Mark Bilgere, Medicare Insurance Broker

Answer: With fewer workers per beneficiary, Medicare will see a funding shortage over the next 20 years. Because Part A is funded by current payroll reductions, any reduction in the number of workers will create a shortage. Although Part B is not funded directly through payroll reductions, it is funded through federal taxes, so again, fewer workers equals lower tax revenue.

To address any funding shortage, the government can take a variety of steps. Tax increases are always an option. Whether they are across the board or are targeted at high income individuals through higher IRMAA charges. The age for eligibility could be raised from 65-67, similar to the Social Security FRA. Part B premiums will continue to increase. Medicare could lower the reimbursement rate for providers, however doing this could force many providers to stop accepting Medicare if the payments don't keep up with the cost of providing care.

Answer: A Medicare Summary Notice is sent when you have any claims filed on your behalf. It is an explanation of what services were and products were paid for by Medicare. It is not a bill.

You should examine your MSN to make sure that the claims listed match the services you received. Check for things like services never received, duplicate billing, equipment never ordered, and suspicious providers. This helps prevent fraud and improves the Medicare system.

Answer: Observation stays are covered by Medicare Part B. This means you are subject to the Part B deductible if you have not already met it. Then Medicare pays 80% of the cost, leaving you 20%. There will also be copays for any services performed or medications given during the stay.

Answer: If you plan on returning to the U.S you should maintain your Medicare. If you permanently relocate overseas and plan to rarely return to the U.S. then giving up your Medicare could make sense.

Answer: International travelers can easily purchase international travel insurance. Since most Medicare supplements and MAPDs only have a reimbursement feature for emergencies, it is a good idea to add international health insurance for any extended trips. Also, Medicare does not cover repatriation if you need to be transported back to the United States. Some international plans have this feature available.

Answer: The reduction in Advantage plans is due to insurance carriers removing certain plans from the market. This reduction is due to cost constraints and profitability for the carriers. If a carrier determines that a plan is not profitable it may stop offering that plan. Because of the rise in medical inflation and a reduction in reimbursement amounts from Medicare many plans have become to expensive for the carriers to maintain.

Answer: Having life insurance does not affect your Medicare eligibility or premiums. Life insurance is separate from your Medicare as Medicare is health insurance.

Answer: Typically Medicare does cover heart monitors when it is a medical necessity. A physicians order and documented symptoms are required. Heart monitors are considered Durable Medical Equipment, so once the Part B deductible is met Medicare pays 80% and the beneficiary pays 20%.

Medicare does not cover devices like Apple Watch or a Fitbit. These are considered consumer electronics.

Answer: Typically no. When you want to move from an Advantage plan to a supplement, you are required to undergo underwriting. However, If you are in a Guaranteed Issue period or a Trial Right period, you can switch during the AEP timeframe, but you're not really using the AEP enrollment period. I

Answer: Ask “Am I being billed because Medicare denied medical necessity, or because paperwork simply expired?” If the paperwork has expired, ask the supplier exactly what they need. Then, contact your physician to get the required prescription or testing that is being requested. If it is just paperwork, that issue can usually be solved fairly quickly. If it is a Medicare denial, you may have more testing and documentation necessary.

Answer: Mental health services are covered by Medicare, however nothing is FULLY covered. Once you reach your Part B deductible Medicare becomes an 80% / 20% plan where Medicare pays 80% leaving you 20% to pay. As with all other Medicare services the providers and hospitals must accept Medicare assignment.

Answer: The insurer's Medical Loss Ratio should not affect the quality of your healthcare. More likely you would see a change in any extra benefits offered by the carrier. When evaluating a carrier MLR can be useful but it should NOT be the primary factor when choosing coverage. The things that you should evaluate more are the providers available, the drug formulary, Star Ratings, the max out of pocket limit and the carriers customer service reputation.

Answer: Medicare Advantage plans are one of the ways people can control their Medicare costs. Advantage plans have both pros and cons and you should always be sure you understand how the plan works and if it firs your specific situation.

Traditional Medicare does not require the use of provider networks, Advantage plans do. This means a doctor has to accept not just Medicare but your specific Advantage plan also. Regular Medicare also has no maximum limit on how much you may spend on health care. Advantage plans have an annual Maximum Out of pocket limit. This is perhaps one of the most undervalued features of an Advantage plan.

What you see advertised on television a lot are the benefits that an Advantage plan offers that Medicare does not. These include, dental coverage, hearing aid assistance and an allowance for eyewear. While these can be valuable benefits keep in mind that they will also require network adherence and will have annual limits.

Answer: There is no penalty for switching from Medicare Advantage to Traditional Medicare. There are some things to be aware of though. Remember, if your Advantage plan had drug coverage, you now need to add a stand a lone Part D Drug plan. Also, you can only make the switch during one of the approved enrollment periods.

Answer: Your provider should be able to tell you if any procedure is covered by Medicare. If you are having trouble finding out from the provider, you can search the Medicare Cost Estimator site.

https://www.medicare.gov/procedure-price-lookup/

On this site you can see the cost for all Medicare covered outpatient services.

Answer: Yes, Medicare will still pay its portion of the bill up to the point that you leave the hospital. Any costs that were medically necessary and approved will still be covered. However, follow-up care, skilled nursing care, and any readmissions may present issues. Readmissions and follow-up care may be closely examined. For Part A to cover skilled nursing care, you must have been an inpatient for 3 days and have been properly discharged.

Answer: Yes, a drug plan can drop a medication mid-year. It can also change the tier of the medication and the rules regarding its requirements for prior authorization. However, if you are currently taking a medication the plan must continue to cover it for the remainder of the year. This gives you time to either find a new plan for the next year or find an alternative medication if your doctor approves it.

Answer: Your part B premium is based on your income from 2 years prior. Most often, a large increase in your Part B premium, after being on it for several years, is due to an IRMAA surcharge you incur due to a large influx of income. The most common causes of this include a large IRA withdrawal, the sale of a business, the sale of real estate, or a ROTH conversion. The proceeds from all these transactions are counted as income. This increase could trigger an IRMAA charge that will last for a year.

Answer: The Part D carriers are exposed to more risk due to some recent changes to Medicare. Subsequently, they are raising prices on plan premiums and on some medications.

Answer: Ignore all of it and ask people you trust who they consulted for their Medicare. Find a local broker who you can meet with to discuss your situation. Personal referrals will be better than responding to unsolicited mail and phone calls.

Answer: Original Medicare with a Part D plan could be beneficial for travelers since there are no network or referral requirements for original Medicare. However, without a Medicare supplement you have no maximum out of pocket limit for medical bills with original Medicare. Medicare supplements and Medicare Advantage plans can protect you from catastrophic healthcare costs.

Answer: Advantage plans typically pay your Part A deductible and your Part B deductible. So on day one with your plan you would have a copay of $350. You would have that for the next 6 days and then it would end. Any Part B type services would have their own copays or coinsurance also. All your costs would be bundled and you would not receive separate Part A and Part B bills.

Answer: There are no tax benefits to paying Medicare premiums. However you may pay more for your Medicare if you receive an IRMAA; Income Related Monthly Adjustment Amount. This is an additional premium you are assessed based on your income 2 years prior to enrolling in Medicare.

Answer: Folks in rural areas will have a difficult time utilizing Medicare Advantage plans. Because MAPDs are focused on a provider network and rural areas have fewer providers it is difficult for a carrier to establish a sustainable network in less populated areas. PPOs were once an option however they are not profitable for the carriers so they are becoming less available.

Answer: Hi there, Mark Bilgere here with Bilgere Insurance, answering another question here on the Medicare Agents Hub. I found this question quite interesting, and it can be kind of a long answer, so I'll do my best to keep it within the short time frame that I have.

The question is, "I am planning out my mother's Medicare and long-term care, and it's quite stressful. What are some advice to make this process more manageable?"

I've been through long-term care events with my parents, my in-laws, or grandparents. So I've seen this, and the fact that you're planning for it is the first step. Believe it or not, because what's even more stressful is when it's thrust upon you. So planning this is the greatest first step you can take.

Secondly, find a broker in your area that can go through it with you. Talk to them a little bit and make sure that you like that person. See if they have any experience with it, whether it's their personal experience or they've just been doing it for a long time and helped a lot of other people. That's okay too. I don't wish long-term care experience on anybody, but it does give you a lot of understanding of it.

Then let them start asking you questions about what you would like for yourself and what your mother would like for herself. Sometimes it's the same, sometimes it's not. If you feel like you're going to become the caregiver, what is going to help you in the future? Are you going to share that responsibility with other siblings or family members? What would that look like?

Knowing what you want the end result to be will help that broker help you go through all the different opportunities and possibilities, the cost, the funding, whatever is available, and the different products that are available. But just sitting and trying to do it on your own will totally be stressful.

Work with someone who has experience doing it and that doesn't pressure you to do it. You already realize you need to do it. Just let somebody help you and relieve that stress because that's the same advice you're going to get when you are a caregiver. Let people help you. So start early.

Answer: Hi there, Mark Bilgere with Bilgere Gear Insurance answering some more questions on the Medicare Agents Hub. This is a very important question, but one of the words in it is kind of confusing. It seems like a very simple word, but I'll tell you why it's so confusing.

The question is simple: does Medicare cover vision care? The reason it's confusing is because people conflate vision with two types of vision care. One is getting glasses, getting their prescription checked, and my far-sightedness and my near-sightedness. Do I have a stigmatism? Right, I need to get my prescription changed. That's one thing.

Then there's eye health, like having glaucoma, macular degeneration, diabetic retinopathy. Some of these are very serious conditions, like cataracts. Medicare is different. Medicare does not cover just a standard checkup to get your prescriptions changed and to pay for your glasses. It doesn't do that at all.

Those other things, like diseases in your eyes or cataracts, Medicare does a fantastic job covering. It's the same as all your other health insurance. So keep in mind when you see advertisements that say "vision, vision, vision," they're talking about your glasses, your contacts, your basic checkup, and like that.

If you have eye disease or some sort of disease in your eyes, Medicare covers that. It's going to fall under your Part B primarily, and then with help from your advantage plan or your Medicare supplement.

So does Medicare cover vision care? It covers your eyes and eye disease, but does not cover your glasses. Thanks!

Answer: Hi there, Mark Bilgere with Bilgere Insurance, answering some more questions on Agent Hub. This question is very important because a lot of agents, or a lot of people like myself, struggle with this. When people have questions, the question is, "My Medicare Advantage plan advertises dental coverage, but it barely covers anything. Is this normal?" In my opinion, yes, that's very normal. My experience has shown that the dental allowances in Advantage plans are typically lacking what most people would like them to be.

Now, remember, Medicare itself doesn't pay for any dental. So any benefit that is in your Advantage plan is being offered by that carrier. It is not part of Medicare. So in a sense, they're not required to do it, but they're doing it to some extent. The most important part is to understand how it works, whether it has a network, whether it's a dental HMO, a dental PPO, or what's called a POS, a point of service dental HMO. Some very restricted networks, dental PPOs are more lenient.

With a dental POS, you can go to just about any dentist, but how much they're going to get paid is going to vary. So how much your allowance is, how far your allowance is going to go, is going to vary for preventative. They're all pretty good for major work. It's going to vary wildly. So make sure you check if your dentist accepts the plan. And if you don't have a dentist that you really must see, just check what kind of deductibles you're going to have and what the annual amount is going to be.

I can almost promise you whatever it says, you are not going to be thrilled by the time it pans out. But keep in mind, some insurance is always better than no insurance, and especially with Advantage plans. Having some of that dental coverage is very important. Thanks!

Answer: Estimating your total cost is difficult since you don't know how much care you will need specifically. However, determining the most you will pay is easy.

First, multiply your Medicare Part B premium by 12. If you have a Medicare Advantage plan, add that number to the MOOP of your specific plan. That is the maximum you will pay for medical care. For your prescriptions, multiply your monthly copays by 12 and add your deductible. If it exceeds $2,100, then you will reach the 2026 catastrophic limit and you will pay no more out of pocket for the remainder of the year.

If you have a Medicare supplement, start the same way. Your Part B premium times 12. Then multiply your supplement premium by 12 and add the current year deductible (2026 = $283). That number will be your max out of pocket for medical care.

For you PDP, multiply your premium by 12 and add the cost of your medications. The biggest difference in this case is that your premium is not added to the catastrophic amount. SO if your copays or coinsurance exceed $2,100, you will still be requires to pay your monthly premium. So the annualized premium and the $@,100 will be your maximum out of pocket for covered medications. Any medications not covered by your plan will add to that amount.

Answer: I explain clearly that there is no FREE healthcare available. Any plans referred to as "premium free" or "no premium" have a cost. That cost could be in the form of copays or coinsurance. It may not have a monthly cost, but it will have payments due.

As you use your Advantage plan, you will have either a fixed dollar amount ( copay) or a percentage (coinsurance) of the bill to pay. The one exception is typically a visit to your primary care provider.

Answer: Unfortunately, the carriers have removed the ability for agents and brokers to help individuals determine and enroll in their PDPs. So now the best way to compare plans is to use the Medicare.gov site.

This site allows you to enter your medications and compare plans in your area. You can then enroll in the plan you select, or you can contact the carrier directly.

Answer: The value of a Medicare supplement is outstanding. They allow you to see any provider that accepts Medicare without regard for network adherence. They also have a low annual deductible before the benefits kick in.

The cost for Medicare supplements vary based on your zip code, your gender and your age as well as the carrier. Carriers charge different amounts for the same plans.

There are many plans available. Different locations may have different carriers available. You will see different costs for the same plan name from different carriers. The biggest carriers may not be worth the cost increase compared to a smaller carrier. The best thing to do is to find a local broker that represents multiple carriers. They can quote the different carriers and different costs in your area.

Answer: Medicare can provide coverage for both of these providers. Both would be covered under the Part B portion of Medicare.

The psychiatrist would be considered a specialist. For medication management you would typically see them once every 1-3 months. If you are on a Medicare supplement, once you reach your deductible, your supplement will pay. If you are on a Medicare Advantage plan, you will have a copay specific to that plan. You may also have a network requirement and a referral requirement. Be sure to confirm that the provider takes your plan and you have all required referrals.

The therapist will also fall under Part B. It will be paid the same way. The only caveat is that you must make sure the therapist is able to bill Medicare. Medicare did expand the types of therapists that can bill Medicare, but it is still your responsibility to make sure the provider has enrolled and accepts Medicare assignment.

Answer: If you weren't covered at all you are probably in an HMO Advantage plan. Some of these plans allow for out of state coverage, but many do not. The most convenient plan for snow birds would be a Medicare supplement. These plans allow you to go to any provider that accepts Medicare, anywhere in the country. Medicare supplements have a monthly premium, in addition to the Part B premium, and they require you to pass underwriting in order to enroll.

A PPO Advantage plan could provide you some more coverage options. These plans allow to go out of network although you will usually pay higher prices for the services you receive.

Answer: You should review your ANOC on your own to determine if your current plan will still meet your needs and that there are no major changes. If your health has changed, your doctor has dropped the plan or your plan has changed dramatically, then you should reach out to your agent. Remember, the purpose of your Advantage plan to to protect you from high and catastrophic medical bills. Focus on your providers and your healthcare costs before getting too wrapped up in the extra benefits.

Answer: First you must get a prescription from your doctor. It must state that the wheelchair is medically necessary. Then you need to find a DME supplier. If you have a Medicare Advantage plan the supplier must be in network for your plan. If you have a Medicare supplement, then as long as the supplier accepts Medicare you can use them.

If you have an Advantage plan, you may have prior authorization requirements and you will have coinsurance, usually 20%. Electric chairs and scooters almost always require prior authorization.

If you have a supplement, Medicare will pay 80% and your supplement will pay the other 20%. You may see excess charges. To avoid these you can ask the supplier if they accept assignment.

Answer: A change in your health doesn't automatically lead to a change in plans. If you are on a Medicare supplement and your health has taken a negative turn you definitely do not want to change plans. While people on a MAPD may look at changing.

The most likely opportunity you will have is moving from a non-chronic plan to a chronic MAPD. These are designed for people with specific chronic conditions. The two most common are Diabetes and Cardio Vascular Disease. A special benefit of these plans is you have a special Enrollment Period if you choose to move from a non-chronic to a chronic plan anytime.

Answer: Your Annual Wellness visit should be covered by your PPO as long as you are In-network, the provider codes the visit as Annual Wellness Visit and there are no extra services added. This means if you tell the doctor your shoulder hurts, there could be additional charges. If any blood work is done, there could be additional charges. If you receive treatment for anything, there could be additional charges.

Remember, your Annual Wellness Visit is NOT an annual physical.

Answer: If you are no a Medicare Advantage plan you will need to see if your current plan covers the new county. Some larger plans cover more than one county. If your plan is not listed for that county then you will need to switch plans. You receive an Special Election Period to make that change.

If you have a Medicare supplement, you do not need to change your plan. You do need to check your PDP to see if it is available in the new county. If so, there is no need to change. If it is not, then you need to find a new PDP.

Answer: Traditional Medicare will probably not cover everything your employer insurance covers. Of course that has a lot to do with the benefits offered by the employer plan. Most employer plans have dental insurance and drug insurance embedded in them. Medicare does not cover those things. However, there are so many variables that go into the decision to give up employer benefits and enroll in Medicare that it is impossible to make a decision without seeing all the options available to you. The main things to consider are: Premium, Annual Deductible, MOOP, Provider Networks, co-pays and co-insurance. In addition you need to consider if any other people are dependent on your employer benefits and what are the consequences if they no longer have them. It is best to work with a local broker who will take the time to educate you on all the options and help you make the right decision for your situation.

Answer: The three midnight rule is based on the Part A rule for entering a skilled nursing facility after a hospital stay. Part A requires that a person be an inpatient for three midnights before they can check into a skilled nursing facility and have Part A pay the first 20 days. However, many Advantage plans have waived this rule in favor of prior authorization.

Many Advantage plans will not require a three night stay, but they will require any skilled nursing care to be pre authorized. Your hospital case manage will need to work with the carrier to determine if you can enter the skilled nursing facility. This process can be very frustrating for the patient and their loved ones.

Answer: So I have one of those questions that at first glance is kind of confusing, but then it really isn't that hard to understand. And this is it: Is my Medicare deductible supposed to change from year to year? Well, I don't know about whether it's supposed to change. I don't know if they wrote that into the laws, but it does change, and it does go up some years. It goes up a lot. Some years it doesn't go up quite as much. But it does change, and it does go up, and it will go up next year.

And how they determine it is built on a whole bunch of different things, and it's not really worth trying to figure out, because the fact of the matter is it's going to go up. So this year, in 2026, your deductible went up to $283. It's going to go up again next year. We don't know how much. We won't know how much till the end of the year. And then, actually, it's finalized right around January of next year. So is it supposed to? I don't know. Will it? Yes. Keep checking back for more answers.

Answer: Hey there, so I got another question today, and it is pretty pertinent because it is actually something that I use and I want to share the answer with you because I think a lot of people are going through this. So the question is, I use a continuous glucose monitor, a CGM, for my diabetes that connects to my smartphone. Will Medicare cover this technology for someone with my condition?

Well, like most things, Medicare maybe is the answer. So Medicare will cover a CGM for two reasons. One, you're on insulin and the doctor prescribes it, but you have to be on insulin. So if you're pre-diabetic or your numbers are real low, just a little over six, and you're not on insulin yet, then Medicare is not going to pay for it. You can still get them because now they have them over the counter. And that's how I used to get them when I'm not on Medicare. But I use one, and they're pretty affordable. But they do have a cost. If you're not on insulin, then you can't get it for having high blood glucose.

The only other reason Medicare will pay for it is if you have chronic hypoglycemia, like seniors, which is chronically low blood sugar. And then it's prescribed, and your doctor can do that for you. But over-the-counter ones that you see now, because you're just trying to get ahead of it and stay off insulin, which is the best idea in the world, Medicare doesn't cover those yet. You have to actually be on insulin and have it prescribed or be hypoglycemic and have it prescribed by your doctor.

So for other questions, I keep checking back. I answer them as soon as I get them. Thanks!

Answer: Medicare may cover some acupuncture. If the treatment is for chronic lower back pain, your doctor prescribes it and you receive it from a Medicare approved practitioner, Medicare may pay for up to twelve sessions, and possibly eight additional if progress is being made. It will not pay for any other reasons.

Answer: Possibly. If you are diagnosed with a qualifying chronic condition, you can change MAPDs. In most states cardiovascular issues or type 2 diabetes are the most common qualifying conditions. Be sure to check in your state if there are others.

Answer: Medicare supplements and Medicare Advantage plans are very different. It is difficult to compare them. Its like apples and oranges.

The benefit of the supplement is the ability to get the care you need when you need it and from the provider you choose. The down side is there is an additional monthly premium and it increases over time.

The benefit of the MAPD is a low cost and a few extra benefits like some dental coverage and help with glasses and hearing aides. However the low price brings with it the cost of provider networks, referrals and prior authorizations.

If you are considering changing from a supplement to an MAPD, look for one that your doctors accept. Depending on how many you currently see, you may not find them all in the same plan. Also, if there is a specific benefit you are interested in, make sure you understand how the benefit works. Dental, vision and hearing benefits also have networks. These networks may be different from the medical portion of the MAPD.

The bottom line is your supplement will give you more freedom and predictability. The MAPD will cost less up front but will have ongoing costs and more hurdles to overcome.

Answer: It is important to know what your Annual Wellness Visit (AWV) is not. It is not an annual Physical. This isn't to say it can't be an important part of your healthcare, but it does have some limitations. Here is what it does include:

* A Health Risk Assessment: Your provider will ask you about your current medications, your medical history, your lifestyle, your home life as far as safety and family and your other current providers.

* Vitals: They will check your blood pressure and your height and weight. (No blood work is done)

* Cognitive Screening: A short memory and thinking test

* A mood and depression screening

* A fall risk and safety review

* A Preventative Screening review: They will check to see if you are up to date on colon screening, mammograms, vision and hearing checks

* A vaccination review

* A personalized prevention plan: These will be the recommendations for the screenings you are missing, any lifestyle changes they recommend, any referrals you should have and health goals for the future.

This is not a physical, no blood work is done and no diagnosis or treatment of new problems is done. If you ask about any new situations, you could be billed separately.

Answer: Unfortunately the providers and the provider groups are not bound to remain in a network. They have a lot of freedom to move. Medicare Advantage members however do not have that opportunity. Please keep in mind that not every doctor makes their own network decisions. Many are part of a large group and the group makes the decision.

Answer: If the client has BCBS-MA Medex which is a supplement, there is not a way to bill this. Since you have opted out of Medicare, there is no Medicare payment of the 80%. Since Medicare will not pay the 80% then BCBS-MA Medex will not pay the 20%.

Answer: The 5-Star SEP allows you to move from a plan that is rated less than 5 Stars into a plan that is rated 5 Stars. The 5-Star SEP is available December 8 through November 30. You may use the SEP once per 5-Star plan in your area. If there is only one 5-Star plan available, then you may only use the SEP once in that year. If there are no 5-Star plans in your area, then this SEP is not available.

Answer: You will not be penalized if you have creditable coverage through an employer or a spouses employer. If the employer has 20 or more employees, your coverage will most likely be creditable. If there are 19 or less employees, you should enroll in Medicare.

Don't assume that employer benefits are always better than Medicare. Every plan is different so it pays to work with a broker in your area that can help you compare the employer benefits to Medicare so you can make the best decision for your situation.

Answer: The short answer is NO. Medicare does not pay for groceries.

However, this is one of those issues that cause a lot of confusion. Some Medicare Advantage plans offer an extra benefit to people who have both Medicaid and Medicare along with a qualifying chronic condition. This is not most people. The problem is that many of the big call centers use this benefit as a lure to get people to call in. Once they have a caller on the phone, they steer them into other plans.

If you are not on Medicaid, you will not qualify for these plans.

Answer: My advice is to not select the company first. Find a local broker that represents all of the major carriers in your area. Discuss with them your individual situation and explore the available options. Then select the solutions that will work best for you.

Answer: Check the various discount programs to see if any of your medications are less expensive using them instead of your insurance. GoodRX is one of the most popular, but there are others.

Many pharmacies also have in house discount programs. You can check in your area if any are available.

Some expensive medications are actually 2 generics put together. You can ask your doctor if separating them would be ok. If so, the individual generics are often less expensive than the single medication.

Most of the manufacturers have programs for limited income individuals. You can check to see if you qualify for any programs through them.

Answer: I believe an Advantage Plan with a Hospital Indemnity plan is a very good option. Although they get a lot of bad press, Advantage Plans can keep medical costs reasonable for most people. I have found the bigger problem with them is the networks, referral requirements and prior authorizations. So if an Advantage Plan can fit your lifestyle, but maybe not your budget, then adding an Indemnity plan to a MAPD can be a great choice.

Answer: You are not required to change your New York Medigap plan when moving to Florida. However, your premiums may change based on your new address. Be sure to update your address with the SSA and your supplement carrier.

Answer: First you need to know if you are actually admitted as an inpatient. If you are staying overnight, but are still classified as under observation your Part B will be the payor.

If you are an inpatient, you will have a deductible for the first 1-60 days. Remember that Part A only covers inpatient costs like semi-private room, nursing, meals, and operating room expenses during your hospital stay for a surgery. Part B pays for your surgeon's fees, anesthesia, outpatient care, and doctor visits. Hospital stays are usually a combination of Part A and Part B.

Answer: Yes, you need to reach the annual deductible before your Medicare Part B will start helping with PT visits. Once you reach the deductible Medicare Part B acts as an 80%/20% plan, Part B paying 80% and leaving you 20%. If you have a Medicare supplement, your supplement will pay the 20%. If you have a Medicare Advantage Plan, your Advantage plan absorbs the Part B deductible and has you pay a set copay for each visit.

Answer: Part A has quite a few gaps in it that make it risky to not have some additional insurance. In addition to a day one deductible, longer stays will have a sizable, daily copay. It is important to remember that Part A Hospital coverage does not cover all the expenses of being in a hospital. It only covers the cost of the room and some services. Many things that are done to you while you are in the hospital will be billable to your Part B. The cost of a hospital stay will be a combination of Part A and Part B.

Answer: Medicare can help with your respite care if your spouse is on Hospice. Part A allows for 5 consecutive inpatient days in a Medicare approved facility for your spouse. These days are for you to have a break from caregiving. Other than this benefit, Medicare does not provide respite care for a spouse.

There are many organizations that will help caregivers get a break. You can contact your Area Agency on Aging or the National Alzheimer's Association among others. Your state Health and Human Services department should also have resources that you can reach out to.

Answer: Because COBRA is not considered creditable coverage, you GI window began when your employer coverage ended on June 30th. Your Guarantee Issue period was only for the 63 days following.

Answer: You can appeal the decision by filing form (CMS-20027). This is a Medicare Redetermination Request. If this appeal isn't approved, you may file a Medicare Reconsideration Request, form (CMS-20033). Finally, if needed you can file a Request for Administrative Law Judge Hearing (OMHA--100). Each level will require you to provide information to justify the appeal.

Answer: The donut hole has been eliminated. It is no longer an issue for Medicare beneficiaries. The cost of drugs and drug plans have increased, but there is no longer a "donut hole".

Answer: Medicare Advantage is health insurance provided by a private company. Your Medicare Part A and Part B are the foundation of the coverage. Once you join an Advantage plan, the carrier is paid to manage your care and offer you a variety of additional benefits that Medicare does not cover. Joining the Advantage plan gives the insurance carrier a lot of control over your care. If you stay with traditional Medicare an insurance company does not control your access to care but there are no extra benefits offered.

Answer: Chiropractic coverage is very limited in Medicare. A broker will be able to help you look at multiple Advantage plans, if there are any in your area with broader coverage, the broker will be able to identify it. However, they tend to cover the same, very limited procedures as Medicare.

Answer: Traditional Medicare does not cover hearing aides. So any coverage depends on which type of Medicare plan you chose. If you have a Medicare supplement, you will not have any coverage for hearing aides. If you have a Medicare Advantage plan you may have some coverage for hearing aides. The amount will vary from plan to plan.

Answer: That is not true. Medicare and life insurance have two very different purposes. They are not dependent on one another in any way.

Medicare does not have any death benefit to help survivors after someone passes away.

Answer: Medicare Part B covers your outpatient Medicare billable services, some medications, primarily medications received in a clinical setting and some Durable Medical Equipment. Once you reach your annual Part B deductible, which for 2026 is $283 , the Medicare Part B acts as an 80%/20% plan. This means Medicare pays 80% of the remaining bill and you are left with the 20%. For small charges, Part B could be enough, but for any substantial charge, Medicare Part B falls short. This is the reason most people choose to add either a Medicare supplement or a Medicare Advantage Plan to their coverage.

Answer: Medicare does not pay for assisted living. It provides some home health coverage, but as far as the cost of a facility, Medicare offers no support. Assisted living and nursing home expenses are either out of pocket, or paid for through the use of a Long Term Care or Short Term Care insurance policy.

Answer: Your Medicare Advantage plan or Stand Alone PDP will cover most antidepressants and anti-anxiety medications. The exact formulary and cost will depend on your specific plan. Some newer medications may not be covered. It never hurts to ask your doctor if they know if a specific medication is covered. They usually know, however they won't know the price for your plan. Each plan is different.

Answer: Yes Medicare will cover Pulmonary Rehab sessions. The level of coverage will depend on what type of plan you have. An Advantage plan will have a specific copay while a Medicare supplement will have your annual deductible to meet and then it will cover the visits.

Answer: Yes Medicare covers neurologist visits and cognitive testing requested by those physicians. Neurologists are specialists so they are covered based on the type of plan you have, a Supplement or an Advantage plan.

Keep in mind that Medicare DOES NOT pay for memory care, or Long Term Care.

Answer: You are eligible to enroll in Medicare 3 months before your birth month, in your birth month and 3 months after your birth month. In total, you have a 7 month window. Remember, if you are are going to continue working and you have employer benefits, you are not necessarily required to enroll in Medicare. You can compare your current coverage to what Medicare would provide and chose the one that is most suitable for you.

Also, if you are starting your Social Security benefits, you will be automatically enrolled into Medicare. Your Medicare Part B premium will be deducted from your Social Security before it is disbursed to you.

The best thing to do is find a local broker who can explain all of the rules to you so you make an educated decision.

Answer: If an agent is captive to a specific carrier, all they can sell is the carrier's advantage plan. If you are working with a broker, you should not feel pushed into a plan. The broker should explain both types of plans, advantage and supplements, and help you decide which fits your situation best. If you are being pushed and the agent shows little interest in your needs it is because HMO advantage plans pay a higher commission than supplement.

Answer: Unfortunately Medicare does not provide coverage for in home custodial care or supervision. Medicare does provide some home health care but it will not help activities of daily living or companion care.

Answer: If you didn't take Medicare because you had employer benefits you need to complete two forms and submit them to Social Security.

Form CMS-40B

Form CMS-L564

You must have your employer complete the CMS-L564 acknowledging you had creditable coverage since you turned 65. Both forms must be submitted to the SS office nearest you. You are unable to do these forms online.

Answer: Some Medicare advantage plans have an allowance for hear I ng aides. Others charge a set copay for different levels of hearing aides. Both types will require you to use a network designated by the plan sponsor.

Answer: Absolutely not! Medicare does not cover dental care or cosmetic procedures. Since dental implants are considered cosmetic it would be a rare event if Medicare paid for implants.

Answer: Don't answer any unsolicited call about Medicare. Do n other resond to T.V. or internet ads that aren't local. Do not talk to your PDP carrier about switching to an Advantage plan. Find a local broker or use a person that was referred by someone you trust.

Answer: The first place to look is the Part D plans available in your area. Different plans may have different co-pays for the same medications. You can also look into programs with the drug manufacturer. They often have plans to help people with the cost of medications. You can look into drug discount programs like GoodRX. Finally you can speak to your doctor to see if they can provide samples or suggest an alternative medication.

Answer: If you have original Medicare a d a supplement then you have no dental benefits. Mant Advantage Plans offer some dental benefits including cleanings. However changing g from a supplement to an Advantage plan just for dental cleanings is not a good idea. The Healthcare available to you with the supplement far outweighs the small savings you would get by switching to an Advantage Plan.

Answer: Sometimes. If you are within six hours of a U.S. port your Medicare should work as normal. Outside of that limit Medicare does not work.

Answer: Get the best that you can comfortably afford. Do not be swayed by "FREE" goodies. Anything you get for free is paid for by taking money from another benefit.

Answer: At this time no. The Trump administration announced a new deal that may allow it by mistake 2026. However, it is not a formalized plan so currently the meds are still not available for weight loss.

Answer: This is a unique case. It is not because of the person's passing that causes the increase. It is most likely a result of income reported 2 years prior to the spouses death. Part B IRMAAs are determined on a 2 year look back. If your joint income exceeded certain thresholds two years prior to the person's death, you could see an increase in your Part B premium. Also, if you filed single instead of joint this year, the income from two years ago may exceed the threshold for a single filer versus a joint filer. Work with a local broker or your tax professional. There are remedies for this situation.

Answer: That it is free. The T.V. commercials are misleading. Medicare is not free. Zero dollar Advantage Plans are not free and zero dollar drug plans are not free. Anything being touted as free, still has a cost. You must know the difference between a premium, a copay, and coinsurance. There is always a cost to every plan with the exception of a Full Dual Special Needs Plan for which most people do not qualify.

Answer: If you will have an IRMAA depends on your MAGI. Work with you tax professional to know the limits for each year and how to keep you MAGI within a desired threshold.

Answer: Special needs plans are Advantage Plans built to provide some extra benefits for people based on specific economic conditions or specific medical conditions.

The plans based on economic conditions are for people on Medicaid. They often provide extra OTC funds and even money that may be used for healthy foods, rent and utilities. Keep in mind, these benefits are limited to those individuals on the highest levels of Medicaid. Additionally, these plans provide financial relief in the form of lower copays for services. The amount if financial help depends on the beneficiary's level of Medicaid. These are the plans often advertised to generate calls to a call center. Most people do not qualify for them. If you are not on Medicaid you will not get a DSNP.

The plans designed for people with ongoing health conditions are called Chronic plans or CSNPs. These plans also offer extra benefits for individuals with certain chronic conditions. The two most common are diabetes and cardiovascular diseases. Some carriers may have additional conditions in different states. Be sure to check with a local broker. Chronic conditions do not include cancer. This is a common question.

As with all Advantage Plans you must make sure your doctor accepts the Special Needs Plan. Not all doctors accept all plans.

Answer: Hey there, Mark Bilgere here with Bilgere Insurance, answering some more questions on the Agents Hub. Today's question has a little bit of a nuanced answer, but you'll see what I mean once you hear the question. The question is, are Medicare agents paid by specific insurance carriers to sign up clients to their plans only?

So the easy answer is not really, because CMS regulates the commissions that can be paid on a plan, the highest that it can be paid. Most independent agents or independent brokers are going to get that level. The problem arises if somebody is an agent or a broker, because a lot of times someone may be an agent for a specific carrier, and then they can only write that carrier. So it seems like they have an incentive to write that carrier, but the incentive is really just to do a good job, right? To do well at their employer, because they're actually an employee of that person.

A broker, on the other hand, represents multiple companies, and they can write for different carriers. In that situation, again, the commission is regulated, so they don't benefit financially by pushing one carrier over another carrier. How they benefit is by asking you questions and finding the plan that will work best for you. You're happy, you refer more people to them, or you stay with them longer, and they allow you to be serviced in other areas. That's the incentive.

So the financial incentive isn't really there, like most people think. The goodwill is a good incentive. For an agent who is an employee, the incentive is to do a good job at their job, not just to sell a particular plan.

So, other questions? Type them into Medicare Agents Hub, and either me or a lot of these other agents will answer for you. Thanks!

Answer: It depends on who is doing the presentation. If it is sponsored by a carrier it will definitely be a sales pitch for that carrier's advantage plans. They will discuss the basics of Medicare but then they will lead you to their products

You will have better luck if you find a local broker that is offering an educational session. They will still want your business but they will be able to tell you about multiple carriers and products. You will have more choices and a more interested partner because brokers are not employed by the carriers. They depend on referrals from happy clients.

Answer: Advisors may work with someone diagnosed with Dementia, however they may not make any changes if the person appears to not understand what is being discussed. This is one of the reasons it is important for our seniors to have a family member or friend whom they trust to help them as they get older and better still have a power of attorney set up in case they are unable to make their own decisions.

Answer: If you are moving you will have a new SEP during which you can change your MAPD or PDP plan.

If you notify your current plan before you move, you get a three month SEP; the month you move plus the following two months. If you move in March and tell the carrier in March, you get March, April and May to enroll in a new MAPD, PDP, or return to original Medicare.

If you move in March, but don't notify the carrier till April, then you will only have April and May as your SEP.

Once your current plan sees you are no longer in the coverage area, you will be removed from the plan. Therefore it is always best to look into the plans available in the new area sooner than later so you can avoid any coverage gaps.

Answer: If Medicare recommends the vaccine for adults in the U.S., it is free. Some fall under Part B while others are under Part D.

Shingles, RSV, Tdap, flu, pneumococcal, and COVID vaccines all have $0 cost.

Travel vaccines are not free as they are not recommended by the Advisory Committee on Immunization Practices.

Answer: You can check your doctors in a few different ways. The first way is to decide which advantage plan you are interested in then call the doctor's office and ask the billing department if they will accept that advantage plan. Be sure to tell them the complete name and number of the plan. Just telling them the carrier name is a sure way to get incorrect information.

Another way to check is to use the Provider Search on the carrier's website. All the big carriers allow you to search for network providers as a guest. You just need to enter your zip code, the plan you are interested in and the doctor's name.

You can also call the carrier directly and ask customer service about a specific doctor. Keep in mind that the representative will use the same system that is available to you online so the information is the same.

If you are trying to help your mom please know that getting advice from her friends is not a good way to decide to move from a Medicare supplement to an Advantage plan. People choose between supplements and Advantage plans for different reasons and no two people have all the same health needs, budget, medications, family situations, and a variety of other things that need to be considered. You should find a local broker you both can meet with and discuss several plans and how accessing health care will change for your mom.

Answer: Hi there, Mark Bilgere with Bill your insurance, answering a prescription question here on Medicare. And that is, does Medicare Part D cover Repatha?

So I'm gonna address Repatha, and then I'm going to address some other things to think about. So, it is often covered by Part D. But what that means is that Part D carriers, the insurance companies that offer Part D plans, can cover it. Whether they choose to cover it or not is still up to them. Because remember, every carrier establishes their own formulary for each plan.

So if there's an alternative to Repatha that they want to cover, as long as they're covering that category, they have to have one medication available. They do not have to have all of them available. So you still have to check with your plan if they cover that specific medicine.

The same is true for a lot of other expensive medicines. The Part D carriers, the insurance companies, decide the formulary and if that specific drug is covered. There may be three drugs that treat the condition that you're looking at, but they may only cover one of them. And you have to try that one first.

Now, could you get an exception? Possibly. It's something you can ask for, but it's up to that company whether they want to do that or not. To know what isn't covered, just think of things that are not medically necessary according to Medicare.

So, weight loss drugs so far still are not medically necessary, but they can be prescribed for other things like cardiovascular disease. ED drugs are not medically necessary, although they can be prescribed for other things, some other cardiovascular things.

Things that would be cosmetic, like hair growth or Botox, those are not going to be covered. Right? Anything that is not medically necessary is probably not going to be covered.

So if you need to know the best way to find out, it is called the carrier of your Part D plan. Or you can look them up online. They'll all have a drug lookup online. Or if you work with a broker, call your broker and they can look it up for you.

Also, they'll let you know ahead of time and probably let you know if there are some alternatives that are listed, in case that's an opportunity for you to save some money. Thanks!

Answer: If you are switching from a Medicare supplement, work with a local broker who represents several plans in your area. They will check to find the plans that have your doctors in their network and cover your drugs. Keep in mind that not all doctors take every plan.

Once you select the plan the broker can enroll you. As the plan is processed, it will automatically disenroll you from the prescription drug plan you are currently on. This will take place at the start of the new coverage period. For AEP your old PDP will end on December 31st, 2025 and your new MAPD will begin on January 1st, 2026.

It is important to remember that your Medicare supplement will not be cancelled automatically. You will need to call that carrier personally and cancel the plan. If you don't, the carrier will continue to charge you for the supplement.

Answer: Medicare Advantage plans will still require Prior Authorizations for certain procedures in 2026. Although CMS is trying to enact some new rules that shorten the decision period it has not eliminated the process altogether.

Answer: As with most Medicare questions, the answer depends on which Part of Medicare. For Part A if you will receive it premium free, than you can usually back date it up to 6 months as long as the start date doesn't exceed your birthdate.

For Part B you cannot backdate it for a medical emergency. You will need to wait until the next general enrollment period if you miss your IEP due to medical emergency.

Answer: As a broker staying up on the changes in Medicare is part of the job. In order to help people, I need to know what the rules, costs and options available to individuals are. I do this by staying connected with CMS and the Social Security Administration through a number of websites. I also follow several industry contributors through blogs and newsletters. In addition, the carriers are required to share any changes with us as they are required to make sure their representatives have been informed of any changes. So for a full time broker, finding the information isn't too hard. The difficulty is finding the available time.

Answer: Have them meet with a local broker who will spend time with them and get to know their situation. Also, attend the meeting with them. Medicare can be complicated and having an extra set of eyes and ears is a good thing. Keep in mind that if your parents ever need you or another family member to be a caregiver, you are going to need to understand how their Medicare works.

Answer: Once you are on Medicare whether you're on a supplement or an Advantage plan, your rates cannot be increased due to your health or your claims. Since the insurance companies still have to insure the whole group, they are unable to lower rates for people based on their claims once they are in a plan. Rate adjustments are based on groups of people, not individuals.

Answer: If you you think you will need custodial care in the future, you need to purchase separate insurance now. Medicare does cover any custodial care in a nursing home or an assisted living facility or in your home. There are Long Term Care plans and Short term Care plans available. LTC plans are much more expensive and have stricter underwriting. Short Term plans that provide up to 360 days of coverage are more affordable and usually have easier underwriting. Keep in mind though, once you need custodial care, you cannot get it.

Answer: If you are already on Medicare, starting dialysis does not change your eligibility. If you are on an advantage plan you will be responsible for the Part B portion which is 20%. However. Every Advantage plan has a Maximum Out of Pocket amount (MOOP) and all part B charges are applied to that amount. You will reach your MOOP amount every year you are on dialysis. How quickly you reach it depends on your location, your other medical needs and the amount listed in your plan. Your MOOP will reset in January of the following year.

If you are on a Medicare supplement your supplement will pay the 20% once you have met your annual deductible/

Answer: If you need long term care after a stay in a skilled nursing facility, your Medicare will continue to pay it's designated Part A and Part B benefits. However, Medicare Parts A and B do not cover any Long Term Care, so your Medicare will not help with the cost of a nursing home, or custodial care. All of those costs will be out of pocket.

Answer: One of the best benefits of Medicare is that you cannot be dropped for using your benefits. Whether you are on an Advantage plan, a Medicare supplement or Traditional Medicare you will keep your benefits no matter how much you use them. Keep in mind that Medicare supplements do have underwriting requirements, so if you apply for one and are not in a guarantee issue period, you can be denied coverage due to pre-existing conditions.

Answer: I assume you mean to get information and sign up for a plan. Calling the carrier is always an option, but a carrier can only tell you about their plans. You would have to call all the carriers in your area to compare all the plans. By using a broker, one person can see all the plans and based off your circumstances, guide you to the most beneficial ones for you to chose from. Since there is no fee to use a broker, it just makes sense to use an unbiased person to select the right plan for you.

Answer: Yes, you will be sent an Annual Notice of Change every year for Medicare Advantage plans and Stand Alone Part D Drug plans. It is important that you read these each year. If your plan changes and you aren't aware of the changes, you will have many unpleasant surprises during the next calendar year.

If you aren't sure how to interpret your ANOC, find a local broker you trust and ask them to explain it to you. Not only will they explain it, but they can show you how the other plans in your area compare to your current plan.

Answer: In a Medicare Advantage plan you will have a Maximum Out of Pocket amount, often referred to as a MOOP. This is a very important number as it is the most you could spend in a calendar year on healthcare. It is important to remember that this amount does not include your drug costs.

In your advantage plan you will have copay amounts and coinsurance amounts listed for each type of service, specialist visits, MRIs, hospital stays etc. If during the year, you add up all the copays and coinsurance you have paid and they equal your MOOP, then you will not have anymore copays or coinsurance for the rest of the calendar year. This is what protects you from catastrophic medical bills. It is one of the best features of an Advantage plan.

The drug portion of your advantage plan will have it's own MOOP amount. In 2026 it is $2,100. Once your drug copays add up to $2,100, you will not have to pay anymore drug copays for the rest of the calendar year. Both MOOPs reset on January 1st of the next year.

Answer: Start by using a local broker who represents multiple carriers and multiple plan types. If you are talking to a captive agent who is employed by a carrier, that person can only tell you about their products and will push you towards their product. A well diversified broker should ask about your situation and show you how each type of plan will work for you. At that point, you can decide which type of plan you want to enroll in. If you call an 800 number from the T.V., you will be pushed into the plan that company sells.

Answer: Yes, you can use your HSA funds to pay Medicare Part A, B, C and D premiums.

You can not use your HSA funds to pay for Medicare Supplement Premiums.

Answer: Outpatient surgery would be covered by your Part B. Part A covers your surgery when you are confined to the hospital as an inpatient.

Answer: The main benefit of Part D is different for different people. If you take one or more very expensive medications, then the main benefit would be the annual Max out of Pocket limit. Only drugs that are covered by your plan apply to this limit. If you don't have a plan, then there is no limit to the amount you may have to pay for drugs.

If you don't take any drugs, then the main benefit is avoiding the Part D penalty later in life when you do need to enroll.

Finally, if you take a few medications that add up to a high monthly amount, the reduced copays and coinsurance amounts would be the main benefit. Even several generic medications each month could add up to a significant amount without insurance coverage.

Answer: Individuals who are receiving SSDI benefits, and have been receiving them for 24 months are automatically enrolled in Medicare. Even if the person is under 65, their healthcare will come from Medicare.

Answer: Everybody loves FREE stuff, but we also know that very few things are really FREE. I prefer to describe Advantage plans as "Premium Free". This means they don't charge you a monthly fee to have the coverage. However, you do have copays and coinsurance for goods and services when you use them. These costs are often overlooked by folks when they are price shopping. When it comes to your Healthcare, Price and Cost are often very different. Something with a low price may cost you a lot of time and frustration and delayed care.

Answer: You can do it on your own by going to MEDICARE.gov and searching for Part D plans. It will ask you for your zip code and the prescription name and dosage. You can then enter the pharmacies in your area and see which plans will cover the drug and how much it will cost at each pharmacy.

Answer: There is no trap in the plans. If you work with a trusted agent, they will tell you that Advantage plans are very clear in what they will and won't pay. They will also explain the network requirements and the possibility of prior authorizations, referrals and such. One problem is that the documents containing all that information are daunting. Another problem is that many agents don't take the time to explain the plans fully and then the beneficiary feels as if the plan did something shady.

This isn't to say that Advantage plans don't have negative aspects. Depending on your situation and needs, an Advantage plan may not be a good fit for you. They aren't perfect and anything that sounds too good to be true, usually is.

If anything resembles a trap, it is the advertising of the plans. The T.V. commercials, radio ads and internet advertisements are vague and misleading at times. All the emphasis is placed on the extra benefits and not the actual healthcare. When looking at the plans in your area, focus on the healthcare first and the extras afterwards.

Answer: Unfortunately no. In order to be eligible for Medicare you must have lived in the U.S. continuously for 5 years. Once you have passed the 5 year requirement and have turned 65 then you are eligible to enroll. The cost of your Medicare will depend on the number of quarters you or your spouse has paid into the system. If you have less than 40 qualifying quarters then you will have a premium for Part A and your Part B. The Part A premium will be based on the number of quarters you do you have, less than 30 hours or 30-39 hours. The actual price will be determined in the year you enroll as those costs change each year.

Answer: It is if when you talk to them you feel they are listening to you and asking you questions to understand your needs. If you feel rushed or pressured, then don't continue with them. Technology allows us to help a lot of people all over, but the process should still be the same, get to know the person, their needs and help them find the best options for them. Be aware that many call center agents are primarily sales, and they will not be available once you have enrolled. So a trusting relationship is still important.

Answer: This is one of the most often asked questions about Medicare. Of course there is not just one simple answer. It depends on a couple of factors.

If you work for a large employer, over 20 employees, you can continue to use your employer benefits and delay your Medicare. However, it is a good idea to compare your employer benefits to Medicare to see which one would be better. Not all employer plans are better than Medicare.

If your employer has less than 20 employees, you should enroll in Medicare. This is because most small plans do not fit the Medicare definition of creditable insurance, and once you turn 65 you are required to have creditable insurance. If you don't, you could be penalized in the future when you do decide to switch to Medicare.

One thing you hear a lot is to enroll in Part A and delay Part B. This can be beneficial if you know the other rules, plus or minus 20 employees, but be aware that if you contribute to an HSA, enrolling in Part A eliminates your ability to continue contributions to that account.

I suggest finding a local broker that will sit down with you and explain all of the details. If you feel pressured into signing up, walk away.

Answer: Medicare only pays for a portion of Part B medical expenses, which an ambulance ride would fall under. Once you have met your Part B deductible, Medicare pays 80% of the cost, leaving you 20%.

If you have an Advantage plan, there is a specific copay you owe for an ambulance ride. The specific amount depends on your plan. They are usually $250 - $400. This is what it sounds like based on a $300 bill.

If you have a Medicare supplement then once you have met the Part B deductible, your supplement will pay the remaining 20% that Medicare does not pay.

Answer: Unfortunately there is no Medicare coverage for Dementia care outside of any medical care. Any custodial care to help with activities of daily living or safety are left up to the individual and the family to pay for.

Answer: The answer to this question lies in the middle. It depends on the types of plan you have and your personal situation. If you have a Medicare Supplement, your coverage doesn't change so changing for that reason isn't necessary. If your premium has become cost prohibitive, you can look for a less expensive supplement, but remember you will need to pass underwriting if you are outside of your guaranteed issue period.

If you are on a Medicare Advantage plan then you may want to check your plan annually, but not necessarily change it. When the MAPDs come out in the Fall, you are sent a letter that explains how your plan will change. If there is something significant that is changing, then you may want to shop around to see if another plan can be a better fit. If there isn't much change, I don't suggest moving. If your plan has worked fine for you and your providers, then stay with it.

In general having a plan for the long run creates fewer issues when it comes to getting care. However it doesn't hurt to look at the new MAPDs each year as they can change significantly and you don't want to be surprised later in the year.

Answer: If you receive a bill that you believe is incorrect start by reviewing the bill and your Medicare Summary Notice, or your Explanation of Benefits if in an MAPD. Check the dates of services, look for duplicate billing or services you didn't receive. Make sure you know if the provider was in or out of network and that they accept Medicare assignment.

If all of that information looks appropriate, you can call the provider and ask for clarification. Errors can occur. If the provider says the billing is correct but you feel it is not, give your carrier a call. Different Advantage plans have different copays and coinsurance. If this is the case, the carrier may be able to explain it.

Be sure to keep records of who you speak to, dates and times, claims numbers and what was promised to you. If you need to send mail, send it Certified and keep copies of your correspondence.

Answer: If you have a family history of colon cancer, this includes a parent, sibling or child who has had colorectal cancer or an adenomatous polyp, then yes you would be considered high risk and Medicare could pay for a screening every 24 months. The regular schedule is once every 120 months.

Answer: When I meet with people, I seldom feel like they ignore my advice. Once we go through their options and I explain how different plans work, they usually decide what is best for them and we usually agree. The bigger problem is people choosing to not use a broker to help them with the process.

Many people feel they are going to save money by doing it themselves. They won't. Brokers are paid a commission by the insurance company and it in no way affects what the client pays. If you call an 800 number on T.V. that company is an agency and they are getting paid commissions too.

Or, people are swayed by the T.V. commercials and Facebook ads they see. They have a fear of missing out on benefits that sound too good to be true, which they are. Those ads at best are evasive.

The best advice if you want to get the most out of Medicare is to ask around for references in your area. Someone with a good reputation will work to keep it. Someone with no reputation has nothing to work for.

Answer: Your doctor should be able to tell you if Medicare is going to cover a certain procedure. If they can't for some reason, you can call Medicare and ask. Be sure you have the specific codes the doctor will be filing. Some procedures are actually several separate procedures and Medicare will pay for for some but not for others.

If you have the codes or the exact name of the procedure you can always look them up on https://www.medicare.gov/procedure-price-lookup/ This will tell you the Medicare cost for all Medicare covered procedures.

Answer: This question has different answers based on who you ask. In my opinion as an experienced agent, I feel the biggest disadvantage at the patient level is the ability for the carriers to deny coverage that a licensed provider has recommended. That isn't to say that there shouldn't be rules and requirements to justify certain procedures but those decisions should be made by other experienced providers trained in the same specialties. The current system uses a less than ideal process with less than ideal decision makers.

However, Advantage plans do provide a lot of benefits that help a lot of people. No one plan is all good or all bad. When you are first entering Medicare, be sure to use a broker that you trust and will take the time to understand your specific circumstances. This way you can get the best information about planning for your future healthcare.

Answer: An income of $1,400 would qualify for a few different national and state programs to help with Medicare costs. The LIS 9Extra Help) programs helps with Part D premiums and copays. The Medicare Savings Program (MSP) can help with Part A and Part B premiums. These programs will also have Resource limits (Assets). Be sure to check for the current year limits for both.

In addition to those two programs, all the states have programs of their own that can work along side the national programs. Again, each state will be different so you should reach out to your state HHS department to see what is available.

Answer: If you are outside of your Guarantee Issue period for your Medicare Supplement, then yes you will have to answer health questions to change Medicare Supplements. Your Guaranteed Issue period is the 6 months following the start of you Part B. During those 6 months, you are not required to answer any health questions.

Answer: Medicare only covers one specific chiropractic service, Spinal manipulation for active subluxation. Medicare does not cover chiropractic adjustments for maintenance, x-rays, diagnostic imaging or any other services provided by a chiropractor.

Some Advantage plans may offer extra chiropractic services.

Many chiropractors do not accept Medicare, so be sure to check before you make an appointment.

Answer: Original Medicare does not pay for care when overseas. Some Medicare Supplements will help with emergency care. They will pay up 80% of emergency costs up to $50,000 after a deductible is met. This is only for emergency care within the first 60 days of an overseas trip. Be sure to keep all receipts for reimbursement.

Some Advantage plans may offer limited international emergency care. This is included by the carrier and is not part of Medicare. Be sure to check with your plan to see if they offer coverage.

Answer: Once you are on Social Security Disability for 24 months, you will be automatically transitioned to Medicare. If you are under 65 you will have Advantage plans available and some Medicare supplements, depending on what state you live in.

When you turn 65 you will have another enrollment period. At that time you will have a new enrollment period and all of the plans available in your state will be available to you.

Answer: If an agent or a broker helped you enroll, they should have told you about all of the benefits included with the plan. If they knew that dental was one of your main concerns, then that should have been one of the main benefits they addressed. If, on the other hand, you called an 800 number from the T.V. than you may have been rushed through the process and were given incomplete information. Any plan you are enrolled in should be discussed completely. There should be no surprises when you use your plan.

Answer: You may or may not need help. Medicare can be very confusing and most people aren't well versed in all the rules and the way coverage works. The ads you see on television do not explain how Medicare works very well as they are focused on selling only their product. The best thing to do is find a local broker that has a good reputation and use them. There is no fee to work with a broker and unlike a captive agent, a broker can show you multiple products instead of just one.

Answer: Each plan must carry at least one drug for each therapeutic condition. If no generic is available, then it will have a Brand name drug. However, if multiple drugs are available, the plan is only required to cover one so there may be others that your specific plan doesn't cover. If a generic does exist, it is most often the preferred drug. The plan will request that you use less expensive drugs before more expensive drugs.

Answer: How often you can change your plan depends on which type of plan you chose to begin with. If you are choosing an Advantage plan you are subject to the official enrollment periods. The most used period is the Annual Enrollment Period. It is October 15th through December 7th. During this period you can evaluate all the plans in your area and if you decide to chose, you may do so.

The next enrollment period is the Open Enrollment Period. This runs from January 1st through March 31st. This period allows people who made a change during the AEP to change once again in case they had made an error.

If you chose a Medicare Supplement, you can change from one supplement to another whenever you like, however, you will be subject to medical underwriting if you have had the plan for 6 months or longer.

Changing your Prescription Drug Plan (PDP) will be subject to the same enrollment periods as the Advantage plans.

I suggest working with a local broker that will take the time to understand your situation and show you the plans that are the best fit for you. Don't call an 800 number you see on T.V. or talk to anyone form an unsolicited phone call.

Answer: Typically once you start your retirement benefits, your Part B is deducted from your monthly benefit. However, there are a few circumstances that could result in getting a bill.

1. If your Medicare starts before your SS is set up, you may receive a bill for the first 1 to 3 months of Part B.

2. If you have an IRMAA surcharge, the extra amount could be billed separately.

3. If your Social Security amount isn't enough to pay the Part B amount you will be billed for the remainder.

4. There could just be an administrative issue.

Usually a phone call to Social Security can get the issue resolved.

Answer: Medicare does not cover home health aides. This type of care is also known as Custodial care. It includes things like cooking, cleaning, shopping, pet care and help with the Activities of Daily Living, (Bathing, Toileting, Dressing, Eating, Transferring and Continence).

Answer: If your preferred hospital is no longer in your Advantage plan network, you have three choices.

1. Select a new hospital that does accept your plan.

2. Change plans during the next enrollment period you have a available.

3. Continue at the preferred hospital but pay the out of network costs. (Least attractive option)

Answer: The greatest misunderstanding seniors have about Medicare coverage for long-term care is that there is any coverage. Medicare does not pay for any long-term care. The cost of assisted living or full nursing care is an out of pocket cost. The national average for assisted living is $54,000/year while a semi-private room in a nursing home is around $100,000 / year. These charges are in addition to regular healthcare and medication costs.

Answer: Since you are enrolled in Plan F, you do not have any copayments. Plan F pays the Part B deductible and all other copays. Unfortunately for anyone who turned 65 after 01/01/23020, Plan F is no longer available.

Answer: Unfortunately, this can and does happen. If your specialist does leave the network you have two options.

1. You can continue to see them but you will have to pay the higher, out-of-network costs.

2. You can select a new specialist that does accept payment from your network.

In some circumstance you may apply for Transition of Care benefits if you are in the middle of a specific treatment. Chemotherapy, surgery prep.

Answer: Your daughter can sit in on discussions with the agent and can help you compare plans. She may ask questions and help you provide information. However in order to enroll in a plan for you she will need a Power of Attorney or be listed as your Authorized Representative with Medicare and the plan.

Answer: The answer to this question depends on the type of plan you have. If you have a Medicare supplement, then there is no need to review your coverage as the benefits remain the same each year. Your premium however may be getting too high for you, in which case you can explore Advantage plans, or switching supplements if you are able to pass underwriting.

If you currently have an Advantage plan, you should be reviewing it each year during the Annual Enrollment Period. This doesn't mean you should change it, but you should check to see if it is changing in a significant way. Each year you receive an Annual Notice of Change letter, (ANOC). This letter tells you how your plan will change from the current year to the next. If it isn't changing or changing very little, you don't need to do anything. You can let the current plan roll over to the next year. If it is changing you may want to look at the other plans in your market.

Be aware that the Annual Enrollment Period is an opportunity for you to make changes if you need to. You are not required to change, and if your plan has worked well for you the previous year, we suggest you don't change. If you, your agent, your provider and your insurance carrier have all worked well together, there is no reason to upset the system.

Answer: SIlverSneakers is an extra benefit provided by the Advantage plan your friend has. Medicare does not provide gym memberships to anyone. Some Advantage plans include a gym membership while some others don't. Even plans from the same carrier can vary on whether or not they offer a gym membership. I recommend working with a local broker that will explain all the benefits of whichever plans you are considering. That way you won't have any surprises later in the year.

Answer: They should work with a local broker that will sit down with them and evaluate their situation. A broker does not work for a specific carrier, they should have access to most, if not all, of the plans in your market. There is no fee to work with a broker. The commissions they earn are regulated by CMS, so there is no incentive to steer you to one plan over another. If they recommend a plan it will be based on your needs and your market.

Ignore the T.V. commercials. Ignore the social media ads. Don't talk to anyone that calls you about Medicare if you haven't requested the call.

Answer: If you are qualified for Medicare, 65 years or older with 40 qualifying quarters, yes you have a SEP when losing employer coverage. You will have 8 months from when the employer coverage ends to enroll in Medicare Part B and 2 months to enroll in Medicare Part D. Keep in mind that COBRA does not count as creditable coverage so staying on COBRA does not extend the 8 month SEP.

Answer: By law, all Medicare Supplements (Medigap plans) are guaranteed renewable. This means the company cannot terminate your plan unless; you stop paying your premium or you were untruthful on your application. The only other way a plan can terminate is if the company goes bankrupt or leaves your state completely. This is rare and if it happens you have a guaranteed right to purchase another Medigap.

Medigap plans cannot cancel your plan or raise your rates based on your individual claims.

Answer: Its hard to figure out because most people only have to do it once in their life and its part of the government bureaucracy. Your question takes a little thought but it isn't too complicated. If you are still working, your employer has more then 20 employees and they offer you health insurance, you may keep that insurance and you do not have to enroll in Part B. Although, you can compare your company benefits to Medicare and chose the one that would work better for you. This is a nice option to have.

If your employer has 19 or fewer employees, you should enroll in Medicare Parts A and B.

Answer: Possibly. A bone density test is considered preventive if you meet certain criteria. Primarily, are you at risk for osteoporosis? If so, there are still several other factors that determine your eligibility. Your provider can tell you if the meet the eligibility requirement. If you do, then yes, the bone density test is covered completely. If you don't meet the requirements, it will be paid according to whichever type of plan you have, either a Medicare supplement or and Advantage plan.

Answer: An IRMAA (Income Related Monthly Adjustment Amount) is determined by looking at your income 2 years ago. If that income exceed a certain threshold, you are accessed an IRMAA. The thresholds change each year. If you are accessed an IRMAA, your monthly premium for Medicare Part B is increased.

There are a variety of exceptions available to have an IRMAA reevaluated. Use Social Security Form SS-44 to apply for reconsideration. The most common reason is a reduction in income when someone retires. They may have had a high salary 2 years before retiring but now they will get very little. This could qualify for a reconsideration.

If you work with a trusted broker they can help you with this.

Answer: Unfortunately, no. By choosing a Medicare Advantage plan you have moved from the Medicare system to the private insurer. Since Medicare has paid the insurance carrier on your behalf, it will not pay for any further services. If you are on a Medicare Advantage plan you are required to use the network providers that accept that plan.

Answer: There are several levels of Medicare appeals.

The first level appeal is a "Redetermination". This can take up to 60 days once Medicare receives your appeal.

The second level is a "Reconsideration". This can also take up to 60 days.

Next, the third level, is a "Hearing before an Administrative Law Judge". This is supposed to be 90 days, but a backlog of cases actually makes it longer. It could be months or a year.

The fourth level is a "Medicare Appeals Council Review". Again this is 90 days from receipt of the request.

Finally, the fifth level is going to "Federal District Court". This process could take months to years.

Answer: Because CMS uses a variety of measurements, and there are many plans throughout the nation, it's difficult to say that one carrier is better than another. A better way to judge plans is by looking at their STAR Ratings. All Advantage plans are rated on a 5 star system, 5 stars being the highest rating. Use a local broker to help you determine the highly rated plans in your area.

Answer: Most people over 65 qualify, but not all people. In addition to being 65, you must have 40 quarters of work during which you paid taxes, or, be married to a spouse who has earned 40 quarters. That is 10 years.

You must also be a U.S. citizen or a permanent resident that has lived in the country for the last 5 years.

Answer: Medicare does not cover in-home caregivers. Medicare covers some home health care when prescribed by a doctor, nut does not pay for any type of custodial care. There are many short term care and long term care policies available that help with the cost of home care.

Answer: Yes Medicare covers blood thinners. The copay cost is determined by the drug's tier level. the lower the tier, the lower the cost. Oral medications that you can take yourself fall under a Part D stand a lone plan or by a Medicare Advantage plan. If you receive them as part of a hospital stay they fall under Part A. If a doctor has to administer it in an outpatient setting, then it will be covered by your Part B.

Answer: Deciding to sign up for Medicare involves several different concerns. If you have POA for your parents, then you need to consider if they have coverage from an employer that is as good as, or better then Medicare. If not and they are 65, then getting them signed up is the thing to do. However, if you don't have POA then you are not able to sign them up or enroll them in any type of supplement or Advantage plan. The best thing to do is find a local broker who can explain the process to you and help you make the best decision for your folks.

Answer: In general Medicare fraud is a concern because it affects the whole system, resulting in higher costs for everybody. At the individual level your greatest concern should be someone using your Medicare number to commit fraud. However this fraud is usually not targeted to the beneficiary, but instead your number is used to make bogus charges for reimbursement.

The best way to help is to keep you Medicare number private. Never give it out over the phone to someone you don't know. Medicare will never call you and ask for your number. Usually you only need to share your number with a new provider or your trusted agent if they are helping you enroll in a new plan or are working with you to resolve an issue with Medicare.

Don't talk to any unsolicited Medicare phone calls.

Answer: Absolutely! Like past years, the Part A deductible and copays will increase. The Part B Premium and annual deductible will also be increasing.

In addition to those increases, Part D premiums will be increasing dramatically for many people. Along with higher premiums, people will see higher drug costs, stricter formularies and fewer plans available.

Advantage plans are also changing. Many plans are being eliminated completely. Plans that are remaining are seeing an increase in copays and a decrease in many of the extra benefits. Be sure to read your ANOC letter to see how your plan is changing.

For Medicare supplement owners, in addition to the part D increases, monthly premiums will continue to rise. Although, these increases are specific to each carrier.

Overall 2026 looks to be a tumultuous year for Medicare beneficiaries, agents, providers and carriers.

Answer: This is a question with a very big answer. Here is a short answer, but there is a lot more to the idea.

If Universal Healthcare actually moves forward we could see a few different things. One could be expanding Medicare coverage to include Dental, Vision and Hearing. Another could be to lower the age for eligibility. Some people have suggested 60. Still, others would like to create a whole new system with coverage for all. Any of these solutions would lead to higher costs for the program, so the way it is funded would have to change. This could mean higher payroll taxes or higher premiums along with strict regulations and oversight.

The private insurance market would also be affected. Medicare Advantage may become the standard, leaving Medigap as less of an option. Or universal coverage could leave private carriers as only a supplement to a government plan and not part of the system.

Answer: Unfortunately it's impossible to say if one is better than the other. Because they have different features and regulations, it is like comparing apples to oranges. What matters most is what fits your situation the best.

Original Medicare does not require the use of networks, prior authorizations or referrals. However it has deductibles and copays that could add up to very high medical bills. It does not include any dental coverage, routine eye checkups or hearing checks.

Medicare Advantage plans usually pay the Medicare deductibles, but have set copays for the services you use. One of the best features of the Advantage plan is it has a Maximum Out of Pocket Limit. This MOOP prevents your medical bills from becoming catastrophic in one calendar year. On the down side, Advantage plans do rely on network adherence, prior authorizations and usually referrals.

Work with a local broker in your area who can explain all the differences and help you select what will be the best for you.

Answer: If you move to a U.S. territory and are on a Medicare Advantage plan, you will be dropped from that plan and return to Original Medicare. You will be able to add a Part D prescription plan.

Medicare supplements may be available. However, they are not regulated the same as in the 50 states and all plans may not be available.

Answer: If you signed up on line then you would have been signed up for both unless you checked the box that indicates you did not want Part B. If you did not check the box, you will be enrolled in both.

If you are enrolled in both A and B and you want to stop your B, you may do so. Sign your Medicare card on the back and return it to Social Security. Include a note indicating that you want to decline your Part B at this time.

Answer: You should not talk to anyone that called you without a request for them to do so. Anyone calling you with Medicare opportunities is either going to get you to switch or try to get your Medicare number in order to switch you without your knowledge. The only people who should call you are people that you specifically gave a "Permission to Contact" form to.

Medicare will not call you and ask for your number. If they need to get a hold of you, they will send you a letter.

Answer: This may be different depending on what type of plan you have. Traditional Medicare does not cover an annual physical, so a Medicare supplement most often does not cover an annual physical. Some supplements will add it as an extra benefit. Most Advantage plans will add it.

The other major cost people will run into is high dental charges. Medicare does not cover dental so supplements do not cover dental. Most advantage plans add some level of dental coverage, but it can vary wildly. The network that the plan uses can also be very restrictive. Always check with the dentists before you go to make sure they will accept the insurance you have.

Answer: Unfortunately the big call centers, FMOs and lead aggregators can use this statement because there are a few people that can get some assistance with groceries. So, technically the programs may be available in your area so they can say it and then find out later that you don't qualify. The number of people that do qualify is small, so they know the chance of each person they call receiving the benefit is small. It's just the way they get you to talk with them and then they find some other benefit that they entice you with. Their goal is to make you switch plans.

Answer: Traditional Medicare does not cover the cost of an annual physical. Some Advantage plans will add an annual physical as an Extra Benefit. In these cases, the insurance carrier is paying the cost. Most Medicare supplements only pay the 20% of what Medicare doesn't pay, therefore they don't cover physicals either. However, there are some Medicare supplements that will cover the cost of the physical as a perk of their plan. These plans usually have a higher starting price, but if that benefit is of value to you, then it is something to consider. Work with a local broker who will help you find the best product for your specific needs.

Answer: The easiest way is to log onto your SSA.gov account and select "Replace my Medicare Card." If you don't have access to the internet, you can call 1-800-MEDICARE and request a new card.

Answer: The main risk of not having a Medigap plan is financial. Because Traditional Medicare has a Hospital deductible and copays in addition to the Part B 20% coinsurance with no Stop Loss, you could face catastrophic medical bills.

By adding a Medigap plan you eliminate having to pay the hospital costs and the 20% Part B coinsurance. In addition to the Medigap premium, you would be responsible for the Part B deductible and once that is met, your Medicare billable charges are paid.

Answer: Annuities can be an important part of a comprehensive retirement plan. Although, they are not the right fit for everyone. Like any financial product they have pros and cons. They can offer stability in a portfolio protecting some of your savings from downside loss. However to get the protection you will give up some of the growth potential. Because there are many different types of annuities, it is important to work with a person you trust who will spend the time getting a full picture of your financial situation.

You can use annuities to provide lifetime income to supplement other sources. Many products have riders that can provide extra money if you experience serious health issue and some can even build LTC insurance into the annuity. Make sure sure understand all the features of any annuity before you purchase it. Used properly an annuity can be a great purchase.

Answer: Right now in 2025, you are required to meet your annual Part B deductible which is $257. Once that is met, you are responsible for 20% of all your Part B charges. The actual dollar amount will depend on the care you need at the time. Most outpatient care falls under Part B and once the annual deductible is met, you are responsible for 29% of the cost of the service.

Answer: If you are already collecting your Social Security Retirement benefits, you will be automatically enrolled in Medicare when you turn 65. You will also have your Medicare Part B premium automatically deducted from your Social Security check. Remember that Medicare does not enroll you in Part D for prescriptions, so you need to make sure you do that also.

Answer: Having you sign a SOA is not just normal, it is required. This document shows that you have agreed to talk with the agent about different Medicare options and limits the SCOPE of things they can talk about at that specific appointment. The options are listed on the SOA and you have the ability to check off the things you wish to discuss. If it is your first appointment you will likely check all of them so the agent can give you a good description of all the options available to you.

It's important to know that signing the scope does not obligate you to work with that agent. It is not a contract.

As far as call centers go, yes they are required to have you agree to a scope. It is a voice signature they can collect over the phone. However, there are some call centers that are very loose with the rules. If they are calling you unsolicited, then don't talk with them and don't give them permission to help you.

I recommend finding a local agent that can spend time with you to understand your situation and go through your options. The majority of call center agents have a quota and try to get as many enrollments as fast as possible. THis may not be the best alternative for you.

Answer: You are not required to sign up again, however you are given the opportunity to enroll again. This opportunity can be worthwhile since it gives you a guaranteed issue period to enroll in a Medicare Supplement without competing the underwriting. This could be advantageous since you have preexisting conditions that would normally cause you to be declined from a Medicare Supplement.

Answer: If you have decided that Medicare is the right choice, then the most important things to know are if your doctors and medications are covered by a specific plan? Too often people are swayed by "extra benefit". These can be nice additions, but your health plan should be focused on your healthcare first and then extra things. Doctors and medications are the foundation of your future healthcare.

Answer: It depends on how the seminar is advertised. If it is listed as a sales or marketing event, then you will most like feel as if you are being sold a specific plan. On the other hand, if it is advertised as an Educational event, then there is not supposed to be any specific plan selling. These seminars usually focus around Turning 65 and general Medicare information, or Annual Enrollment Period information without specific plan information. If it presented by an insurance carrier then chances are you will feel sod to.

Answer: Supplement plans can be applied for at anytime. However, depending on how long you have had your Medicare you may need to pass underwriting to change plans. If you do change supplements, you will need to wait till an official enrollment period to change your PDP, as they follow the same rules as Medicare Advantage plans.

Answer: All you should tell him is thanks for your opinion, I'll consider it. Then, what you should think about is what kind of care you will need, what medications you take, what doctors you want to see, where you want to travel, what your budget is, what experience you've had with other friends and family and all the other things that are different about your life than his. No two people are the same, so basing your choice only on the premium is short sighted. It doesn't mean it's bad, it's just only a small part of the decision. I recommend using a local Medicare broker that can explain both Medigap plans and all the Advantage plans in your area.

Answer: If you are accessed an IRMAA surcharge, then you are responsible for paying it. Where there can be confusion is when one spouse doesn't have income, yet has an Income Related Monthly Adjustment Amount. This is because IRMAAs are determined by your tax return and those Married Filing Joint share their income. So the total income is counted, not individual income. Check with a local Medicare broker and make sure you understand what you will be paying for your Medicare and what options you have.

Answer: The one piece of advice seniors should know is that the price and the cost of your healthcare are not the same thing. The price of your premium is one thing to consider, but the ability to get care when you need it or the inability to get it is the cost. Does it cost a lot of time and frustration? Does it require phone calls to the carrier? Does it require your provider to battle with the carrier to get preauthorization? When making your selection, consider both the price and the cost.

Answer: Your summary of benefits will list the extra benefits available in your plan. If Hearing Aids are included, they will be listed along with the copays you are responsible for. It will also tell you which hearing network you are required to use in order to receive the benefit. You can always call your broker or the Carrier for help.

Answer: The premium may only be part of the issue. It sounds like the person who helped you did not take the time to properly explain the plan and how it works. Whether you chose an Advantage plan or a Medicare Supplement, you should be able to know what your bill will be before you ever have a procedure or visit a doctor. Always confirm with the provider what is going to be done and what it will cost ahead of time. Of course the occasional complication or emergency can arise at which time the provider may need to do something that was not foreseen. This however should be the exception and not the rule.

Answer: Unless your company has a retiree health plan or you have TriCare for Life from the military, you will need to enroll in Medicare when you retire to avoid any penalties later on. You will need Parts A, B and D. AN Advantage plan (Part C) or a Medicare Supplement (medigap) are not required however most people chose one or the other to help with the costs of things that Medicare does not cover: Copays, Deductibles, Dental...

Answer: For standard cataract lens replacement, Medicare does a great job. If you have a supplement, you will need to pay your annual deductible(2025 = $257). If you have already paid it, then you should have no copay if you are plan G or F. If you are on a Medicare Advantage plan, there is a set copay listed in your Summary of Benefits. It varies from plan to plan.

Medicare will not pay for upgraded lenses. Those costs will be out of pocket.

Answer: If it is a Part D medication, something you take at home, Medicare does not cover it as Medicare does not cover any Part D medications. TO get coverage for these self-administered drugs, you must have a PDP, MAPD, VA or a retiree plan in addition to PART D. To determine if your plan covers the medication you need to check the formulary for your specific plan.

If the medication qualifies as a part B medication, usually infusions or something that need to be administered in a clinic or hospital, then it may be paid 80% by Medicare, leaving 20% for you. Again, you would need to check with Medicare first to see if it is a Medicare approved drug.

There are many plans available, be sure to check that whatever plan you are considering covers your drug. The plans are not required to cover all drugs.

Answer: This is one of the most common Social Security misunderstandings. When one spouse dies, the surviving spouse receives the higher of the two benefits. Not both checks. This mean the survivor ALWAYS takes a cut in pay from Social Security.

Answer: This is my favorite question. Working with a local Medicare broker ensures that the person you're working with knows about your area. They have an understanding of the plans available in your area and are familiar with what works well and what doesn't. Plus you can meet the person and know where you can get help if you need it, or at least follow up with someone if you can't.

Working remote isn't automatically a bad thing. If you live in a very rural area, or if you're limited in your mobility then the convenience of working over the phone or internet is wonderful. Or if you're working with an agent that your are already familiar with. But, if you are new to Medicare and live in an area with lots of brokers, why not meet someone face to face? You will feel better about any decisions you make.

Answer: Hi there, Mark Bilgere with Bilgere Insurance, and we're answering some more questions here on Agent Hub. This question today is a little bit longer, but the answer is pretty short. The question is, have you ever encountered a situation where a health care power of attorney made a significant difference? And what guidance would you offer to someone thinking about setting one up?

Well, I'll actually go backwards. The guidance I would give is absolutely set one up. Every person, every senior citizen, I believe that has someone else who's going to help them at some point needs to do this earlier as opposed to later.

Have you ever encountered a situation where it was helpful? I absolutely have. My father-in-law granted power of attorney, not just for health care but for his finances and everything. To my wife, he was progressively getting worse from chronic kidney disease. He was having to go to the dialysis center, and then we started doing it at home. But he still had to go to the nephrologist office pretty often. He was having some TIAs, so we were taking him to a neurologist, of course, his primary care physician, all those people.

Not only do people sometimes not have the ability to make their decisions, they just lose interest. They honestly just get beat down by the constant medical attention and stuff that they don't want to participate in. And that was easier for my wife to go ahead and help make decisions for him at the time.

Along with that, the other thing you need to make sure you have in place is your living will. What a lot of us would call a DNR, do not resuscitate. Those things, if you don't want them to go to extreme measures, you have to let them know. Otherwise, especially first responders are required to try to help. So get those in order. You'll need multiple copies. Have one at home, have one at the specialist's office, have one at your primary care doctor's office on file there, and have one at your hospital on file there. Because if they don't have it, you can't tell them, "Oh, I have one at home," or "I have one in another doctor." They need to have it there.

A lot of those you can do online. Most states, you can find them yourself and do it. Get it notarized if you want. Most attorneys can handle that. It's not super expensive, and it doesn't take a lot of time. But if you need that confidence, they'd be happy to do that for you.

So get your affairs in order long before you need to. You can always rescind it, you can always change it. It's an excellent thing to have, get power of attorney, and it makes everyone's life easier. Thanks!

Answer: Medicare will not help you with Long Term Care coverage at all. The only way the government is helping people plan for long term care is by incentivizing them to prepare on their own through state partnership programs and certain tax incentives. See the PPA, effective January 1, 2007.

Answer: You will not have a Part B penalty as long as your wife's employer has more than 20 employees. Remember, once you enroll in any part of Medicare (Part A) you can no longer contribute to an HSA plan.

Answer: First its important to know what causes an IRMAA. Your IRMAA is based off your Modified Adjusted Gross Income. For most people this is the same as their GI. The MAGI just adds back in any interest from Municipal bonds. SO if you have a high AGI, you will have a high MAGI. THis will cause you to have an IRMAA.

To avoid an IRMAA, there are a few things you can do.

1. Send some of your RMDs directly to a charity. This can keep yor income lower.

2. If you are still working, use all the pre-tax contributions available to you. 401K. IRA

3. Avoid bunching large capital gains, real estate sales and ROTH conversions together

If you already have an IRMAA and you have a qualifying life changing event, you can file for a reevaluation. Form SSA-44 Retirement does count.

The most important step to take is to be aware and use a local broker that will help you determine if you will have an IRMAA.

Answer: Yes. Plans are determined by your location. When looking for plans, your broker will need your zip code and the name of your county. Advantage plans can change benefits drastically within a state, depending on the county you live in. Large metro areas usually have more competitive plans while rural areas typically offer less at a higher cost.

Medicare supplements do not change plans based on location, but they do changes their premium costs. Of course like all things Medicare there are 3 states that sell their Medicare supplements differently. Minnesota, Wisconsin and Massachusetts sell their supplements in what is know as "ala carte". This means the beneficiary can choose which Medicare benefits they would like to purchase without having to purchase them all.

Answer: Traditional Medicare does not have a set limit on the number of PT visits. Although at a specific dollar amount threshold, your provider will need to provide additional documentation to Medicare.

Medicare Advantage plans can have their own rules and limits, and they will have limits. To find out what you plan covers you will need to contact the plan.

Answer: My strategy starts with asking the person what is most important to them. I have a list and we go through it together. Once we go through the list we look at the plans that match the closest to their needs and wants. The hard part is they usually tell me the whole list is important. Then when I show them that there is no plan that includes everything they want at the cost they want, we go through the list again and decide what is really the most important. This is why no broker should ever tell you there is a "Best Plan." There isn't!

Once they have a better understanding of how the plans are structured, we usually start with their doctors and medications. Remember, Medicare plans are about your health first. Then, we move into costs and extra benefits.

Answer: In my opinion the biggest mistake new Medicare beneficiaries make is asking their friends and family what plan they recommend. While this sounds like a good idea, it misses the opportunity to make sure the plan you pick is the best for your situation.

A better way to get advice from your friends and family is to ask them if they like the plan they are on and then ask them, "What broker did you use to get that plan and do they still help you?" Whatever their answer is you will know if you should use that person or not. If they like their plan and they know they can go to their broker with questions, start with that person. If they don't like their plan and they can't get help, then avoid that broker.

Your Medicare is just that, your Medicare. Each person's situation is different. Work with someone that can help get you the best plan and coverage for your situation.

Answer: The different plans do not change in accordance with changes in your health. The option that may be available is possibly changing your plan based on your health. However, there are limitations to this. Advantage plans and PDPs have enrollment periods and Medicare Supplements require underwriting once you are no longer in your guarantee issue period.

The most common ways to switch an Advantage plan is during the Annual Enrollment Period, Oct. 15- Dec. 7th. These changes take affect on January first of the next year. If you are diagnosed with a chronic condition, you may be able to switch into a Chronic Special Needs plan at anytime. The conditions that qualify for a C-SNP can differ by location and plan so be sure to check with a local broker in your area.

Medicare supplements can be changed whenever you like. However, if you are outside of your GI period you will need to complete underwriting, If your health has deteriorated, the chances of passing the underwriting go down. Keep in mind that your agent will ask you all of the questions but they do not make the decision. That is 100% in the hands of the carrier.

Answer: Unfortunately, Medicare does not cover Medical Marijuana when prescribed for pain. On the Federal level, Marijuana is still classified as a Schedule 1 drug with no medical use. So, since Medicare is a federal program, and marijuana is not an FDA approved drug, Medicare cannot pay for it.

Answer: Using your dental allowance from an Advantage plan can be a challenge. Part of the difficulty is that the dental portion of your Advantage plan isn't always the same type of network as the medical portion. Dental plans can be Dental HMO, PPO or POS. The type of dental network will determine how easy it is to use. Dental HMOs are the most restrictive. PPOs are a little more generous and usually open up more doctors to be available. A POS typically pays any provider for covered services. Knowing which services are covered is also very important. There is a lot of fine print in the dental portion of an Advantage plan. If the dental benefit is important to you, make sure you understand how it will work. If you're not sure, ask your provider and always get an estimate before any major work. This will help prevent unexpected bills.

Answer: Yes. Medicare PART A covers Hospice Care. In a few rare circumstance there could be a small charge. Possibly medication from a hospice pharmacy, or for the cost of in-patient respite care for a caregiver. However, these costs are rarely seen and are very low if even charged.

Answer: This is one of the most often asked questions when talking about Medicare. Like so many aspects of Medicare there are nuances to the answer. In General, you and your doctor will make decisions regarding your medical treatment. However, depending on the type of Medicare plan you have, there may be input from the insurance company.

If you have a Medicare supplement the Insurance company does not make any decisions regarding your care. If the care is billable to Medicare, the insurance company will pay their part. Keep in mind that Medicare does not pay for everything. Although what it does pay for is quite extensive and providers know what is and isn't covered. The primary things that are not covered are experimental procedures and strictly cosmetic procedures. In addition, dental care, glasses, hearing aids, long term care and assisted living are not paid for by Medicare so therefore are not paid for by a Medicare supplement.

On the other hand, a Medicare Advantage plan does have the right to deny certain procedures or at least ask for additional documentation before agreeing to pay. This is one of the possible cons to an advantage plan. If you run into this situation, don't give up hope. There is an appeal system set up and many people who appeal a denial end up getting the care they are seeking. This is not guaranteed, but it is often worth the effort.

Be sure to work with a trusted broker that will take the time to explain how each plan works and the value each plan has. Remember, cost and price are not always the same thing. Something with a low price could cost you more than you think.

Answer: Your Medicare IRMAA is reevaluated each year on a 2 year look back. However, if you experience a drop in income due to a life changing even, you can request a reduction in your IRMAA anytime. Like most things Social Security you do this by filing a form. In this case, a form SSA-44. This form will explain the life changing events that qualify and give instructions on how to submit it.

Answer: In my opinion, the only reason someone might pick a higher total cost is because of brand loyalty. Many people have a company when they are on their employer insurance and they think it's easier to just stay with that company. This may or may not be a good strategy depending on where you live and what your needs are. Some carriers that are big in the Under 65 space may not be as strong in the Medicare space. They are two separate businesses. I suggest people on Medicare find a local broker who is familiar with their area and can guide them on the proper carriers for their individual situation.

Answer: Medicare does not cover nursing home care. There are a couple of alternatives.

1. Medicaid: If the person has very low assets and income they may qualify for Medicaid. Keep in mind that each state funds Medicaid differently and they have different rules for recouping the money they spent. They will try to get as much of the money back after the beneficiary has passed. Make sure you check your state's rules before assuming Medicaid is the way to go.

2. Pay out of pocket: This is extremely expensive. Depending on where you live you may see monthly rent at $7,000 - $9,000 per month for a semi-private room.

3. Long Term Care Insurance: The LTC industry has changed a lot in the past few years, mostly for the better. However, insurance is something you need to purchase BEFORE you need it. Once you need LTC, you will most likely not qualify for it. Plus, the older you are, the more expensive it is.

Answer: If someone is new to Medicare I spend time explaining how Traditional Medicare works. Then, I explain the choices available to fill the gaps. Then, I ask questions to find out what the client needs the most and what they feel is most important. Finally we talk about next steps.

For someone already on Medicare, I ask them how their plan has been working for them. I find out if there have been any major changes in their health or if other needs have changed. If they are happy and everything is working fine, we stay the same. If they need or want to look at other options, we do that.

Answer: It depends on what type of plan you have and the carrier. If you have a Medicare supplement, you should not need proof authorization if your doctor recommends the surgery. If you have an Advantage Plan then prior authorizations are common for larger surgeries. No plan is all good or all bad. They all have different features. Stay persistent and be your own advocate.

Answer: Your local broker should be able to help you understand how the drugs are being billed. Some medications are billed under Part D and some under Part B. That of course assumes the medications are covered by Medicare and by your drug plan. Drug plans are not required to cover every drug. Check you plan's formulary. You can call the carrier and ask about coverage.

Answer: One of the most regrettable decisions people make is signing up for something because a neighbor, friend or relative said that's what they should do. Instead, meet with a trained broker that will get to know your personal situation and make recommendations based on your needs. There is no fee to work with a broker, so trying to do it yourself is often not a great decision either.

As far as a very regrettable decision that a lot of people make is missing out on their Guaranteed Issue period to join a Medicare Supplement when they first enter Medicare. If you pass on your GI period and want to get a supplement later, you will need to pass medical underwriting. Many people are disappointed when they become sick and need more care and then its too late to get a supplement. Make sure you know how both Supplements and Advantage plans work.

Answer: If you are starting your SS retirement benefits, or have already started them you don't need to do anything. Anyone receiving their retirement benefits is automatically enrolled in Medicare. However, if you are not receiving your SS benefits you will need to enroll online, or on the phone. If you need help, seek out a local Medicare broker in your area and they will walk you through the process. There is no fee to use their services.

Remember, if you are going to continue working and you have creditable coverage through an employer, you are not required to enroll in Medicare. Compare your current benefits to Medicare and decide which one will work better for your situation. Your broker can help you compare.

Answer: Fortunately, your retirement counts as a Life Changing Event. You can file FormSSA-44 along with proof of your retirement and request that your IRMAA be recalculated.

Answer: Beginning in January of 2025, Medicare did approve some Digital Therapeutics when order by a provider. The approved therapeutics are:

SleepioRx for Insomnia

Somryst for Chronic insomnia

DaylightRx for Generalized anxiety disorder

Rejoyn for Major depressive disorder

reSET for Substance use disorder

reSET‑O for Opioid use disorder

Answer: No, Medicare will not cover genetic testing without a confirmed diagnosis, even with a strong family history. Beware also of offers to run these types of tests at health fairs. Medicare will not cover preventative genetic screenings.

Answer: Medicare Advantage plans definitely save seniors money compared to traditional Medicare by it's self. However the plans work in a specific way and if you don't understand how it is supposed to work, then you may feel it isn't. A lot of people think because a plan has no premium, that it is a free plan. That is not the case. All Advantage plans have some level of cost sharing that is passed on to the member. There is no such thing as FREE and COST is not always measured in dollars.

Answer: The problem with this statement is that there is more than one type of plan, and if you are just looking at a price, you are not looking at the different plans.

Medicare supplements have a monthly premium, so they have a cost in addition to your Part B premium. However they eliminate the requirement of using networks, getting referrals and most prior authorizations for services. The plans themselves are standardized so even though prices can vary from carrier to carrier, the amount they pay for your Medicare charges are the same.

Medicare Advantage plans on the other hand are often $0 plans. This means they cost less each month. But, they all have different copay amounts, different network sizes, different Extra Benefits, different Max Out Of Pocket protection and different Star ratings. With this many variables and no monthly cost, the cheapest is no longer a factor. Will you be able to use the plan where and when you want to is more important.

The best way to get the coverage that works best for you is to find a local agent you can meet with. One who will take the time to understand your situation and explain both types of plans to you.

Answer: The overall point of the PPO is the flexibility to see a wider range of providers. However, the opportunity to go out of the network comes with increased costs, not at just out-of-network providers, but even the in network providers. The same providers that are in the HMO will cost more if you choose the PPO. So, what's the point?

If you live in or near a major metro area, you probably have very large networks with the large carriers. Unless you have a lot of specialists, or you travel and live in other parts of the country for extended periods (think snowbirds) an HMO will probably work fine for you if you opt for an Advantage plan.

However, if you live in a more rural area, the number of providers and the size of the networks is more likely limited, if there are any at all. If this is the case, then you need a PPO so you can travel to the areas where the doctors are.

One last thing to keep in mind is that just because you have a PPO you are not guaranteed to see any provider you want. Providers can still choose to not accept a plan. Always check with the provider prior to showing up at the office.

Answer: The short answer to this question is No. Different people may pay different prices. Here is a short summary.

Part A - If you have accumulated 40 quarters of qualified work, your Part A is a $0 premium benefit. It is not free, as you have been contributing during your working life. If you do not have 40 quarters or your spouse doesn't have 40 quarters (you qualify if your spouse has them), then you can purchase Part A for the current year cost.

Parts B & D - The cost of Part B can vary depending on your earning level. Every year CMS sets a Base price. Along with the base price, CMS establishes IRMAA thresholds. If your income, 2 years prior exceeds any of the thresholds, you will be required to pay more for both your Part B and also your Part D monthly premium.

The cost of all the parts change each year as do the IRMAA thresholds. Check with a local broker if you have questions about the current cost on Medicare.

Answer: Having Medicare parts A & B alone will provide a substantial amount of coverage, but probably not enough to make you feel comfortable. Plus, there are several things that traditional Medicare doesn't cover at all, primarily, prescription medications.

Since Medicare does not cover prescription medications, you will need to add Part D. This is done by enrolling in a stand alone drug plan .

Both your Part A and Part B will have deductibles and copays. These amounts can add up to be significant, even catastrophic, if you experience a serious illness or injury. Traditional Medicare does not have a cap on these expenses.

So there really isn't a yes or no answer. If you never need much care then Traditional Medicare can be fine. However, insurance is made to protect you from unforeseen events that could cost a lot. By adding either a Medicare supplement or Advantage plan, you can protect yourself from the financial cost of a catastrophic event.

Answer: This is a dilemma a lot of people face. Although our friends and families are well intentioned, they are often uninformed about the different aspects of Medicare and Medicare options. The best option is to find a local Medicare broker that represents several carriers. Schedule an appointment and ask your kids or neighbor to tag along. Then everyone can be on the same page. No two people are exactly the same when it comes to their health needs, medications, budget, family history, past medical needs, future living and travel plans and long term care needs. An experienced broker will gather information to help you decide on a plan that is best for you.

Answer: Like all things Medicare, any mental health services must be FDA approved and provider prescribed. This means if it is part of a treatment plan prescribed by your physician and it is FDA approved, your Part B should cover it after you have met your Part B deductible. If you're on an Advantage plan, be sure to make sure that any mental health provider, including telepathy, is included in the plan's network.

Answer: You didn't make a mistake, but your rates may have put you in a tough spot. All Medigap plans increase in price over time. Unfortunately, there is no way to know exactly how much they will go up. There is a history to each company increases, but past history does not guarantee future rates. So, what options do you have?

Depending on your health, you can shop for a new plan. Your health matters because you will have to pass the underwriting process. Different companies charge different prices, so if you can pass UW, you may be able to get the same plan at a lower cost.

If your able to pass UW you can also change plan levels, for example, Plan F to Plan G or Plan G to Plan N. SO you may change companies and plans or just one of them.

If any Medigap plan is just too expensive now, you can switch to a Medicare Advantage plan if there are some in your area. The premiums are typically pretty low. Just make sure you understand all the benefits and network requirement as they are significantly different from Medigap plans.

Plus, if you decide to try an Advantage plan, you have a 12 month trial right. This allows you to go back to your Medigap plan within the first year if you are unhappy with the Advantage plan.

Answer: This is a common feeling, and there are several things Medicare beneficiaries can do to avoid it.

1. Ignore all the Medicare commercials on TV.

2. Do not talk to any unsolicited call you receive from a medicare agent, broker or company.

3. Find a local broker or agent to work with. One that you can call with questions after you enroll.

4. Do not be swayed by the "Xtra benefits" until you understand the health benefits, drug benefits and the network requirements of an Advantage plan. For every Xtra they give you, you pay more somewhere else.

5. Make sure you you get a print out of your plan benefits and create your online portal once you are enrolled. One of the best parts of Advantage plans is that they have fixed costs that are stated in the Summary of Benefits, so any unusual bills are usually a misunderstanding of what procedures are going to be done, or a billing error after their done. A local agent or broker can help you determine costs before procedures and help guide you to the right place for billing errors.

Answer: As of 2025, CMS has made some great progress in protecting beneficiaries from those "Horror Stories". The main change is the implementation of a $2,000 Maximum Out of Pocket annual limit.

If you select an Advantage plan, your drug plan is usually built into the plan. This means you will not have an additional Part D drug premium. You may still have a drug deductible and you will have drug cost. The good news is agents and brokers can look up your medications and tell you exactly what they will cost in each Advantage plan.

If you select a Medicare Supplement (Medigap) you will then need to add a stand alone Part D plan. This most likely will have an additional premium in addition to a deductible and the cost of the drugs. However, your agent can also look up all of your medications in the different Part D plans and tell you what your drug cost will be for the year.

Answer: The Part D tiers are often a point of confusion for many people. Here are some simple ways to think about them.

The Tiers are generally numbered 1-5. The lower the number equals a lower price

Tier 1 – Preferred generics (lowest cost): These are the common meds a lot of us take. Often $0

Tier 2 – Generic drugs: These are less common, but still relatively inexpensive

Tier 3 – Preferred brand-name drugs: Start getting expensive. If you see it advertised on TV, it's a Tier 3 or higher

Tier 4 – Non-preferred drugs: Expensive but often have a lower cost alternative

Tier 5 – Specialty drugs (very high cost) You know if you take one of these

Keep in mind that different carriers may place the same medication in different tiers. Although most are in the same category, it is not a requirement. Make sure you check your medication costs each year.

Answer: There is no specific date to start preparing. You should should looking for a letter from your current Medicare Advantage plan starting in August. This is when the carriers start sending out you Annual Notice of Change letter (ANOC).

The ANOC letter will tell you if, and how, your current plan will change, starting January 1st of the next year. Because all plans don't settle on their changes at the same time they send their letters on different dates however they must be delivered by September 30th. Agents and brokers are not permitted to discuss the new plans until October 1st.

The annual Enrollment Period starts on October 15th.

Answer: So this question is about Medicare drug costs being capped at $2,000 for 2025. Well, that was true. However, now we're in 2026, so the number went up just a little bit. $2,100 is the maximum out-of-pocket you will pay for covered drugs and the copays for covered drugs. So if you have a standalone PDP, you'll still have to pay the premium for the plan. But if your copays for your covered drugs ever reach the $2,100 mark, then your copays will go away for the rest of the calendar year, and it will reset again in January of 2027.

Answer: This is a difficult situation but one every child of an elderly parent should consider.

If your parent still has the capacity to make decisions, the process is much easier. Although you can make an arrangement with Medicare to be your parent's "Medicare Representative", this only gives you permission to discuss their plan with Medicare. It does not give you the ability to make any changes. To do this, have your parent sign a Durable Power of Attorney. This will give you broad authority to help with medical and financial decisions. In most states this does not require using an attorney although you should check in your state as I am not an attorney and cannot give legal advice.

If your parent no longer has capacity to sign the DPOA, you will need to petition the court for guardianship to help with medical decisions and conservatorship for financial matters. This will require an attorney and is a longer process.

Answer: So, question. I get a lot of what's the difference between a Medicare agent and a Medicare broker? Well, a Medicare agent typically works for just one carrier, so they can only write the plans for that one carrier. If you talk to them or call them, that's all they're gonna be able to discuss with you. A broker, on the other hand, usually represents several different carriers and has a variety of plans that they can show you and hopefully find the ones that fit you the best.

So, agents typically work for one carrier, while brokers typically have more than one carrier that they can represent. Now, out in the real world, agent and broker get used a lot interchangeably. So, what you need to do is ask the person that you're working with which companies they represent. If they only represent one, they're working more as an agent. If they represent several, then they're gonna be working as a broker.

The one good thing about it is for brokers, all the different companies they represent, especially for advantage plans, their compensation is regulated by CMS, and it's the same for all. So they don't really have a financial incentive to work one plan over another plan. Their main incentive should be to find the plan that best fits you, so you'll be happy with the coverage that you have. You'll be happy with that agent, and you'll provide referrals and send your friends their way.

We'd love to help you. For more questions, stay tuned.

Answer: You're right to feel frustrated, this is a common misunderstanding about Medicare’s Annual Enrollment Period (AEP) and Open Enrollment Period (OEP). First, it is important to know which enrollment period we're discussing. During AEP (Oct 15–Dec 7), you can change your Medicare Advantage or Part D drug plan. However many plans change on December 31st so a provider that was in the plan when you enrolled may no longer be in the plan on January 1st. This is when the Open Enrollment Period OEP (Jan 1 - March 31st), is in effect. If you made a change to your Advantage plan during AEP, you get a chance to change again during the OEP. This is when you can find a new plan that your provider does accept. Keep in mind that after March 31st, there are no more chances to change due to network issues. The only way to change after the OEP is to use a Special Enrollment Period (SEP) which depends on individual circumstances and is a whole other topic.

Answer: The thing I like the most about being a Medicare agent is educating clients on how the program works and how it applies to each individual in a different way. Even though there are some strict rules surrounding Medicare, the large number of products and services available still leave a lot of options for each person. Being able to offer all the products and not being captive to a specific carrier, gives me the ability to focus on the client and not the quota required by an insurance company.