehabilitation. Medicare Advantage plans may cover some of these additional benefits but Original Medicare does not. Over the counter benefits, food cards, and gym memberships are also not covered by Original Medicare. When someone illegally cold calls and tells you Medicare covers these things and you are eligible because you have Parts A and B, hang up, this is not true.

Answer: Switching from paper applications to online applications has greatly streamlined processes for signing beneficiaries up on plans, but it has also increase agents misleading clients as well and opened the door for non-compliance. Now a signature is not required on most electronic applications, all the agent has to do is check a box which in my opinion is not a good practice or secure. It has also increased the illegal cold calling for Medicare Advantage and allows these call centers to break many laws including lying to the beneficiary simply to make a sale and move on. I myself have recently gone on Medicare and the 40 to 50 illegal daily cold calls are actually harassment and needs to be stopped. I advise clients to never ever talk to these people and to simply hand up.

Answer: I really have not found this has affected my work as a Medicare Agent. I do believe the Medicare Advantage plans have adjusted and set copays for procedures and tests based on hospitals charging more than stand alone facilities and physician group facilities.

Answer: Being licensed in Florida, I see many really great plans pop up every year largely due to the large population of Medicare beneficiaries in Florida. Plans vary not only state to state but also county to county so it is hard to say one state or another has the "best" policies for Medicare Advantage and Part D. Medicare supplements do not vary in their coverage, but they do vary in the premiums. Where you live determines the premiums and what plans are available to you.

Answer: I would advise contacting a local elder care lawyer or someone versed in your states Medicaid guidelines for Nursing Homes. There should be a local Agency on Aging in your area that can help too.

Answer: Because you already have A and B, you are subject to the 63 day window for losing employer coverage for the Guaranteed issue period for a Medicare Supplement. Normally, Cobra will be costly and will not excuse the penalty period for picking up a Part D plan either.

Answer: I always advise Veterans to pick up both A and B. Having Part B gives you options and choices outside the VA. I am a Vietnam Veterans widow and understand some of the challenges and limitations when using and dealing with the VA. I hear Vets complain about the Part B premium but there could be ways to minimize that cost depending on what is available in your area. If you delay your Part B, if you want to add it in the future you will have to pay a penalty so I never advise that because it could cost even more with the penalty.

Answer: No, you will not be penalized as long as you are on insurance through an employer or a spouse's employer. It is advisable though to weigh the differences in her plan and going on Medicare, it could be a better option to fully switch to Medicare. Also check with her employer to be sure they don't require you to go on Medicare when first eligible. If she works for the state or local school system or government, they usually do require you to switch over to Medicare when first eligible. Note too that you can get Part D with just A and to avoid a penalty for not picking up a Part D plan when first eligible for Part A, you will need to be sure her plan is considered credible coverage according to Medicare's guidelines. It probably is, but you will want to be sure. This is a separate penalty from delaying Part B due to employer coverage.

Answer: With a Masters Degree in Education and 17 years working for the state of Tennessee in education, I enjoy educating seniors on their options for Medicare and retirement. I love what I do and have been working as an Independent Agent for almost 2 decades taking care of my clients as well as taking care of their insurance choices. I'm a senior myself and on Medicare so I understand the challenges of aging. I truly consider my clients my friends.